Professor Carolyn Unsworth
A quick and easy pen and pencil test, the Occupational Therapy-Drive Home Maze Test (OT-DHMT), is showing its usefulness for predicting fitness to drive after stroke.
Speaking to the limbic after her presentation at the Stroke Society of Australasia 2019 Conference, Professor Carolyn Unsworth said the test was part of the OT- Driver Off Road Assessment Battery but could also be used by neurologists as a stand-alone indicator.
“I guess one of the really important findings was that not only is the OT-DHMT really great when it is used as part of the OT’s process for assessing fitness to drive, but it’s a great little tool that I think maybe physicians could use as a stand alone in their discussions with patients about readiness to undergo a driving assessment.”
“It’s quick and easy to use and it gives physicians a really good idea about the psychomotor capacity of the client. It measures speed, accuracy, style of movement, thinking patterns, planning…and because it generates a score in seconds, the physician can straight away say ‘I don’t think you are quite ready yet’ or if the person is really insisting they are ready the physician can say ‘okay, it’s a good idea to go and get a formal assessment done’.”
She said most people, even those without high levels of education, can look at a maze test and feel comfortable doing it.
Professor Unsworth, from Central Queensland University, said many people were ready to re-engage with community activities including driving about six months after their stroke.
“There is growing awareness that we have to make sure we are talking to all our patients and clients about driving and we don’t just assume that they are doing the right thing.”
She said clinicians should provide written information to patients who “especially don’t remember what they don’t want to hear”.
“We as health professionals need to be keeping in mind that fitness to drive is a dilemma because there are serious consequences from two extreme outcomes. If they give up prematurely or don’t get the right advice to get assessments done and get back on the road, that can lead to a downward spiral of social isolation, loss of role, and even premature relocation to supported housing.”
“And at the other end of the spectrum, it they go back to driving before they are ready and certainly before the legislation allows – there are serious consequences there,” she said
Professor Unsworth said physical problems after stroke can often be accommodated with vehicle adaptations such as left accelerator pedal or spinner knobs on steering wheels so drivers don’t need two hands to drive.
“Cognitive and perceptual problems – that’s what is going to stop them from driving.”
She said other individual components of the OT-Driver Off Road Assessment Battery including the Mini Mental State Examination and the Road Law Road Craft Test had also been shown to predict whether people were fit to drive.
“This is a good story that is getting better. We are getting more and more evidence to show us what kinds of rehab work but we are still right at beginning of research in this area.”
She said one area of research was using a driving simulator to identity in a very low risk environment the various specific problems patients might be having.
“To begin with, people when they are resuming driving after a stroke can have difficult with lane keeping and with right hand turns across traffic at controlled and uncontrolled intersections.”
Driving simulators were a low cost option to practice those skills without having to go out on the road with a driving instructor.