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 Center’s 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. 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 America’s 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%) Transportation Facts

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 Client’s Vehicle

13. Referrals • Sources • Vocational Rehab/OSDP counselors • Worker’s Comp • School Systems • Veteran’s Administration • Doctor’s • Therapist

14. Clinical Assessment • Information Intake • Valid driver’s 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 Cont’d • 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 Cont’d • 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. Driver’s Training • Based on the client’s performance during the initial evaluation • Can vary from a few to several hours • Graded – based on skill level Low Traffic/Speed Little External Stimulus Parking Lot Subdivision County/Country Roads State Highways Interstate Town/City 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 o’clock 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 vendor’s 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 Client’s Vehicle • Usually performed in circumstances where a certain comfort level is desired in client’s 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