Kristin Knapp

55
Bilateral Vestibular Hypofunction (BVH)

I am one of the thousands of people in the United State who live with vestibular dysfunction. Following my diagnosis of bilateral vestibular hypofunction (BVH), I doggedly pursued any path that had potential to give me back the quality of life that I had lost. Over the past twelve years I have been able to adapt to my condition: regaining some things, finding new ways to do others, and letting some things go. Driving a car, however, is the one skill I’ve been unable to bring back or compensate for.

Driving is a large part of a way of life that most people in the U.S. take for granted. Unfortunately, driving can be dangerous for many of us who have a vestibular disorder. A 2004 study of driving in patients with severe vestibular impairments shows patients have difficulty driving when visual cues are reduced, precise spatial navigation skills are needed, and rapid head movements are required. Many of the patients surveyed reported incidents of having to pull off the road due to vertigo. While some in the study had been advised by their doctors not to drive, many continued to drive due to a lack of alternative transportation (Cohen, Wells, Kimball and Owsley, 2003).

Twelve years ago, and about a year after receiving my diagnosis, I made the tough decision to give up driving except under very limited circumstances. I was struggling to see where I was on the road when driving in low-light conditions and in the rain. Simple things like garage ramps and concrete barriers in construction areas caused a feeling of disorientation. Checking my blind spot or monitoring traffic left and right to exit a parking lot required rapid head movements that brought on episodes of vertigo. Straight highway driving that once would have been monotonous quickly became visually overwhelming, causing sudden and severe vertigo. While driving with BVH was dangerous, giving up driving posed significant challenges for me as well. My profession required driving and I had to give up my job. I needed to go to medical appointments but I couldn’t drive myself. I didn’t realize how much I valued my independence until I didn’t have it anymore. I can truly say that the toughest part of living with vestibular loss has been giving up that car and everything it represents.

But today, I see something new on the horizon that shines like a beacon of hope: the development of self-driving cars. Autonomous vehicle technology may soon have the potential to revolutionize mobility for thousands of people who are either unable or limited in their ability to drive a standard car. In 2013, The National Highway Traffic Safety Administration (NHTSA) defined five levels of autonomous driving systems ranging from Level 0 (no automation) to Level 4 (full self-driving automation). Right now, some newer cars are offering Level 2 (combined function automation) features such as adaptive cruise control and automatic lane centering. These are helpful tools, but they still won’t enable me to return to driving. I believe it will be the leap to Level 3 (limited self-driving automation) that will be a game changer for those of us with limited driving abilities due to a vestibular disorder. At Level 3, the car will be designed to drive, steer and monitor what’s going on around it. When the system senses that it is no longer able to support automation, it will prompt the human driver to take over control of the vehicle. At this level, the driver is not expected to constantly monitor the roadway, allowing those of us with a vestibular impairment to better manage the vertigo-inducing aspects of driving.

Autonomous vehicle technology is advancing at a rapid pace, but there are a number of technical, legal, regulatory, and ethical hurdles that must be overcome before automakers will be able to bring self-driving cars to the consumer market. Although it may take some time to address these factors, there is no doubt that we are approaching a historic turning point in automotive travel. In fact, some Level 3 technology has already been developed by several car companies, and it holds tremendous promise for those of us with vestibular impairments.

As manufacturers work toward bringing self-driving technology to the consumer market, it is my hope that there is room in the clamor of technical, legal, regulatory, and ethical debates, for the voices of disabled people to be heard. Level 4 technology, which doesn’t require human intervention at all, will offer enhanced mobility and accessibility to the broader disability community, including those with visual and auditory impairments and those with ambulatory and intellectual disabilities. It will truly change what it means to be a driver. Design decisions can be made early on that support inclusion and accessibility for a broad range of individuals who, like me, hope to one day drive safely and independently.

References
Cohen, J., Wells, J., Kimball, K, Owsley, C. (2003). Driving Disability and Dizziness. Journal of Safety Research 34, 361 – 369.
National Highway Traffic Safety Administration, Preliminary Statement of Policy Concerning Automated Vehicles 4-6 (2013).

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