SINGAPORE, Nov 1 — After a traumatic motorbike accident in 2013 left Muhammad Khairul Khamari with crippling nerve damage in his left arm, he thought his life of independence was over.
Khairul, then 19, underwent a number of surgeries to repair the damaged network of nerves that sends signals from the spinal cord to the shoulder, arm and hand.
However, he did not regain full mobility and strength of his left upper limb and is unable to lift his arm.
He had to re-learn many basic skills such as dressing himself and could not return to his former job in the events industry handling light and sound effects.
Recounting his fears upon discovering the extent of his injuries, Khairul, now 26, said: “I wondered if I could ever have a normal life again. Would I be able to support myself, have a family and do all the things I love with my friends and family?
“My greatest fear was that I would not be able to do all of those things independently.”
Despite his fears, his physical limitations have not stood in his way of regaining independence.
In 2017, Khairul went on to learn to drive and successfully obtained a driving licence through the Driving Assessment and Rehabilitation Programme (Darp) run by Tan Tock Seng Hospital (TTSH), which allows people with medical conditions to learn driving or return to driving.
Using only his good right arm, he drives an automatic van that comes equipped with a modified steering wheel. Attached to the steering wheel is a right spinner knob device that allows for single-hand steering.
Now a father of two young children aged two and four, Khairul works as a deliveryman and is his family’s sole breadwinner.
“At every single driving lesson I attended, I remember feeling shock and amazement that I could actually be driving.
“Till now, I still have that amazing feeling. I sometimes ask my wife, ‘Can you believe that I’m driving you guys around, to wherever we want to go?’”
More demand for programme
Khairul is among a growing group of people with disabilities or medical conditions who have signed up for TTSH’s programme, which is also open to patients not from the hospital via specialist doctors’ referral
Demand for it has gone up in the past years. Last year, 820 people signed up — a 50 per cent jump since 2014.
Lim Hui Hui, a senior occupational therapist at TTSH, said that people who attend Darp have medical conditions that results in physical limitations or cognitive impairment.
For example, they might have lost a limb due to amputation, sustained a spinal cord injury or have a congenital limb deformity, cerebral palsy and progressive neurological weakness.
Some are stroke survivors; others have had traumatic brain injuries or mild dementia.
While some Darp participants already have a valid driving licence before their medical condition, there are others, such as Khairul, who are beginners learning to drive for the first time.
Lim said: “They may want to learn to drive or return to driving for various reasons, including increasing job opportunities or responsibilities within their household to fulfil their roles in the family.
“It empowers them to regain their independence and continue doing the activities they used to enjoy and live a fulfilling life.”
Lim said that Darp came about when occupational therapists at TTSH saw patients who were vocational drivers and were unsure if they could return to work due to their medical conditions.
Under a tripartite framework set up by the hospital in 2008, the Darp team works with the Handicaps Welfare Association (HWA) and the Traffic Police, Lim said.
Darp therapists assess the person’s ability to return to driving safely, based on the Singapore Medical Association’s Medical Guidelines on Fitness to Drive and the requirements of the Traffic Police (Road Traffic Act).
HWA provides specialised driving instruction classes for people with disabilities and modified vehicles.
TTSH has also shared its best practices on driving assessment and rehabilitation with Jurong Community Hospital to benefit more patients, Lim said.
The cost of undergoing Darp Occupational Therapy Assessment ranges from S$140 to S$250. The cost of driving lessons at HWA depends on the type of course (either beginner or refresher) the client needs and the booking duration of a driving instruction, HWA said.
There are subsidies available, such as for Pioneer Generation Card holders and blue card holders under the Community Health Assist Scheme (Chas).
How the programme works
Before embarking on Darp, people with medical conditions would require a referral from a registered doctor, preferably one who has been following up on their conditions.
Khairul went through a structured process involving two components: An off-road and an on-road assessment.
It took him around seven months to complete the programme.
The off-road assessment comprised an interview on his medical condition and driving experience. An occupational therapist trained in driving assessment at TTSH assessed his physical, cognitive and visual abilities required for driving.
Lim said that the on-road assessment is a joint assessment conducted by a TTSH driver-assessor trained occupational therapist with a certified driving instructor from HWA.
Khairul was assessed based on his ability to observe the road environment, follow driving instructions and have physical control of his vehicle or vehicle modifications.
Lim said: “Clients who require vehicle modification will subsequently continue their driving lessons with the certified driving instructor at HWA prior to undertaking the Traffic Police Proficiency Test.
“Those who do not require vehicle modifications may proceed to undertake the driving lessons at the driving schools or private driving instructors, like regular learners.”
Assistive devices and modified vehicle
The Land Transport Authority (LTA) said assistive devices may be fitted in vehicles including cars, vans and motorcycles to enable people with physical disabilities and who possess a valid Singapore driving licence to safely drive them.
Between 2017 and 2019, LTA approved an average of 30 of such installations yearly.
Its spokesperson said: “For the safety of motorists and other road users, vehicle owners who wish to install assistive devices on their vehicles have to submit a Change of Vehicle Particulars (CVP) application to LTA. The vehicle must also pass a CVP inspection at an LTA-authorised inspection centre.”
The devices may include left-foot accelerators, hand-style emergency brake handles and tri-pin steering knobs that can be fixed onto the steering wheel — allowing drivers with weaker hand grip to steer the vehicle.
For instance, the spinner knob, which Khairul uses, enables single-hand steering.
Lim of TTSH said that this can be used in cases of stroke resulting in hemiplegia (weakness of one side of the body), upper limb amputation or brachia plexus injury, which was what Khairul had.
Hand controls, which enable driving with hands only, allow paraplegic or bilateral lower amputees to drive.
Upon passing the Traffic Police Proficiency Test, the driver will be issued a qualified driving licence, with the classes of driving licence stated like a regular driving licence, Lim said.
A code is assigned if the client passes the proficiency test using a modified car, she added.
Simon Ching, transport manager at HWA, said that drivers who complete the programme and get their driving licence are allowed to drive “auto” cars using the required gadget recommended by the occupational therapist.
On whether drivers can use their vehicles for work, Ching said: “Based on our understanding, some disabled drivers do currently work as taxi or Grab drivers.
“As for deliveries, it may be a bit challenging as they may have issues getting up to the van or lorry. Nevertheless, it depends on the type of physical disability and the occupational therapist’s advice during assessment.”
Lim of TTSH said that several factors would be taken into account. They include recommendations from the Singapore Medical Association’s Medical Guidelines on Fitness to Drive, fulfilling LTA’s requirement to further obtain a Private Hire Vocational Licence and other physical demands of the delivery job such as lifting of heavy load.
Freedom and independence
Ever since he obtained his driving licence, Khairul has experienced a sense of freedom and independence he once thought would elude him after his accident.
He switched jobs, from telemarketing to delivery, because he wanted to put his driving licence and skills to good use. Besides using his modified van to earn a living, he also loves driving his family around.
Encouraging people with physical disabilities not to give up on themselves, Khairul said: “I remember feeling useless after the accident. But when life changes, I think the most important thing to do is to try to learn to adapt.”
On his recovery journey, Khairul said that he is also immensely grateful to his wife.
“My wife has been so supportive and she is very proud of how far I’ve come. I’m very proud of myself, too.” — TODAY
