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Objectives

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OBJECTIVES

After reading this chapter, the reader will be able to:

  • Describe the role of the driver rehabilitation specialist

  • Describe the options available to assist with grip on the steering wheel

  • Understand the availability of different types of hand controls

  • Understand the importance of adequate dynamic balance in a moving vehicle

  • Discuss the multitude of vehicle options

  • Understand the impact that cognitive and visual deficits have on driving

  • Appreciate the complexity of driving issues for the individual with SCI

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Introduction

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Driving goes beyond the transportation realm in today's society; for many, it is a rite of passage from adolescence to adulthood. Therefore, the loss of driving privileges has emotional, social, and financial ramifications. The consequences of losing the privilege of driving imbue driving with significance well beyond the use of the brake and accelerator pedal. But in today's populous cities, where traffic is congested and wheelchair-accessible public transportation may be limited, safety must be the first and foremost consideration when performing a driving evaluation.

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The driver rehabilitation specialist is a relatively new role in North America and Europe. In the United States and Canada, the Association of Driver Rehabilitation Specialists is the professional organization that provides education and certification examinations to therapists in the field of driver assessment and training. Finding a qualified therapist is a critical step to start the process. While many people believe that the individual with disability will know what will best suit his or her needs, most people with limits in functional capacity are not aware of what their options are and often rely on a salesperson or others who have limited knowledge to make these decisions. The therapist will have no financial interest in the individual's purchase and have an extensive knowledge of the medical issues necessary for decision making. Yet, the individual with disability is an integral part of the evaluation and decision-making process, and his or her desires and needs must be addressed whenever possible.

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Although long-time drivers think of driving as a simple task, the effort is truly quite complex. A driver must be able to execute multiple tasks simultaneously, including observing the signs and signals, visually tracking the roadway, moving the steering wheel as much (or as little) as is required for a given situation, and applying the brake or accelerator with adequate speed and pressure. Accomplishing all this while driving at 30, 40, 50, or 60 miles per hour requires multiple skills and coordination! Speed is a critical component in this equation. The faster the car is moving, the less time is available to acquire and process critical information, and the shorter the time available to take the necessary action.

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Critical Components of the Driving Task

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Vision

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Vision may be affected in the individual with spinal cord injury (SCI) in many different ways. The eye may be ...

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