Left foot accelerators and hand control types: how to choose, train and drive safely
Compare control styles, plan your training and keep the equipment working safely
Safety Behind the Wheel Foundation built this guide from guidance by the Association for Driver Rehabilitation Specialists (ADED) and the National Highway Traffic Safety Administration (NHTSA), federal vehicle modification rules, Bureau of Transportation Statistics (BTS) travel data and published research on drivers with disabilities. Every source is listed at the end. It goes deeper on control styles, training, daily habits and checks after a collision. Our guide to driving with a disability covers the full path from evaluation to funding.
What hand controls and alternative pedal controls do
Most cars expect your right foot to press both the gas and the brake. When a leg is weak, missing, numb, painful or slow, that work can become unsafe. Hand controls and alternative pedal controls move it to a part of your body that can do it well.
A hand control lets you work the gas, the brake or both by hand [1]. It can mount to the steering column or to the floor [1]. Most mechanical versions use rods that press on the car’s own pedals. A left foot accelerator is a second gas pedal placed left of the brake, so your left foot does the work [1]. A block or full guard may also be added over the original gas pedal [1].
The main job of this equipment is preventing collisions. Smooth speed control and fast, firm braking are the core of safe driving. If either one is late, weak or wrong, a crash becomes more likely.
Driving also matters for daily life. In 2022, about 18.6 million Americans age 5 and older reported a disability that limits travel [7]. Among adults 18 to 64 with such a disability, 65.9% drove on at least one trip, compared with 93.4% of those without one [7].
The main types, in plain words
Hand controls come in a few basic styles. Names vary, but nearly all brake when you push the handle forward, toward the dashboard. The styles differ in how you ask for gas. Evaluators also choose between mechanical and electric hand controls [1].
Comparison compiled by Safety Behind the Wheel Foundation
Hand control and pedal options compared
| Type | How it works | Questions to raise |
|---|---|---|
| Push pull hand control | Push forward to brake. Pull back toward you for gas. | Can I hold steady gas on a long drive? |
| Push rock (push tilt) | Push forward to brake. Rock the handle back for gas. | Is this easier on my wrist and fingers? |
| Push right angle | Push forward to brake. Push down toward your lap for gas. | Can I reach it without leaning? |
| Push twist | Push forward to brake. Twist the grip for gas. | Do I have enough wrist turn and feel? |
| Electric (low effort) hand control | Powered parts do most of the work, so less force is needed. | What happens if power or a part fails? |
| Left foot accelerator | A second gas pedal sits to the left of the brake. | Is my left leg quick and accurate enough? |
| Pedal block or guard | A cover keeps a foot off the original gas pedal, or both pedals. | Who removes it when others drive? |
With hand controls, one hand stays on the control most of the time. That leaves one hand to steer, so most users also need a steering device. Our companion article on pedal extensions and adapted steering controls covers those tools.
You still need turn signals, the horn, wipers and the headlight switch. Evaluators check whether you can reach these quick use controls from the driver’s seat [1]. Some hand controls can carry buttons for them on the handle.
Who uses hand controls and pedal changes
These controls are for drivers whose needs are not met by standard foot pedals. National medical guidelines for licensing agencies say many people can return to safe driving after a spinal cord injury with an evaluation and training on the right equipment [3]. They say the same for many stroke survivors [3]. For amputations, they note it is very rare that a car cannot be changed to fit a physical limit [3].
Common reasons include:
- Paralysis or weakness in both legs, such as after a spinal cord injury.
- Loss of a leg, or loss of use of a leg.
- Right side weakness after a stroke, or a lasting right leg injury.
- Leg spasms, numbness or fatigue from a nerve or muscle condition.
Two people with the same diagnosis may need very different setups. Function, not the name of a condition, guides the choice. Our guide to medical conditions and driving explains why.
Buyers are not only drivers. Caregivers often help choose the equipment and may share the car. Paratransit agencies and other employers may adapt a work vehicle for a driver with a disability. They need the same steps, plus a plan for other staff who use it.
Why the evaluation comes before the equipment
A full evaluation looks at vision, strength, range of motion, coordination, reaction time and judgment [2]. It also tests your driving with adaptive equipment [2]. The evaluation looks ahead, too, at how your condition may change and how much repeated strain a device may put on certain muscles [2]. That matters with hand controls, because one arm and shoulder do the gas and brake work on every trip.
The “good side” still needs testing
A left foot accelerator sounds like a simple swap. Research suggests it is not. In one study, 20 stroke survivors and 10 healthy adults did pedal reaction tests [4]. People with right side weakness were slower with both legs, including the unaffected one [4]. People with left side weakness braked about as fast as healthy adults with their stronger leg [4].
A 2023 study of 10 drivers with left side weakness found they reacted as fast as healthy drivers [5]. But their unaffected leg showed poorer control when moving from the gas to the brake [5].
For hand control users, the data are encouraging. In a simulator study, 20 men with paraplegia using hand controls braked in 0.92 seconds on average, compared with 0.90 seconds for 20 men using their feet [8]. The gap was not statistically significant, and among the hand control users, more years of driving went with faster braking [8]. These were small studies, so your own test results matter most.
Thinking skills count, too. Evaluators watch for errors that first time users often make. They also check whether memory or attention problems will make it hard to use the equipment the same way every time [1].
Matching the controls to the vehicle
The equipment must fit the car, and the car must fit you. NHTSA notes that lowering a van floor by even half an inch can affect your ability to use equipment or see the road [2].
Hand controls are generally paired with an automatic transmission. There must be room for your knees around the control and its rods. The seat must let you reach every control and still see well. Our guide to driving with a disability covers vehicle choice, air bags and funding.
Where to get hand controls and who should install them
The usual path has two stops. First, a driver rehabilitation program, often based at a rehabilitation hospital or clinic, does the evaluation and writes the prescription. Second, a qualified mobility equipment dealer installs the equipment to match it. Avoid buying controls online and installing them yourself.
The national trade group for mobility equipment dealers runs an accreditation called the Quality Assurance Program. The group describes it as best practices meant to keep installs in line with federal safety and industry standards [9]. Ask dealers whether they hold it.
A business that modifies vehicles for people with disabilities must register with NHTSA within 30 days of its first such job [6]. Ask your installer to confirm it is registered. The rule allows only listed changes to federal safety features, such as removing an original foot pedal when the change requires it [6]. The installer must put a permanent label on the vehicle [6]. You must also get a document listing the safety standards the car may no longer meet, and the business must keep a copy for at least five years [6].
NHTSA advises that you will likely need to attend fittings while the car is changed [10]. Professional guidance calls for a final fitting with you, your specialist and the dealer before you take the car home [1]. NHTSA notes that hand controls can cost under $1,000 [2]. The evaluation, installation and training add to that total.
Learning to drive with new controls
New and experienced drivers both need training on newly installed equipment, including on road practice with a specialist [2]. Training should begin in a low risk place, such as a large, empty parking lot [1]. Safety Behind the Wheel Foundation encourages every driver, however experienced, to train this way before heading into traffic.
Switching from familiar pedals takes work. A survey in Scotland shows why training matters. Of 589 drivers who replied, 79% had returned to driving [11]. Return was highest in standard cars with a manual gearbox (86%) and lowest for drivers using the left foot for both gas and brake (66%) [11]. Drivers who reported crashes or retraining problems were more likely to use unfamiliar controls, especially hand controls [11]. The authors said larger studies should confirm this [11].
Some programs use simulators. In one study of 32 drivers learning new aids, those who started on a simulator and those trained only on the road had no significant difference in later road test results [12]. Interviews with specialists, installers and users found differing views on how much training is enough [13]. A careful plan follows your progress, not a fixed number of lessons.
A typical training path looks like this:
- Learn the controls with the engine off, including each button.
- In an empty lot, practice smooth starts, gentle stops and hard stops on a signal.
- Add turns, backing and parking while you steer with one hand.
- Move to quiet streets at low speed with your specialist beside you.
- Build up to busier roads, highways, night driving and rain.
- Complete any road test or paperwork your state requires.
Daily habits that keep you in control
Build these habits into every drive:
- Keep your hand on the control while the car moves, so braking is instant.
- Keep the floor clear. Loose bags, bottles and thick mats can block rods or pedals.
- Make sure any pedal guard or folding pedal is locked before you start.
- Wear shoes with good pedal feel if you use a left foot accelerator.
- Plan breaks on long drives, since one arm or leg is doing extra work.
Other people may drive your car. Professional guidance says they should use only the original factory controls [1]. Show them how to fold away a left foot pedal or secure a hand control. Then make sure your setup is restored before you drive.
Limits and common mistakes
These controls solve one problem: moving the gas and brake work away from your right foot. They cannot fix slow thinking, poor vision or severe fatigue. That is why the evaluation covers much more than your legs [2].
Common mistakes include:
- Buying a car or the equipment before the evaluation.
- Copying a friend’s setup without testing your own needs.
- Skipping training because you have driven for years.
- Assuming your unaffected leg or arm works perfectly.
- Letting someone untrained drive the adapted car.
Health can change. Professional guidance says to return for another evaluation after any loss of function, a sudden medical event or a new health condition [1].
Maintenance, inspections and what to do after a collision
NHTSA notes that adaptive equipment may need more attention, or more frequent checks, than the vehicle alone [2]. Specialists, dealers and users do not all agree on how often hand controls need service [13]. Ask your installer for a written schedule and follow it.
A crash can bend brackets or rods, even when the car looks fine. Before you drive again, have the installer inspect the controls. Tell your insurer and body shop about the equipment, and show them your modification papers [6]. Ask that a qualified mobility dealer remove and reinstall any controls during repairs. A cheap repair that skips this step can leave a brake or gas control that does not work as it should. Take the same care after brake work or any repair near the pedals.
Frequently asked questions
Can I learn to drive with hand controls if I have never had a license?
Yes. All states require a valid learner’s permit or license before an on road evaluation [2]. You cannot be denied the chance to apply for a permit or license because of a disability [2]. Start with your state’s permit steps, then ask a driver rehabilitation program about an evaluation and lessons.
Is a left foot accelerator easier than hand controls?
Not always. It depends on your left leg’s speed, strength and control, and on your thinking skills. In one survey, drivers using the left foot for both gas and brake had the lowest return to driving rate, at 66% [11]. Studies after stroke also found the unaffected leg can be slower or less precise [4, 5]. Your evaluator can test both options before recommending one.
Can I move my hand controls to a new car?
Sometimes, but plan for it like a new install. The new car may have a different column, floor, pedals or seat height. Ask your installer whether your controls fit the new model before you buy it. Have the work labeled and documented again [6]. Then book a check with your specialist to confirm you can still use every control safely.
What about rental cars and travel?
Portable hand controls exist, but treat them like any new control. Ask your specialist whether a portable style is safe for you, and train with it first. Ask the rental company well ahead what it can provide. Before you leave the lot, test the brake and gas in an empty corner. If anything feels loose, do not drive.
What if my condition changes?
Tell your doctor and contact your driver rehabilitation program. A decline in function, a sudden medical event or a new condition is a reason for another evaluation [1]. You may need an adjustment, a different control or more training. A change does not automatically end your driving. It is a reason to check the fit again.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Safety Behind the Wheel Foundation recommends treating training and regular checks as part of the equipment, not extras. Hand controls and left foot accelerators help many people drive safely when standard pedals no longer work for them. But the equipment is only one link in the chain. Safety comes from a careful evaluation, the right vehicle, a qualified installer, real training and steady upkeep.
If you or someone you love is considering these controls, start with a driver rehabilitation specialist. Then learn the new controls well before you head into traffic.
Related articles
- Driving with a disability: adapted vehicles, hand controls and next steps
- Medical conditions and driving: why function, not diagnosis, decides
- Checking if you’re fit to drive after crash injuries
- Vehicle maintenance for safety: tires, brakes, lights and warning signs
- Vehicle recalls and safety defects: how to check, fix and report
Sources and further reading
- 1Association for Driver Rehabilitation Specialists (ADED). Best Practice Guidelines for the Delivery of Driver Rehabilitation Services. Published 2016. cdn.ymaws.com/…/ADED_BestPracticeGuidelines_.pdf
- 2National Highway Traffic Safety Administration. Adapted Vehicles. Accessed October 2026 (no update date shown). nhtsa.gov/vehicle-safety/adapted-vehicles
- 3American Association of Motor Vehicle Administrators and National Highway Traffic Safety Administration. Driver Fitness Medical Guidelines. Published September 2009. nhtsa.gov/sites/nhtsa.gov/files/811210.pdf
- 4Pauley T, Ismail F, Boulias C, Devlin M, Phadke CP. Comparison of foot pedal reaction time among patients with right or left hemiplegia and able-bodied controls. Topics in Stroke Rehabilitation 20(6):500-508. Published 2013. [https://pubmed.ncbi.nlm.nih.gov/24273297/](https://pubmed.ncbi.nlm.nih.gov/24273297/) (DOI: [https://doi.org/10.1310/tsr2006-500](https://doi.org/10.1310/tsr2006-500)) doi.org/10.1310/tsr2006-500
- 5Ogawa T, Fujita K, Kawabata K, et al. Is it safe to control the car pedal with the lower limb of the unaffected side in patients with stroke? Traffic Injury Prevention 25(1):27-35. Published 2023 (issue dated 2024). [https://pubmed.ncbi.nlm.nih.gov/37773056/](https://pubmed.ncbi.nlm.nih.gov/37773056/) (DOI: [https://doi.org/10.1080/15389588.2023.2260914](https://doi.org/10.1080/15389588.2023.2260914)) doi.org/10.1080/15389588.2023.2260914
- 6Electronic Code of Federal Regulations. 49 CFR Part 595, Subpart C: Vehicle Modifications to Accommodate People With Disabilities (sections 595.6 and 595.7). Up to date as of October 1, 2026. ecfr.gov/…/subpart-C
- 7U.S. Department of Transportation, Bureau of Transportation Statistics. Travel Patterns of American Adults with Disabilities. Published March 27, 2026. Data year: 2022 (National Household Travel Survey). bts.gov/travel-patterns-with-disabilities
- 8Santos S, Brech GC, Alonso AC, Greve JMD. Brake response time between male drivers with and without paraplegia: Association between sociodemographic, motor and neurological characteristics. Traffic Injury Prevention 22(3):207-211. Published 2021. [https://pubmed.ncbi.nlm.nih.gov/33661082/](https://pubmed.ncbi.nlm.nih.gov/33661082/) (DOI: [https://doi.org/10.1080/15389588.2021.1880007](https://doi.org/10.1080/15389588.2021.1880007)) doi.org/10.1080/15389588.2021.1880007
- 9National Mobility Equipment Dealers Association (NMEDA). Quality Assurance Program. Last modified February 13, 2026. nmeda.org/quality-assurance-program
- 10National Highway Traffic Safety Administration. Adapting Motor Vehicles for People With Disabilities (DOT HS 810 733). Revised June 2015. nhtsa.gov/node/4566
- 11Prasad RS, Hunter J, Hanley J. Driving experiences of disabled drivers. Clinical Rehabilitation 20(5):445-450. Published 2006. [https://pubmed.ncbi.nlm.nih.gov/16774096/](https://pubmed.ncbi.nlm.nih.gov/16774096/) (DOI: [https://doi.org/10.1191/0269215506cr957oa](https://doi.org/10.1191/0269215506cr957oa)) doi.org/10.1191/0269215506cr957oa
- 12Couture M, Vincent C, Gelinas I, Routhier F. Advantages of training with an adaptive driving device on a driving simulator compared to training only on the road. Disability and Rehabilitation: Assistive Technology 16(3):309-316. Published online 2019. [https://pubmed.ncbi.nlm.nih.gov/31617768/](https://pubmed.ncbi.nlm.nih.gov/31617768/) (DOI: [https://doi.org/10.1080/17483107.2019.1673837](https://doi.org/10.1080/17483107.2019.1673837)) doi.org/10.1080/17483107.2019.1673837
- 13Lowe E, Drouin N, Venhovens PJ, Brooks JO. Understanding the needs of hand control users, driver rehabilitation specialists, and dealers/installers. Occupational Therapy in Health Care 28(4):394-409. Published 2014. [https://pubmed.ncbi.nlm.nih.gov/25050985/](https://pubmed.ncbi.nlm.nih.gov/25050985/) (DOI: [https://doi.org/10.3109/07380577.2014.933379](https://doi.org/10.3109/07380577.2014.933379)) doi.org/10.3109/07380577.2014.933379
This article reflects the safety priorities of adaptive driving equipment and safe, independent driving for people with disabilities. It is general education, not legal, medical, insurance or financial advice. Rules and programs change, so verify details with official sources. For your own situation, talk with your doctor, a driver rehabilitation program, a qualified mobility equipment dealer, your state motor vehicle agency and your insurer. Reviewed October 2026.
Cite this article: Safety Behind the Wheel Foundation. “Left foot accelerators and hand control types: how to choose, train and drive safely.” drivewithcare.org, https://drivewithcare.org/hand-controls-left-foot-accelerators/. Reviewed October 2026.
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