The Effect of Treadmill Aerobic Exercise in Stroke Patients

OBJECTIVE: To investigate the effect of treadmill aerobic exercise for eight weeks on cardiopulmonary fitness and functional mobility in stroke patients METHOD: Twenty one stroke patients who could walk independently and had MMSE score of 24 or higher were included. We used maximal exercise test by means of modified Harbor protocol before and after eight weeks' treadmill aerobic exercise. We monitored patients' status with EKG, heart rate, blood pressure and Borg rating of perceived exertion, and measured maximal O2 consumption, maximal heart rate, blood pressure, minute ventilation, rate pressure product and respiratory exchange ratio during maximal exercise test. We also assessed functional mobility by Fugl-Meyer assessment of lower extremity, Berg balance scale, five times sit to stand test, timed up & go test, dynamic gait index scale, activities-specific balance confidence scale and Korean-modified Barthel index before and after 8 weeks' training. RESULTS: Twenty one patients completed treadmill aerobic exercise training. After eight weeks' treadmill aerobic exercise, the cardiopulmonary fitness, measured by maximal O2 consumption, maximal heart rate, minute ventilation, systolic blood pressure, functional mobility measured by Fugl-Meyer assessment of lower extremity, Berg balance scale, five times sit to stand test, timed up & go test, dynamic gait index scale, activities-specific balance confidence scale and Korean-modified Barthel index showed statistically significant improvement (p<0.05). CONCLUSION: Eight weeks' treadmill aerobic exercise improved the cardiopulmonary fitness and functional mobility in ambulatory stroke patients.

Evaluation of Driving Ability in Older Drivers

OBJECTIVE: To assess the driving ability of older drivers, their visual function, cognitive-perceptual function, motor function and driving performance were evaluated. METHOD: Subjects were 55 drivers aged 65 years or older. Visual function test included visual acuity, visual field, color vision and contrast sensitivity. Cognitive perceptual function was evaluated with the cognitive perceptual assessment for driving (CPAD) and clock drawing test. For motor function, muscle strength and range of motion were evaluated. Driving performance was evaluated by virtual reality based driving simulator. For comparision, 48 younger drivers aged between late twenties and early forties underwent the same evaluation. RESULTS: Among older drivers, 21 (38.2%) had visual acuity less than 20/40, 3 (5.5%) had visual field narrower than 140degrees bilaterally. Contrast sensitivity was significantly decreased in both day and night with glare light conditions. In cognitive-perceptual function assessment, 20 subjects (36.4%) passed CPAD test, 3 subjects (5.5%) failed, and 32 subjects (58.1%) fell into borderline group. Mean CPAD score was 50.65+/-5.62, which was significantly lower than that of younger drivers. 18 subjects (32.7%) were incorrect in clock drawing test. In motor function assessment, 4 subjects (7.3%) in older drivers showed hemiparesis secondary to stroke. In driving simulator, 21 subjects (38.2%) failed whereas only 4 subjects (8.3%) did in younger drivers. Average demerit score was 24.09+/-15.53 and was significantly higher than that of younger drivers. CONCLUSION: Older drivers showed significantly higher incidence of visual and cognitive-perceptual dysfunction, and poorer driving performance compared to younger drivers group.

Driving Status, Habits and Safety of Older Drivers

OBJECTIVE: To investigate the actual driving status and driving related safety issues of older drivers aged 65 years or older. METHOD: We conducted a survey on 56 elderly drivers about driving status, driving habits, safe driver self check list, and medical conditions that may affect safe driving. For comparison, 50 younger drivers aged between third and fifth decades were also surveyed. RESULTS: The mean age of total 56 elderly drivers was 69.96 years old. Their mean driving time in life was 23.6 years and the purposes of driving were shopping (23.2%), religion activity (21.4%) and leisure (16.1%). Most vehicles were equipped with automatic transmission (83.9%) and power steering (91.1%) and the most common type of vehicle was a sedan (82.1%). The incidence of their motor vehicle accidents in recent 2 years was 21.4%, which was higher than that of control group (18.0%) without statistical significance. The driving habits questionnaire revealed elderly drivers tend to avoid rush-hour traffic, driving at night, and high-traffic roads in 75.0%, 69.6%, 51.8% of subjects respectively. The result of safe driver self check list showed that mean demerit score of elderly drivers was 4.3, which was higher than that of younger drivers (3.2). Elderly drivers had hypertension (33.9%), diabetes mellitus (17.9%), eye disorders (8.9%), heart disease (8.9%), arthritis (8.9%), stroke (7.1%), and respiratory disease (5.4%). CONCLUSION: Compared to younger drivers, elderly drivers tend to avoid unsafe driving situations and reported more safety problems in the safe driver self check list. Elderly drivers also had more medical conditions that may affect safe driving, such as eye disorders, cardiovascular, and metabolic diseases.