Handicapped and Amputee Drivers

CHARLES H. EPPS, JR., MD AND E'LISE BROWN, MA*Washington, D.C


AIthough Section 504 of the Rehabilitation Act of 1973 guarantees accessibility to public buildings and transportation, the objective has not been realized for all handicapped individuals. The problem lies in the fact that the disabled person often lacks mobility in the community. For example, if the individual is unable to get to the barrier-free building, he cannot utilize any of its services. Therefore, mobility as well as transportation, become pivotal considerations.

Basically, three alternative modes of transportation have been proposed by the Congressional Budget Office in its Budget Issue Paper for Fiscal Year 198 1, Urban Transportation of Handicapped Persons: Alternative Federal Approaches. the transit plan, the taxi plan and the automobile plan. Greatest mobility is achieved through the automobile plan, a contention based upon experiences in helping the handicapped use privately licensed automobiles. Examples include multi-limb-deficient children, as well as children and young adults with cerebral palsy, arthrogryposis, myelomeningocele, osteogenesis imperfecta and muscular dystrophy.

Four phases of mobility management precede licensure: 1) identification, 2) assessment, 3) training and 4) evaluation. The process begins by identifying an individual who is a candidate for driver's training. Medical criteria are reviewed, including the Driver Licensing Guidelines for Medical Advisory Boards developed by the American Medical Association with the American Association of Motor Vehicle Administrators. Conditions that disqualify a potential driver are listed.

The next step is assessment by the mobility specialist to determine the need for adaptive equipment. Engineering creativity and cost are the only limiting factors. Special seating and custom mechanical controls, including foot- and hand-control systems, may be required. Various servocontrol systems utilize a few pounds of force acting through a minimum range, for example, Scott Van, CCI-Hardin and Target Van. The assessment process also determines the individual's physical, perceptive and cognitive capabilities, as well as psychosocial characteristics.

Once it is determined that the individual is a suitable candidate, the training process begins. Simulators and actual road experience are utilized. Later the student driver is taken to a driving range where he is challenged by obstacles and unusual driving conditions and circumstances.

The next phase is evaluation. The mobility specialist determines if the student driver has achieved all objectives and is able to get into the car and operate the vehicle safely. Reasons for any failure are explored and a decision made regarding whether or not to extend the training.

The handicapped drivers who pass the evaluation phase present themselves for licensing. Each state has a specific process for granting a license, which must be regarded as the ultimate evaluation. Neither the medical personnel who identify and approve the individual's program nor the mobility specialist who trains the driver confers the final award. Rather, the state official who issues the license assumes the liability for licensure. Studies document that handicapped drivers as a group are as safe or safer than so-called normal drivers.

*D.C. General Hospital, l9th and Massachusetts Avenue, SE, Washington, DC 20003