In this section, you will find information about return to driving following a spinal cord injury for people living in the province of Ontario. The information includes the following:
- Physician responsibilities as directed by the Ministry of Transportation (MTO)
- Driving Assessment and Training Centres
- Do I need to go?
- When is the right time to go?
- Types of vehicle modifications
Ministry of Transportation (MTO) and the Highway Traffic Act (HTA)
Ontario physicians are required by law to report anyone who is potentially unfit to drive. After an injury or change in medical status, the physician must report the altered physical or cognitive status of their patient to the MTO if in his or her opinion the medical condition may interfere with the person’s ability to safely operate a motor vehicle.
The Highway Traffic Act is the main piece of legislation for driving in Ontario. It affects a person who has sustained a spinal cord injury or disability. The act considers driving to be a privilege retained only by those who can demonstrate that they can drive safely (HTA section 31). The MTO makes the decision as to whether or not a person’s license will be medically suspended.
What happens next?
If your doctor sends a letter to the MTO, you will in turn get a letter from the Ministry within 3 months. The letter will outline your options and how to proceed. You can always contact the Ministry directly to find out the status of your license.
Note: There is a check box on the license form indicating if a person has a physical impairment that prohibits their ability to drive. If you answer ‘yes’ to this question, you will receive a letter outlining your options.
The 3 main options the MTO could request:
- Satisfactory medical report (from a physician or neurologist stating that all physical, cognitive, visual and perceptual concerns have been addressed)
- Satisfactory ophthalmology report (from an eye specialist)
- Successful completion of a driving assessment at a recognized Driver Assessment Centre
The MTO will consider the information in these reports (this may take 6 weeks or longer), make a decision about your driver’s license, and notify you by letter. They may:
- Reinstate your license
- Ask for further reports or information
- Require you to take an on-road driving test (at an MTO recognized Driver Assessment Centre).
You may appeal the decision.
MTO Driving Assessment Centres (Greater Toronto Area)
Drive Again (formerly Bridgepoint Community Rehab)
2700 Dufferin Street Unit 44
Toronto, ON M6B 4J3 (Dufferin and Lawrence)
Tel: 416-640-0292
WRI group – DriveLAB Inc.
145 Haist Avenue, Unit 8
Woodbridge, ON L4L 5V1 (Highway 7 and Pinevalley)
Tel: 905-851-9391
Saint Elizabeth Health Centre
Driver Rehabilitation Services
(formerly at Bloorview MacMillan & DriveABLE)
1140 Sheppard Ave. W., Unit 4
Tel: 416-398-1035
Driver Assessment and Training Centres
These centres were created because it is difficult for medical doctors to sign off on an individual’s ability to drive. Your occupational therapist can help with arrangements for a referral to a driving assessment centre. The assessment centre will thoroughly assess all skills required for driving including:
- Range of motion
- Strength and endurance
- Coordination and dexterity
- Attention
- Memory
- Judgment
- Reaction time
- Insight
- Vision and hearing
- Frustration tolerance
Once they have determined your skill level and needs, they will conduct an on-road assessment. Not all assessment centres provide vehicles for all levels of ability, so call ahead to ensure the centre can meet your needs. The centre will make recommendations for vehicle modifications and driving lessons.
The cost of the assessment is approximately $400 to $500. You may also have to pay for additional lessons with the prescribed modifications before your road test. At the end of the lessons, the assessment centre will help you through the process of taking a Ministry road test.
The cost for basic hand controls in a vehicle is about $1,500. Van conversions are much more expensive, depending on your needs and function.
When is the right time to return to driving?
Your rehab team will help you decide the most appropriate time to pursue driving. Information from your rehab team will be communicated to your doctor, who may use the findings to inform decisions about your medical fitness to return to driving.
- Allow adequate recovery time and the time you need to participate in therapies before you consider a return to driving.
- Ensure that you are medically stable and have your mobility aid finalized before going for an assessment.
- If you are assessed too early and then you continue to improve, you may end up with very expensive vehicle modifications that you no longer need.
- Specific information about your spinal cord injury and your abilities will help determine what type of driving methods are required, such as hand controls, the type of transfer you will use, or whether you will need to drive from your wheelchair.
- Obtain information from your rehab team about what your wheelchair will look like (power or manual, size, style, etc.). This will determine what type of vehicle you can use (car or van).
- Think about your functional abilities and how you will get your wheelchair into the vehicle. Will you have the balance and strength to pull the chair into the vehicle? Is it easy for the chair to go across your body or behind the seat? Your might consider a car with a ‘suicide door’ as it makes it easier to put the chair into the back seat.
Types of vehicle modifications
Do as much research as you can and learn before you buy. The Driver Assessment and Training Centres are a good resource for information.
This person has good trunk control and upper body strength.
Two different hand control mechanisms are shown here: the spinner knob for a person with a higher level injury (left) and a hand control (right), which can be portable or installed permanently, depending on individual needs.
Van modifications
Vans can be modified to accommodate a wheelchair user as a passenger or a driver. Power and manual ramps are available at varying prices. Do your research on van conversions before purchasing to modify. Some are easier to convert than others.
Back entry can only accommodate a passenger and that person needs to stay in their wheelchair. Back entry has limitations: If you park on the street, you may not be able to access the rear ramp. However, side entry has limitations as well: People will park too close to your van, so you may not be able to access the side ramp.
High-tech van modifications (approximately $75,000 conversion) include:
- Easy lock tie downs that are automatic, and keep the driver in place
- Zero-effort steering
- Push-button gearing system
- Electronic gas and break system
Used vehicles are available for resale. Check the
Canadian Paraplegic Association website at
www.canparaplegic.org
Drawbacks of driving
- Not covered by the Ontario Health Insurance Plan (OHIP) or by the majority of extended health carriers
- Workplace Safety Insurance Board (WSIB) and motor vehicle accident (MVA) insurance cover some expenses but not all
- March of Dimes Home and Vehicle Modifications Program will pay for up to $15,000 of the cost of modifications. See website at www.marchofdimes.ca for application details (under Programs & Services, Home & Vehicle Modification Program).
The good news
Many individuals with spinal cord injuries successfully return to driving following recovery of an incomplete SCI or through the use of the appropriate vehicle modifications.