Adaptive Driving�By Eric Knox, OTR/L, CDRS�The T.K. Martin Center for Technology and Disability

The 3 Hallmarks of an Independent Driver?

• Independently entering and exiting the vehicle.
• Having the ability to drive safely.
• Independently transporting one’s own mobility device.

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Who Qualifies for Adaptive Driving???

• New drivers- Most new drivers are individuals with a congenital diagnosis (Ex. CP, spina bifida) but some are individuals injured during childhood.
• Physical Dysfunction- Individuals who know how to drive and were avid drivers, but now need a way to operate the vehicle. (Ex. SCI, stroke, amputees, neuropathy)
• Brain injury- Individuals who have had a TBI or stroke now need to be evaluated for safety purposes. Physical injuries may be included as well.
• Mild neurocognitive disorder or dementia.
• EVERYONE must have a valid license or permit.

Clinical Assessment

• Valid driver’s license or permit
• Driving history
• Medical history overview
• Vision screening
• Manual Muscle Testing (MMT) and ROM
• Visual Perception and Cognition

Behind the Wheel �(BTW)

• 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 driver’s skills in a variety of traffic and roadway environments.

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.

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Equipment Prescription

• States what type of equipment needs to be installed and where.

Example:

Steering

Vehicle to have low effort steering with a spinner knob mounted at the 4:00 position.

Accelerator/brake controls

Sure Grip Push/Rock hand controls mounted for left hand use.

Final Fitting

• Conducted at the vendors workshop.
• TK Martin should be contacted ASAP if we request to be at the fitting!
• Determine that all the prescribed equipment is provided.
• Determine that all equipment is mounted in the best accessible location.
• Prior to completion, the client will demonstrate the ability to use the equipment correctly.

Primary Driving Controls

• Steering
• Accelerator
• Brake

Steering Modifications

Low and No Effort Steering provided by Drive-Master Corporation

Steering Controls

Digital Steering

Pictured is the AEVIT W-Series by EMC

Brake Modifications

Low and No Effort Braking provided by Drive-Master Corporation

Accelerator/Brake Controls

Menox Pedal Extensions

Accelerator/Brake Controls

Push/Rock hand controls by MPS

Accelerator/Brake Controls

Left Foot Accelerator

Accelerator/Brake� Controls

Electronic Gas and Brake Control

Pictured is the AEVIT L-Series by EMC

Steering/Accelerator/Brake Controls

Joystick Control

Pictured is the AEVIT J-Series by EMC

Steering Orthotics

Tri-pin and V-Grip by Sure Grip

Spinner Knob by Sure Grip

Orthotics

Amputee Ring by Drive-Master Corporation

Steering Cuff by Drive-Master Corporation

Secondary Controls

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

Secondary Controls

Quad Key Turner by MPD

Right Hand Turn Lever by MPD

Secondary Controls

Additional Options

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• Scanning
• Voice recognition

Vehicle Access

Trimway Lift by Ricon Corporation

Entervan dropped-floor minivan by The Braun Corporation

Personal Access

Asento by Adapt Solutions

Braun Turny Seat

Mobility System Loading

Bruno Space Saver

Harmar Tilt-n-tote

Mobility System Loading

Out-Rider by Bruno Independent Living Aids

AL500 by Harmar Products, Inc

Mobility System Loading

Scoota Trailer

Chair Topper by

The Braun Corporation

Funding

• Mississippi Department of Rehabilitation Services (MDRS)
• Go Fund Me
• Church support

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Commentary Driving

The practice of talking through the driving process out loud, including identifying road signs, traffic conditions, hazards, and intended actions. It allows the evaluator to assess the driver's awareness, hazard recognition, and decision-making in real time.

Bioptic telescopic lens system:

A combination of a 2 lens (standard/conventional and telescopic) optical system.

What’s the purpose of a bioptic lens system???

• 1. Interchanging between corrective lens viewing and bioptic lens viewing.
• 2. Detecting/identifying distant objects.
• 3. Decreasing the margin of error between visually impaired drivers and objects in their environment.

Frequency of use

• Dependent on the driver’s environment which is constantly changing.
• Familiarity to the area
• Dynamics of the environment
• Dependent upon the individual’s functional vision related to awareness acuity vs. identification acuity vs. preferred viewing distance.

The clinical evaluation process

• Vision/chart overview-Confirming that the individual complies with the standards for bioptic driving.
• Novice or seasoned driver/ driving experience???
• A novice driver will typically require much more behind the wheel time.
• Have they had prior training with their bioptic??
• AROM/Strength test

Behind the wheel (btw)

• The client begins as a passenger.
• Their job is to verbally operate the vehicle (redlight ahead, begin slowing down, we’re too close/far from the vehicle in front of us).
• Once the client is behind the wheel we begin in an empty parking lot where the following is observed in action:
• Spatial awareness
• General Vehicle control
• Anxiety
• Gas/brake discrimination
• Novice driver’s generally do not make it pass this phase.

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Behind the wheel (btw) continued

• We progress to lower traffic areas where secondary control operation is evaluated. (blinkers, horn, lights, windshield wipers, etc.)
• Depending on the progress of the client, highway and higher densities of traffic are assessed as well.

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Training

• Bioptic drivers in the state of Mississippi are required to have 6 hours of behind the wheel training.
• Is dependent on how quickly each client progresses.
• Drivers with a learner’s permit must perform a behind the wheel road test with the mhp to attain their operator’s license.
• It is not guaranteed that a person will attain the skills necessary to become a safe driver.

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