Physical Disabilities & Adaptive Driving Equipment ADSEA Conference July 22, 2019

Physical Disabilities & Adaptive Driving EquipmentADSEA Conference July 22, 2019 Donna Stressel OTR, CDI, CDRS Sunnyview Rehabilitation Hospital

Objectives • Familiar with the most common medical conditions or disabilities that would indicate the need for adaptive driving equipment. • Understand the role of the Driver Rehabilitation Specialist (DRS) • Knowledgeable about vehicle selection, adaptations, and modifications that are available to assist individuals with disabilities. • Knowledgeable about state license restriction and procedures

Medical Conditions that may Impair Driving • Aging • Cardiovascular • Cerebrovascular • Congenital • Metabolic • Musculoskeletal • Neurological • Psychiatric • Respiratory • Vision The Question is FUNCTION

Vision Many medical conditions and diseases can cause vision impairment. The most common include; Cataract, Macular Degeneration, Glaucoma, Diabetic Retinopathy, and Brain Injury (TBI/CVA)

Vision • Acuity • Binocularity • Contrast Sensitivity • Visual Fields • Ocular Motility/Scanning • Night Vision/Glare Recovery • Color

Visual Perception Many medical conditions and diseases can impair visual perceptual processing. The most common include; Brain Injury (TBI/CVA), Multiple Sclerosis, Cerebral Palsy, Spina Bifida and Alzheimer’s/Dementia • Spatial Neglect • Depth Perception • Form Constancy • Figure Ground • Visual Memory • Visual Closure • Position in Space • Spatial Relationship

Cognition Many medical conditions and diseases can cause cognitive impairment. The most common include; Brain Injury (TBI/CVA), Learning Disabilities, Alzheimer’s and Dementia • Attention/Concentration • Direction Following • Memory • Processing Speed • Knowledge of Traffic Signs and Road Markings • Rules of the Road • Planning and Organization • Behavior and Self-Control • Judgment and Insight

Physical Many medical conditions and diseases can cause physical impairments. The most common include; Spinal Cord Injuries (acquired and traumatic), Amputations, Neurological Impairments, and Birth Defects • Range of Motion • Strength • Muscle Tone • Sensation • Endurance • Coordination • Reaction Time • Reflex Integration

The Driver Rehabilitation Specialist Referral for a driving evaluation would imply there is concern about increased risk when operating or ridding in a motor vehicle • Licensed drivers with a medical condition or change in functional status • New drivers with a physical or learning disability • Older drivers with questionable safety concerns

The Driver Rehabilitation Specialist • Perform targeted clinical assessments and functional on-road assessment • Train clients in the use of adaptive driving equipment and provide recommendations for vehicle modifications (driver and passenger) • Provide recommendations about driving skills and safety to clients, physicians, and families • Assist with state licensing regulations and medical review processes

When to Evaluate? • Before a person who may be at increased risk for driving wants or needs to drive • When an individual with a disability reaches the state age required to pursue driving. • When an individual with a physical disability who requires adaptive equipment is purchasing a new vehicle • When vehicle modification recommendations are needed to facilitate passenger transportation

Clinical Assessment • Medical History • Medications • Driving History and Habits • Vision • Cognition • Physical • Transfers • Mobility aid management

Functional (On-Road) Assessment • Parking Lot • Residential Area • Rural Area • City Area • Light/Heavy Traffic • Expressway/Highway Driving

Parking Lot • Entry/Exit Skills • Mobility Aid Management • Seating and Positioning • Primary and Secondary Controls • Backing and Parking

Vehicle Selection • Is vehicle to be modified one that is already owned or to be purchased or leased? • What mobility aids are used; power wheelchair or scooter, manual wheelchair, walker or cane? • How does the person ambulate and transfer? • What are the other family needs? • What funding sources are available?

Transfers: Vehicle Selection and Modification

Vehicle Selection and Modification • Transfers:

Vehicle Selection and Modification • Wheelchair/Scooter loading devices:

Vehicle Selection and Modification • Lifts and Ramps:

Vehicle Selection and Modification • Van lifts and ramps:

Vehicle Modification • Wheelchair Tie-down and Occupant Restraint System (WTORS): For securing a wheelchair in a motor vehicle and a restraint system for the occupant

Wheelchairs WC19 and WC20 are voluntary standards for wheelchairs and seating systems that are used as a seat in a motor vehicle. • Four permanently attached and labeled securement points that can withstand the forces of a 30 mph impact • A path of travel that allows placement of the safety belts next to the skeletal parts of the body. • Anchor points for a wheelchair pelvic safety belt, that can withstand a 30 mph impact, and has an interface to connect to a vehicle shoulder belt. www.rercwts.org/WC19 up-to-date list of successfully crash tested wheelchairs ant seating systems

Vehicle Technology • 1950 – 2000 Safety/Convenience Features: Seat Belts, Antilock Brakes, Cruise Control • 2000 – 2010 Advanced Safety Features: Electronic Stability Control, Blind Spot Detection, Forward Collision Warning, Lane Departure Warning • 2010 – 2016 Advanced Driver Assistance Features: Rearview Video Systems, Automatic Emergency Braking, Rear Cross Traffic Alert, Lane Centering Assist • 2016 – 2025 Partially Automated Safety Features: Lane keeping assist, Adaptive cruise control, Traffic jam assist, Self-park • Fully Automated National Highway Traffic Safety Administration

Vehicle Technology • Tilt and telescoping steering wheel: maintain a safe distance and angle from airbag for individuals with small body size • Adjustable foot pedals: ability to reach controls and maintain a safe distance from the airbag

Vehicle Technology • Remote start: beneficial for individuals with temperature intolerance, and to clear windshield of ice • Keyless entry and ignition: helpful for individuals with limited hand function and to avoid pain that can occur by turning a key

Vehicle Technology • Gated or electronic shifters: helpful when driver has limited strength or hand function • Hand operated or electronic parking brake: eliminate the need to use foot

Vehicle Technology • Larger dashboard controls with buttons: easier to manipulate for elderly or individuals with limited hand function or dexterity • Voice activated systems: easier for individuals with limited hand function or when driving with adaptive equipment

Vehicle Technology Smart headlights: reduce glare and improve night vision • on/off with ignition, and can automatically adjust high and low beams based on the distance of traffic • pivot to illuminate road during turns • reduces glare that occurs when headlight beams are reflected off particles of precipitation and rain

Vehicle Technology • Blind spot warning systems: warn drivers of objects in blind spots while changing lanes, merging and parking. Helps those with limited flexibility in neck or decreased peripheral vision.

Vehicle Technology • Reverse monitoring systems: helpful for drivers with reduced flexibility and depth perception judge distances, and back up safely.

Vehicle Technology • Head-Up Display: projects key information onto the windshield • Traffic Sign Recognition: can notify drivers of posted speed limits, stop signs, do not enter signs and yield signs

Vehicle Technology • Moving object detection: alerts the driver to moving objects around the vehicle • Crash mitigation systems: applies brake pressure when an unavoidable collision is determined

Vehicle Technology • Lane departure warning, lane keeping and lane centering assist: monitors the vehicle’s position and warns or assists the driver if the vehicle deviates outside the lane

Vehicle Technology • Adaptive cruise control: maintains a set following interval behind detected vehicles • Traffic jam assistance: a combination of cruise control with lane assist, having the potential to reduce crashes in heavy traffic

Vehicle Technology • Drowsy driver alerts: monitor the degree to which a driver may be inattentive while on the road and helps alert drivers to the driving task

Vehicle Technology • Navigation System: GPS is beneficial for individuals with memory impairments, learning disabilities and low vision impairments • Vehicle Tracking System: can track current location, driving history and habits, and send an automatic alert if the vehicle is moved or leaves a geofence

Vehicle Technology • Emergency response systems: offer quick assistance to drivers in the case of a medical emergency or collision, often allowing emergency personnel to get to the scene more quickly

Vehicle Technology • Self-driving car

Vehicle Adaptions • Panoramic or convex spot mirrors: help drivers compensate for limited range of motion or difficulties twisting to check blind spots while merging or backing up

Vehicle Adaptions • Seat cushions: improve line of sight, help alleviate back or hip pain and improve seat belt fit

Vehicle Adaptions • Seatbelt: Improve fit and comfort

Vehicle Adaptions • Adaptive car seat: For individuals with medical needs or who exceed maximum height and weight limitations for conventional car seats

Vehicle Adaptions • Built up grips: Requires less hand and wrist strength to grip and handle, reduces pain

Vehicle Modification • Steering devices: For individuals steering with one hand or foot

Vehicle Modification • Pedal modifications: For short stature or individuals who have an impairment in their right leg left foot acceleratorpedal extenders

Vehicle Modification • Hand Controls: For individuals that are unable to use the brake and accelerator due to both legs amputated or non-functional for driving due to strength, sensation or coordination

Vehicle Modification • Secondary controls:

Physical Disabilities & Adaptive Driving Equipment ADSEA Conference July 22, 2019