Throughout America, the ability to drive is often fundamental to maintaining self-sufficiency and independence. In cities without adequate public transportation, seniors and disabled who cannot drive can find themselves isolated and alone or dependent on others. Those who are unable to drive may not be able to interact fully with their community or access medical care in a timely manner, often with tragic consequences.

A recent study from researchers at Brigham Young University found that social isolation increased a person’s risk of dying within seven years by 30 percent.

But a disability doesn’t have to mean the end of driving. Cars can be adapted with a variety of devices that allow individuals to continue to drive safely. A 2004 Scottish study, for example, found that some 80 percent of disabled individuals who were evaluated and deemed able to drive returned to driving despite their disabilities, with accident rates no higher than that of non-disabled drivers.

“To be able to help somebody who is already using a wheelchair to get out of their house, it’s so big,” said Trudi Cruzen, an occupational therapist and certified driver specialist at St. Charles Bend. “It is life-changing when they can no longer drive.”

St. Charles has two vehicles, a car and van, that have been fitted with adaptive technology that Cruzen uses to teach clients.

Left-foot only

For those who have lost the ability to use their right leg, whether due to a stroke or an amputation, the car can be fitted with a left-foot accelerator. “It’s not safe to cross over with your left foot,” Cruzen said.

Hands only

For individuals who can’t use their feet to drive at all, cars can be outfitted with hand controls for the gas and the brake, generally a wand like a turn signal, that can be pushed down to accelerate and up to brake. Hand controls are generally paired with a plate that blocks access to the gas and brake pedals. “When somebody drives with hand controls, we take away their ability to use their feet,” Cruzen said. “Because we don’t want to use both the hands and the feet.”

Both adaptations require significant training, she says, to make them second nature.

Cruzen said the left-foot accelerator is among the more difficult adaptations to master, even harder than using hand controls.

Drivers are so used to stepping on the gas or the brake with their right feet, it takes time to unlearn that habit.

“It’s an automatic response,” she says. “What we’re trying to do in our training it to get to the point where it’s reflexive.”

Wheel gear

Steering wheels can be fitted with a variety of knobs or other devices that allow for steering with one hand. Those who can’t grip a knob might be able to use a ring or a v-grip.

One of the biggest challenges, Cruzen said, is figuring out how disabled drivers can get in and out of the car to begin with. For those in wheelchairs, they need to be able to transfer from the chair to the driver’s seat, and then to bring the wheelchair into the car.

If that’s not practical, drivers might have to consider a van that they can roll their chair into and then transfer to a seat.

St. Charles has a van — complete with an “IM ABLE” vanity plate — that has a motorized chair that turns to allow someone to transfer from a chair in the back of the van.

“It’s swivelable,” Cruzen said laughing. “Is that a word?”

While some of the adaptations, like a steering knob, can be added for less than $100, the more extensive the adaptation, the higher the price tag. Installing hand controls, for example, can run about $1,500.

“In the reality of the world of owning a car, $1,500 is not bad,” Cruzen said. “But for an older person on a fixed income …”

Vans and their modifications can run into the tens of thousands of dollars. St. Charles works with Advanced Mobility of Bend, which specializes in car adaptations and can help people sort through more or less expensive options. Owner Dan Cummins warns that not all cars are easily adaptable, particularly some of the European models that have a lot of equipment or wiring compacted under the dash.

Some adaptive tools might come in handy for drivers who don’t consider themselves disabled but might need a little extra help. Auto supply stores carry mirrors that can be strategically placed to expand the view around the car and reduce blind spots. Many older individuals could benefit from a handle that can be attached to the door latch to help them get in and out.

If there’s any question whether drivers can continue to drive with disabilities, the therapists at St. Charles can do an evaluation.

“We can be the bad guy,” she said. “I’ve had people say, ‘I’m scared to get into the car with my dad. He doesn’t have good judgment of distance.’”

Cruzen will then take the person on a test drive and evaluate his or her driving skills.

“I won’t go just by what the family says. We want to give that person a chance,” she said. “But usually the family has pretty good insights.”

Cummins said most disabled drivers wind up driving only for a short period of time. They often return used equipment or even modified vehicles to be sold to others. That’s one way to offset costs for individuals who are already facing high medical costs due to their disabilities.

Medicare and private insurance, he says, rarely pay for adaptations, although Veterans Affairs will often cover the costs for disabled vets.

“You lose your license, you lose your ability to go out on your own,” he says. “This business is a feel-good business. We make so many friends here when we give them their freedom back.” •