Musculoskeletal Flashcards
What tasks must a commercial motor vehicle driver do relevant to the musculoskeletal exam, according to FMCSA standards?
- safely drive and operate commercial motor vehicle
- perform pre and post trip safety checks
- secure loads
-If an employer standards are less demanding than Federal requirements, driver must meet Federal requirements
- if employer standards are more demanding than Federal requirements, driver must meet company requirements
What three named regulations (know the numbers!) apply to the musculoskeletal system?
49 CFR 391.41b (1) - driver cannot have loss of foot, leg, hand, or arm
49 CFR 391.41b (2) - driver cannot have impairment of:
-Hand or finger which interferes with prehension or power grasping
- arm, foot, or leg which interferes with the ability to perform normal tasks associated with driving a commercial motor vehicle
- any other significant lip defect or limitation that would interfere with ability to perform tasks associated with driving a commercial motor vehicle
49 CFR 391.41b (7)
Which standard will allow a driver who has limb impairment or limb loss to keep driving as long as they are able to be granted a skill performance evaluation certificate by the FMCSA?
49 CFR 391.49
What standard is an alternative to the combination of standards 49 CFR 391.41b (1) and 49 CFR 391.41b (2)?
49 CFR 391.49
Use this particular standard as the alternate standard if the driver meets all other standards except for 49 CFR 391.41b (1) and 49 CFR 391.41b (2), AND the driver has been granted a skill performance evaluation certificate by the FMCSA.
Which standard deals with loss of limb?
49 CFR 391.41b (1)
- standard says that a driver driver cannot have loss of foot, leg, hand, or arm
- if the driver has lost one or more of these appendages, they can’t meet the standard. Therefore, they must obtain a skill performance evaluation (SPE) certificate in order to keep driving
-for less severe loss (e.g. loss of fingers, toes), examiner determines on a case-by-case basis
Which standard deals with limb impairment ?
49 CFR 391.41b (2)
Driver needs to be able to perform tasks req to operate a vehicle, incl:
-Hand and finger prehension and power grasp
-Arm, foot, and leg flexibility, mobility, strength
Det on case by case basis whether driver needs a skill performance evaluation (SPE) .
What does standard 49 CFR 391.41 (b)(7) say?
Says a driver cannot have an established history or clinical diagnosis of Rheumatic, arthritic, Orthopedic, muscular, neuromuscular, or vascular disease which interferes with ability to control and operate a commercial motor vehicle safely
- this regulation is not saying that a driver can never have arthritis or some other musculoskeletal condition
-it’s just saying that if the driver has a diagnosis of arthritis or some other musculoskeletal disease, the disease cannot be so severe that it prevents the driver from being able to operate the commercial motor vehicle safely
- qualify if driver is able to control and operate vehicle safely
-disqualify if driver’s condition is not reversible or is progressive
Describe typical CMV tasks.
1.control lg steering wheel and console switches
-need strength and dexterity in UEs
2.engine and vehicle checks
-involves squatting, reaching, stretching, loosening/tightening connections
3.enter/exit cab
-reqs 3 points of contact for safety inc use of hands, arms, legs
4.joining and disjoining trailers
-reqs grip strength, dexterity
5.use of mirrors on both sides of truck to check surr traffic, or to back up the vehicle
-reqs movement of head and neck
6. Maintain pressure on pedals
7. Change tires
8.secure load
9. Make multiple stops
10. Respond to emergencies
Who must decide whether or not the severity of the dz impairs driver’s ability to operate the vehicle safely?
-med examiner must determine if severity of a reversible or progressive MS disease interferes with driving ability
-may need driver to have eval by physiatrist or neurologist who understands functions and demands of commercial driving
Examiner must verify that prehension and power grasp are adequate to maintain grip on lg steering wheel, shift gears, and maneuver vehicle into a crowded area. What is the recommended minimum grip strength?
58 lbs of force is recommended if a dynamometer is used
Can also test grip using a sphygmomanometer
A driver needs a minimum grip strength of ___ pounds to be certified when a dynamometer is used.
58 pounds
Name two exs of peripheral neuropathy.
Guillan Barre
Diabetic neuropathy
Can pts with peripheral neuropathies be certified?
-disqualify, but appeal is possible with eval by physiatrist or neurologist
-specialist may advise a simulated skills driving test
-if appeal successful, pt can be certified annually
If a pt with a peripheral neuropathy wins the appeal to be certified, for what period of time can they be certified? How often must they recertify?
1 year
annually
What is autonomic neuropathy?
Dz of nerve fibers affecting nerves of the autonomic system that affect vital functions
What body functions are affected by autonomic neuropathy?
Blood pressure
HR
Bowel and bladder fxn
digestion
When can a pt with autonomic neuropathy be certified?
-etiology is confirmed
-treatment has been shown to be safe
-nature and severity of the dz is not enough to pose a danger to public safety
What is the max certification period for a pt with autonomic neuropathy ?
Two years
What is the req f/u for a pt with autonomic neuropathy ?
-addt’ testing on case by case basis
-consult with specialist when indicated
-biennial exam; more often when indicated
You don’t have to disqualify all drivers who have autonomic neuropathy. What renders a pt with autonomic neuropathy ineligible for certification?
1.cardiovascular autonomic neuropathy that causes
Resting tachycardia
Orthostatic bp
- Other organ autonomic responses that may interfere with driving ability
