Personalized purpose of components for lower limb prostheses in the system of providing disabled people with rehabilitation technical means

Authors:

Smirnova Ludmila Mikhailovna — Grand PhD in Medical sciences (Dr. Med. Sci.), leading researcher of the Department of Biomechanical Studies of the Musculoskeletal System of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Professor of Department of Biomedical Engineering, St. Petersburg Electrotechnical University, 5 Professora Popova Street, 197376 St. Petersburg, Russian Federation; e-mail: info@diaserv.ru; https://orcid.org/0000-0003-4373-9342.

Suslyaev Vadim Gennadievich — PhD in Medical sciences (Cand. Med. Sci.), leading researcher of the Department of Expert Rehabilitation Diagnostics, Federal government institution “Main Bureau of Medical and Social Expertise for the City of St. Petersburg”, 58A Liteiny Ave, 191014 St. Petersburg, Russian Federation; leading researcher of Department of innovative technology for technical means of rehabilitation of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: vadims1964@yandex.ru; https://orcid.org/0000-0003-0651-5497.

Ivanov Oleg Vladimirovich — Head of the Department of Expert Rehabilitation Diagnostics, Federal government institution “Main Bureau of Medical and Social Expertise for the City of St. Petersburg”, 58A, Liteiny Ave, 191014 St. Petersburg, Russian Federation; e-mail: digitalis2@yandex.ru; https://orcid.org/0009-0002-9242-5868.

Sokurov Andrey Vladimirovich — Grand PhD in Medical sciences (Dr. Med. Sci.), Director of the Institute of Additional Professional Education, Albrecht Federal Scientific and Educational Centre ofMedical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: ansokurov@yandex.ru; https://orcid. org/0000-0002-3736-2895.

Fogt Elizaveta Vladimirovna — Head of the Department of Biomechanical Studies of the Musculoskeletal System of Institute of Prosthetics and Orthotics, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; postgraduate student of Department of Biomedical Engineering, Saint Petersburg Electrotechnical University, 5 Professora Popova Street, 197022 St. Petersburg, Russian Federation; e-mail: fogtlisbet11@yandex.ru; https://orcid.org/0000-0002-1017-6179.

Annotation:

Introduction. One of the ways to increase satisfaction with a prosthesis is to intensify a personalized approach to the selection of models for its components (prosthetic modules), the need for which is justified and recognized both in the scientific community and in the management segment. Employees of the Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation were justified the basic principles of the technology for personalized synthesis of lower limb prostheses on the basis of determining individual requirements for functional properties, design parameters, operational and aesthetic characteristics of the prosthesis in accordance with the state of the structures and functions of the disabled person’s body, his activity and participation and environmental factors. However, the success of the creation and implementation of such technology also depends on its congruence with the legislative and regulatory framework.

Aim. The purpose of the work is to study the possibility of using a personalized prescription of components models for a modular prosthesis of the lower limb in the existing set of regulatory rules for providing disabled people with technical means of rehabilitation.

Materials and methods. An analysis of statistical data for 2020-2022 was carried out, indicated in the form of statistical observation No. 7-social security in the Federal Institution “Main Bureau of Medical and Social Expertise for the City of St. Petersburg”. A content analysis of the legislative legal framework for the rehabilitation of patients with amputation defects of the limbs was carried out. The informational and empirical basis for the study was the regulatory legal acts of the Russian Federation that define the rules for providing disabled people with technical means of rehabilitation, as well as reference and analytical data.

Results. A significant increase in the number of IPRAs developed in 2022 with the prescription of lower extremities prostheses was revealed compared to 2020 and 2021, and a multiple predominance of IPRAs number with the prescription for lower extremities prostheses compared to the upper extremities. For these reasons, the personalized prescription components for modular prosthesis in the existing system of providing for disabled people is considered in the article using the example of modular prostheses for the lower extremities. The interaction between participants in providing a citizen with a prosthesis is displayed in algorithm form. The procedures for performing the stages of providing a prosthesis in terms of personalized selection of its components are considered in detail. The problems of determining in an individual rehabilitation program for a disabled person a specific type for each prosthetic component were analyzed, i.e. its functional, design and operational features.

Discussion. Over the past year, a significant step has been taken in terms of organizing personalized synthesis of prosthetic limbs for disabled people; a reference book of parameters of lower limb prostheses for the formation of IPRA has been developed and approved. However, this reference book does not provide a complete list of acceptable values of factors reflecting the condition of a disabled person, which should determine the prescription of components for a modular prosthesis, which does not allow making an unambiguous choice. In addition, it is advisable to expand the list of factors influencing the choice of module type for a particular patient. It is necessary to create an electronic catalog with a database of information about the characteristics of prosthetic modules available on the market, as well as to develop software with a decision support mode.

Conclusion. Currently, in terms of personalized selection of types of prosthesis components, unresolved issues remain: development of a methodology for collecting the necessary data about the patient; development of software for selecting models of prosthetic modules with decision support mode; creation of a unified information space between participants in the appointment and performance of prosthetic services in compliance with confidentiality requirements and ensuring the protection of personal data of a disabled person.

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