Access Type

Open Access Dissertation

Date of Award

1-1-2010

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Psychology

First Advisor

Lisa J. Rapport

Abstract

ABSTRACT

AWARENESS OF DEFICIT AND DRIVING SIMULATOR PERFORMANCE AFTER STROKE

by

CAROLYN A. SCOTT

December 2010

Advisor: Dr. Lisa J. Rapport

Major: Psychology (Clinical)

Degree: Doctor of Philosophy

Fifty-four stroke survivors completed a driving evaluation. Measures included predicted, postdicted, and actual performance on a driving simulator evaluation and a modified Biber Cognitive Estimation Test. Survivors nominated a significant other to serve as a knowledgeable informant about their abilities. Awareness of deficit was assessed via survivor-significant other difference scores on the Awareness Questionnaire. Five predictors (age, stroke severity, and awareness of cognitive, behavioral/affective, and motor abilities) reliably distinguished between survivors who passed and failed the driving simulator evaluation and predicted 34% of the variance in simulator prediction. Unawareness of cognitive and motor/sensory skills showed a stronger inverse relationship to driving performance than did awareness of the emotional/behavioral domain. Awareness of deficit moderated the accuracy of survivors' self-evaluations of their simulator performance (predicted and actual): Among survivors aware of their deficits, simulator prediction and postdiction scores were modestly related to actual simulator performance; among survivors unaware of their deficits, only postdiction correlated with simulator performance. Level of awareness did not affect correlations between self-ratings of cognitive, behavioral/affective and motor/sensory abilities and actual simulator performance, predicted simulator performance, or postdicted simulator performance. Survivor self-ratings of behavioral/affective abilities were unrelated to driving simulator performance whereas self-ratings of motor/sensory and cognitive abilities were negatively correlated with driving ability. General cognitive estimation skills were positively correlated with prediction of performance on the simulator in both the aware and unaware survivor groups, with stronger prediction for the unaware participants. However, cognitive estimation scores were not related to the accuracy of self evaluations of driving skills on the simulator. Thus, stroke survivors who overestimated their cognitive and motor/sensory abilities made less accurate estimates of their driving ability and performed worse in a driving simulator than did survivors who were aware of their deficits; however, the accuracy of their self-ratings improved significantly after the simulator evaluation. This work supports research showing that awareness moderates driving ability and that awareness is multidimensional. Furthermore, the driving simulator may be a useful tool in raising survivors' awareness of their deficits as it relates to driving ability.

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