Personalized synthesis of lower prosthesis limbers: requirements for the purpose of shock absorber modules with a strategy for import substitution

Authors:

Smirnova Ludmila Mikhailovna, Grand PhD in Engineering sciences, leading researcher of the Department of Biomechanical Studies of the Musculoskeletal System of the 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, Saint 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 Genadievich, PhD Medical Sciences, Associate professor, leading researcher of Department of innovative technology for technical means of rehabilitation of the 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; doctor-specialist of the department of expert rehabilitation diagnostics, Main Bureau of Medical and Social Expertise in St. Petersburg, 58 Liteyny Ave., 191014 St. Petersburg, Russian Federation; e-mail: vadims1964@yandex.ru; https://orcid.org/0000-0003-0651-5497.

Yankovskiy Vladimir Mikhailovich, PhD in Medical Science, leading researcher of Department of innovative technology for technical means of rehabilitation of the 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: yankovsky.vladimir@yandex.ru; https://orcid.org/0000-0002-4258-920X.

Bolshakov Vladimir Aleksandrovich, senior researcher of the design department of the 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: pko09_903@mail.ru; https://orcid.org/ 0000-0002-5889-3759.

Annotation:

Introduction. Cushioning modules can significantly improve the quality of prosthetics, but their use in the prosthesis has a different degree of significance for different patients. In accordance with the strategy aimed at digitalization in the field of medicine, it is relevant to develop a methodology for prescribing depreciation modules based on a multifactorial formalized calculation of the indicator of the expediency of their use in a prosthesis to facilitate the decision of the prosthetist.

Aim — substantiation of the personalized appointment of depreciation modules based on a multifactorial formalized calculation of the indicator of the expediency of their use in the prosthesis.

Materials and methods. The methods of analysis, synthesis and analogy are applied in the work. The results of prosthetics were studied in 253 patients aged 18 to 80 years with amputation defects of the lower extremities, who underwent prosthetics at Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation in 2017-2022. The MOBIS classification was used to determine the level of motor activity.

Results. A wide range of feet and specialized shock-absorbing modules is presented on the world market of prosthetic and orthopedic products. However, in the synthesis of modular prostheses of the lower extremities, the use of components with increased shock-absorbing properties is often undeservedly neglected in their composition. The method of multifactorial formalized calculation of the indicator of expediency of providing increased depreciation properties of the prosthesis of the lower limb is substantiated. The factors of the patient’s walking skills on the prosthesis, diseases or defects of the stump, the level of the patient’s motor activity, the presence of social indications for the use of the prosthesis with increased physical exertion on the lower extremities were taken into account.

Discussion. The unreasonable absence of shock-absorbing modules in the prosthesis does not allow achieving the highest possible level of prosthetics, and the unjustified use of shock-absorbing modules can not only increase the cost of the prosthesis, but also make it heavier, complicate learning to walk on the prosthesis, thereby increasing the risk of injury. On the domestic market, models of shock-absorbing modules are presented that are not inferior to foreign models. At the same time, it is expedient to expand their assortment.

Conclusion. The method of multifactorial formalized calculation of the indicator of expediency of prescribing depreciation modules is intended to facilitate the decision-making by the prosthetist. The choice of the type of module depends on the requirements for the depreciation properties of the prosthesis, taking into account the presence or absence of walking skills on the prosthesis, defects and diseases of the stump, the level of physical activity, the presence of social factors in the use of the prosthesis under increased loads and the level of amputation, which may limit the possibility of placing a certain module design in prosthesis.

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