Driver Rehabilitation:
Reclaiming the Road
Wesley Perry, MSBME, ATP, CDRS
Cliff D. Dedeaux, OTR/L, ATP, CDRS
November 2006
Introduction
Wesley L. Perry, MSBME, ATP, CDRS
M.S., Biomedical Engineering
Certified Driver Rehabilitation Specialist (CDRS), 2000
Assistive Technology Practitioner (ATP), 2005
Member ADED, The Association for Driver Rehabilitation
Specialists
Dec. ’98 – present; Research Associate, T.K. Martin Center for
Technology and Disability, Mississippi State University,
responsibilities include coordinating the Center’s adaptive
driving program.
Introduction
Cliff D. Dedeaux, OTR/L, ATP, CDRS
Occupational Therapist Registered (OTR), 2001
Certified Driver Rehabilitation Specialist, 2005
Assistive Technology Practitioner, 2005
March, ‘03 – present; Research Associate II, T.K. Martin Center
for Technology and Disability, Mississippi State University,
responsibilities include rehabilitation driving, seating & mobility,
and Mississippi AgrAbility Project
“For people without disabilities,
technology makes things easier;
for people with disabilities,
technology makes things
possible” (IBM, 1991).
Agenda
• Introductions and overview
• Transportation Information
• Introduction to the driving
assessment process
• Review of different vehicle
adaptations
• General overview of Bioptic
Driving
• Discussion
Workshop Goals
Upon completion the participant 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
• The United States is
the most mobile society
in the World
• 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
• America’s highways
and roads are
dominated by personal
motor vehicles
•
•
•
Over 95 percent of all US
adult residents drive or ride
in personal motor vehicles
(Bureau of Transportation
Statistics’ Omnibus Survey,
2002)
The number of vehicles in
the US is increasing at an
annual rate of almost one
and one-half times that of
the total population.
Most people travel to work
in a privately owned
vehicle (91%)
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:
•
•
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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
(The New York Times, September 20, 1998)
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
Assessment
Usually Cognitive Impairments
Strokes
Some
Brain Injuries
Overlap
Dementia
Adaptive Equipment
Assessment
Usually Due to Physical or
Sensory Limitations
Spinal Cord Injury
Amputee
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/OSDP counselors
– 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
•
•
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•
•
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 onroad 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
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•
•
•
•
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…
•
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•
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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
Glide ‘N Go by
Access Unlimited
Transfer Seat
Base by
VMI/Ricon
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
Low effort
“No” effort
40 oz
20 – 24 oz
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
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•
•
•
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 DriveMaster Corporation
Spinner Knob
Product shown is by DSI
Steering Cuff
Product shown is by DriveMaster 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
Van ramp
Product shown is by Handi-Ramp
USATote Plus by
U.S. Abilities, Inc
Tilt ‘N Tote by
Wheelchair Carrier
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
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Rules of the road
• Behind-the-wheel training
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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
States Allowing Driving with Bioptics
Alabama
Louisiana
North Dakota
Arizona
Maryland
Ohio
Arkansas
Massachusetts
Oregon
California
Michigan
Pennsylvania
Colorado
Mississippi
South Carolina
Delaware
Missouri
South Dakota
Florida
Montana
Tennessee
Georgia
Nebraska
Texas
Idaho
Nevada
Vermont
Illinois
New Hampshire
Virginia
Indiana
New Jersey
Washington
Kansas
New York
Wisconsin
Kentucky
North Carolina
Wyoming
Ref: Driving with Confidence: A Practical Guide to Driving with Low Vision
by Eli & Doron Peli
Resources
The Association for Driver Rehabilitation
Specialists (ADED)
www.driver-ed.org
National Mobility Equipment Dealers
Association
www.nmeda.org
Bioptic driving…
www.nhtsa.dot.gov/people/injury/olddrive/OlderDrivers
Book/pages/Mississippi.html
www.lowvisioncare.com/visionlaws.htm
www.biopticdriving.org
Contact Information
T.K. Martin Center for Technology and Disability
Box 9736
Mississippi State, MS 39762
Phone: 662-325-1028