Given the right combination of effort, will, money and technology, a surprising range of people with "compromised physical and cognitive" abilities can be given their mobility in vans, cars, trucks, motorcycles and farm equipment.

That was made clear at the Bridgepoint Community Rehab Driver Assessment and Training Centre in Toronto, a facility to help get people mobile. There are scores of other places across the country doing the same work -- and the extent of that work has been increasing.

According to Shirley Rolin, the clinical director of driver assessment services at Bridgepoint, "the technology now exists to overcome most physical handicaps in a motorized vehicle."

The extent of the ability to give people their independence was made plain by Greg Brown, Heather Coulson and Rick Riley, who have different situations to deal with.

Brown, 48, and Riley, 42, have conditions (myotubular myopathy and multiple sclerosis, respectively) that have been making general mobility and the operation of a vehicle harder as they developed.

Coulson is a 27-year-old with no use of her legs and very limited movement in her hands and arms as the result of a spinal-cord injury from a diving accident when she was 15. Because of the nature of her physical abilities, it is Coulson's case that seems the most remarkable.

Thanks to a fully automated wheelchair ramp, state-of-the-art electronic and computerized controls for gas, brake and gears, and voice-activation technology for such secondary controls as turn signals and horn, Coulson is able to drive.

Driving is indeed "the only thing I can do completely independently," said Coulson, who gives credit to the staff who evaluated and trained her at another of Bridgepoint's facilities.

"I've developed the skills and confidence to do it well," she said. "I don't have to be as reliant on others to get around as much any more, and I intend to take full advantage of that."

At Bridgepoint, Coulson consulted with Rolin and Remo Minichiello, director of driver training.

Rolin used the centre's computer-based cognition and vision screening and its physical assessment tools to measure Coulson's condition as it applied to driving, and then, with Minichiello, designed the converted van that the creative photography student now drives to Humber College on a regular basis and to Lake Placid and Florida on family outings.

Brown did not need a specially-created vehicle, just a spinner knob and hand controls for acceleration and braking installed in his Jeep. After driving for 30 years with traditional controls, Brown was "very concerned about the reliability of hand controls," so he wanted specialized training.

"Training made me much more comfortable with hand controls and other modifications and gave me the confidence I needed," Brown said, adding "it also made me a better and safer driver. The training was a great refresher on rules of road and safe-driving techniques."

In Riley's case, MS had caused him to use a wheelchair for the past four years, but he was still able to use his legs to operate the traditional brake and gas pedal until about six months ago.

When Riley found that he had to use both legs to keep the brake depressed, he decided to see what else he could do. As the co-owner of a snowplowing and landscape business called Jimricks Property Services that operates 19 vehicles for commercial customers, he needs to get around.

For Riley, "one of most challenging things was learning hand controls. You instinctively think about using legs to brake instead of using hand controls, so driver training was instrumental."

The training even provided Riley with a flash of nostalgia, since he "felt like I was 16 again, learning to take my driving test. I have a 15-year-old son who is going for his licence soon, so I had to set a great example. There was no way I was going to fail."

Just as important for Riley was the fact his wife, Marlene, can drive the car with the regular controls. "None of the equipment impedes driving the car with regular equipment," he said.

As encouraging as these stories are, it must be noted not everyone who wants to gain or regain their automotive mobility will be able to do so. Rolin said she has had to recommend people's licences should be revoked or not reinstated.

She said that "typically will happen when someone has a level of cognitive impairment -- judgment, decision making, problem solving or processing speed -- where driving would have them be unsafe to the community and themselves.

"This could be someone who has dementia, a brain injury, or a cognitive impairment as a result of a stroke, MS or Parkinson's disease."

There is also the issue of cost, which is not insignificant. Bridgepoint charges $425 for the overall assessment of a client's condition and $95 an hour for the training sessions.

Beyond that, there is the cost of converting a vehicle to accommodate whatever is needed to help the driver -- and that can be very expensive.

Some of the costs might be covered if the client situation is the result of a car crash or a workplace incident, and there are charities committed to such situations, but the exact situation will vary by the individual person.