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As you and your family already know, life after a spinal cord injury is never the same. Often one of the final steps in regaining your independence is returning to driving. Driving frequently leads to being able to return to work, school, and leisure activities. As with other activities of daily living you have already learned to do in a new way, you will need training and adaptive equipment to be safe and successful when returning to driving.

If you want learn to drive or return to driving following a spinal cord injury, the first step is to have a driving evaluation. A driver rehabilitation specialist will first determine if driving is a realistic goal for you; not everyone is able to drive again. If driving is not a goal for you, they will assist you in finding alternative modes of transportation or you can contact a mobility equipment dealer, who will assist you in finding an appropriate vehicle for passenger purposes. More on this later.

Ideally, this evaluation would be completed by a certified driver rehabilitation specialist.

To find an appropriate driver rehabilitation specialist you should visit The Association of Driver Rehabilitation Specialists (ADED) website, www.ADED.net. On this website you will be able to locate ADED members in your state and identify if there is a certified driver rehabilitation specialist near you.

The comprehensive driving evaluation should include both a clinical evaluation and a behind the wheel evaluation.  The clinical evaluations assess your visual, perceptual, cognitive, and physical abilities.  That, in conjunction with the behind the wheel assessment, will help to determine if driving is a realistic goal, and if so, what driver training and adaptive driving equipment you will need to achieve this goal.

Although you will no longer be able to drive an automobile in the same manner, there are multiple types of driving equipment that can allow a person with a spinal cord injury to drive. The driver rehabilitation specialist will specify what type of adaptive driving equipment you will need. The amount and type of equipment will vary depending on your strength, range of motion, coordination, balance and functional use of your arms.

Most individuals who have sustained a spinal cord injury will need a set of mechanical hand controls and a steering device, such as a spinner knob. There are multiple types of mechanical hand controls. The equipment attaches directly to the vehicle’s gas and brake pedals, and allows the driver to operate the gas and brake using their hand instead of their feet. All mechanical hand controls operate the brake by pushing the control toward the dashboard.  The method to depress the gas pedal differs depending on the manufacturer. Your driver rehabilitation specialist will determine which type works best for you, taking into account your functional ability, size, and vehicle type.

A spinner knob is a type of steering device that is mounted on the steering wheel. This removable piece of equipment allows a person to use one hand to steer the vehicle (when the other hand is on the hand control). There are different types of steering devices available to accommodate different types of hand functions.  These will allow a person to steer a vehicle safely.

If you have decreased functional use of your arms, more complex equipment may be needed for you to safely accelerate, brake, and steer the vehicle. Individuals with greater loss of function will require higher-tech. equipment.

A few examples of this type of equipment are:
• Horizontal steering- This system moves the steering wheel to a horizontal plane and uses a smaller wheel to compensate for decreased motion and strength
• Electric gas and brake- hand controls that are operated electrically and require only a small amount of range of motion and strength
• Reduced effort steering and braking- compensates for decreased arm strength and range of motion
• Joystick driving systems- allows for one hand operations of brake, acceleration, and steering

If you require the higher tech equipment, you will most likely also need equipment to operate your secondary vehicle controls.  Secondary controls includes all functions other than gas, brake and steering (ex. turn signal, windshield wipers, air control, radio...) This equipment can be as simple as adding a toggle switch or making a knob larger.  It can be as complex as a system which electronically operates all the secondary controls by voice prompting.

Once the driver rehabilitation specialist determines your driving equipment needs, they will send the recommendation to a mobility equipment dealer. Selecting the appropriate mobility equipment dealer is as important as choosing a qualified driver rehabilitation specialist. The mobility equipment dealer is an individual or business that installs equipment or modifies vehicles for individuals with disabilities for use as a passenger or driver. You can find a qualified mobility equipment dealer by visiting the adaptive driving alliance website (www.adamobility.com) and the national mobility equipment dealer association website (www.nmeda.org).

Whether you are able to return to driving or not, choosing the appropriate vehicle to meet your needs is critical to regaining your independence. The mobility equipment dealer will assist you with this process. It is very important that you consult with them prior to buying a vehicle, as not all vehicles are suitable for modifications and some may not work for your needs, even if they are able to be modified. T

he type of vehicle you need is dependent on many factors, including the following:
• Your ability to transfer in/out of a vehicle
• The type of wheelchair you use
• Your weight and height in your wheelchair
• Your ability to store and retrieve your wheelchair
• Whether you will be a driver or passenger

Vehicle modifications that address a person’s ability to get in/out of the vehicle, handle the wheelchair stowage, or drive or ride in an appropriate vehicle or safely secured wheelchair include:
• Lifts to stow and retrieve the wheelchair
• Specialized transfer seats
• Lowered Floor Minivans- the floor of the minivan is lowered and the rear of the vehicle lowers (kneels), to allow someone in a wheelchair to enter and exit the vehicle easily using a ramp and to be able to see outside once in the vehicle. These vehicles also have removable driver and passenger seats to allow someone in a wheelchair to drive, ride in the front passenger area, or in the midship space
• Full Size Vans- A lift is needed for individuals in a wheelchair to enter a full size van. These vehicles can also have a raised door, raised roof, and lower floor added for someone who sits tall in their wheelchair

Remember, always consult a qualified driver rehabilitation specialist and mobility equipment dealer prior to making any decisions or purchases regarding a vehicle or driving equipment. Failing to do so can result in significant problems in the vehicle or adaptive equipment’s functionality.   Economics and the safety of the driver, passenger and vehicle can be negatively affected by uninformed decisions.