The ability to drive is considered a basic freedom, one that is often taken for granted. For many, getting to work, school or even the store is difficult, if not impossible, without a driver's license or vehicle. When that skill is impacted by a medical condition, what options exist? The Adaptive Driving Program at Baylor Scott & White Institute for Rehabilitation (BSWIR), run by driver rehabilitation specialists (CDRS), assists patients in getting back behind the wheel.
Driving is one of the most complex activities of daily living (ADLs) to perform after extended illness or injury, requiring the expertise of a driver rehabilitation-certified occupational therapist. Working in tandem with BSWIR’s specialized Day Neuro Program, the Adaptive Driving Program provides an essential opportunity for survivors of stroke, brain or spinal cord injury or those dealing with other neurological conditions.
“The excitement when an experienced driver learns how to safely drive again using specialized equipment is fulfilling for the person and family. The other aspect that resonates with me is when a new driver learns to operate a vehicle - with or without special equipment - through individualized training techniques. We continue to be thankful for these success stories,” said Stephen Adams, an occupational therapist and driver rehabilitation specialist at BSWIR – Dallas.
Our program includes an evaluation by specialists to identify the best modifications based on personal and vehicular needs. They also recommend and procure the correct equipment.
Most vehicles can be adapted to suit individual needs. Stroke survivors may need hand controls, pedal modifications or steering attachments to compensate for weakness on one side. Reduced steering effort, ramps and adjustable seats can help spinal cord injury patients. In June 2021, a new, fully customized adaptive training vehicle – a 2020 Chrysler Pacifica – was put into service at BSWIR - Dallas. It was designed to give Adaptive Driving Program participants the opportunity to learn what is possible following an injury. This SUV is equipped with a six-way transfer seat, variable steering wheel, hand controls, steering attachments, pedal and secondary control extensions and special attachments for individuals with limb loss.
Additionally, the program’s fleet includes an adaptive minivan and two sedans used for student driver training.
Assessment is key
Accurate assessment is vital for a successful, safe return to driving. Several occupational therapist-guided possibilities exist, including on-road experiences and digital simulations. A driving simulator at BSWIR-Frisco evaluates patient readiness through motor reaction time assessment of braking and steering, visual scanning, divided attention, spatial reasoning and hazard perception skills. It provides a safe, virtual environment for practicing entering and exiting a vehicle and a variety of real-world driving scenarios.
This technology is especially helpful to patients with hemispatial inattention or visual field cuts, allowing them to practice hazard scanning and proper lane positioning. Typically, the simulator is used as a pre-assessment tool to identify whether patients can advance to the Adaptive Driving Program. Poor simulator performance can strongly indicate safety risks that preclude driving resumption.
More than just driving
Due to the nature and extent of their disability, not every individual is a candidate for driving. The BSWIR driver rehabilitation specialists frequently must make tough decisions for the safety of both the patient and the public, and recommend against driving resumption. In that case, the Adaptive Driving Program offers resources and education on accessing public transportation. The end goal is to help patients succeed in regaining independence, whether behind the wheel or through other transportation methods.
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