United States version of the Stroke Driver Screening Assessment: a pilot study.

BACKGROUND: Most stroke survivors who resume driving in the United States do so within the first year. More than 87% of these individuals resume driving without a formal evaluation of their fitness to drive because of the absence of standard practices and generally accepted and valid screening tools. The Stroke Driver Screening Assessment (SDSA) is an established battery for predicting stroke survivors' driving performance but is not currently used in the United States. This pilot study investigated the predictive ability of the US version of the battery in a US-based cohort of stroke survivors. METHOD: Fifteen first-ever stroke survivors (age, 52±12 years) and 16 healthy adults (age, 40±16 years) were administered the US version of the SDSA in a standardized format. Performance on the SDSA was compared with driving performance in a high-fidelity driving simulator. RESULTS: Stroke and healthy participants' driving performance was predicted with 87% and 88% accuracy, respectively. CONCLUSION: The US version of the SDSA battery has the potential to be a good predictor of driving performance of mildly impaired stroke survivors. Larger studies are needed to further establish its predictive accuracy.

Driving simulation for evaluation and rehabilitation of driving after stroke.

Driving is an important activity of daily living. Loss of driving privileges can lead to depression, decreased access to medical care, and increased healthcare costs. The ability to drive is often affected after stroke. In approximately 30% of stroke survivors, it is clear from the onset that driving will no longer be possible. Approximately 33% of survivors will be able to return to driving with little or no retraining, and 35% will require driving-related rehabilitation before they can resume safe driving again. The ability to drive is not routinely evaluated after stroke, and there is no established rehabilitation program for poststroke driving. When driving evaluation does occur, it is not always clear which tests are the most salient for accurately assessing poststroke driving ability. Investigators have examined the efficacy of various methodologies to predict driving performance after stroke and have found mixed results, with each method having unique weaknesses, including poor predictive ability, poor face validity, poor sensitivity or specificity, and limited reliability. Here we review common models of driving to gain insight into why single-construct visual or cognitive off-road measures are inadequate for evaluating driving, a complex and dynamic activity that involves timely interaction of multiple motor, visual, cognitive, and perceptual skills. We also examine the potential for driving simulators to overcome the problems currently faced in the evaluation and rehabilitation of driving after stroke. Finally, we offer suggestions for the future direction of simulator-based poststroke driving evaluation and training.

Reducing visitor noise levels at Muir Woods National Monument using experimental management.

Noise impacts resources and visitor experience in many protected natural areas, and visitors can be the dominant source of noise. This experimental study tested the efficacy and acceptability of signs asking visitors to be quiet at Muir Woods National Monument, California. Signs declaring a "quiet zone" (at the park's Cathedral Grove) or a "quiet day" (throughout the park) were posted on a randomized schedule that included control days (no signs). Visitor surveys were conducted to measure the cognitive and behavioral responses of visitors to the signs and test the acceptability of these management practices to visitors. Visitors were highly supportive of these management practices and reported that they consciously limited the amount of noise they produced. Sound level measurements showed substantial decreases on days when signs were posted.