Service Process Guidelines

Preparation of the opinion 

1. Accurately describe the person's daily mobility method, indicating which assistive device the person is able to use.
2.  Indicate possible risks associated with the use of the prosthesis.

Possible risks (examples)

• Hand function impairments that affect the safe use of the assistive device for mobility.
• The person's inability to stand on one leg and move with the assistive device (in the case of unilateral amputation).
• Cognitive function impairments – the person must be communicative and able to follow the specialist's instructions.
  Necessary documents
  Any available medical information that may help the client make the most optimal decision.

Preparation of the client for in-depth functional assessment

• It is recommended to consult the person before the functional assessment regarding preparation for prosthetics – promoting mobility and compression therapy for the amputation stump.
• If the person is already using a prosthesis, it should be brought to the functional assessment.

Brief description of the functional assessment

• During the functional assessment, specialists evaluate mobility skills (changing positions, walking, etc.). In the case of unilateral amputation, it is preferable to walk at least 10 m with the assistive device.
• The compliance of the soft tissues of the amputation stump for prosthetics is assessed, compression therapy (bandaging) is performed, and recommendations are provided. It is advisable to bring an elastic bandage.

Methodological materials

• Recommendations after amputation
• Bandaging of the amputation stump (above the knee)
• Recommendations for children after amputation

1. Describe the deformities of body structures (bones, joints, ligaments, etc.).
2. Describe the functional impairments (muscle strength, range of motion in joints, gait characteristics, etc.) for which the use of technical aids is planned to reduce or compensate.
3. Clearly specify the goals of using technical aids (e.g., pain relief, slowing the progression of deformities, stabilizing gait).

Possible risks (examples)

• Tissue trophic and sensory disorders – increased risk of pressure sores and skin damage or wound formation.
• Behavioral disorders and tendencies towards self-harm – risk of inappropriate use of technical aids or causing harm to oneself.

Required documents

• Available medical information (doctor's conclusions, discharge summaries, examination results, etc.).
  Preparation of the client for a detailed functional assessment
• Ensure that the client can demonstrate functioning in conditions close to daily life during the functional assessment (e.g., usual shoes, orthoses, if already in use).

Brief description of the functional assessment

• During the functional assessment, specialists evaluate the person's functioning (muscle strength, range of motion in joints, gait, etc.), paying special attention to the necessary assistive devices.
• Deformities of body structures are evaluated using measurements and examinations.

Methodological materials

Methodological materials for prescribing orthopedic shoes

1. Accurately describe the person's functional impairments for which it is recommended to use technical aids.
2. Indicate potential risks associated with the use of technical aids.

Possible risks (examples)

• Epileptic seizures – indicate the frequency and type of seizures.
• Visual impairments – vision correction with appropriate glasses must be performed before the functional assessment.
• Language comprehension disorders (e.g., sensory aphasia).
• Mental function disorders – the person must be able to communicate and follow the specialist's instructions.

Required documents

• Available medical information (doctor's conclusions, extracts, examination results, etc.).
• The person applying for the electric scooter or electric wheelchair must bring completed self-assessment questionnaires.

Client preparation for in-depth functional assessment

• Ensure that the person can participate in practical technical aid trials during the functional assessment.

Brief description of the functional assessment

• A test ride with an electric wheelchair or scooter is mandatory during the functional assessment.
• Based on the results of the test ride and information about environmental conditions, the functional assessment specialists provide an opinion on the allocation of technical aids, postponement (if training, environmental adaptation, or additional documents are needed), or refusal.

Preparation of the opinion

1. Accurately describe the difficulties in maintaining a sitting posture, spinal and joint deformities.
2.  In the case of a car seat – describe the ability to maintain the torso and head, as well as justify why a standard child car seat is not safe.

Possible risks (examples)

• Due to prolonged forced posture, self-correction of sitting posture is not possible.
• A thigh abductor built into the seating system may affect transfer activities.

Required documents

• Any available medical information.

Preparation of the client for an in-depth functional assessment

• Ensure that the person can demonstrate the maintenance of sitting posture during the PFN.

Brief description of the functional assessment

• During the PFN, specialists assess the person's spinal and joint deformities, ability to maintain a sitting position, and mobility skills.

1. Accurately describe the person's daily communication methods
2. Indicate potential risks associated with the use of assistive devices for alternative communication (AKTPL).

Potential risks (examples)

AKTPL with hand control:
   • Fine motor skill impairments affecting the use of buttons or touch screens.
   • Cognitive function impairments – the person must be able to engage and follow the specialist's instructions.

AKTPL with gaze control:
   • Eye fixation impairments – the person cannot fixate their gaze on a single point for at least 5 seconds.
   • Cognitive function impairments – the person must be able to engage and follow the specialist's instructions.

Required documents
   • Any available medical information.
   • It is preferable to include examinations for vision and hearing impairments, if conducted.
   • The person must bring completed self-assessment questionnaires – link to forms

Client preparation for in-depth functional assessment
   • If a personal computer or tablet is needed for AKTPL use, please do not purchase the device before the functional assessment (PFN).
   • FNL specialists will provide consultation and recommendations on the most suitable technology in person.

Brief description of the functional assessment
   • During the PFN, specialists evaluate the person's ability to recognize images, fine motor skills, communication skills, etc.
   • Appropriate alternative communication devices are mandatory to be tested.

PFN is performed for upper and lower limb prostheses, orthoses and orthopedic shoes, mobility assistive devices (electric scooters, wheelchairs), seating systems, and adapted children's car seats, as well as alternative communication technical aids (AKTPL).

PFN is required in cases where the compliance of technical aids with a person's functional abilities and daily needs is assessed, especially in cases of assigning more complex assistive device groups.

PFN is performed for upper and lower limb prostheses, orthoses and orthopedic shoes, mobility assistive devices (electric scooters, wheelchairs), seating systems and adapted children's car seats, as well as alternative communication technical aids (AKTPL).

The report must describe the person's functional impairments, the performance of daily activities, the intended purpose of the assistive device usage, and the possible risks associated with the use of the specific assistive device.

The person's communication skills, fine motor skills, visual and auditory functions, eye fixation abilities (in the case of gaze control), and the state of mental functions are evaluated.

In the PFN process, FNL specialists use data from state and institutional systems, including e-health, Datamed, and NRC “Vaivari” information systems.