1389
Car-Driving Abilities of People With Tetraplegia
Yoshifumi Kiyono, MD, PhD, Chozo Hashizume, MD, PhD, Noriko Matsui, OTR,
Kuniyoshi Ohtsuka, MD, PhD, Kunio Takaoka, MD, PhD
ABSTRACT. Kiyono Y, Hashizume C, Matsui N, Ohtsuka
K, Takaoka K. Car-driving abilities of people with tetraplegia.
Arch Phys Med Rehabil 2001;82:1389-92.
correlated closely to levels of mental well-being and to per-
ceived overall QOL.
Most often, individuals with tetraplegia have a desire to
drive, but they do not know whether they can because of the
lack of information. Most health care professionals have no
guidelines for which domains must be assessed. The driving
ability of people with tetraplegia is affected by many factors
including SCI level, residual muscle strength, physique, age,
motivation, and the opportunity to practice automobile driving.
It is difficult to predict precisely whether the individual with
Objectives: To examine the relationship between the spinal
cord injury (SCI) level, age, and car-driving ability in people
with tetraplegia and to explore the association between car-
driving ability and social activity.
Design: Retrospective clinical survey.
Setting: Rehabilitation center in Japan.
Patients: Sixty-two subjects with traumatic complete tetra-
plegia.
Interventions: Driving evaluation; comprehensive driver’s
training (muscle strengthening, transfer training, adjustment of
equipment, on-road training); and questionnaire (car-driving
status, employment, participation in sports).
6,8
tetraplegia will be able to drive. Several reports deal with the
car-driving abilities of tetraplegic individuals. However, there
are a limited number of articles that have precisely studied the
1
ability to drive a car as a function of SCI level and the
relationship between the driving ability and social interaction.
The first aim of our study was to investigate the relationships
Main Outcome Measures: The SCI level (Zancolli’s clas-
sification), age, functional status of activities of daily living
9
between the SCI level (Zancolli’s classification) (table 1), age,
and car-driving ability in people with complete traumatic tet-
raplegia and to determine the critical level of independence for
car driving. The second objective was to examine what kind of
functional abilities during daily living correlate with the ability
to drive a car. The third was to explore the associations be-
tween the ability to drive a car and social activities, particularly
with respect to employment and sports.
(
ADLs), and driving ability were obtained from the medical
records. Vocational status and engagement in sports activities
were investigated by questionnaire.
Results: The SCI level and age strongly influenced the
patients’ ability to drive a car independently. The highest
neurologic level in which independent driving was achievable
was C6A. Toilet transfer ability almost paralleled the ability to
drive a car. Eighty-four percent of the people with tetraplegia
who had a defined job could drive independently and 70% of
the driving-independent individuals held a job. Half of driving-
independent individuals participated in some sports activities.
Conclusions: Toilet transfer ability is a reliable indicator for
driver’s training. Driving ability is an important factor that
allows individuals with tetraplegia to participate in work and
sports-related activities.
METHODS
The Nagano Rehabilitation Center in Nagano, Japan, in-
cludes a hospital as well as a vocational and ADL training
center for the handicapped with a special drivers training
school. Two modified automobiles are available with hand
controls for braking and acceleration, powered steering con-
trols, a steering wheel with hand holder, and emergency brake
for the instructor. There is also a special on-road driving course
for the handicapped in the driver’s training school. After med-
ical treatment and evaluation by the rehabilitation team at the
hospital, patients enter the vocational and ADL training center.
People with tetraplegia are also encouraged to participate in the
simple driving evaluation, which includes testing individuals’
ability to manage car transfers and their ability to turn the
powered steering wheel with a hand holder. This evaluation is
conducted by the experienced driving school instructors. If an
individual has the potential to drive, comprehensive driver’s
training is started, including muscle strengthening and transfer
training by the physical therapists, adjustment of equipment for
driving by the occupational therapists, and on-road driver’s
training within the school. If needed, deltoid-to-triceps trans-
Key Words: Automobile driving; Japan; Rehabilitation; So-
cial interaction; Spinal cord injuries; Tetraplegia.
©
2001 by the American Congress of Rehabilitation Medi-
cine and the American Academy of Physical Medicine and
Rehabilitation
NCREASING ATTENTION is now being paid to the qual-
I
ity of life (QOL) of persons with tetraplegia. QOL is mul-
tidimensional and is influenced by, among other things, inde-
1
,2
pendence of activities of daily living (ADLs), psychologic
3
,4
5-7
4
adjustment to injury, and social issues. Siosteen et al
studied 56 subjects with spinal cord injury (SCI) and reported
that engaging in social activity and driving one’s own car
1
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fer and reconstructive hand surgery are performed during
the stay in the hospital.
From the Nagano Rehabilitation Center (Kiyono, Hashizume, Matsui, Ohtsuka);
and the Department of Orthopedic Surgery, Shinshu University School of Medicine
Source Population and Coverage of the Study
(
Takaoka), Nagano, Japan.
Accepted in revised form December 13, 2000.
No commercial party having a direct financial interest in the results of the research
Sixty-nine patients with complete tetraplegia after cervical
SCI were admitted and trained for driving in the Nagano
Rehabilitation Center between 1977 and 1997. Twelve with
tetraplegia were interviewed directly and 57 were mailed a
questionnaire. Of those, 2 had died at the time of follow-up and
supporting this article has or will confer a benefit upon the author(s) or upon any
organization with which the author(s) is/are associated.
Reprint requests to Yoshifumi Kiyono, MD, PhD, Dept of Orthopedic Surgery,
East Nagano National Hospital, 2-477 Uwano Nagano City, Nagano 381-8567, Japan,
e-mail: ykiyono@avis.ne.jp.
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could not be traced. Therefore a total of 62 tetraplegic
subjects (59 men, 3 women), were available for this follow-up
study. All interviews were performed by the first author.
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003-9993/01/8210-6418$35.00/0
doi:10.1053/apmr.2001.26089
Arch Phys Med Rehabil Vol 82, October 2001