Bionic Prosthetics: How, Where, When, and How much money?

The stabilization of physical condition within the post-prosthesis period directly depends on the prosthetic process itself, in particular - where, when, and how it can be obtained. Realizing all the specifications of this issue independently is extremely difficult, so it is necessary to navigate people through resources that can be helpful.

 What types of prosthetics are there?
Upper or lower limb prosthetics can be provided to anyone with any type of injury. First, it's important to understand which type of prosthesis suits you best. Therefore, prosthetics can be categorized based on different indicators. For instance, by purpose, functional prosthetics (partially replacing the function of the lost limb) and cosmetic prosthetics (shells, replicating the appearance of the lost limb in some way; allowing walking but not running; performing basic hand actions such as holding a spoon) are distinguished.

In total there are 4 types of functional arm prosthetics - mechanical or cable-driven; bionic or myoelectric; hybrid (combined) and special prosthetics for specific activities.

Myoelectric (bionic) prosthetics allow people to regain the functions of the lost limb as they utilize the voltage of surviving muscles, and this effort is transmitted from sensors to servo drives, which move the fingers or bend the prosthesis at the joint part. Moreover, it's not just mechanical tension that is read from the muscles, but an electrical impulse transmitted from the brain to the muscles. Eventually, prosthetics connected directly to the brain, responding to its signals bypassing the muscles, have recently emerged. However, it's important to understand the condition of the innervation of the stump. If it's lost - unfortunately, the bionic one may not work.

Such prosthetics are created individually every time: the socket to which the bionic arm or leg is attached must perfectly fit in shape and size. Sometimes, several models have to be made, and weeks go by for training and rehabilitation.

On average, the lifespan of a bionic prosthesis is 4-5 years. It can be extended through careful use. However, there is a risk that the prosthesis may become outdated. Manufacturers provide a 2-year warranty, and each subsequent one can be purchased additionally.

Sports leg prosthetics for various sports

Limb loss does not exclude sports activities. It's worth noting that the possibilities of runners with specialized running prosthetics are even expanding! Comparing the results of runners at the Olympic and Paralympic Games, researchers have concluded that specialized modern sports leg prosthetics with a special foot construction and hinge joint can even improve the performance of professional athletes.

Sports prosthetics are made individually, taking into account the specifics of the stump, the physiology and anatomy of the patient, their lifestyle - for sports prosthetics, the type of sport and the load are considered. There are such types of sport prosthetics: for running, jumping, cycling, for team ball games - football, volleyball, etc., for skiing, mountaineering, weightlifting, for martial arts, fencing, etc.

Modern carbon polymers and lightweight alloys serve as materials for making sports prosthetics, making the products very lightweight and strong, able to withstand impacts and dynamic loads that occur during sports activities. A material with an increased friction coefficient is applied at the junction of the prosthesis with the surface - for different sports, it can be different.

When can a prosthesis be fitted?

Nowadays, technologies allow fitting a prosthesis 2-4 weeks after amputation. During this time, the stump is prepared for prosthetics. It can be fitted even several years after amputation, but the pivotal role plays the importance of exclusion of muscle atrophy, and this depends on the quality of rehabilitation, which can be undergone in private or charitable rehabilitation centers (for instance, Superhumans Center in Lviv).

How much does a limb prosthesis cost?

The price depends on the type of prosthesis itself, its equipment, the activity level of the lifestyle, and the patient's or client's preferences. Someone may want a more complex prosthesis, someone may need to add specific components, so it will be more expensive accordingly. Amputation at the ankle, thigh, or forearm level requires different prosthetics, and they also cost differently. For instance, in one case, you may need to pay 23 thousand UAH, and in another - 220 thousand UAH.

In general, the cost of prosthetics is covered by the state (through the Social Protection Fund for Persons with Disabilities, which pays for prosthetics for people who have lost limbs. It pays for the prosthesis to the prosthetic enterprise, which later issues the prosthesis to the customer). The maximum reimbursement amount for a prosthesis is 2 million UAH. It can be both common mechanical and quite expensive bionic prosthesis. Firstly, a person is provided with a simpler prosthesis (according to Cabinet of Ministers Resolution No. 321), but within a year, he can reapply for prosthetics and receive a more expensive and complex model if there is a need for it. Sometimes the allocated funds are not enough. This issue takes place, if the injury is very complex or the patient's desires do not coincide with what is offered. Then you will have to look for money or co-finance yourself.

What documents should be submitted to get a prosthesis for free?

At the Civil Service Center or through the electronic account of a person with disabilities, the following documents must be submitted:

- application for prosthetic provision (application examples depending on the type of prosthesis);
- a certificate of injury circumstances from the commander of the military unit (for military personnel);
- conclusion of the Military Medical Commission (for military personnel) or the Medical Advisory Commission (for civilians);
- passport;
- identification code;
- certificate of combatant (for military personnel).

The decision to approve the application will be sent through the electronic account or issued as an electronic referral through the Civil Service Center. As soon as the person receives it, he can contact the company that manufactures prosthetics.

Vadym Svyrydenko

The Ambassador of the KOLO Charitable Foundation notes:

"Prosthetics procedure in Ukraine is governed by two resolutions: No. 321, which is the main one, and No. 518 (prosthetics within a year due to more advanced technologies). Currently, these resolutions are undergoing revision, so we are expecting innovations. According to the current resolutions No. 321 and No. 518: any prosthetics are carried out at state expense. However, there are certain nuances, particularly regarding queue formation. That is, where to get a prosthesis is a question because most establishments deal with prosthetics of lower limbs, consequently, prosthetics of upper limbs are carried out by fewer enterprises. Moreover, there are prosthetic enterprises that have better experience in certain cases. If we consider high-level arm amputations, these are Lviv (Oksana Lytvynenko), Kyiv (Iryna Tkach), and there are also specialists in Poltava. The list of prosthetic enterprises is available on the website of the Ministry of Social Policy in the form of a map".

The regulatory acts governing prosthetics in Ukraine are:

- Resolution of the Cabinet of Ministers of Ukraine dated April 5, 2012, No. 321 "On Approval of the Procedure for Providing Technical and Other Means of Rehabilitation to Persons with Disabilities, Children with Disabilities, and Other Separate Categories of the Population, and Payment of Cash Compensation for Independently Purchased Technical and Other Means of Rehabilitation, their List" (as amended by the Resolution of the Cabinet of Ministers of Ukraine dated April 12, 2022, No. 454);
- Resolution of the Cabinet of Ministers of Ukraine dated October 1, 2014, No. 518 "Some Issues of Prosthetics and Orthotics with Products of Increased Functionality Using Advanced Technologies and Manufacturing Technologies Absent in Ukraine, and/or Special Products for Sports for Certain Categories of Citizens Who Have Lost Limb or Limb Functionality" (as amended by the Resolution of the Cabinet of Ministers of Ukraine dated April 12, 2022, No. 454);
- Joint Order of the Ministry of Social Policy of Ukraine and the Ministry of Health of Ukraine dated November 20, 2020, No. 774/2691 "On Approval of the List of Diagnoses According to the Name of Technical and Other Means of Rehabilitation in Accordance with the International Statistical Classification of Diseases and Related Health Problems, registered with the Ministry of Justice of Ukraine on January 18, 2021, No. 74/35696;
- Order of the Ministry of Social Policy of Ukraine dated March 17, 2021, No. 134 "On Approval of the Procedure for Prescribing Technical Means of Rehabilitation According to the Functional Capabilities of Persons with Disabilities, Children with Disabilities, and Those Affected by the Antiterrorist Operation" (as amended by the Order of the Ministry of Social Policy of Ukraine dated June 29, 2021, No. 358), registered with the Ministry of Justice of Ukraine on April 1, 2021, No. 429/36051.

Useful resources providing information on prosthetics possibilities in Ukraine:

- Ministry of Social Policy;
- Protez Hub - a team of people who have been working on the development of the prosthetics and orthotics industry at the state level since 2014 and implementing systemic changes to improve the quality of services in all areas;
- U+ Center (U+ Help program was created in spring 2022 and is being developed in response to the consequences of military actions);
- SuperHumans (all-Ukrainian modern center for prosthetics, reconstructive surgery, rehabilitation, and psychological support for adults and children affected by war. Application form for participation in the prosthetics program);
- Esper Bionic (a company specializing in the production of bionic prosthetics).