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a sufficient thumb-grip function is present on each hand enabling the applicant to manipulate the aircraft
controls safely. Consideration might be given to whether or not a prosthesis may be acceptable under
special circumstances. For Class 2 and Class 3 Medical Assessments an applicant may be considered fit
if fitted with a satisfactory prosthesis.
In the case of lower extremity amputation, an applicant may be considered fit for a Class 1 Medical
Assessment if fitted with a satisfactory prosthesis and adequate skill is demonstrated using it. Restriction
to a specific aircraft type is likely to be required.
Unwanted effects from the use of medication to control muscle spasm or other medical conditions e.g.
sequelae from a head injury caused by an accident that resulted in the limb deficiency, must be
considered. Sometimes the medication rather than the limb deficiency will be the limiting factor for
certification.
GUIDELINES FOR ASSESSMENT
ICAO Preliminary Unedited Version — November 2009 III-8-3
Problems relating to orthopaedic deformities, amputations, limitations in the range of movement of joints,
weakness of muscle groups, etc., must all be assessed on an individual basis. As with any other medical
condition of importance for flight safety, the medical examiner must bear in mind both the possibilities of
interference with the applicant’s ability to perform necessary tasks under normal conditions, and the
particular risk of sudden incapacitation or deterioration in flight, including prolonged and difficult flights.
In the absence of objective neurological signs, this problem becomes a question of the degree of
disability, and is rendered difficult but no less important by the predominantly subjective character of the
available information.
The evaluation of these cases will often necessitate a special medical flight test as outlined in Part I,
Chapter 2. This will give an opportunity for an applicant to demonstrate ability to carry out competently
all the necessary tasks that may be required in each type of aircraft which the applicant is otherwise
entitled to operate.
During a medical flight test the applicant should be assessed with regard to ability to reach readily and
operate effectively all controls that would normally require the use of the deficient extremity (or
extremities). The applicant should also be assessed with regard to his ability to move his head and torso to
compensate for any lack of neck motion.
The distance over which any given control moves needs to be compared to full range of travel available to
the limb in question, as well as full force required for each aircraft flown. In many aircraft elevator and
rudder pedal control requires considerable force. Engine, accessory and propeller controls, as well as flaps
and landing gear are usually activated by short control movements, fore and aft, up and down, or in rotary
directions, with relatively little force. Radio controls and small switches, however, while requiring
negligible force, do usually require reasonable pinch or opposition. Some prostheses do provide these
functions. When assessing lower-limb function, the medical examiner should give special attention to the
applicant’s safe and efficient performance when ground braking action is applied.
A handicapped applicant should be required to demonstrate the ability to safely compensate for the
handicap. The applicant should thus be required to be able to perform satisfactorily not only under normal
flying conditions but also during any presumptive emergency procedures that might occur during flight,
and during emergency evacuation. Lacking inherent stability, helicopters usually require more control
inputs than aeroplanes.
The assessment of a prosthesis should also take into consideration the airworthiness aspects of any
technical attributes required. When the prosthesis is required for safe aircraft operation, it should be
considered as an extension of the controls of the aircraft and as such be of an equivalent airworthiness
standard.
The applicant’s fitness for aviation duties should, as a rule, be based on a full medical investigation,
including functional assessment in consultation with an operational expert. The licence may require
endorsement with some special limitation or limitations, such as operation of a particular type of aircraft
only or of an aircraft fitted with a special control or cockpit equipment. Although applicants with
musculoskeletal difficulties may provide an aeromedical challenge, given adequate time and effort on
behalf of the regulatory authority and the individual in order to devise a safe operating system, and with
an appropriate limitation as necessary, many applicants with significant orthopaedic conditions can be
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Manual of Civil Aviation Medicine 2(11)
