Reinforcement-Based Head Scan Training for Drivers With Homonymous Visual Field Loss: Improves Blind-Side Detection

IF 4 2区医学 Q1 REHABILITATION

Archives of physical medicine and rehabilitation Pub Date : 2026-10-01 Epub Date: 2026-05-14 DOI:10.1016/j.apmr.2026.04.038

Yi Ni Toh PhD, Jing Xu PhD, Patrick Baker BS, Alex R. Bowers PhD

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引用次数: 0

Abstract

Objective

To evaluate whether a reinforcement-based head scanning training program improves blind-side hazard detection in drivers with homonymous visual field loss.

Design

Single-arm nonrandomized clinical trial with 1-month follow-up.

Setting

Research laboratory.

Participants

Inclusion criteria included ≥3 months post–onset hemianopia or quadrantanopia, no neglect or major cognitive decline, and current or former driving experience. Sixteen of 23 volunteers met criteria and completed the study (median age=52.5y; 56% left-sided field loss).

Interventions

Participants completed three 1-hour sessions of a reinforcement-based head scanning training program in a driving simulator. An auditory reminder cue served as immediate, error-contingent feedback, sounding from a loudspeaker on the participant’s blind-side if they failed to make a large, early head scan to their blind-side before an intersection.

Main Outcomes Measures

The primary outcomes were rates of proactive blind-side scanning (the proportion of intersections with an early large head scan) and blind-side hazard detection (the proportion of hazards detected) assessed without reminder cues at pretraining, 1 week posttraining, and 1 month posttraining. All hypotheses were prespecified.

Results

Proactive blind-side head scanning increased significantly from 17.5% (95% CI, 8.9%-26.0%) at pretraining to 83.6% (95% CI, 76.5%-90.7%) at 1 week posttraining and 72.6% (95% CI, 63.4%-81.9%) at 1 month posttraining. Likewise, blind-side hazard detection improved significantly from 55.6% (95% CI, 41.3%-69.9%) to 85.6% (95% CI, 76.3%-95.0%) at 1 week posttraining and 82.5% (95% CI, 70.1%-94.9%) at 1 month posttraining. Improvements were primarily because of fewer scanning-related errors.

Conclusions

Three sessions of reinforcement-based head scanning training significantly improved blind-side head scanning and hazard detection in drivers with homonymous visual field loss, with benefits lasting at least 1 month. These results support the promise of this rehabilitation approach for poststroke driving and warrant further evaluation in a randomized controlled trial.

查看原文本刊更多论文

基于强化的头部扫描训练对视场丧失驾驶员盲侧检测的提高。

目的：评价基于强化的头部扫描训练方案是否能提高同侧视野丧失驾驶员的盲侧危险检测。设计：单臂非随机临床试验，随访1个月。环境：研究实验室。参与者：纳入标准包括发病后≥3个月的偏视或象限视，无忽视或严重认知下降，目前或以前有驾驶经验。23名志愿者中有16名符合标准并完成了研究（中位年龄 = 52.5岁；56%左侧视野丧失）。干预措施：参与者在驾驶模拟器中完成了三个1小时的强化头部扫描训练项目。如果参与者没有在十字路口前对自己的盲区进行大规模的、早期的头部扫描，那么一个听觉提醒提示就会从他们盲区一侧的扬声器中发出，作为即时的、偶然错误的反馈。主要结果测量：主要结果是在训练前、训练后1周和训练后1个月，在没有提示提示的情况下评估主动盲侧扫描率（早期大头扫描的十字路口比例）和盲侧危险检出率（检测到的危险比例）。所有的假设都是预先设定的。结果：主动盲侧头部扫描从训练前的17.5% （95% CI:[8.9%, 26.0%]）显著增加到训练后1周的83.6% （95% CI:[76.5%, 90.7%]）和训练后1个月的72.6% （95% CI:[63.4%, 81.9%]）。同样，盲侧危险检出率在1周后从55.6% （95% CI:[41.3%, 69.9%]）显著提高到85.6% (95% CI:[76.3%, 95.0%])， 1个月后从82.5% （95% CI:[70.1%, 94.9%]）显著提高。改进主要是由于较少的扫描相关错误。结论：三次强化型头部扫描训练显著提高了同侧视野丧失驾驶员的盲侧头部扫描和危险检测能力，且效果持续至少一个月。这些结果支持卒中后驾驶康复方法的前景，并需要在随机对照试验中进一步评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of physical medicine and rehabilitation 医学-康复医学

CiteScore

6.20

自引率

4.70%

发文量

495

审稿时长

38 days

期刊介绍： The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.