Road sign recognition during computer testing versus driving simulator performance for stroke and stroke+aphasia groups.

Donovan, Neila J.; Savage, Meghan C.; Varnado, Chantelle; Brown, Caitlin · 2015 · ROSA P / Maritime Transportation Research and Education Center

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Summary

This study addresses the critical gap in understanding how poststroke aphasia affects the ability of older drivers to recognize and interpret road signs. While driving is essential for maintaining independence in older adults, stroke survivors often face neurological deficits that impair safe driving. Previous research largely excluded individuals with aphasia or failed to account for language deficits, leaving healthcare professionals without consistent guidelines for determining when these patients can safely return to driving. The researchers hypothesized that aphasia would significantly decrease accuracy and increase response time in interpreting road signs, particularly as the linguistic and symbolic complexity of the signs increased. The study involved 20 older participants (ages 50–85) divided into two groups: a control group of 10 neurologically normal individuals and an aphasia group of 10 individuals with left-hemisphere stroke and mild-to-moderate aphasia. Participants were matched for age and education. Using a computer-based experiment, participants viewed 33 validated road signs and selected the correct interpretation from three options, with response times and accuracy recorded. The task required participants to determine what action a driver should take upon seeing each sign, rather than simply matching signs to contexts. Statistical analysis included a between-groups MANOVA to compare the effects of aphasia on accuracy and response time. The results demonstrated that the presence of aphasia had a significant negative impact on both accuracy and response time. The aphasia group was significantly less accurate, averaging 28.60 correct interpretations compared to the control group’s higher performance, and significantly slower, with a mean response time of 2777.62 milliseconds versus 1211.58 milliseconds for the control group. Analysis of individual signs revealed that performance deficits in the aphasia group were exacerbated by increased complexity. Signs containing only words (e.g., "Road Closed Ahead") or a combination of words and symbols (e.g., "Change in Speed Limit") elicited the largest accuracy gaps between groups. Conversely, pictorial signs like "Watch for Bicyclists" were interpreted more quickly and accurately by both groups. The "Chevron Arrow" sign was the most frequently misinterpreted by both groups, suggesting potential issues with the sign’s design or context rather than aphasia-specific deficits. These findings provide preliminary evidence that poststroke aphasia impairs the functional interpretation of road signs, particularly those with high linguistic or symbolic density. The study suggests that road signs may function as a unique language system vulnerable to damage in stroke-affected language centers. Consequently, the authors recommend that road sign designers consider simplicity and clarity to accommodate drivers with cognitive and language impairments. Furthermore, the results highlight the need for healthcare professionals to incorporate assessments of road sign interpretation into evaluations for return-to-driving decisions for patients with aphasia, as current protocols often overlook this specific deficit.

Key finding

Participants with poststroke aphasia demonstrated significantly lower accuracy and slower response times in interpreting road signs compared to neurologically normal controls.

Methodology

lab_experiment

Sample size: 20

Provenance

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.

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• post concussion