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Purpose: to develop the capability of effective provision of prosthetics and orthotics to the citizens of the Republic of Georgia and the Caucasus Region. Such capability will require improvements in facilities, equipment, design, and personnel structure.
Goals:
Self-sufficient production of prostheses and orthoses by the Republic of Georgia.
Production capacity to provide care in lower-limb prosthetics for 20 persons per week and in orthotics for 20 persons per week.
Adequate administrative structure to provide physiotherapy follow-up for newly-fitted prostheses and orthoses.
Adequate administrative structure to provide training in Prosthetics and Orthotics to clinicians elsewhere in Georgia and in the surrounding Caucasus region.
Continual development of prosthesis design to improve lower-limb use and function.
Background:
The Republic of Georgia faces a serious need for medical care in prosthetics and orthotics. The poor state of the health care system, combined with a large number of amputees injured in wars or land mine explosions, has produced a growing number of people unable to obtain an essential prosthesis or orthosis. Currently only three facilities provide prostheses for the country. These facilities are administered by the International Committee of the Red Cross (ICRC). They produce a standard lower limb prosthesis out of plastic and foam; the prosthesis is inexpensive and innovative but is somewhat limited in function. The role of the ICRC is to provide temporary relief, and their current arrangement with the Ministry of Health of Georgia is due to expire at the end of this calendar year. It is imperative that the Ministry of Health prepares now for self-sufficient operation of the prosthetics facilities. An even greater need exists for orthotic care. Hip and spinal orthoses are produced on rudimentary equipment in inefficient processes, if they are produced at all. Finally, follow-up physical therapy is lacking. Patients need long-term therapy for their return to ambulation and the clinical care of their limb and prosthesis.
Improvement upon the current conditions in Georgia is critically needed. The goals of this project are designed to improve the design and delivery of prosthetics and orthotics. Each goal is critical to the project:
Self-Sufficient Production
When personnel from the ICRC depart, the Ministry of Health needs a plan already in place to maintain and improve production of prostheses. The Ministry must identify a Program Director who will oversee all three Prosthetics and Orthotics facilities in Georgia. The program director must assemble a staff with adequate training to provide care on a similar level to that of a Certified Prosthetist/Orthotist in the West. In addition, technicians need to be trained in the maintenance and operation of production equipment. Finally, an established structure must be in place to insure thorough charting of individual patient care.
Production Capacity Improvements
The current ICRC facility produces approximately seven prostheses per week. Waiting lists are often years long. Capacity will be rapidly increased with the implementation of CAD/CAM technology in the manufacture of prostheses and orthoses. A digitizer will be used to obtain the desired shape of the limb of brace, and a CAM mill will produce the device automatically.
Physiotherapy
Because of the Soviet structure of separate, highly-focused health care facilities, physiotherapy (PT) is currently viewed as a separate clinical provision. PT must be considered a required addition to patient care. Either PT facilities should be centralized with the Prosthetics and Orthotics facility, or administrative steps should be taken to insure that patients receive physical therapy after a new device is provided.
Training for Clinicians Elsewhere
The improved prosthetics and orthotics program in Tbilisi should serve as a role model for the Caucasus region. In that regard, the program should be able to replicate itself elsewhere in Georgia and the region. Training for personnel is the first essential step in such a program exportation. Training should be organized for new prosthetists, orthotists, technicians, and physiotherapists. Eventually, specific guidelines should be drawn up for certification of these health care providers.
Prosthesis Design
Improvements in the function of the prosthesis will generate improvements in patient acceptance and in patient mobility. The production of the prosthesis and training of technicians must be flexible to allow for improvements in the design. A standard design provided for each patient results in lower cost but in limited function. Improvements in the standard design should work within the framework of available materials and equipment, but should improve limb function in areas of rough-terrain ambulation, swing phase knee flexion, durability, and energy storage and return.
Milestones
By the end of the first six months of the program, the following milestones should have been accomplished:
The establishment of a program director to oversee operations,
CAD/CAM production of above and below knee prosthetic sockets, ankle-foot orthoses, and spinal orthoses,
Required, monitored physiotherapy for amputees who receive their first prosthesis, andInitial development of administrative structure for training of prosthetists and technicians.
Increases in numbers Ð production capacity, number of patients receiving PT, number of trainees Ð should improve with time over the first full year.
Deliverables:
In the early stages of the program, the Program Director should be expected to provide monthly reports to the ministry of health addressing:
the number of patients seen,
the number of devices provided, and, for each patient (when possible),
a record of follow-up 3 months after initial treatment and therapy.
This follow-up should determine whether or not the patient is using the device given. These reports will provide an overall measure of production capacity, availability of PT, and effectiveness of the devices provided. The overriding goal of the program is to improve mobility and ambulation. This improvement must be documented as well as possible through patient follow-up and individual case studies. If this goal is not being met, the inadequacies in the program must be identified.
Budget (five years):
Personnel $275,000
Renovation $30,500
Equipment $250,000
Faculty $150,000
Total $705,500CONTACT
Mark Geil - mark.geil@hps.gatech.edu
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