Driver Rehabilitation: Reclaiming the Road

1
Driver Rehabilitation Reclaiming the Road

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

November 2006
2
Introduction
Wesley L. Perry, MSBME, ATP, CDRS M.S.,
Biomedical Engineering Certified Driver
Rehabilitation Specialist (CDRS), 2000 Assistive
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
Centers adaptive driving program.
3
Introduction
Cliff D. Dedeaux, OTR/L, ATP, CDRS Occupational
Therapist Registered (OTR), 2001 Certified Driver
Rehabilitation Specialist, 2005 Assistive
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
4
For people without disabilities, technology
makes things easier for people with
disabilities, technology makes things possible
(IBM, 1991).
5
Agenda

• Introductions and overview
• Transportation Information
• Introduction to the driving assessment process
• Review of different vehicle adaptations
• General overview of Bioptic Driving
• Discussion

6
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

7
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
• Americas 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)

8
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

9
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)
10
What is a driving evaluation?

• The driver assessment is a complete evaluation of
  an individual's potential to operate a motor
  vehicle independently.

11
Components
Some Overlap
12
From Start to Finish
Referral 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
Clients Vehicle
13
Referrals

• Sources
• Vocational Rehab/OSDP counselors
• Workers Comp
• School Systems
• Veterans Administration
• Doctors
• Therapist

14
Clinical Assessment

• Information Intake
• Valid drivers 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

15
Clinical Assessment Contd

• Visual Evaluation
• Use screener to test
• Visual acuity both and individual eyes
• Color vision
• Depth perception
• Phoria (eyes working together)
• Horizontal peripheral field

16
Clinical Assessment Contd

• 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.

17
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

18
Drivers Training

• Based on the clients 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
Little External Stimulus
High Traffic/Speed
Unlimited Stimulus
19
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
  oclock position for right hand use
• Accelerator/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

20
Final Fitting

• Conducted at vendors 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

21
Training in Clients Vehicle

• Usually performed in circumstances where a
  certain comfort level is desired in clients
  vehicle prior to independent driving
• Passenger side training brake is temporarily
  installed for training purposes and removed at
  completion of training

22
Vehicle Types and Adaptive Driving Equipment
23
Vehicle Types

• Sedans
• SUVs
• Minivans
• Full-size vans
• Trucks

24
Wheelchair Access for Minivans
Vision conversion by Viewpoint Mobility
Entervan lowered-floor minivan by The Braun
Corporation
25
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)

26
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

27
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

28
Wheelchair Access for the Full-size Truck
Conversion by Ryno Mobility

• Approximate specifications
• Headroom 55 ½ to 58
• Width of lowered floor area 29
• Length of lowered floor area 58

Nissan Titan, GMC Sierra, Chevrolet Silverado
Suburban Demonstration recommended prior to
purchase!!!
29
Personal Access
Notched transfer board
EZ Transfer by Access Unlimited
30
Personal Access
Transfer Seat Base by VMI/Ricon
Glide N Go by Access Unlimited
TAS System by Bruno
31
Manually operated wheelchair tiedowns
Q5001 System by Q-Straint

• Some points to consider
• Availability of tiedown attachment points
• Knowledge and ability for correct use

32
Automatic wheelchair tiedowns
EZ Lock wheelchair tiedown system
Some points to consider

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

33
Primary Driving Controls

• Steering
• Accelerator
• Brake

34
Steering Controls
Column extensions and different-sized steering
wheels Products shown are by Drive-Master
Corporation
35
Steering Modifications
Actual effort will vary relative to the vehicle.
36
Steering Controls
Foot Steering System by Drive-Master Corporation
37
Steering Controls
Digital Steering Pictured is the AEVIT W-Series
by EMC
38
Brake Modifications
Actual effort will vary relative to the vehicle.
39
Accelerator/Brake Controls
Pedal extensions by Drive-Master Corporation
40
Accelerator Controls
Left Foot Accelerator Pedal by FujiAuto
41
Mechanical Hand Controls
Sure Grip hand controls by Howell Ventures
Monarch hand controls by MPS

• Hand control types
• Push / 90 pull
• Push / pull
• Push / tilt or rock
• Push / twist

42
MPD Hand Controls on Utility Vehicles
Big Country Cub Cadet
John Deere Gator
Golf Cart
43
Accelerator Brake Controls
Electronic Gas and Brake Controls Pictured is the
AEVIT L-Series by EMC
44
Steering-Accelerator-Brake Controls
Joystick Control Pictured is the AEVIT J-Series
by EMC
45
Steering-Accelerator-Brake Controls
Scott Driving System by dSI
46
Orthotics
Tri-pin Product shown is by Drive-Master
Corporation
Spinner Knob Product shown is by DSI
Steering Cuff Product shown is by Drive-Master
Corporation
47
Secondary Controls

• Turn signals
• Horn
• Lights/Dimmer switch
• Gear shifter
• Park Brake
• Etc.

48
Secondary Controls
Quad Key Turner by MPD
Right Hand Turn Lever by MPD
49
Secondary Controls
SureSwitch by Howell Ventures Limited
Digipad II Econo Series by EMC
50
Secondary Controls

• Remote switch options
• Scanning
• Voice recognition

51
Transport of Unoccupied Mobility Systems
Tilt N Tote by Wheelchair Carrier
Van ramp Product shown is by Handi-Ramp
USATote Plus by U.S. Abilities, Inc
52
Transport of Unoccupied Mobility Systems
Products shown are by Bruno Independent Living
Aids
53
Transport of Unoccupied Mobility Systems
Chair Topper by The Braun Corporation
AL500 by Harmar Products, Inc
54
Transport of Unoccupied Mobility Systems
Products shown are by Bruno Independent Living
Aids
55
Driving With Bioptic Lenses
56
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

57
Bioptic Driving

• Common Misconceptions
• Bioptics are not a cure for low vision
• Bioptics are not for constant use when driving

58
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
• Trainingboth in the use of the bioptic lens and
  for driving

59
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

60
The Assessment Procedure

• Interview
• - Medical and driving history
• Active ROM strength
• Reaction times
• Passenger in-vehicle
• Behind-the-wheel assessment

61
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

62
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.

63
Assistive Technology

• Filters
• Talking GPS

64
States Allowing Driving with Bioptics
Ref Driving with Confidence A Practical Guide
to Driving with Low Vision by Eli Doron Peli
65
Resources

• The Association for Driver Rehabilitation
  Specialists (ADED)
• www.driver-ed.org
• National Mobility Equipment Dealers Association
• www.nmeda.org
• Bioptic driving
• www.nhtsa.dot.gov/people/injury/olddrive/OlderDriv
  ersBook/pages/Mississippi.html
• www.lowvisioncare.com/visionlaws.htm
• www.biopticdriving.org

66
Contact Information

• T.K. Martin Center for Technology and Disability
• Box 9736
• Mississippi State, MS 39762
• Phone [phone]