Self-Evaluation of Driving Simulator Performance After Stroke

Background and Purpose: Despite the potential dangers associated with premature return to driving after stroke, very little research has examined the relationship between impaired self-awareness (ISA) and driving. This study examined self-awareness of driving simulator and neuropsychological performance among stroke patients, comparing them with healthy control participants. Methods: Thirty stroke survivors and 30 controls each were asked for prediction and postdiction ratings of their performance on various driving simulator and neuropsychological tasks. Self-estimates versus actual performance discrepancy scores were calculated for various simulator and neuropsychological measures by converting scores to a shared metric. Results: Across all measures, the stroke survivors greatly overestimated their performance in comparison with the accuracy of self-evaluations among the controls, thus suggesting ISA. This pattern of overestimating was observed on both novel (neuropsychological) and familiar (driving) tasks. However, there was some evidence to suggest that stroke survivors can benefit from feedback, as seen by increased accuracy in postdiction versus prediction self-evaluation scores. Both stroke survivors and controls also showed a greater shift toward accurate self-estimation on postdiction of driving performance than on postdiction of neuropsychological test performance. Conclusion: Although the temporal stability of the shift in awareness is not known, these results support the use of driving simulators as a useful and safe method of assessing and potentially improving stroke survivors' ISA.