Would anyone disagree that driving provides tremendous freedom and opportunity? Looking at it from a disability angle, and factoring in possible negative consequences, United Spinal Association recently stated in a 2014 position paper on transportation: “Inadequate access to transportation creates barriers to employment, contributing to high unemployment and poverty rates”. Not to mention personal freedom.

However, nice as it would be to claim otherwise, not everyone can safely drive. Yes, there has been tremendous progress in the field of adaptive technology, but unfortunately there are still a few physical problems that can prevent a wheelchair user from being able to drive — without proper assessment and training. Occupational therapist and certified driver rehabilitation specialist Anne Hegberg reports that in her experience the most common limiting conditions are: “uncontrolled spasms (SCI), exaggerated startle reflex (CP), apraxia with poor coordination throughout (e.g., Friedrich’s ataxia), uncontrolled seizures, and anyone who does not have at least one semi-functional extremity; also those that have a combination of issues, such as people with MS, who have physical as well as possible visual and cognitive deficits.”

As with all categories of freedom, driving carries with it tremendous responsibility. The first step in this direction is getting tested for the feasibility of driving.

One good nationwide resource for both evaluation and driver training is the Association for Driver Rehabilitation Specialists, a nonprofit organization whose members promote safe, independent community mobility for people with disabilities and older individuals. In the U.S. and Canada, there are 360 active certified driver rehabilitation specialists who may be located on the organization’s website (www.aded.net/?page=725).

If you decide to learn (or re-learn) to drive with a qualified or certified driver rehabilitation specialist in a driver rehabilitation program, there are certain steps to follow: You must find a program matched to you. “If the person needs a wheelchair accessible van, they should be evaluated and trained in such,” says Anne Hegberg. “Unfortunately, as there are limited programs, and they are even more limited the higher tech you need, there may be some travel involved either for the client or CDRS. The National Mobility Equipment Dealers Association has some great information for consumers on their website (www.nmeda.org).”

An ADED instructor will clinically evaluate your physical functioning via a visual, perceptive and cognitive screening, and where applicable, a wheelchair and seating assessment. As we are talking about safe driving here, the clinical assessment will likely explore the following questions:

• Have you had a recent injury or trauma, as your need for adaptive equipment may change in the future (perhaps to the point where it becomes unnecessary)?

• Have you ever had a driver’s license, and if so, what type — full or provisional — and if applicable, the number of years you drove?

• Have you ever had a head injury/period of unconsciousness/brain surgery?

• Have you ever had epilepsy, and how recent was your last seizure?

• Do you have fainting episodes, and if so, when was the last attack?

• Do you suffer from dizziness or vertigo, and how recent was the last occurrence?

• Do you have diabetes? If so, is it controlled (by diet, insulin, tablets), and have you ever had a hypoglycemic attack?

• Do you have any vision problems that eyeglasses do not correct?

• Do you have a hearing problem?

• Can you independently transfer into and out of a car?

• Do you need equipment/assistance to transfer?

• Can you independently load and unload your wheelchair into a vehicle?

• Can you provide a list of medications, including those you may have been prescribed, but do not take?

The next step is the in-vehicle assessment. The instructor takes you for an on-road driving evaluation using a vehicle outfitted with the adaptive driving equipment you need. (Note: If the final assessment recommends driving lessons, you will most likely use a similar vehicle during the driver training sessions.) However, Anne Hegberg points out, “It’s not until the end of training that there is a final recommendation of equipment. During the evaluation you have a good idea what the person will need, but that may change slightly as they drive in higher density traffic and faster speeds throughout the training process.” Altogether, the two-part assessment takes a few hours.

According to Elizabeth Green, executive director of ADED, the assessment fees are set by either the individual tester or his or her organization. The cost is based largely on the time spent with the client or the type of evaluation performed. Charges range from $250 to $800.

Green says that various U.S. organizations may cover the cost of the assessment, such as Vocational Rehabilitation or workers’ compensation insurance — if the disability resulted from a work place accident. If you are a veteran, Veterans Affairs may pick up the expense. If the potential driver studies in a public high school, his or her educational district may absorb the cost of the assessment and training. Also, organizations such as the Lions Club, Junior Achievement, Rotary Club and even some local churches may help with the expense. For older drivers privately insured by The Hartford, the insurance company offers coverage for the cost of a comprehensive driving evaluation.

The lessons themselves are on a case-by-case basis, suited to the driver’s particular needs. As such, there is no set number of lessons. According to Hegberg, “An experienced driver who needs basic mechanical hand controls might require four to six hours, while a new driver using high tech equipment can need 30-plus hours. The cost of the lessons varies greatly by programs — generally $100 to $150.” As with assessment costs, Vocational Rehabilitation, worker’s compensation insurance, and Veteran’s Affairs may help with the cost of driver’s training.

The key is for the potential driver to receive enough training to both safely and confidently operate a car or van outfitted with the prescribed equipment, and to prepare for the motor vehicle authority (DMV/MVA) road test for licensing.

While North America has a nationwide organization for learning to drive specialized vehicles, it’s a different story altogether when it comes to obtaining the actual license. Unlike the situation in many European countries, the United States offers no national driver’s license. Licenses are awarded on a state-by-state basis upon successful completion of driving lessons and a driving test. Whether you use a wheelchair or not, you must be certified to drive by your state of residence.

Moreover, the driver rehab specialist’s “prescribed” vehicle modifications are individually based. The written prescription would include a description of the vehicle and any mobility aid, such as a wheelchair or scooter, or adaptive equipment used, such as hand-operated controls. According to Hegberg, if you drive from a wheelchair, it is critical to have “the correct wheelchair for the driving task. Not all wheelchairs are appropriate for driving.” Once obtained, the outfitted vehicle would be thoroughly checked for fit and operation.

Once you have jumped through all the hoops, good luck when you take to the road.

Special thanks to Elizabeth Green and to Anne Hegberg for help with this article.

Websites of Interest:

• Adaptive terminology: www.nmeda.com/media/newsroom-terminology/
• Advice offered by the National Highway Traffic Safety Administration: www.nhtsa.gov/cars/rules/adaptive/brochure/brochure.html

Images and Videos:

• www.pinterest.com/vintageimages/drivers-rehab/

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Consumers Beware

More and more adaptive vehicle vendors are requiring wheelchair-using drivers to take a certification class prior to installing the necessary assistive technology in their specialized vans or cars, especially in California. According to Christina Mills, deputy director of California Foundation of Independent Living Centers, this certification is not necessary if you already have been granted a driver’s license from your state that indicates what equipment you need to have on your vehicle. However, certain vendors may insist on proof of certification despite your having such a license. NEW MOBILILTY’s Everyday Advocacy column will dig deeper into the legality of this issue, and whether it is a national trend, in an upcoming issue.

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Trouble Renting Cars?

If you have had trouble renting cars with adaptive controls from certain airport rental companies, just this past summer, the U.S. attorney general and Enterprise Car Rental reached an agreement by which the company will provide “vehicles equipped with hand controls or other devices, such as left-foot accelerators, pedal extenders, and/or spinner knobs (collectively, “Adaptive Driving Devices” or “Devices”) to persons with disabilities requesting such accommodations at no cost to the customer.”

You can read the terms of the agreement by accessing this document online: Settlement Agreement between the United States of America and the U.S. Rental Car Operating Subsidiaries of Enterprise Holdings, Inc., U.S. Department of Justice Complaint Number 202-12C-286, www.ada.gov/enterprise_sa.htm).

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