physical and cognitive impairments due to cerebrovascular disease cause difficulty driving , 
 resulting in limitation of stroke patients social participation and vocational resumes1 . driving enables mobility within the 
 community and is thus important to the ability of brain injury patients to sustain an 
 independent lifestyle2 . for most clients 
 of rehabilitation specialists who have experienced a stroke , spinal cord injury , or 
 traumatic brain injury , loss of driving ability appears to result from deficits in sensory 
 function , vision , perception , cognition , and language , as well as motor function3 . although actual on - road driving training 
 is ideal for regaining driving skills after brain injury , safety issues due to road hazards 
 must be considered . therefore , virtual reality driving simulations are used as training 
 tools by several driving rehabilitation centers4 . the effectiveness of driving simulator training has been tested in 
 previous studies of older adults or patients with traumatic brain injury or spinal cord 
 injury and of a normal adult with anxiety after a car accident5 , 6 . driving simulators have 
 also been used in several studies to identify driving errors in elderly individuals and 
 those with cerebral injury7 , 8 . according to the american stroke association , drivers who 
 have suffered a stroke commit more than twice as many driving errors as normal drivers , 
 including errors in making left turns9 . the aim of this study is to compare the driving errors made by stroke patients with right or 
 left hemispheric lesions , a distinction that has not been addressed in previous studies . thirty stroke patients who received rehabilitation training at a day - care center in seoul 
 were included in the present study . participants included 23 males ( 76.7% ) and 7 females 
 ( 23.3% ) with a mean age of 47  years ( sd = 12.96 ) and mean driving experience before stroke 
 of 15  years ( sd = 8.22 ) . 16 of the patients had right hemispheric lesions ( 53.3% ) and 14 had 
 left hemispheric lesions ( 46.7% ) . all participants were informed of the purpose and methods 
 of this study , in accordance with the ethical principles of the declaration of helsinki 
 ( 1975 , revised 1983 ) . the subjects provided written consent prior to the experiment , which 
 was approved by the institutional review board of the national rehabilitation center . patients were included if they had received their first stroke diagnosis one year ago and 
 had a driver s license and driving experience before the onset of stroke . patients were 
 excluded if they were unable to comprehend or follow the instructions for using a driving 
 simulator . the 
 driving simulator included a virtual on - road course with road traffic rules . the test course 
 simulated driving in downtown seoul and on the highway and was designed to resemble actual 
 driving , incorporating various buildings , moving cars , traffic signals , and road signs . while participants used the simulator , driving errors were tracked by the simulator 
 software . driving errors that were assessed included failure to use the seat belt , maintain 
 speed , or follow the road , and crossing of the center line . safe driving was indicated by a cut - off score of 80 points ; scores 
 below this threshold were marked as failures10 . participants completed one practice trial using the exercise mode 
 of the simulator , because some patients appeared to develop symptoms of motion sickness 
 while using the simulator11 . approximately 10  min were required for normal drivers to 
 complete the test course . descriptive statistics were used to summarize the general characteristics of the 
 participants . the student s t - test and test were used to compare driving 
 errors between participants with left or right hemispheric lesions . there were no significant differences between participants with left or right hemispheric 
 lesions in the frequencies of failure to use the seat belt , exceeding the speed limit , or 
 drop - out of the course . however , there were significant differences in the frequencies of 
 center line crossing , turn signal errors , and accidents , as well as brake reaction time , and 
 total driving error scores ( table 1table 1.comparison of driving errors between stroke patients with left and right 
 hemisphere lesions ( n = 30)right hemisphere lesion ( n = 16)left hemisphere lesion ( n = 14) ( df)odds ratiofrequency ( % ) or mean  sdfrequency ( % ) or mean  sdfailed to use seat belt9 ( 56.2%)9 ( 64.3%)0.021 ( 1)0.71exceeded speed limit3 ( 18.8%)2 ( 14.3%)0.107 ( 1)1.38turn signal errors34.37  20.55 * 12.64  9.53*drop out the course5 ( 31.2%)7 ( 50.0%)1.09 ( 1)2.20crossed center line10 ( 62.5%)*7 ( 50.0%)*0.47 ( 1)*1.66*accidents4 ( 25.0%)*8 ( 61.5%)*3.95 ( 1)*4.8*brake reaction time ( sec)0.99  0.21 * 9.00  29.18*total error score32.12  18.47 * 18.64  16.57**significant difference between right and left hemisphere lesion groups , p < 0.05 . there was no significant difference in the time needed for participants to 
 complete the test course ; however , there was a significant difference in the test failure 
 rate ( total test score < 80 points ) ( table 
 2table 2.comparison of driving simulation time and failure rate between patients with left 
 and right hemisphere lesions ( n = 30)right hemisphere lesion ( n = 16)left hemisphere lesion ( n = 14) ( df)odds ratiofrequency ( % ) or mean  sdfrequency ( % ) or mean  sdtotal driving time ( minutes)24.26  7.7319.86  8.02failures4 ( 25.0%)*9 ( 64.3%)*4.69 ( 1)*5.4**significant difference between right and left hemisphere lesion groups , p < 0.05 . sd : standard deviation * significant difference between right and left hemisphere lesion groups , p < 0.05 . driving rehabilitation is important for the ability of stroke survivors to maintain an 
 independent lifestyle and to participate in the community12 . to help drivers who have experienced strokes to regain their 
 mobility within the community , driving rehabilitation specialists assess their driving 
 skills and analyze driving errors . the aim of this study was to compare driving errors 
 between stroke patients with left or right hemispheric lesions . significant differences were 
 shown in the frequencies of turn signal errors and center line crossing , accident rate , and 
 brake reaction time . specifically , participants with right hemispheric lesions were 
 approximately 1.7 times more likely to cross the center line and 4.8 times more likely to 
 have an accident compared to participants with left hemispheric lesions . additionally , there 
 was a significant difference between participants in overall driving safety , as shown by a 
 significantly higher failure rate among patients with right hemispheric lesions compared to 
 those with left hemispheric lesions . these results are similar to those of a previous study 
 conducted by akinwuntan and colleagues , which argues that the hemisphere affected by the 
 lesion is an important factor influencing driving performance after stroke13 . similarly , a study conducted by quigley 
 and colleagues , which included 50 stroke patients who participated in driving 
 rehabilitation , found that 52% of participants with right hemispheric lesions passed the 
 relicensing test , compared to 74% of participants with left hemispheric lesions14 . these results may be due to symptoms 
 caused by right hemisphere lesions such as unilateral spatial inattention . recognition of 
 and attention to features of the driving environment , such as vehicles , roads , and traffic 
 signs , are critical for safe driving . it is possible that patients with unilateral spatial 
 inattention due to lesions of the right parietal areas experienced difficulties receiving 
 sensory information related to the driving environment . as with all studies , the number of participants was small , and 
 all participants had lesions restricted to the left or right hemispheres . therefore , further 
 studies should recruit greater numbers of subjects and investigate driving errors among 
 patients with multiple lesions or different types of stroke , such as ischemic or hemorrhagic 
 stroke . despite these limitations , this study has important implications for driving 
 rehabilitation . significant differences were found in driving errors between stroke patients 
 with left and right hemispheric lesions . therefore , driving rehabilitation specialists 
 should be trained to consider the specialized functions of each hemisphere when teaching 
 driving skills to stroke survivors .
[ purpose ] the aim of this study was to compare the incidence of driving errors among 
 patients with left or right hemispheric lesions due to stroke . [ subjects and methods ] 
 thirty stroke patients participated in the study . 
 driving errors were assessed using a 
 virtual reality driving simulator . 
 [ results ] significant differences were shown in center 
 line crossing frequency , accident rate , brake reaction time , total driving error scores , 
 and overall driving safety between participants with left or right hemispheric lesions . 
 [ conclusion ] driving rehabilitation specialists should consider hemispheric function when 
 teaching driving skills to stroke survivors , because patients with lesions in the left or 
 right hemispheres after stroke show differences in driving skills .