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 PN Paraplegia News April 1995 3

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(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.

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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 leveroperated 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 transportationequipment 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 PN Paraplegia News 01-03876 April 1995 33