Navigating the Expanse of Driving Aids

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December/January 2001

By Maryfrances Gross, COTA, LDI, CDRS

Maryfrances Gross, COTA,LDI, CDRS, helps her client Sheree Martin with a tri-pin steering device.

A driver rehab specialist is a necessity when considering adaptive driving aids for clients with disabilities, from choosing equipment to training

As the number of technology aids for driving increases, more individuals with disabilities are becoming more independent through transportation, which opens the door for independence in their social, vocational, and recreational lives. The functional limitations resulting from most disabilities can vary from mild to severe. The adaptive driving aids needed will also vary between individuals, even those with the same disability. One system does not fit all. A driver rehabilitation specialist’s expertise is imperative when prescribing a proposal for vehicle modifications.

Professional Associations

There are two professional associations that provide certification programs for the driver rehabilitation specialist and the vehicle modification vendor.

The Association for Driver Rehabilitation Specialists (ADED) is the only professional association to offer certification for these specialists. ADED sets professional ethics, recommends standards of practice, and offers certification testing for the driver rehabilitation specialist. Certified driver rehabilitation specialists use CDRS as their professional title. For more information on ADED, visit its Web site at www.driver-ed.org.

The National Mobility Equipment Dealers Association (NMEDA) is the leader in the vehicle modifier profession for setting standards for vehicle installations. NMEDA has established a Quality Assurance Program (QAP) that allows vendors to become certified as QAP vendors. For more information on NMEDA, visit its Web site at www.nmeda.org.

The Evaluation

The evaluation process for vehicle modifications, with the driver rehabilitation specialist assisting in evaluating the client’s need can be a cost saving to the customer. The driver evaluation process begins by accessing clients’ physical, cognitive, and visual perceptual abilities to determine their need for vehicle modifications as a passenger or driver. The evaluation will come to conclusions in one or more of the following areas.

Entry and Exit Systems

Individuals with disabilities need to consider the full range of adaptations needed to enter and exit a vehicle. There may be a need for an adapted key if the person is unable to manipulate a standard key. An adapted key will allow a person with limited hand function to unlock the vehicle door and turn the key in the ignition.

Some individuals cannot operate the door levers on the vehicle they wish to enter. There are various devices that can take the place of a vehicle door handle, including some that are remote controlled.

Some individuals may be able to ambulate for short distances but must use a scooter or wheelchair for distances. In this situation a person may choose to use a loader for the scooter or wheelchair in the trunk of a car or on the rear bumper of the vehicle. Caution should be exercised because many modern cars are too small to carry such a device safely. Consult the owner manual to determine the maximum weight the car can safely carry. Rooftop wheelchair loaders may help transport folding manual wheelchairs.

If clients cannot transfer into a car, they may need to consider a van with a wheelchair lift. There are two types of lifts: fully automatic and semiautomatic. A fully automatic lift that folds, unfolds, or rotates by electronic controls is necessary for a person in a wheelchair to use independently. However, if a person is only being transported in the van, a less expensive solution for a passenger is a semiautomatic lift, which does require manual effort to fold and unfold the lift.

Ramps are often seen in minivans, but they are normally part of a package that lowers the floor of the minivan several inches, thus allowing a person enough height to sit in the wheelchair inside the vehicle. Some minivans can be modified with a lift; however, the van usually needs a raised roof to allow enough height for the wheelchair passenger.

There are a number of entry system modifications ranging from lifts and ramps, to raised doors, lowered floors, and wheelchair tie-down systems that allow people to safely ride in their wheelchairs. All the options need to be individually considered by the person the vehicle is being modified for. The vehicle modification needs to accommodate the individual’s need for riding in the vehicle, other passengers in the vehicle, parking, and storage. The driver rehabilitation specialist and the vehicle modification dealer will be able to answer questions about various options.

Primary Control Driving Systems

A primary driving control is a vehicle modification that allows a person to operate the gas and brake of a vehicle. A person can be seated in the driver position in various ways. An individual may transfer into the driver seat of a car. Another person may transfer into the seat of a van by using a power transfer seat base that will move the driver seat to the wheelchair in the van allowing, for easy transfer from the chair into the driver seat. Other individuals who cannot transfer from their wheelchair will need to drive from their wheelchair. These persons will need a lowered floor with an automatic wheelchair tie-down system to secure the chair in the driving position.

Once the driver is seated at the driver’s station in a car seat, a van seat, or a wheelchair, the next issue becomes vehicle control. Individuals who have short legs can use extended pedals. Individuals who have lost the use of only their right leg can use a left foot accelerator. Individuals that have lost the use of their legs will need hand controls that operate the gas and brake. Those that need to use hand controls must devote one hand for using the hand control and the other hand for steering. While many individuals steer with one hand by palming the wheel, others may need a steering device, which provides the driver with a continuous tight grip yet rotates to maintain contact with the wheel. Steering devices can range from a simple knob to a cuff for people with reduced hand function, a tri-pin for people with reduced hand and wrist function, or an amputee ring for someone with a prosthetic hook.

If clients do not have the strength to operate a standard hand control, they may need to have the controls made easier to operate. There are methods available to reduce the effort needed to operate the brakes and the gas by modifying the vehicle factory systems. These control systems use converted power from the vehicle (pneumatic, hydraulic, or electrical) to enable the person to use a light touch on a lever to apply the gas and brakes. These devices cost approximately 10 times the cost of a hand control, but they may be the only way for some individuals to drive safely.

If an individual has a problem steering the vehicle, the steering effort can be reduced in the vehicle factory system. There are remote steering systems that attach to the vehicle factory steering system to allow the individual to use a small secondary wheel. The remote steering systems have the additional advantage of making it possible to place the steering wheel in the best position to enable the individual to reach and operate the system.

Individuals who cannot use both upper extremities simultaneously to operate controls, or who have only one functional upper extremity, may need to use a single lever control system. These systems combine the powered systems from the powered control and the remote steering into one control. The operator may use a simple joystick, similar to a wheelchair joystick, to push forward for gas, pull back for brakes, and move side to side for steering to the left or right. These types of vehicle modifications can be quite expensive, sometimes even exceeding the cost of the vehicle.

Secondary control Driving Systems

A secondary system is any control in the vehicle other than gas, brake, or steering. Depending on the type of driving system, the secondary controls will vary extensively. Ignition switches can be required, or an adapted key or a special set of push buttons may be needed for starting the vehicle. Gear shifting may involve an extension of the shift lever or a push button-operated power shifter. The parking brake can be an extension of the parking brake lever or a push button-operated power parking brake. Horn and dimmer must be available for quick operation during driving and may be placed on the hand control or activated by buttons on the door panel. If the turn signals cannot be operated from the steering column, the turn signal control can be incorporated into some hand controls, or as added push buttons on the door panel for elbow operation. Other controls such as wipers, heat/air, and radio, can be incorporated into the same type of panels.

Although there is technology that allows people with even the most severe disability to drive, it is essential that the person is equipped with the correct modifications. Not all vehicles can be modified. The best source of information before purchasing any vehicle or vehicle modification is to meet with a driver rehabilitation specialist. The other important factor is having the individual use the modification before purchasing.

Having an evaluation for a driver system is especially important. A person should seek a facility that has an evaluation vehicle that can be equipped for evaluation before a modification prescription is written for that individual’s personal vehicle. The interaction of a person using a driver system control will determine an individual’s ability to operate the control. The individual’s body parts (torso and especially arms) react to acceleration, deceleration, and turning. Individuals who need this type of vehicle modification may not be able to control their bodies during cornering on highways or evasive maneuvers. Only training and practice can determine if the individual will be a safe driver.

Maryfrances Gross, COTA, LDI, CDRS, is the owner of On The Road, Again—Modified Mobility Services in San Diego, which provides adaptive driving evaluations and training for persons with disabilities. She is also the current president of ADED.

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December/January 2001