The safety of driving a commercial motor vehicle after a stroke.

BACKGROUND AND PURPOSE Current guidelines for commercial motor vehicle (CMV) drivers to return to driving after a TIA or stroke was last reviewed in 1988. Updated recommendations are presented based on recent evidence. METHODS A 3-member medical expert panel chosen by the U.S. Department of Transportation's Federal Motor Carrier Safety Administration used findings of systematic literature review up to January 2008 to provide updated recommendations for return to driving for CMV drivers after TIA or stroke. RESULTS Evidence from the systematic review showed that TIA patients are at increased risk for stroke, and stroke patients are at increased risk for motor vehicle crash. Although no studies provide direct evidence of predictability of crash risk of CMV drivers using outcomes of neuropsychological assessments, there is evidence that certain neuropsychological tests can identify on-road driving performance after stroke. CONCLUSIONS The medical expert panel recommended driving cessation for 1 year after a TIA or stroke, and return to driving a CMV should be allowed only after successful completion of a comprehensive neurological evaluation, neuropsychological assessments, and on-road testing.