the certification of pilots with a musculoskeletal disability
Pilots with disabilities who wish to fly professionally will need to undertake an initial Class 1 medical at an Aeromedical Centre (AeMC), as is the case for all Class 1 applicants. An MFT is likely to be required (as above) with the report submitted to the AeMC who will refer the applicant to a CAA Medical Assessor. During the MFT the applicant will be required to demonstrate that they can assist passengers with emergency egress from an aircraft.
Class 1 certificate applicants with upper limb
prosthetic(s) will be required to demonstrate the presence of a satisfactory
thumb grip function on each hand.
An initial applicant with a
disability should attend an Aeromedical Examiner (AME) for a medical
examination. In consultation with a CAA Medical Assessor a Class 2 medical
certificate may be issued with a safety pilot limitation (OSL) and any other
appropriate limitations providing the examination is satisfactory in all other
respects, apart from the disability. Once the student pilot’s instructor feels
that the pilot is ready to go solo, the pilot can undertake a Medical Flight
Test (MFT) with a Chief Flying Instructor. The form (PDF) for this is available on
our website. The test should include an assessment of the ability of the pilot
to evacuate the aircraft in an emergency. The MFT form should be submitted to
the AME and if satisfactory, the AME should reissue the Class 2 medical
certificate with the safety pilot limitation removed, in consultation with a
CAA Medical Assessor. This will allow the pilot to continue flying training,
which can include solo flying. The pilot will usually be limited to
demonstrated aircraft types only and, therefore, the “OAL” limitation should be
added to the medical certificate following the MFT. Additional types may be
added by undertaking a check ride with a Chief Flying Instructor (CFI)
following which the CFI signs the pilot’s logbook, stating that the pilot can
safely fly the additional aircraft type and the pilot should submit a further
MFT form to their AME.
The most common types of
disability which prospective pilots present with are spinal cord injuries and
amputations. Other disabilities are assessed on an individual basis and the
advice of the CAA should be sought.
Student pilots with paraplegia
usually adapt quickly to the flying environment but do need to use a hand
controller to operate the rudder and fly an aircraft that is fitted with
hand-operated brakes rather than toe operated brakes. There is usually a
preference forlow wing monoplanes, as the access to the cockpit on these
aeroplanes is easier for a paraplegic pilot. The most popular aircraft used by
people with paraplegia are the PA28 series.
The following hand controllers
have EASA approval under a grandfather clause for private flying only (Class
1. The Blackwood hand controller
- it has the disadvantage that it requires a certified aircraft engineer to fit
and remove the controller from the aircraft.
2. The Visionair hand controller
- this is a development of the Blackwood hand controller and has the advantage
that it can be fitted and removed from an aircraft by the pilot and does not
require the procedure to be signed off by a certified aircraft engineer.
EASA is the approving body for
hand controllers, which means manufacturers will need to approach them directly
include the use of muscle relaxants which have significant Central Nervous
System side effects, analgesics (often opioid based) and bladder control
medication, including the anticholinergic and tricyclic groups. Unfortunately, most
of these medications are unacceptable for certification and applicants will
need either to stop these medications or not take them for a suitable period
before flying, in order to hold a valid certificate. Sometimes, on stopping the
muscle spasm relieving drugs, individuals with paraplegia develop significant
muscle spasm and clonus which may represent a significant inflight safety
UK CAA has not yet
certificated a paraplegic helicopter pilot and there is currently no EASA
approved hand controller to operate the yaw controller on helicopters.
Pilots often use a prosthesis which can be
clamped to the yoke and in general the prosthesis does not need to be
certificated by the CAA, providing that failure of the prosthesis (e.g. falling
off the stump) would not result in the pilot losing complete control of the
aircraft. This should be considered during any medical flight test or simulator
check. In the case of double upper limb amputees, the prostheses need to be
certified by EASA to ensure that they are manufactured to the same standard as
aircraft parts. In this circumstance they are considered as part of the
aircraft control system.
Bilateral lower limb amputees will usually require an approved hand controller
whereas single lower limb amputees usually do not. Below knee amputees, usually
wear their prosthesis and operate the rudder and toe brake controls with their
prosthetic leg. A fixed ankle prosthesis is generally preferred by pilots rather
than an articulated ankle which tends to make fine rudder and brake inputs
somewhat difficult. Above knee amputees generally do not wear their prosthesis
whilst flying and can operate the rudder either by means of a toe-strap being
fitted to the rudder pedal which is operated by the remaining leg, or the
so-called “dancing” technique. This technique was first developed in America
and utilises the remaining leg to control both rudder pedals by swiftly
transferring the foot from the right to left rudder peddle. Initially, there
were some concerns that in an “on limits” cross wind landing, this would
compromise flight safety, but it is now felt that it is an acceptable
Aeromedical concerns with amputees
Consideration must be
given to the possibility of phantom limb pain in amputees. If present, the
medication used to control or alleviate this symptom is likely to be
disqualifying for flight.
Many pilots with
hand injuries or deformities have devices manufactured which enable them to
operate controls which their own hands could not operate. An example of this is
a pilot with very severe rheumatoid hands who uses a specially manufactured
device to operate the fuel flow control. A medical certificate may be issued
with a limitation that requires the pilot to carry this device at all times.
Applicants should be referred to a CAA Medical Assessor for assessment.
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