What to Know Before You Start Adaptive Driving

For people living with neuromuscular diseases, driving can be more than a convenience — it can be a road to independence.

Chad Strowmatt provides adaptive driving training.

“We want people not to have to worry about if the transit system is going to show up, or whether a ride service will get them to a job interview or doctor’s appointment on time,” says Chad Strowmatt, an occupational therapist and owner of Strowmatt Rehabilitation Services, which provides adaptive driving training and resources.

But getting behind the wheel with adaptive driving equipment involves a thoughtful approach that can require extensive preparation. While this might not be for everyone, “I believe everybody should have the opportunity to see if they can drive,” Chad says.

Work with the right driver rehabilitation specialist

Finding a qualified, collaborative certified driver rehabilitation specialist (CDRS) is one of the most important steps in the process. The Association for Driver Rehabilitation Specialists has a searchable list of evaluators by city, state, and province, along with information about their areas of expertise.

College student AJ Johnson

College student AJ Johnson lives with spinal muscular atrophy (SMA) and began adaptive driving in his junior year of high school. He spent more than a year studying and training, eventually buying a customized vehicle.

As he got closer to his licensing test, challenges arose, including insufficient seating stability that his instructor hadn’t accounted for.

“When I started out, I thought, ‘OK, I’ll get a trusted driving specialist, and whatever they say to do, I’ll do,’” AJ says. “I quickly realized that was a bad decision. One homemade device failed and led to me getting injured, so that kind of stopped the whole process.”

The device was a mechanical chest strap designed to be tightened and loosened using his wheelchair’s joystick to keep his upper body stable while driving. “Luckily, someone else was driving at the time, so when one of the welds failed, it didn’t cause a car accident,” AJ says. However, it caused him to fall partially out of his wheelchair while the car was stopping for a red light, injuring his foot.

After this experience, AJ gave up driving for a while. He plans to start the process over with a new driving specialist.

“You need to advocate for yourself from the beginning,” AJ says. If something doesn’t feel right or if equipment doesn’t support your mobility and strength, ask questions early. Once modifications are installed in a vehicle, it is difficult to make changes.

According to Chad, a good CDRS will walk you through each step of the process, communicate expectations clearly, and ensure you feel supported.

Research adaptive vehicles and equipment

Before you meet with a specialist or test equipment, take time to understand the landscape, including the cars, evaluations, training, budgets, and more. After all, there is a lot to learn, and the technology varies in complexity and “road feel,” Chad says.

Adaptive driving equipment may include:

• Joysticks
• Hand controls
• Steering assist devices
• High-tech electronics
• Custom mounting systems

Vehicle selection is equally important, and potential drivers should evaluate ramp styles, interior height, seating needs, and the long-term maintenance costs.

When researching, AJ suggests leaning on the neuromuscular community, including connecting with people on social media who have tried adaptive driving — successfully and unsuccessfully.

Chad also notes that the cost of high-tech vehicles has roughly quadrupled since he started in the early 1990s, now often exceeding $120,000 for a converted van. Funding sources like vocational rehabilitation (VR) often cover the cost of modifying a vehicle, as they did for AJ. While this is more affordable, the funding source may have requirements about the vehicle and specialists or vendors you can use.

Usually, you’ll need to purchase a qualifying base vehicle and customize it. Once the car is outfitted for your needs, it can still be converted back to its original configuration. Each manufacturer of adaptive equipment has a procedure for reinstalling removed seats and seat belts, and turning off the after-market driving controls.

Adaptive driving evaluations and training

Each state has specific adaptive licensing requirements for testing, behind-the-wheel training time, and more. However, most states require completing standard driver’s education or earning a learner’s permit.

CDRS evaluations for driving safety and adaptive equipment needs typically include:

• Clinical testing: Vision, reaction time, perception, strength, and cognition.
• Endurance evaluation: Determining how long you can safely drive.
• Functional testing: Trying different adaptive control setups. Chad’s team maintains multiple vehicles that can be adjusted to accommodate different functional abilities for test driving.
• Stability assessment: Ensuring you can maintain a safe posture during turns, braking, and acceleration.

For many people with neuromuscular conditions, trunk and head control while driving are major safety considerations. When trunk and head stability are strong, technology can adapt to a wide range of abilities. According to Chad, many clients need a wheelchair headrest, snug-fitting thoracic support, and a molded seating and back support system.

Training usually starts with short sessions to build endurance, then progresses to customized sessions multiple times per week. Chad’s lessons include freeway merging, night driving, managing wind or road tilt, and reacting to unexpected traffic behavior.

Part of this process is getting comfortable on the roads because anxiety is common for new drivers. One fun way to get more comfortable? Driving video games that simulate roadway experiences. Chad also recommends that younger drivers pay attention while they’re riding as passengers to see how friends and family navigate various situations — whether that’s merging onto the highway, navigating a roundabout, or dealing with unusual roadway conditions.

“Now that cars have some self-driving features, it gives us more safety margins of error,” Chad says. “I think the integration of those two sides is going to really help folks who may not have been able to drive for a long time and keep that ability to stay independent for longer than they would have a few decades ago.”

Ultimately, safety must guide every decision. Chad adds that while technology continues to improve, it cannot compensate for every safety limitation. Not everyone will ultimately be able to drive — and that’s OK. The evaluation process exists to help individuals determine the safest path forward.

With preparation, the right team, and the right technology, many people with neuromuscular conditions can experience independence behind the wheel. Adaptive driving is a significant commitment — but for many, the freedom is well worth the preparation.