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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
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Europa Medicophysica 2001 December;37(4):275-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Hemianopsia and driving

Netz J., Wolbers T.

From the Neurologisches Therapiezentrum an der *Heinrich Heine Universität, Düsseldorf, Germany


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Back­ground. ­Many ­countries ­have set ­strict ­rules for per­mit­ting ­driving of ­patients ­with homon­y­mous hemi­-anopsia. ­This ­study inves­ti­gates the ­effects of com­pen­sa­tory eye move­ments on the ­driving ­ability of ­patients ­with homon­y­mous hem­i­anopsia.
­Methods. ­Patients and con­trols are exam­ined on a ­highly ­advanced inter­ac­tive ­driving sim­u­lator. The ­search ­time cri­terion was ­used to ­divide the ­patients ­into two ­groups. ­Patients ­with ­search ­times ­exceeding the ­average ­search ­time of the con­trol ­group ­plus two stan­dard devi­a­tions ­were ­labelled “­patients ­with explor­a­tory def­i­cits”, ­patients ­whose ­search ­times ­fell ­below ­this cut-off ­value ­were ­labelled “com­pen­sa­tors”. The ­driving beha­viour was ­assessed ­based on a ­detailed obser­va­tion ­sheet ­that con­tained ­every ­traffic sit­u­a­tion ­with the ­actions ­required by the ­driver.
­Results. The per­for­mance of the ­patients ­with explor­a­tory def­i­cits was sig­nif­i­cantly ­worse com­pared to the con­trol sub­jects. ­Even ­though ­these ­patients ­drove at sub­stan­tially ­lower ­speeds and per­formed ­less over­taking manoeu­vres ­than ­both the con­trols and the com­pen­sa­tors, ­they ­were ­unable to ­drive ­safely and to ­react ­quickly and ade­quately in dan­gerous ­traffic sit­u­a­tions. In ­both ­patients ­groups ­with a quad­rantanopsia and ­with a com­plete hem­i­anopsia ­there ­were ­some ­able to com­pen­sate and ­some not. So the prob­lems of ­patients ­with ­homonym ­anopic ­lesions can not be ­directly ­related to the ­size of the homon­y­mous ­defect in a ­simple ­manner. ­Patients who can com­pen­sate for ­their ­field ­defects ­either spon­ta­ne­ously or ­after a suc­cessful explo­ra­tion ­training ­seem to be ­able to ­meet the require­ments of ­modern ­traffic.
Con­clu­sions. Con­se­quently, it ­should be dis­cussed ­whether it is ade­quate to ­deny ­these ­patients ­driving per­mis­sion in gen­eral or ­whether ­this deci­sion ­should be ­based on the ­results of a prac­tical/sim­u­lator ­driving ­test and an assess­ment of the ­visual explo­ra­tion.

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