I have recently had the pleasure of working with several clients who have had a lower limb amputation who were wanting to return to driving.  People often ask “what is the best vehicle modification for a person who wishes to return to driving with a lower limb amputation?”

For some people, a lower limb amputation may occur from a traumatic injury such as motor vehicle accident whereby they may also have other associated conditions such as a head injury or spinal cord injury.  For other people, their lower limb amputation may occur because of poor circulation due diabetes or other cardiovascular condition.

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Driving a motor vehicle is a complex task involved perception, appropriate judgement, adequate response time and appropriate physical capability (Austroads, 2022). As an occupational therapy driving assessor, there are many components to our assessment:

  • The Person
    Individual performance component skill level, the type of amputation (below or above knee), co-morbidities, their functional capacity in daily life as well as their mobility (prosthesis and/or wheelchair user).
  • The Environment
    Where do they live, work, etc, as well as the social environment/context. Goals for driving and does the environment support this?
  • The Occupation (Driving)
    Individual driving history, habits, where they would like to drive to, any specific vehicle modifications or preferences they have looked into?

    There are a range of vehicle modifications options that could be considered – left foot accelerator is common for people who have a right lower limb amputation, hand controls (hand accelerator and brake, of which there are several types) are also common, and many people report they have found this easier to learn to drive with compared to a left foot accelerator. 

    There are a small number of people who have a well-fitting and tolerated prosthesis (usually with a below knee amputation) and have good sensation (superficial and proprioception) who can drive with their prosthesis.  

    This and other vehicle modifications can be trialled in an on-road assessment with the occupational therapy driving and specialist driving instructor.  This is undertaken in dual controlled vehicle to ensure safety for everyone involved in the assessment process. 

I have discovered that no two clients are the same, and there is not a one size fits all approach that works for everyone.  It all comes down to individual assessment of clients and their needs.  An occupational therapy driving assessment can help individuals to trial and test a range of vehicle modification options to find the best fit for them based on their needs and preferences.