Built Tough 2/1/2013 Accessible Vehicle Providers Share Challenging Cases

By Elisha Bury

Accessible Vehicle Providers Share Challenging Cases

Driving modifications in a minivan at Lift-Aids Inc. in Euless, Texas. Photo by Elisha Bury
Driving modifications in a minivan at Lift-Aids Inc. in
Euless, Texas. Photo by Elisha Bury

If your wheelchair or prosthetic fitting experience taught you anything, it's that much of the mobility business is custom. That means that even if you have the same diagnosis as the person sitting next to you, you're unlikely to get the same exact equipment.

It's no different in the world of accessible vehicles. Just ask Darrell Frank, sales and service manager of Lift-Aids Inc. in Euless, Texas.

"No two things are ever the same. That's what's kept me here for 25 years. It's never boring," he says.

Indeed, when asked to give a general overview of the process of getting fitted for an accessible vehicle, Frank can't answer the question.

He wants to know if we are talking about paras or quads because the level of injury means different abilities and therefore different strategies. Are we talking about manual or power chairs? Different equipment means different vehicles, different lifts. Are we talking stroke? The side of paralysis makes a big difference in figuring out how someone will open and close the door. Does the person have multiple sclerosis? This progressive disease means different equipment at different stages. Is it ALS, a disease that moves very fast?

Finally, Frank explains that there is no “standard” process per se. What a mobility provider does depends greatly on the individual client.

That means each case is a new challenge for mobility providers, whose business it is to dream up a system that works specifically for your needs. For example, Frank says that most lifts have a weight capacity of only about 400 pounds—and that's including the mobility equipment. After years of working with bigger guys who wheel bigger chairs, Frank invented his own heavy-duty version that lifts 1,100 pounds. He calls it the Ox.

Truth be told, there's a lot of creativity that goes into building a modified vehicle: from adding head room so taller guys don't bang their heads when going over a speed bump, to unique hand controls so people with limited hand dexterity can steer with their shoulder strength, to kneel systems so manual chair users can reduce the slope when wheeling in. And even if the product isn't on the market, that doesn't mean that it isn't living and breathing inside a mobility provider's head.

With all that know-how, The Mobility Project had to ask: What stumps you? What are your toughest cases?

Tough Case #1: Craig   

It takes seconds for Frank to land on his toughest case, surprising for a man who's been in business for 25 years.

"Craig," Frank says.

Craig's mom took a drug called thalidomide that was prescribed to pregnant women for nausea in the 1950's. The drug caused serious birth defects, especially missing limbs. Craig was born without legs and missing one arm. On the other arm, surgeons modified the area so that his available fingers formed a bit of a clamp that stopped around elbow length. He also has a 4- to 5-inch projection in the area of one of his legs.

So how do you create a vehicle for someone who is essentially missing all four limbs?

Lift-Aids installed pedal extenders, which Craig can control via his stump. In addition, Frank mounted a spinner knob on the steering wheel and attached a round hook so that Craig could use his available fingers to steer.

So that Craig could drive independently, Lift-Aids also installed power doors and a lift to get his wheelchair inside.

"I'd rather ride with him than most of my friends," Frank says.

Even though the case was challenging, Frank had no trouble getting Craig into a comfortable driving setup.

Tough Case #2: Jill

Cindy Ketcherside, general manager of VMI Mobility Center in Phoenix, Ariz., has some trouble choosing her toughest case, and you can tell right away it’s because she always gets her customer into a vehicle.

“That's our job to try to make the process as easy as possible, where even if there are glitches in the road, you try not to allow that to affect your client because you truly want to get them into something to be able to get them out into the world again,” Ketcherside says.

Still one particular case stands out to her. Jill, who has a genetic disorder that makes her shorter in stature, came in with a very clear idea of what she wanted: a Toyota minivan.

Unfortunately, the Toyota product has a deep 14¾-inch drop, which makes it difficult for someone who is shorter in the wheelchair to see over the steering wheel.

Generally, Ketcherside says the mobility provider will take measurements of the person’s height in the chair, leg length as well as the size of the chair. For example, a power chair requires more room or a larger vehicle with a larger opening and more head room.

“If somebody is very tall and they're in a large power chair, really we'd look toward the option of a Toyo

But Jill had her heart set on the Toyota.

Ketcherside and her team looked at putting in a platform that would raise Jill high enough to see over the steering wheel. But Ketcherside had reservations about the safety of the platform. She was worried it wouldn’t be as secure if Jill were to get into a car accident.

So Ketcherside took Jill into her showroom to check out four different models.

“It's very easy for them to be able to go from one vehicle to another and to be able to see, ‘Oh gosh, I can't see over the steering wheel here. Oh I can see over the steering wheel here.’ “ Ketcherside said.

That demo was all it took for Jill to change her mind. In the end, Jill ended up in a Honda minivan that has a 12-inch drop.

“She now of course has the ability to get out and be able to have that freedom,” Ketcherside says.

“Once we get them into the right floor drop and the right head drop and the right space, it tends to be not as difficult of a process.”

Tough Case #3: Jean*

Varieties of hand controls at Lift-Aids Inc. in Euless, Texas. Photo by Elisha Bury
Varieties of hand controls at Lift-Aids Inc. in
Euless, Texas. Photo by Elisha Bury

For Mike Neher, who heads up sales at Performance Mobility in Portland, Ore., figuring out the best way for someone to operate a vehicle can be challenging.

Steering modifications can compensate for loss of strength and function and reduced range of motion. And Neher knows firsthand that the difference between mechanical and electronic gas and brake controls might make all the difference.

One of Neher’s tough cases was a woman, Jean, who has muscular dystrophy. Although Jean had been driving for years, including transferring out of her wheelchair and using her feet for the gas and brake pedals, she had begun to lose her strength and function. She could no longer move her arms in a complete circle, for example, and she wasn’t able to transfer.

“She was basically doing what we call a shuffle,” Neher says. “She would make turns just by shuffling her hands on the bottom of the steering wheel.”

Jean’s goal was to continue working, and so Neher was challenged with coming up with a solution to ensure she could continue to drive to work.

The first step was making adjustments so that Jean could drive from her wheelchair without transferring. For this, Neher put Jean into a Toyota Sienna minivan.

“It worked out that in her new wheelchair she was able to sit with a 14-inch–drop floor in the Sienna and have really good vision seeing out when she was actually driving from her wheelchair,” he said.

Figuring out the gas, brake and steering wheel situation was a bit more complicated.

To address steering, Neher fitted the minivan with a small secondary electronic steering wheel that mounts to the floor and comes up on the right side of Jean’s wheelchair armrest. The wheel has three switches that when engaged enable Jean to turn the wheel from far left to far right three times versus the normal five or six times. The steering wheel itself has a smaller diameter of about 3 to 4 inches and is mounted horizontally. So not only is Jean turning fewer times, she’s also turning a shorter distance with a lot less effort.

On her left side, Neher added electronic gas and braking. The electronic system requires only minimal effort from Jean.

“There’s a little box that has a lever that comes up, and she grabs this little handle on the top of the box and she goes forward for brake and backward for gas,” Neher explains. “That’s about 3-4 inches of full throttle and full brake, whereas with a mechanical hand control you would have to be pushing mechanically straight forward about 6-8 inches and gas would be down 2-6 inches.”

Overall, Jean’s system was extremely successful.

“It totally reduced her fatigue,” Neher says. “It reduced the amount of time it takes to get into and out of the driver’s seat. And she’s still working, and that was the primary goal.”

*Not the client’s real name.

Tough Case #4: The New Wheelchair User

Ketcherside says there’s a reason that working with a new wheelchair user is harder: It’s the psychological challenge.

“A mobility product wasn't even in their world four to eight weeks ago, and now they're having to learn all different kinds of things in regards to being a wheelchair user,” Ketcherside says.

In these cases, it’s not always figuring out the equipment that’s challenging—rather it’s convincing clients that they can be more independent than they might have thought.

Ketcherside says that mobility providers can assist with that transition by simply showing them what’s out there, including vehicle conversions, lift and ramps, and hand controls.

“We are working with a gentleman right now who his injury only occurred 9 weeks ago,” she says. “He's getting out of the hospital next week, and we've actually brought two different products over to him so he can actually see it.”

But mobility providers don’t work alone in helping someone transition to what she calls “a new normal.” A team of physical and occupational therapists as well as a driving evaluator help show modifications that can help new wheelchair users see the possibilities.

Ketcherside says that being able to envision those possibilities makes all the difference when it’s time to buy.

“The first thing in the process is coming with an open mind to saying, ‘Okay, my main thing that I want to do—and I think it's getting that mindset first—is I want to be able to get out. I want to find a way to be able to be a driver again. I want to find a way to have reliable and easy transportation that will help me.’ ” she says.

Sometimes that means letting go of preconceived notions about brands.

“When we talk to our clients, we feel that if they don't get the right product, the right fit, what they'll end up doing is if it's a hassle they'll just stay at home. We try to give them the options of looking at how can we make this as easy as possible for you to want to be out.”

If you’re in the market for an adapted vehicle, click here to locate a provider through the National Mobility Equipment Dealers Association.