Upon completing this chapter, you will be able to do the following: 1. Describe correct use of child restraint systems for passenger safety 2. Describe correct use of child restraint systems designed for children with special needs 3. Understand basic features of standards for crashworthiness of wheelchairs and seating systems 4. Understand use and basic features of standards for wheelchair tie-downs and occupant restraint systems 5. Identify major components of driver evaluation 6. Discuss major design features to consider when making a vehicle purchase 7. Discuss vehicle access issues for individuals with disabilities 8. Describe vehicle modifications to promote access for individuals with disabilities The inability to drive was more than a retreat from mobility, for it was one step away from spontaneity and the free exercise of will. Whereas I could once act on whim and fancy, I now had to exercise planning and foresight. This was true of even the simplest of actions.25 Chapter 12 focused on personal mobility systems, specifically manual and electrically powered wheelchairs, that afford individuals the ability to move within their immediate environment and for short distances between local environments. In this chapter, we consider mobility systems that afford movement over longer distances, such as movement between home, school, work, and community sites such as shopping and leisure venues, as well as travel between communities. Our focus is on safe personal (car, van, etc.) and public transportation across the lifespan, including travel as a passenger or a driver. This chapter discusses technology that enables a person with a disability to ride safely in a vehicle (private or public) using devices provided by the original equipment manufacturer (OEM), infant/child restraint systems, or wheelchair occupant restraint systems. The chapter also describes devices that assist individuals to transfer into and out of the vehicle, including those devices that assist the caregiver. Box 13-1 lists a number of useful Web sites. There are three main types of vehicle restraint systems for children: rear-facing infant seats, forward-facing infant seats, and booster seats. A number of Web sites provide access to up-to-date information on the proper use and installation of these devices for their specific jurisdiction (Box 13-2). The Co-operators Insurance and the Infant and Toddler Safety Association have the “Buckle up Bears” education program. Daimler-Chrysler and the U.S. National Highway Traffic Safety Administration (NHTSA) offer the “SeatCheck” program, which provides free car seat inspections and a determination of whether the vehicle restraint system is properly installed.* In the United States, the NHTSA maintains current information on vehicle restraint systems. The American Pediatric Association also provides current information on vehicle restraint systems, including those specifically for children with disabilities. Federal regulations exist that govern the structure and testing of vehicle restraint systems, including those for children with disabilities. In the United States, the Federal Motor Vehicle Safety Standards (FMVSS) group produces these regulations, and in Canada they are produced by the Canadian Motor Vehicle Safety Standards (CMVSS) organization. Restraint systems that meet these regulations are labeled with a sticker identifying either FMVSS or CMVSS and the specific standard that the system has met. These regulations can be found at http://www.nhtsa.dot.gov/cars/rules/rulings/ChildRestrSyst/Index.html or http://www.tc.gc.ca/eng/roadsafety/safe drivers-childsafety-index-53.htm for the U.S. or Canadian standards, respectively. Rear-facing infant seats (Figure 13-1, A) are intended for use from the time the infant leaves the hospital after birth to the time they reach 12 months and 22 pounds (10 kg). While most vehicle restraint systems indicate a height and weight limit for the child, rear-facing infant vehicle restraint systems have an age and weight limit, which means that the child must be 12 months of age before they are turned to the forward-facing position. Infants younger than this age do not have sufficient head control and their bones are not sufficiently developed to withstand even a minor crash.1 A common error on the part of parents is to move a child to the next type of child vehicle restraint system too early.10,36,37,38 Many children reach the 22-pounds/10-kg weight limit well before their first birthday. In this instance, they should be moved to a vehicle restraint system that will accommodate their heavier weight but will allow them to remain in the rear-facing position. Rear-facing infant seats are typically not left in the vehicle in the long term. Instead, the child is transported in the infant seat between the vehicle and destination. The car seat belt system provides restraint for the child and the seat inside the vehicle. Some seats secure into a base that remains installed in the vehicle over the long term. Forward-facing vehicle restraint systems (Figure 13-1, B) are intended to be installed in a vehicle and remain for the long term. These systems typically accommodate children up to 40 pounds and 40 inches. This technology does change, so it is important to check your local area for the current law. Useful information can be found on the Web sites listed in Boxes 13-1 and 13-2, or check with your local jurisdiction. Proper installation of these systems is critical. A biomechanical study of parents installing a forward-facing vehicle restraint system into a mock-up of the back seat of a sedan found that proper installation required efforts that were higher than the maximum that many participants were able to produce. Because the space in the back seat area is limited, parents were in postures that made it difficult to tighten straps so that the restraint system was properly secured. These postures put parents at risk for low back injury.12,29 Two errors are common when installing the forward- facing car seat: (1) nonuse or misuse of the tether strap, and (2) improper use of the strapping system of the restraint system.20,22 These seats all fasten to the vehicle frame with a tether strap. All new vehicles in North America are equipped with tether anchors, which allow the seat to be fastened to a ring that is attached to the vehicle frame. The tether strap must be fastened and tightened so that an excursion of the restraint system of no more than ½ inch is allowed. The strapping component of the restraint system should be snug to the seat with the chest buckle about two fingers’ width below the child’s neck. Often, these straps are loose, allowing the child to wiggle free of them. Since 2002, vehicles have been equipped with Lower Anchor Tethers of Children (LATCH) (U.S. name) and Lower Universal Anchorage Systems (Canadian name) that make installation of forward-facing car seats simpler. Clasps attached to the restraint system are attached to anchors that are fixed at the level of the seat. These systems are tested to a weight of 48 pounds (21 kg). Box 13-3 summarizes the research on misuse of child safety restraint systems. Once a child reaches 40 pounds and 40 inches, they can be moved to a booster seat. Again, this specification varies by jurisdiction and by product, so it is important to know the product specifications and to be up to date with legislation in your jurisdiction. These seats position the child so the vehicle seat belts fit properly. The vehicle seat belt provides restraint when a booster seat is used. Figure 13-2 shows the proper positioning of the seat belt, coming over the shoulder and not across the neck, and across the lap and not the abdomen. Booster seat laws are relatively recent and do not necessarily have the same provisions for when the child is ready to move to use the vehicle seat belt assembly alone. Usually, a child is ready to move to use of the vehicle seat belt only when they reach 80 pounds and are at least 4 feet 9 inches in height. Some booster seat laws specify an age at which a child can be moved to the vehicle seat belt assembly. However, given the variations of height and weight, some children will not be tall or heavy enough at the specified age to be safely restrained by the vehicle seat belt assembly, so they will benefit from remaining in the booster seat. The safest location for the child in a motor vehicle is the center rear seat.1,2,9 When this position is not available, the right outboard seat (opposite side of the driver) is preferred because this seat is usually on the side of the lane that borders the road shoulder rather than the side that faces oncoming traffic (at least in jurisdictions where vehicles travel on the right side of the road). Booster seats require the use of a three-point seat belt assembly (i.e., one that has both a shoulder and lap portion), which sometimes precludes locating the child who uses a booster seat in the rear center seat because the restraint system in this location does not always include the shoulder portion. Children under the age of 12 should not travel in the front passenger seat of a vehicle that has passenger-side air bags. The air bags can seriously injure or kill a young child when they deploy. Some advances have been made, and there are “smart” air bags that sense the weight of the occupant of the front passenger seat and either adjust the force of the air bag deployment or turn it off. As previously mentioned, some children with mild-to-moderate seating needs are able to use a car seat that is designed for children without disabilities. This option is preferred, when possible, due to the costs of vehicle restraint systems that are designed specifically for children with disabilities. In some cases, the child may be able to use the child restraint system without any modification. When modifications to these systems are required, elements of the system that are provided by the Original Equipment Manufacturer (OEM) cannot be altered or removed since the system was crash-tested with those elements present. Alteration or removal may limit the ability of the seat to protect the child in a crash. Similarly, nothing can be placed underneath the padding or the straps. In the case of the strapping system, placing something underneath alters the direction of the pull on the child’s body and may cause him to be ejected from the seat in a crash. However, rolls can be placed alongside the child’s legs, trunk, or head to help them maintain an upright position. A roll can also be placed under the child’s knees to reduce extensor tone.3 Current commercial systems for children with disabilities can accommodate children up to 130 pounds and 56 inches/142 cm. The weight limit varies on these products so the ATP needs to check to determine that the child can be accommodated safely. In addition to accommodating children who are heavier than 100 pounds, these systems provide more postural support. In particular, these systems provide support to position the pelvis and trunk so that the child can maintain an upright position while seated. Postural control may be achieved by the form of the seat shell, providing contouring of the seat and more integral fit with the child’s body, or by padding that is supplied by the manufacturer. Some of these products have the option for the addition of a pommel to maintain leg abduction. Tilt in the system helps maintain postural control in a similar manner as that provided in mobility systems described in Chapter 12. These systems must meet federal safety standards and be crash tested for use as a vehicle restraint system. Systems that meet federal requirements will have the FMVSS or CMVSS sticker or appropriate labeling from another jurisdiction. Transportation for children who are unable to maintain a sitting position is difficult. Federal regulations exist for car beds but the companies that manufactured or distributed these devices no longer produce them. The E-Z-ON Vest remains on the market as a product that will help restrain the child in the supine position. Box 13-4 lists Web sites of companies that manufacture child safety systems for children with disabilities. Voluntary standards have been developed by ANSI/RESNA and the ISO that make provisions for the testing of wheelchairs and seating systems to determine their performance in a 21 g/48 km/h (30 mph) frontal impact crash simulation. These standards are: ISO 7176-19: Wheeled Mobility Device for Use in Motor Vehicles,5,14 ANSI/RESNA Wheelchairs/Volume 1: Requirements and Test Methods for Wheelchairs (including Scooters),4 and ISO 16840: Seating Devices for Use in Motor Vehicles.17 See Box 13-5 for a summary of the ANSI/RESNA WC-19 standard. The first two standards identify crash test procedures and manufacturer requirements for labeling and provision of information for a wheelchair and its dedicated seating. The use of an after-market seating system invalidates the wheelchair crash testing. Because many consumers purchase a wheelchair from one manufacturer and a seating system from another, ISO 16840 makes provisions for testing of a seating system independent of a specific wheeled mobility base. These standards are specific to a frontal impact crash; further development is required to test crashworthiness in side and rear impact crashes. Similar standards for wheelchair transportation exist or are being developed for Canada (Z605), Australia (AS-2942), and other parts of the world (ISO 10542, Parts 1 to 5). More information can be found on standards for wheelchair transportation on the Web site of the Rehabilitation Engineering Research Center on Wheelchair Transportation Safety (RERC WTS).* It is important to remember that the vehicle restraint system (i.e., the vehicle seat belt) provides restraint for the wheelchair occupant. The straps affixed to the wheelchair, which are intended to provide seating and positioning support to the user, will not protect the user in a crash.6,31 The rating system that evaluates use of the vehicle restraint system considers the following factors: the size of the opening through which the vehicle restraint system is threaded, the contact of the system with the consumer’s body and where that contact is made, the angle of the pelvic portion of the restraint system, and whether or not the vehicle restraint system comes into contact with any sharp surfaces.5,14,17 As was described earlier for positioning of the vehicle restraint system for a child using a booster seat, the vehicle restraint system must sit across the pelvis, not the abdomen, and rest on the shoulder, not on the neck. Further, the vehicle restraint system must not be held away from the user’s body by any part of the wheelchair or seating system. When assisting a person who uses a wheelchair, it is important to pay attention to these specifications in particular: that the seat belt strapping is not in contact with a sharp surface that can damage it, and that the seat belt is properly positioned on the individual and in contact with their body. Box 13-5 Summary of ANSI/RESNA WC-19 Standard • Specifies general design requirements, test procedures, and performance requirements related to frontal impact performance for manual and powered wheelchairs. • Applies to passengers in paratransit, public transit, school bus, over-the-road coaches, and personally licensed vehicles. • Applies to securement of wheelchairs by four-point-strap–type tie-down systems that are occupied by children and adults. • Applies to a wide range of wheelchairs, including manual, powerbase, three-wheeled scooters, tilt-in-space wheelchairs, and specialized mobile seating bases with removable seating inserts. • Specifies strength and geometric requirements for wheelchair securement points and occupant restraint anchorage points on the wheelchair. • Provides requirements and information for wheelchair accessory components, seat inserts, and postural support devices with regard to their design and use in motor vehicles. • Applies primarily to wheelchairs that are retrofitted for use as a motor vehicle seat by the addition of after-market add-on components.
Technologies for Transportation and Driving
Safe transportation for children
Vehicle Restraint Systems for Children
Location in the Motor Vehicle
Vehicle Restraint Systems for Children with Disabilities
Safe transportation of individuals using wheelchairs
Crashworthiness of Wheelchairs and Seating Systems
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Technologies for Transportation and Driving
