"It's the car, that is the wor, that is worst." The importance of driving and experience of driving cessation for people with aphasia post-stroke: a systematic search and review

Background: Driving cessation after stroke is associated with significant psychosocial consequences including diminished community participation; reduced social networks; decreased meaningful life roles; compromised self-identity, and increased risk of depression. Understanding these consequences and identifying strategies to improve outcomes of driving cessation post-stroke has been an important focus of research. Emerging research suggests that people with aphasia, or language impairment post-stroke, may face an increased risk of driving cessation. However, little is known regarding the significance of driving for people with aphasia, or whether communication difficulties exacerbate the challenges of driving cessation. Aims: To explore the literature regarding the importance of driving for people with aphasia and the experience of driving cessation for the aphasia population. Methods: Systematic search and review using bibliographic databases (e.g. PubMed, CINAHL, Scopus) and secondary search methods. Following screening, two reviewers independently assessed full-text articles. Data relating to source details, characteristics, and review objectives were extracted, with a narrative synthesis of results. Outcomes & Results: Sixteen sources contributing to review objectives were included. Narrative synthesis revealed that: (1) returning to driving is a high priority for people with aphasia; (2) psychosocial impacts of driving cessation are significant for this population, and may be intensified due to the compounding effects of living with driving loss and communication support needs; (3) strategies aimed at addressing the practical and emotional needs of stroke survivors following driving cessation, such as supporting access to alternative transport and the provision of psychoeducation and counselling, may not be suitable or accessible for people with aphasia. Discussion: Return to driving is important for people with aphasia and, at times may be a higher priority than goals related to communication alone. Returning to driving may provide a means for people with aphasia to retain aspects of their autonomy, independence, functional status, community and social engagement, and self-identity, otherwise jeopardized by living with a communication difficulty. Furthermore, there may be a compounding effect resulting in worsened physical, mental and social well-being due to the combined challenges of living with aphasia and driving loss. This is further complicated by the potential for communication difficulties to impact on interventions to support the transition to, and improve outcomes associated with, driving cessation. Health professionals working with individuals with aphasia need to recognize the significance of driving for this population and understand the unique challenges people with aphasia may face in navigating driving cessation.