Impact of left vs. right hemisphere stroke on driving: lateralized attention deficits and executive dysfunction linked to impaired driving.

Introduction: For many people, driving is essential to quality of life because it facilitates social integration and community participation. Indeed, many stroke survivors return to driving within months post-stroke. Few studies, however, have specifically characterized post-stroke driving errors as a function of affected hemisphere (LH vs. RH) and cognitive impairment. Methods: This study examined driving performance in LH and RH stroke survivors and age-matched controls using a fully interactive driving simulator. Results: Analysis revealed that the direction and severity of visuospatial attention deficits were significant predictors of post-stroke driving performance and executive dysfunction correlated with specific types of driving errors. Moreover, the cerebral hemisphere affected by stroke had a significant impact on lane positioning errors, with RH stroke survivors experiencing more difficulty maintaining lane position. In addition, a higher incidence of lane departures on the contralesional side of the lane was observed after stroke. Notably, neither age, months post-stroke, nor simple reaction time were reliably associated with scores or pass/fail ratings on the simulated driving assessment. Discussion: This work highlights how LH and RH strokes differentially impact driving and suggests that driving assessment and rehabilitation efforts should consider both the direction and severity of visuospatial attention deficits as well as the degree of executive dysfunction in stroke survivors who wish to continue driving.