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Transcript of 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