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Eley, Tom --- "Disability-related vehicle modifications" [2016] PrecedentAULA 20; (2016) 133 Precedent 38

DISABILITY-RELATED VEHICLE MODIFICATIONS

By Tom Eley

‘Mary’ is a middle-aged woman with C5 quadriplegia who has recently had her van modified so that she can drive it independently without leaving her powered wheelchair. She operates the steering, brakes and accelerator with a four-way joystick; she has a low-effort, push-button transmission control and a remote-controlled vehicle ramp access and ignition. This means she is able to independently access the community for work and leisure. Mary says that being able to drive independently has been ‘like being released from prison’. The process of developing the modifications and teaching Mary how to utilise them cost just under $250,000.

The technology available for vehicle modifications for catastrophically injured people has advanced on all fronts over the last decade, both for those with a significant disability seeking to drive independently and for people travelling as passengers. The modifications often entail complex bespoke technological solutions and may therefore be expensive.

People with high-level spinal cord injuries, both complete and incomplete,[1] and people with multiple amputations, can now potentially drive themselves. The available technology may not be able to benefit everyone; however, for those who are both interested and capable, it can be life-changing. The increased independence afforded by vehicular mobility can have powerful psychological and rehabilitative benefits.

DRIVING INDEPENDENTLY WITH A CATASTROPHIC INJURY

A small number of companies in Australia currently specialises in modifying vehicles to enable a catastrophically injured person, often seated in their own wheelchair, to drive independently and safely. Following physical testing of what people can do, systems are developed to maximise independent access and control of the vehicle. Doors and ramps can be automated and operable from a wheelchair’s native control panel, or even via a smartphone app. Driving controls for steering, braking and accelerating are available that require only grams of force to operate. Remote start systems and push-button automatic controls can be fitted that are suitable for a wide range of disabilities and functions.

The associated costs of such modifications are significant. The cost of the base vehicle, wheelchair access modifications and specialised controls can add up to as much as $250,000. These vehicles and control systems have a service life of about 10 years (or 160,000km) and therefore also represent a significant recurrent cost. As a result, some insurers (that is, bodies such as WorkCover or Victoria’s Transport Accident Commission) have been guarded about funding this available technology.

The assessment of a person’s ability to drive with the high-end modifications described above, together with the associated training and vehicle modification, are highly specialised areas of expertise. There are currently only a few occupational therapists and vehicle conversion workshops able to provide such services. However, given the enormous benefits that accrue, there is a great need for an expansion of service providers. As someone who has repeatedly seen the difference travel independence can bring to someone’s life, I believe that the possibility of independent driving should always be considered when looking at a person’s post-injury needs.

TRAVELLING AS A PASSENGER IN A WHEELCHAIR

‘Kevin’ is a young man living with quadriplegia who had an inappropriate vehicle with poor ride quality, and was only able to travel for periods of 15 minutes, after which he had to be hoisted out of his chair for a rest. He is now able to travel in his properly modified vehicle for many hours at a time without experiencing pain, discomfort or fatigue.

Riding in a wheelchair can be far less comfortable than being seated in a normal vehicle seat. A normal vehicle seat has multiple springs and thick foam padding, while a wheelchair has a flat metal seat base covered by as little as 25mm of cushion under the occupant. It is therefore imperative that vehicles modified to accommodate people in wheelchairs, either as drivers or passengers, have a suspension that is designed to provide a comfortable ride. Ride quality impacts greatly on a person’s endurance because people with limited musculature need to work hard to maintain their posture, while those with little or no available musculature will be displaced in their wheelchairs, which inevitably requires frequent stopping for repositioning.

Given the available solutions, a modified commercial van and a simple hoist setup is no longer a reasonable outcome. Clients have described travelling in such vehicles as like ‘travelling in a washing machine’. Quite apart from this poor ride experience, the wheelchair’s position in the vehicle makes for very poor communication for the disabled person with the driver. Furthermore, this set-up in existing commercial vehicles often allows for very limited safety features.

The safety features available to a disabled passenger should be identical to those that are standard for an able-bodied passenger. If modifications are done correctly, having a wheelchair-seated passenger in the front passenger position will not only grant access to the safety features of the front and side airbags, but will also facilitate conversation with the driver.

A FINAL WORD OF CAUTION

There is no one-size-fits-all solution, as every person’s abilities are unique. It is imperative to have an individual’s specific requirements assessed and the modifications implemented competently so that their needs are fully met and the options chosen last as long as is feasibly possible.

Tom Eley is an occupational therapist, qualifying in 1987 and working in private practice since 2000. He specialises in the prescription of vehicle modifications for both drivers and passengers. He is a Vicroads-accredited OT driving assessor, a qualified driving instructor and a qualified motor mechanic. He is a Paravan (Germany) accredited driving instructor in the use of drive-by-wire driving controls. PHONE 0419 318 855 EMAIL tomeley@otsolutions.net.au.


[1] A ‘complete’ spinal-cord injury is one in which the spinal cord has been completely severed or damaged such that no signals to or from the brain are able to be transmitted; an ‘incomplete’ spinal-cord injury is one in which permits some degree of voluntary movement and sensation.



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