Transportation

Transportation Options for People with Disabilities

Kathy Norton, MClSc (OT)

Options

• Cars

• Trucks

• Vans

• Taxis

• Handidart

• Bus (City, Greyhound)

• Plane

Car Considerations

• 4-door vs 2-doors

• Seat options: bench vs bucket; height

• Types of transfers required vs abilities

• Folder vs rigid frame w/c

Truck Considerations

• Better in snow - clearance and 4WD

• Transfers required vs abilities

• “BrunoBruno EZ RiderEZ Rider” and “Cab Sider”

• ‘Twin or extended’ cab required

• Must be indep. with transfers!

• e.g. Ford F150

Van Options

• Full-sized vs Mini van• Tie-downs vs ‘EZ Lock’• Consider wheelchair/seating needs – size and

wheelbase• Ramp location: In floor, Under vehicle (UVL), or inside • Driver vs passenger.• Overall client height for head clearance!!!

Car vs Truck vs Van

• Power vs Manual• Chair type + seating

needs• Transfers• Energy Expenditure• Time Requirements• Skin Integrity

• Injuries (temporary overuse)

• Environment / weather

• Family, social, and work requirements

• Financial issues• Maintenance

Conversion Options for VansMINI FULL-SIZED

Commonly Converted Vans

GM Chevy Venture (Silhouette)

Ford Windstar

Chrysler Plymouth Voyager (Grand Caravan)

Ford E150 / E250

(3/4 or 1 ton)

GM/Chevy

4WD Full size

Available Conversions & Modifications

Lowered Floor

Raised Roof

Side or rear Ramp

(manual fold-out vs power)

Power Kneel

Power Side Door

Removable Seats

Power (4 or 6 way) Front Seats

Tie-Downs vs EZ lock

All Driving Modifications

Lowered Floor (Ford Only) 4” or 6”

Raised Roof (sport top) 6-8”

Back or Side Lift

Power Door

Removable Seats

Power Front Seats

All Tie-Down Options

All Driving

Modifications

Conversion Options for VansMINI FULL-SIZED

Handling Drives like a Car Bigger to drive and park

Clearance Less clearance under van, not appropriate for all terrain, snow

Better clearance

Have to be aware of height

Inside Space

Less space for wheelchair maneuverability inside

Can be more space for larger wheelchairs

Great for those with less confidence and skill

Door Height

54-56” (side door) 53” with lowered floor, may need raised roof also

Cost New Van + Conversion:

$55,000 - $60,000

Just conversion:

$18,000 - $25,000

Used Van + Conversion:

$25,000 – $40,000

New Van: $38-45,000

Just conversion:$63,000+

Van + Conversion

$25-33,000

Used Van + Conversion:

$5,000 – $20,000+

Van Conversions

• VMI -

• VanAction -

• Vantage -

Driving Modifications

• Primary and Secondary Driving controlsPrimary and Secondary Driving controls• PrimaryPrimary: gas, brakes, steering• Spinner Knobs, T-handle,Tri-pin,• Zero-Effort Steering• Toggle/Switch Control• SecondarySecondary: remote start, voice activations,• climate control, stereo, lights, washers etc…

Driver Assessment & Rehab

Driver Rehab Ctr

Vancouver

604-322-8335

Robertson Rehab

Vernon

250-558-4584

Glenrose Rehab Hospital Driver Rehab Program, Edmonton

780-471-2262

Vehicle Dealers

CanAm Cruisers PG Surg-Med

Kelowna Prince George

250-491-0003 Lift installation only

www.canwill.com 250-562-2240

Shoppers Home Health Care Others:

Edmonton 780-562-4002 -SideWinderSideWinder – Chilliwack

Vancouver 604-326-1117 (all vans and conversions)

[email protected] -Tom HarrisTom Harris – Vancouver Is

(GM Dealer)

Flying!

• In own w/c until last minute loading

• Transfer to narrow aisle chair

• Own w/c gets taken to luggage

• At risk of damage to w/c, esp. powerchair controls

• Pressure relief and positioning in seat!

• Contact airline ahead of time for assistance or to book a practice session

SCI HANDS: Form and Function

• Assessment

• Tenodesis training

• Splinting Protocols

• Deformity prevention

• Range of Motion and exercise

• Tendon Transfer Surgery (Maura)

• FES

Hand Assessment

• COPM – client’s occupational goals!!• grip and pinch strength• AROM / PROM• dexterity and fine motor assessments• Functional hand assessments /observation• Sensation: pin prick, light touch, temperature• Edema control• Spacticity / tone issues

C4/5 level

• Shoulders and biceps only• Doral Wrist Support - with wrist

extension• Pocket or cuff on palm• Long opponens • ?tendon transfers• Resting splint and passive ROM

(ice/wax)• Self feed, teeth, sign name etc…

Tenodesis: C6-8 level

• Active wrist extension = passive finger flexion • Passive ROM: • Wrist strengthening • Splinting: resting splint, boxing glove, short

opponens, universal cuffs• ?tendon transfers• See Handout package for program• Feed, groom, write, type, wash, toilet, cook…

Why splint?

• Functional hand vs flat hand, claw hand

• Prevent deformity• Maintain functional hand position• Maintain good alignment of thumb in

relation to index finger• Enhance Function – short opponents,

thumb CMC or thumb post splint• Clients often prefer no splint at all

Types of Grasps in tetraplegia

• Key grip (lateral grip) – paper, tv remote• Palmar grasp - joystick• Cylindrical grasp - glass• Interdigital or interwoven – writing, cutlery • 2 handed – cooking, drinking, lifting• Wrist hook technique – dressing • Use of thumb to hook – mug, u-cuffs• Use teeth to assist – opening containers

Gadgets….!!!

Self Care / ADLs

**U-cuffs: toothbrush, hairbrush, cutlery, writing, typing, shaver, make-up…

Bathing / toileting routines

Kitchen / cooking – safety and independence

Reading

Writing / typing

Phone

Hands cont’d….

• Have client learn self-ROM program

• Wax or flax bags (heated) very popular

• Focus on client’s specific goals

• Call us here!

• Internet SCI resources – see handout!

• BCPA / Peers – best ideas come from those living with SCI

Contact Info

• GGF Strong Occupational Therapy Dept. 604 737-6286

• GFS Toll-Free: 1-866-906-1888