Chapter 18
Driver’s Training
Driving is an important aspect of our lives. It allows us greater independence. Many people with spinal cord injuries can relearn this skill with the assistance of a therapist with specific education in driver rehabilitation, a certified driver rehabilitation specialist (CDRS), or a qualified driver training instructor. These individuals can evaluate your need for adaptive equipment and provide the behind-the-wheel training needed to become a safe driver. Hand controls and steering devices enable people with spinal cord injuries to operate a vehicle.
HOW TO OBTAIN A LICENSE
The first step in obtaining a license is to contact your local department of motor vehicles. Each state has a slightly different procedure but most will require that you have your doctor complete a form stating that you are medically stable to drive. The form may also comment on your current medication, history of seizures, or need for adapted equipment. Even if your current license does not expire for years, you are responsible for having your driving record updated to reflect the change in your medical condition.
The next step in obtaining or updating your license is to complete an evaluation with a certified driver rehabilitation specialist or qualified driver’s trainer. This person will assist you in determining the specific equipment to meet your needs and provide a "hands-on" trial of the equipment to ensure that you can resume safe driving.
Finally, if you are driving with adapted equipment, you can expect to be required to retake the driving test. Your license will be updated with the equipment restrictions. In most states, it is illegal to drive with adapted equipment that is not reflected on your license.
DRIVER TRAINING
Finding a Certified Driver Rehabilitation Specialist or Qualified Driver’s Trainer
Many of the well-known driving schools are unable to offer the evaluation with specialized equipment and training that you require to resume safe driving. Many major rehabilitation medical centers and VA hospitals have driving programs for people with disabilities. The driver training instructors are usually therapists who have pursued additional training and experience to become certified as driver trainers.
If you are unable to find a qualified person who does driver training for people with disabilities in your area, contact your local department of motor vehicles, the American Automobile Association (AAA), or the Association of Driver Educators for the Disabled (ADED). (See the resources at the end of this chapter).
When You Should Begin Driver Training
In the initial months after your injury, you are very busy focusing on the medical and therapeutic aspects of your rehabilitation. This is an important time to gain the skills you’ll need in preparation for driving. Driver training is usually addressed closer to discharge.
Depending on your level of skill, mobility, and transportation needs, you may want to wait at least a year or more before driving. People, especially those with quadriplegia, may make additional improvements in strength and abilities and may want to maximize their functional skills before considering driving. If changes occur in your skills, the expensive equipment and training you purchase could be no longer useful or appropriate in a few months. The decision of when to start training should be made with the guidance of your doctor and therapist. Some orthopedic or neurological restrictions and medications may affect your readiness for driving.
If your injury included a loss of consciousness, seizure, head injury, or stroke, there may be a mandatory waiting period before you resume driving. Contact your state’s department of motor vehicles for details.
Training
To begin the process, you will need to complete an in-clinic assessment. Therapists will do some tests to determine your visual acuity, depth perception, spatial orientation, range of motion, balance, coordination, and reaction time. In addition, they will ask you about your previous driving experience and in what type of environment and weather conditions you would be driving in your community. This will allow the therapist and you to develop a training program to meet your specific needs.
After the in-clinic assessment, the therapist will select and educate you on the type of adaptive equipment options available and what you need. This equipment may be set up on a driving simulator to enable you to try out while the therapist is determining your ability to drive safely.
Once the appropriate equipment is determined, an in-vehicle, "behind-the-wheel" assessment is done and you will be trained in the use of the equipment. The therapist will begin teaching you to drive in a parking lot or another safe practice area. Usually the vehicle has dual control brakes for your safety. As you progress in developing your skills, you will have more complex driving opportunities and will be instructed in defensive driving techniques.
At the completion of training, you will be prepared to take the road test at your local department of motor vehicles. Often you can use the driver training vehicle, since you may not have the time or finances to already have your own vehicle modified.
EQUIPMENT OPTIONS
- Standard hand controls. Hand controls are mechanical levers attached to the foot pedals of the vehicle and mounted under the steering column. You push forward to brake and downward to accelerate. Hand controls eliminate the need to use foot pedals but do not interfere with others who drive with their feet.
- Left-foot accelerator. If only the right side of your body has loss of use, then a simple pedal can be installed to enable the left foot to do gas and braking.
- Steering devices. When you are using hand controls, one hand must do the gas and brake while the other steers. To make this easier, a steering device can be installed to assist in the full rotation of the wheel, making turns faster and easier.
- Steering force reduction. If the steering wheel requires too much force to turn or is beyond your reach, the steering box of the vehicle can be removed and rebuilt, changing the gear ratio so the force needed for turning is reduced. This includes a pump and back-up system in addition to the standard power steering.
- Electronic dash switches. Operation of the gearshift, ignition/start, turn signals, headlights, wipers, heater, and cruise control can be difficult if you have limited reach and hand function. Electronic switches can be installed to replace and control the dash switches and require only light pressure touch.
- Electronic hand controls. For people with high level quadriplegia, standard equipment may require too much effort and consequently alter your sitting balance and control of the vehicle. "High tech" computer interfaced steering and hand controls can enable a person to drive with a small diameter wheel placed close to the lap and hand controls operated in a push/pull motion against a few ounces of effort with less than 6 inches of movement.
SELECTING A VEHICLE
Your vehicle decision is based on whether you can use a car or a van with modifications. If you use a motorized wheelchair, a van equipped with a ramp entry or wheelchair lift is usually indicated. Although there are "portable" power wheelchairs available, they usually require assistance for disassembly and lifting for trunk storage. Your choice of vehicle also needs to account for who else in the family will be driving and where you will park.
If you use a manual wheelchair, you need to choose a vehicle that suits your transfer and wheelchair storage ability. Use of a rigid frame wheelchair will definitely influence how you load it into a car and what seating is available for your passenger. The seating height of some cars may provide a level height for the wheelchair transfer to and from the driver’s seat. The seating height of a truck may mean transferring up to 10 or more inches, which may be difficult for some people.
What to Look for in a Car
Certain vehicles are better suited for transfers, wheelchair storage, or installation of hand controls. Your therapist can provide you with specific equipment and vehicle selection criteria. The following list offers general guidelines on purchasing an accessible car.
- A two-door vehicle is recommended for ease of access because the doors open wider. This means that you can position the wheelchair closer for transfers and have more space for your transfer.
- An intermediate or large car is generally recommended because the seat height may be higher and there is more legroom under the column where the hand controls are installed. Before you buy a vehicle, you should always call a vendor who installs hand controls to make sure the vehicle can be modified. Adjustable angle steering columns, air bags, and under-dash vents make hand control installation more challenging and costly.
- Bucket seats may provide improved trunk balance and stability by providing support. However, a bench-type front seat will enable you to enter from either side of the vehicle and slide to the driver’s position.
- A center armrest/console may be desirable for long-distance driving, as well as driver stability and balance during turning maneuvers. It can also provide assistance with pressure relief when driving.
- If you use a folding wheelchair, there should be enough room between the front and back seats to allow for storage. Also, check that seat belt anchors do not interfere with access.
- Seat belts are required to be worn in all vehicles. In addition, seat belts and shoulder harnesses can help maintain stability and balance on stops, during turns, etc.
- Four-wheel drive is recommended for those driving on snow and ice and is now available on many different makes and models.
- Automatic transmission is required to operate hand controls.
- Power steering is recommended for improved turning and to avoid over-fatiguing your arms. Most people using hand controls use the other hand to steer with a one-handed technique.
- The steering column must be designed so the bracket for the hand controls can be attached.
- A tilt steering column allows more space when entering and exiting and gives you wheel height adjustment.
- Power brakes respond faster with less force of movement needed and may be required for your safety and control of the vehicle.
- Cruise control allows the driver to maintain a steady speed without having to constantly maintain pressure on the accelerator. This helps prevent arm fatigue during long-distance driving with hand controls.
- Power windows are recommended for drivers with limited hand function. It is also a good idea for hand-control users because it is an easier method of operation.
- Power door locks are recommended for drivers with limited hand function or limited mobility.
- Air conditioning is recommended for people with respiratory problems and may be considered a medical necessity for temperature regulation.
- Remote adjustable outside mirrors give the driver optimum rear vision without having to adjust them outside the vehicle.
- Rear window defroster and rear window wipers will improve overall vision and safety while driving.
What to Look for in a Van
The cost to buy and modify a van can be very expensive. The general guidelines for a van are similar to the car criteria. The equipment and type of van that you require will be very personalized. You must work closely with your driver training professional before making this purchase. Measurements for the wheelchair entry, headroom, and turn-around space inside the van, and whether or not you plan to transfer into the driver seat will be critical factors in your van selection. You will need to determine if a full-sized or a mini van meets your needs.
If you are not able to transfer into the driver seat, your therapist will assist you in deciding if you will need any special accommodations to your wheelchair for postural support and balance. A wheelchair is not designed to be used as the seating in a van but can be optimized to increase your safety if you cannot transfer.
What to Look for in an Installation Vendor
The vendor who will install your equipment is invaluable. They should have certifications to install specific equipment and carry liability insurance to cover the equipment and work performed.
To find a qualified vendor, ask your instructor or contact the National Mobility Equipment Dealers Association (NMEDA). (See Additional Resources at the end of this chapter).
CAR INSURANCE
You will need to inform your insurance company of the change in your medical status and driving methods. They may require proof that your license has been updated with adapted equipment restrictions and that your physician feels you are medically safe to drive. Your insurance company cannot cancel your policy because of a spinal cord injury.
It is also important to tell the issuance company about any adapted equipment you have installed on your vehicle. This will ensure that it is covered under your policy.
REBATES ARE AVAILABLE TO HELP BUY EQUIPMENT
Currently, the major vehicle manufacturing companies offer cash reimbursement for adapted driving equipment. These rebates range from $500 to $1,500. General guidelines for all programs include:
- Equipment must be installed on new/current model vehicles only.
- Customers must have a prescription for adapted equipment written by a qualified driver trainer professional.
- Customers receiving outside funding will be eligible for reimbursement for their out-of-pocket expenses only.
- Programs are offered in addition to any other applicable cash rebates in effect at the time of purchase.
- Reimbursement is intended for adapted-driving aids or conversion equipment only.
You can obtain needed forms and applications for the rebates and additional details by contacting the numbers listed below.
- Chrysler Motors Physically Challenged Resource Center
(800) 255-9877
- Ford Mobility Motoring Program
(800) 952-2248
- General Motors Motoring Program
(800) 323-9935
THE IMPORTANCE OF TIEDOWN SYSTEMS
If you are transported by a Cabulance service, take public transportation, or even ride in your van in your wheelchair, then you need to use a tiedown system. These are the straps that secure your wheelchair to the floor of the vehicle. You should also use a pelvic and chest belt to secure you to the wheelchair. When a tiedown is secured properly, it will prevent the wheelchair from moving around. Your wheelchair brakes are not sufficient, especially in an accident.
It is your responsibility to learn how to instruct people in how to best attach the tiedowns to your specific wheelchair. Review it with your driver trainer or therapist.
Some general guidelines for use of tiedowns include:
- Tiedown systems should be attached to the frame of the wheelchair - never secure them to removable parts such as footrests or armrests.
- A four-point tiedown system is the safest. This system uses four straps secured at all points of the wheelchair - two in the front and two in the back.
- In addition to securing your wheelchair, you will want to have a separate wall-mounted shoulder/lap harness. This will keep you in the wheelchair in case of a sudden stop.
- Whenever possible, tiedowns should be positioned so that you are facing forward in the vehicle. You do not want your back lined up against a wall or window.
- All systems should be safety tested at speeds up to 30-mph/20 G force.
HOW TO GET A DISABLED PARKING PERMIT
Contact your local department of motor vehicles for an application for a disabled person’s parking permit. Most states require that your doctor sign a form indicating your need for this type of parking. Most states are beginning to issue removable placards that you can place on the dashboard or rearview mirror. Placards are more versatile than the license plates because they allow you to use disabled parking when you are in a car other than your own. If you travel, make sure that other states will honor your parking permit.
As an independent driver, you will want to know if your state has legislated a policy pertaining to gasoline stations. In many states, your disabled parking permit entitles you to purchase gas at self-service prices while having the full-service attendant dispense the gasoline. This is meant to prevent price discrimination against those who are physically unable to complete the task.
FUNDING SOURCES
Your state department of vocational rehabilitation may provide funding for evaluations, training, and vehicle modifications. Technology services and devices may be considered as a provision of the 1992 reauthorization of the Rehabilitation Act of 1973. This legislation authorizes your state to administer assistive technology services under vocational rehabilitation. To establish eligibility, you must outline your vocational objectives and the services necessary to achieve them in an individual written rehabilitation plan.
The Department of Veterans Affairs provides assistive technology equipment and related professional services to individuals who have a service-connected disability.
LOOKING TO THE FUTURE
It is your responsibility to become a safe driver and to maintain your vehicle and the adapted equipment. If you experience changes in your medical condition, have new neurologic or orthopedic problems, have increased spasticity, change your medications, or change the wheelchair you use (whether you transfer or use it as the seating in the van), you need to re-evaluate your driving.
Periodic re-evaluation may be necessary to assist you in staying safe to drive. Advances in technology have enabled people to drive a vehicle using a joystick for gas, brake, and steering. Voice control can operate the windshield wipers and turn signals, making these operations completely hands free.
Although the cost and risks involved in using such technology must be considered, people with spinal cord injuries have extensive resources and options to facilitate and prolong their ability to handle a vehicle.
RESOURCES
Organizations
American Automobile Association Traffic Safety and Engineering
1000 AAA Drive
Heathrow, FL 32746-5063
(407) 444-7000
www.aaa.com and www.aaafts.org
AAA’s Disabled Driver Mobility Guide is particularly useful for drivers with a disability.
Association of Driver Educators for the Disabled (ADED)
P.O. Box 49
Edgerton, WI 53534
(608) 884-8833
www.driver-ed.org
ADED provides educational support for professionals in the field of driver education, transportation options, and equipment modifications for people with disabilities. ADED has a list of certified driver rehabilitation specialists in your area.
National Mobility Equipment Dealers Association
11211 N. Nebraska Avenue, Suite A-5
Tampa, Florida 33612
(813) 932-8566
www.nmeda.org
This association maintains the standards of practice for manufactures and vendors of vehicles and adaptive equipment.
RESNA
1700 N. Moore Street, Suite 1540
Arlington, VA 22209
(703) 524-6686
www.resna.org
RESNA is an interdisciplinary association that assists people with disabilities through advancement of rehabilitation and assistive technologies. RESNA has a list of professionals who can assist you in seeking specialized information and can keep you up-to-date on research.
U.S. Department of Veterans Affairs Prosthetic and Sensory Aids Service
Mailing Code 113
Washington, DC 20420
(202) 273-8815
VA reimburses the cost of equipment and installation for those veterans who are eligible for the department’s services.
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Driver’s Training