Transcript Adaptations for Driving with a Disability

Adaptations for Driving with a
Disability
Anita Perr, MA, OT, ATP, FAOTA
Clinical Assistant Professor
New York University
[email protected]
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….
Will the person use a van or a car?
This decision is usually based on whether (s)he
can transfer into the driver’s seat and stow
his/her wheelchair
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 wheelchair
into the vehicle
Car Toppercan 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 seated
in a wheelchair
• Usually van
• Lift v. ramp
– lift/lower
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Opening/closing door
*Head height
Restraint system/Seat belt
Head rest
Full Size Van With Raised Roof
And 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
raising/lowering
and
opening/closing
independently
Switch options:
•Driver control
•Pendant
•Magnetic switch
in light box
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
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•
Acceleration- gas pedal
Braking- brake
Steering- steering wheel
Other
horn
window washer
radio
A/C
mirrors
windows
Driving Adaptations For Acceleration
• Left foot accelerator
• Hand control
– push/pull control
– push down/forward
control
• Joystick control
(Digidrive)
• Low effort
Left 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
JoystickDigidrive
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.
Spinner knob
JoystickDigidrive
Small steering wheel with cuff
Other Stuff
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Adjusting Mirrors
Horn
Heat and A/C
Turn Signals
Radio
other?
Headrest with
switches
imbedded
Power Headrest System
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
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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 Conference
Time to change
focus to
Augmentative
Communication
American Speech-LanguageHearing 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