Paralyzed People's Skills Predict Driving Ability
By Charnicia E. Huggins

NEW YORK (Reuters Health) - People who are paralyzed from the trunk down and have limited arm movement may be eager to drive, but often don't know if they are able to, researchers report. And most healthcare professionals lack guidelines for evaluating their driving ability. Now new study findings suggest that a person's ability to move independently from the wheelchair to the toilet strongly predicts whether he or she can drive a car.

``Toilet transfer ability would be a straightforward and reliable indicator for drivers' training,'' lead study author Dr. Yoshifumi Kiyono of East Nagano National Hospital in Japan told Reuters Health.

To investigate, Kiyono and his colleagues conducted a study from 1977 to 1997 that included 62 individuals with lower-body paralysis (tetraplegia). Twenty-eight had undergone reconstructive surgery on one or both hands, while 18 had elbow extension reconstruction on one or both arms. All received driving instruction in specially equipped cars, but only 33 were able to drive either independently or with some assistance.

Patients' ability to transfer from a wheelchair to a toilet almost paralleled their driving ability, Kiyono and his team report in the Archives of Physical Medicine and Rehabilitation. The ability to transfer from a wheelchair to a bed or bathtub, and the ability to dress the lower body were other daily living activities associated with driving ability.

For example, 27 of the 31 (87%) people who could perform toilet transfers independently could drive without assistance, while about 77% of individuals who could independently dress their lower body were able to drive on their own.

Driving ability decreased, however, with increasing age and increasing severity of spinal cord injuries, the report indicates.

The study participants' ability to drive independently was also related to their later occupational status and sports participation, the researchers report. For example, 7 out of 10 individuals who were able to drive without any assistance reported having a regular or irregular job at follow-up, such as self-employment, computer data entry and public service. And half of the independent drivers said they participated in a sport such as basketball, road racing or tennis.

``Evaluation of car driving abilities as well as driver's training should be added to the rehabilitation program for people with tetraplegia, (particularly) because driving ability is an important factor that allows tetraplegic individuals to participate in work and sports-related activities,'' Kiyono said.

SOURCE: Archives of Physical Medicine and Rehabilitation 2001;82:1389