Driving without legs, hand controls and other car modifications: Disability 101
[ID: A photo of a mechanical push-pull hand control system, with "Driving without legs: Hand controls and modifications" "Disability 101" in white bubble text. /End ID]
One really common assumption I see about people who's disabilities effect their legs, such as leg amputations, spinal injuries or joint dysplasia, is that we can't drive. It's a common enough assumption that it makes its way into media portrayals of these kinds of disability all the time, though often in very subtle ways that are hard to directly point to, but noticeable once you know what to look for, or rather, what's missing. It's also an assumption I see come up more directly in the replies and reblogs to a lot of my content more often than I expected it too, and almost never as a direct question, but as statements that are part of a separate point. "My character is in a wheelchair so they need to catch the bus..." or "My leg amputee is missing the leg they need to drive so their friend/family member has to drive them to the place where the plot happens..."
but the thing is, It's a misconception! Having a disability that effects your legs or even arms in some cases (or results in you having none at all) doesn't stop you from being able to drive, at least not on it's own. It's not even a barrier to driving other kinds of vehicles, like motorcycles, aeroplanes or heavy machinery, and that's because of a type of assistive technology called vehicle modifications.
I've chosen to make this a disability 101 post, mostly because it is just kind of general disability-awareness content, even if I am focusing mostly on authors and creatives, but also because finding resources about this topic can be genuinely difficult if you don't know the names of the modifications or devices, so I've provided some resources throughout (and at the end in the sources section) that could be helpful for disabled people who are interested in getting these kinds of modifications themselves.
I do want to give a quick disclaimer before getting into this though, that I just have modifications, I'm not a mechanic or an expert on how they work, nor am I an expert of cars and other vehicles. Like anything, be sure to do your own research and fact check anything you see here, especially if the more technical stuff is relevant to you and/or your writing.
Ok, with that out of the way, let's get into it!
Cars
Lets start by talking about the vehicle modifications available for cars, trucks and other similar vehicles. For the sake of simplicity, I'm going to be referring to anything with more than 4 wheels collectively as "cars" but know this includes everything from actual cars, to trucks, to even road-trains.
Control Modifications
The most common type of control modification you'll typically see are called "hand controls" and there's dozens of types available for cars. How they do it changes, but they all work by taking the parts of a vehicle that are controlled with your feet, and make them controllable with your hands in some way.
The most common version of this, and the type I use, is called a "push-pull hand control". It works by replacing the foot pedals in (usually automatic) cars with a bar which sticks out from the side of the steering wheel that can be pushed forwards to apply the break, and pulled towards you to accelerate. This is the set-up I have in my car.
[ID: A photo of the interior of a holden car showing the steering wheel and dashboard. On the top left of the steering wheel is a round door-knob shaped grip assist, and on the bottom left is the bar of a hand control sticking out from behind the wheel. /End ID]
One way to set this up is done by attaching a long mechanism or pole under the steering column that physically pushes down on the pedals for you when you push or pull on the control bar. This is the type that I have, and as I understand, it's one of the cheaper ways to do it.
[ID: Another photo of the car interior, this time showing the area where the driver's legs go (which is covered in a lot of dust) the pedals and steering wheel. A long metal rod connects the control bar to the pedals. /End ID
(please excuse the dirt, I live on a farm and it's been raining, so avoiding mud and dirt is impossible right now)
There are also versions of this systems that bypass the pedals entirely and connect the control bar to the car's internal systems. This is more commonly seen in electric vehicles or in cars that are being used by people with little to no control of their legs who might be at risk of pressing the pedals accidently - in which case, the pedals are also modified so they can be either folded up or shut off when the hand controls are in use, and then folded back down or turned back on when someone without a leg disability wants to drive.
There is also portable hand controls, which are very similar to permanent push-pull systems, but can be attached to almost any automatic car and removed as needed. Most I've seen have clamps that attach to the pedals, two adjustable poles, connected by a bar at the top, similar to push-pulls that essentially act as levers to press the pedals, and many are connected to the steering wheel via a Velcro strap. these are by far the cheapest and overall most flexible option, but they also happen to be mostly illegal where I live, so I've never actually seen them used in person. Technically, they can be used under very specific conditions here, but I've never met anyone who had them legally. Most people I know who tried to get approved were rejected. For everyone who doesn't live in or isn't writing a story set in NSW Australia though, Diamond Garrette has a demonstration of how they work on her YouTube channel, which I suggest checking out if you want to know more about them!
This isn't the only way the controls can be set up for the acceleration and breaking though. Other common variations include an over-ring control, trigger controls or joystick controls. In trigger hand controls, you still have a bar that extends out from the steering wheel that you push forward to break, but the accelerator is controlled using a trigger-like button underneath, similar to the accelerator on a motorbike. Joystick controls allow a driver to control steering and acceleration through a joystick (including sometimes the joystick built into the driver's power chair), and are usually a small part of larger modification systems. Over-ring hand controls, also called push-rings, are a type of control where the accelerator is tied to a ring that sits either over the top of the steering wheel, or just behind it, and you either use your thumbs to press down on it while you drive, or your fingers to pull it towards you if it's placed behind. The brake can either be another bar you push away from yourself like the others, or grip that sits beside the wheel that can either be pushed forward or squeezed in towards the wheel.
If you'd like a demonstration for how over-rings work, Des Gosling Mobility has a demonstration on their youtube page!
Trigger, joystick and over-ring controls are all often used by people who's disabilities effect their arms and legs, and who might have more difficulty with the heavier push-pull bar.
Because one of your hands will usually be occupied with most of these methods though (with the only exception being the over-ring and portable controls), many hand controls also have a second set of blinkers (indicators) controlled by buttons or a small flickable switch on either the hand control itself or a different location like the head-rest for easier access. While not as common, many also include extra buttons for the horn, windscreen wipers and headlights. On mine, I can control all of these "extras" through a small control pad attached to the bar, though only the blinker buttons and horn are actually connected (all the others cost extra).
ID: A close-up of my hand control, described earlier, to show the buttons. /End ID
Another thing you'll often see on cars with hand-controls is either a spinner knob or some other style of grip assist on the steering wheel itself. Spinner knobs - which you can see in the first photo on this post, usually look like a door-knob attached to the top left or right side of the wheel (depending on what side of the road you drive on) that allow you to turn easier with your remaining hand, but other options include tri-rod spinners (which are mostly the same, but with three rods the user can place their hand and wrist on if they have problems with their grip) and joystick controls, which I described earlier.
I mentioned before that most of these hand-controls are mainly used in automatic cars, and that's because manual transmissions add some extra complications that, honestly, most people I know just prefer to avoid. That's not to say hand controls are only for automatic cars though, they just aren't as popular due to the extra hassle it brings. One option I am aware of is called the "duck clutch" which is a small leaver installed on the back of the gear-stick that lets you control the clutch pedal. This video from Problem Management Engineering shows how it works, though the person in their video still uses their foot for the accelerator instead of a hand controlled accelerator/break.
There are many other types of control modifications outside of these, including alternate-side foot pedals for drivers who don't have (or can't use) the leg they'd need to reach the accelerator, pedal extensions for people with dwarfism, or chin controls for people with no use of their (or no) arms. It's always a good idea to check and see if there are options available for people with you/your character's disability before making the assumption that they can't drive at all.
Obviously, not every disability can be accommodated behind the wheel. For example, some autistic people struggle with the sensory processing and fast decision making needed for driving, and no amount of modification can help with that. Conditions like blindness and dementia are also pretty sure-fire disqualifiers once they reach a certain point (as both these disabilities exist on spectrums), but it's always worth checking if you've never been told for sure, especially if you are not disabled yourself.
Modifications for access
Another common kind of modification you see in cars for disabled people help them get in and out, as well as occasionally where and how they sit.
larger vehicles like vans have the most options available. My previous work vehicle (owned by a disability organisation with mostly disabled employees) for example had a large sliding door on the side that you could open to reveal a small lift. When not in use, it would fold up and sit against the door and when we needed to get in or out, you'd open the sliding door and put the lift in the "open" position, and it would lift you up to be level with the van floor so you could just roll in, or lower you down to the ground to let you out. It was a converted tradie van (a big white van usually used by electricians and other tradesmen to carry large amounts of tools and equipment) that had the back seats and a lot of the interior torn out, so you could take your chair all the way up to the driver or passenger seats and just transfer in, and I've seen similar set-ups with the lift coming out of the back as well.
The major downside of these kinds of modifications, is that they require a lot of space, both in and outside of the vehicle. I dreaded taking the work van anywhere other than our planned destinations because finding parking spaces large enough for the lift to fully extend (about a metre, if I remember right) was a nightmare - though many places now have parking spots next to the accessible spaces that are kept empty specifically to help with that (if you've ever seen a parking space with stripes painted over it, that's what they're for).
Some vans can also have small fold-out ramps instead of lifts, which are a lot cheaper and don't require a power supply, but these tend to only be good if your van is low enough to the ground to keep the ramp small, otherwise getting in and out becomes a challenge. This is the approach I see used the most in wheelchair accessible taxis too.
As for the seating in vans, some people are able to get the driver's seat modified to spin around, making getting in and out of the driver's seat easier. I've also seen this in some cars and trucks, where the seat can rotate outwards to make transferring easier, or in some trucks that are higher off the ground, the seat can come out and be lowered, and then lift the driver back into the truck. While less common, I have also seen a few vans that allow wheelchair users to push directly up to the steering wheel and drive from their chair once it's secured, such as Problem Management Engineering Spacedrive System (The video linked here also contains a demonstration of a joystick control modification).
Some smaller cars and trucks can also have chair lifts installed that store mobility aids like wheelchairs either on the top of the car or, if it's a ute (a truck with a bed on the back) in the open bed.
Getting in and out without modification
Not everyone has these kinds of modification though. In fact, most manual wheelchair users I know don't have any seating or access modifications at all. For people with mobility aids like manual wheelchairs, getting in and out can be done without modifying the car in a few ways:
If someone is able to walk a little bit, they may put their wheelchair (or other mobility aid like a walker) in the boot (trunk) of their car, or on the back seat if they don't have the boot space. If their wheelchair folds, this makes it easier, but even non-folding, rigid-frame wheelchairs can fit in most car boots by taking off the wheels. If, like me, you have a car with a tiny boot where that's really not an option, many people will slide their wheelchairs onto the back seat of the car instead. Usually, this is done by putting the footplate of the chair where a person's legs would sit, and sitting the frame on the seat with the backrest up against the car seat backrest. It kind of looks like a weird booster seat once it's in. After that, wheels sit on-top of the seat. This even works with tiny cars! If a human can fit, most wheelchairs can too.
But what if they can't walk at all?
well, that's a bit trickier, but its still doable for a lot of people. If we're travelling with someone, we just get them to do the steps I mentioned before, but if we are on our own, most wheelchair users I know (and myself) will get into the driver's seat, take the wheels off our wheelchairs, put both the driver-side and passenger-side backrest as low as it will go so they're both basically laying down, then pull the frame over ourselves and place it on the passenger seat in the same position as I described before. frame on the seat, footplate in the leg area and backrest up against the back of the car seat backrest once it's sat back upright - or, if you're cars a bit of a tighter fit like mine is, just put the frame and footrest on the passenger seat and leave the car backrest laying down. Then we put the wheels on top (if they fit, they usually don't) or on the back-seat.
I'm a bit out of practice, since I usually have someone with me when I use the car, but this is a sped-up video showing my whole process:
[Video Description: A fast-forwarded video of Cy, a fat, white double leg amputee wearing a light purple shirt and blue jeans that cover their stumps as they get into their car, a small, black holden SUV. They start by putting their phone in the car door storage, transferring into the driver's seat and laying the seat all the way back. They then turn their wheelchair away from them and lift it so it is balancing on it's front footplate while they remove the wheels and put them to the side. With a bit of manoeuvring, they pull their wheelchair frame up, over their body, but it gets stuck, requiring them to fold down the handle bars so it will fit. They try again, but their chair gets stuck on something inside the car, out of view. Cy lowers the passenger seat to a laying down position and then continues to pull the wheelchair frame in, placing it on the seat. Lastly, they put the wheels on the back seat behind them. The video then fade-cuts to show them getting back out again, which is mostly the same process but in reverse, starting with the chair frame. They lift it over themself, then lean the chair forward so it is resting on it's footplate again, but the backrest is leaning up against the doors. They pull out one wheel from the backseat and re-attach it to the frame, then rotate the chair around and retrie the other wheel to put it back on the other side. Once both wheels are on and the chair is re-assembled, Cy then lifts their seat back up and transfers back into their wheelchair, and gives the camera a thumbs-up. /End Video Description]
Obviously though, this won't be an option for everyone. Not everyone has the strength or flexibility needed to get their wheelchairs in and over their bodies. I personally struggle with getting in and out of the car by myself because I have short arms and a big belly which gets in the way of getting my chair over the top of me to put it on the passenger seat. For people with joint dysplasia, doing this might risk something dislocating. Some power-chairs can weigh hundreds of kilograms, and no one, even able bodied, is lifting that on their own. and some wheelchairs are just physically too large to fit in a normal car, and that's when these access modifications can come into play.
Less-than-legal modifications
Sorry for yet another disclaimer, but just a reminder that this post is mostly for writing advice, which sometimes includes writing for characters who can't or don't care about doing everything correctly and by the book. It is not a guide on how to do this or encouragement to try it yourself, so…
Do not, under any circumstances, try anything in this section at home!
Sometimes, for reasons we'll talk about in a minute, “proper modifications” might not always be an option. Maybe you're writing someone who just doesn't care about the law that much, maybe they need to use an unmodified car in an emergency. Maybe its a zombie apocalypse and you can't be picky. Maybe your character just lives somewhere where the law isn't as strict. In those cases, know that disabled people have been Macgyver-ing and DIY-ing their own solutions for as long as cars have been a thing, regardless of what the laws have to say about it. Being in a rural area with a lot of space to drive off of public roads, I've also personally seen quite a few... creative solutions.
One especially common method to get around a lack of hand controls in cars for someone without the use of their legs, is a walking stick. Just a cheap one you can get from the shops, to help reach the pedals. I have a family friend who used to drive his old farm truck this way (again, never on public roads) and I may or may not have tried it as a teenager. It's definitely not a safe or convenient way to do it, but it's... a way, I suppose?
I've also seen a few home-made spinner knobs and chair lifts to help people get in and out of trucks easier as well as known a few leg amputees and little people who have extended their own pedals in old farm cars so they can reach without things like prosthetics or orthotics.
humans are shockingly creative sometimes. But once again, please, do not try these at home.
Other things to be aware of
I mentioned before that disability alone doesn't always stop people from driving, but there are other things to consider for disabled drivers that you should be aware of if you're writing us (or if you're a disabled person wanting to get modifications yourself) either because they can create extra barriers, or they're just important to know.
Initially, I tried to make this section as generally applicable to people in different countries and with different disabilities as I could, but outside of the "cost" section, I don't really think that's possible unless I wanted to spend weeks researching and trying to get answers out of insurance companies and governments and this post is already really long.
So instead, I think the best approach I can make on a limited timeframe is to talk about the barriers I've faced, or that people I know have faced, to kind of give you a general idea of what to look for in your own research. What barriers you or your characters face will change massively depending on your location and disability, but hopefully this will give you a stepping-off point.
Cost
So the first major barrier that a lot of disabled drivers face outside of their actual disabilities, is the cost of these modifications.
The hand controls in my personal car that I've been describing throughout the article are considered basic, and when I had to get them replaced in 2024 due to an accident, I was quoted $8,925 AUD (which is a little over $5,700 USD), just for the mechanical push-pull mechanism, blinkers and horn button, and this is pretty average in terms of price for this kind of system. I have seen them go for cheaper, for example, my first set of hand controls were second hand and it still cost around $2,500 AUD, but this was several years ago now. I think around 2016. prices for everything related to disability in Australia have sky-rocketed since then.
I also happened to be working in the office the day the quote came in for the modification to my old workplace's vehicle when we first got it, (the one with the side access lift, which also had a push-pull hand control but no additional blinker/horn buttons and rotating seats) and we were told it would cost over $50,000 AUD to do all the modifications. I'm pretty confident this was also a discounted rate too, since our company had several modified vehicles and we always went to the same place for installation. Once again, this was a good number of years ago now, probably around 2018 at the latest.
Like a lot of disability aids, depending on where you live, either government-run healthcare programs, public insurance or private (usually health or car) insurance can *sometimes* either subsidise or cover the cost of modifications outright. However, this isn't always an option for everyone and a lot of people end up having to pay for their modifications (and all the other extra legal hoops they have to pay for, that I'll talk about soon) out-of-pocket.
In Australia, the NDIS (A disability-specific public insurance system) is generally considered to be responsible for covering vehicle modifications in the public sector, and on paper at least, they do. But like with most insurance companies, there's a million different conditions and "gotcha's" that let them get out of paying for them.
My first set of hand controls were funded by them, but not without a substantial amount of arguing and a small army of both medical and mechanical experts to vouch for both me needing the modifications for my disability, and my car actually surviving long enough for it to be worthwhile paying for them.
You see, at that point in time, if your car was less than 3 years old or had less than a certain number of kilometres on the odometer (I have no idea what it was, something ridiculously low), you could get your hand controls covered, mostly no problem. Statistically though, most people with disabilities severe enough to even qualify for these modifications, didn't have the money for a car that new due to systemic barriers. There was a bit of leeway though, as long as your car was less than 10 years old, you could sometimes get them covered regardless, so long as you could prove your car wasn't falling apart on the road already. Unfortunately, my car was from 2004. So... a little bit outside that window. Honestly, I don't know how we got it approved.
Today, those rules are a bit different, they've extended the "usually fine" margin to 5 years OR if your car is still under a manufacturer's warranty, but the 10 year cut-off is much stricter than it used to be (because as we all know, after 10 years your car just starts to disintegrate, obviously).
There are also a bunch of other seemingly random things that can disqualify you from getting vehicle modifications covered, including "not being good value for money" or there being other services available (when I applied they originally tried to argue this with me, and suggested public transport was an option). Honestly, whether or not you get approved for them or not just seems to come down to who was working in the office at the NDIA that day and if they'd had their morning coffee when they saw your request.
If you want to know more, this is the publicly-available outline the NDIS has. If you live in Australia and you're thinking of getting vehicle modifications yourself, it's worth a read, but be mindful it's never as simple in reality as it is in these kinds of outlines.
In Australia, private health insurance will cover it sometimes, and I know a few people who got theirs that way, though I don't know what the process is like. I do know private car insurance will also replace existing modifications if you're in an accident that destroyed your old ones, which is how I got my second set of modifications. Also after a lot of arguing. You see, in Australia, our disability anti-discrimination law, the DDA, does protect disability-related car modifications as essentials that can't be charged extra for, but that doesn't mean insurance companies won't try to get out of covering them if they can. Many will claim they don't have to cover the modifications unless you paid for "extras" to be insured too, and bet on customers not knowing that's against the law. Unfortunately, the DDA is a massive law and while most people know it exists, they don't know exactly what it covers and this lie ends up working. Even if a person does know it's illegal, if an insurance company refuses to budge once its pointed out to them, many disabled folks don't have the time, energy or money to actually hold them accountable in court, so they still get away with it, and another barrier is created, even if, legally, it's not supposed to.
From what I was able to find, in America, private insurance companies will sometimes cover the cost vehicle modifications but even if you get them, another barrier arises in the form of insurance premiums. unlike the DDA, the ADA doesn't always protect the modifications as essentials. Because of that, it's not uncommon to have to pay more on car insurance if you do have them and want them covered, which presents a different kind of cost barrier and makes driving with them legally riskier.
Legal restrictions and getting "approved" for use
I mentioned this in passing before, but in order to get modifications for your vehicle, at least in Australia, you actually have to get "approved" by your state government to be able to use them at all. Also, in NSW, for control modifications like hand controls, once you're approved to use them, that's all you're allowed to use. This means, if you and your friend both own a car with different kinds of hand controls, you're not allowed to use the other person's car. This was actually the case for me and my previous roommate, she had an over-ring, while I had the push-pull mechanism. Legally, we couldn't drive each other's cars. Despite both having hand controls and being physically able to drive each other's cars, we weren't legally allowed to.
This is because in most places around the world, the modification of cars in general and specifically the use of alternate controls systems like hand controls are very heavily restricted for a variety of safety reasons (some of which are reasonable, and others... eh... not so much) - Even some US states forbid things like spinner knobs from being used without state government approval. Australia is... a little extra in this regard, to put it mildly, and their restrictions can be serious barriers all on their own.
Usually, to get approved to use modifications here, you have to go out with an Occupational therapist to test which type of modifications work for you. For control modifications specifically, once a best fit is found, this will be added as a condition to your licence, meaning you can now only drive with that style of control. This isn't too bad if you get your modifications covered by the NDIS or insurance, since they'll usually cover the cost of the OT as part of this, but if you're one of the unlucky people that can't get covered, you also have to pay for the OT, which can be thousands of dollars on top of the other costs.
Access to installation and maintenance
Another major barrier for a lot of disabled people who need these kinds of modifications is physical access to someone who can actually put them in and maintain them.
You see, not just any mechanic can install disability modifications, especially control modifications. You have to go to a specific type of engineer. The only exception to this rule, as far as I'm aware, is the portable hand control, which is a big part of the reason why they're banned in my state, as they can't be assumed to be safe.
Unfortunately, this is a pretty niche area of speciality, so there aren't a lot of options to get the installations done. There are only 8 in all of NSW (which has an area bigger than 3 times the entire UK), according to Australia's National Equipment Database, and the vast majority of them are in the Greater Sydney Region. This means, if you don't live near Sydney, you're out of luck for the most part, unless you can spare a few days to make the trip (since the installation can also take some time). Some companies do offer to come and get the vehicle for you, but not all, and even those that do, may not be able to come get it if you're 8+ hours away.
And that's just the installation. Thankfully, normal car maintenance still can be done by a general mechanic, even with modifications installed, but if anything happens to the modifications themselves, you normally have to go back to the person who installed them for repairs.
Personally, I now live around 4 hours out of Sydney, and around Christmas, the wiring in my hand controls failed. It was a simple repair, but my partner and I had to go all the way back to Sydney for it, and we had a lot going on at the time, so we had no choice but to leave it for over a month. Meaning there was a whole month where I just couldn't drive.
Uneducated Law Enforcement
Ok, so this one is kind of a... luck of the draw situation and it's not a common barrier in my personal experience, but I also recognise that, as a white person who can still pass as cis if needed, my experience here won't be universal. Disabled people with intersecting identities such as POC and visibly queer folks, may have a substantially harder time with this.
Unfortunately, because disability modifications are not super common in the general public, it's not uncommon for police to have never seen them before. And when police don't know about something, that can become your problem very quickly. Most of the time, there's no issue, but I have been accused on two separate occasions of having "illegal racing modifications" in my car, because the police didn't know what a hand control was and jumped to that assumption (I'm not even sure what they would have been confusing them for, I've seen racing mods and they don't look anything like hand controls). I was also once told I'd have to get my car towed when on my way to get it checked by a mechanic for registration, because the officer didn't believe me that a regular mechanic could do it due to my hand controls, so obviously I must be lying and trying to drive my unregistered car around town (I don't know what the law is in other places, but here you are allowed to drive an unregistered vehicle to the mechanics if they know you’re coming). Both situations were pretty minor and were resolved quickly, but they could have easily been a lot worse if the officers decided not to believe me, or in the case of the second situation, they didn’t believe the mechanic who had to be called to convince the officer I was telling the truth.
Other Kinds of Vehicles and Modifications
Cars aren't the only vehicle you can modify to drive with a disability, they're just the most common! Honestly, each other vehicle was originally going to be it's own segment, but this post is already incredibly long, so here's just a quick overview of the modifications I know about for other vehicles!
Motorbikes and trikes often don't need much in the way of control modification for most riders, but many bikes can be modified to be easier to balance on or hold a wheelchair, either on the back or side, and trikes can be made to allow the rider to stay and ride from their wheelchair directly.
The laws for this are different everywhere, but in Australia and the UK, light aircraft can also be modified to be accessible to people with some physical disabilities, including wheelchair users with hand controls. Wheelies With Wings is a Melbourne based organisation that specialises in helping wheelchair users learn to fly. For those in the UK, Freedom of the Air offer similar services. Though as you might expect, there are some pretty substantial cost barriers involved for this.
I also know a few people who have also (legally) modified their farm equipment, like tractors or even heavy machinery, like bulldozers.
Pretty much anything can be modified. More often than not, if something can't be, it's usually more due to legal problems than it being physically impossible.
Conclusion
There's so many kinds of vehicle modifications out there, for all different kinds of vehicles, this is really just a general overview, so be sure to research what would be applicable to you or your characters