Musculoskeletal

• Coupling and uncoupling trailers requires strength and full range of motion to climb, balance, grip, and pull
• Loading and unloading trailers of freight after sitting for a long period of time without any stretching period
• Lifting, installing, and removing heavy tire chains in the range of 35 to 90 pounds
• Lifting tarpaulins to cover open top trailers requires pulling/lifting motions in the range of 50 to 100 pounds
• Performing pre-trip and post-trip safety checks requires climbing, bending, kneeling, crawling, reaching, stretching, turning, and twisting
• Moving gear shift levers requires timely coordination and complex manipulation skills of right upper and left lower extremity
• Controlling the steering wheel requires mobility, power grasp, and prehension of hands and fingers
• Operating brakes and accelerator pedals requires coordinated movement in lower extremities
• Operating light switches, windshield wipers, directional signals, emergency lights, horn, etc. requires mobility and manipulative skills of upper extremities
• Backing and parking requires adequate depth perception and coordinated manipulative skills

View Driver Demands & Duties Document

Some diseases have acute episodes with symptoms that may interfere with the ability to operate a CMV safely. Others are slowly progressive and do not significantly interfere with the driver’s abilities until later stages.

Considerations:

• The nature and severity of the driver’s condition
  • Sensory loss
  • Loss of strength
• The degree of limitation present
  • Range of motion
  • The rate or stage of progression

The SPE is only applicable for fixed deficits of the extremities where the driver does not have sufficient functional capacity to perform the duties of a driver. An SPE certificate is not available for impairment of the spine or torso that does not result in loss, impairment, defect, or limitation of a limb.

• Drivers with the loss of a hand (or loss of all 5 fingers)
• If the severity of a fixed deficit is less than the whole hand but not sufficient use, or if the driver has a complete functional loss of the hand
• Drivers requiring the use of bracing, assistive, or a prosthetic device

Precision prehension = grasping and manipulating knobs and switches using the fingers/thumb

Power grasp prehension = grasping, holding, and maneuvering the steering wheel using a hand

SPE certificate eligibility requirements for the upper extremities:

• If an individual does not have a hand or extremity, a prosthesis is required
• If an individual with an upper limb impairment is not capable of demonstrating prehension without a prosthesis or orthotic device, this individual must be able to demonstrate adequate prehension with a prosthesis or orthotic device
• During the functional capacity exam found at the end of the SPE application, either the physiatrist or the orthopedic surgeon performing the exam must indicate that the applicant can demonstrate prehension with each hand separately.

Decisions regarding whether the loss, impairment, defect, or limitation is fixed will be made during a medical evaluation by a physiatrist (doctor of physical medicine) or orthopedic surgeon, and be reviewed by FMCSA, as part of the SPE application process.

SPE Application Process

The ME’s role:

• Perform the exam and mark the box that sates, “Accompanied by a Skill Performance Evaluation (SPE) Certificate
• Give the driver their certificate and a copy of the medical examination report form

The driver’s role:

• Have the Medical Evaluation Summary (the last 5 pages of the application) completed by a physiatrist or orthopedic surgeon
• Provide FMCSA with a description of any bracing, assistive, or prosthetic device being used
• Obtain a driving record of the past 3 years from their state drivers licensing agency
• Obtain a road test with the FMCSA representative using the trailer type that the driver intends to use

View and/or Download the SPE Application

Check for the following symptoms/conditions:

• Surgical scars and deformities
• Tenderness and muscle spasm
• Loss in range of motion/painful motion
• Kyphosis, scoliosis, other spinal deformities
• Check for balance, coordination, deep tendon reflexes, and Babinski reflex
  • A positive Babinski test may trigger a neurological evaluation

Check for the following symptoms/conditions:

• Gait, mobility, posture (weight bearing), limping or signs of pain
• Strength, function, mobility of both upper and lower extremities
  • There is no specific lifting weight requirement
• Can they perform the demands and duties of a driver? (See dropdown tab.)

Grasp Power: extremity strength

• No specific test is required but may use the following:
  • Dynamometer designed to measure grip strength
  • Sphygmomanometer – Have driver repeatedly squeeze the inflated cuff while noting maximum deflection of gauge

Prehension:  the ability to achieve sufficient “friction” on an object

• Consider using a broom stick or oversized steering wheel

Insights:

• Abnormalities within the nerve or muscle membrane causing abnormal muscle excitability
• Diseases that may interfere with safe driving:
  • Myotonia
  • Isaac’s Syndrome
  • Stiff-man Syndrome

  Considerations:

  • The nature and severity of the driver’s condition
  • The degree of limitation present
  • Can they perform the demands and duties of a driver?

  Waiting Period: The FMCSA handbook does not provide one

  Certification Interval: It is unlikely that an individual with one of these conditions will qualify. If certified, consider up to one year.