Disability in transfemoral amputation

Admission to the intensive care unit after endoprosthesis occurs when there is moderate or severe impairment of motor function, leading to limitation of the patient's activities of daily living (LSD)

How to get a disability certificate in 2023: features of registration and requirements for the patient

If you are partially or completely disabled, you can legally receive various types of assistance. However, before you can do this, you must confirm your special status. Today you will find out how this works and what you need to pay attention to.

The concept of disability

The suffering must be caused by an acquired or congenital injury, illness or impairment.

Who is entitled to disability

A permanent impairment does not always mean that a person is disabled. This certificate is only valid for people who are unable to live and work normally and require social and other support.

It is possible to obtain disability based on a medico-social assessment, during which the potentially disabled person provides a package of documents and a referral from a doctor or the social security authority.

The question of whether a person is the result of a radiation disaster or a man-made one:

– Radiation or a man-made disaster is disabled.

In addition, other disabilities acquired throughout life are also taken into account. In any case, people with disabilities are entitled to services that enable them to socialize, rehabilitate and live better.

Criteria for disability

To determine the degree of disability, one must contact the MSE office. The experts take into account the following criteria:

– the way in which the illness affects your social activities;

– the level of need for social security and public assistance;

– the presence of secondary illnesses and the loss of the ability to work in general.

If at least several items on the list are identified, a certificate will be issued.

Important! In addition to your state of health, the doctor will also take into account your living situation and other important aspects.

Categories of disability

The intensive care unit determines the existing limitations and also determines the degree of disability. The latter is used to determine the degree of disability.:

Categories of disabilities

It is customary to divide disabilities into the following categories: impairment of statodynamic (motor), circulatory, respiratory, digestive, excretory, metabolic and energetic, and endocrine functions.

It can also include physical problems (when arms, legs and spine are not healthy), sensory problems (lack or absence of the senses of sight, hearing, smell and touch). It can also include mental disabilities related to perception, memory, attention, thinking, will, feelings, intelligence, etc.

First degree of disability

Persons with at least a mild to severe or permanent total disability can be awarded a first degree physical disability. These people require constant care and special support. This usually applies to seriously ill people such as terminal cancer patients, people who are completely paralyzed and people with amputated limbs.

People with congenital or acquired blindness, deafness or dementia are also included in disability group I. This group of disabled people also includes people who are completely unable to move independently, orientate themselves in space, communicate and control themselves.

As a rule, they are not employable. However, in some cases, Group 1 disabled people are able to perform certain work, although they require constant care. For example, completely blind or deaf people can work under special conditions, e.g. B. in button production.

– Severe malignant tumors with metastasis, decay and other effects;

– Missing one leg (at hip level) and one arm (at shoulder level);

– Persistent mental problems, be it oligophrenia, schizophrenia, idiocy or mental retardation;

– Evolving forms of CNS abnormalities in which speech, movement, coordination, etc. are impaired;

– Loss of ability to see the world, in which one cannot cope without help.

– The vision of both eyes cannot be restored, that is, there is complete blindness;

– Absence of legs up to 1/3 of the thigh or more;

– a progressive disease of the central nervous system with pronounced and irreversible impairments of speech, vision, movement, etc.);

– Respiratory failure (Stage 3) due to abnormalities of the respiratory system;

– There is a mental disorder lasting more than a year, associated with frequent epileptic symptoms and dementia;

How long is the waiting time for medical care?

Citizens receive medical care in three forms - planned, emergency and urgent.

The urgent form provides medical care for sudden acute illnesses, conditions and exacerbations of chronic diseases that are life-threatening to the patient. Emergency medical care is provided to the citizen by the medical institution and health professionals promptly and free of charge. Refusal is not permitted.

The emergency form provides medical assistance in the event of sudden, acute illnesses, conditions and exacerbations of chronic diseases without clear signs of danger to the patient's life.

The planned form provides medical assistance in the field of prevention, for diseases and conditions that are not life-threatening for the patient, do not require urgent and urgent medical treatment and the postponement of which for a certain period of time does not cause an aggravation of the patient's condition or a threat to his life or would mean to his health.

Depending on these forms, the Government of the Russian Federation sets maximum waiting times for medical assistance.

For example, the waiting time for the provision of primary health care services in emergencies cannot exceed 2 hours from the moment the patient reports to the health facility.

Waiting times for the provision of elective healthcare services for:

• Waiting times for admission by district doctors, doctors General practitioners (family doctors) General practitioners (family doctors)The waiting time for the provision of scheduled medical services by general practitioners (family doctors) and district pediatricians should not exceed 24 hours from the moment the patient is called to the health facility;
• Consultations with specialists should not exceed 14 calendar days from the moment the patient visits the healthcare facility.
• Diagnostic instrumental examinations (X-rays, including mammography) Functional diagnosticsThe duration of instrumental diagnostic examinations (X-ray, including mammography, functional diagnostics, ultrasound) and laboratory studies in primary care should not exceed 14 calendar days from the date of prescription;
• Computed tomography (including single photon emission computed tomography), magnetic resonance imaging and angiography should not exceed 30 calendar days in primary care and 14 calendar days in cancer patients from the date of prescription;
• The duration of specialist medical services, with the exception of emergency services, may not exceed 30 calendar days from the date of the regulation. by the attending physician Referral for hospitalization and, for cancer patients, 14 calendar days from the day of diagnosis.

What you don't have to pay for

According to the legislation of the Russian Federation in the field of public health, the following services when providing medical assistance under the program and territorial programs are not payable at the expense of citizens

• provision of medical services;
• Prescribing and administering medicines in inpatient hospital conditions day clinicIn emergencies and urgent cases, medicines for medical indications:

(a) which are included in the list of essential and essential medicines;

(b) which are not included in the list of essential and vital medicines if they need to be replaced due to individual intolerance or for vital indications;

• Prescription and use of medical devices, blood components Blood componentsTherapeutic nutrition, including the use of specialty therapeutic foods for medical indications;
• Accommodation in small departments (cabins) for patients with medical and/or epidemiological indications;
• Inpatient services, including room and board, for children under 4 years of age if a parent, other family member or other legal representative visits the health facility together, and for a child over this age if there is a medical indication;
• Transport services if the service provider accompanies an inpatient patient in cases where diagnostic tests are required and these tests cannot be carried out by the service provider themselves.

Who is entitled to payments

Persons who are eligible are: have officially confirmed their disability. To do this, you need to go to a medical institution and get a certificate from the commission that your health has deteriorated and not improved.

In the Russian Federation there are several categories of disability depending on the state of health:

• Group I A person is unable to support himself and is often rely on the help of third partiesA person can get lost in space and have no control over their own actions.
• Group II. Able to work with the help of aids. Able to move independently and maintain spatial orientation.
• Group III. Major illness . can carry out the activities of the profession to true requirements.
• Children with disabilities. General category including. Children who are not yet of age..

Apply for an MIS card to receive the aid.

Flat-rate allowance for the disabled.

This service is granted once. The support can be granted not only in cash, but also in kind. It is up to the individual to decide how they would like to receive the benefit.

When it comes to the consideration of benefits in kind, the following aspects should be taken into account

• public transportation;
• annual visit to a sanatorium;
• a package of social benefits;
• dental services; Dentures every 5 years.

The amount of the cash benefit depends on the type of category granted:

• Group I -. 3897 rubles;
• Group II -. 2 783 rubles;
• Group III -. 2,228 rubles;
• Children with disabilities -. 2,783 rubles.

To receive this type of support, the following documents must be submitted

• Application;
• documents proving identity;
• a copy of proof of disability;
• a copy of the insurance certificate.

If the documents are to be submitted by an authorized person, proof of identity and a notarized power of attorney are also required.

Sections of the individual program

Providing technical aids to a disabled person

Disabled Russian citizens who find themselves in a difficult financial situation can receive hygiene and rehabilitation measures free of charge. At the time of submitting an application, the commission determines a list of necessary items and medicines.

It is important to read the Commission's report to understand how much support you can expect. During the registration process, make sure your doctors have included everything you need in the IPR. The committee may not consider important things like a denture bath or repairing rehabilitation equipment. You will have to wait about a week or even a month for your IPR to be reissued.

• crutches, walking aids;
• wheelchairs, strollers;
• Prostheses of all kinds;
• shower and bathing facilities;
• Personal hygiene items, etc.

Medical rehabilitation

Medical intervention includes rehabilitation measures to improve health. A complex of therapeutic measures is prescribed. Convalescence in a sanatorium is possible. To obtain a stay in a sanatorium, the commission's doctors must note this in the rehabilitation certificate.

For amputee patients, the need for prostheses and the adaptation of orthopedic structures is taken into account. A bespoke reconstructive surgery service is available.

Vocational rehabilitation

After an acquired disability, the person affected in most cases loses their job. In order to recover, the person must obtain a job to support themselves. The person is offered a job due to their disability:

How do you receive rehabilitation funds under the IPR?

To receive rehabilitation funds, you must:

1. Submit an application for technical aids to the Social Security Fund.
2. Complete a form issued by a fund employee.
3. Enclose your passport and IPR with the application.
4. Within two weeks, the committee will make a decision so that the citizen receives everything he needs. If the result is positive, the person will be added to the register to obtain the necessary goods.

You will receive notification of the positive or negative decision in the form of a notification by post.

Applying for a prosthesis from the social and insurance fund

After submitting your individual rehabilitation program, you can apply to the Welfare Fund for a free leg prosthesis. You then choose the type of compensation (offer or cash benefit) and apply for the necessary documents.

The person affected can decide for themselves in which form they would like to receive the compensation: to a bank account or by postal order.

An important note: If you purchased an item that is not recommended by the IPR, the state is not obliged to reimburse the cost. Only goods that are on the federal list and provided for in the developed rehabilitation program are issued free of charge.

Development of an individual rehabilitation program (IPR)

An IPR is a set of measures aimed at rehabilitating a citizen with a disability. It is issued by a center of medical and social expertise after assessing the patient's ability to cope with the situation. The IPR includes all facilities and services that contribute to the normalization of the life of a disabled person. It is important to know that the rehabilitation program must include the repair of a hip prosthesis or other limb prosthesis and cover the costs.

An amputee must be provided with four types of prostheses free of charge: active, functional, with an external power unit, cosmetic.

Can a diabetic with a leg amputation above the knee receive a first degree of disability?

Hello, my grandmother is in the final stages of diabetes and as a result already has a leg amputation above the knee, 10% vision and high blood pressure. She has a 2nd degree disability. Please let me know if there is any basis for a Grade 1?

Good morning!!! The question about that
The question of the degree of disability is decided by the intensive care unit. organization
the State Medical and Social Examination Service, which is part of the system of
of social protection of the population of the Russian Federation is carried out by the Federal
Law of the Russian Federation on social protection of people with disabilities in the Russian Federation
This service is responsible, among other things, for the social protection of people with disabilities in the Russian Federation.

The service is responsible, among other things,
the determination of the group of disabilities, their causes, their duration and when they arose
Disability and the needs of people with disabilities for various forms of social protection;
Development of individual rehabilitation programs for people with disabilities; Exploring the extent and the
causes of disability in the population; and participation in the development of comprehensive programs for
prevention of disabilities, medical and social rehabilitation and social protection of people with disabilities
The Commission shall develop a program for disability prevention, medical and social rehabilitation and social protection of persons with disabilities, etc. in accordance with the adopted criteria.

Based on these criteria.
The respective medical facility is recommended for referral. Processing of applications
Treatment of citizens is free.

What type of disability applies to my brother?

My 27-year-old brother had his left arm amputated up to the elbow after an accident at work (27,000 volts).

His left arm was amputated up to the elbow. What pension is he entitled to?

Helenka, good morning! Disability is determined on the basis of a medical examination. To do this, you must undergo a medical-social assessment (MSE) at the MSE office; You can receive a referral either from a medical facility or from the social welfare office.

If you refuse the transfer to the MSE, you will receive a certificate on the basis of which you can submit the documents to the MSE yourself. After the examination you will receive a confirmation document.

When the leg is amputated above the knee

Modern methods of treating diabetes avoid many negative consequences and complications.

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However, in medical practice there are cases when severe vascular damage to the lower extremity occurs due to negligence of doctors, irresponsibility towards one's own health or incorrect therapy technique.

Patients with type 1 diabetes are treated surgically and must have their leg amputated above the knee if they have the following symptoms

• Diabetic drip that has spread beyond the foot, when there is tissue damage in the lower leg up to the knee joint,
• Gangrene grade 3-4 with incipient necrosis of at least 50 % of the lower extremity,
• Blockage of the smallest capillary blood vessels by sugar crystals, which has spread to most of the leg,
• Infection of the leg tissue in the area of the lower leg or knee joint, which occurred as a result of mechanical trauma and poor wound healing, as well as high blood sugar levels,
• Thromboembolism in the large blood vessels, which occurs in diabetics who lead a sedentary lifestyle, sitting or standing a lot.

If therapy is initiated quickly and there are no signs of extensive necrotic process, the lower extremity can be saved or amputation below the knee joint can be performed. This is a very important aspect for the patient's subsequent rehabilitation and for choosing a high-quality prosthesis.

Disabled people group

After amputation of the lower limbs, a diabetic is entitled to a disability pension. Immediately after the operation and wound healing, the patient is examined by a medical commission, which determines the damage to health and draws up a report indicating the degree of damage. This document entitles the patient to receive a disability pension.

For the first 6 months, during which the patient is unable to move independently and undergoes rehabilitation measures, he is granted a group 2 disability pension. Once the surgical suture has completely healed, the patient has assimilated the prosthesis and begins to move independently without crutches or a wheelchair, the patient is re-evaluated by a doctor and recognized as Group 3 disability without the need for re-evaluation.

Disability during DOA and after arthroplasty

In medical forums on the Internet you can find many indignant letters that sound something like this:

My mother, a nurse at City Hospital No. 2, had knee replacement surgery a year ago. Since then she has been in constant pain, especially before a change in the weather her leg hurts. She can no longer bend her knee like she used to, and she can no longer walk. She reported to the intensive care unit, but she was not allowed a group after the operation…. And why?

To understand this, we should analyze the principle of disability for the diagnosis of OA.

The following problems may be considered reasons for a disability diagnosis:

• deforming inflammation of both hip or knee joints at least in stage II and moderate impairment of joint function
• Stage III DOA of one or more joints (hip, knee, ankle, shoulder, elbow, wrist), with ankylosis or shortening of the limb
• Bilateral arthroplasty, which leads to significant impairment of joint function

Arthroplasty alone does not constitute a basis for a disability decision. On the contrary, surgery can be recommended in the later stages of DOA as a treatment for osteoarthritis and as a way to alleviate multiple disabilities (OWD)

The person agrees to the operation because he does not want to be disabled but, on the contrary, wants to avoid disability.

The situation is different if the joint replacement is not successful, for whatever reason:

• The quality of the prosthesis is poor.
• The surgeon did not perform computer navigation and the geometric dimensions of the prosthesis were incorrectly selected.
• The patient did not receive rehabilitation after surgery or the rehabilitation was not as good as it should have been.

A referral to the intensive care unit after an endoprosthesis occurs if there is a moderate to severe mobility restriction that results in a limitation of the patient's ability to function (LSD)

Medical and social assessment of deforming arthritis

Post-traumatic arthritis is considered the most disabling osteoarthritis because it is characterized by the following features, among others

• the most pronounced functional disorders (contractures, restricted movement, shortening of the limbs, muscle loss)
• Increased frequency of exacerbations
• Speed of disease progression

The following assessment criteria are required for the OST:

1. Radiological diagnosis according to Kosinski
2. Functional Diagnosis
3. Determination of the degree of statodynamic function (SDF)
4. Determination of the degree of moderate progression of DOA:
   • How quickly the disease progresses
   • How often do relapses occur?
   • What complications does the disease cause?

Radiological diagnostics in the intensive care unit

The diagnostics used in medical and social assessment differ from the usual diagnostic methods of modern medicine:

• For example, the degrees of osteoarthritis in orthopedic medicine are classified according to the Leuquesne classification, which distinguishes between four different degrees of osteoarthritis.
• Only the Kosinski classification (three grades) defines the degrees of osteoarthritis in the ITU

The Leuquesne third degree may coincide with the Kosinski second degree, which can be controversial.

Degrees of DOA according to Kosinski

• Restriction of the joint in certain directions
• Harsh, cracking noise when moving
• Joint two to three times narrower than normal.
• Moderate muscle atrophy
• Large osteophytes
• Signs of osteosclerosis and cystic defects in the subchondral bone epiphysis

Learning to walk with a prosthesis (walking school)

Learning to walk with a prosthesis (walking school): In this phase of rehabilitation, the prosthesis is made and the patient is actively introduced to walking.

After fitting the prosthesis, frequent skin checks of the stump enable defects and problems in the stump joint socket to be quickly corrected and prevent skin damage. Skin checks are carried out more frequently in the beginning and can also be carried out by the prosthesis wearer after each long period of wearing the prosthesis. The reason for this is the increased sensitivity and vulnerability of the skin on the stump, as the skin in the thigh or shin area is generally not adapted to high static loads.

Initially, a check may be necessary every 10-15 minutes or after one or two periods of wearing the prosthesis. If both the patient and the medical staff (prosthetic technician) are satisfied with the prosthetic socket, the frequency of skin inspection of the residual limb can be reduced. Monitoring the preserved stump is also necessary and should become a daily, lifelong practice to avoid complications resulting from the increased stress of walking.

When learning to walk on a tibial prosthesis, special techniques are taught to contract the calf muscle during the transfer phase of the prosthesis and to relax it during support on the prosthetic stump.

In addition, the flexion contraction of the knee joint is practiced when supported on the prosthesis. The contraction of the calf muscle during the transfer phase helps to properly hold the prosthesis on the stump, and the relaxation during the support phase improves the blood supply to the stump. When training to walk with a tibial prosthesis, there is no separation of phases like when training to walk with a hip prosthesis. During the first training session, depending on age and physical condition, the patient can learn to stand and walk on the tibial prosthesis as the knee joint is preserved. This gives more stability and confidence and makes learning to walk on a prosthesis easier and quicker. Learning to walk on a tibial prosthesis is possible within a few days [Dr. SF Kurdybaylo, Dr. KK Shcherbina].

Incorporation

Integration of the amputee into society: communication with the family, restoration of his role in society, restoration of emotional balance, development of strategies for a healthy lifestyle, leisure activities and hobbies, etc.

Vocational rehabilitation: assessment and vocational retraining, assessment of further educational needs or change in working conditions.

For safety reasons, there may be restrictions on activity when the patient returns to work. Examples of this include the following restrictions: walking without support with crutches or a cane; climbing over 1.2 meters; Lifting or carrying loads weighing more than 16 kg when walking with a lower leg prosthesis, or 10 kg when walking with a hip prosthesis; and working in moving vehicles or on uneven surfaces in the workplace.

For some amputees, activities that require crawling, running, or jumping may not be desirable and switching to another activity should be considered if possible.

• Orthopedic footwear under IPR.
• prosthetic legs.
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• prosthetic leg.
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• Manufacture of lower limb prostheses.
• Modern leg prostheses.