Fitness-to-drive recommendations in post-stroke patients: a retrospective study.

BACKGROUND: Stroke sequelae can have an impact on daily life activities such as driving. French legislation stipulates that post-stroke patients should undergo a multi-professional fitness-to-drive assessment before being allowed to drive again. This retrospective study aims to explore the determinants of multi-professional fitness-to-drive recommendations. METHODS: Sixty-six post-stroke patients assessed for fitness to drive in the Kerpape Center, France in 2019 were included. Favorable or unfavorable driving recommendations were attributed to patients following a joint decision by a multi-professional team. Individual characteristics obtained from medical records were compared. RESULTS: Findings showed that 64% of stroke patients received a favorable fitness-to-drive recommendation. Across all demographic, clinical, and driving characteristics, the time interval between stroke and assessment was significantly longer for patients designated as unfit to drive than for those designated as fit to drive (P = .004). Furthermore, the proportion of instrumental sequelae was higher in patients designated as unfit to drive than in those designated as fit to drive (P = .022). Stepwise logistic regression showed that the presence of instrumental sequelae, mainly aphasia, was the best predictor of fitness-to-drive recommendations. CONCLUSIONS: The post-stroke time interval and the presence of instrumental sequelae explained the difference between patients recommended as fit-to-drive and unfit-to-drive. Furthermore, aphasia was found be the best predictor of a fitness-to-drive recommendation. It is possible that aphasia impacts the understanding of instructions during on-road testing. These findings emphasize the need for a standardized multi-professional fitness-to-drive assessment, since the determinants of fitness-to-drive recommendation differ between studies.

Hemodynamic responses to visual cues during attentive listening in autonomous versus manual simulated driving: A pilot study.

Emerging automation technologies could have a strong impact on the allocation of drivers' attentional resources. The first objective of this pilot study is to investigate the hemodynamic responses evoked to relevant visual stimuli in manual and autonomous driving. The second aim is to examine how the inclusion of a secondary task (attentive listening to a broadcast) modulates these hemodynamic responses in both driving situations. Frontal, temporo-parietal and occipital activations were recorded using a functional Near-InfraRed Spectroscopy (fNIRS) system. Event-related analysis was used to determine whether visual cue processing (specifically, the lighting of a lead vehicle's brake-lights) could induce different brain responses depending on the driving mode and on the presence or absence of a competing task. Mind-wandering as reported by the participants was more pronounced during autonomous compared to manual driving. Our results showed an increase in the OxyHb concentration in the right temporo-parietal and occipital areas during manual compared to autonomous driving, suggesting greater allocation of attentional resources for processing visual cues in the first condition. Finally, an event-related decrease in right frontal activity during autonomous driving when listening was observed, suggesting that attentional resources were more focused on the secondary task than on monitoring the driving scene.

Driving anxiety and anxiolytics while driving: Their impacts on behaviour and cognition behind the wheel.

Introduction: The interaction between road safety and drivers' mental health is an important issue to take into consideration on transportation and safety research. The present review deals specifically with the link between anxiety and driving activity from two complementary points of view. Method: A systematic review into primary studies, following the PRISMA statement, was carried out in four databases: Scopus, Web of Science, Transport Research International Documentation and Pubmed. A total of 29 papers were retained. On the one hand, we present a systematic review of research articles exploring the cognitive and behavioural effects of driving anxiety, regardless its onset, when concerned people have to drive. The second goal of the review is to compile the available literature on the influence of legal drugs, which are used to fight against anxiety, on actual driving tasks. Results: Eighteen papers have been retained for the first question, whose main findings show that exaggerated cautious driving, negative feelings and avoidance are associated with driving anxiety. Most of the conclusions were drawn from self-reported questionnaires and little is known about the effects in situ. Concerning the second question, benzodiazepines are the most studied legal drugs. They affect different attentional processes and could slow reaction times down depending on the population and treatment features. Conclusions: The two standpoints included in the present work allow us to propose some possible lines of research to study certain aspects that have not been explored in depth about people who either feel apprehensive about driving or who drive under the effects of anxiolytics. Practical applications: The study on driving anxiety may be crucial to estimate the consequences for traffic safety. Furthermore, it is relevant to design effective campaigns to raise awareness about the issues discussed. To propose standard evaluations of driving anxiety and exhaustive research works to find out the extent of anxiolytics use are also important to be considered for traffic policies.

Cognitive and body manifestations of driving anxiety according to different onsets.

BACKGROUND: Driving anxiety can have deleterious effects not only on driving behavior, but also on life quality. The interaction between motor vehicle collision (MVC) experiences and driving anxiety has been studied from different standpoints. However, the comparison with other events triggering it has been scarcely considered. Objectives: To analyze the body manifestations and the driving cognitions related to the accident, social and panic concerns in people suffering from different levels of driving anxiety. Method: A total of 260 participants suffering from driving anxiety were included in a survey, including Driving Cognition Questionnaire and Body Sensation Questionnaire. Results: Panic attacks and criticisms are the most relevant onsets of driving anxiety, more than MVC. Only 11.4% of MVC victims considered it as the onset. People with MVC history showed lower scores in social concerns than people without MVC experience and neither the responsibility of the MVC nor the role (driver/passenger) seemed to have an impact on the anxiety level. Conclusions: Although the most relevant body sensations, heart palpitations and sweating, were the same in people with panic attack experiences and MVC victims, a discrimination of the emotions behind the concept of "driving anxiety" is desirable to clarify the psychological effects of different onsets.