Training and education for physically challenged drivers

By: William Earl Jones

Date: Tuesday, 09. January 2007

William Earl Jones is a former Assistant Professor at the University of Central Oklahoma who now operates his own training service for physically challenged drivers in Oklahoma City, USA. He can be contacted at Voice/Fax: (405) 840-2933

Training and education for the driver with aphasia

APHASIA {uh-fay'-zhuh} is the loss or impairment of the ability to use spoken and written words. The disorder may follow damage to the dominant hemisphere of the brain, which, in right-handed persons, is almost always the left hemisphere.

The two broad classifications of aphasia are Broca's and Wernicke's. In Broca's aphasia-also known as expressive, motor, nonfluent, or telegrammatic aphasia-patients understand speech reasonably well but have difficulty in retrieving words and hence in naming objects or expressing themselves. In Wernicke's aphasia-also known as receptive, sensory, fluent, or jargon aphasia-patients produce fluent but nonsensical speech, or jargon, and comprehend poorly the speech of others.*

An aphasic person is characterized by having either expressive difficulties or perceptive difficulties, or a combination of the two. This does not mean that aphasic drivers cannot understand what they hear or are unable to explain what they want to explain. Instead, it means that, because of the disability, there is, in some cases, an inability to express themselves or to receive communication from the teacher. It is, therefore, paramount that the teacher secure a clear understanding of the difficulty of the aphasic driver and develop techniques to communicate, such as pointing, moving the hand in different directions, or other actions to permit the aphasic driver to know what the teacher wants. It should be recognized that this may be considered a part of hemiplegia, which suggests similar difficulties in expressing or understanding speaking and writing, all of which may have an adverse effect on driving skills.

Suggested Evaluation

1. Secure a physician's evaluation in terms of the student's potential for safe driving.
2. Consult occupational and physical therapists concerning the student's capabilities and limitations for safe driving.
3. Check the student for recognition and understanding of road signs, signals, and markings. This may require innovative ideas on the part of the teacher.
4. Evaluate the student on the psychophysical tests with particular attention to vision and reaction time. This is for screening purposes only.
5. Evaluate the student on a complex reaction timer.
6. Check for possible perceptual difficulties, including peripheral vision.
7. Check out the student on different modes of communication, particularly response to oral instruction.
8. Evaluate the student on a simulator. Permit extensive practice and check for response to changing traffic patterns.
9. Permit the student to drive in controlled areas. Record ability to receive instruction and express reactions to be used for later instruction.

Suggested Aids

The nature of the aphasic student does not readily lend itself to adaptive mechanical driving aids unless there is a physical disability. If this is the case, other parts of this publication may be used for direction.

Teaching Suggestions

1. Utilize the information obtained from the physician, occupational therapist, and physical therapist in terms of limitations imposed by the disability.
2. Be prepared to develop means of communication on a one-to-one basis based on hand signs, pointing, diagrams, or any other means of modified communication.
3. Remember that understanding and patience with the aphasic driver can be most helpful.
4. Use off-street driving skill procedure as developed in teacher preparation courses.
5. Use the figure eight practice extensively to determine perceptual difficulties in the form of left or right hemiopsia.

Summary

The aphasic driver represents a selected type of disability in which reception of instruction and expression of thoughts may be difficult or in some cases practically impossible. Therefore, the teacher must understand the disability and develop an individualized method of teaching the student. The occupational and physical therapist can be helpful, if available.

Aim

To develop an understanding of asphasia as it relates to teaching the aphasic student to drive.

Objectives

The teacher will be able to:

1. Define aphasia
2. Describe characteristics of aphasic driver.
3. Explain how the medical team examines the aphasic driver.
4. Identify techniques the teacher should use in teaching the aphasic driver.
5. Explain what procedures should be taken when the aphasic driver exhibits characteristic aphasic tendencies.

The teacher and the physically challenged driver

The teacher should have basic education and preparation in all phases of the driver and traffic safety program and should particularly have some instruction in teaching drivers with disabilities. It is assumed that in the near future several states will require some instruction or even a preparatory course in teaching the physically challenged to drive as one of the basic areas of teacher preparation.

The teacher of people with disabilities should have all of the attributes of any other well-prepared teacher, including knowledge, enthusiasm, self-discipline, maturity, interest in all students, a positive attitude toward the traffic safety program, and a desire to continually upgrade competency in the field.

One of the important aspects of upgrading competencies is the upgrading of teaching skills necessary in working with the physically challenged student. Therefore, teacher preparation courses and programs should include instructional techniques such as lesson planning, units of study, seminars, workshops, and other educational modes of teaching the physically challenged driver.

In summary, if a physically challenged student desires to enroll in a driver education course, the student must be provided an opportunity to enroll. The only exception is when a student cannot function in a normal driver education course because of severity of his or her disability.

Education/defensive driving for the physically challenged

In terms of actual driving by the physically challenged, the driver education teacher is the key person. However, the teacher must rely on the professional opinion of the physician, occupational and physical therapist, counselors, psychologists, and other professionals about the driving ability of the disabled driver.

The teacher must take the information from these professionals and utilize knowledge and skills of the safe driving performance task to develop the remaining attributes of the driver to the best of the physically challenged person's ability.

Careful consideration should be given by the teacher to the motor and sensory levels remaining, and the effectiveness of utilization of mechanical, electrical, hydraulic, and similar devices to assist the driver to maximize his or her skill potential within the limitations of this ability.

The teacher should keep in mind that safety is paramount in each situation. Due to various disabilities, it will take a long time, and more persistence on the part of the teacher, to teach the physically and mentally impaired. But that is the challenge and, under current law, the obligation of the public education system. Most driver education teachers will accept this obligation willingly.

The physician and the physically challenged driver

The physician's role in evaluating drivers with disabilities is a crucial one because motor vehicle crashes constitute one of the nation's largest health related problems and the physician can contribute a major part in the assessment of a driver's mental and physical capabilities and limitations.

Medical conditions can seriously impair ability to drive, and failure to recognize this fact could lead to serious consequences. Physicians, therefore, need to be in a position to give informed advice to patients under their care.

Many times the physician will consult with the occupational therapist, physical therapist, psychologist, counselor, driver education teacher, and others to help make a more valid evaluation. The physician may not be specifically asked to determine who should be licensed to drive but can determine if driver limitation exists.

Physicians can judge, for example, if any individual lacks the physical and mental ability to manipulate controls; fails to meet specific driver licensing standards in the state; is likely to suffer from fatigue; has serious emotional disorders; or is likely to experience temporary impairment due to drugs, infections, or medical therapy.

Consultation with a physician should include:

1. The degree of adjustment the student may have to make.
2. The ability or inability to flex, extend, or rotate parts of the body.
3. The use of cuffs, grips, prosthetic devices and/or any vehicle modifications.
4. Musculoskeletal involvement if the student suffers from a type of disease such as arthritis, muscular dystrophy, multiple sclerosis, or cerebral palsy.
5. Mental, neurological or emotional assessment.
6. The perceptual skills of the student.
7. Prescribed medications the student may be using.
8. Date of onset of the disease or disability.

Careful and periodical appraisal must always be made by the physician to determine if the student is continuing to maintain the stable level of physical, mental, and emotional control necessary to safely operate a motor vehicle. This is especially true if the student has a chronic or progressive disease.

Because disabilities may be temporary, chronic, progressive, or in a state of remission or relapse, it is of utmost importance that the teacher discuss these matters with the physician and the student before making final decisions about driving.

There is no substitute for the evaluation, especially the physician's, because not all disabled persons can or should drive. Therefore, based on evaluation by the teacher, the physician, and other previously cited key personnel, an informed decision can be made concerning the ability of the physically challenged individual to be taught to drive.

Reference:

Agranowitz, Aleen, and McKeown, Milfred R., Aphasia Handbook (1975); Darley, Frederick L., Aphasia (1982). (Grolier's Academic Encyclopaedia).

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