1. Adaptations for Driving with a Disability Anita Perr, MA, OT, ATP, FAOTA Clinical Assistant Professor New York University anita.perr@nyu.edu

2. 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

3. 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

4. The first big decision…. This decision is usually based on whether (s)he can transfer into the driver’s seat and stow his/her wheelchair Will the person use a van or a car?

5. 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

6. Lifting the wheelchair into the vehicle

7. Car Topper- can be set-up to use while seated in seat Trunk rack: attaches to tow bar; requires person to walk around car to seat

8. Driving while seated in a wheelchair Usually van Lift v. ramp –lift/lower Opening/closing door *Head height Restraint system/Seat belt Head rest

9. Full Size Van With Raised Roof And Windshield Lowered floor is also often necessary

10. Van Entry Swing arm lift Full-size van: side lift Mini-van: rear entry ramp

11. Mini Van - these have lowered floor and ability to “kneel” Lift Ramp

12. Full Size Van- side lift

13. Switch options: Driver control Pendant Magnetic switch in light box raising/lowering and opening/closing independently

14. Restraint systems Two restraints are needed: One to hold the wheelchair to the vehicle –Lock-down –Tie-down One to hold the person

15. Restraint Systems Tie down system requires assistance Lock down system may be done independently

16. The next big decision… What type(s) of adaptive equipment will be necessary for the person to be safe and drive easily?

17. Driving Adaptations to Compensate for Motor Impairments Acceleration- gas pedal Braking- brake Steering- steering wheel Other radio A/Cwindows horn mirrors window washer

18. Driving Adaptations For Acceleration Left foot accelerator Hand control –push/pull control –push down/forward control Joystick control (Digidrive) Low effort Left foot accelerator

19. Driving Adaptations For Braking Hand Control –push/pull control –push down/forward control Joystick control (digidrive) Low effort

20. Acceleration and Braking Electronic gas and braking system Push down/forward system: Blue- brake Pink- acceleration Joystick- Digidrive

21. 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

22. Driving Adaptations (steering) cont. Small steering wheel with cuff Joystick- Digidrive Spinner knob

23. Other Stuff Adjusting Mirrors Horn Heat and A/C Turn Signals Radio other? Power Headrest System Headrest with switches imbedded

24. Custom Adaptations Extender for turn signal Foot block to prevent left foot from interfering

25. 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

28. Driver evaluation Visual acuity Visual fields Reaction time Motor abilities Cognition –Reading –Problem solving –Planning –Safety judgment

29. Driver Simulator- used most often for evaluation and screening May also be used for driver training

30. Standards –RESNA/ANSI standards for restraints –Crash testing The Association for Driver Rehabilitation Specialists (ADED) http :// www. driver-ed.org Annual ADED Conference

31. Time to change focus to Augmentative Communication

32. American Speech-Language- Hearing 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.more than 123,000 members and affiliates

33. 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

34. Picture Cards

35. 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

36. Personal Communication Book

37. PECS Laminated Cards

38. Aug com using head pointer

39. Mounting Augmentative Communication Devices

40. Augmentative Communication

41. Dynavox

42. Prentke Romich Vanguard Plus

43. Pocket Communicator

44. Tango