A prosthesis is not a panacea. What you need to know about artificial arms and legs

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A light artificial leg stands next to a couch on which a soldier with an amputee is strengthening his back muscles. Behind him are a dozen more fighters who also diligently perform the exercises of a physical therapist. Crutches are waiting for someone, and a wheelchair for someone. Each of them dreams of getting back on their feet the way they were before the injury. It is not so easy: the loss of a lower limb requires work on balance, strengthening of the muscle corset, banal habits, distribution of weight and load. However, the prosthesis remains a means of adaptation in everyday life. This also applies to hand prostheses – they will never replace tactility and sensations, but they can be useful in everyday life. In general, the number of varieties and configurations of prostheses can be compared to the “stuffing” of a computer. Even key parts can have different power, function and cost. Specialists of the rehabilitation center “Unbroken” (UNBROKEN Ukraine) explained why bionic hands are not a panacea, and why you should not drive a car with a prosthetic leg. The head of prosthetics Nazar Bagniuk and physical therapist Roksolyana Shmylo talked about adaptation to life with new limbs. Multifunctional hook First of all, prosthetist Nazar Bagniuk says that it is impossible to compare your hand with a prosthetic (even bionic) hand. “With our hands, we perform many functions that we do not think about. For example, about tactile, preceptive (that is, when communicating), we know in which position it is, etc. But the prosthesis does not have sensitivity. Therefore, it must be constantly controlled by sight. Therefore, the prosthesis is auxiliary a tool that helps a person in everyday life. At the same time, the functionality depends on the person, his ingenuity and ability to adapt,” he says. Nazar in the workshop where prostheses are made. Photo: “Unbreakable” The prosthetist explains with an example: there is a patient with a mechanical prosthesis whose main attachment is a hook. This man learned to hold a carrot with that hook, and to peel it with his good hand. “It should be remembered that there are no limits to the adaptation of the human body. And it depends more on imagination and on how the patient will perceive the “device”, – notes Nazar Boroznyuk. According to the expert, the most functional in everyday life and the economy is a hook on a mechanical prosthesis “Cosmetically, it does not look very good, but functionally it covers many needs. You can use it to open the latch without even using it. You can also hold, lift, hook something. He is not afraid of anything at all – neither moisture, nor dirt, nor sharp or heavy objects. You can even hit it with a hammer – and nothing will happen,” the prosthetist lists the advantages. The design of the mechanical prosthesis is a system of cables and levers. It is worn on the back and shoulders. A special loop goes through the opposite shoulder, so when a person extends his arm, he ” opens” thanks to the tension of the cable. Training in the rehabilitation center “The worst thing that can happen in a mechanical prosthesis is a break in the cable. In this case, a person will not be able to open it with his body, but it will be possible to do it with the other hand,” explains the prosthetist of the Nezlamni center. In addition, in addition to the hook, other attachments for the mechanical prosthesis can be made. In the doctor’s practice, there have already been patients who have turned to to blacksmiths and made the necessary “holders”, specific hooks for work. The bionic hand is not a “magic pill” Bionic hand prostheses are now very popular, and patients often consider them a panacea. However, prosthetist Nazar notes that patients ignore the disadvantages of myoeloelectric prostheses . The bionic hand has 5 motors, a number of sensors, various tractions and “brains”, that is, certain algorithms of movements in a small “on-board” computer. “The design is quite “fragile”, fragile and requires careful handling. I remind you that a person does not have the sensation of a prosthesis, so it is possible to accidentally hit a surface or “bend” your fingers with it,” explains Nazar. In addition, this device is capricious: it is afraid of moisture, dirt, it can discharge or break. Then it will come out out of order. Bionic hand Physical therapist Roksolyana Shmylo adds that with a bionic prosthesis it is forbidden to lift heavy objects and push off. It is interesting that there is a whole “dimensional grid” of brushes – both for women and for men, and the rubber coating is selected individually – according to the color of the skin . This glove protects the prosthesis from external hazards, but does not guarantee 100% protection of the electronics. In addition, the bionic prosthesis is not suitable for everyone. It depends on many factors, including the condition of the muscles in the injured limb. Contraindications are neurological diseases or the inability to develop myoelectric impulse (that is, when the flexor or extensor muscles are damaged).It is also worth considering the cost of a bionic prosthesis – one such hand costs approximately one and a half million hryvnias. The rehabilitation center collects 50 such hands, but they are only given to patients who need this solution. Read also: Happiness is to have a hand again. Military about injury, amputation and electrical prosthesis Adaptation to walking on a prosthesis A leg prosthesis compensates for the main lost function – it restores a person’s mobility. “The disability of a person without a leg is much greater, because he cannot move. This applies to moving around the apartment, to the toilet, on the street, going to the store. Constantly moving around on crutches is not an option,” says prosthetist Nazar. Each patient gets used to his prosthesis individually. “There are people from whom you don’t even expect that they can be quickly adapted, and he just takes a prosthesis, gets up and goes. For example, I had a 72-year-old patient. He came in a wheelchair, because he did not have the strength to lean on crutches. But as soon as a prosthesis was made for him, he put a stump in the prosthesis, stood up and walked. Without help – neither crutches, nor a stick, nor a walker,” the specialist recalls. The patient on crutches adapts to the prosthesis. The main criteria for adaptation are the patient’s comfort. “It is important that nothing presses, does not rub. And also – that the patient learns to distribute the load 50 by 50 between the two limbs. A positive dynamic is when, conditionally, the patient starts walking with a walker, switches to crutches, then to inverted crutches, so that to have a smaller point of support. Soon he will walk without them, and we will be able to discharge him home,” says physical therapist Roksolyana. You can even learn to walk on a prosthesis without being noticed by outsiders. It depends on three components: the level of amputation, the competence of the prosthetist and physical therapist, and the patient’s desire. “If the prosthesis is made incorrectly or the length of the limb is incorrect, then a deformation occurs in the back muscles, and the person constantly tilts to one side. Because of this, the patient cannot control the movement of bending and extending the knee,” explains the physical therapist. Physical exercises are an integral part of recovery Reasons for discomfort Prosthetist Nazar adds that the adaptation process can be complicated by scars, burns, neuromas (a small tumor or pathological growth of a nerve) and osteophytes (bone growths). “Usually, the patient’s objective desire is that there is no pressure anywhere. But the surfaces on which the prosthesis “sits” have never had such a load before. That is, the weight of the body was distributed over the entire leg, and the most pressure was on the foot, and now the point the support is a stump,” he explains. Another cause of discomfort is improper adjustment of the load and the prosthesis. “You may not notice it right away. But if a person walks for a while and quickly gets tired, feels significant discomfort, then the biomechanics of movement are probably broken. Then the body compensates for it,” the specialist adds. A patient with a double amputation Patients also sometimes complain about the weight of the prosthesis – as if it is too heavy. “They forget how much their arm or leg weighed. That is, their limb was abruptly cut off, and by the time they are ready for prosthetics, they already forget about this weight. You can draw an analogy with shoes: in winter, we are fine in boots, but in summer they will give out extremely heavy. But it also works in the other direction: when the patient gets used to the prosthesis, without it he feels like he has no leg,” Nazar explains with a smile. Also, the prosthetist emphasizes that once a year you should undergo a diagnosis and “technical examination” by a prosthetist, and once every 3 years you should change the prosthesis (if a double amputation – more often). Read also: “Carry my legs back.” How a 24-year-old military man with a triple amputee learns to live Unobvious inconveniences with a prosthesis Despite the fact that the prosthesis restores the ability to move, experts do not advise playing professional sports with a walking prosthesis. They differ in their structure and biomechanics. However, we can talk about making a sports prosthesis no earlier than after a year of using the classic one. The doctor says it’s like comparing soccer cleats and regular sneakers. You should run after the ball on the field in boots. The same goes for playing sports in a sports prosthesis. Each type of sport has its own type of prostheses or components. “The biomechanical phase of walking and running is very different. In walking there is a bipedal step, that is, when we stand on two legs, but in running there is no such thing. And vice versa: in walking there is no flight phase, but in running it is”, – explains the prosthetist. Restoring the work of muscles Physical therapist Roksolyana notes that it is possible to exercise in the gym with an ordinary prosthesis, if the loads are adequate. In addition, during the manufacture of a prosthesis, doctors always ask about lifestyle and activity level. “If, for example, you put a quadruple knee, then a person will be able to ride a bicycle,” she says. It is better to learn how to fall and get up in the rehabilitator’s office. “For some reason, our patients are afraid to use the practice of falling, but all over the world this is the first thing that is taught to people with amputations. They have to learn to stand up, because the situations are different. For example, if you lock the knee (fix its sitting position) and forget about it, the risk of falling increases. When you have two limbs, you can react to a certain situation faster, but life with a prosthesis makes its own adjustments,” says Roksolyana Shmylo. The physical therapist adds that with a leg prosthesis you cannot raise the limb high, because then the load on the stump increases. And this is almost the only strict restriction in playing sports with a prosthesis. Playing sports with and without prostheses While a person gets used to walking on a prosthesis, he may walk slower than he is used to. But this is only a matter of habit, experts remind. In summer, the body, in particular, the legs, sweat more actively. Therefore, condensed sweat can accumulate in silicone liners and stump receivers. It is worth pouring it out and wiping the surface and the limb. Roksolyana also emphasizes that with a prosthetic leg, regardless of the level of amputation, it is extremely dangerous to drive a car with mechanics. “The mechanical leg has no sensitivity. At the moment when it is necessary to brake or move, a person cannot always react correctly. Therefore, we advise you to switch the car to manual steering for the sake of safety,” she explains. Viktoriya Andreeva, UP.Zhyttia Read also: “Kesha” prosthesis instead of an amputated leg. How in Ukraine, for the first time, a child who lost a limb in the war is being given prosthetics

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