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Physicians could use maze test when discussing driving assessment readiness of stroke patients

Published:07 October 2019

Professor Carolyn Unsworth

A quick and easy pencil test is showing its usefulness for predicting fitness to drive after stroke.

CQUniversity's Professor Carolyn Unsworth says the Occupational Therapy-Drive Home Maze Test (OT-DHMT) was part of the OT-Driver Off Road Assessment Battery but could also be used by neurologists as a stand-alone indicator.

Speaking at the recent Stroke Society of Australasia 2019 Conference, Professor Unsworth said that the OT-DHMT was not only great when used as part of the occupational therapy process for assessing fitness to drive.

"It's also a great little tool that I think maybe physicians could use as a stand-alone in their discussions with patients about readiness to undergo a driving assessment," she said.

"It's quick and easy to use and gives physicians a really good idea about the psychomotor capacity of the client.

"It measures speed, accuracy, style of movement, thinking patterns and planning. Because it generates a score in seconds, the physician can straight away say 'I don't think you are quite ready yet' or if the person is really insisting they are ready the physician can say 'okay, it's a good idea to go and get a formal assessment done'."

Professor Unsworth said most people could feel comfortable doing a maze test, even if they did not have high levels of education.

She said many people were ready to re-engage with community activities, including driving, about six months after their stroke.

"There is growing awareness that we have to make sure we are talking to all our patients and clients about driving and we don't just assume they are doing the right thing," she said.

"Clinicians should provide written information to patients who especially don't remember what they don't want to hear.

"We as health professionals need to be keeping in mind that fitness to drive is a dilemma because there are serious consequences.

"If they give up prematurely or don't get the right advice to get assessments done and get back on the road, that can lead to a downward spiral of social isolation, loss of role and even premature relocation to supported housing.

"At the other end of the spectrum, if they go back to driving before they are ready and certainly before the legislation allows, there are serious consequences there too."

Professor Unsworth said physical problems after stroke could often be accommodated with vehicle adaptations such as left accelerator pedal or spinner knobs on steering wheels, so drivers did not need two hands to drive.

"Cognitive and perceptual problems - that's what is going to stop them from driving," she said.

"Other individual components of the OT-Driver Off Road Assessment Battery including the Mini Mental State Exam and the Road Law Road Craft Test have also been shown to predict whether people are fit to drive."

Professor Unsworth said one area of continuing research was using a driving simulator to identify, in a very low-risk environment, the various specific problems patients might be having.