Modifications for Mobilization
Suzanne Pritchard, MS, OTR, CDRS Occupational Therapist Certified Driver Rehabilitation Specialist, Easter Seals Crossroads
Mobility and independence go hand in hand, so most stroke survivors are interested in returning to driving. There are a number of products designed to help survivors drive, as well as products to help caregivers transport their loved ones and mobility devices.
Some of the modifications are inexpensive and easy to install on a stroke family’s current car. Other solutions involve major changes to the vehicle or the purchase of a different vehicle. The cost of this equipment will vary, and rates for installing equipment will be different from vendor to vendor. Unfortunately, there are not a lot of options to help pay for these modifications. Insurance is not a source. In some states, the agency that deals with vocational rehabilitation may be able to assist.
The first step when returning to driving is to find a Certified Driver Rehabilitation Specialist (CDRS) who can help guide you through this process. The CDRS can evaluate your ability to return to driving, prescribe the appropriate equipment that matches your capability and provide the necessary training. It is never appropriate to have a vendor install equipment or modify a vehicle without an evaluation first. Most reputable vendors will not install equipment without a prescription. Fees vary for this evaluation; here in Indiana it is around $400, but it assures you that you are getting exactly what’s necessary.
The most common modifications for survivors are typically the left-foot accelerator, steering wheel spinner knob and the crossover turn signal. These are inexpensive modifications that can be made to most vehicles.
While it is easy to purchase something online and put the equipment in yourself, that is highly discouraged. It is important to be trained on their use, especially the left-foot accelerator. It seems simple to use, but as a result of using the other foot, one must move right to get to the brake pedal. If you haven’t had proper training, one is likely to have pedal confusion. Obviously, inability to react and use the brake pedal appropriately can be extremely dangerous.
Spinner knobs attach to the steering wheel and swivel as it is rotated. These knobs were common before power steering. They make it possible to control the steering wheel with one hand.
The crossover turn signal is simply a rod that allows one to use their right hand to engage the turn signal.
A panoramic rearview mirror (also called a blind spot mirror) eliminates blind spots and gives you a complete view of the traffic around you. They clip easily to your current rearview mirror. Blind spot mirrors can also be attached to the side mirrors. It is important to be aware of individual state laws that may limit driving with certain visual impairments.
Mods for Mobility Devices
Survivors using wheelchairs or scooters typically require more extensive and expensive modification to their vehicles.
There are several types of devices to lift and stow wheelchairs. The type you select depends on the size and weight of the mobility device and the towing capacity and type of your vehicle. A pickup truck can take almost any exterior lift because of its towing capacity and because a hitch can be easily installed. There are booms that can come out of the back of a pickup truck and load wheelchairs into the bed.
Survivors in power chairs, which are very heavy, may require a modified minivan. Mobility and transfer status of the survivor is key in choosing a lift. Because of the variety of lift devices, vehicle requirements and the cost involved, a consultation with a CDRS is valuable.
Some questions to consider:
- Should you switch wheelchairs or would it be better to switch vehicles?
- Is there another way to get a wheelchair in the car?
- Families with an SUV have several options that aren’t possible with a sedan.
- Can the survivor ambulate from the rear of the vehicle to the driver’s seat?
- Will the survivor only be a passenger?
For Survivor Drivers Who Require Mobility Devices
Another option is a turning auto seat (TAS). With these devices, the driver or passenger seat lifts out of the vehicle, turns and lowers to the ground. The survivor can laterally transfer out of the wheelchair onto the seat. Then with the touch of a button, the seat is lifted back into the vehicle and turns to face forward. Many different vehicles can be modified to accept these seats.
For survivors who want to drive from a wheelchair, extensive vehicle modifications are required. Typically the floor of the minivan must be lowered or with a full-size van the roof may need to be raised. Driving from a wheelchair will also require removing the driver’s seat and installing devices to lock the wheelchair in place in the driver’s station.
Minivans can be modified by lowering the floor 10-14 inches. When the side door opens, the ramps deploy. To reduce the angle of the ramp, many vans have a “kneeling system,” which lowers the threshold allowing easier ramp angle. The survivor can then maneuver into driving position.
The survivor who will be a passenger can also take advantage of a number of the above options. Caregivers can use a number of lifts for stowage of wheelchairs and mobility devices. The TAS can be installed for the passenger side and modified minivans are always a good option for passengers. Removable front passenger seats are available, as are middle row options. Securement devices for passengers who ride in wheelchairs can be installed in the location of choice.
A less expensive option for transferring a survivor into the passenger seat from a wheelchair is a sliding board. This simply bridges the gap between the wheelchair and the passenger seat. The survivor slides across with their own strength or with the help of a caregiver. This saves the caregiver from having to lift the survivor and allows the survivor to transfer without bearing weight on their legs.
Another less expensive option to help with transfers is a round seat cushion that merely rests on top of the passenger seat and spins in place. It is useful for survivors who can bear weight on one leg. The cushion helps the survivor rotate their body to face forward and swing their legs into place.
Expect Even More to Come
In the nine years that I have been a CDRS, the options available to survivors have expanded enormously. With the aging population, there will be amazing things to come that will give people even better choices as drivers and passengers.
A good place to begin your investigation is the National Mobility Equipment Dealers Association website. They also have a Quality Assurance Program to help you find a qualified vendor. Remember to check with your state’s department of motor vehicles about what is necessary to get your driver’s license amended to reflect the use of any specialized equipment.
In conclusion, the best place to start is with a CDRS who can consult with you over the phone to determine if an evaluation is necessary and help guide the process with the state bureau or department of motor vehicles. There are many more options for equipment than what is listed above. The CDRS can help narrow what will be appropriate and effective to allow survivors to maximize their independence.
This information is provided as a resource to our readers. The tips, products or resources listed have not been reviewed or endorsed by the American Stroke Association.