Driving Pedal Reaction Times Following Traumatic Right Below Knee Amputations
| Principal investigator(s): | Benjamin Meikle
(St. John's Rehabilitation Hospital);
Michael Devlin
(West Park Healthcare Centre) |
| Co-investigator(s): | Christos Boulias
(West Park Healthcare Centre) |
| Sponsoring Institution: | WestPark Healthcare Centre |
Objective
Driving represents a major achievement in the rehabilitation of traumatic lower extremity amputees as it allows increased mobility and freedom, and it is often necessary in order to return to work. Although it is generally accepted that persons with right leg amputations can return to driving following an amputation, it is unclear how they should drive. Many experts recommend that all right leg amputees who drive require their car to be modified to have either a left foot accelerator or hand controls. However, a recent survey has shown that the majority of right leg amputees who returned to driving did so without modifying their vehicles, and many of them used their prosthesis on the foot pedals. Unfortunately, research in this field is lacking and there is no available evidence to indicate how a right below knee amputee should drive. It is not known if an amputee can safely operate foot pedals with their prosthesis, and it is not known if they can safely operate manual transmission automobiles (which require the use of both feet on the pedals). This study was designed to be a preliminary investigation of the following 2 questions: Can right below knee amputees safely operate vehicle foot pedals with their prosthesis? What technique of operating the foot pedals is associated with the fastest reaction times?
Method
This study measured the driving brake pedal reaction times of right below knee amputees while using four different techniques of operating the foot pedals, including the following:
1. Right sided accelerator with prosthesis operating accelerator and brake
2. Right sided accelerator with prosthesis operating accelerator and left foot operating brake
3. Right sided accelerator with left foot operating accelerator and brake
4. Left sided accelerator with left foot operating accelerator and brake
A total of 10 right below knee amputees participated in this study. They were tested in a controlled setting using an electronic device that simulated driving position. Individuals depressed the accelerator pedal, and a random visual stimulus signalled them to rapidly release the accelerator and depress the brake fully.
Results
The reaction times were the fastest with the left foot operating a conventional automobile setup (a right sided accelerator). There were slightly slower but still acceptable response times with the prosthetic operation of a right sided accelerator pedal setup, as well as with left footed operation of a left sided accelerator setup. The slowest reaction times were using the two footed technique.
Conclusions
This study would suggest that many right below knee amputees have the potential to safely operate driving pedals with their prosthesis. In addition, this study suggests that right below knee amputees should be instructed not to drive with a two-footed technique, and they may benefit from using a left-foot cross-over technique. Given these findings, many amputees should have the potential to return to driving manual transmission vehicles, which may be vital for a return to work. Further research is recommended in order to develop clear guidelines regarding return to driving following amputation.
Publications
Meikle B., Devlin M., Pauley T. (2006). "Driving Pedal Reaction Times After Right Transtibial Amputations." Archives of Physical and Medical Rehabilitation 87(3):390-394.
For more information:
bmeikle@gbhs.on.ca
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