Abstract WP151: Increased Risky Driving in Acute Compared to Chronic Ischemic Stroke Drivers

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Introduction: Guidelines recommend that patients refrain from driving in the acute phase of stroke. Patients are permitted to resume driving if no significant motor, cognitive, or perceptual deficits are present. This study investigated the driving performance of patients with mild ischemic stroke in the acute and chronic stages of recovery. It was hypothesized that patients with acute stroke would commit more risky driving errors (e.g. collisions, lane deviations) and that patients with chronic stroke would perform comparably to healthy matched controls.

Methods: Driving simulator technology (STISIM) was used to compare the driving performance of 11 patients with acute mild ischemic stroke (NIHSS<5, <1 month post-stroke), 11 patients with chronic mild ischemic stroke (NIHSS<5 at discharge, >3 months post-stroke), and 11 healthy age- and education-matched controls. Participants completed a city-driving task and a car following task, which requires sustained attention and error monitoring.

Results: Patients with acute stroke committed over three times as many risky driving errors compared to healthy controls during the city-driving task (6.2 vs. 1.7, p<0.01). Acute stroke patients made more errors (8.7 vs. 2.0, p<0.05) and had difficulty maintaining proper lane position (p<0.05) compared to controls during the car following task. Patients with chronic stroke committed fewer errors than acute stroke patients during the car following task (3.0 vs. 8.7, p<0.05) and tended to commit fewer risky driving errors during the city-driving task (2.7 vs. 6.2, p=0.076). Patients with chronic stroke performed comparably to controls during the driving tasks.

Conclusions: Results suggest that patients with acute mild ischemic stroke may demonstrate impaired driving ability and that performance may improve in the chronic phase of recovery. The results reinforce the importance of refraining from driving in the acute phase of stroke and suggest that patients with good functional and cognitive recovery may be safe to resume driving in the chronic phase of injury. A large-scale longitudinal study is required to determine the optimal time for patients to resume driving after stroke.

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