Your

TICKET
to Independence

by Margaret A. Johnson, O.T.R./L.

Regaining the ability to drive is a

basic part of independent living.

When you were 16 years old, you excitedly and nervously

prepared for the behind-the-wheel portion of your driver's test
Passing the exam was your ticket to independence. No more riding
shotgun with the folks or listening to backseat drivers giving orders.
You were on your own-and what a good feeling this was!

Injuries or disease can affect you mentally, physically, and

emotionally-to the point of temporarily or permanently impairing
driving. But, because your physical capabilities have changed,does
this mean you must ride shuttles and carpool? Certainly not!

How do you go about learning what you may need if you are
unable to drive a conventional vehicle? The first step is to acquire
a doctor's referral for evaluation by an occupational therapist
(OT) or driver rehabilitation specialist knowledgeable in the
medical field.

I am an OT who was a driving evaluator for several years.

When I worked with clients, I first assessed their mental, physical,
and emotional status.

Adequate vision is crucial for drivers, and we provided a

thorough screening. In one case, the result of a man's testing was
far below the state's minimum standard for visual acuity. The client
was asked to return for completion of the evaluation after he had
visited his eye doctor. The physician found a hemorrhage in the
man's eye: early discovery and laser treatment saved his vision.
The client went on to successfully drive again.

Following an eye test you are screened in the areas of cognition

and perception. Are you able to think quickly? Do you have good
judgment and decision-making skills? One young woman drove without
mishap for 20 minutes, but as we neared completion of the in-vehicle
assessment, something told me to extend the length of the route.
In the next block, she failed to brake when two pedestrians crossed
her path. I stopped the vehicle and questioned her about this serious
mistake. She said she saw the women, but "it just didn't register."

Evaluators also test your muscles and movement for strength,

coordination, range of motion, and endurance. Strong muscle-spasms
can interfere with safe driving; many times a change in medications
may be a solution. Independent car-transfer was a grueling process
for one man, whose legs had severe spasms; he was breathless and
exhausted before he even turned on the ignition. Balance is an
important consideration for driving. Can you maintain an upright
sitting posture while making a sharp evasive right or left turn?
It certainly defeats the confidence of

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01-03874

(PHOTO CAPTION)
With the help of "driver" Laura Schleiger, Occupational
Therapist Margaret Johnson demonstrates in-vehicle assessment.

(PHOTO CAPTION)
In the Adapted Driving Program at Good Samaritan Regional
Medical Center in Phoenix, Nick Mereles learns to transfer to
the driver's seat of the facility's adapted van.

(PHOTO CAPTION)
An Adapted Driving Program van acquaints Mereles with equipment
and vehicle modifications.

drivers who are on sharp curves suddenly find themselves staring

at the kneecaps of those in the passenger seat. OTs can evaluate
your hand function and recom-mend a chest restraint adapter so you
can apply the strap, even if you can't use your fingers.

The final test is the actual in-vehicle assessment. The car is

equipped with a reversible set of hand controls, various steering
devices, a right- and left-sided turn signal, and a left-foot
accelerator. Following demonstration and instruction, you begin
to drive in a safe, empty park-

(PHOTO CAPTION)
FROM TOP: As part of Good Samaritan's Program, Charles Mascari's training
includes stowing his chair behind the driver's seat.
01-03875

ing lot. After an increase in confidence and ability, you drive

in residential areas and finally go into more complex traffic-but
only if you feel comfortable.
Your evaluation is then typed up and, with the required
state forms, sent to your physician for review. You visit one of
a list of recommended reputable vendors, where the prescribed adapted
automobile equipment is installed. You may need further training at
a local licensed driving school that has personnel skilled in
instruction with adapted controls. At some facilities, OTs conduct
this training. Once your controls are installed and you are proficient
in their use, the therapist gives you final approval. You must have
a state test for effectiveness in using special equipment. Your
driver's license receives a code that denotes adaptive-equipment-use
restriction similar to the one for people who wear glasses.
OTs and your vendor can help suggest appropriate vans or
automobiles. Installation of hand controls is difficult in extremely
small vehicles; some compact vans may not have room for you and
your particular form of mobility. Many car manufacturers offer
rebates for purchasing hand controls or other adaptive equipment..
 If your needs cannot be met in an adapted automobile, you will
be referred to a facility that has specialized adapted vans.
Vehicles of this type allow you to experiment with using a lift
for access and with various interchangeable steering devices.
A raised roof or dropped in floor accommodates drivers in wheelchairs.
These vans even have interchangeable steering wheels and lever-
operated accelerators and brakes.
The Association of Driver Educators for the Disabled(ADED), an
intenational organization, is devoted to the supportof professionals
working in the field of driver education and transportation-
equipment modification. ADED's goal to maximize transportation
options for people with disabilities because driving is an earned
privilege-for all of us.

Margaret A. Johnson, formerly an occupational therapist in the Driver

Evaluation Program at Vanderbilt University Medical Center,
Nashville, is now coordinator of Occupational Therapy at Nashville
Rehabilitation Hospital. For assistance locating an evaluation
center in your area, contact ADED at (608) 884-8833 /
884-4851 (fax).

for Evaluation-Then
for Independence

Driver-evaluation is performed at many sites around the country.

Examples are the programs at Vanderbilt University Medical Center.,
Nashville, and at Samaritan Rehabilitation Institute. Good Samaritan
Regional Medical Center, in Phoenix. Margaret A. Johnson (author
of "Your Ticket to Independence") worked for eight years in the Driver
Evaluation Program at Vanderbilt University Medical Center. "Clients
were always surprised at how thorough the evaluations were," she
recalls. "Many of them remembered their original driver's exams,
in which they answered some questions, took a 20-minute ride,
and received their licenses. They had no idea our assessment was
two or three hours long."
Drivers-evaluation programs emphasize safety as well as
defensive driving. "I told clients to always use restraints (seat
belts, etc.) and to raise their headrests to provide more protection,"
Johnson says. "Many of them received spinal-cord and head injuries
because their headrests weren't properly adjusted."
According to Johnson, some clients are afraid evaluators will
take away their driver's licenses. "I'm not employed by the state,
and I don't have the authority to do something like that," she would
tell them. After putting this fear to rest, she'd get on with the
business at hand: putting qualified drivers with disabilities back
on the road again.

According to Carol Blanc, 0.T.R., a driver-rehabilitation

specialist, the Adapted Driving Program at the Arizona facility
annually processes 100- 130 people whose disabilities range from head
and spinal-cord injury to amputation, stroke, arthritis, and neurological
diseases and problems. Clients must be of legal age and have a
physician's referral and a valid Arizona driver's license or permit.
The length of the course depends on client disability and previous
driving experience. Fees are charged by the hour; some insurance
assist with these costs. Participants also receive help with obtaining
their driver's licenses.
For more information about the driving programs mentioned in this
article, contact:

Adapted Driving Program Vanderbilt University

Samaritan Rehabilitation Institute Medical Center
Good Samaritan Regional Medical Center Rehab Services
Phoenix Nashville
(602) 239-4757 (615) 322-0100

Margaret Johnson
Nashville Rehabilitation Hospital
(615) 226-4330

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