Cognitive and motor deficits contribute to longer braking time in stroke

Oh for fucks sake,  you describe a problem,  offer NO SOLUTION. Useless. 

I think even at only 21 months post stroke I was sufficiently capable of braking;

In March 2008 and driving home at dusk, a deer ran in front of my car. I managed to at least slow down a little by hitting the brakes, killed the deer, kept the car on the road. Luckily it was still driveable. Since  it was a deer accident it was fully covered by comprehensive with no deductible. Some 3500 dollars in damage.

Solve the primary problem of 100% recovery and this secondary problem goes away. 

You don't want this to happen so ask your doctor for EXACT STROKE PROTOCOLS TO RETURN TO DRIVING.

Health goes downhill when older adults stop driving

The latest here:

Cognitive and motor deficits contribute to longer braking time in stroke

• Neha Lodha,
• Prakruti Patel,
• Joanna M. Shad,
• Agostina Casamento-Moran &
• Evangelos A. Christou 

Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 7 (2021) Cite this article

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Abstract

Background

Braking is a critical determinant of safe driving that depends on the integrity of cognitive and motor processes. Following stroke, both cognitive and motor capabilities are impaired to varying degrees. The current study examines the combined impact of cognitive and motor impairments on braking time in chronic stroke.

Methods

Twenty stroke survivors and 20 aged-matched healthy controls performed cognitive, motor, and simulator driving assessments. Cognitive abilities were assessed with processing speed, divided attention, and selective attention. Motor abilities were assessed with maximum voluntary contraction (MVC) and motor accuracy of the paretic ankle. Driving performance was examined with the braking time in a driving simulator and self-reported driving behavior.

Results

Braking time was 16% longer in the stroke group compared with the control group. The self-reported driving behavior in stroke group was correlated with braking time (r = − 0.53, p = 0.02). The stroke group required significantly longer time for divided and selective attention tasks and showed significant decrease in motor accuracy. Together, selective attention time and motor accuracy contributed to braking time (R² = 0.40, p = 0.01) in stroke survivors.

Conclusions

This study provides novel evidence that decline in selective attention and motor accuracy together contribute to slowed braking in stroke survivors. Driving rehabilitation after stroke may benefit from the assessment and training of attentional and motor skills to improve braking during driving.(Or just maybe you want to get them 100% recovered, then you don't have to solve this driving problem.)

Introduction

Fast and accurate braking is essential to avoid collisions and drive safely [1]. Braking depends on the integrity of cognitive and motor processes [2]. Cognitive skills are required to perceive, extract, and process relevant information from the continuously changing driving environment [3]. Motor skills are necessary to manipulate the gas and brake pedals with accurate and consistent leg movements [4]. However, following stroke, both the cognitive and motor capabilities can be impaired to varying degrees [5, 6]. Consequently, individuals with stroke may experience difficulty in performing driving related tasks such as braking. To date, the influence of cognitive and motor impairments on braking in stroke survivors has not been investigated.

Braking is a critical driving-related task that is associated with collision risk in older adults [7]. Prior research has examined the role of cognitive-motor impairments in overall driving, but not in braking performance following stroke [8,9,10].Cognitive impairments such as executive dysfunction, attentional deficits, and visuospatial disorientation are a common occurrence after stroke [5, 11, 12]. The decline in visual perception and executive function predict poor driving outcomes and fitness to drive following stroke [13, 14]. Stroke survivors with impaired attention show worse on-road driving skills and are less likely to resume driving [15, 16]. In addition to cognitive impairments, stroke affects motor capabilities in over 70% of survivors [6, 17]. Stroke-related declines in motor functioning, strength, coordination, and range of motion are likely to impact an individual’s ability to accurately operate car controls and influence the decisions for voluntary driving cessation after stroke [18, 19]. To-date, the majority of driving research in stroke has focused on the cognitive factors, and only a few studies have considered motor factors that are arguably essential for driving safely [9, 10]. Given that cognitive and motor impairments occur simultaneously after stroke, it is critical to examine how these deficits impact braking during driving.

The purpose of the current study was to determine the relative contribution of cognitive and motor impairments to braking time in chronic stroke survivors. Prior work has extensively documented that attentional skills are critical for rapid braking response [1, 7]. Therefore, we quantified cognitive function with processing speed, divided attention, and selective attention. Further, decline in ankle muscle strength is shown to be associated with slower braking and unsafe driving in older adults [20, 21]. In addition, we recently demonstrated that decreased ankle position accuracy contributes to impaired braking response in stroke survivors [22]. Therefore, we measured motor function with strength and position accuracy of ankle dorsiflexors and plantarflexors. We measured braking time in a simulated driving environment. Based on previous findings in older adults [20], we hypothesized that motor and cognitive impairments together will be better predictors of braking time than cognitive impairments alone.

Methods

Participants

Twenty stroke survivors (64.35 ± 14.83 years) and 20 healthy older adults (67.45 ± 8.39 years) participated in the current study. Inclusion criteria for the stroke participants were as follows: (1) diagnosed with a unilateral cerebrovascular accident at least 6 months prior to testing, (2) current or past drivers, (3) a minimum active range of motion of 15 degrees of ankle dorsiflexion and 5 degrees of active plantarflexion against gravity, and (4) have the ability to understand and follow a three step command (e.g., “Take this piece of paper in your right hand. Fold it in half. Put the paper on the floor.”) (Well that would fail me right there, folding a paper in half with one hand is nigh impossible.) . Exclusion criteria were (1) presence of any other neurological or musculoskeletal disorder, (2) pain or injury affecting limb movements, (3) spatial neglect, vision, and hearing impairments, (4) psychiatric illness (such as clinical depression or anxiety) or untreated sleep disorder, and (5) history of simulator sickness. The self-reports on these impairments were used to screen the participants. Prior to participation, all individuals read and signed an informed consent approved by the University of Florida’s Institutional Review Board.