Adaptations for Driving with a Disability

Anita Perr, MA, OT, ATP, FAOTAClinical Assistant Professor

New York Universityanita.perr@nyu.edu

Safe Driving

• Complicated set of visual motor actions based on complex input and requiring precise action

• Impairment in any one area can dramatically impact safe driving

• Compensation methods may or may not be sufficient

• Many states require re-test after a change in physical status; driver’s license lists qualification for driving (adaptive equipment)

• Most (all?) insurance companies require notification with change in physical status

Safe, Independent Driving is Comprised of:

• Getting in/out of the vehicle• Driving to various locations• Maintaining the vehicle in good

working condition

Adaptive equipment

is available for all of these aspects of driving

The first big decision….

This decision is usually based on whether (s)he can transfer into the driver’s seat

and stow his/her wheelchair

Will the person use a van or a car?

Driving while seated in driver’s seat

• Usually car; can be truck, van, etc.

• Transfer to driver’s seat• Stowing wheelchair (or other

device)– manually– electrical hoist

Lifting the wheelchairinto the vehicle

Car Topper- can be set-up to use while seated in seat

Trunk rack: attaches to tow bar; requires

person to walk around car to seat

Driving while seatedin a wheelchair

• Usually van• Lift v. ramp

– lift/lower

• Opening/closing door• *Head height• Restraint system/Seat

belt• Head rest

Full Size Van With Raised RoofAnd Windshield

Lowered floor is also often necessary

Van Entry

Swing arm lift

Full-size van: side lift

Mini-van: rear entry ramp

Mini Van- these have lowered floor and ability to “kneel”

Lift

Ramp

Full Size Van- side lift

Switch options:

•Driver control

•Pendant

•Magnetic switch in light box

raising/lowering and

opening/closing independently

Restraint systems

Two restraints are needed:• One to hold the wheelchair to

the vehicle– Lock-down– Tie-down

• One to hold the person

Restraint Systems

Tie down system requires

assistance

Lock down system may be done independently

The next big decision…

What type(s) of adaptive equipment will be necessary for the person to be safe and drive easily?

Driving Adaptations to Compensate for Motor

Impairments

• Acceleration- gas pedal

• Braking- brake• Steering- steering

wheel• Other radio

A/C windows

horn

mirrors

window washer

Driving Adaptations For Acceleration• Left foot

accelerator• Hand control

– push/pull control– push down/forward

control

• Joystick control (Digidrive)

• Low effortLeft foot accelerator

Driving Adaptations For Braking

• Hand Control– push/pull control– push down/forward control

• Joystick control (digidrive)• Low effort

Acceleration and Braking

Electronic gas and braking system

Push down/forward system:

Blue- brake

Pink- acceleration

Joystick- Digidrive

Driving Adaptations For Steering

• Low- or Zero Effort• Joystick• Steering handle

– Spinner Knob– Tri-pin (quad holder)

• Steering wheel size• Steering wheel position

– horizontal– closer to driver

Driving Adaptations(steering) cont.

Small steering wheel with cuff

Joystick- Digidrive

Spinner knob

Other Stuff• Adjusting

Mirrors• Horn• Heat and A/C• Turn Signals• Radio• other?

Power Headrest System

Headrest with switches

imbedded

Custom Adaptations

Extender for turn signal

Foot block to prevent left foot from interfering

Maintenance and Upkeep

• Getting gasoline- most states require stations to provide service at self-service cost to people who need

• Regular Maintenance• Road side repairs– not just for

the vehicle, but also for the lift equipment and other adaptive driving equipment

Driver evaluation

• Visual acuity• Visual fields• Reaction time• Motor abilities• Cognition

– Reading– Problem solving– Planning– Safety judgment

Driver Simulator- used most often for evaluation and screening

May also be used for driver training

• Standards– RESNA/ANSI standards for restraints– Crash testing

• The Association for Driver Rehabilitation Specialists (ADED)

• http :// www. driver-ed.org

Annual ADED ConferenceAnnual ADED Conference

Time to change focus to

Augmentative Communication

American Speech-Language-Hearing Association (ASHA)

• ASHA is the professional, scientific, and credentialing association for more than 123,000 members and affiliates who are speech-language pathologists, audiologists, and speech, language, and hearing scientists in the United States and internationally.

Augmentative and Alternative Communication (AAC)

• Augmentative and alternative communication (AAC) refers to ways (other than speech) that are used to send a message from one person to another. We all use augmentative communication techniques, such as facial expressions, gestures, and writing, as part of our daily lives. In difficult listening situations (noisy rooms, for example), we tend to augment our words with even more gestures and exaggerated facial expressions. (ASHA)

• Augmentative communication users don’t stop using speech

Picture Cards

Picture Exchange Communication System (PECS)

• PECS is an alternative communication system that uses picture symbols. It is taught in six phases starting with a simple exchange of a picture symbol for a desired item. Individuals learn use picture symbols to construct complete sentences, initiate communication, and answer direct questions.

• Used frequently with children with autism

Personal Communication Book

PECS Laminated Cards

Aug com using head pointer

Mounting Augmentative Communication Devices

Augmentative Communication

Dynavox

Prentke Romich Vanguard Plus

Pocket Communicator

Tango