Elaboration of a Sensitive Evaluation Protocol to the Necessary Cognitive Processes for Driving After Stroke
Conditions: Stroke, Drive
Sponsor: University of Malaga

RESEARCH PROJECT: Development of an assessment protocol 
sensitive to the cognitive processes necessary for driving after 
stroke 
21st November 2022 
OBJECTIVES 
GENERAL OBJECTIVE 
TO DEVELOP AN ASSESSMENT PROTOCOL BASED ON ANALYSIS OF VARIABLES THAT MAY 
PREDICT SAFE "FITNESS TO DRIVE" ("Fitness to drive") IN PATIENTS WITH STROKE  
 
SPECIFIC OBJECTIVES 
1. SELECTION AND CREATION OF A BATTERY OF NON-DRIVING TESTS: COGNITIVE 
TESTS, PERSONALITY TESTS, RISK ESTIMATION AND ASSESSMENT OF DRIVING 
STYLES THAT MAY PREDICT SAFE "FITNESS TO DRIVE" ("Fitness to drive") IN 
PATIENTS WITH STROKE: 
 
- 
Creation of the driving planning test: Evaluation of driving planning on Map 
(COMAP) 
- 
Cross-cultural adaptation and validation in Spanish population of Stroke Driver´s 
Screnning Assessment (SDSA).  
- 
Cognitive tests to predict driving performance and identify cognitive deficits, 
including general cognitive tests, attentional tests, speed of processing, visual 
memory and executive functions. 
- 
Personality and Risk Estimation Tests: Risk Estimation Test: DOSPERT-i.e. 
Recreational Risk Perception and Sensitivity to Reward and Punishment Test -
SPSRQ-20 SR* - Sensitivity to Reward. 
- 
Assessment of driving styles: Multidimensional Driving Styles (MDSI), self-
reported driving styles questionnaire: Maladaptive vs. Adaptive (Cautious) 
Padilla, Castro, Doncel, Taubman-Ben-Ari, 2019). 
- 
PERFORMANCE-BASED TESTS ON HAZARD PERCEPTION AND RISK ESTIMATION, 
using recordings of naturalistic driving situations (Castro et al., 2014; 
Ventsislavova et al., 2016). 
 
2. CREATION OF A DRIVING SIMULATOR DRIVING PERFORMANCE ASSESSMENT 
TEST. The test called EDEC (Performance Evaluation of Driving) will be designed 
through a panel of experts (content validity) and the psychometric properties 
will be analysed. 
 
HYPOTHESIS 
Based on the literature on the subject of driving after stroke, our hypothesis is that this 
selection of non-driving, performance-based tests in conjunction with the two newly 
created tests: COMAP and EDEC will be crucial in establishing a decision as to whether a 
patient with stroke, who previously had a driving licence, is able to drive safely.  

In relation to the SDSA battery, our hypothesis is that the translated and cross-culturally 
adapted version will be a tool with good reliability and validity. 
METHODOLOGY 
STUDY DESIGN 
Validation of an assessment protocol for safe driving ability in stroke patients, analysing 
the ability of selected tests designed to predict safe driving in on-road tests. 
PARTICIPANTS AND INCLUSION CRITERIA 
For the study, there will be 2 groups: (participants will sign the informed consent to 
participate in the study).   
Patient group:  50 adults (between 18 years and 70 years) in chronic phase of stroke (>6 
months since stroke) who have a driving licence and have been driving in the three 
months prior to stroke.  
Exclusion criteria:  
- 
Patients must have medical clearance to participate in the study (indicating that 
they are medically stable to participate in the study, regardless of whether they 
can drive or not). 
- 
Patients will be excluded if they have a stroke score below 24 on the Mini Mental 
State Examination, epileptic seizures, visual impairments (uncorrected visual 
acuity with glasses, diplopia, severe campimetric or visual field deficits, etc.), 
attentional hemineglect syndrome, severe motor/balance disturbances and 
people who don't know/can read.  
- 
They will be required to be able to move independently in a standing position, 
even if they need the help of assistive devices to do so.  
 
Control group: 50 adults, matched in age, healthy, matched in driving experience 
(number of years of driving licence, kilometres driven in the last year, frequency of 
driving -daily, weekly, monthly, monthly, yearly, etc... ), age, sex and educational level 
with the following characteristics age, sex and educational level with the group of people 
with stroke with a valid driving licence.   
 
RECRUITMENT 
Patients will be recruited from the Regional University Hospital of Malaga and the 
Hospital of Torremolinos (Malaga), both hospitals provide care for most of the stroke 
patients in the province of Malaga from the public system. In addition, SINERGIA AISSE 
neurorehabilitation center and acquired brain injured association ADACEMA (Málaga) 
and ACTIVANEURO (Málaga).  
 

VARIABLES
 
 

 
Psycho-technical driving test 
Continuous quantitative 
Concentrated attention, Multiple reactions, 
Anticipatory speed, Bimanual coordination, 
Decision making and Personality 
* Average response time, in hundredths of a 
second. For its calculation, omissions and 
null responses are not taken into account. 
Omissions and null responses are not taken 
into account in the calculation. 
* No unanswered stimuli, i.e. errors of 
omission: the subject does not respond to a 
stimulus. 
No unanswered stimuli, i.e. errors of 
omission: the subject does not respond to a 
stimulus. 
* No confusions in front of stimuli, i.e. errors 
due to confusion: the subject presses the 
wrong button/pedal. 
presses the wrong button/pedal. 
* No non-stimulus responses, or null 
responses: the subject anticipates and 
Performance Evaluation of Driving 
(EDEC) 

presses a button or pedal without the 
stimulus. 
No stimulus responses, or null responses: 
the subject anticipates and presses a button 
or pedal without any stimulus appearing. 
* Percentages of confusions, omissions and 
null responses. 
 
 
Tests for inclusion/exclusion of patients 
- 
Boston test (reading comprehension): The person has to read 4 sentences and 
determine the correct option to finish the sentence (4 options).  
- 
Test Snellen: is a visual test carried out on the patient to evaluate their eye 
capacity and to see if there is any alteration that may be hindering their vision, 
thus measuring their visual acuity. 
- 
Time up and go: is a test used to assess a person's mobility and requires both 
static and dynamic balance. It uses the time that a person takes to rise from a 
chair, walk three meters, turn around 180 degrees, walk back to the chair, and 
sit down while turning 180 degrees.  
- 
5 Sit to Stand Test: measures one aspect of transfer skill. The test provides a 
method to quantify functional lower extremity strength and/or identify 
movement strategies a patient uses to complete transitional movements.  
 
- 
Evaluation of simulator performance possibility and pain. 
 
 
PROCEDURE 
 
The occupational therapists will contact those responsible for the recruitment centres 
to indicate the inclusion/exclusion criteria for participation in the present study. 
Participants who meet the criteria will be informed about the study and if they 
voluntarily agree to participate, they will be asked to sign a consent form authorising 
them to give their telephone number to the researchers.  The researchers will provide 
more detailed information about the study by telephone, and if the person agrees, an 
appointment will be made to carry out the assessment.  
The total duration of the evaluation protocol will be approximately 7 hours, although it 
depends on the participant's performance. It will be divided between the sessions 
required by the person, depending on their abilities, but will be at least 3 sessions.  
In the first session, the participant is again informed about the project and encouraged 
to ask any questions he/she may have. The person will be offered an information sheet 
and the participant will have to sign the informed consent form. The assessment will 
then begin, asking questions about socio-demographic data, collecting information 
about the injury and data in relation to driving. Subsequently, the list of off-road tests 
indicated in the protocol will be administered. In all sessions, approximately 30 minutes 
of driving time will be spent on the driving simulator in order to mitigate possible non-
serious adverse effects such as dizziness. Once the off-road tests have been completed, 
the in-car simulator test will be carried out, followed by the on-road test. For the on-
road test, in all patients, a 30-minute session will be devoted to adapt to that driving 

mode. The on-road test will be carried out in the presence of 3 people: a driving school 
teacher and 2 researchers.  
At the end of the on-road test, general feedback will be given by the driving instructor.