NEUROTRAUMA

Oahu | Kauai | Maui | Molokai | Lanai | Island of Hawaii
Disability Parking Permit | Vehicle Safety Issues | A Word To Those Driving

Transportation

Transportation can be an extremely important service for those with neurotrauma disabilities. Even those receiving services at home, may need transportation to doctors' offices, hospitals, to public agencies and other parts of their communities.

Types of transportation services vary by island. Our neighbor islands also provide mass transit to varying degrees and are mentioned below. Oahu has the largest population for the islands and is served by it’s City and County's contracted mass transit system (TheBus and Handi-van). Handi-van and The Kauai Bus services require at least a twenty-four hour advance notice. Contact each operator as to their established policies concerning cost, availability and if personal escorts are permitted. MOE, Inc. for Maui County makes mention of special accommodations for transporting those with disabilities. Inquire if such services are also available for Molokai and Lanai. The following listing describes the mass transit system as well as some listings of private-for profit businesses.

Oahu

TheBus: Oahu Transit Services, Inc.

Oahu's mass transit offers discounted rates for peole with disabilities. For further information contact 848-5555, or for customer service contact 848-4500. Visit TheBus website at http://www.thebus.org/ for information on their routes and timetables, their rates (http://www.thebus.org/Fare/Fare.asp) and other misc. information.

Medicare recipients can show their Medicare card to TheBus driver and ride for one-half the regular adult fare. The one-half fare policy does NOT apply to Medicaid or QUEST recipients, unless they also have a Medicare card. Medicare cardholders and qualified disabled individuals can also apply for a Person with a Disability bus pass, which costs $30.00 for an annual pass. For more information, contact TheBus Pass Office at (808) 848-4444.

Handi-Van

The Handi-Van site is http://www.co.honolulu.hi.us/dts/riders.htm. In order to ride on Oahu's Handi-Van, contact their office at 523-4083 and have them mail a copy of their application packet to you. In the packet is service information, Application for ADA Paratransit Eligibility and Eligibility information. The Application must be filled in and mailed to: ADA Paratransit Eligibility, Department of Transportation Services, 711 Kapiolani Boulevard, Suite 275, Honolulu, Hawaii 96813. If the individual requests an escort (personal care attendant or companion), this must be mentioned and justified as well in the application. For example, a person with Alzheimer’s disease having significant memory problems could request that the escort accompany him or her- free of charge. For reservations, call 456-5555. Customer service is reached by calling 454-5050. For Cancellations or a Late Van, call 454-5055.

Access Aloha Travel

Travel arrangements for those with disabilities, including group travel, lodgings, cruises, tours and accessible van rentals. 414 Kuwili Street, Suite 101, Honolulu, HI. 96817. Phone: 545-1143 (V), 521-4400 (T), 545-7657 (Fax) or 1-800-480-1143 (toll free).
E-mail: access@lava.net
Website: http://www.accessalohatravel.com

Kauai

Kauai Bus

The County of Kauai offers a public (fixed route) bus service and paratransit (door-to-door) bus service between Hanalei and Kekaha daily except for Sundays and County holidays. There is service to the airport and limited services to Koloa/Poipu. Visit their website on the County of Kauai website for additional information (schedules, fees, acceptable carry-ons. For people with disabilities, the County of Kauai - Transportation Agency requires you to be certified and registered ADA eligible. 3220 Hoolako Street, Lihue, HI 96766. Phone: 241-6410; Fax: 241-6417

Maui

Maui Public Transit

MEO Shuttle Bus

Funded by the County of Maui, Maui Economic Opportunities, Inc. provides free shuttle service for persons who have a disability. They have routes between Wailuku and Kahului (Route 1, Route 2) as well as a Rural Route. An application form is available at their office. Fill it out and then have your doctor sign the medical approval portion. Return the form to the MEO office and wait a week for approval. Although all their shuttles are wheelchair acessible, you should call the MEO office when you need special accommodations. Phone: 877-7651 (V); 871-2171 (Fax); Monday - Friday; 7:30 am. - 4:30 pm.; 189 Kaahumanu Avenue, P.O. Box 2122, Kahului, HI 96732.

MEO's Ala Hou "On the Move Again" Program

Funded by the County of Maui, this program provides transportation to people with disabilities. For details on how to apply for this program, making reservations and times of operation, click on: http://www.meoinc.org/Ala_Hou.htm or call 877-7651(V); 871-2171 (Fax); Monday - Friday, 7:30 am. - 4:30 pm.; 189 Kaahumanu Avenue, P.O. Box 2111, Kahului, HI 96732.

Roberts Hawaii

Effective July 1, 2004, Roberts Hawaii provides three public routes for the County of Maui. These routes provide service to in and between central, south and west Maui communities. One way fare varies from $1 to $3. For details: http://www.co.maui.hi.us/bus/

Molokai

Molokai's Branch of MEO

Maui Economic Opportunty, Inc. offers services on Molokai (all ages). Call 553-3216 (V); 553-3776 (Fax); 380 Kolapa Place, Molokai.

Lanai

Lanai's Branch of MEO

On Lanai there is a charge for this service (all ages). Copies of applications and/or schedules are available from participating youth centers and the MEO offices. Call Maui Economic Opportunity, Inc. phone: 565-6665 (V), 565-665 (Fax) 1144 Ilima Avenue, Suite 102, Lanai.

Island of Hawaii

County of Hawaii's Mass Transit Agency

The County of Hawaii provides public transportation around the island with its "Hele-On Buses" and its "Shared Ride Taxi" service is offered in the urbanized areas of Hilo and Kona. Visit their webpage for information on bus schedule, fares and rules/regulations. Phone: 961-8744 (V); 961-8343 (T); Fax: 961-8745. 25 Aupuni St., Hilo, HI 96720

Disability Parking Permit

The Disability and Communication Access Board is responsible for administering Disability Parking Permits. Visit their website for information on how to apply for a disability parking permit http://www.state.hi.us/health/dcab/ . The application form is at http://www.state.hi.us/health/dcab/resources/resources.htm.

National Highway Traffic Safety Administration (NHTSA)

The NHTSA website offers information on automotive safety issues that people with disabilities should be aware of. NHTSA regulate the manufacture of automotive adapative equipment and modified vehicles. http://www.nhtsa.dot.gov/cars/rules/adaptive/index.html

A Word To Those Driving

The following excerpts are from the American Medical Association's Physician's Guide to Assessing and Counseling Older Drivers Click to view the AMA website.

Traumatic Brain Injury: Patients should not drive until symptoms have stabilized or resolved. For patients whose symptoms resolve, driving may resume following medical assessment and, if deemed necessary by the physician, driver evaluation (including on-road assessment) performed by a driver rehabilitation specialist.

Patients with residual neurological or cognitive deficits should be assessed and managed as described under the dementia recommendations of this section.

If the patient experiences seizure(s), see the seizure recommendations in this section.

Stroke: Patients with acute motor, sensory or cognitive deficits should not drive. Depending on the severity of residual symptoms and the degree of recovery, this restriction may be permanent or temporary.

Upon the patient's discharge from the hospital or rehabilitation center, the physician may recommend temporary driving cessation until further neurological recovery has occurred. Once neurological symptoms have stabilized, physicians should refer patients with residual sensory loss, cognitive impairment, visual field deficits, and/or motor deficits to a driver rehabilitation specialist, if available, for driver assessment and rehabilitation. The specialist may prescribe vehicle adaptive devices and train the patient in their use.

Patients with neglect or inattention should be counseled not to drive until symptoms have resolved and safe driving ability has been demonstrated through assessment by a driver rehabilitation specialist.

All patients with moderate to severe residual hemiparesis should undergo driver assessment before resumption of driving. Even if symptoms improve to the extent that they are mild or completely resolved, patients should still undergo driver assessment, as reaction time may continue to be affected.

Paraglegia/Quadriplegia: Referral to a driver rehabilitation specialist is necessary if the patient wishes to resume driving or requires vehicle modifications to accommodate him/her as a passenger. The specialist can recommend an appropriate vehicle and prescribe adaptive devices (such as low-resistance power steering and hand controls) and train the patient in their use. In addition, the specialist can assist the patient with access to the vehicle, including opening and closing car doors, transfer to the car seat, and independent wheelchair stowage, through vehicle adaptations and training.

Driving should be restricted until the patient demonstrates safe driving ability in the adapted vehicle.

Dementia: The following recommendations are adapted from the Alzheimer’s Association’s Position Statement on Driving and recommendations of the Canadian Consensus Conference on Dementia.

A diagnosis of dementia is not, on its own, a sufficient reason to withdraw driving privileges. A significant number of drivers with dementia are found to be competent to drive in the early stages of their illness. Therefore, the determining factor in withdrawing driving privileges should be the individual’s driving ability. When the individual poses a serious risk to self or others, driving privileges must be withdrawn.

Physicians should consider the risks associated with driving for all of their patients with dementia, and they are encouraged to address the issue of driving safety with these patients and their families. When appropriate, patients should be included in decisions about current or future driving restrictions and cessation; otherwise, physicians and families must decide in the best interests of the patient whose decision-making capacity is impaired.

• Physicians are recommended to perform a focused medical assessment that includes history of driving difficulty from a family member or caregiver and an evaluation of cognitive abilities, including memory, attention, judgment, and visuospatial abilities.
• Physicians should be aware that patients with progressive dementia require serial assessment, and they should familiarize themselves with their state reporting laws and procedures for dementia (if any).
• If there is concern that an individual with dementia has impaired driving ability, and the individual would like to continue driving, a formal assessment of driving skills should be administered. One type of assessment is an on-road driving assessment performed by a driver rehabilitation specialist. Such an assessment should lead to specific recommendations, consistent with state laws and regulations, as to whether the individual is safe to drive.
• Physicians should encourage patients with progressive dementia to plan early for eventual cessation of driving privileges by developing alternative transportation options. The patient should be encouraged to coordinate these efforts with their family members and caregivers, and to seek assistance (as needed) from their local area agency on aging.

Seizure disorder: The seizure recommendation below is adapted from the Consensus Statements on Driver Licensing in Epilepsy crafted and agreed on by the American Academy of Neurology, American Epilepsy Society, and Epilepsy Foundation of America in March 1992. Please note that these recommendations are subject to each particular state’s licensing requirements and reporting laws.

A patient with seizure disorder should not drive until he/she has been seizure free for three months. This three-month interval may be lengthened or shortened based on the following favorable and unfavorable modifiers:

Favorable modifiers:

• Patient experiences only simple partial seizures that do not interfere with consciousness and/or motor control.
• Seizures have consistent and prolonged aura.
• There is an established pattern of pure nocturnal seizures.
• Seizures occurred during medically directed medication changes.
• Seizures were secondary to acute metabolic or toxic states that are not likely to recur.
• Seizures were caused by sleep deprivation.
• Seizures were related to reversible acute illness.

Unfavorable modifiers:

• Noncompliance with medication or medical visits and/or lack of credibility.
• Alcohol and/or drug abuse in the past three months.
• Increased number of seizures in the past year.
• Prior bad driving record.
• Structural brain lesion.
• Noncorrectable brain functional or metabolic condition.
• Frequent seizures after seizure-free interval.
• Prior crashes due to seizures in the past five years.

Single unprovoked seizure: The patient should not drive until he/she has been seizure free for three months. This time period may be shortened with physician approval. Predictors of recurrent seizures that may preclude shortening of this time period include:

• The seizure was focal in origin.
• Focal or neurologic deficits predated the seizure.
• The seizure was associated with chronic diffuse brain dysfunction.
• The patient has a family history positive for epilepsy.
• Generalized spike waves or focal spikes are present on EEG recordings.

Withdrawal or change of anticonvulsant therapy: The patient should temporarily cease driving during the time of medication withdrawal or change due to the risk of recurrent seizure and potential medication side effects that may impair driving ability.

If there is significant risk of recurrent seizure during medication withdrawal or change, the patient should cease driving during this time and for at least three months thereafter.

If the patient experiences a seizure after medication withdrawal or change, he/she should not drive for one month after resuming a previously-effective medication regimen. Alternatively, the patient may resume driving after three months if he/she refuses to resume this medication regimen but is seizure-free during this time period.

The American Medical Association's Physician's Guide to Assessing and Counseling Older Drivers also includes the following handouts in Appendix B:

• Am I a safe driver? is designed to help patients assess their own driving skills and increase self-awareness of driving safety.
• Tips for safe driving is a tip sheet that provides guidance to patients on being a responsible and safe driver.
• Getting by without driving provides numerous ideas on how to accomplish everyday activities without driving a car and and information on locating alternative transportation.
• How to help the older driver provides information to family members and caregivers on how to help a loved one with driving retirement.
• Successful aging tips is a list of general recommendations for staying fit and healthy in later years.

Back to Top