Driver Rehabilitation:

Reclaiming the Road

Agenda

• Introductions and overview

• Transportation Information
• Introduction to the driving
assessment process
• Review of different vehicle
adaptations
• General overview of Bioptic
Driving
• Discussion
Upon completion the student will be able:

• to list 3 components of the clinical

assessment
• to list and describe at least 5 adaptive
driving controls
• to describe general use of bioptics
lenses for driving
Transportation Facts
• People love the flexibility of such vehicles to travel
where and when they want without having to
schedule in advance, wait at stations, or endure
other constraints
Personal Mobility
• Personal mobility is the key to true independence
– Personal mobility in terms of assistive technology
includes:
• Wheelchairs and
• Accessible vehicles
• It has social, health, economic, and symbolic functions
• Creates true urban and rural connections for everyone.

• Fundamental to opening the door to choices in so

many areas:
– Increasing social, community, and vocational participation
– Allowing choices about where one lives
– Expands choices:
• Who provides medical, dental care, etc
• Where to shop
• What church to attend
• So on and so on
 People with disabilities spend
their days overcoming barriers.
Many find that using a private
vehicle is the essence of
personal freedom
What is a driving evaluation?
• The driver assessment is a
complete evaluation of an
individual's potential to operate a
motor vehicle independently.
Components

Driver Rehabilitation

Driver Skills Adaptive Equipment

Assessment Assessment

Usually Due to Physical or

Usually Cognitive Impairments
Sensory Limitations
Strokes
Some Spinal Cord Injury
Brain Injuries
Overlap Amputee
Dementia
Low Vision
From Start to Finish
Referral

Clinical Assessment

Behind-the-Wheel Assessment

Driver Training (as Needed)

Adaptive Equipment Prescription Supplied to

Referral Source

Final Inspection Entails Equipment Inspection and

Fitting

Follow up Training in Client’s Vehicle

Referrals
• Sources
– Vocational Rehab
– Worker’s Comp
– School Systems
– Veteran’s Administration
– Doctor’s
– Therapist
Clinical Assessment
• Information Intake
– Valid driver’s license or Permit
• Ever suspended or revoked? If so, why?
– Driving History
• Is the client currently driving (any close calls?)
• If not, why and when was the last time?
• In what type of traffic environment do they drive?
• Any experience with adaptive equipment?
• Found at fault for any wrecks? If so, reason?
• Any traffic violations?
– Medical History
• Where they have been and where are they now in recovery
• Current medication? Any side effects?
• Try to get the client to paint a picture of how they feel they
are doing; this gives good indication if they have grasp on
current abilities and where they are in the recovery process
• Physical Evaluation
– Range of motion (active and passive)
– Strength available through AROM
Clinical Assessment Cont’d
• Visual Evaluation
– Use screener to test:
• Visual acuity both and individual eyes
• Color vision
• Depth perception
• Phoria (eyes working together)
• Horizontal peripheral field
Clinical Assessment Cont’d
• Visual-Perceptual/Cognitive Evaluation
– Reaction times
– Figure ground
– Short term memory
– Figure completion
– Visual attention, scanning, planning, and
sequencing
– Visual processing speed
– Divided and selective attention
– Rapid decision making
– Attention shifting
– Etc.
Behind-the-Wheel Assessment

• Based on the clinical evaluation

results, an in-vehicle evaluation is
conducted to determine the type
and level of adaptive driving
equipment needed, and/or an on-
road performance evaluation is
conducted to determine a person's
driving capabilities in a variety of
traffic and roadway environments
Driver’s Training
• Based on the client’s performance during the initial
evaluation
• Can vary from a few to several hours
• Graded – based on skill level
Low Traffic/Speed Parking Lot Little External Stimulus

Subdivision

County/Country Roads

State Highways

Interstate

High Traffic/Speed Town/City Unlimited Stimulus

Equipment Prescription
• Mainly states type of equipment and where to
install
– An example for steering and gas/brake
controls could be as follows:
Steering
- Vehicle to have zero-effort steering installed
- Tripin steering orthotic mounted at the 3 o’clock
position for right hand use
Accelerator/brake controls
- MPD Push/Ninety Pull Hand Controls with
offset handle and quad wrist support mounted
for left hand use
- A brake rod extension may be needed to
access a full brake; this will be determined at
fitting
Final Fitting
• Conducted at vendor’s workshop
• Determine that all prescribed equipment is
provided
• Fit or mount equipment in best locations for
access (i.e., switch to be used by elbow, etc.)
• Prior to completion, client demonstrates ability to
use equipment in driving environment
Training in Client’s Vehicle
• Usually performed in
circumstances where a certain
comfort level is desired in client’s
vehicle prior to independent
driving
• Passenger side training brake is
temporarily installed for training
purposes and removed at
completion of training
Vehicle Types and
Adaptive Driving
Equipment
Vehicle Types

• Sedans
• SUVs
• Minivans
• Full-size vans
• Trucks
Wheelchair Access for Minivans

Vision conversion by
Viewpoint Mobility

Entervan lowered-floor minivan

by The Braun Corporation
Wheelchair Access for Minivans

• Side doorway clearance height: 52 ¾” to 56”

• Ramp width: 29” to 30”
• Conversions available for
- Ford
- GM (Chevrolet, Pontiac, Buick)
- Toyota
- Honda Odyssey (TBA)
Wheelchair Access for the Full-size Van

• Original side doorway clearance height

• Lowered floor (4” to 9”)
• Raised roof (54” to 60”)
• Note the year, make and model
Comparing Minivans and Full-size Vans

Points to consider…
• Feel of the vehicle
• Gas mileage
• Vehicle height ~ “Garageability”
• Interior room
• Payload capacity or weight limitations
• Ground clearance
• Vehicle seating: front passenger and middle row
• Adaptive driving requirements
Wheelchair Access for the Full-size
Truck

Conversion by
Ryno Mobility

Approximate specifications…
- Headroom: 55 ½” to 58”
- Width of lowered floor area: 29”
- Length of lowered floor area: 58”
Nissan Titan, GMC Sierra, Chevrolet Silverado & Suburban
Demonstration recommended prior to purchase!!!
Personal Access

Notched transfer board

EZ Transfer by Access
Unlimited
Personal Access

Transfer Seat
Base by
Glide ‘N Go by VMI/Ricon
Access Unlimited
TAS System
by Bruno
Manually operated wheelchair tiedowns

Q5001 System by Q-Straint

Some points to consider…

• Availability of tiedown attachment points
• Knowledge and ability for correct use
Automatic wheelchair tiedowns

EZ Lock wheelchair
tiedown system

Some points to consider…

•Caster clearance width
•Footrest clearance height
•Battery/frame clearance
•Clearance of tiedown bracket
•Impact on a manual wheelchair
Primary Driving Controls

• Steering
• Accelerator
• Brake
Steering Controls

Column extensions and different-sized

steering wheels

Products shown are by Drive-Master Corporation

Steering Modifications

Approximate steering effort

OEM steering 40 oz
Low effort 20 – 24 oz
“No” effort 6 – 8 oz

Actual effort will vary relative to the vehicle.

Steering Controls

Foot Steering System by Drive-Master

Corporation
Steering Controls

Digital Steering
Pictured is the AEVIT W-Series by EMC
Brake Modifications

Approximate braking effort

OEM braking 20 foot*pounds
Low effort 11 foot*pounds
“No” effort 7 foot*pounds

Actual effort will vary relative to the vehicle.

Accelerator/Brake Controls

Pedal extensions by
Drive-Master Corporation
Accelerator Controls

Left Foot Accelerator Pedal by FujiAuto

Mechanical Hand Controls

Sure Grip hand

controls by Howell
Ventures
Monarch hand
controls by MPS

Hand control types

• Push / 90° pull
• Push / pull
• Push / tilt or rock
• Push / twist
MPD Hand Controls on Utility Vehicles

Big Country Cub Cadet

John Deere Gator Golf Cart

Accelerator & Brake Controls

Electronic Gas and Brake Controls

Pictured is the AEVIT L-Series by EMC
Steering-Accelerator-Brake Controls

Joystick Control
Pictured is the AEVIT J-Series by EMC
Steering-Accelerator-Brake Controls

Scott Driving System

by dSI
Orthotics

Tri-pin
Product shown is by Drive-
Master Corporation
Spinner Knob
Product shown is by DSI

Steering Cuff
Product shown is by Drive-
Master Corporation
Secondary Controls
• Turn signals
• Horn
• Lights/Dimmer switch
• Gear shifter
• Park Brake
• Etc.
Secondary Controls

Quad Key Turner by MPD

Right Hand Turn Lever

by MPD
Secondary Controls

SureSwitch by Howell
Ventures Limited
Digipad II Econo Series
by EMC
Secondary Controls

Remote switch options

• Scanning
• Voice recognition
Transport of Unoccupied Mobility Systems

Tilt ‘N Tote by
Van ramp Wheelchair Carrier
Product shown is by Handi-Ramp

USATote Plus by
U.S. Abilities, Inc
Transport of Unoccupied Mobility Systems

Products shown are by Bruno

Independent Living Aids
Transport of Unoccupied Mobility Systems

Chair Topper by
The Braun Corporation
AL500 by Harmar
Products, Inc
Transport of Unoccupied Mobility Systems

Products shown are by Bruno

Independent Living Aids
Driving With Bioptic
Lenses
Bioptic Driving

The Premise…
Vision is the primary sensory input for
driving…
…but acuity is only one aspect of vision
Bioptic lenses applied to the Driving Task
• Central vision vs. Visual field
• Fine detail vs. Gross vision
Bioptic Driving

Common Misconceptions
• Bioptics are not a “cure” for low vision

• Bioptics are not for constant use when driving

General eligibility criteria
• Distance acuity – best corrected with
conventional lenses
• Acuity using bioptic lenses
• Nature of vision diagnosis – expected changes
in vision
• Visual field (including central vision)
• Head, neck and eye movement
• Maximum lens power
• Training…both in the use of the bioptic lens
and for driving
Training in the use of the Bioptic Lens

Recommended by Mississippi Dept. of Public Safety

• Tracking/Saccades
• Spotting
• Visual Memory
• Peripheral Awareness

Orientation and Mobility Training

• General use of bioptic lenses for the everyday
environment
• Use in the driving environment
– Judging speed & distance
– Use of mirrors
– Critical object/hazard awareness
– Maintaining peripheral awareness
The Assessment Procedure

• Interview
- Medical and driving
history
• Active ROM & strength
• Reaction times
• Passenger in-vehicle
• Behind-the-wheel assessment
The Training Procedure

• Classroom-based driver education

- AAA Driver Ed series
- Rules of the road
• Behind-the-wheel training
- Minimum training time
- Progression from low to high complexity
- Exposure to multiple driving conditions
- May include local training
Scope of License

The Driver License remains valid

while the Licensee drives through
other States.

However, if the Licensee moves to a

different State, then they fall under
the Driver Licensure Guidelines
specific to that particular State.
Assistive Technology

• Filters

• Talking GPS