Effects of visual retraining on return to driving after acquired brain injury

Transcription

1 Community Accessible Rehabilitation Effects of visual retraining on return to driving after acquired brain injury Meghan Maiani Brittany Jamieson Megan Metzler

2 Sheldon M. Chumir Health Centre, Calgary Alberta

3 Community Accessible Rehabilitation CAR Clients from Southern Alberta who require specialized treatment Three locations in Calgary Interdisciplinary (OT, PT, SLP, Rec T, SW, Psych, TA) Two streams, neuro & musculoskeletal diagnosis Clients must be living in the community Neuro clients work towards function-based goals Canadian Occupational Performance Measure (COPM)

4 CAR Pre-Driving Assessment Service CAR PDAs for neurological diagnoses & amputees only Excludes diagnosis of dementia 3 OTs, one is a CDRS (certified driving rehabilitation specialist) Combination of: - Physical assessment (OT DORA) - Pencil & paper (Trails A & B, MVPT) - Useful Field of View (UFOV) - Virage simulator - Optec vision tester - Dynavision Performance Assessment Battery (DPAB)

5 CAR Pre-Driving Assessment Service No capacity for on road evaluation Collaboration with local Alberta Motor Association (AMA) & Canadian Paraplegic Association ( AMA Adapted Driver Training Program ) Recommendations following PDA are made to Driver Fitness and Monitoring (DFM) who then inform of next steps

6 Background Information CAR has been assessing and treating visual perceptual impairments in clients who wish to return to driving Alberta Transportation, Driver Fitness & Monitoring (DFM) Physicians not required to report clients after medical event onus is on the client to report themselves Canadian Council of Motor Transport Administrators Standards 2015 Individual assessment, functional approach & ability to compensate

7 Recommendations from the literature regarding visual field cuts & driving Blind side hazard detection is a key point of assessment Overtaking & passing other vehicles is a problem area for clients with a visual field cut May need to re-teach lane positioning sense E.g.: right side visual field cuts drive more to the left of the lane which increased when going into a right hand turn 8-10 sessions on-road are recommended, clients must be able to consistently perform driving skills with newly acquired scanning skills

8 Enablers for successful on-road performance in visual field cuts Less binocular visual field loss Some evidence to suggest clients with right cuts are more successful in return to safe on road than left Younger age correlates to successful return to driving Current drivers Process speed Contrast sensitivity Blind spot detection

9 Barriers for successful on-road performance with visual field cuts Difficulty with anticipatory behaviours & environmental changes Left visual field cuts More difficulty maintaining lane position Left cuts had more difficulty making left hand turns (North American data) Steering stability Speed adaptation Older age Greater field loss

10 Development of research question Anecdotally, treatment at CAR has improved scanning ability Evidence in literature that visual-perceptual retraining can improve scanning abilities Cutoff scores in literature link performance on cognitive & perceptual assessments to driving risk CAR has been providing visual-perceptual retraining for a number of years: Do these clients successfully meet their goal of returning to driving? Do these clients note improvement in ADL performance? Methods: 52 charts reviewed, clients received treatment between

11 Treatments Offered Dynavision training Useful Field of View (UFOV) training Computer based training (Lumosity, Brain HQ, EyeSearch) Attention Process Training (APT 1-3) Scancourse Pencil & paper (Mary Warren scan sheets, LUV reading program) Treatment in clinic, 1-3 times a week for mins Combination of activities - varies each session Home program

12 Demographics who are we treating? N 52 Age (M = 56, SD = 17) Time Since Injury 19 days 14 years (M = 310 days, SD = 762 days) #of Treatment Sessions 0 49 (M = 13, SD = 10) Right brain lesion 18 Left brain lesion 17 Bilateral PCA/multifocal 16 Hemianopsia 8 Quadrantanopsia 21 Impaired visual attention 6 Hemi inattention 5 Impaired visual process speed 12

13 Results of Paired Sample T-Tests *All effect sizes are in the large range as per Cohen s d Canadian Occupational Performance Measure Performance Scale Satisfaction scale Useful Field of View Process speed p>.05 Divided attention speed Selective attention speed t(24) = 3.982, p=.001 t(36)= 3.970, p=.001 t(36)= 5.142, p<.001 t(36)= 5.232, p<.001 Dynavision Performance Assessment Battery SDT score SDT reaction time DDT score CDT score CDT composite (x t scope score) EDT score EDT reaction time t(29)= 7.253, p<.001 t(28)= 5.281, p<.001 t(26)= 6.596, p<.001 t(12)= 3.380, p=.005 t(10)= 3.166, p=.01 t(20)= 6.118, p<.001 t(20)= 3.580, p=.002

14 Results - Correlations Positive trend in the direction that more training sessions resulted in better performance on: Dynavision Performance Assessment Battery Simple Dynavision Task (reaction time) Difficult Dynavision Task (number of targets hit) Complex Dynavision Task (number of targets hit) COPM Performance Score

15 Clinical implications and limitations Clients were trained with the same equipment on which they were assessed Unable to make conclusions regarding driving outcomes as sample size too small, not able to extrapolate to real world driving ability Dosage mean of 13 treatment sessions (approx 4-5 weeks) may help inform practice Client assessment scores improved significantly following training, suggesting that clients do benefit from rehabilitation for visual-perceptual disorders

16 Future Directions New information from data analysis and literature review points to be incorporated into treatment Use of simulator to train clients with visual-perceptual impairments in driving behavior Continue to increase numbers in the database and continue with analysis of data Collect data on PDA outcomes including driving status 6-months post assessment Look at role of insight & behaviour (easily frustrated or angered during treatment/training) on driving ability

17

18

19 References Aslaksen, P., Ørbo, M., Elvestad, E., Sch äfer, C., & Anke, A. (2013). Prediction of on-road driving ability after traumatic brain injury and stroke. European Journal of Neurology, 20, Barco, P., Wallendorf, M., Snellgrove, C., Ott, B. & Carr, D. (2014). Predicting road test performance in drivers with stroke. American Journal of Occupational Therapy, 68, (2), Dickerson, A. (2013). Driving assessment tools used by driver rehabilitation specialists: Survey of use and implications for practice. American Journal of Occupational Therapy, 67, (5), Fisk, G., Novack, T., Mennemeier, M. & Roenker, D. (2002). Useful field of view after traumatic brain injury. Journal of Head Trauma Rehabilitation, 17, Fisk, G., Schneider, J. & Novack, T. (1998). Driving following traumatic brain injury: prevalence, exposure, advice and evaluations. Topics in Stroke Rehabilitation, 12, (8), Klevora, P., Gaskovski, P., Martin, K., Forsyth, R., Heslegrave, R., Young, M., & Quinn, R. (1995). The effects of Dynavision rehabilitation on behind-the-wheel driving ability and selected psychomotor abilities of persons after stroke. American Journal of Occupational Therapy, 49, Klevora, P., & Warren, M. (1998). Rehabilitation of visuomotor skills in poststroke patients using the Dynavision apparatus. Perceptual and Motor Skills, 86,

20 References Kroner-Bitensky, N., Sofer, S., Kaizer, F., Gelenais, I. & Talbot, L. (1994). Assessing ability to drive following an acute neurological event: are we on the right road? Canadian Journal of Occupational Therapy, 61, (3), Marshall, S., Molnar, F., Man-Son-Hing, M., Blair, R., Brosseau, L., Finestone, H., Wilson, K. (2007). Predictors of driving ability following stroke: A systematic review. Topics in Stroke Rehabilitation, 14, Mazer, B., Sofer, S., Korner-Bitensky, N., Gelenais, I., Hanley, J., & Wood-Dauphinee, S. (2003). Effectiveness of a visual attention retraining program on the driving performance of clients with stroke. Archives of Physical Medicine and Rehabilitation, 84, Murie-Fernandez, M., Iturralde, S., Cenoz, M., Casado, M. & Teasell, R. (2012). Driving ability after stroke: evaluation and recovery. Neurologia, 29, (3), Ortoleva, C., Brugger, C., Van der Linden, M. & Walder, B. (2012). Prediction of driving capacity after traumatic brain injury: A systematic review. Journal of Head Trauma and Rehabilitation, 27, (4), Vesia, M., Esposito, J., Prime, S., & Klevora, P. (2008). Correlations of selected psychomotor and visuomotor tests with initial Dynavision performance. Perceptual and Motor Skills, 107,

21 Questions?

22 Thank you Our clients & Therapy Assistants Tom Hufkens Program Manager & CAR Therapists Virage Systems & Dynavision Corps