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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.
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.
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Automobiles often have controls and switchgear that are difficult to operate with insufficient pinch strength.
Most wheelchair vans are based on regular production models which are then significantly modified to support the loading and unloading of a wheelchair with a passenger in it. Minivans such as a Dodge Grand Caravan or Toyota Sienna are modified by having a large channel cut into the floor, which has a ramp at the end that folds out. Vans of this type will have an increased ride height, at least at the rear, to prevent the suspension from coming into contact with the channel. Vans which use a ladder frame construction, such as full-size Ford E-Series vans, will have an unmodified floor and instead have a raised roof placed on top of the bodywork. These vans are similar to many camper conversion vans. An electrically powered hydraulic wheelchair elevator is used to raise and lower the wheelchair into the back of the van.
Both types of vans will have compromised driving dynamics compared to their unmodified counterparts. Ride quality in full-size vans is never good, especially toward the rear, and the modifications to minivans with sunken floors negatively affects their ride quality as well. An individual riding in a power wheelchair may not be able to see ahead due to the rake of the vehicle or shape of the roofline obstructing forward visibility from the rear.
Loading times for vans with a loading ramp or an elevator are relatively similar. A loading ramp will still work if the vehicle is not running or has a dead battery, whereas an elevator requires power from the vehicle. The vehicle must be left running during operation of the elevator to prevent draining the battery; this may be a disadvantage if loading and unloading is in a confined space such as an apartment parking garage. Vans with a raised roof are typically very tall; many are incapable of fitting in parking garages or through drive-thrus.
Towing is not possible with a van that has a sunken floor at the rear, as there is no place to securely mount a trailer hitch receiver. Full size vans with an unmodified floor may still be able to tow if the hitch receiver does not interfere with elevator operation. However, the trailer itself, and the drawbar in the receiver would need to be disconnected in order to permit elevator operation.
Full-size vans with wheelchair elevators are generally able to be converted back into a standard van with a raised roof, which could then be reused or sold as a camper conversion. The wheelchair elevator itself could be sold independently. Minivans with a sunken floor have irreversible modifications and will forever be wheelchair vans with no other useful purpose.
Table: comparison of full-size van with elevator, and minivan with sunken floor | ||
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Item | Full size van with elevator | Minivan with sunken floor |