Efficacy of Simulation Training for Enhancing Driving Independence Among Recovering Stroke Patients

PURPOSE: Stroke survivors commonly experience cognitive, motor, and visual impairments, which are essential for safe driving. While simulation-based interventions show promise for stroke rehabilitation, evidence is lacking for its implication for driving independence in clinical practice. The purpose of this study is to investigate the efficacy of virtual reality (VR) simulation-based interventions in improving cognitive, motor, and visual skills in stroke rehabilitation and its implications for driving reintegration compared to conventional treatment as usual (TAU).

DESIGN: This efficacy study contains randomized controlled trials (RCTs) including patients recovering from a stroke with cognitive, motor, or visual impairments and involved in simulation-based interventions were systematically reviewed.

METHOD: English databases, PubMed, EBSCOhost, and CINAHL, were utilized to accumulate relevant studies with key search terms including ‘occupational therapy,’ ‘virtual reality,’ ‘simulator training,’ ‘driving,’ ‘stroke,’ and ‘independence.’ Covidence software utilized to systematically screen relevant studies to be critically evaluated through individualized data abstractions and risk of bias.

RESULTS: Overall, VR simulation-based interventions significantly improved attention (p < 0.01), spatial awareness (p < 0.01), generalized cognitive functioning (p < 0.001), moderately neurologically impaired on-road testing (p = 0.03), Ashworth Scale (p = 0.002), FMA-UE (p = 0.00), ARAT (p = 0.00), Box & Blocks (p < 0.001), MoCA (p < 0.001), GMLT (p < 0.001), and SST (p < 0.001).

CONCLUSION: VR simulation-based interventions effectively target impaired cognitive, motor, and visual domains, allowing for improvements and increased deficit awareness impacting safe and independent driving. Integrating simulation programs and TAU allows maximum effectiveness of stroke rehabilitation interventions to support driving prognosis.

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