Amputations, handicapped people and driving

Most amputations in Western society are caused by peripheral vascular disease in patients over the age of 50

During recent years, due to traffic accidents, the number of amputations carried out on young people has increase, particularly those using motorcycles.

In thse cases, recovery and adaptation to driving is a more complex process because of associated injuries, as these patients suffer multiple trauma.

Standard post-operative care for all amputations includes sufficient resting period for the tissues using ferula, compression of the injured tissues, exercise and changes in posture to avoid contractures.

Subsequent rehabilitation eventually allows a prosthesis to fitted, compatible with the patient’s needs and abilities, which include driving.

Tips

• The amputation of a lower limb requires a long period of adaptation, from learning to walk with crutches to being able to walk safely with the help of the definitive prosthesis.
• Driving comes after this process has come to an end and requires adaptations suitable for the vehicle.
• When an upper limb is amputated, this will often require exhaustive training to be able to participate in daily activities and work, including driving an adapted vehicle.

Corporal integrity and disability

People should be physically intact to be able to drive, meaning that in principle drivers should be expected to have four correctly functioning limbs.

There shouldn’t be any disabilities that prevent the driver from sitting normally and using the controls and devices in the vehicle, or doing things that require abnormal or tiring positions.

Fortunately, if a physical disability makes it impossible to drive a normal vehicle, technical advances now allow these people to continue to travel independently by car.

The abnormalities and conditions that require adaptation or restrictions on people, vehicles and traffic, are determined according to the patient’s deficiencies, and must be carefully detailed in a medical report, which will later be evaluated at recognised centres.

Groups of experts from several EU member states meet periodically, to evaluate the ability of disabled people to drive or their special needs to help advance methods, techniques and common rules.

There are people who have controllable defects and are not disabled when using the controls of the vehicle, such as in the case of visual or hearing impairments that can be corrected by hearing aids or lenses to bring the deaf or visually impaired within the standards of sight or hearing required by law.

In cases of monocular vision or hypoacusia, accessories can be added to the vehicle such as rear view mirrors on both sides or a panoramic inside rear-view mirror, so as to cover all the risks these disabilities can give rise to.

In some cases, speed limits are imposed as an additional safety measure.

There should be no progressive illnesses nor anomalies.

It is recommended that the doctor issues a report to his patient at each check up, informing him of aspects of his disease that have improved, deteriorated or remained the same.

The report should be used to maintain or change the extension of the patient’s driving licence, and its period of validity.

More than 75 per cent of limb injuries that can affect driving are of the lower limbs.

Many people suffering from disabled limbs solve the problem by attaching devices to the controls of their vehicles that allow them to drive in a particularly safe and comfortable manner.

The same occurs with prosthesis which can be used to perfectly substitute the limbs they replace.

Adapting vehicles can allow a disabled person to reach all the controls he needs to drive, have sufficient strength to be able to operate them, be capable of reacting quickly enough in an emergency situation and coordinated while carry out all controlling the entire operation of the vehicle.

Time is needed to learn all the adapted devices, such as, for example, getting in and out of a wheelchair, loading and unloading the chair and other goods, putting on the seat belt, using secondary controls, such as the gear lever, hand brake, indicators, window handles or buttons, lights and windscreen wipers, sitting up straight in the seat with an unstable trunk, and preparing the vehicle.

Technological advances mean that vehicles with power steering and automatic gears allow certain disabled people to drive professionally, a situation which was previous unthinkable.

Anatomical or functional losses or deficiencies that simultaneously affect one or both upper or lower limbs require exhaustive individual study and subsequent adaptation according to technical criteria, always in accordance with the medical report.

When all possible attempts at modifying the vehicle have failed to allow patients with diminished sensiomotor ability to control the vehicle with guaranteed safety, the person will not be allowed to drive.

When there are mechanical, motor problems or postural difficulties affecting the head, neck and trunk, an appropriate orthesis is obligatory to stablise the trunk, and if necessary a harness-type seat belt and / or appropriate rear view mirrors will be fitted. In addition, there will always be a maximum speed limit.

Controls of vehicles adapted for the physically disabled should allow not only the disabled driver for whom it has been modified to drive, but also able bodied drivers, except in cases of special modifications with restricted use.

The facilities installed must not irreversibly affect the original parts of the vehicle except in cases of restricted use, and must allow periodic services to be carried out.

Steering, signalling, gear changing, acceleration and braking must be guaranteed.

The vehicle must bear a identification plate, visible from driving position, and the equipment installed must comply with the general conditions established under current law.

Diseases and deficiencies of the limbs have changed over the years. War mutilations have came rare sights, as have motor sequelae caused by infectious diseases such as polimielitis.

Nevertheless, people are living longer and there is an increase in degenerative neuromuscular problems in the elderly. Patients with congenital disease have longer life spans and they want to continue driving, overreaching their limitations.

The increase in cardiovascular, neurological, musculoskeletal diseases and their complications mean a daily increase in the number of disabled patients who need to be helped to adapt to a new situation.

Traffic accidents sadly result in many disablements, with a large number of young people affected.

Preventing disease in all fields of medicine, including driving, whose preventable disease is the traffic accident, will allow us to reduce disability and the adaptation problems of the disabled.

It has been shown that the accident rate of adapted cars per 100 adapted cars per annum is 17 times lower than the general rate of accidents per 100 normal vehicles per annum.

The number of accidents caused by adapted cares is 6.5 times lower than that of normal cars.

Therefore, having a physical defect does not make driving impossible, and so long as the necessary minimum requirements are met and there is willpower do to things well, the disabled person can drive a car well, and with guaranteed safety.

Collaborating with specialist physicians treating the disabled driver is a key aspect of correctly evaluating the conditions under which the driving licence is issued and its period of validity, and also for the appropriate and safe adaptation of the vehicle, if this is required.

It is important to identify, within the limitation of the locomotive system producing the disease, only those interfering with driving.

A specialist medical report giving detailed information will need to be evaluated at recognised centres with extreme care, to determine which of all the disabilities really interferes with driving.

In cases of doubt, it is a good idea to facilitate communication among the professionals involved.

Most amputations in Western society are caused by peripheral vascular disease in patients over the age of 50.

During recent years, due to traffic accidents, the number of amputations carried out on young people has increase, particularly those using motorcycles.

In thse cases, recovery and adaptation to driving is a more complex process because of associated injuries, as these patients suffer multiple trauma.

Standard post-operative care for all amputations includes sufficient resting period for the tissues using ferula, compression of the injured tissues, exercise and changes in posture to avoid contractures.

Subsequent rehabilitation eventually allows a prosthesis to fitted, compatible with the patient’s needs and abilities, which include driving.

The amputation of a lower limb requires a long period of adaptation, from learning to walk with crutches to being able to walk safely with the help of the definitive prosthesis.

Driving comes after this process has come to an end and requires adaptations suitable for the vehicle.

When an upper limb is amputated, this will often require exhaustive training to be able to participate in daily activities and work, including driving an adapted vehicle.