Medical Conditions and Driving: A Review of the Literature (1960  2000)
TRD Page
Section1: Introduction
Section 2: Vision
Section 3: Hearing
Section 4: Cardiovascular
Section 5: Cerebrovascular
Section 6: Peripheral Vascular
Section 7: Nervous System
Section 8: Respiratory
Section 9: Metabolic
Section 10: Renal
Section 11: Musculoskeletal
Section 12: Psychiatric
Section 13: Drugs
Section 14: Aging Driver
Section 15: Anesthesia and Surgery
Appendix A
List of Tables
List of Figures
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Section 5: Cerebrovascular Diseases

Table 11  Summary of Studies Assessing Fitness-to-Drive in Individuals Post-CVA



Assessment Criteria


Jones et al. (1983)

(L) CVA = 43

(R) CVA = 48

On-road assessment (ability to operate vehicle controls, perceptual and cognitive responses in demanding situations, knowledge of rules of the road, and general attitude). Criteria not specified.

(L) CVA = 42 percent failed the road test.

(R) CVA = 48 percent failed the road test.

Lincoln & Fanthome (1994)

CVA = 36
(at least one year post stroke).

Stroke Drivers Screening Assessment (SDSA).

-Dot cancellation (DC).

-What’s in the square? (WIS).

-Road Sign Recognition (RSR).

Algorithms for predicting likelihood of passing a road test and likelihood of failing a road test used.

PASS = [(DC time x 0.012) + (DC false positives x 0.216) + (WIS x 0.049) + (RSR x1.168)] -13.79.

FAIL = [(DC time x 0.017) + (DC false positives x 0.035) +(WIS x 0.185) + (RSR x 0.813)] -10.04.

Patients tested on two occasions 6 weeks apart.

Initial Assessment
8 passed.
28 failed.

Second Assessment
6 passed.
0 failed.

Significant practice effects observed on individual tests.

However, patients who initially failed did not pass the second assessment as a result of practice.

Lings & Jensen (1991)

(L) CVA = 67

(R) CVA = 46

C = 109

LH: Disease duration, 2 yrs (median)

RH: Disease duration, 2 yrs (median)

Mock Cars (Part-task driving simulators-tested sensorimotor performance).

Neuropsychological testing.

Stroke patients performed significantly worse than controls on most all measures.

Reaction times longer for paretic and contralateral extremities.

Strength in unaffected side also reduced.

More directional errors in (L) CVAs.

Clinical examination did not predict Mock Car performance.

Mazer et al. (1998)

CVA = 84 (tested on average 4.5 months after stroke)

Battery of Perceptual Tests

Complex Reaction Timer.

Motor Free Visual Perception Test (MVPT).

Cancellation Test (Single and Double letter).

The Money Road Map Test.

Trail Making Tests A & B.

On-road evaluation (based on standard provincial testing procedures-43 item assessment form).

On-Road Evaluation
Pass = 33
Fail = 51

As a group, those who failed the on-road evaluation performed more poorly on most perceptual tests.

Logistic Regression Results:

Study group as a whole

The greatest odds of failing were predicted by the MVPT. Those who scored < were 8.7 times more likely to fail the road test than those who scored > 30.

L Hemisphere Lesions

Those who had 3 or more errors on Trails B were 11 times more likely to fail road test.

R Hemisphere Lesions

Those scoring < 30 on MVPT were 15 times more likely to fail road test.

Nouri et al. (1987)

(R) CVA = 23

(L) CVA =16

Tested 6 weeks-4 years post stroke

Cognitive Assessment

Cube Copy Test.
Dot Cancellation.
Rey Figure Copy and Recall.
Four Choice Reaction Time.
What’s In the Square?
What Else Is In the Square?
Pursuit Rotor. Token Test
Part V. Road Sign
Recognition Test. Titmus
Vision Tester.
Hand Sequencing Task.
Recognition Memory
Hazard Recognition Task.
Road Test

Rated on 23 items (good or faulty) and graded as Pass (Good, Average) or Fail(Borderline, Below Standard). Criteria not defined.

Results of Road Test
Pass = 22
Fail = 17

Discriminant Function Analysis
used to determine best predictors. Results revealed that Dot Cancellation, Rey Figure, What Else Is In The Square, Pursuit Rotor, Token Test, Vision Testing, Recognition Memory test, Cube Copying, and Hazard Recognition were the best predictors.

Algorithm developed which correctly classified 37 of the 39 patients (94.9 percent). (Misclassified 1 case who failed the road test as a pass (5.9 percent), and 1 case who passed the road test as a fail (4.5 percent).

Sivak et al. (1981)

(L) CVA = 10
(R) CVA = 6

Diffuse brain damage = 7

Spinal cord damage = 8

Able bodied = 10

Neurocognitive Tests
(Perceptual and cognitive). Visual acuity and stereodepth.

On-Road Test.

Closed Course
(Number of knocked over cones, displaced cones, correct responses to a secondary task, and time).

Rated on an average of 144 actions, with rating based on a 2 point scale: well executed and not well executed.

Neurocognitive Tests
Subjects with brain damage, as a group, performed worse than able-bodied subjects.

On-Road Test.

Closed Course.
Subjects with brain damage per formed significantly worse on several measures. Spinal cord damage subjects’ performance did not differ from able-bodied subjects’ performance.

4 subjects (1-CVA, 3-diffuse brain damage) were deemed unsafe for open-road assessment based on closed course performance (2) or open-road drive terminated shortly after commencing.

In general, subjects with brain damage performed significantly worse on several on-road measures than able-bodied (No percentages of pass/fail as a function of group membership are provided).

Those with spinal-cord damage did not differ from controls.

No correlations were found between closed course measures an open road driving for brain damaged individuals.

Several of the neuropsychological tests were correlated with open road Composite Driving Index, but tests for the brain damaged subjects were different than those for the non-brain damaged.

Sundet et al. (1995)

(L) CVA = 29

(R) CVA = 43

M. Infarct = 7

Neuropsychological Testing

-visual perception.
-spatial attention.
-visuospatial processing.

Decisions re: driving suitability based on clinical judgment.

Patients with CVA tested an average of 4 months post stroke.

Classified as unsafe to drive based on Clinical Global Ratings.

(L) CVA’s = 41 percent.

(R) CVA’s = 58 percent.

Wilson & Smith (1983)

CVA = 11

Older C = 11
(45-65 years)

Young C = 8

On-Road assessment.
(Mixture of city driving, motorway driving, and country driving).

Scored on a 5 point scale.

Stroke drivers were significantly impaired on entering and leaving motorways and handling traffic at roundabouts. On private roads, stroke patients were relatively unaware of other vehicles, had difficulty in reversing, in doing two things at once in an emergency, and had difficulty in placing car accurately on the left (Great Britain study).

C = Controls

TBI = Traumatic Brain Injury

(L) = Left

LH = Left Hemiparesis

CVA = Cerebrovascular Accident

THI = Traumatic Head Injury

(R) = Right

RH = Right Hemiparesis