M L M Tant¹, W H Brouwer¹, A C Kooijman², F W Cornelissen²
¹University of Groningen, Psychology, Groningen, The Netherlands; ²University of Groningen, Ophthalmology, Groningen, The Netherlands
Background We studied practical fitness to drive in 28 patients with Homonymous Hemianopia (HH). We focussed upon visual performance during driving (VIS) and related this to neuropsychological visuo-spatial test performance. Methods Driving safety and fluency was assessed by means of a practical test-ride and scored using a structured protocol. Visuo-spatial neuropsychological performance was assessed by means of a test battery including clinical and experimental tasks. These were evaluated in terms of speed, accuracy and asymmetry. The asymmetry index provides an indication of differential lateralised performance. Results We found that VIS was significantly related to neuropsychological performance. A combination of the asymmetry, speed and accuracy components (in that order) derived from the a priorily defined neuropsychological factors explained 77% of the variance in VIS. We observed that the majority of HH patients showed low to modest visuo-spatial performance both on neuropsychological tests and during the driving test, suggesting the need for specific therapeutic intervention. Seventeen of those poorly performing patients took part in a compensation training to reduce visuo-spatial limitation, specially focusing on compensation during driving. We evaluated visuo-spatial performance in driving and in neuropsychological tests, before and after the training. The inter- and intrarelations were comparable. We found an improvement in visuo-spatial performance during driving after rehabilitation, but not in other aspects of driving, or in neuropsychological test performance. Conclusions Our results suggest that HH is not necessarily a contra-indication for fitness to drive. Further, visuo-spatial limitation can be reduced by saccadic compensation training. Currently we are comparing the effectiveness of this compensatory rehabilitation approach with an adaptive prism approach, using monocular peripheral prisms.
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