Hazard perception of stroke drivers in a video-based Japanese hazard perception task.

Objective: Hazard perception (HP) is the ability to identify a hazardous situation while driving. Though HP has been well studied among neurologically intact populations, little is known about the HP of neurologically impaired populations (in this study, stroke patients). The purpose of this study is, first, to investigate the HP of stroke patients and, second, to verify the effect of lesion side (right or left hemisphere) on HP, from the viewpoint of hazard types. Methods: Sixty-seven neurologically intact age-matched older drivers and 63 stroke patients with valid driver's licenses conducted a video-based Japanese HP task. Participants were asked to indicate the hazardous events in the driving scenario. These events were classified into 3 types: (1) behavioral prediction hazards (BP), which are those where the cause is visible before it becomes a hazard; (2) environmental prediction hazards (EP), which are those where the ultimate hazard may be hidden from view; and (3) dividing and focusing attention hazards (DF), which are those where there is more than one potential hazard to monitor on approach．Participants also took part in the Trail Making Test (TMT) to evaluate visual information processing speed. Results: The results showed that the number of responses was significantly fewer for stroke patients than for age-matched drivers for all hazard types (P < .001), and this difference was not affected by lesion side (P > .05). It was also found that stroke patients showed a slower response time than age-matched drivers only for BP (P < .001). The lesion side did not affect response latency (P > .05). Results of the TMT revealed that age-matched drivers completed the task significantly faster than stroke patients (P < .001) and that neither TMT-A nor TMT-B differentiated between patients with left hemisphere damage and patients with right hemisphere damage (P > .05). Conclusions: Firstly, HP in stroke patients is low compared to age-matched drivers. Secondly, even if stroke patients notice hazards, their response may be delayed in a BP situation, due to a slower visual information processing speed. Thirdly, the lesion side does not appear to affect HP.

Reliability, validity, and factor structure of the Cognitive Behavioral Rating Scale for stroke patients.

The aim of this study was to explore the reliability, validity, and factor structure of a newly developed Cognitive Behavioral Rating Scale (CBRS), designed to assess cognitive function through observation. The study included 180 stroke patients and 58 orthopedic patients. The CBRS and the Functional Independence Measure (FIM) were administered. Data on discharge disposition were also collected. The inter-rater reliability, construct validity, concurrent validity, predictive validity, and factor structure of the CBRS were evaluated. The interclass correlation coefficient was 0.736 (P<0.0001). Cronbach's α for the CBRS was 0.92. Patients with stroke showed a significantly higher total CBRS score than those with orthopedic problems (P<0.0001). Spearman's rank correlation coefficient (rs) was -0.70 (P<0.01) for the total FIM score and the CBRS, and -0.72 (P<0.01) for the cognitive FIM and the CBRS. The return-to-home group had a significantly lower CBRS total score than the not-to-home group (P<0.01). The CBRS comprised three factors: (i) 'language and performance', (ii) 'control of performance', and (iii) 'space-self relation.' The CBRS appears to have a high reliability and validity for the assessment of cognitive function.