The NADME DOT certification training course states that the recommendation for DOT certification following a stroke is one year.  One of our providers has since been told that the recommendation is 6 months…She wondering which is correct.

The recommended (not required) minimum waiting period for DOT physical after a stroke is one year for a stroke without risk for seizure, eg cerebellar or brainstem, but 5 yrs for cerebral stroke.  Maximum recommended certification is one year.  If you as the medical examiner feel a shorter certification is warranted, that is at your discretion, just document the reasoning for your decision in the comments section.  There is no specific 6 mo provision.

Ref: FMCSA Medical Examiner Handbook

Embolic and Thrombotic Strokes

More than 3 million individuals have survived a stroke, and it is a major cause of long-term disability. Embolic and thrombotic cerebral infarctions are the most common forms of cardiovascular disease. Risk for complicating seizures is associated with the location of the lesions.

  • Cerebellum and brainstem vascular lesions are not associated with an increased risk for seizures.
  • Cortical and subcortical deficits are associated with an increased risk for seizures.
  • Evaluation by a neurologist is necessary to confirm the area of involvement.

Drivers with embolic or thrombotic cerebral infarctions will have residual intellectual or physical impairments. Fatigue, prolonged work, and stress may exaggerate the neurological residuals from a stroke. Most recovery from a stroke will occur within 1 year of the event. The neurological examination should include assessment of:

  • Cognitive abilities.
  • Judgment.
  • Attention.
  • Concentration.
  • Vision.
  • Physical strength and agility.
  • Reaction time.

 

Waiting Period (recommended, not required)

For DOT Physical certification after a stroke: Minimum — 1 year if not at risk for seizures (cerebellum or brainstem vascular lesions) Minimum — 5 years if at risk for seizures (cortical or subcortical deficits) NOTE: If more than one waiting period applies (because of multiple conditions or other comorbid diseases), examine the driver for certification after the completion of the longest waiting period.

Decision

Maximum certification — 1 year

Recommend to certify if:

  • The driver with a history of stroke has:
  • Completed the appropriate waiting period.
  • Normal physical examination, neurological examination including neuro-ophthalmological evaluation, and neuropsychological testing.
  • No neurological residuals or, if present, residuals of a severity that does not interfere with ability to operate a commercial motor vehicle.
  • Clearance from a neurologist who understands the functions and demands of commercial driving.

Recommend not to certify if The driver:

  • Has not completed the appropriate waiting period.
  • Uses oral anticoagulant therapy because of the risks associated with excessive bleeding.
  • Uses any other drug or combination of drugs that have potentially high rates of complications (e.g., depressing effects on the nervous system).
  • Has residual intellectual or physical impairments that interfere with commercial driving.
  • Does not have clearance from a neurologist who understands the functions and demands of commercial driving.

Monitoring/Testing

You may on a case-by-case basis obtain additional tests and/or consultation to adequately assess driver medical fitness for duty.

Follow-up

The driver should have an annual medical examination


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