Driving With an Upper Limb Difference: What Families and Teens Need to Know

For many families raising teens with an upper limb difference, learning to drive brings excitement and anxiety. Driving represents independence, adulthood, and freedom — but when disability enters the picture, the process can become confusing, inconsistent, and sometimes frustrating.

One of the most important things parents and teens need to understand is this:

There is no single, standardized experience for learning to drive with an upper limb difference.

Driving instructors, adaptive driving programs, and Bureau of Motor Vehicles (BMV) staff often approach disability very differently. What one family is told may be completely different from what another family hears, sometimes within the same state.

This post is meant to help families understand the nuance, the long-term implications, and the questions worth asking before making decisions that may affect a teen’s driving future.

Upper limb differences and driving: the big picture
Adaptive driving equipment: helpful tool or long-term commitment?
Steering knobs and license restrictions
State laws vary — sometimes significantly
Talk directly to the BMV or DMV before the road test
The takeaway
Explore more resources

Upper limb differences and driving: the big picture

Teens and adults with shortened, absent, or anatomically different upper limbs drive successfully every day. There are many ways to operate a vehicle safely depending on:

Which limb is affected (right, left, bilateral)
Level of limb difference
Range of motion, strength, and endurance
Compensation patterns already in use
The type of vehicle
Whether adaptive equipment is used

Driving ability is not binary (can vs. can’t). It exists on a spectrum, and most people with upper limb differences fall somewhere in the middle—capable drivers who may or may not need adaptations.

Adaptive driving equipment: helpful tool or long-term commitment?

Adaptive equipment, such as steering knobs, spinner knobs, or modified controls, can be incredibly useful when truly needed. However, families are often not told that using certain devices during a driving test can result in a permanent license restriction.

Steering knobs and license restrictions

A common example is the steering knob:

A teen may be encouraged (or required) to use a steering knob during the road test
The BMV may then issue a license stating that the driver must use that adaptive device at all times
That restriction can follow the driver for years—or indefinitely—unless formally reassessed

What families often don’t realize:
The restriction is not automatically removed if the driver no longer needs the device. In many states, removing a restriction requires additional documentation, medical clearance, a formal reassessment, or even a repeat driving test. For some drivers, that process is straightforward; for others, it can be time-consuming, costly, or discouraging enough that the restriction simply stays in place.

This doesn’t mean adaptive equipment should be avoided. It does mean that families deserve to understand the long-term implications before a device is introduced during a road test.

Important questions to ask before using adaptive equipment during a driving test:

Is this device required for safety, or is it being suggested out of caution or unfamiliarity?
If my teen uses this during the test, will it result in a license restriction?
If so, what is the process for removing that restriction later?
Who makes that determination—the examiner, the BMV, or a medical professional?

State laws vary — sometimes significantly

Driving regulations related to adaptive equipment are state-specific, and even within a state, interpretation can vary by examiner or office.

One helpful resource is suicideknob.net, which provides a state-by-state overview of laws related to steering (spinner) knobs and other devices. While it’s not an official government site, it can be a useful starting point for understanding what may be permitted in your state and what questions to ask next.

Historically, steering knobs were often restricted to drivers with documented disabilities. Today, in many states, any driver may legally use a spinner knob, regardless of disability status. However, some states still have specific requirements, and others allow them broadly but attach conditions when they’re used during a licensing exam.

This is why it’s so important not to rely solely on what one instructor, therapist, or examiner says.

Talk directly to the BMV or DMV before the road test

Before scheduling a driving test, families should consider contacting someone knowledgeable at their local BMV or DMV, ideally someone who works with medical reviews or adaptive driving cases.

Helpful questions include:

If a steering knob is used during the test, will that result in a restriction?
Is there flexibility in how the test is conducted?
Can a teen test without adaptive equipment if they typically drive without it?
What documentation is required if adaptations are used or removed later?

Having these conversations ahead of time can prevent surprises and give families more control over the decision-making process.

The takeaway

Adaptive equipment can be empowering, protective, and sometimes essential, but it should be introduced intentionally, not automatically.

Teens with upper limb differences are not a monolith. Some will benefit from adaptive tools long-term; others may use them temporarily or not at all. The goal is to make informed choices that support safety without unnecessarily limiting future options, not to prove independence or avoid supports.

Driving with an upper limb difference is absolutely possible. The path there just requires better information, better questions, and a system that recognizes ability exists on a spectrum.

Frequently asked questions

Can you drive with one hand?
Yes, many people drive safely with one hand while many use compensatory strategies or adaptive equipment when needed.

Do you have to use a steering knob if you have a limb difference?
No. Some drivers choose to use one, but using it during a driving test will result in a license restriction. In most states, you should be able to test without the steering knob (so it isn’t a license restriction) and then use it while driving.

What is a driving evaluation with an occupational therapist?
It’s a specialized assessment that evaluates your physical and cognitive ability to drive and helps determine if adaptive equipment is needed.

Explore more resources

👉 Check out the Free Handouts
👉 Learn about Seeing the whole child with a limb difference: celebrating strengths & supporting struggles
👉 Read Winter Care for Partial Arms and Hands: Skin, Circulation, and Warmth

Posted in Life Stages, Limb Difference, Teenage Years