¶ Introduction
Automobiles are often an important part of a person's life, especially for those living in areas with limited transit options. Getting into and out of a vehicle, and driving in it pose certain challenges for individuals with significant ALS progression.
Individuals which are not able to sit in standard vehicle seats will instead sit in a wheelchair which enters and exits the vehicle via a ramp or elevator. Such systems are retrofitted to heavily modified vehicles known as accessible vehicles.
¶ Ingress and Egress
¶ Doors
Hinged doors (i.e. "normal" doors) offer very little space for an assistant to help the patient get into or out of the vehicle. Sliding doors are a significant advantage in this regard.
¶ Hip height
Hip height is a measurement used by the automotive industry to refer to the distance between the ground and the hip bone of the occupant while seated in the seat. Pickup trucks and large SUVs have a high hip height, while sports cars and some compact cars have a low hip height.
Sports car with very low hip height. The car itself is quite low, and the seat bottom is very close to the floor of the car.
Vehicles with a hip height that is very close to the hip height of the individual when they are standing are the easiest to get in and out of.
Vehicles with a very high hip height require the use of running boards or a footstep to get into. These devices are similar to stepping up a step, which requires significant strength in the leg and hip extensor muscles. There is a higher risk of falling. The individual should seek assistance from others to maintain sufficient points of contact and stabilization.
Vehicles with a very low hip height requires significant strength in the leg and hip extensor muscles in order to be able to stand up out of them. Getting into such a vehicle is also difficult, as the individual will need to squat down while also moving inward to land on the seat, instead of on the vehicle's rocker panel. It can be difficult for an assistant to help someone get out of a low vehicle, as they must lift the individual upward against gravity while working in a confined space.
¶ Transfers
A door catch handle is a small grab handle that fits into the door catch of a car, which is used to assist with getting in and out of the car. The position of the door catch varies from car model to car model, and may not always be in an ideal position for using this product. Adequate strength in the triceps muscles is required for this product to be useful.
A transfer board can be used when transferring from a wheelchair to a vehicle's seat. However, the base of most car seats are on a significant rearward angle, which can affect the positioning of a transfer board. Further, the transfer board may need to be very long in order to adequately reach all the way from the wheelchair to the seat.
A power wheelchair with a seat elevator feature may be adjusted to make the transfer into or out of the vehicle always be downhill; otherwise either ingress or egress will likely be an uphill trip instead, which may require assistance.
¶ Driving
¶ Steering
Steering an automobile requires adequate use of the upper limbs and hands. Driving with weakened pinch strength may be possible for a moderate amount of time, however, once weakness has progressed more substantially, it will no longer be possible to safely steer the vehicle.
A driving maneuver typically known as a “moose test” can be used to determine if steering ability is adequate. A “moose test” involves making a sharp left-hand maneuver, followed by a sharp right-hand maneuver, as if to make one lane change followed quickly by another in the opposite direction. Such a maneuver should be performed in a controlled environment on a private roadway, free from harm of people or property. Moose test videos found throughout the Internet are very dramatic; an individual with ALS could do the test at speeds below 10 mph (16 km/h).
A steering assistance device known as a Brodie Knob is used by some individuals with disabilities. An individual with ALS would see little benefit in their use if they have not retained their grip strength to hold the knob. Further, Brodie Knobs are illegal to use in most parts of the world unless prescribed by an occupational therapist or physician.
¶ Pedal Operation
Depression of the pedals requires sufficient strength in the quadriceps and gastrocnemius muscles; alternating between the throttle and brake pedals require sufficient strength of the hip flexor muscles, as does moving the left foot from the footrest to the clutch pedal.
The weight of the brake pedal in most automobiles typically provides direct feedback to the driver as to whether they have retained enough strength to safely operate it. Heavy brake pedal pressure while stopped with the engine running can be used to determine if strength is in fact adequate. Hip flexor strength, which is required to move the foot from one pedal to another, is more often overlooked. Alternating the right foot from brake pedal to throttle pedal back-and-forth repeatedly would test the strength and control of the right hip flexor muscle. The left hip flexor can be tested by placing the foot on and off of the clutch repeatedly.
¶ Operation of Accessories
Automobiles often have controls and switchgear that are difficult to operate with insufficient pinch strength.
Temperature controls are important for safety. If they are too difficult to operate, they should be pre-set to a suitable range so that the vehicle does not get too cold.