Guidance for the certification of pilots with a musculoskeletal disability

Certification

Class 1 Applicants

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.

Class 2 Applicants

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.

Flying with disability

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.

Paraplegia – Fixed Wing Flying

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.

Hand controllers

The following hand controllers have EASA approval under a grandfather clause for private flying only (Class 2/LAPL):

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 for approval.

Medication

Aeromedical considerations 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 hazard.

Paraplegia – Rotary Flying

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.

Amputees

Upper limb

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.

Lower limb
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 technique.

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.

Hand injuries

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.