Before your teen starts driving

Here are some important things to keep in mind:

1. Just because your teen has an upper limb difference or limb loss doesn’t mean they need adaptive equipment. Some people drive without adaptations, while others find equipment or other strategies helpful.
   
2. Your teen should have a voice in the process. Safety and function are important. So are comfort, convenience, confidence, and how your teen feels about using a particular device.
   
3. Pay attention to what happens during early practice. Parent-supervised driving can give you useful information about what your teen can do, where they may have difficulty, and whether fatigue or awkward movement patterns show up.
   
4. A recommendation is worth investigating. If a driving instructor, school, or other professional says your teen needs a particular adaptation, find out why. Is it required by the licensing agency? Is the instructor recommending it based on an observation? Or are they simply unfamiliar with your teen’s abilities?
   
5. Consider an evaluation before buying equipment or making licensing decisions. A qualified driver rehabilitation professional can help determine what your teen actually needs and how different equipment may assist them.
   
6. Think beyond the first road test. Adaptive equipment, license restrictions, vehicle changes, moving to another state, renting a car, college, fatigue, and long-term comfort also can be important factors.

Want to know more?

For many families raising teens with an upper limb difference or limb loss, learning to drive can bring both excitement and anxiety. Driving represents independence, adulthood, and freedom, but the process can become confusing when disability enters the picture.

There is no single, standardized experience for learning to drive with an upper limb difference or limb loss. Driving instructors, adaptive driving programs, and Bureau of Motor Vehicles (BMV) staff may approach disability differently, sometimes even within the same state.

This post is designed to help families recognize the difference between a recommendation and a requirement. It also can be helpful to know what questions to ask before making decisions that could affect a teen’s driving experience or future licensing options.

Upper limb differences and driving: the big picture
Include your teen in the decision-making process
Start with the permit and supervised practice
The vehicle matters
Finding a driving school and instructor
Know that disability rights may apply
Adaptive driving equipment: helpful tool when it’s actually needed
Adaptive equipment and license restrictions
When should you consider a driving evaluation?
Thinking beyond whether an adaptive device works
State laws vary — sometimes significantly
Frequently asked questions
Where to find more information
Have you been through this process?
Explore more resources

Upper limb differences and driving: the big picture

Upper limb differences and limb loss vary widely. A driver may have a unilateral or bilateral limb difference, a difference involving the hand, forearm, or upper arm, or may use a prosthesis. The strategies and equipment that work for one driver may not be appropriate for another.

The important question is not simply what type of limb difference someone has, but how that person’s abilities, strategies, equipment, and vehicle interact. These factors include:

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

Include your teen in the decision-making process

Your teen should have a meaningful role in decisions about how they learn to drive and whether they use adaptive equipment.

Ask your teen what feels comfortable, what they notice in their body while driving, and what they think about the various options. If someone recommends an adaptation, give your teen opportunities to understand and practice with it before making decisions about equipment or licensing.

A device may be functionally helpful but also still raise questions for a teenager about appearance, attention from peers, convenience, or whether they want to use it every time they drive. These concerns deserve to be part of the conversation.

The driver’s experience of using the equipment is as important as safety concerns. The goal is to find a driving approach that is safe, functional, comfortable, and acceptable to the person who will actually be behind the wheel.

Start with the permit and supervised practice

For many teens, the first driving experiences happen with a parent or other supervising adult before formal driving instruction begins. This can be an important opportunity to observe what your teen can do without adaptive equipment.

Pay attention to their abilities to:

• Steer
• Turn
• Signal
• Start and stop
• Park
• Manipulate other vehicle controls

Concerns about safety, comfort, fatigue, or the amount of compensation required may be good reasons to seek a professional driving evaluation rather than simply adding equipment.

Early practice can provide useful information. It does not have to be a commitment to a particular driving strategy.

The vehicle matters

A driving strategy that works in one vehicle may not work in another. Consider whether your teen will learn in the family vehicle, a driving school’s vehicle, or a vehicle they may eventually own. A strategy that works in a driving school’s vehicle may not transfer directly to the family car or a future vehicle.

Features worth considering include transmission type, turn-signal placement, start/stop systems, parking brake, seat and mirror adjustments, seat belt operation, steering wheel design, the location of other controls, and backup camera and safety features.

Finding a driving school and instructor

Families sometimes expect the most difficult part of learning to drive to be the licensing test. In reality, dealing with a driving instructor or school that is unfamiliar with upper limb differences may have a bigger impact on your teen’s experience than the licensing test itself.

Your teen should be treated as the driver, not as a problem to be solved. An instructor should not assume what your teen can or cannot do.

Look for an instructor who is willing to:

• Ask your teen how they already do things before suggesting a different approach
• Give them an opportunity to demonstrate their abilities
• Talk directly with your teen rather than directing every question to the parent
• Focus on learning to drive rather than repeatedly drawing attention to the limb difference
• Be willing to adapt instruction when needed without making the teen feel singled out
• Recognize that there may be more than one safe way to operate the vehicle

Your teen should also feel comfortable speaking up if something is uncomfortable, confusing, or not working. A good driving instructor should be part of the learning process, not another barrier your teen has to navigate.

If an instructor seems unwilling to learn about your teen’s abilities, repeatedly assumes they cannot perform a task, or makes your teen uncomfortable about their limb difference, it may be worth looking for a different instructor or school.

Know that disability rights may apply

Private driving schools are generally subject to the Americans with Disabilities Act (ADA), although exactly what a school must provide depends on the circumstances. The ADA prohibits discrimination on the basis of disability and may require reasonable modifications or auxiliary aids and services when necessary, subject to applicable limitations. (See U.S. vs. Wold Driving School)

If a driving school tells you that your teen cannot participate, must use a particular adaptation, or must pay additional costs because of their disability, ask the school to explain the basis for that requirement. You may also want to contact an appropriate disability-rights organization or legal resource for guidance specific to your situation and state.

Adaptive driving equipment: helpful tool when it’s actually needed

Adaptive equipment, such as steering knobs or modified controls, can be very useful, protective, and sometimes essential for a driver. However, adaptive devices should be introduced intentionally rather than automatically. The question is what this particular driver needs to operate this particular vehicle safely and effectively. The goal is to make informed choices that support safety, comfort, and long-term independence.

A recommendation for adaptive equipment should be based on the driver’s abilities and needs, not simply on the presence of a limb difference.

If a driving school tells you that your teen must use a particular device or work with a specialized instructor, ask:

• What requirement or assessment are they basing that recommendation on?
• Has the teen been observed driving without it?
• Is the equipment required by state licensing rules, or is it a recommendation from the instructor or driving school?
• Is a specialized driver rehabilitation evaluation recommended?
• Could using the equipment during the licensing process result in a restriction?
• If so, what exactly would that restriction require?

Families do not have to accept the first recommendation they’re given, even from a driving instructor. Some recommendations are well-founded. The goal is to understand the reason.

Adaptive equipment and license restrictions

In particular, steering knobs can be very helpful for some drivers, but they are not necessary for every person with an upper limb difference.

One important consideration is what happens when adaptive equipment is used during the licensing process. Depending on the state and the circumstances of the evaluation, equipment used during a driving test may be reflected as a restriction on the driver’s license.

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

• If my teen uses this device during the road test, will it be documented as a license restriction? If so, what exactly will the restriction say?
• Would my teen be permitted to drive a vehicle without an adaptive device?
• What would be required to remove or change the restriction in the future?
• Who makes that determination?

A family should understand the licensing implications before introducing equipment specifically for the purpose of passing the road test.

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

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

When should you consider a driving evaluation?

A driving evaluation can be helpful when there are questions about whether adaptive equipment is needed, which equipment would be appropriate, or how a driver’s physical abilities interact with a particular vehicle.

A driver rehabilitation specialist can provide a more comprehensive assessment when there are questions about whether adaptive equipment is needed. The National Highway Traffic Safety Administration (NHTSA) notes that these specialists evaluate factors such as strength, range of motion, coordination, reaction time, judgment, and the ability to drive with adaptive equipment. They also can make recommendations about equipment and restrictions.

For a comprehensive driving evaluation, families may want to look for a Certified Driver Rehabilitation Specialist (CDRS®) or another appropriately qualified professional with experience evaluating drivers with upper limb differences. The Association for Driver Rehabilitation Specialists (ADED) also offers a Driver Rehabilitation Professional (DRP) microcredential for providers of basic and low-tech driver rehabilitation services.

A comprehensive evaluation may include clinical and on-road assessment of strength, range of motion, coordination, reaction time, vision, judgment, vehicle controls, and the ability to operate the vehicle safely with or without adaptive equipment.

When contacting a program, ask:

• What credentials does the evaluator hold?
• What does the evaluation include?
• Will the evaluation be conducted in the vehicle my teen will actually drive?
• Is a physician referral required?
• Does insurance cover any portion of the evaluation?
• What is the expected wait time?

Thinking beyond whether an adaptive device works

A driving strategy can be functional and still become uncomfortable or fatiguing over time.

Families and teens should pay attention to shoulder, neck, arm, or trunk discomfort; fatigue during longer periods of driving; and whether a particular hand position requires sustained effort or awkward positioning.

These factors can be especially important when a teen is considering equipment they may use for years. A driver rehabilitation evaluation can help identify whether a particular adaptation supports efficient, sustainable vehicle operation rather than simply making the task possible.

State laws vary — sometimes significantly

Driving regulations related to adaptive equipment are state-specific. Some states have medical review processes or require additional documentation when a driver has a disability. Requirements can also differ depending on how equipment is used during the licensing process. Check your state’s official licensing agency for current requirements.

Historically, steering knobs were often restricted to drivers with documented disabilities. Today, in some 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. A restriction may mean that the driver is required to use that equipment when driving. The process for changing or removing a restriction also varies by state.

This is one reason families should find out what their state’s rules are before deciding what equipment to use during a road test.

Some states have medical review processes or require additional documentation when a driver has a medical condition or disability. Requirements vary, so families should ask their state licensing agency what documentation, if any, will be required.

This is why it’s so important not to rely solely on what one instructor, therapist, or examiner says, but to look up the laws in your state.

Keep copies of relevant evaluations, recommendations, license documentation, and equipment information. Your teen may eventually move for college, purchase a different vehicle, or rent a car while traveling, and licensing requirements or equipment needs may change.

Frequently asked questions

Do you have to use a steering knob if you have an upper limb difference or limb loss?
No. Some drivers with upper limb differences use steering knobs, while others drive safely without them. Whether a steering knob is required, recommended, or results in a license restriction depends on the driver’s needs and the rules and procedures in their state.

What steering knobs do you recommend?
There are many different steering knob designs, and the best choice depends on the person’s vehicle, steering method, hand function, ease of use, installation, and other factors. I don’t recommend choosing a device based solely on an online product description.

When there is uncertainty about whether a steering device is needed or which type would be appropriate, a driver rehabilitation specialist can help evaluate the driver’s needs and recommend appropriate equipment

If I have a steering knob license restriction, can I install one in a rental car?
Rental-car policies regarding adaptive equipment can vary. Before traveling, it’s important to contact the rental company directly and ask whether they permit customer-installed equipment, whether they offer adaptive equipment, and whether there are vehicle-specific requirements. Never assume that a device can be safely or appropriately installed on every steering wheel.

Where to find more information

Association for Driver Rehabilitation Specialists (ADED)

Find information about driver rehabilitation and search for providers, including CDRS® professionals. ADED identifies CDRS® as its highest credential for the field.

National Mobility Equipment Dealers Association (NMEDA)

NMEDA provides consumer resources, equipment information, and a locator for accredited mobility equipment dealers.

National Highway Traffic Safety Administration: Adapted Vehicles

The NHTSA website covers adaptive equipment, licensing, evaluation, vehicle modification, training, and finding qualified professionals.

State licensing information

Find your state’s official driver licensing agency through the USA.gov site above or the Federal Motor Carrier Safety Administration (FMCSA) and look for information about medical review, adaptive equipment, license restrictions, and driving tests.

Have you been through this process?

I’m interested in hearing from teens and adults with upper limb differences, as well as parents who have helped their children learn to drive. You can contact me here. Here are some of my questions about your experiences:

• What did your driving instructor understand well?
• Where did you encounter confusion or unnecessary barriers?
• Were you encouraged to use adaptive equipment that you didn’t actually need?
• Did you encounter unexpected costs or requirements?

Experiences vary by state and individual circumstances, so please include your state and, if you’re comfortable sharing, whether the experience involved a standard driving school, an adaptive driving program, or a driver rehabilitation specialist.

Disclaimer

This is general education, not medical or legal advice. Rules and regulations change, so make sure to verify any information that affects you or your family.

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

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post Driving With an Upper Limb Difference: What Families and Teens Need to Know appeared first on On The Other Hand.

Intro
My daughter Brittany was born missing both her hands and part of her arms below the elbow. She has always been independent, but now she faces true independence. As I reflect on her middle school through high school years (ages 13 through 17), I would like to share with you some of the things we have learned, as well as her challenges and triumphs.

Transitioning from Elementary to Middle School
Going from elementary school (K through 6th grades) to middle school (7th and 8th grades) was a major transition for Brittany. Most children are nervous about the new environment both because in middle school they switch classes and they are not familiar with the school’s layout. Brittany’s concerns went beyond that. For the first time in 7 years, she would be entering a school where she would be meeting new kids. We weren’t sure how students would react towards her. Quite frankly, I was more nervous than she was. As she was approaching the end of the elementary school, I began to toughen her up. We talked about how to respond to kids who say unkind things, and we discussed the fact that not all kids’ disabilities can be seen. Fortunately, she did not have any significant negative feedback during those years.

Shortly after school started, I requested a meeting with her teachers, mostly because I didn’t want her teachers to “walk on eggshells.” I wanted them to understand that she was not to be treated “special”, that she would ask for help if needed, and that they could feel free to ask her any question they had on their minds. I emphasized that she would not be insulted or feel awkward by their questions. This meeting helped the teachers to relax and be comfortable around Brittany, and also allowed them to ask me any questions they had.

Tackling Logistics: Carrying Heavy Books
One of the problems Brittany experienced was carrying her books. The books that she had to take home were quite heavy on her back and caused her back pain. Not having hands to hold them in front of her, all the weight was on her back. As a result of the meeting with her teachers, Brittany was given a second set of books to keep home so she would not have to carry them back and forth to school.

As time marched on, Brittany attended various dances the school had, interacted with other students with no problems, and lived life like a “normal” teenager. My only frustration with the school was that they did not place her correctly in math class. Her math grades were excellent, yet she wasn’t placed in Algebra in 8th grade. Since I thought the school knew what they were doing plus Brittany was a little nervous about taking Algebra, I decided not to say anything. BIG MISTAKE!!! As a result, she was bored in her high school math classes. Since she is going to focus on engineering in college, she lost the opportunity to take calculus in high school, which was a set back for her. My advice to all parents is: if you feel your child can do the work, then challenge the school and fight for your child. You don’t realize how much your child’s placement in high school can affect her opportunities in college. Since that time, the same school tried to place my son incorrectly in high school. I challenged his middle school, I won, and my son is doing excellent in high school.

Life Beyond School
Life outside school became more complicated and challenging. Prior to Brittany’s 16th birthday, my husband and I began to teach her to drive. We found that she had no problem securing the steering wheel and moving the stick from park to drive. Soon I was teaching her along with the driving school. Like many parents, my hair got grayer and my foot kept reaching for what I called “the invisible brake” on the passenger’s side. The education portion of driver’s education was no problem – it was the driving portion that could have been a problem. We were very fortunate that the woman who owned the driving school had worked with various students with disabilities and was willing to go out with Brittany to see how she did. We were quite thankful that we gave her driving experience prior to her sessions with her instructor. This experience helped boost Brittany’s confidence, especially since she was nervous driving a different car that did not have the same kind of steering wheel she had. Her steering wheel had multiple bars going from where the horn is to the wheel, allowing Brittany to move the wheel from the inside. The steering wheel in her instructor’s car did not have the same configuration, which made driving a little more difficult. By the time driver’s education was over, Brittany did very well and was ready to take the test. The department of motor vehicles said that she had to go through the handicap division. We were totally opposed to this because they would classify her and try to evaluate her for special devices on the car. She was quite capable of driving without special devices, and we felt that she shouldn’t be restricted to driving with devices. We contacted the owner of the driving school. She then contacted someone she knew at DMV who was able to take Brittany for her test. As a result, she got her license without disability restrictions. My advice to anyone going through this is to make sure that the driving school has worked with kids with disabilities and is supportive of them. If you have that, the owner will go the extra mile for you if you need it.

Another important factor is making sure your child drives everywhere during the time he has his permit. Brittany was much more seasoned than many of her friends. We took her on the highway, the back roads, and anywhere else we had to go. As a result, she was quite comfortable reading signs, going where she needed to go, and even getting lost at times.

Another consideration was the car she had to drive. We put a cover on the steering wheel that had ridges so that it was easier for her to hang onto the wheel. We had to make sure she could reach the ignition, could manipulate the console, reach the radio, and handle her seat belt. Some cars were more of a challenge for her than others.

Taking on Responsibility
Life definitely changed after driving. Brittany was handling money more frequently because she was going out with her friends to restaurants, movies, the shopping mall, and the grocery store. Yes … I did say the grocery store. One of Brittany’s weekly chores was to make out a grocery list and do the grocery shopping. This activity served several purposes. It made her conscious of store prices, taught her a skill that she would be using when living on her own, allowed her to experience challenges at a time when I was able to advise her, and got her out into the public. Her presence in the public was not only beneficial to her, but also to the public. On one occasion, a woman saw her shopping and approached her. She stated that she was so happy to see her and asked Brittany if she could give her a hug. Brittany did not know her, yet she agreed. Brittany didn’t understand at the time what had happened, but I suspect that the woman either had a child or grandchild with a disability and seeing Brittany must have given her the faith that the child was going to be okay. On another occasion, I happened to go with Brittany to the grocery store and noticed that the deli employees and the fish employees were all saying hello to her. When Brittany went to another part of the store, a gentleman from the deli counter told me how amazing Brittany is, and that I should be very proud of her. Our children were given to us for many reasons, some of which, I believe, are to instill faith in others and make people appreciate what they have.

Handling Money
Regarding the handling of money, we found that a man’s bifold wallet was best because it opened wide and was long enough to balance on a counter so that she could flip through the dollars. She never liked handling change, so she would let that drop to the bottom of her purse. I have made other suggestions to her for managing the change, but the bottom of the purse is what worked for her.

Eating Out
When Brittany went with us out to dinner, we always would cut her food. So that she wouldn’t get embarrassed, we would swap plates, cut her food, and then swap the plates again. This worked well when we all went out to dinner as a family, but now that she was becoming independent, she needed to eat independently. Some foods she was able to cut, and she was comfortable asking some friends to cut her food for her. When she was in a situation where she didn’t want friends to do it, she would ask the waiter/waitress to have the food cut prior to it being served. This eliminated any embarrassing situations, and also allowed her to order whatever she wanted without being concerned if she was able to cut it or not.

Money Matters
The next challenge was shopping at the mall. Since I didn’t function well as a bank, I felt that it was time that I set her up with a checking account and ATM card. Although she wasn’t yet 18 years old, I was able to setup a checking account as long as my name appeared jointly with hers. By doing this, I was able to teach her about money management, how to balance a checkbook, how to use the ATM machine, and also how to use the ATM card to make purchases and pump gas. Brittany earned allowance by doing chores at home, money by working over the summer, and she received money from birthdays and holidays. This gave her an opportunity to control her spending and understand the consequences of spending too much. Thanks to the Internet, I was able to login to the bank’s website and observe her spending so that she didn’t get herself into trouble. The only problem she ran into was with our bank’s ATM machine. It wasn’t what we call, “Brittany friendly”, because the slot the card goes into has an indentation where the card must be pushed in and pulled out. She had no trouble pushing it in but couldn’t pull it out. She avoided using that bank’s ATM. However, we did come up with a solution: we attached one of those small black paper clips that fold down over paper. We clipped it onto the card, which allowed her to remove it independently. I also notified the bank, because by law the ATM is supposed to be accessible to all people with disabilities. Brittany’s disability happens to be one they didn’t plan for.

Chores
Along with grocery shopping, Brittany had to alternate setting the table, doing the dishes, emptying the small garbage cans, and doing her laundry. The purpose was to allow her to earn money, which enhanced her money management skills, and for her to learn life skills. Seeing the challenges our children experience at home allows us to assist our children with adapting, correcting mistakes, and recognizing their limitations if there are any. Once children move out, it is difficult for parents to advise, since they aren’t there to witness. For example, teaching Brittany to do laundry before she went to school was challenging; she had trouble reaching the clothes at the bottom of the top-load washer. She would have to get a step stool and then put her head in the washer to grab the clothes. I am sure there are devices she could use to get the clothes out, but this worked for her. It also taught her – and us – that a front-loading washer is more practical. Handling the front-loading dryer was no problem.

Emptying the garbage cans was also difficult, because she had to put the entire garbage can into the waste bag. She was unable to hold the bag with one hand while emptying with the other. Again, this was another life skill that she had to figure out.

To help with the dishes, Brittany had to work the sponge to clean them in the sink so that she could put them in the dishwasher, and then she had to stand on chairs to put them away when the load was clean. Once again, she did it her way and got them cleaned. If the dishes that didn’t go in the dishwasher weren’t cleaned well enough, she would have to do it again with me watching so I could determine where she was having the problem.

Summing Up
Much has happened during this time period and we all learned a lot. I share all of this with you to reinforce the importance of communicating with teachers, fighting for your children, and teaching your children valuable life skills before they leave home. Leaving home is a major transition and will provide many challenges. The fewer new challenges that they have to deal with, and the more things they are familiar with, the easier the transition will be for them. As far as the parents … nothing is easy when your child leaves home and nothing can prepare you for it. So enjoy having them home, because before you know it, you will be walking in my shoes.

Contacting Me
If anyone is interested in speaking with me directly, I can be reached in the evenings at 203 925-0446 or via email at LKTofinchio@aol.com. Brittany and I have had 18 plus years of challenges in our lives, and we wouldn’t change a thing! We would be happy to assist you in whatever way we can. My best to all of you.

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