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Licence to Drive

If you are interested in receiving an Licence to Drive Booklet, please contact the National Amputee Centre by calling 1 877 622-2472 or email nac@waramps.ca.

Licence to Drive Brochure CoverDriving is an important means to independence for amputees, enabling you to carry out daily living tasks outside the home as well as take part in social activities, without having to rely on others for transportation.

Whether you are already a licenced driver who has recently become an amputee, or an amputee going for your driver's licence for the first time, the information here applies to you. Will you need special devices on your vehicle, or special driver training? What will obtaining or renewing your driver's licence entail? Will you have any restrictions on your licence?

This article answers the most frequently asked questions regarding amputation and driving in Canada, and provides lists of resources in all regions of the country. However, information in this article is meant only as a guide. Driving is an area under provincial, rather than federal, control; therefore, the procedures and criteria differ for each province. In fact, in many cases there are no specific provincial procedures but rather guidelines for motor vehicle offices, so experiences may vary from city to city within a given province.

While no two amputees will have exactly the same experience obtaining a driver's licence, there are three main possibilities:

1) No Special Requirements 

The process will be no different than for the general population.

2) Assessment Not Necessary 

A Ministry official may presume that all amputees must undergo a special assessment. However, by being prepared in advance you may be able to demonstrate to the official that an assessment is, in fact, not necessary. Examples - a) a left above- or below-knee amputee can drive a vehicle with automatic transmission without special devices as their artificial limb does not impact on the ability to use the gas and brake pedals which are on the right - a restriction may be placed on the licence stating that the amputee must drive an automatic car rather than a standard because of the clutch that needs to be operated with the left foot; b) a right below- or above-knee amputee may require a left-foot accelerator pedal - an amputee can illustrate they have researched this and provide information about how they will be having one installed into the car they will be driving.

3) Assessment Necessary 

For some amputees an assessment will be deemed necessary to determine what devices may need to be fitted to the car and/or to satisfy the Ministry that the amputee will be able to drive safely.

The information in this article is a general overview of the situation in Canada, based on information gathered from different provinces. It is your responsibility to explore the exact requirements in your area.

If you can share an experience or information that will add to the material provided here, please let us know by calling 1 877 622-2472 or email nac@waramps.ca.

Process

Obtaining a driver's licence is a lengthy procedure for anyone, and for an amputee that process is even more extensive. You may be required to be assessed at a rehabilitation centre or hospital, which sometimes have long waiting-lists (you may have to wait weeks just for an appointment). Be sure to start early and allow yourself plenty of time to go through each step of the process. Knowing what the process entails well in advance and preparing ahead of time can prevent some of the frustration and disappointment that can result if you are not prepared.

Throughout the process of obtaining a driver's licence you may have to deal with individuals who, understandably, have little or no knowledge of amputation. Until you became an amputee yourself, you really had no idea of what it was all about, did you? Individuals may not be aware of your capabilities and thus may question your ability to drive safely. Therefore, they may suggest or even insist that you undergo an assessment or more testing than you personally feel is necessary. Driving carries very serious responsibilities - as is often said, driving is a privilege, not a right. Therefore, although you may feel certain procedures are unnecessary, you have to do what is reasonably requested to prove your ability to drive safely.

What can you do to speed up the process? Knowing in advance what devices you may need will certainly help. For instance, if you are a right leg amputee, a left-foot accelerator is suggested; for an arm amputee, a spinner knob may be suggested.

Permit

The learner's permit gives you permission to drive a vehicle, but it is not a licence. The permit has specific restrictions set down by the Ministry of Transportation that apply to all new drivers (an example might be the requirement to always be accompanied by a fully-licenced driver).

If you already have a valid driver's licence when you become an amputee, you will most likely not need to go through the process of obtaining a learner's permit again, but may have to be retested to prove your ability to drive as an amputee.

When medical conditions or disabilities are present, you also may be required to have a medical form signed by your doctor or be required to undergo an assessment before a permit will be issued.

Previously Licenced Drivers

If you had a driver's licence before your amputation, you will most likely have to go through the process of renewing your licence by being retested to prove your ability to drive as an amputee. Under most provincial laws, physicians have a legal responsibility to inform the Ministry of Transportation of any changes in a patient's medical condition that may affect driving ability; therefore, most doctors will automatically inform the Ministry of all new amputations. In Ontario, for example, the Highway Traffic Act states:

203. (1) Every legally qualified medical practitioner shall report to the Registrar the name, address and clinical condition of every person sixteen years of age and over attending upon the medical practitioner for medical services who, in the opinion of the medical practitioner, is suffering from a condition that may make it dangerous for the person to operate a motor vehicle. 

What will happen once the Ministry of Transportation is informed of your amputation will vary. In some provinces, an assessment is mandatory; in other provinces, a road test to prove that you can still safely drive is all that is required. Procedures and regulations vary, so contact your provincial Ministry of Transportation to find out the exact legal requirements.

Assessment

Assessments of a person's ability to drive and recommendations regarding any special equipment that may be required are often available through rehabilitation centres or hospitals in each province. The individuals who are employed at assessment centres are specifically trained to assess individuals with disabilities. Many belong to the organization Association of Driver Rehabilitation Specialists [ADED- (go to Membership Directory, where you can enter either a company name, a province (listed under state), or a country in the search function] which provides education and information to professionals who work in the field of driver education/training and transportation modifications for drivers with disabilities. Assessments can cost in excess of $500, so you will want to undergo one only if it is compulsory or if you personally prefer to have one. The cost of an assessment is not usually covered by provincial health plans. Some private insurance companies may cover it as an occupational therapy service. Check with your insurance provider to find out what costs, if any, it will cover for an assessment.

An assessment is recommended (and required) for amputees with multiple amputations to ascertain the modifications or special devices needed (e.g. hand controls for a bilateral leg amputee); an assessment is not usually necessary for individuals with single limb amputations as the devices required, if any, are straightforward.

If you are advised by your local motor vehicle office to undergo an assessment that you feel is not necessary, be prepared to discuss the matter with the licensing officer or his/her supervisor. You must be prepared to demonstrate that you take the privilege of driving seriously and, therefore, you have already explored the equipment that will enable you to drive safely.

There can be lengthy waiting lists for appointments at some centres, so call early to book your appointment. Most assessment centres are located in major cities, so travel may be necessary. The list of ADED members is extensive, but if you are aware of other centres not on this list please let us know by calling 1 877 622-2472 or email nac@waramps.ca.

If an assessment is required, you will be referred to the nearest assessment centre. This referral can either come from the Ministry of Transportation, or in some cases your doctor will refer you. The process will vary between centres, but one example is as follows. You will meet with an occupational therapist (OT) who will work with you to determine what will be required to make you an independent and safe driver. Following this meeting, you will go for a drive with a driving instructor and the OT. This will provide an opportunity to determine which devices will work best for you. The vehicles at assessment centres are equipped with all kinds of adaptive devices, including spinner knobs, left-foot accelerators, and hand controls. Safety features, like passenger-side brakes, ensure control of the vehicle rests with the instructor while the person with a disability tries out different equipment.

Prescription

After the assessment, the assessment centre will provide a prescription for you. In the case of a simple adaptation (e.g. a spinner knob or left-foot accelerator), you may be given the prescription and a list of companies in your area that sell and install such devices. An assessment centre may suggest a particular company, but you may also explore several companies to obtain cost quotes and estimations of when the work can be completed to choose the one that works best for you.

It is extremely important to ensure that the company who installs the equipment is experienced in doing the modifications you require. Never have devices installed or modifications made to your vehicle by someone inexperienced (it is not recommended to have a well-meaning friend or relative who is "mechanically inclined" do the work).

If the modifications or devices required are more extensive (e.g. a multiple amputee who requires touch-boards, relay switches or electric shifters), the centre may write your prescription and send a copy to companies on their tender list that are experienced in doing these types of modifications. These companies then send you quotes for the work and you choose the one that best suits your needs.

Driving Instruction

Generally, driving lessons through a certified driving school is a good idea as they provide you with sound knowledge of traffic regulations and many safety tips to help make you a confident and safe driver. If you have undergone an assessment and met with an occupational therapist (OT), the OT may recommend that you take driving lessons. In certain cases the OT will issue a prescription for driving devices that is contingent upon your having lessons.

Amputations may present unique issues to be considered when driving. Therefore, an OT may suggest that you take your driving lessons through an assessment centre, or an instructor who specializes in teaching drivers with disabilities. Please refer to the assessment section of this document for more information. Instructors experienced in working with people with disabilities will train you in the little details like the importance of flipping a left-foot accelerator up and out of the way for the next driver. This will prevent an accident caused by another driver who might mistakenly push down on the left-foot accelerator instead of the brake.

Sometimes an OT will suggest that not all lessons need to be taken at an assessment centre, but that three or four hours of driver training with an instructor at the assessment centre is sufficient before continuing driving lessons with a regular driving instructor. A person who has already had their licence and is "relearning" how to drive as an amputee may require a longer period of instruction through an assessment centre than a new driver - as well as learning how to drive with adaptations, they also have to overcome the urge to drive as they did before their amputation. For example, a recent amputee driver may drive well their first few times using the adaptations at the centre as they are conscious of doing well, but when they go back out onto familiar roads they return to their old habits and attempt to brake using a leg which is no longer there. The extra driver training at the centre can reinforce the new driving technique, and make the transition to being an amputee driver easier.

Road Test

In some provinces you must have your learner's permit for a certain length of time before you are allowed to take your road test. In Ontario, for example, you must have held your learner's permit (Level G1) for at least eight months if you have completed a driving course (within that eight-month period) or one full year if you have not taken a driving course before you are eligible to take your road test. Your road test will take place at your local Ministry of Transportation office. You will be required to provide a vehicle for your road test equipped with any necessary modifications. There can be long waiting lists for road tests, so be sure to call early to book your appointment.

When it is time for your road test there is the question of whether you should use an adaptation or device, even your prosthesis, during your road test. If you cannot safely drive without a vehicle adaptation or using your prosthesis, and an assessment has indicated you should use an adaptation, then obviously you should use it during the road test. However, what if you are a driver for whom a device is not absolutely necessary in order to drive, but you opt to use one for comfort? For example, a right leg below-knee amputee who can drive fine with the prosthesis on the gas pedal, but who chooses to have a left-foot accelerator installed for comfort? Or an arm amputee who can drive well with or without wearing their myoelectric arm?

It is a good idea to check with your licensing office where you will do your test to find out what provincial regulations are in place. In some instances certain devices will be suggested by the Ministry of Transportation; in other instances if you use an adaptive device or your prosthesis during the road test then the examiner must make a notation on your licence stating that you are not legally allowed to drive without the device since that is how the examiner saw you drive; while in yet other instances it is at the discretion of the examiner. If the examiner feels it is necessary, he or she will place a restriction on your licence in the same way that a restriction for glasses or corrective lenses might be indicated. If you intend to always drive using the device then this may not be of concern to you. However, if you do not intend to always use the device or wear your prosthesis, or if you plan on occasionally driving other vehicles which are not equipped with adaptive devices, then having a restriction on your licence will be an inconvenience. If you plan to drive without the device as well as with it, it is best to show the examiner that you can drive without the device or prosthesis so that you do not get a restriction placed on your licence.

Vehicles and Adaptations

Different amputations will necessitate different adaptations. An amputee may also select a certain kind of vehicle to suit his/her needs. For example - a leg amputee who uses a wheelchair may opt for the space and accessibility of a van; someone who uses a wheelchair or a scooter will also need to consider whether a van or a rooftop wheelchair carrier or a carrier on the back of the car is most appropriate; an arm amputee may decide to purchase a vehicle with power steering in order to minimize the amount of effort required to control the vehicle; a leg amputee may opt for cruise control to reduce the strain on the residual limb on long trips; and many amputees, both leg and arm amputees, choose automatic transmission instead of a standard vehicle for issues related to the stick control and the clutch.

To find out if your province has any regulations in this area for persons with disabilities, contact your provincial Ministry of Transportation.

Devices

Below is a chart showing some of the common devices often recommended for particular amputation types. Remember, these are only guidelines. You may wish to discuss your options with your occupational therapist or rehabilitation centre. Sometimes, depending on your amputation(s), it might help to try several devices to find what works best for you.

Other devices or adaptations which amputees may find useful are an ignition key holder which allows easier access to the ignition, pedal extenders, or having the steering column extended.

AMPUTATION 

RECOMMENDED DEVICE(S) 

 

 
 
Left leg (below-knee)  No devices/ adaptations required
Left leg (above-knee)  Parking brake extension
  • Allows for operation of a foot-operated parking brake.

  • Applies to older vehicles 

 
Right leg (below-knee)  Left-foot accelerator
  • Allows for operation of the gas pedal with left leg.

  • Some below-knee amputees have enough control of their prosthesis to use standard pedals and will not find this necessary. 

 
Right leg (above-knee)  Left-foot accelerator
  • Allows for operation of the gas pedal with left leg.

  • Some right leg above-knee amputees choose to move their prosthesis out of the way and use their left leg to use standard pedals without any modifications. 

 
Bilateral leg amputee
(below- and above-knee)
 
Hand controls
  • Replace foot controls.

  • Operate gas, brakes, horn and dimmer.

  • May be separate or combined into a single "joystick"-type device.

*Note - some bilateral below-knee amputees have control with their prostheses and do not require any adaptations. 

Left arm  Right-hand steering knob or ring
  • Spinner knobs for one-handed control of wheel.

  • Rings used with a prosthetic hook (Artificial limbs should have soft pincers i.e. neoprene).

Right hand directional signal extension 

  • Crossover lever operates turn signal with right-hand.

 
Right arm  Left-hand steering knob or ring
  • Spinner knobs for one-handed control of wheel.

  • Rings used with a prosthetic hook (Artificial limbs should have soft pincers i.e. neoprene).

Left-hand gear shift lever extension 

  • Crossover lever operates a gear shift with left hand.

 
Bilateral upper limb  Check with your occupational therapist, one option is a floor-mounted steering wheel for foot control of steering.

Electronic Steering Devices

Another option would be to use an electronic steering device, such as a Digipad or a Touchpad. These devices allow you to control the vehicle and vehicle accessories using digital buttons and switches. Some electronic controls resemble a joystick which allow the steering, gas and brake to be operated using a single device.

Modifications

Once your specific needs have been identified, you will need to have the modifications made to your vehicle by a company that sells and installs driving devices. It is always best to go to a company experienced in making such vehicle modifications rather than making the adjustments yourself or having an unqualified friend do them. This not only ensures that the device(s) is installed properly for your own safety, but also will avoid any concerns that could be raised by an insurance company.

Many, but not all, companies that perform vehicle modifications belong to an association called NMEDA (National Mobility Equipment Dealers Association). As members of NMEDA, the companies that do modifications are required to meet certain standards. The companies in NMEDA purchase manuals which pertain to vehicle modifications, the revenues from which are used to buy adapted vehicles to be used for further testing. Both of these help to ensure that even smaller companies have the knowledge and resources to ensure that modifications are performed correctly.

If you are aware of a company which is not on this list please let us know by calling 1 877 622-2472 or email nac@waramps.ca.

Tips

The following are a few tips for you to keep in mind when you are going through this process:

  • Some amputees have a device, such as a metal plate, installed beside the brake to prevent their prosthesis from inadvertently slipping underneath the brake which would be very dangerous.

  • Be sure to plan ahead when getting your licence. By leaving yourself plenty of time to get through the process you will help to prevent some of the stress and frustration that you might experience when trying to work your way through any red tape which you may encounter.

  • One arm amputee had her signal lights moved onto the door of her car so that she could use them, rather than trying to reach through the steering wheel with her residual limb.

Contact us by calling 1 877 622-2472 or email nac@waramps.ca, if you have a tip to share with other amputees.

Insurance

It is a good idea to inform your insurance company of any adaptations that have been made to your vehicle. Adaptations and devices can raise the value of your vehicle. By ensuring your insurance company is aware of your amputation and the adaptations to your vehicle, you may help to prevent problems with your claim in the event of an accident.

Rebates

Many automobile manufacturers offer rebates to customers to help cover the cost of vehicle adaptations. These rebates apply only to new vehicles. There are different programs and restrictions for each car company so it is best to contact your car dealer directly to find out exactly what each offers.

The following is a list of car manufacturers and their rebate programs applicable to new vehicles:

  • Ford and Lincoln have The Mobility Plus Rebate program which offers a rebate up to $1000.

  • Daimler Chrysler's AutoAbility program offers rebates of up to $750 on cars and $1000 on vans and wagons on their Chrysler, Dodge, and Jeep vehicles.

  • GM (Chevrolet, GMC, Pontiac, Buick, Cadillac, Asuna, Saab, Isuzu, Oldsmobile, Geo) has the Mobility Program for persons with disabilities which offers up to $1000 in rebates.

  • Honda has a Handicap Conversion Discount of up to $600 for certain disabled drivers.

  • Toyota's Mobility Program offers up to $1000 towards the cost of installing adaptive equipment.

  • Volkswagen's Mobility Access Program offers up to $500 towards the cost of installing adaptive equipment.

If you are a Canadian citizen you can also apply for a GST/HST Rebate from the Canada Revenue Agency. The GST/HST Specially Equipped Motor Vehicle Rebate Application can be used to claim the GST which you have paid on the purchase of a qualifying vehicle or a modification service performed on your vehicle. A qualifying vehicle means a vehicle which is equipped with a device designed exclusively to assist in placing a wheelchair in the vehicle without having to collapse the wheelchair, or with an auxiliary driving control to facilitate the operation of the vehicle by an individual with a disability. The application, form GST518, is available online under the Forms and Publications section.

DRIVESAFE!

Since the 1970s, child amputees in The War Amps CHAMP Program have been warning other children to PLAYSAFE. In the 80's, they started sharing an important message with adults: DRIVESAFE! Children who have lost limbs in vehicle accidents are helping The War Amps convey this vital message to drivers everywhere. In hard-hitting public service announcements, Champs display the artificial limbs they must wear because of someone's careless driving.

To ensure the message gets across, The War Amps offers a pamphlet on defensive driving tips, a safety checklist, and DRIVESAFE! windshield stickers. A short DRIVESAFE! animated video shares the message in a powerful way via television stations and as part of presentations to schools and community groups. As an ongoing reminder, the DRIVESAFE! message is prominently displayed on the millions of key tags mailed to Canadian drivers.

Starting Early

The information presented here clearly demonstrates the importance of starting early in order to allow the amputee plenty of time for each step of the process. This cannot be emphasized enough — waiting-lists for assessments and road tests as well as the time it can take to have prescriptions written up and modifications made all add up. By booking appointments early and having a thorough knowledge of the steps you need to take, you can put yourself on the road to success.

Provincial and Territorial Contact Information

For further information contact the ministry responsible for driver licensing in your province or territory.