Impact of post-stroke cognitive dysfunction on driving ability

The paper aims to present the current views on the impact of post-stroke cognitive deficits on driving ability, and diagnostic assessment practices in this area. Firstly, the neuropsychological consequences of stroke are briefly presented. This part focuses specifically on visuospatial and executive dysfunctions. Among those dysfunctions, unilateral neglect, especially as it is frequently associated with anosognosia, may have the greatest impact on driving ability, leading to an increased accident risk. Then, different approaches to assessing fitness to drive after stroke are presented, including on-road testing, testing with the use of simulator, and clinical assessment focusing on cognition. The role of cognitive assessment in predicting fitness to drive is described in more detail. The Clock Drawing Test is the most appropriate screening measure in this context, as it engages both visuospatial and executive functions. The Trail Making Test is the most popular working memory test in the context of drivers’ assessment, as it requires visual search and psychomotor speed. The Rey Complex Figure Test is another commonly used test. It requires visuospatial and executive functions, and may also serve as a measure of visuospatial memory. Finally, the legal aspects of the assessments are discussed with reference to the practices used in Great Britain, Belgium, Sweden, and Germany. In Poland, there are no detailed standards for post-stroke fitness-to-drive assessment.

Download Full-text

Einfluss kognitiver Dysfunktionen auf die Mobilität im Verlauf der neurologischen Rehabilitation nach Schlaganfall

Neurologie & Rehabilitation ◽

10.14624/nr2010001 ◽

2020 ◽

Vol 26 (4) ◽

pp. 207-213

Author(s):

M. Froß ◽

M. Sailer ◽

J. Lamprecht

Keyword(s):

Executive Functions ◽

Motor Impairment ◽

Cognitive Disorders ◽

Neurological Rehabilitation ◽

Kognitive Störungen ◽

Schlüsselwörter Schlaganfall ◽

Stroke Patients ◽

Rehabilitation Process ◽

Post Stroke ◽

The Impact

Zusammenfassung Kognitive Störungen treten häufig nach einem Schlaganfall auf, persistieren meistens länger als motorische Funktionsstörungen und können den Verlauf der Therapie beeinflussen, da die kognitive »Performance« und das motorische Lernen in Beziehung zueinander stehen. Die Studie adressiert daher folgende Fragen: a) Welche kognitiven Störungen weisen Schlaganfallpatienten zu Beginn der Rehabilitation auf? b) Wie verändert sich die Mobilität im Rehabilitationsverlauf? c) Welche kognitiven Störungen beeinflussen die Verbesserung der Mobilität im Rehabilitations-verlauf negativ? Im Ergebnis zeigte sich, dass ein Drittel der Schlaganfallpatienten zu Rehabili-tationsbeginn unter kognitiven Störungen, vor allem im Bereich der Exekutivfunktionen, leidet. Dabei haben insbesondere Einschränkungen im konvergenten Denken einen negativen Einfluss auf eine Mobilitätsverbesserung im Verlauf der neurologischen Rehabilitation. Schlüsselwörter: Schlaganfall, Neurorehabilitation, Kognition, Exekutivfunktionen, Mobilität The impact of cognitive dysfunctions post stroke on the mobility during the neurorehabilitation process Abstract Cognitive impairment post stroke is common and usually persists longer than motor impairment and may influence the rehabilitation process, because cognition and motor learning are related. Therefore, this study addresses the following questions: a) Which cognitive disorders appear in stroke patients at the beginning of rehabilitation (admission)? b) How does mobility change during the rehabilitation process? Which cognitive disorders negatively influence the improvement of mobility during the rehabilitation process? The results reveal that one-third of stroke patients suffer from cognitive disorders at admission, especially in the domain of executive functions. Particularly impairments in convergent thinking negatively influence the improvement in mobility during the neurological rehabilitation process. Keywords: stroke, neurorehabilitation, cognition, executive functions, mobility

Download Full-text

Predicting On-Road Driving Skills, Fitness to Drive, and Prospective Accident Risk in Older Drivers and Drivers with Mild Cognitive Impairment: The Importance of Non-Cognitive Risk Factors

Journal of Alzheimer s Disease ◽

10.3233/jad-200943 ◽

2021 ◽

Vol 79 (1) ◽

pp. 401-414

Author(s):

Max Toepper ◽

Philipp Schulz ◽

Thomas Beblo ◽

Martin Driessen

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Older Drivers ◽

Accident Risk ◽

Fitness To Drive ◽

Cognitive Predictors ◽

Driving Skills ◽

Cognitive Risk ◽

Cognitive Risk Factors

Background: On-road driving behavior can be impaired in older drivers and particularly in drivers with mild cognitive impairment (MCI). Objective: To determine whether cognitive and non-cognitive risk factors for driving safety may allow an accurate and economic prediction of on-road driving skills, fitness to drive, and prospective accident risk in healthy older drivers and drivers with MCI, we examined a representative combined sample of older drivers with and without MCI (N = 74) in an observational on-road study. In particular, we examined whether non-cognitive risk factors improve predictive accuracy provided by cognitive factors alone. Methods: Multiple and logistic hierarchical regression analyses were utilized to predict different driving outcomes. In all regression models, we included cognitive predictors alone in a first step and added non-cognitive predictors in a second step. Results: Results revealed that the combination of cognitive and non-cognitive risk factors significantly predicted driving skills (R2adjusted = 0.30) and fitness to drive (81.2% accuracy) as well as the number (R2adjusted = 0.21) and occurrence (88.3% accuracy) of prospective minor at-fault accidents within the next 12 months. In all analyses, the inclusion of non-cognitive risk factors led to a significant increase of explained variance in the different outcome variables. Conclusion: Our findings suggest that a combination of the most robust cognitive and non-cognitive risk factors may allow an economic and accurate prediction of on-road driving performance and prospective accident risk in healthy older drivers and drivers with MCI. Therefore, non-cognitive risk factors appear to play an important role.

Download Full-text

Tourism Development in Post-Industrial Facilities as a Regional Business Model

Sustainability ◽

10.3390/su13042028 ◽

2021 ◽

Vol 13 (4) ◽

pp. 2028

Author(s):

Marek Jóźwiak ◽

Patrycja Sieg

Keyword(s):

Business Model ◽

Tourism Development ◽

Legal Aspects ◽

Industrial Facilities ◽

Business Partnership ◽

Post Industrial ◽

The Impact ◽

The City

In the article presented, the authors have attempted to define the development of post-industrial facilities, on the example of a thematic trail located in Bydgoszcz, as well as to assess the impact of this route on the city’s attractiveness. The TeH2O thematic trail is an example of a business model that utilizes post-industrial facilities for the development of a business partnership between the route facilities, the objects located in the vicinity, as well as the route participants. The article discusses the use of post-industrial facilities for tourist purposes and the legal aspects associated with the process of transforming such facilities. This paper presents the results of a research carried out on two groups of respondents, i.e., the residents of the city of Bydgoszcz and the tourists who have visited or are about to visit the city of Bydgoszcz. As a result of the research carried out, it has been found that the thematic trail examined affects the attractiveness of the city of Bydgoszcz. Both the respondents from the city of Bydgoszcz as well as the tourists visiting the city acknowledged it. The TeH2O thematic trail is more popular among the inhabitants of Bydgoszcz than among the visitors.

Download Full-text

The Impact of Idiopathic Generalized Epilepsy on Executive Functions

Annals of Neurosciences ◽

10.1177/0972753120968751 ◽

2021 ◽

pp. 097275312096875

Author(s):

Haritha Koganti ◽

Shasthara Paneyala ◽

Harsha Sundaramurthy ◽

Nemichandra SC ◽

Rithvik S Kashyap ◽

...

Keyword(s):

Executive Functions ◽

Executive Dysfunction ◽

Cross Sectional Study ◽

Idiopathic Epilepsy ◽

Idiopathic Generalized Epilepsy ◽

Word Fluency ◽

Cross Sectional ◽

Generalized Epilepsy ◽

Multiple Domains ◽

The Impact

Background: Idiopathic generalized epilepsy is defined as seizures with a possible hereditary predisposition without an underlying cause or structural pathology. Assessment of executive dysfunction in idiopathic generalized epilepsies based on standard Indian battery is not available in the literature. Aims and Objectives: To assess specific executive functions affected in patients with idiopathic epilepsy and their association with various variables. Materials and Methods: Type of observational cross-sectional study, where clinical profile of all idiopathic epilepsy patients attending the neurology OPD was studied and their executive higher mental functions were assessed using the NIMHANS battery. Results: A total of 75 idiopathic generalized epilepsy patients were included in the study. Executive functions that were commonly found abnormal in our study were word fluency ( P ≤ .001), category fluency ( P < .001), verbal n-back ( P < .001), Tower of London ( p < 0.01), and Stroop test ( P < 0.01). Executive functions showed a significant correlation with age at symptom onset, duration of epilepsy, and in those with uncontrolled seizures. Conclusion: Patients of idiopathic generalized epilepsy according to the present study were found to have significant executive dysfunction in multiple domains. This necessitates the screening for executive dysfunctions, which if detected should prompt the clinician to initiate cognitive retraining.

Download Full-text

Influence of Physical Activity and Socio-Economic Status on Depression and Anxiety Symptoms in Patients after Stroke

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158058 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8058

Author(s):

Małgorzata Paprocka-Borowicz ◽

Mona Wiatr ◽

Maria Ciałowicz ◽

Wojciech Borowicz ◽

Agnieszka Kaczmarek ◽

...

Keyword(s):

Physical Activity ◽

Physical Therapy ◽

Economic Status ◽

Depression Scale ◽

Post Stroke ◽

Positive Effects ◽

Socio Economic Status ◽

Treatment Of Depression ◽

Post Stroke Depression ◽

The Impact

Stroke is a high-risk factor for depression. Neurological rehabilitation is greatly difficult and often does not include treatment of depression. The post-stroke depression plays an important role in the progress of treatment, health, and the life of the patient. The appropriate treatment of depression could improve the quality of life of the patient and their family. The study aimed to evaluate the impact of physical activity and socio-economic status of the patient on the effectiveness of recovery from depression and the severity of the symptoms of depression. The study was conducted with 40 patients after stroke aged 42–82 years, and included 10 women and 30 men who were hospitalized for two weeks. The severity of depression/anxiety (D/A) symptoms were evaluated two times; at admission and after two weeks of physical therapy. The hospital anxiety and depression scale (HADS) questionnaire was used for this purpose. Socio-economic status was evaluated by several simple questions. It was revealed that physical therapy has a positive influence on mental state. The severity of D/A symptoms after stroke is related to the financial status of the patients (2 = 11.198, p = 0.024). The state of health (2 = 20.57, p = 0.022) and physical fitness (2 = 12.95, p = 0.044) changed the severity of symptoms of anxiety and depressive disorders. The kinesiotherapy in the group of patients with post-stroke depression had positive effects; however, economic and health conditions may influence the prognosis of the disease.

Download Full-text

European Respiratory Society Statement on Sleep Apnoea, Sleepiness and Driving Risk

European Respiratory Journal ◽

10.1183/13993003.01272-2020 ◽

2020 ◽

pp. 2001272

Author(s):

Maria R Bonsignore ◽

Winfried Randerath ◽

Sofia Schiza ◽

Johan Verbraecken ◽

Mark W Elliott ◽

...

Keyword(s):

At Risk ◽

Motor Vehicle ◽

Task Force ◽

Present Report ◽

Sleep Apnoea ◽

Accident Risk ◽

European Respiratory Society ◽

Obstructive Sleep ◽

Patients At Risk ◽

The Impact

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure (CPAP) has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk for OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a Task Force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA, the mechanisms involved in this association, the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance, the impact of treatment on MVA risk in affected drivers, and highlights the evidence gaps regarding the identification of OSA patients at risk for MVA.

Download Full-text

Effect of post-stroke spasticity on voluntary movement of the upper limb

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00876-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Hadar Lackritz ◽

Yisrael Parmet ◽

Silvi Frenkel-Toledo ◽

Melanie C. Baniña ◽

Nachum Soroker ◽

...

Keyword(s):

Upper Limb ◽

Target Location ◽

Distance Measure ◽

Movement Time ◽

Motor Impairment ◽

Reach To Grasp ◽

Motion Patterns ◽

Post Stroke ◽

The Impact ◽

Elbow Motion

Abstract Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.

Download Full-text

The Impact of Financial and Non-Financial Work Incentives on the Safety Behavior of Heavy Truck Drivers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052759 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2759

Author(s):

Sebastjan Škerlič ◽

Vanja Erčulj

Keyword(s):

Financial Incentives ◽

Structural Equation ◽

Traffic Accidents ◽

Positive Impact ◽

Road Transport ◽

Truck Drivers ◽

Driving Ability ◽

Transport Sector ◽

Safety Behavior ◽

The Impact

The goal of the research is to determine how compensation affects the safety behavior of truck drivers and consequently the frequency of traffic accidents. For this purpose, a survey was conducted on a sample of 220 truck drivers in international road transport in the EU, where the results of the Structural Equation Model (SEM) show that in the current state of the transport sector, financial and non-financial incentives have a positive impact on the work and safety behavior of drivers. Financial incentives also have an impact on drivers’ increased perception of their driving ability, while moving violations continue to have a major impact on the number of accidents. The proposed improvements enable decision-makers at the highest level to adopt legal solutions to help manage the issues that have been affecting the industry from a work, social and safety point of view for the past several years. The results of the research therefore represent an important guideline for improvements to the legislature as well as in the systematization of truck driver compensation within companies.

Download Full-text