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Pre-Driving Assessment for People with Disabilities

Introduction

Driving is a complex task that requires physical and sensory skills besides cognitive-perceptual abilities such as observation, attention, and the ability to make decisions, reaction time and accurate perception. A person with Disabilities (PWDs) is defined as a person who suffers long-term disabilities in physical, mental, intellectual or sensory when facing multiple barriers which may restrict their full participation in a society.

The purpose of a disability test is to ensure that people with disabilities are assessed on their capabilities of maneuvering motor vehicle safely. Following the Pre Driving Screening, appropriate recommendations will be made for the individual and their referring physicians.

An Occupational Therapist role in the assessment are to :

  • Determine a client’s ability to meet the defined competency criteria in driving
  • Identify impairment in related to deficiencies in driving performances
  • Identify factors contributing to driving difficulties
  • Identify modifications required to facilitate driving functions

Component of pre driving assessment include :

  1. Driving and medical history
    Information of license requirement, driving license status, medical history and medications, client’s driving habits and driving experience.
  1. Physical evaluation
    Assessment of physical capabilities such as the ability to transfer in and out of cars, muscle strength, range of motion, movement, ability to operate and control the vehicle and reaction time.
Assessment range of motion Assessment of Muscle strength
  1. Sensory evaluation
    Evaluation of vision problems (near and distance acuity), traffic light color recognition, as well as evaluating the sensory problems in the upper and lowerlimbs.
  1. Cognitive – perceptual evaluation
    Assessing cognitive-perceptual ability such as concentration, attention, memory and decision making.
  1. Emotional evaluation
    Evaluate whether there is panic or anxiety reactions while driving.

The problems faced by the disabled to drive

In general, the problems faced by the disabled to drive is as follows :

  1. Range of motion and strength problem
    Limitation of range of motion in the hip joint, knee and ankle can cause problems for disabled people to transfer in and out of the car. It also affects disabled people to sit in a comfortable situation to control the vehicle components such as horns, steering wheel, signal lights, gears, mirrors and others. In addition, the limitation of movement in the legs, especially ankle joint will impact the pressure to be placed on the accelerator and brake pedal to control the speed of the car.
  1. Muscle tone problem
    Increase muscle tonus (spastic) or low (flaccid) will result in difficulty in controlling muscle movement while driving, especially during steering control or handle a motorcycle. Moreover, if one is available spasm, it can also cause functional hands and feet will be distracted while driving.
  1. Sensory Problem
    Problems usually identified are pain, reduce sensation, vision, proprioception and kinesthesia where disabled people likely to have difficulty putting the foot in correct position on the accelerator pedal and keep driving even if feet are not in the correct position.
  1. Balance Problem
    Balance problems affect the ability to transfer in and out of the car safely.
  1. Perception and cognition problem
    Difficulty concentrating, attention, information processing, memory, planning, decision making, judgment and reaction time while driving between the problem to be evaluated for a test drive.

In conclusion, the Officer / Medical Occupational Therapist will conduct an assessment to look at the seriousness of the problem and any information obtained will be used to determine:

  1. Vehicles should be modified or not
  2. If necessary, modify the type of vehicle needed
  3. Driving license must be maintained or changed to license A (disabled) or
  4. Not recommended to drive for safety issues

Conditions and car modifications

Disabled vehicle modifications can be done on any registered vehicle workshop with the Department of Road Transport. Lists of registered workshop can be checked on the www.jpj.gov.my. After the pre-driving assessment has been conducted, Occupational Therapist will determine an individual’s functional limitation and type of modification to be done to ensur safety.

Modifications will be suggest according to client’s disabilities condition or disabled as follows :

Disability Effects on driving Suggested driving aids
Left Leg Missing or Non-Functional
  • possible inability to maintain body balance
  • Inability to use clutch
  • Possible interference of leg or foot with driving mechanisms
  • Automatic transmission
  • A restrain (e.g belt, loop) to keep disable leg or foot from lodging against brake or accelerator.
Right Leg Missing or Non-Functional
  • Inability to use standard accelerator
  • Possible inability to maintain body balance
  • Inability to use clutch
  • Accelerator adapted to the left side
  • Automatic transmission
  • A restrain (e.g belt, loop) to keep the disabled leg or foot from lodging against brake or accelerator
Both Legs Missing or Non-functional
  • Inability to use brake and accelerator
  • Possible difficulty entering car
  • Hand-operator brake and accelerator
  • Automatic transmission
  • Transfer board/swivel seat
Left Arm Below Elbow Missing or Non-Functional
  • Difficulty performing hand-over-hand steering maneuvers
  • Inability to shift gears while steering
  • Power steering and spinner knob attached to steering wheel, mounted at 3 or 4 o’clock position for the sound hand
  • Automatic transmission
Right arm Below Elbow Missing or Non-Functional
  • Difficulty performing hand-over-hand steering maneuvers
  • Inability to shift gears while steering
  • Power steering and spinner knob attached to steering wheel, mounted at 8 or 9 o’clock position for the sound hand
  • Automatic transmission is easier
Kedua-dua lengan di bawah paras siku tiada atau tidak berfungsi
  • Tidak boleh memegang dan memusing steering wheel yang standard.
  • Kesukaran untuk mengendalikan komponen di  dashboard.
  • Kesukaran untuk memegang, menarik atau memusing alat pengawalan yang kecil  seperti mengunci pintu kereta, radio knobs dan window cranks.
Memakai prosthesis

  • Driving ring or steering knob diletakkan di steering wheel di sebelah tangan yang dominan.
  • Meletakkan ring pada tempat kawalan dashboard.
  • Ring diletakkan di alat pengawalan yang kecil untuk mudah dikendalikan.

Tanpa memakai prosthesis:

  • Boleh memusingkan stering menggunakan kedua-dua lengan, jika tidak boleh dicadangkan menggunakan extended telescopic steering
  • Dashboard extension
  • Power door locks dan power window
Left arm above elbow Missing or Non-Functional
  • Inability to perform hand-over-hand steering maneuvers.
  • Disability reaching left-hand dashboard controls
  • Difficulty to reaching left hand dashboard controls
  • Difficulty activating horn while right hand is occupied
  • Steering knob or other steering aid mounted on the right
  • Right hand extension on left hand dashboard controls
  • Parking brake release adapted for use by the left foot
  • Automatic transmission
  • Horn ring that can be reached without letting go of the steering knob
Right Arm above Elbow Missing or Non-Functional
  • Inability to perform hand-over-hand steering maneuvers
  • Difficulty reaching right-hand dashboard controls
  • Possible difficulty turning ignition key
  • Inability to shift gears on standard tarnsmission
  • Steering knob or ather device mounted on the left
  • Left hand extensions for right hand dashboard controls /signals
  • Ignition key reachable with the left hand while parked or adapted for the left hand.
  • Automatic transmission
Kedua-dua lengan di atas paras siku tiada atau tidak berfungsi
  • Tidak boleh menggunakan stering yang standard.
  • Tidak boleh untuk mengendalikan gear yang standard.
  • Tidak boleh mengendalikan signal, ignition key, pengendalian komponen dashboard, hon, parking brake release dan penukaran gear.
  • Pengawalan stering menggunakan kaki.
  • Automatic transmission
  • Pengendaliaan gear menggunakan kaki kanan,
  • Remote control menggunakan lutut untuk pengendalian ignition key, lampu  wiper hon, signal dan brek.

Conclusion

Pre-driving assessment for People with Disabilities is important to improve independency and a patient’s safety in driving and could indirectly improve services towards disabled patients.

In addition, there are also guidelines of medical standards for driving license for people with disabilities issued by the Occupational Health Unit, Division of Disease Control, Ministry of Health Malaysia in 2011. These guidelines are to ensure an assessment report on a disable who wishes to apply for a license does not pose peril to society by being prone to accidents. Vehicle are only authorized if criteria are met under provisions of section 30 (1) AND (2) of the Road Transport Act 1987 and the rules The Motor Vehicles (Driving Licences) Order 1992.

References

  1. Mallon,K. Wood, J.M.(2004).Occupational therapy assessment of open-road driving performance: Validity Of directed and self-directed navigational  instructional components. American Journal of Occupational Therapy,58, 279-286.
  2. Galski,T. Ehle,T.H. Bruno,L.R. (1989, December 13). An assessment  of  measure to predict the outcome of driving evaluations in patients with cerebral damage, American Journal of Occupational Therapy, 709-713.
  3. Physical disabilities ( missing or non-functional body parts ) their effects on driving and suggested driving Aids.

 

Last Reviewed : 16 February 2016
Writer/Translator : Suzana bt. Zakaria
Accreditor : Premalatha a/p Sundram
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