CONFERENCE on NEUROLOGICAL DISORDERS and COMMERCIAL DRIVERS
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CONFERENCE ON NEUROLOGICAL DISORDERS and COMMERCIAL DRIVERS office of Motor Ca rr ie rs Pub. No. FHWA-MC-88442 July 1988 Was hi ng to n , D.C. 20590 NOTICE The contents of this report reflect the views of the authors, who are responsible for the facts and accuracy of the aata presented herein. The contents do not necessarily reflect the official policy of the Department of Transportation. The United States Government does not endorse products or manufacturers. Trademarks or manufacturer’s names appear herein only because they are considered essential to the objective of this document. This report does not constitute a standard, specification, or regulation. / July 1988 CONFERENCE ON NEUROLOGICAL DISORDERS AND 6 Per fo rmin g Org an i z a ti on Cod e COMMERCIAL DRIVERS i L 6 Per f or mi ng Or ga ni za tio n Rep or t No. Aut ho I I I Harold E. Booker, M.D., et . a l. a, Per fo rming Org ani za ti on Name an d Add r e ss The Washington Consulting Group, Inc. 11 Con tra ct 0. Gra nt No. 1625 Eye Street, N.W., Suite 214 DTFH61-8 7- Z00 011 Washington, D.C. 20006 13. i ype of Rep or t an d Per io d Cove re d 2. Sp on sor in g Age nc y Name an d Add re ss Final Report U.S. Department of Transportation June 1987 - August 1988 Federal-Highway Administration Office of Motor Carriers Washington, D.C. 20590 5 Sup pl emen ta ry Note s Prepared in cooperation with Prospect Associates, Ltd. This document represents the outcome of a conference sponsored by the Office of Motor Carriers to review the current medical standards covering neurological disease. The standard (FHWA regulations, 49 C.F.R. section 39 1. 41( b) ( 7, 8,9 ) as established in 1971 and revised in 1983) permits qualification of individuals to drive a commercial motor vehicle if that person has no established medical history or clinical diagnosis of epilepsy, or any condition which is likely to cause lo ss of consciousness or the loss of ability to control a commercial vehicle, or rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease such that the condition interferes with his/her ability to safely control and operate a commercial vehicle. During a two-day conference, neurology specialists, occupational health physicians, and motor carrier industry experts reviewed and proposed modifications to the neurological regulations and recommended te st procedures and decision mat ri ci e s designed to guide neu r ol ogi c examinations. Since the U.S. Department of Transportation's neurological standards were adopted in the 1970' s meeting participants considered over a decade of advances in the diagnosis, treatment, and rehabilitation of these conditions. Four task forces discussed and prepared reports on the following topics: Static Neurological Conditions, Progressive Neurological Conditions, Episodic Neurological Conditions I, and Episodic Neurological Conditions II. These task force reports will assist the Department in creating a systematic and scientific basis for updating the neurology standards. 7. Key Words 18 . Dis tri bu tio n St at e ment -Epilepsy -Central Nervous -Convulsion System Disease Ant i c on vu l s a nts -Motor Vehicle -Neuromuscular Disease -Traffic Accident -Seizure -Driver 19 . Se cu ri ty Cl a ss if . ( of th is re por t ) 20 . Se cu ri ty Cla ss if . ( of thi s pa ge ) 21 . No. of a ge s 22. Pri ce unclassified unclassified 79 orm DOT F 1700.7 (8-72) TABLE OF CONTENTS Executive Summary .............................. I Preface ................................... II Task Force I Report: Static Neurological Conditions ................. 19 Task Force II Report: Progressive Neurological Conditions .............. 25 Task Force III Report: Episodic Neurological Conditions I .............. 31 Task Force IV Report: Episodic Neurological Conditions II .............. 47 Appendix A: A Guide for the Functional Assessment of Commercial Drivers. .... : . 61 Appendix B: Conference Participants ....................... 63 Appendix C: Observers and Other Attendees .................... 61 Appendix D: Conference Speakers ........................ 69 Appendix E: Conference Agenda ......................... 11 References . , . 73 CONFERENCE ON NEUROLOGICAL DISORDERS AND COMMERCIAL DRIVERS EXECUTIVE SUMMARY The Office of Motor Carriers (OMC), Federal Highway Administration (FHWA), U.S. Department of Transportation (DOT), sponsored a conference on April 7 and 8, 1988 to review the current medical standards for commercial motor vehicle drivers with neurological disorders. Conference participants numbered twenty-eight and included physicians and scientists experienced in the care of people with neurological disorders, and representatives from the motor carrier industry. The current standard (FHWA regulations, 49 C.F.R. section 391.41(b)(7,8.9) as established in 1971 and revised in 1983), permits qualification Of in- dividuals to drive a commercial vehicle if that person has no established medical history Or clinical diagnosis of epilepsy, or any condition which is likely to cause loss of consciousness or the loss of ability to control a commercial vehicle, or rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease such that the condition interferes with his/her ability to safely control and operate a commercial vehicle. The administrative rule applied to the commercial driver with neurological conditions was reviewed in light of the many advances in the diagnosis and care of neurological conditions that have accrued since 1971. Four major categories of neurological conditions were carefully reviewed by four task forces, discussed at a plenary session, and following integration of all information presented, further discussed in-depth by members of the Steering Committee. The following summaries were prepared: Executive Summarv--Static Neurological Conditions Recommendations are made for cerebrovascular disease, head and spinal cord injury and static neuromuscular disease and peripheral neuropathy. Transient Ischemic Attacks (TIAs) are associated with a high rate of recurrence during the first year. Therefore, this automatically precludes commercial driving for one year. After one year certification would depend upon the interval history, general health, neurological examination, and compliance with the treatment program. Transient Global Amnesia is generally benign. If a thorough neurological examination including electroencephalography and psychiatric tests are normal, the commercial driver should be permitted to drive. Embolic or Thrombotic Infarction should, as a minimum have the same limitations as TIA. Seizure limitations as outlined by Task Force IV should be added. Anticoagulant therapy and medications that suppress the nervous system are disqualifying. Intracerebral and Subarachoid Hemorrhage due to operated aneurysm or arteriovenous malformation (AVM) requires the in-depth examination described for infarction. In addition, a patient with an aneurysm or AVM that has ruptured and has not been surgically repaired should not be permitted to drive commercial vehicles. I Head Injury Head injury requires the implementation of the seizure limitations recommended by the Task Force IV Report: Episodic Neurological Conditions. In addition, complete physical examination, neurological examination and neuropsychological testing must be normal before permission is given to operate the vehicle. Spinal Cord Injury Spinal cord injury resulting in paraplegia is disqualifying. Any weakness should be reevaluated to determine whether the deficit interferes with commercial drivers. Static Neuromuscular Disease and Periopheral Neuropathy These conditions are discussed in detail by Task Force II: Progressive Neurological Disorders. For those that produce static dysfunction, permission to operate a commercial vehicle should depend upon demonstrated ability as determined by examination. Any driver with a deficit that requires special evaluation and screening by this method should have annual recertification. Executive Summary--Progressive Neurological Conditions The task force felt that the current medical examination for commercial driving certification was inadequate for assessing neurological conditions. The task force recommends tha! any applicant having neurologic signs or symptoms be referred to a neurologist for more detailed and qualified evaluation of neurologic status in relation to certification for driving commercial vehicles. This specialist would be provided guidelines for evaluating certification of applicants. For progressive neurologic disorders we recommend two categories for disqualification. The first category includes chronic diseases that would unequivocally indicate disqualification*: * Dementia. * Motor neuron disease. * Malignant tumors of the central nervous system. * Huntington’s disease. * Wilson’s disease. The second category includes diseases for which disqualification would be likely, however, appeal of this decision under specified conditions would be possible: * Multiple sclerosis. * Peripheral neuropathies. *Appeal would be possible only for changes in and/or verification of diagnosis. 2 Myopathies. Neuromuscular junction disorders. Benign brain tumors. Dyskinesias. Treatable dementias. Cerebellar ataxies. Appeal would include evaluation by a board certified or eligible neurologist, _ ^ neurosurgeon, or physiatrist Specific evaluation criteria d ev el op e d by the task force include successful completion of neurologic history and examination, driving skills testing or equivalent functional testing. If an individual