Hand Controls Keep You on the Go

Get evaluated, try before you buy, research low- and high-tech options

Mechanical and electronic hand controls can mean the difference between staying on the road and feeling trapped in your own home.

But while hand controls may sound like the be-all and end-all solution, there’s a long (and often expensive) road ahead. Planning, driver evaluations and training all are required in order to find the right equipment to safely meet your driving needs.

Spend money to save money — get evaluated

Once driving abilities start to change due to progressing muscle weakness, don’t make the mistake of ignoring it. If you can’t adequately turn the wheel or react as quickly to hit the brake, you’re not only endangering yourself, but also your passengers and everyone else on the road.

And that’s where a Certified Driver Rehabilitation Specialist (CDRS) can make a world of difference. A CDRS can help determine whether you’ll be able to drive with modifications and adaptive equipment.

The first step is to speak with an occupational therapist (OT) about changes in driving ability. An OT also may be able to help locate a CDRS in your area (and many driver rehab specialists also are OTs).

Next, obtain a doctor’s prescription giving medical approval for an initial driver evaluation.

Don’t buy anything until you’ve been evaluated by a CDRS. During the evaluation, drivers have the opportunity to try various kinds of driving equipment in different vehicle settings.

While you may be able to use any of the available hand controls, the CDRS will determine the best system for your abilities, now and in the future.

For example, the CDRS will evaluate whether you can stop the car safely. If not, low- or zero-effort braking controls may be recommended. Or, if you have difficulty maneuvering a traditional steering wheel, the CDRS may recommend a steering control, a smaller steering wheel or reduced-effort steering.

“Drivers need to get to a CDRS,” said Peter Ruprecht of Drive-Master, a hand control manufacturer. “It’ll cost them some money to get evaluated, but they’ll get prescribed correctly, and they’ll be a safer driver. Some states require that it be done through a CDRS. And in the long run, it can save them some money by getting a prescription for the right equipment the first time.”

Getting a good eval

“You can make some very costly mistakes if you just order a certain driving system off the Internet,” warns Lori Benner, an OT and CDRS at Penn State’s Hershey Medical Center in Hershey, Pa., and president of the Board of Directors of the Association for Driver Rehabilitation Specialists (ADED).

Although driving specialists prefer to prescribe — and drivers prefer to buy — the least costly and least technologically advanced system possible, that system still has to be usable a year from now, she notes.

“We can prescribe driving systems where the total vehicle cost can be upwards of $100,000. Certainly, you don’t want to make a $100,000 mistake.”

People with neuromuscular diseases should ask the driver rehab specialist “what kind of experience have you had with someone like me?” Benner advises. “You don’t want to train with someone who isn’t familiar with muscular dystrophy and its progression.”

The CDRS should ensure that driving adaptations will work “on your weakest days,” and can accommodate progressive weakness, she emphasizes.

Behind-the-wheel training

Both low- and high-tech hand controls require behind-the-wheel training in real-life traffic situations.

To apply for many adapted driving programs, drivers need a physician’s referral, and a valid driver’s license or learner’s permit.

The number of training hours depends on the driver’s experience and type of equipment used. A first-time hand-control driver may take longer than someone who’s had hand controls but is training with a different system.

Benner advises training with a CDRS who uses the equipment you’ll be using, and who will train in your vehicle once the hand control system has been installed.

She says it may take 10 to 12 hours to train on a simple set of mechanical hand controls, and up to 40 hours to train on a high-tech system. It’s costly (see below), so ask the CDRS for an estimate beforehand.

Everyone learns at his or her own rate, so the amount of behind-the-wheel training will vary, says Carol Blanc, a CDRS at Banner Good Samaritan Rehabilitation Institute in Phoenix, Ariz., who specializes in high-tech driving systems.

After the initial evaluation, Blanc trains the driver to determine which system will work best. Halfway through the training, she starts behind-the-wheel training because “the most valuable thing is to see that they can handle all means of traffic.”

Once she’s convinced the driver can handle the equipment in all levels of traffic and various challenging situations, she’ll write a prescription for the hand control system and modifications. After the system has been installed, she helps transition drivers into their own vehicles and continues training for an undetermined amount of time.

With Blanc’s final approval, the driver can take the field driving test to become licensed in the vehicle.

What’s it cost?

The price tag for an evaluation and subsequent training with a CDRS depends upon location, type of facility, extent of training, and the person’s age and driving experience.

Before applying to a program, ask how the cost will be calculated.

For example, at Banner Good Samaritan Rehabilitation Institute, Blanc said fees are charged by the hour. A typical evaluation costs $212 per hour and can range from two to four hours. For behind-the-wheel training, the hourly price is $180 for a car and $192 for a van.

Prices vary, but on average:

• Evaluations in a van run $424 for two hours and $850 for four hours;
• 10 hours of training in a van runs $1,920; and
• 40 to 60 hours of training in a van ranges from $7,680 to $11,520

Your insurance company may assist with some or all of the cost.

If you’re working, check first with your state’s department of vocational rehabilitation. They may pick up the bill for your vehicle’s modifications — including the installation of hand controls — and also may cover the cost of an evaluation and training.

Equipment costs

The driver’s needs and type of vehicle play a major role in the cost of adaptive driving equipment. Prices can start as low as $500 for a basic mechanical hand control, and hit the $100,000 mark for a high-tech, all-electrical gas, brake and steering system.

It pays to work with a reputable mobility dealer, especially one who understands progressive muscle diseases. (To locate a NMEDA mobility equipment dealer, visit www.nmeda.org, or call 800-833-0427). Equipment and installation costs vary nationwide.

Manufacturers and mobility dealers can customize many hand control systems to better meet specific needs — for a price.

For example, with most mechanical hand controls, the user has one hand on the steering wheel and the other on the hand control lever. If people find steering with one hand difficult, a steering wheel device like a spinner knob can be added for better control and maneuvering.

However, costs rise when you add devices like spinner knobs. Costs also climb as you add specialized electronic secondary controls and modifications to the steering and brake features, including horizontal steering, reduced-effort steering, and low- to no-effort braking.

For people with progressive muscle weakness, manufacturers often advise buying controls that can compensate for decreasing strength and range of motion. Although pricey, purchasing a system that will accommodate future weakness is more cost-effective.

Low-tech systems

Some basic information on mechanical hand controls:

• There are four basic designs — push/pull, push/right angle, push/twist and push/rock.
• With all four styles, drivers push the control to engage the brake.
• Hand controls can be mounted on the right or left side depending upon the user’s abilities and needs.
• Prices range from $500 to $2,000, depending upon the kind of vehicle and additional equipment/modifications.
• Electronics can be used in conjunction with mechanical controls to customize systems.

The push/pull design requires the driver to push the control forward to brake, and to pull back and hold to accelerate. Peter Hilcoff of Automobility, which manufactures a standard push/pull control, explains that “the benefit of the push/pull is that you’re either going or stopping because you can’t gas and brake at the same time.”

While there’s less room for confusion, a person may require more arm strength to operate the push/pull, which must be pulled toward the body and held to maintain speed.

In addition, Driving Systems Inc. (dSI) and Mobility Products & Design (MPD) each offer floor-mounted push/pull controls. DSI’s Menox system and MPD’s 3700 vertical push/pull can be installed on the right or left side of the steering wheel.

Some drivers find it easier to push down for the gas instead of pulling toward their bodies.

With the push/right angle, drivers push forward for the brakes and down toward the lap for gas. However, the system doesn’t preclude drivers from pushing down for the gas and forward for the brake at the same time, which can be a safety concern.

“The weight of your hand can hold the desired cruising speed, which can be less fatiguing than other options,” says Tom Stowers, president of Creative Controls Inc., which manufactures push/pull and push/right angle controls. “If you’re pulling toward you, you have to keep the muscles contracted and hold that effort, which could be more fatiguing.”

Keith Howell, president of Sure-Grip, says his company’s push/rock hand control is ideal because the handle is in a vertical position, allowing the driver more two-handed contact on the wheel. It’s not necessary to grip the control; a driver rocks his or her hand on the top of the handle, rocking back to accelerate and forward to apply the brakes.

The push/twist style requires twisting the handle for the gas and pushing the hand control lever for the brakes. The big difference between this and the push/pull is that the driver doesn’t have to pull the lever back and hold in order to accelerate.

More power, less effort

Driving Aids Development Corp. offers push/twist and push/pull hand controls with power assist, which makes it easier to operate and alleviates the fatigue factor. DADC’s power-assist control ranges from $850 to $1,200.

“This might not seem like a big deal, but it can be,” says Lee Perry, DADC’s owner. “If you operate the gas on the typical hand control, it’s not really that hard to operate. However, try it over and over again for a long period of time, and the moderate force of the manual controls can add up to feel quite heavy.”

Perry also notes that the power assist feature accommodates drivers with limited range of motion.

“With power assist, the driver doesn’t have to move his hand as far in order to get the full range, from idle to full throttle,” Perry adds. “The handle often can be located in a more comfortable position, usually higher above the driver’s lap.”

Perry says another power assist benefit is that, since the throttle motion is shorter, the handle can be located closer to the driver, meaning the driver doesn’t have to reach as far when applying the brakes.

“The power assist hand controls are a great intermediate step between two ends of the spectrum [low and high tech],” Perry says. “Many people who may not be able to use the manual controls comfortably could get the power-assisted controls instead of the electronic controls, and for much less money!”

High-tech solutions

Customization plays a significant part in outfitting a driver with adequate hand controls. This often means combining mechanical controls with some electronics, as well as systems that rely on pneumatic and all-electronic gas, brake and steering features.

For example, a driver may have an electronic or pneumatic control for gas and brake that can be used in conjunction with the factory steering wheel. A system like this can range in price from $15,000 to $30,000.

Creative Controls, Troy, Mich., manufactures a pneumatic (air-driven) gas and brake system called the AirTouch Extreme, which can be used with standard or modified steering systems. The system responds to a light touch and has a short distance between pushing forward for the brake and pulling back for the gas. Control sensitivity can be adjusted based on the user’s strength and range of motion.

In addition, KEMPF, Sunnyvale, Calif., manufactures a digital accelerator ring that sits inside the steering wheel (starting price $12,000). Drivers push lightly to accelerate. The ring is used in conjunction with the factory steering wheel and a mechanical hand brake lever installed on the left or right side of the wheel.

“It’s a very convenient way of driving with both hands instead of having one hand on the steering wheel and the other on the hand control,” said Martine Kempf, KEMPF’s CEO. “It allows you to keep all of the car’s original safety features, including the driver’s side airbag and the airbag in the steering column under the dash.”

With traditional mechanical hand controls, Kempf says that the dealer typically has to disable the airbag under the dash.

Or, if a driver is unable to use the factory steering wheel, he or she may try an electronic gas and brake control for one hand and a smaller, electrical steering wheel to use with the other hand. Prices range from $35,000 to $60,000, depending on additional modifications and equipment.

Joystick controls

Drivers who can use only one hand for driving and who have limited strength and range of motion in both upper and lower extremities may require a completely automatic system, like a joystick control for gas, brake and steering.

Joysticks are beneficial for someone “who’s very weak” but “has good sensation and good fine motor control,” says CDRS Carol Blanc.

She notes, “If we’re looking at the long term, I will go to the more high-tech equipment earlier because muscular dystrophy is progressive. However, joystick hand controls are very hard to learn. It takes conscious effort until you really know it. It’s not for everyone.”

Joysticks are a last-resort solution, “and you don’t ever want to make it your first option,” says a sales representative from Ace Mobility (formerly Ahnafield Corp.).

“This stuff is expensive, and depending on how much equipment is needed, it could cost more than the vehicle.” Joystick driving packages can top the $90,000 to $100,000 mark.

Ace Mobility’s joystick, or drive-bywire system, is an electronic-over-hydraulic system: The electronics are the brain, and the hydraulics make it go. The system is operated by moving the joystick forward for the brake and pulling back for the gas, while moving the stick left or right to steer.

Systems that brake by pushing forward are better for people with low strength and limited range of motion. It’s easier to apply the brake in the forward direction, an Ace Mobility sales rep says, because the momentum of the vehicle helps the person push.

With costs so high, experts in the field advise drivers to work closely with a CDRS and mobility dealer in evaluating disease progression before settling on a high-tech system.

Drivers need to plan for the future, and purchase a high-tech system that will work now and beyond. It could save a lot of money in the long run — which, let’s face it, you’re going to need for gas.

For more information on the products mentioned in this article, plus other resources for drivers with disabilities, see InfoQuest.