残疾、驾驶证和驾驶技术：意大利现状

Antonino Ridolfi

Introduction

In latter years there has been an acceleration with regards to the needs/rights of people with motor disability to move around.

In particular,with the end of the second World War it immediately came to the attention of the health authorities the problem of everyone who,having survived the fighting,had been left with serious disabilities which went from amputation of limbs to spinal injuries with permanent disability such as paraplegia or tetraplegia.

For all these people,especially if they came from Anglo-Saxon countries,the question right from the beginning was what to do with one's life and,especially,how to live it.Some eminent doctors,such as Sir Ludwig Guttmann,quickly laid down the basis for rehabilitation that had the fundamental aim of reinserting these people back into the social fabric with the same dignity they had previously and allowing them to fully exploit all their"remaining capabilities".In 1944,with Government consensus,the"National Spinal Injuries Centre"at Stoke-Mandeville was founded.

This Spinal Unit has been,for years,a legend in health rehabilitation for the whole of Europe and beyond.Paraplegics or amputees managed to go back to everyday life notwithstanding the traumatic experience they had undergone.It was in this Centre that sports activities for the disabled started and in 1952 for the first time the Stoke Mandeville Games became international and in 1960 they took place after the Olympics in Rome.But it was in the field of personal autonomy that Guttmann spent most energy and,thanks to this,many people found the will to live again going back to driving a car,to moving around in their environment freely and unconditionally.It is also from this initiative that the culture of the removal of architectural barriers was born in England,a country where anybody can use almost any type of transport and almost all public buildings as well as private.

In the nineties in Italy,government policies in favour of the disabled were heavily influenced by the progresses in science and by world,but particularly by European,technology.The new laws promulgated in this decade signalled an important change in approach.

The words Rehabilitation and Autonomy became key words around which various provisions were constructed and the assessment of a person's capability and potential on which to base all therapeutic plans and most of the interventions were entrusted to rehabilitation.

This is why also in the field of assessment of a person's capabilities for the purposes of the concession of a driving licence,an important part is entrusted to the medical rehabilitation path.

This same medical rehabilitation path also intervenes in the discrimination of access to the right to economic incentives for the purchase of a suitable car.

Rehabilitation,remaining capability and technological supports

Starting from these considerations it is evident that whoever carries out and is carrying out their own profession in the field of"Rehabilitation"cannot prescind from the concept of"Autonomy"with regards to the disabled person they are following and,it is obvious that,among all the rehabilitation practices that are deployed also that of the assessment of motor capability,with regards to driving a modified vehicle or not,will have full consideration equal toother concerns.

But what do"remaining capability"and"capability"mean?Normally a"capable person"is understood as someone who is able to carry out a specific manual function,intellectual or other,finishing it in a way so that usually one says"well done".But that same person could carry out a different type of function"not very well"or"not well at all".This doesn't mean that that person is disabled：the person could,as is normally the case,not be at all disabled.This is why when a person with motor,cognitive or sensorial problems is assessed,they shouldn't be assessed as totally disabled but as disabled only with regards to functions that they can't carry out"well";and it is when considering this that one can assert that people with serious disabilities,motor disabilities for example,even though they can't manage to get up from a chair or eat autonomously can,on the other hand,manage to drive a vehicle in complete autonomy.This is due not only to the"remaining capabilities of a person"but also to the"support technologies for the vehicle and person".

Many other and diverse forms of disability exist;and,only to remain on motor disabilities,let's try to make a list：

—Amputations,

—Paraplegia,

—Tetraplegia,

—Hemiplegia,

—Muscular Dystrophy,

—Multiple Sclerosis,

—Amyotrophic Lateral Sclerosis,

—Result of Brain Trauma,

—Phocomelia.

These are all either results of accidents or of illnesses or progressive illnesses that affect the capability of movement of the single limbs or of the whole body.For each of these forms and for each subform(e.g.paraplegia D1 rather than D12,right hemiplegia rather than left hemiplegia),technology has provided us with mechanisms to allow us to drive a car.

From a functional point of view we can try to unite the various disabilities into three distinctive groups,not forgetting that such strange forms of disability exist that they can be called"unique".These groups are：

1.Disabilities where motor function involves one single limb;

2.Mixed disabilities that affect different functions,both in the upper and lower limbs;

3.Disabilities that exclusively affect either the lower or the upper limbs;

4.Disabilities that affect all four limbs.

Technological supports that allow disabled people to drive

What are the technological supports that allow a disabled person to drive a vehicle on sale normally?Technological supports,more commonly called"Adaptations",are"Approved",after having been submitted to a series of tests by the Ministry of Transport and Infrastructure at the suggestion of the manufacturing companies.These adaptations correspond to the new Community Codes and are signalled by the new driving licences foreseen by European Union normatives.

The present situation of approved driving Devices foresee specific technology for the car's single functions.Numerous variant technologies exist for each function(and they have been coded)that permits a wide choice in the type of adaptation most suitable to a person's capabilities.

Who therefore has the necessary competence to choose a particular model that can be adapted not only to the limitations of a disabled person but also to that person's potential,which is not always evident?

Only the rehabilitator(the rehabilitation team),sharing the assessment and choice with the person himself,can suggest,propose,identify,and evaluate the most suitable solution.In Italy,identification of the adaptation of the most appropriate car for each person is carried out,at least for the first time,within the individual rehabilitation path where a special programme is conceived for everybody who has the possibility of driving,independently to whether they actually want to drive or not.

In practice,the person is told—even if he is disabled—that,out of all the activities that he could carry out there is also the driving of any type of motor vehicle and the most suitable technical solutions will be suggested.

In order to help the understanding of the complexity of the choice and the need for specific competence,we will list the various possibilities available today on the Italian market.

Servo Clutch There are 14 systems called"Servo Clutch"that permit the insertion of gears in the manual gearbox without having to push the clutch pedal down.Other systems also exist and will be described as follows：

Accelerator pedals substituted by hand controlled accelerator ring(24 types)

Driving wheel accelerators of the ring type have undergone,in these last few years,a rapid evolution and,as we will see,different types with different functions and technical characteristics exist.As for all other types of adaptation the choice is linked to various factors,general,subjective and objective,which will all be closely evaluated.The cost,ergonomics,simple assembly and look are general factors that can influence choice.The assurance of rapid assistance,the driving"styles"of the car(normal,city,sporty)are subjective factors that direct us towards one or another type of adaptation.Adaption experiment times(the time of arrival on the market),versatility of the chosen car and therefore the possible combination with the adaptation,are objective factors that push us towards one product or another.

If the above is valid in general for all types of adaptation,it assumes a particular value for steering wheel accelerators.It is not by chance that manufacturers are investing heavily in this line of products.These systems are varied and go from the simple mechanical ring to a pneumatic ring or even to an electronic ring.MCTC(civil motorisation agencies)have approved about 10 different types which can be divided into two subgroups;those above and those below the steering wheel.The most modern rings allow you to drive,differently to the older types,using only the pressure from one hand as they are very light to the touch.Those above the steering wheel are,except for one(incompatible with an airbag),all integral to the steering wheel and they move in synchrony with it.Those under the steering wheel,on the other hand,are free and move independently from the steering wheel.They should almost all be compatible with airbags,but it is always necessary to check.Shift of accelerator pedal to the left(reversible)(10 types)

This system allows acceleration with the left foot,is easy to install and is reversible.Regarding this,we have found that among the solutions on the market today there is one that permits an alternate use,in complete safety,either the right or the left pedal with the simple release of one or the other which disappears from view so there is no risk of accidental activation.

Monolever and driving for tetraplegics(15 types)

In latter years,in Italy too,people with severe motor disability to the upper limbs are able to drive cars equipped with automatic gears combined with special devices.One of these is commonly called the monolever;it can be installed underneath the steering wheel on the right or on the left and carries out the functions of acceleration and braking.Usually it is used by the stronger and more dextrous limb and its peculiarity lies in the fact that by pulling the lever towards you it accelerates and by pushing it forwards it brakes.Other controls too can be transferred to the grip of the lever itself such as the horn or the indicators.Technological evolution has led some manufacturers to produce elaborate systems that work using the same principles as the monolever but with a ball-grip placed also in different positions to the steering wheel.In general these configurations are custom built for the user.

Brake lever(13 types)

There are now many types of adaptations to substitute the brake pedal.Until a short time ago only one system could be used that,to activate,had to be pushed forwards;only recently,in Italy too,braking systems that are activated by pushing the lever towards the bottom of the car have been authorised and thus approved.This dual option offers new opportunities to all those people who are unable to completely extend their upper limbs and who need to use therefore an alternative method of braking or who,even if it may seem banal,want to choose a model of car that can be fitted with only one of the two types of lever.

Brake lever with incorporated accelerator(1 type)

This is a rarely used system but maybe it should be tested more in order for it to be used more.

Control box(11 types)

Combined with other adaptations this device allows direct control from the steering wheel of many of the car's electrical functions(lights,windscreen wipers,indicators,etc.).The control box is generally equipped with a ball-grip which permits turning of the steering wheel in the chosen direction and is usually indicated for those who have the use of only one upper limb.In this case too the products on the market are beginning to be very interesting,also with regards to aesthetics.

Pedal extension(4 types)

Pedal extension systems are mainly used by people with restricted growth and in general they are combined with adaptations to the driver's cabin which involves the bringing forward of the steering wheel and different seat conformation.

Gear lever systems(5 types)

This type of device is also destined to people who are without the use of a hand.The automatic gear stick,which in some cases can be electric,can thus be activated.

Steering wheel grip(9 types)

These are for tetraplegics or for people with similar pathologies to grip the steering wheel.Different grips exist：tripod grips(to keep the wrist firm if it can't be extended),fork grip(where the person slips the palm of his hand in),etc.

Handbrake systems(3 types)

This type of solution allows also those people who are without the use of a hand to use the handbrake in perfect autonomy.Horn(4 types)

Using the horn is anything but a secondary function when at the wheel of a car.Alternative systems to traditional horns exist that are activated mainly by foot or by the ring on the steering wheel or,finally,by buttons positioned on the same brake lever.Steering wheel lever accelerator(2 types)

This system of acceleration is made up of two levers assembled under the steering wheel which can be activated alternately thus allowing one hand to use the lever(right or left)and the other to use the steering wheel,brake lever,etc.There are also two versions of this type of adaptation,one mechanical and the other electro-pneumatic.

Accelerator ball-grip(2 types)

This adaptation is considered debatable not only from the point of view of functional efficiency but also from a technical profile point of view.We know however that a circular from MCTC foresees it as a possible alternative combined with the accelerator ring.It must be pointed out that,for a while now,the Local Medi-cal Commissions have been prescribing them less and less.It is a system that is combined with the brake lever.

Various systems for command devices(7 types)

These are systems that allow for the positioning of the command devices(lights,windscreen wipers,indicators,etc.)at various point inside the driver's cabin and in any case in the position most suitable for the disabled person.

Various service brake systems(5 types)

In the case of paralysis of the right arm it may be useful to transfer the service brake lever to the left;this option is guaranteed with sufficient simplicity.

Lower limb driving system(2 types)

Thanks to this system also people affected by phocomelia or bilateral amputees of the upper limbs can drive a car.In this case all the main controls(steering wheel,brake,accelerator,automatic gear lever)are activated directly by the lower limbs.

Electronic accelerator not on the steering wheel(2 types)

This is a new acceleration system,essentially aimed at those with good use of the upper limbs and the hands.It substitutes the steering wheel ring and it is definitely an adaptation worthy of attention as it permits acceleration with the simple touch of the right or left thumb.At the same time this solution does not alter the original look of the car and does not interfere with any safety system(for example,airbags)or driving(sequential gears or similar).Vocal command system(1 type)

It is this system that allows you by only using your voice to control all the car's auxiliary controls(lights,windscreen wipers,etc.).Naturally,as this is a delicate and particular system it is prescribed and used only in very specific cases.

Reduction brake-clutch command pedal(1 type)

This system can be used when the strength in the lower limbs may still be sufficient to use specific pedals.Steering system through joystick(2 types)Crank steering system(1 type)

These two systems are very useful for those people with serious or extremely serious disability who,though,want to try to drive again.In this case it is evident that the car must be driven directly with the driver in their wheelchair so the vehicle(usually a van)is designed to allow the person to reach the driving position directly with their wheelchair.

As we have said,these systems conform to European norms on codes and a code number exists for each adaptation that is at the moment technically possible.Codes also exist that refer directly to the person.Without going into the subcodes,here are the"families"foreseen by the normative.

DRIVERS(health reasons)

01.Correction and/or protection of sight,

02.Hearing aid or aid for communication,

03.Prosthetics/orthotics for limbs,

05.Limited use(use of subcode compulsory,driving subject to re

strictions for health reasons).

VEHICLEADAPTATION

10.Adapted speed change,

15.Adapted clutch,

20.Adapted breaking system,

25.Adapted acceleration system,

30.Adapted combined system of breaking and acceleration,

35.Adapted device control,

40.Adapted direction systems,

42.Adapted rearview mirrors,

43.Modified driver's seat,

44.Motorcycle adaptations(use of subcodes compulsory),

45.Motorcycles only with side-car.

People with disabilities considered fit by the Local Medical Commission have to practise in a car equipped with the adaptations prescribed by the same Commission unless the possibility exists of changing the adaptations if,during instruction,other systems prove to be more suitable.

For serious disability(the more serious the disability,the more expensive is the purchase of the vehicle/adaptations)not only does the driving instructor intervene in the assessment of the capabilities/potential of the disabled person but also the entire rehabilitation team which has followed,or is following,the disabled person.

Instruction will occur differently according to whether the person has motor,sensorial or cognitive problems：and on this point closer attention should be paid by all the Authorities and by all the Professionals involved.

It is certainly not a scandal to say that nowadays,summing up the above,there are people who drive cars in very"strange"ways,such as those who drive kneeling down or who use a normal steering wheel with their feet rather than with their hands or who activate controls through a Joystick.It is precisely because all the"remaining capabilities"can be exploited today,(almost)everybody can,if they want,drive anything,from motor vehicles to airplanes as well as boats and tractors.

It is a big goal that we have reached,made possible by technology and through social solidarity;a goal that we arrived at moreover through rationality as it is based on criteria and the establishment of precise laws which regard safety as the absolute denominator;this also works,seeing that the levels of accidents among disabled drivers are among the lowest that exist.

Conclusions

What we have discussed until now is certainly a reason for consolation and pride as it is the proof how,working together,we can resolve problems that would have a heavy impact on the quali-ty of life of many people.However,at the same time,some sobering thoughts come to mind and it is worth reflecting on them.A considerable number of people,often very young,are disabled following road accidents.Many of them can certainly take up driving again thanks to the progresses in medicine and technology that we have just seen：but wouldn't it be better if this progress were important only to those who unfortunately found themselves disabled following trauma or illness and not due to road accidents?Wouldn't it be better if everybody drove carefully so we wouldn't have to benefit from the miracles of the modern world and then become prudent drivers only after the damage has been done?

In life many unpleasant things can happen：for things that are inevitable we can do little,only resign ourselves;but for the things that are avoidable we can do something,sometimes a lot.It is to be hoped that this"doing to avoid",or prevention,will continue to influence the behaviour of everybody,young people in particular.

Driving license and disabled people

In Italy people with disabilities are fully aware that they are normally allowed to drive;they only have to undergo a special assessment and follow a special course to obtain their driving licence.

The driving licence

"Special"driving licences which qualify to drive different categories of vehicle can be issued to disabled people who want to drive：

A motorcycles;

B normal cars

C lorries

D buses.

Today therefore in Italy,disabled people can drive practically all types of vehicle that we commonly see on the roads.They only have to obtain a"special"version of the normal category of driving licence issued normally to people for the different categories of vehicle.

The check up

To obtain a special driving licence,the disabled person has to undergo a medical check up at the Local Medical Commission in charge of such an assessment;usually there is one Commission per province;in some cities(e.g.Milan,Rome and others),there is more than one commission,divided among the biggest Local Health Care Authorities(ASL).

The Local Medical Commission is presided over,as a rule,by the forensic medicine Manager of the ASL where it is located,and is made up of two other doctors and integrated(in the case of special licences)by a local community rehabilitation service doctor and by a specialised engineer from M.C.T.C.(civil motorisation agency)The Local Medical Commission can also avail themselves of experts(art.330 of CdSRegulation).

To request the medical check-up,a doctor's certificate written on a special form together with a document of identity needs to be presented.

If the disabled person is already a holder of a normal driving licence(which will be transformed into a special licence),this will be shown in place of the document of identity.

During the check-up further clinical documentation in possession of the disabled person can be shown(preferably issued by a rehabilitation service or by a specialist in the disability illness in question);the disabled person can,furthermore,be assisted by a trusted doctor.

If,during the course of the check-up and analysis of the certificates the Commission has doubts regarding suitability,they must move on to a practical test in a vehicle"adapted to the particular needs".This means that suitability cannot be refused only on the basis of clinical or documental assessments.

The Local Medical Commission,confirming fitness to drive,issues a certificate of fitness valid for 90 days.On the certificate of fitness the Local Medical Commission will indicate the compulsory adaptations that must be applied to the car,for that person.If the disabled person does not accept the indications of the Commission and considers himself able to drive without any of the foreseen adaptations or other types of adaptation,he can present an appeal.

An example:

The Commission prescribes as adaptations a ring accelerator,automatic gears and a long-armed brake lever.The candidate is convinced he is able to drive without automatic gears or however with servo clutch(in such a case the Local Medical Commission must signal both options).

The candidate can present an appeal and must newly undergo assessment.

The driving test

As we have seen,the Medical Commission indicates on the fitness certificate what driving devices the disabled person must use;these modifications must be reported on the provisional document that temporarily authorises driving and,subsequently,on the definitive driving licence.

After acknowledgement of fitness and the issue of the temporary driving authorisation document,the disabled person can practice driving and do the theory and practical test for the attainment of the driving licence using vehicles with the prescribed adaptations.During the practical test,it is the faculty of the engineer from the Civil Motorisation agency to confirm the adaptations hypothesised by the Medical Commission or foresee others.The disabled person himself can request different adaptations to the ones prescribed by the Medical Commission.It is not compulsory to use,for driving practice,a car equipped with dual controls,one set for the disabled person and one for the driving instructor,the important thing is that the car is adapted with the systems prescribed by the Local Medical Commission.

The definitive adaptations will be noted on the driving licence：the disabled person can only drive vehicles fitted with such driving devices.The norm where it was compulsory to write the number plate of the car usually driven on the driving licence has been abolished.

If the disabled person is already in possession of a normal driving licence,the driving test does not need to be carried out;the disabled person can drive any vehicle as long as it is fitted with the adaptations indicated on the certificate of fitness issued by the Commission.

Testing of adapted vehicles is carried out by the Civil Motorisation;usually such tasks are carried out by the same workshops that modified the vehicle.

Renewal

For special driving licenses validity duration is five years,even if often—seeing the specific situations or specific disabling pathologies—a shorter validity period is indicated.

For the renewal of a special category driving licence a medical certificate written on a special form together with a copy of the present driving licence must be presented to the Provincial Medical Commission and an appointment for the medical fitness check-up must be requested.European driving licence

Until now also the compulsory adaptation was written on a special licence,for example："automatic gears,long-arm brake,steering wheel accelerator etc."The new European licence foresees the same layout and the same codes in all European Union countries.With the receipt of the community Directive that institutes the European licence,the description of adaptations must be substituted by a numerical code too.Regarding this specific aspect in fact,on 14th September 2000 a further community directive(Dir.2000/56/CE)introducing the harmonised community codes for driving licences was approved.The Ministry of Transport,in agreement with the European Commission,has adopted codes and procedures in advance which are useful for the insertion of the most information possible on the new driving licence,also to eliminate additional sheets regarding adaptation of controls for special licences.These indications are contained in the Ministry of Transport Circular,Department of National Transport(ex MCTC)B/45 from 12th June 2010.

What is happening?

From June 21st 2000 local medical commissions have had to indicate on the certificate relative to a special driving licence,besides the description of the prescribed adaptations,also the corresponding codes and subcodes.The adaptations are then indicated on the special licences only through the codes that counter distinguish them and that are listed in the Circular which,as they have been elaborated by the European Commission,can be modified only by competent community bodies.On the driving licences therefore we will only find the numerical codification.

From June 21st 2000 each possible adaptation(or maybe it would be better to say"known")will be catalogued by a code which must be noted on the driving licence.

Some examples：

20.13 ：Knee activated brake

20.14 ：Electric handbrake

25.01 ：Adapted accelerator pedal

25.03 ：Rocking accelerator pedal

25.04 ：Manual accelerator

25.05 ：Knee activated accelerator

25.06 ：Servo accelerator(electronic,pneumatic,etc.)

25.07 ：Accelerator pedal to the left of the brake pedal

40.09 ：Foot steering gear

40.10 ：Steering gear adapted in other manner(joystick etc.)

40.11 ：Ball-grip on steering wheel

40.12 ：Hand orthosis on steering wheel

40.13 ：(Use of steering wheel)with orthosis

Disabilities

The logic in the list of disabilities has been simplified;there are thirteen categories which are closely connected to the possible adaptations for each case.

·left lower limb disability;

·right lower limb disability;

·lower limb disability(coordination defects,amputation of lower limbsetc.);

·non functional lower limbs(amputation,paralysis,seating position defects etc.)

·right upper limb disability;

·left upper limb disability;

·upper limb disability;

·left upper limb and left lower limb disability;

·right upper limb and right lower limb disability;

·three limb disability;

·four limb disability-upper spine injury(from C5to C7);

·restricted growth-phocomelia;

·other.

Cumulative codes

The new provisions propose for each type of impairment also a series of adaptation combinations.There are 193 foreseen combinations but there is the possibility that in the future adaptation combinations can be prescribed and obtained which at the moment haven't even been contemplated

Let's give an example.Among the various foreseen combina-tions for four-limb disability,one,code 60.15,foresees：

10.02 ：automatic speed gear;

10.04 ：adaptation of gear lever;

20.06 ：manual service brake(adapted);

20.08 ：maximum use of emergency brake integrated with service brake;

25.04 ：manual accelerator;

40.01 ：standard servo steering.

Let's give another example.Among the different combinations foreseen for the disabilities which lead to the non-functioning of the lower limbs,one is foreseen with the code 53.01,which comprises：

15.03 ：automatic clutch;

20.06 ：manual service brake(adapted);

25.04 ：manual accelerator;

30.05 ：neutralised/suppressed accelerator and brake pedals.

One important aspect of this new normative consists in the fact that the descriptions of adaptations only express the"function"of the adaptation and do not limit in any way the possibility of choice of product on the part of the user.This is especially evident in some cases.Let's present a further example regarding upper limb impairment,no.56.13,which foresees：

10.02 ：automatic speed change;

20.08 ：maximum use of emergency brake integrated with service brake;

35.01 ：control devices can be used without negatively influencing driving and manoeuvres(headlamps,windscreen wipers,acoustic signals,indicators,etc.);

40.01 ：standard servo steering;

40.10 ：steering adapted in other way(joystick etc.)

It should be pointed out,in this case,the completely new adaptation n.40.10 that introduces,for the first time in our legislation,the word"joystick".

A disabled person will be able to choose any model of device that carries out the indicated functions.

Complete list of the adaptation possibilities of vehicles and relative codes

10.Modified speed gears

10.01 Manual gears

10.02 Automatic gears

10.03 Electronic gears

10.04 Adapted gear lever

10.05 No second gear change

15.Modified clutch

15.01 Adapted clutch pedal

15.02 Manual clutch

15.03 Automatic clutch

15.04 Clutch pedal with protection/bendable/removable

20.Modified braking devices

20.01 Modified brake pedal

20.02 Widened brake pedal

20.03 Brake pedal adapted to used with left foot

20.04 Buttonhole foot pedal

20.05 Rocking brake pedal

20.06 Manual service brake(adapted)

20.07 Maximum pressure on service brake reinforced

20.08 Maximum pressure on emergency handbrake integrated in emergency handbrake

20.09 Modified service brake

20.10 Electric service brake

20.11 Pedal service brake(adapted)

20.12 Brake pedal with protection/bendable/removable

20.13 Knee brake

20.14 Electric service brake

25.Modified acceleration devices

25.01 Modified accelerator pedal

25.02 Buttonhole accelerator

25.03 Rocking accelerator pedal

25.04 Manual accelerator

25.05 Knee accelerator

25.06 Assisted accelerator(electronic,pneumatic,etc.)

25.07 Accelerator pedal on the left of the brake pedal

25.08 Accelerator pedal on the left side

25.09 Accelerator pedal with protection/bendable/removable

30.Combined braking and acceleration devices

30.01 Parallel pedals

30.02 Same level pedals(or nearly)

30.03 Slide accelerator and brake

30.04 Slide accelerator and brake for othosis

30.05 Accelerator pedals and brake bendable/removable

30.06 Raised floor

30.07 Protection element at side of brake pedal

30.08 Protection element for prosthesis at side of brake pedal

30.09 Protection element in front of brake pedal and accelerator

30.10 Heel/leg support

30.11 Electric accelerator and brake

35.Modified control device(light switches,windscreen wipers,acoustic signals,direction indicators,etc.)

35.01 Operable controls without compromising other driving operations

35.02 Operable controls without removing hands from steering wheel or from its accessories(ball-grip,fork,etc.)

35.03 Operable controls without removing the left hand from steering wheel or from its accessories(ball-grip,fork,etc.)

35.04 Operable controls without removing the right hand from steering wheel or from its accessories(ball-grip,fork,etc.)

35.05 Operable controls without removing hands from steering wheel or from its accessories(ball-grip,fork,etc.)nor from the combined system of acceleration and braking

40.Modified steering

40.01 Servo steering standard

40.02 Servo steering reinforced

40.03 Steering with safety system

40.04 Extended steering wheel column

40.05 Adapted steering wheel(widened in sections and/or reinforced,reduced diameter,etc.)

40.06 Inclinable steering wheel

40.07 Vertical steering wheel

40.08 Horizontal steering wheel

40.09 Feet controlled steering

40.10 Adapted alternative steering(lever,etc)

40.11 Steering wheel with crank grip

40.12 Steering wheel equipped with hand orthosis

40.13 With orthosis linked to tendons

42.Rearview mirror/s modified

42.01 Lateral external rearview mirror(left or)right

42.02 External rearview mirror placed on mudguard

42.03 Additional internal rearview mirror to control traffic

42.04 Panoramic internal rearview mirror

42.05 Rearview mirror to prevent rearview blind spot

42.06 Electric external mirror/s rearview mirror/s

43.Modified driver's seat

43.01 Driver's seat at suitable height and at normal distance from steering wheel and from pedals

43.02 Driver's seat adapted to body shape

43.03 Driver's seat with lateral support to stabilise the seating position

43.04 Driver's seat equipped with arms

43.05 Driver's seat with lengthened slide

43.06 Modified safety belts

43.07 Four point safety belts

44.Motorcycle modifications(the code must be indicated in detail)

44.01 Braking system on one lever only

44.02 Manual brake(adapted),front wheel

44.03 Brake pedal(adapted),back wheel

44.04 Accelerator lever(adapted

44.05 Manual gears and clutch(adapted)

44.06 Mirror/s rearveiw mirror/s(adapted)

44.07 Controls(adapted)(direction indicators,stop,etc.)

44.08 Height of seats to allow driver,from seated to reach the floor with both feet at the same time Tax relief on disabled cars

Disabled people and their families who purchase a car or a vehicle can count on four benefits or tax concessions：

· Value-added tax(VAT)reductions,

· IRPEFdeductibility,

· Car tax exemption

· Exemption of taxes when reselling a car

The concessions are granted differently depending on the type of disability and on the possession of a special driving licence.To give an idea here below are indications for access to VAT concessions.

AUTOMOBILEACQUISITION:VAT REDUCTIONS

At the moment of the purchase of a vehicle,new or second-hand,disabled people or their families on whom they are dependent can benefit from a reduction in VAT which is calculated at 4%.

This reduction is applicable to the sum relative to the purchase of a car,to any adaptations and relative accessories and to the cost of labour for the carrying out of the same adaptations(on new and second-hand vehicles).VAT reductions for maintenance costs,repairs and purchase of spare parts are excluded.

The reduction is applicable to one vehicle only and once every 4 years unless the vehicle has been cancelled from the Public Automobile Register for destruction,scrapping or theft without recovery.

For what vehicles can the reduction in the rate be obtained

You can benefit from VAT reductions for the purchase of petrol run cars(up to 2000 cc)and diesel(up to 2800 cc)belonging to the following categories：

·three-wheelers：vehicles with three wheels destined to transport people,capable of carrying maximum 4 people including the driver and equipped with suitable bodywork

·motor vehicles for mixed transport：three-wheel vehicles destined for the transport of people or things,capable of carrying maximum 4 people including the driver

·motor vehicles for specific transport：three-wheeled vehicles destined for the transport of specific things or people in particular conditions and characterised by being permanently equipped with special equipment relative to this aim

·motor cars：vehicles destined for the transport of people,having maximum 9 places,including that of the driver.

·motor vehicles for mixed transport：vehicles having a global mass when fully loaded not superior to 3.5 or 4.5 tonnes if with electric or battery traction,destined to the transport of people and things and capable of containing maximum nine places including that of the driver.

·motor vehicles for specific transport：vehicles destined to the transport of determined things or people under particular condi-tions,characterised by being permanently equipped with special equipment relative to this aim.

Completely blind people,the partially blind,seriously visually handicapped and deaf and dumb people can benefit from the reduction in VAT only for the purchase of vehicles belonging to the last three categories(motor cars,motor vehicles for mixed transport and motor vehicles for specific transport).Purchases relative to three-wheeled cars are excluded from any reductions.

Also excluded from VAT reductions are campers but for these a tax reduction of 19%is foreseen.

Regarding vehicle registration,if the disabled person has his own income,the vehicle and the documents proving the costs sustained(invoice)must be registered in his own name;while in the case where the disabled person is dependent on a family member,the vehicle and the relative documents proving the costs can be registered indifferently to the person in question or to the family member.

Who has right to concessions

Those who have right to concessions are：

·Holders of special driving licence B,with reduced or impaired motor capability with the obligation to use special driving devices for vehicles to which modifications have been made prescribed by the provincial medical commission for special driving licences and noted on the driving licence.

·People with motor disability who,for the nature of their handicap,need particular adaptations to the vehicle to be transported by others by vehicles adapted for transport.

·People with serious limitations in walking or affected by multi-amputations to whom the condition of severely handicapped person has been recognised according to the norms in force(article 3 comma 3 of Law 104/92)by the competent medical commissions for vehicles without any adaptations.

·People with psychic deficit who have been recognised the right to receive benefits and to whom the condition of serious handicap has been ascertained in conformity with the norms in force(article 3 comma 3 of Law 104/92)by the competent medical commissions for vehicles without any adaptations.

·Completely blind people,the partially blind,seriously visually handicapped and deaf and dumb people for non adapted vehicles.It is specified that for blind people with regards to tax reductions for the purchase of a vehicle,it is meant those who are completely blind,the partially blind and seriously visually handicapped people while for people defined as deaf and dumb,they are those who were affected by deafness at birth or before learning the spoken language

·Families who have dependent children or adults with serious motor disabilities who need particular adaptations to a vehicle for driving or to be transported for vehicles adapted for driving or for transport.

·Families who have dependent children or completely blind or partially blind or seriously visually handicapped adults and deaf and dumb people for vehicles without any adaptations.

·Families who have dependent children or adults with serious limitations in walking or affected by multi-amputations to whom the condition of severely handicapped person has been recognised according to the norms in force(article 3 comma 3 of Law 104/92)by the competent medical commissions for vehicles without any adaptations.

·Families who have dependent children or adults with psychic deficit who have been recognised the right to receive benefits and to whom the condition of serious handicap has been ascertained in conformity with the norms in force(article 3 comma 3 of Law 104/92)by the competent medical commissions for vehicles without any adaptations.In the case of children,exemption from car tax is not admitted if the person in question has the right to attendance benefits even if their condition of serious handicap has been recognised according to article 3 comma 3 of Law 104/92.

Adaptations

Driving adaptations,including automatic gears,which give the right to a reduction in VAT are those prescribed by the provincial medical commission for special driving licences and noted on the licence.

Adaptations to vehicles for the transport of a person with serious motor disability which give the right to exemption from car tax are only those listed below,for example：

·mechanical/electric/hydraulic lifting platform;

·mechanical/electric/hydraulic rollaway slide;

·mechanical/electric/hydraulic lifting arm;

·mechanical/electric/hydraulic hoist;

·simultaneously sliding-revolving seat in order to facilitate placing of the disabled person inside the vehicle;

·wheelchair anchorage system with attached retaining system for the disabled(safety belts);

·sliding door;

Other adaptations not listed,provided that the equipment is characterised by permanent connection to the vehicle so that it is an effective adaptation of the vehicle,give the right to exemption of car tax payment

The fitting out of simple accessories with optional functions or the application of devices already foreseen in the homologation of the vehicle,assembled as an alternative and at the request of the buyer—are not to be considered"adaptations"

All adaptations,for driving or for transport,must be homologated by the Civil Motorisation and permanently fixed to the vehicle.

Vehicles without adaptations

The reduction in VAT is valid also for the purchase of non adapted vehicles providing they are destined to the transport of disabled people belonging to one of the following categories：

·People with serious limitations in walking or affected by multi-amputations to whom the condition of severely handicapped person has been recognised;

·Completely blind people,the partially blind,seriously visually handicapped and deaf and dumb people;

·People with intellectual or psychic deficit and to whom the condition of serious handicap has been ascertained in conformity with the norms in force(article 3 comma 3 of Law 104/92)by the competent medical commission and who have been recognised the right to receive benefits.

How to obtain the VAT reduction

To obtain the reduction in VAT documents must be presented proving the effective right by to VAT reduction by law,at the moment of purchase directly to the seller;in his turn the seller must report the conditions of the norm which gives right to a reduction of VAT on the invoice.Disabled people,with motor disabilities,with special driving licences where the adaptations prescribed by the provincial medical commission for driving licences.

These must be presented among the other documents：

·photocopy of the certificate of handicap or invalidity which states the motor disability

·photocopy of the special driving licence;

·photocopy of the logbook where the prescribed adaptations are noted;

·auto certificate(in substitution of a notary act)where it is declared that in the last 4 years no car has been purchased with the VAT reduction or the cancellation by PRA of a car for demolition or theft;

·any photocopies of tax declarations or auto-certification if the vehicle is registered in the name of a family member with a dependent disabled person.

Many years have passed since 1995 when the first Mobility Centre was inaugurated near the trial circuit of"La Mandria"in Turin.Since then Mobility Centres have multiplied,adapting their functionality with the integration of even more diversified and sophisticated batteries of tests to carry out on people to be trained or to be retrained how to drive.

To this end we have turned to applied informatics,to a simulator,or better,an Assessor of Remaining Capabilities(Valutatore di CapacitàResidue,VCR).But we also continue to use"real vehicles"with diversified adaptations depending on the type of disability to assess.The number of these devices has grown over the years,becoming also more refined.

At the centre of everything is always the person：the main aim is still that of allowing everyone with motor disabilities,and not only,to assess their"fitness to drive".All this bringing together two principles：the right to autonomy and to personal mobility and road safety.

The birth and development of the Centres has over the favoured years constructive collaboration with Public Administration and the private sector,activating,furthermore,significant synergies and exchanges of experience with local health authorities(ASL)and Local Medical Commissions for driving licences,with the single Provincial Motorisation Organisations and with consumer Associations.

What do the centres do?

The Centres,with the support of those who manage them locally,assure various services.All of these,and it does well to repeat it,are free to the user.The first service is the assessment of motor capabilities through trials carried out with the already cited Assessor of Remaining Capabilities(VCR)which,through a battery of versatile tests,allows us to obtain objective results.The second service consists in driving lessons in multi-adapted Fiat cars in special spaces closed to normal traffic or outside but nevertheless protected.

The Centres also provide legislative information and technical data both on the cars and on their adaptations for driving and for transport.

The VCR Simulator

In the Mobility Centres,not only is it possible to effect real and proper driving lessons on a circuit in specially equipped cars,but also to"virtually"test your own abilities on a special driving simulator called VCR(Valutatore di CapacitàResidue)—Assessor of Remaining Capabilities.

The simulator allows us to identify and assess those deficits—of a physical,sensorial or cognitive nature—of a person who,maybe amplified by the presence of external agents(alcohol or drug abuse,tiredness),which could negatively influence driving behaviour and cause dangerous situations.

There are many tests available on the VCR simulator,8 types in all：steering wheel strength and ability test;accelerator modulation capability test;brake command strength test;reaction to acoustic stimuli test;reaction to visual stimuli test;reaction to visual stimuli spread over a wide area test;reaction to complex stimuli test;visual field test.