Medical Driving Evaluations

Driving After a Limb Amputation

Posted by Joan Cramer on Sep 24, 2019 7:27:17 AM
Joan Cramer
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When you lose part of your body to amputation, it can be a long road to recovery, both physically and mentally. On top of the time spent healing from the surgery, going through physical therapy, and adapting to the use of a prosthetic limb, there is also a loss that needs to be grieved and a new way of life that needs to be adopted. Part of this new life is wrestling with how your amputation will impact your mobility and independence. Once daily tasks such as driving become difficult or seemingly impossible, and you may be tempted to give up. But don’t throw away the keys yet, there’s good news. In most cases, with rehab, training, and possibly some adaptive driving devices, you can get back behind the wheel and continue living your life in freedom.

What is amputation and why does it happen?

Amputation occurs when a part of the body must be cut off for some reason, often to save the life of the patient. This can happen for a variety of reasons. In the United States, the most common cause of amputation is vascular disease. Diabetes, peripheral vascular disease, blood clots, or other conditions can decrease circulation to the extremities. When this happens, the tissue in your limbs is unable to receive adequate nutrients and oxygen. This leads to tissue death, which if left untreated can cause severe infections. Limbs are often removed to prevent infection from spreading to the rest of the body.

Limbs may also be injured by burns, frostbite, or traumatic injuries. If the damage is severe, there can be excessive bleeding or tissue death that leads to severe infection. Both of these complications can be fatal, and the limb may need to be removed to save the patient’s life.

The other leading cause of amputation is cancer and tumorous growths. In order to remove these, it may be necessary to remove the entire affected limb.

Depending on the cause of amputation, a person may lose part or all of any of their four limbs. The severity of the amputation affects how much function the limb is able to retain and what sort of prosthetic devices can be used to supplement that function.

How can limb amputation affect my ability to drive?

Amputations can happen on any limb or combination of limbs, and at any place between the body’s trunk and the end of the limb. Because of this, there are many ways that amputation can affect your driving. The challenges that one driver faces may be completely different from those of another driver, but their commonality is that it makes operating the vehicle controls more difficult.

Some leg amputees may be able to continue or relearn how to operate the gas, brakes and clutch with their good leg or with their prosthetic. Others may require special adaptive devices such as hand controls.

Arm amputees may likewise be able to continue or relearn how to drive with their prosthesis, or they may need special adaptive devices to operate the steering wheel, horn, signals, and other controls.

Some amputees may find that their prosthetics are helpful when it comes to driving, but others may find them clumsy, awkward, and in the way, and may choose to remove them in order to operate vehicle controls.

Some patients may have a combination of arm and leg amputations. Regardless of which limbs are affected or how much of the limb has been removed, it can be possible to make a full return to driving in most cases with the right combination of time, rehab, and adaptive devices.

What can I do on my own to prepare for driving again?

Make sure you take the time to adequately recover before you take on driving again. Eat well and get plenty of sleep so your body can heal. You may feel like rushing back in to resume normal life as quickly as possible, but if you do not give your body the time it needs to recover, you put yourself at risk for further injury, and you may also jeopardize the safety of others on the road.

It is very important that you follow the advice of your physician and physical therapist. Discuss with them your goals for driving and ask them to teach you exercises that can improve your strength, flexibility, coordination, and overall functionality. This allows you to maximize your physical ability to operate a vehicle again. The exact therapy activities you do will depend largely on the type and severity of your amputation.

If you became an amputee as the result of a traumatic injury, make sure to address any other physical complications you may have, such as spinal cord injury (HYPERLINK) or traumatic brain injury (HYPERLINK).

Who is responsible for determining if I can continue to drive with my amputation?

There are no laws in Connecticut that specify that a driver must stop driving if they have an amputation. That being said, it is important for you to talk to your physician and physical therapist about what you will need to do to return to driving. There will be a period of time immediately following the amputation where driving is not possible. Ask your physician to help you create a transportation plan to help you get around until you are ready to return to driving.

In some circumstances, your physician, law enforcement, or concerned family members may also submit a voluntary report to the DMV expressing their concern with your ability to drive, and you may have your license revoked until such a time as you can prove that you are fit to get back behind the wheel. The forms for these reports can be found at https://www.ct.gov/dmv/cwp/view.asp?a=818&q=245036. They can be submitted anonymously or identifying the submitter, and state law protects the submitter from legal action as long as they are acting in good faith.

It is important that you ask your doctor to refer you to a Certified Driver Rehab Specialist (CDRS) who can evaluate you and help you determine if you are able to get back behind the wheel, and if so, what needs to happen to make that possible. The CDRS will make recommendations to your physician and the DMV based on their findings and prescribe you a course of action to get back on the road or to set up a long-term transportation plan.  If you require special adaptive equipment to operate your vehicle, you will need to reapply for a driver’s license with the DMV and pass a driving test with your new equipment.

What Next Street looks for when assessing amputees for driving

At Next Street, we come to you. When possible, we meet with you in the comfort of your own home and carry out an assessment of your abilities. All you need to do to prepare is to get a good night’s sleep and eat normal meals so you have the strength and energy to get through the visit, which can take up to two hours. Don’t worry about needing to memorize anything, this isn’t a test of your knowledge, it is an assessment of your motor skills and your cognitive and visual abilities.

During your appointment with our CDRS, we check your range of motion, flexibility, strength, and coordination to see if you can handle operating a vehicle. We test your vision, reflexes, and judgment skills. We also take the time to evaluate you for adaptive devices to see which equipment would work best for you. Depending on how this first appointment goes, we will schedule you for a behind-the-wheel evaluation at a later date.

Possible driving outcomes

Drive on

For some amputees, it may be possible to make a full return to driving. In some cases, such as left-leg amputations, you may no longer be able to manually shift gears, but this is easily remedied by driving an automatic transmission. For others, it may be possible to continue driving with your prosthetic limbs and no additional adaptive devices in your vehicle.  

Adaptive driving devices

Many amputees will need some form of adaptive driving devices to safely operate a vehicle again. If you have had fingers, your hand, or an arm amputated, you may need a steering wheel knob to help grip the wheel, or modifications to other controls such as the turn signals, steering, and lights.

Foot and leg amputees may need devices to help operate the gas and brakes and may also need additional support for their body to prevent themselves from slipping as they drive. You may also need vehicle modifications to accommodate a wheelchair, such as a ramp, lockdown system, or hoist for stowing your chair if you can transfer yourself to the driver’s seat.

If you have had three or four limbs amputated, you may need more intensive modifications to your vehicle. It is not uncommon for amputees to start out with a set of vehicle modifications, only to discover that they would prefer that certain controls be moved to make them easier to access. Since each amputee is unique, you need to work with your rehab specialists to determine which solutions are best for you. 

Restricted driving privileges

While you may still be able to drive with your amputation, there might be times where you must have restrictions on your license. If we determine that your amputation causes you to have slower reaction times or that you are unable to physically make quick changes in speed or direction, you may be restricted from driving at night, in inclement weather, or in busy locations such as freeways.

Retirement from driving

In some rare cases, amputees may be unable to safely return to driving. This can be due to the severity of the amputation, the prohibitively high costs of vehicle modifications, or complications from other injuries and health issues in addition to the amputation. If this is the case, Next Street will work with you to create a transportation plan so you can continue to maintain your mobility. This may include working with specialty transportation services to set up transportation or with loved ones to equip them and their vehicles to better assist you. 

 

Topics: driver rehab, medical driving, limb, adaptive driving

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We Are Here to Keep You Safe Behind the Wheel

Our Driver Rehabilitation program works with patients whose change in health may affect their ability to safely drive. We have a team of Certified Driving Rehab Specialists that will work with patients on evaluating your driving abilities. We also have a team of professional instructors to help you gain or regain the skills you need to drive. We created this blog to talk about the various diagnoses we experience and how they may affect your experience behind the wheel. 

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