Upper and Lower LimbsSeptember 8, 2022
BILATERAL UPPER AND LOWER LIMBS
e.g. quadriplegics, Cerebral Palsy, etc.
Where all 4 limbs are affected, e.g. a quadriplegic, the conversions start getting a lot more involved. The driver will require both hand controls and a steering spinner. Where they have limited hand function they will also require adaptations to the gear shift, park brake and other secondary controls. If they do not have the strength to manage the steering or if the limbs as missing due to amputation then they need to consider an electronic system such as a joystick or mini-steering. Unfortunately 4-way joy sticks are currently not available in SA and would therefore have to be imported.
Many quadriplegics have difficulty transferring themselves into the vehicle and loading their wheelchair, in this case the option of driving from the wheelchair can enable them to drive independently. [Go to Drive from wheelchair]
If a person with limited hand function chooses to use a push pull hand control they will need a U-shaped grip to enable them to pull it.
Spinners for quadriplegics have either two or three prongs which hold the hand in place. The cheaper spinners stay permanently on the steering wheel; however it is also possible to get quick release spinners, where the spinners handle slots into a base on the steering wheel. This is very convenient for when the vehicle is shared by an able body and a disabled driver.
ADAPTATIONS FOR LIMITED HAND FUNCTION
These need to be designed according to the individual’s function. A person with limited grip, may require many small adaptations to enable them to use all the vehicle functions.
Examples of quad adaptations:
Steering Grip: Some people prefer not to use a spinner and can manage by improving their grip on the steering wheel, by wrapping it with a leather or rubber binding, or by using a non-slip material and increasing the size of the steering wheel to enable them to use a tenodesis grip.
Depending on which hand is on the hand control or which hand is in a spinner, the indicators may need to be moved to enable them to be accessed from the opposite side of the steering wheel. The indicators can also be activated by buttons which can be positioned on the hand controls, or anywhere around the driver to enable them to activate them with a specific part of their body.
A door opener lever may be useful for opening a door handle if the driver has no finger function.
Some vehicles make use a of a twisting action for turning on the head lights, a small lever can be fitted to enable a person to twist the lever by hooking a finger over it. An excellent feature that is available on many modern cars are automatic lights, which do not need to be swithced on and off, and they automatically dim when there is an oncoming car at night.
On automatic cars the gear shift frequently has a button that need to be pulled in to enable to lever to be moved into gear. This button is usually positioned to the side or at the front of the gear shift so the adaptation will depend on the position of the button.
A hand brake also usually requires a button to be pushed in, in order to release it. A foot park brake may require a hand control type attachment to enable it to be released by hand.
It may be helpful to have the key built up or add some form of lever grip to enable it to be twisted without a grip.
The design of the switches of the auxiliary controls is a factor to consider when choosing a vehicle. These toggle switches on a Mini are well suited for quad hands.
Manual seat adjustments may need an extension to accommodate limited hand function.
SINGLE UPPER AND LOWER LIMBS
e.g. hemiplegic, cerebral palsy, stroke, head injury, amputees, etc.
Left side affected
Where both the left arm and leg are affected, the driver will need to drive an automatic car with the use of a spinner on the steering wheel in order to provide an adequate grip while driving one handed. [Go to Steering Spinners]
Where there is still some function in the arm and leg the driver should be individually assessed to evaluate whether there is adequate grasp and release on the steering wheel, park brake and gears, and if the foot control is good enough for the clutch.
With combination amputations, most below knee amputees can drive safely using a prosthesis on the clutch, but their gear changes and use of hand brake will depend on the length up residual arm. Use of an automatic vehicle will eliminate this problem.
Right Side Affected
Where the right arm and leg are affected, the driver will require an automatic car with a left foot accelerator pedal, [Go to left foot accelerator pedals] along with a steering spinner [Go to steering spinners] on the steering wheel in order to provide an adequate grip while driving one handed.
Where there is still some function in the right arm and leg, the foot may still be used for driving if there is adequate sensory feedback and strength in the hip to ensure fast, accurate movement between the pedals. The grasp and release in the hand should be assessed to evaluate the safety of using it on the steering wheel.
With combination amputations, some well rehabilitated below knee amputees can drive safely using their prosthesis on the pedals. Otherwise a left foot accelerator pedal [Go to left foot accelerator pedals] is recommended. If a manual vehicle is driven they will need a spinner for the right arm to ensure adequate grip on the steering wheel during gear changes. Each individual should be set- up according to their individual function.
TRIPLE LIMB AMPUTATIONS
Where three limbs are severely affected – through a spinal injury or multiple amputations, the adaptations will need to be custom built according to the function that they have in the remaining stumps and limbs. Where there is one functional limb the main option is a 4-way joystick control. Unfortunately these are not available in South Africa and will have to be imported.
|This is an example of a system that was built by Easy Drive WC, for a triple amputee, where they were able to use the sideway action of his leg for braking and the acceleration, steering and secondary controls were all managed by his right hand using a spinner with the secondary controls on buttons that he could activate with his fingers, and the acceleration on a Pulsar electronic accelerator, designed by Guidosimplex.|