Neurological Disease and Operation of Machinery

Employment in the agricultural sphere entails operation of tools and machinery, including apparatus that demand specific and highly developed sequences of decisions and actions by the operator. Impairments of any aspect of neurological functioning may contribute to impairment of such abilities and to permanent disability in more severe cases. In addition to personal risk and morbidity, patients are often found in situations where their actions are likely to affect the risk of injury and even death of others. This consideration places a social demand on the physician who is assessing fitness of the patient to drive and operate agricultural machinery (26).

Unfortunately, the ability to safely drive or operate machinery cannot be determined in a medical office. Issues such as judgment and unnecessary risk-taking behavior may be impossible to address in an examination room. Unrealistic expectations on the part of the patient, the employer, and various government agencies also persist, even though it should be fairly obvious that physicians are not specifically trained in this highly technical area in the same way that certified driving instructors or equipment manufacturer representatives are (27,28).

The general consensus is that patients severely affected by dementia, including posttraumatic epilepsy, multiple sclerosis, or movement disorders, should be thoroughly evaluated for their fitness to drive or operate machinery. No consensus or guidelines exist that would serve as a reliable "calibration" tool applicable to at least a substantial majority of patients (29,30).

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