Perhaps the biggest challenge for a stroke victim is getting back to normal daily routines. That includes driving. Texas Health Plano has added driver's rehabilitation technology to help patients restore their confidence behind the wheel.
Dr. Ryan Cheung, a neurohospitalist and the hospital's stroke program director, talked with KERA's Sam Baker about some of the challenges of getting even virtually back on the road.
Dr. Cheung: Some patients, depending on the location of the stroke, they can have their vision be obstructed or vision loss.
Double vision, which we call diplopia, can make driving a challenge when you're not seeing a true image, or you could lose half your vision, in which case you might not be able to see your mirrors and blind spots become even more of a challenge.
Cognitive impairments are very common after stroke, and it can impair things like judgment, language, so being able to interpret signs and directions can be a factor.
Reaction time, decision-making, judgment - all play a part into driving, and when those are affected, patients can obviously get into dangerous circumstances, but it also can affect their confidence and they don't feel comfortable getting out on the road safely.
Baker: Tell me about the driving rehab technology. How does this work?
Dr. Cheung: We have a driving simulator complete with a steering wheel and pedals, as well as several monitors and screens to simulate the driving experience. There are three screens they can use to simulate more peripheral vision that they have to use to scan the road, to see oncoming cars, traffic lights, and signs.
While the patients are in the driving simulator, there's an occupational therapist who's trained to help these patients. This is what can give them the feel and experience of being in a car without being on the road.
And it allows the body to retrain itself. With any sort of recovery after stroke, we call that neuroplasticity. And it's about retraining the brain to form these new pathways.
And so driving is a very complex activity that we do. And it includes things like vision and attention, judgment, reaction time - all these skills that we need to rebuild and retrain, and also continuously assess so the driving simulator does give that feedback and can measure those things to help patients get ready for being back on the road and the community.
Baker: Does the technology put you on the path to getting to drive or does it make you ready and able to get on the road?
Dr. Cheung: It's a first-step kind of bridging between the bedside and getting to a car physically because it's just a virtual kind of structured environment. And after a virtual simulator, there are programs with trained occupational therapists in a special driving car, usually with adaptations that can be made. Also, the passenger side has like a brake that they can use to stop the car just in case anything were to happen.
Baker: Who is or isn't suitable for this program?
Dr. Cheung: This is suitable for patients who have the physical ability to use a steering wheel and to use foot controls with the pedals. And these are patients who obviously were driving beforehand, they were independent, and we want to get them back to that. And it can be used to measure, you know, who is ready to get on the road. And if they're not ready to be able to train them on the driving simulator as part of their recovery.
Baker: I imagine one of the things that can come out of this is that they either get fully or get on the way to gaining their confidence back, maybe.
Dr. Cheung: It doesn't replace real-world driving, but it can help identify things that they need to work on so they can build safer skills to getting on the road.
And it can be a pathway to getting them to the next step, or perhaps we find that patients maybe just aren't ready and we might need to find another safer way for them to get to different places because safety is the number one.
RESOURCES:
Driving After Stroke (National Library of Medicine)
Stroke: How to prevent stroke - Assess Your Stroke Risk
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