Bulletin of Semashko National Research Institute of Public HealthBulletin of Semashko National Research Institute of Public Health2415-84102415-8429FSSBI «N.A. Semashko National Research Institute of Public Health»328310.69541/NRIPH.2026.03.020Original ArticleRegulatory framework for medical rehabilitation: compliance with the needs of children requiring upper limb prostheses due to congenital conditionsKuziakinaAlina Sergeevnaalina.bolshova@inbox.ruAvksentevaMaria Vladimirovnaavksent@yahoo.comThe Institute of Leadership and Healthcare Management, First Moscow State Medical University named after I. M. Sechenova, Moscow, Russian Federation02102026312913607102026Copyright © 2026,2026Annotation. The study analyzed the extent to which the current regulatory framework for medical rehabilitation meets the needs of children requiring upper limb prostheses due to congenital conditions. The analysis covered the principal regulatory legal acts governing medical rehabilitation and prosthetic care for children with disabilities, including Federal Laws No. 323-FZ of November 21, 2011, and No. 181-FZ of November 24, 1995, Order No. 1705n of the Ministry of Health of the Russian Federation dated December 29, 2012, Order No. 878n of the Ministry of Health of the Russian Federation dated October 23, 2019, and Order No. 449n of the Ministry of Labour and Social Protection of the Russian Federation dated July 21, 2025, as amended by Order No. 138n dated April 8, 2026. Despite significant progress in the regulatory framework governing medical rehabilitation, the current regulations do not fully address the needs of children requiring upper limb prostheses. The analysis identified the absence of legally established mechanisms for coordination between the medical rehabilitation system and prosthetic services provided within the social protection system, the undefined regulatory status of occupational therapy, and the lack of clinical practice guidelines for this patient population. The findings support the need for further development of the regulatory framework to ensure continuity between medical rehabilitation and social support services and to facilitate the implementation of the core principles of the rehabilitation process.Pediatric medical rehabilitation. Upper limb prosthetics. Legal and regulatory framework. Multidisciplinary rehabilitation team. Occupational therapy. Social protection of persons with disabilities.Медицинская реабилитация детей. Протезирование верхних конечностей. Нормативно-правовое регулирование. Мультидисциплинарная реабилитационная команда. Эрготерапия. Социальная защита инвалидов.1.Kuzyakina AS, Avksentyeva MV. Comprehensive model of rehabilitation for children requiring upper limb prosthetics due to congenital disorders. National Health Care. [Nacional’noe zdravoohranenie]. 2024;5(1):50—57 (in Russian). DOI: 10.47093/2713-069X.2024.5.1.50—572.Kuzyakina AS. Standardization of rehabilitation care for children requiring upper limb prosthetics: a review of legal regulation. Problems of Standardization in Health Care. [Problemy standartizacii v zdravoohranenii]. 2020;(1—2):11—16 (in Russian).3.Biddiss E. A., Chau T. T. Upper limb prosthesis use and abandonment: a survey of the last 25 years. Prosthetics and Orthotics International. 2007;31(3):236—257.4.Clarke S. D., Patton J. G. Occupational therapy for the limb-deficient child: a developmental approach to treatment planning and selection of prostheses for infants and young children with unilateral upper extremity limb deficiencies. Clinical Orthopaedics and Related Research. 1980;148:47—54.5.Davids J. R., Wagner L. V., Meyer L. C., Blackhurst D. W. Prosthetic management of children with unilateral congenital below-elbow deficiency. The Journal of Bone and Joint Surgery. 2006;88(6):1294—1300.6.Dromerick A. W., Schabowsky C. N., Holley R. J., Monroe B., et al. Effect of training on upper-extremity prosthetic performance and motor learning: a single-case study. Archives of Physical Medicine and Rehabilitation. 2008;89(6):1199—1204.7.Johnson S. S., Mansfield E. Prosthetic training: upper limb. Physical Medicine and Rehabilitation Clinics. 2014;25(1):133—151.8.Kelly B. M., Davis A. J., Justice D., Miller Q. L., et al. Comprehensive care for the child with upper extremity limb deficiency. Journal of Pediatric Rehabilitation Medicine. 2009;2(3):195—208.9.Management of Upper Extremity Amputation Rehabilitation Working Group. VA/DoD Clinical Practice Guideline for the Management of Upper Extremity Amputation Rehabilitation. Washington: Department of Defense; 2014.10.Smurr L. M., Gulick K., Yancosek K., Ganz O. Managing the upper extremity amputee: a protocol for success. Journal of Hand Therapy. 2008;21(2):160—176.11.Voynovskiy AE, Efanov AE. Analysis of the legislative framework for medical rehabilitation in Russia. Rehabilitology. [Reabilitologija]. 2024;2(1):115—121 (in Russian). DOI: 10.17749/2949—5873/rehabil.2024.1512.Blinov DV, Solopova AG, Sandzhieva LN, Achkasov EE, Korabelnikov DI, Ampilogova DM, et al. Improving the organization of medical rehabilitation in the healthcare system: situation analysis. PHARMACOECONOMICS. Modern Pharmacoeconomics and Pharmacoepidemiology. [FARMAKOJeKONOMIKA. Sovremennaja farmakojekonomika i farmakojepidemiologija]. 2022;15(2):237—249 (in Russian). DOI: 10.17749/2070—4909/farmakoekonomika.2022.14013.Golovina ON, Vinyarskaya IV. Content analysis of legal regulation of medical and social rehabilitation of children with cerebral palsy in the Russian Federation. Problems of Social Hygiene, Public Health, and History of Medicine. [Problemy social’noj gigieny, zdravoohranenija i istorii mediciny]. 2023;31(3):360—367 (in Russian). DOI: 10.32687/0869-866X-2023-31-3-360-367