Driver Rehabilitation: Reclaiming the Road

Wesley Perry, MSBME, ATP, CDRSCliff D. Dedeaux, OTR/L, ATP, CDRS

November 2006

Introduction

Wesley L. Perry, MSBME, ATP, CDRS

M.S., Biomedical EngineeringCertified Driver Rehabilitation Specialist (CDRS), 2000Assistive 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), 2001Certified Driver Rehabilitation Specialist, 2005Assistive 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:

• 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.

Driver Rehabilitation

Driver Skills Assessment

Adaptive EquipmentAssessment

Usually Cognitive ImpairmentsStrokes

Brain InjuriesDementia

Usually Due to Physical or Sensory LimitationsSpinal Cord Injury

AmputeeLow Vision

Some Overlap

Components

From Start to FinishReferral

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

• 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

Parking Lot

Subdivision

County/Country Roads

State Highways

Interstate

Town/City

Low Traffic/Speed

High Traffic/Speed

Little External Stimulus

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 useAccelerator/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

Entervan lowered-floor minivan by The Braun Corporation

Vision conversion by Viewpoint Mobility

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

Nissan Titan, GMC Sierra, Chevrolet Silverado & Suburban

Demonstration recommended prior to purchase!!!

Conversion by Ryno Mobility

Approximate specifications…- Headroom: 55 ½” to 58”- Width of lowered floor area: 29”- Length of lowered floor area: 58”

Wheelchair Access for the Full-size Truck

Personal Access

Notched transfer board

EZ Transfer by Access Unlimited

Personal Access

Glide ‘N Go by Access Unlimited

TAS System by Bruno

Transfer Seat Base by VMI/Ricon

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

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

Some points to consider…

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 SteeringPictured 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 byDrive-Master Corporation

Accelerator Controls

Left Foot Accelerator Pedal by FujiAuto

Mechanical Hand Controls

Monarch hand controls by MPS

Sure Grip hand controls by Howell Ventures

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 ControlsPictured is the AEVIT L-Series by EMC

Steering-Accelerator-Brake Controls

Joystick ControlPictured is the AEVIT J-Series by EMC

Steering-Accelerator-Brake Controls

Scott Driving System by dSI

Orthotics

Tri-pinProduct shown is by Drive-Master Corporation

Spinner KnobProduct shown is by DSI

Steering CuffProduct 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

Van rampProduct shown is by Handi-Ramp

Tilt ‘N Tote by Wheelchair Carrier

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

AL500 by Harmar Products, Inc

Chair Topper byThe Braun Corporation

Products shown are by Bruno Independent Living Aids

Transport of Unoccupied Mobility Systems

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

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 Associationwww.nmeda.org

Bioptic driving…www.nhtsa.dot.gov/people/injury/olddrive/OlderDriversBook/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