Adaptive Driving Equipment

Transportation

By Michael Dresdner

Last Updated:

This article has been written to aid in a basic understanding of items that may be prescribed by a Certified Driver Rehabilitation Specialist (CDRS) as part of a driver evaluation.

First, it is important to understand that any person who has suffered a brain injury (or any disability) should have a driver evaluation. Some brain injuries leave individuals with noticeable impairments. Others do not and changes in ability to drive are subtle. Only a trained Driver Rehabilitation Specialist can determine if you or a family member is prepared to operate an automobile. A list of driver rehabilitation personnel is available at the Association of Driver Rehabilitation Specialists.

Once you have been evaluated and it is determined that driving is an option, your Driver Rehabilitation Specialist may recommend specific adaptive equipment enabling you to drive safely and efficiently. For persons who will not drive and require adaptive equipment, see “Automotive Mobility Equipment and Modifications” published within this web site. Some individuals may need no equipment at all in order to safely operate a vehicle. It is extremely important to heed the following advice: If you are planning to purchase a new car or van to enhance your transportation options, do not make a purchase until you have been evaluated and you fully understand your needs. The type of car or van you choose may greatly affect the efficiency and the cost of your future independent or dependent transportation.

In most cases, persons with a brain injury who are able to drive will not need sophisticated adaptive equipment. In rare instances where an individual has a dual diagnosis, brain injury and spinal cord injury and is able to drive, some sophisticated equipment may be required. In this article, I will discuss the more basic equipment. In my 13 years experience as an adaptive equipment retailer, I have noted that persons with a brain injury most frequently require little equipment, but ample training. This reflects the need to reacquaint with them with the driving process. In other cases, individuals may be plagued by weakness in an extremity, joint and limb flexibility issues (tone), visual issues and overall mobility limitations.

The following modifications are the most common items requested.

Difficulty Using Standard Automotive Mirrors

Many persons with a brain injury (and other disabilities) just don’t have the range of neck and upper body motion to scan mirrors as provided by the automaker (OEM- Original Equipment Manufacturer) efficiently and safely. For this client, there are many aftermarket products readily available. They include the following.

Wide angle rear view mirrors: This type of mirror is clipped over or added to the OEM rear view mirror. This mirror is curved in design and will allow viewing of a substantial amount of the road that would typically be scanned in the right and left side mirrors.
Forward mounted mirrors: It is possible to place right and left side mirrors well forward on a car, in the vicinity of the front wheel wells. This allows right and left side rear view mirrors to be scanned by a driver with limited range without turning substantially.
Blind spot mirrors: These mirrors attach to the right and left side mirrors and can show additional portions of the road that are often hard to scan.
Cross check mirrors: Mirrors can be located within the car or externally that point at and allow view of any given area. For instance, if a driver has the ability to easily look to the right, but not to the left, a cross check mirror that is focused across the vehicle at the left lane of traffic can be installed on the right hand side. This allows view of traffic to the left with a glance at the mirror on the right.
Wide angle window lens: This type of lens is generally used in a van. Vans have rear windows that are positioned in a vertical plane and most cars have rear windows that are positioned tilting forward. A wide angle lens works best in a vertically mounted position. A wide angle lens has the capability of showing a broad cross section of what is behind a vehicle within a limited area by bending light (images) through a “fresnel effect” and focusing the images in a limited area. There could be some effective gain even on a sloped rear window.

The mirrors discussed above generally are inexpensive. They are available at many auto parts stores and RV centers. It is important to point out that they must be prescribed and properly located by the CDRS and installed by a competent mobility dealer.

Difficulty Using Secondary Controls

Secondary controls are all the controls of an automobile with the exception of gas, brake and steering. Among others, these include turn signals, horn, dimmer, wipers, cruise control, lights, air conditioning and heater controls (HVAC), power windows and door locks.

There are a variety of ways to modify secondary controls. In many cases, individuals have lost the efficient use of their right or left arm. Most controls that are located on the left can be relocated to the right and vice versa. Sometimes a simple mechanical device like an extension or a lever is all that is needed to place the operation of a secondary switch or control within the reach of a disabled driver. Other situations require a different approach. With the advent of more sophisticated automobiles, often, a more sophisticated approach is needed. Many cars now have complex electrical systems which can be difficult to interface with aftermarket switches. Specialty devices are available to relocate secondary switching to remote locations.

Touchpads:: These specialty switching devices are specifically designed to allow the relocation of a specific automotive function(s) to a remote location. Flexible and easily mounted for use with fingers, elbow, knee or other extremity, the touchpad is an excellent option for relocating a limited number of functions to a remote location.

See http://www.emc-digi.com/2function.htm or http://www.creativecontrolsinc.com/specialcciproducts/c-tech-2-control/ for more touchpad information. Touchpad operation (with exception of a remote ignition switch) will not effect the operation of the OEM switches by an able-bodied driver.
Multi-function secondary controls:: In cases where an individual requires the relocation of several secondary controls, a more refined approach may be required. Although a combination of extensions and levers and some minor use of touchpad’s may be an option, devices are now available that make the relocation of a group of functions possible. Additionally, groups of switch functions can be located remotely for use by a disabled driver without compromising their use for an able-bodied driver.

For more information on multi-function switch relocation, see http://www.emc-digi.com/digitone.htm and http://www.creativecontrolsinc.com/specialcciproducts/c-tech-2-control/.
Voice Command switching:: Although not commonly used for persons with a brain injury and more expensive than the options listed above, voice command switching is available for automotive use. Voice command can be used for most secondary vehicle functions. See http://www.emc-digi.com/digivoice.htm for more information.
Multi-function secondary switching integrated into a steering device:: These multi purpose devices are gaining in popularity for person who have suffered a stroke or a brain injury. Often, both steering assistance and secondary switching assistance are a requirement of this category of disability. As a general statement, these devices offer assistance with gripping/controlling the steering wheel and operation of some secondary switching functions.

For more information on this type of product see http://www.accessunlimited.com/infra-touch/mini-touch.html and http://www.drivingsystems.com/SG12.HTM. Additional information regarding steering devices is contained further in this article.

Difficulty Shifting

Operating the OEM shift could limit your ability to drive. Fortunately, there are simple mechanical and electrical devices that can greatly help in this area.

Shifter crossover:: Allows the extension and relocation of the right side factory column shift to the left side. These are not practical on all cars and can be affected by the location of OEM shifter and other variables including client strength and range.
Shifter extension:: An extension can be added to the OEM column shifter as a leverage and positioning aid. Shift extensions are generally very effective. For more information on the crossover and the extension see http://www.mobilityproductsdesign.com/products.asp.
Difficulty with a floor shifter:: There are no off-the-shelf products available for floor shifters. It is possible for a mobility equipment dealer to fabricate parts that can be extremely effective for added leverage and/or to aid in depressing the detent button (the button on the side or bottom of all floor shifters that keep you from shifting inadvertently).
Powered electric shifter:: In cases where a shift extension or crossover is not adequate, there are powered shifters available. Powered shifters are touchpad operated and work well for clients with very low strength and limited range.<br />

For more information see http://www.emc-digi.com/smartshift.htm and http://www.creativecontrolsinc.com/specialcciproducts/memory-shift/index.htm.

Difficulty Operating the Parking Brake

Use of the parking brake is often not viewed as absolutely necessary. In my view, it is important and it is a necessary component of safe vehicle operation. Both manual parking brake extensions and powered parking brakes are available.

Manual parking brake extension:: Allows for added leverage in depressing the OEM foot operated park brake lever via hand and arm motion. These devices are inexpensive and work very well. Good upper body strength is required. For more information see http://www.mobilityproductsdesign.com/products.asp.
Powered parking brake:: Some individuals can not adequately deploy the parking brake with an extension as described above. Also, in some cases, individuals may be wearing a chest restraint (see driver stability below) that restricts their ability to reach a parking brake extension. In these cases, a power parking brake is recommended. Power parking brakes are electrically operated and the activation switch can be located virtually anywhere in the driver’s compartment.

For more information see http://www.emc-digi.com/electricbrake.htm# and http://www.creativecontrolsinc.com/specialcciproducts/parking-brake/index.htm.

Difficulty with Foot-Operated Gas or Brake

It is not uncommon for a person with a disability to require modifications to the foot operated gas and brake controls. The following are the most common requests.

Left Foot Gas Pedal:: In the case where an individual has lost the use of their right foot, a left foot gas pedal, also known as a left foot accelerator pedal can be installed. The left foot gas pedal allows use of both the gas and brake pedal via the left foot. The added left foot accelerator pedal is placed to the left of the brake pedal in the same relationship as the OEM gas pedal had been installed on the right. A simple linkage transfers the operation to the new pedal on the left. Due to spacticity and muscle control issues, a pedal block over the right side OEM accelerator pedal is recommended in many cases.

For more information see http://www.mobilityproductsdesign.com/products.asp.
Hand Controls:: Hand controls allow hand operation of the OEM foot operated gas and brake pedal. These would be necessary when an individual can not control or fully control his/her feet or legs. Hand controls mount under the steering column and are easy to use after a period of training. They can be installed for left or right hand use and fit most automobiles. There are several varieties of hand controls including push right angle, push/pull, push/rock, push/twist and for some sedans, there is now a very attractive floor mount control. Due to spacticity and muscle control issues, a pedal block over the OEM accelerator and brake pedal is recommended in many cases.

For more information see http://www.mobilityproductsdesign.com/products.asp. For more hand control models see http://www.wells-engberg.com/, http://www.suregrip-hvl.com/suregrip.html, http://www.drivemaster.net/hcontrol.htm and http://www.creativecontrolsinc.com/specialcciproducts/moto-mate/index.htm.
Enlarged gas or brake pedals:: Often a driver needs a slightly lager target or a relocated target for gas or brake pedal foot operation. A mobility equipment dealer can fabricate many custom designs that could be effective for this use.

Difficulty Steering

The most common problem we see in respect to steering is gripping the steering wheel.

Steering devices:: There are a myriad of steering devices available. Often with limited hand function or strength, a steering device can make a world of difference with respect to steering ease and control. See http://www.mobilityproductsdesign.com/products.asp.

Although there are many other custom solutions for steering issues including a reduced diameter steering wheel, low effort steering and highly technical remote servo-type steering, they are not commonly requested when dealing with an acquired brain injury. For more information on these more complex modifications, see your mobility equipment dealer (find a mobility equipment dealer at www.nmeda.org) or email the author at mdresdner@hdsvans.com.

Difficulty Braking

As discussed previously in this article, if difficulty braking is experienced, assistance may be available through the use of hand controls. One other aid may be an enlarged or relocated foot operated brake pedal. There are no other off-the-shelf aids for braking.

Although there are many other custom solutions for braking issues including low effort braking and highly technical remote servo-type braking, they are not commonly requested when dealing with an acquired brain injury. For more information on these more complex modifications, see your mobility equipment dealer (find a mobility equipment dealer at www.nmeda.org) or email the author at mdresdner@hdsvans.com.

Difficulty Maintaining Balance

It may be necessary for an individual with a brain injury to require assistance with balance while driving. This is especially true for persons using hand controls. Balance and stability are critical to vehicle control.

Chest Restraint:: The most common aid to a driver’s stability is a chest restraint. A chest restraint consists of an adjustable strap that is secured to the driver’s seat and runs around the driver’s torso at the chest level. Chest restraints can be equipped with a variety of fastening devices as to be easily operable by a disabled driver. The straps are manufactured out of a wide webbing to avoid the strap chaffing the driver and allow for a maximum allowable comfort level.

For more information see http://www.imec-online.com/torsosupportbelts.htm.
Specialized Seating:: In some cases, custom seating may be required. A Mobility Equipment Dealer, working in conjunction with a Driver Rehabilitation Specialist and possibly a seating specialist can design and fabricate seating with proper contours or shape to aid greatly in stability. Specialty seating can also aid greatly with postural issues that may arise over time. These are custom products and as far as I know, there are no off-the-shelf products available.

Difficulty With Egress/Ingress

Entering and exiting an automobile can be a difficult process for a person with a disability. There is now a new generation of automotive seats that allow options for egress/ingress.

Turning Automotive Seat:: In many cases, a Turning Automotive Seat (swivel seat or TAS) can substantially assist a driver (or passenger) in entering or exiting his or her vehicle. Both powered and manual systems are available. The Bruno TAS not only swivels out the door of a car or van but also lowers up to 8” allowing a level transfer. Since seating is an integral component of automotive safety, it is important to understand that the seat products mentioned in this article meet all Federal Motor Vehicle Safety Standards (FMVSS). Seats that have not been tested should not be used. It is common place when utilizing a TAS product that you must use an aftermarket seat. This is due to the overall size and height of an OEM seat and the need for the TAS product to swivel through the door opening. Aftermarket seats, if desired can be covered to match your automotive interior. For more information on TAS products see http://www.bruno.com/tas.htm.
Grab and assist handles:: Your Mobility Equipment Dealer can help you with custom grab and assist handles in many location of your car or van. Styles can be chosen that match your car or van interior style and color. Find a mobility equipment dealer at www.nmeda.org.
Running boards or steps:: In many cases your Mobility Equipment Dealer can install running boards or a custom step to aid in entering and/or exiting your vehicle. For a general overview of running boards and steps see http://www.truckaccessorysuperstore.com/default.plx/32/989. This is just one of hundreds of sites that display this type of product. Your Mobility Equipment Dealer may also have specific suggestions or may be able to build you a custom step or running board. To view a specialty pick up truck “powered running board lift” see http://www.startracks.org/truck_lifts.htm.

Loading a Mobility Device

In cases where a driver can walk short distances and needs to load an unoccupied mobility device (scooter or wheelchair) or needs to enter and exit a vehicle seated on his or her mobility device please see the companion article, “Automotive Mobility Equipment and Modification” located within this site by the author.

Resources

View Handicapped Driver Services web site at www.hdsvans.com. View Accessibility Services Plazas web site at www.accessibilityservicesplaza.com.

The following web sites also may prove helpful.

Unoccupied Wheelchair and Scooter Lifts
www.bruno.com
www.harmar.com
www.freedom-lift.com

Occupied Wheelchair and Scooter Lifts
www.braunlift.com
www.ricon.com

Lowered Floor Minivans
www.braunlift.com
www.imsvans.com
www.vantageminivans.com
www.viewpointmobility.com

Michael Dresdner is President of Handicapped Driver Services, Inc. in Atlanta, Georgia and Jacksonville, Florida. Michael recently developed “Accessibility Services Plaza” in Marietta, Georgia a one stop rehab shopping facility. Handicapped Driver Services has provided vehicles, modifications and evaluation services to the disabled community for over 25 years. He is a member of the National Mobility Equipment Dealer’s Association (NMEDA), past NMEDA board member. Michael is also the ADED board, vendor representative for 2002-3.

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