rehabilitation activities. Types of rehabilitation programs and conditions

Disabled people constitute the most numerically significant group in need of social assistance.

Rehabilitation of disabled people is a system and process of full or partial restoration of the abilities of disabled people for household, social and professional activities. Rehabilitation is aimed at eliminating or, if possible, more fully compensating for limitations in life activity caused by a health disorder with a persistent disorder of body functions, in order to socially adapt disabled people, achieve their financial independence and integrate them into society. On social services for the elderly and the disabled: Federal Law No. 122-FZ of August 2, 1995 (as amended on November 21, 2011) // Collected Legislation of the Russian Federation of August 7, 1995. - No. 32. - Art. 3198.

The main goal of rehabilitation is the restoration of the social status of a disabled person, the achievement of material independence and his social adaptation.

Rehabilitation for the disabled includes vocational training and employment, provision of means of transportation, provision of vehicles, prosthetic and orthopedic care. The state guarantees the disabled to carry out rehabilitation measures, receive technical means and services provided for by the federal list of rehabilitation measures, technical means of rehabilitation and services provided to the disabled at the expense of the federal budget. Belousov M.S. Social security law / M.S. Belousov. - M.: Okay-book, 2009. - S. 77.

The main mechanism for the implementation of the rehabilitation of individuals is an individual program for the rehabilitation of a disabled person (IPR), which is developed on the basis of a decision of the authorized body that manages federal institutions, medical and social expertise, a set of rehabilitation measures that are optimal for a disabled person, including certain types, forms, volumes, terms and the procedure for the implementation of medical, professional and other rehabilitation measures aimed at restoring, compensating for impaired or lost functions of the body, restoring, compensating the ability of a disabled person to perform certain types of activities.

The development of an IPR consists of the following stages: conducting expert rehabilitation diagnostics; evaluation of rehabilitation potential and rehabilitation prognosis; determining the list of activities, services and technical means that allow a person to restore impaired or compensate for lost abilities to perform household, social and professional activities.

IPR includes a set of measures consisting of medical, professional and other measures aimed at restoring, compensating for impaired or lost body functions, restoring, compensating the ability of a disabled person to perform certain types of activities, and consists of three programs:

Medical rehabilitation is a process, the implementation of which is aimed at restoring and compensating by medical and other methods the functional capabilities of the human body, impaired due to a congenital defect, illness or injury. It consists of outpatient, inpatient and sanatorium stages and is carried out in accordance with the developed standards;

Vocational rehabilitation is a process and a system for restoring the competitiveness of a rehabilitator in the labor market. Includes:

2) Medical-professional stage - "medical-professional rehabilitation") - the process of rehabilitation, which combines medical rehabilitation with the definition and training of professionally significant functions, the selection of a profession and adaptation to it;

3) Professional stage - a system of measures (primarily educational) that provide an opportunity to get a suitable job or keep the old one and move around the service (work), thereby contributing to its social integration and reintegration;

4) Labor stage - the process of employment and adaptation at a particular workplace;

Social readaptation and reintegration - a system of activities that improve the level and quality of life, create equal opportunities for full participation in society. It is carried out in all phases, focused on teaching the rehabilitator the skills of self-service and ensuring independence by technical, pedagogical and other means. There are social, social, environmental and socio-legal directions in the readaptation and reintegration of disabled people.

The IPR is obligatory for execution by the relevant state authorities, local self-government, as well as organizations, regardless of their organizational and legal forms and forms of ownership. Refusal of the IPR by a disabled person as a whole or from its separate parts releases the said bodies from responsibility for its implementation and does not give the disabled person the right to receive compensation in the amount of the cost of rehabilitation measures provided free of charge. At the same time, this program is advisory in nature for a disabled person, he has the right to refuse any type, form and volume of rehabilitation measures.

In accordance with the IPR, educational institutions, together with social protection authorities and health authorities, provide pre-school, out-of-school upbringing and education for disabled children; obtaining by invalids of average general and professional education.

Federal Law "On the social protection of disabled people in the Russian Federation" On the social protection of disabled people in the Russian Federation: Federal Law No. 181-FZ of November 24, 1995 (as amended on July 2, 2013) // Collection of Legislation of the Russian Federation of November 27, 1995. - No. 48.- Art. 4563. consolidated the provision that the state guarantees disabled people the necessary conditions for education and training (art. 9). Vocational training of the disabled is carried out in educational institutions of general and special type, as well as directly at enterprises in accordance with the IPR. Vocational training and retraining of disabled people is carried out primarily in priority professions and specialties, the mastery of which gives disabled people the greatest opportunity to be competitive in the labor market.

Upon admission to secondary specialized or higher educational institutions, they enjoy certain benefits - they are enrolled regardless of the admission plan. When receiving vocational education, disabled people are given the opportunity to study according to an individual schedule. Disabled people can also use distance learning, external study practice, as well as homeschooling. During the period of study, a scholarship is paid in an increased amount.

For disabled people who need special conditions for receiving vocational education, special vocational educational institutions of various types are created or appropriate conditions are created in vocational educational institutions of a general type. Vocational training of disabled people is also carried out in special educational institutions of the system of the Ministry of Social Protection of the Population.

Vocational training of disabled people can also be carried out directly at work. It has a number of advantages due to the presence of a wide production base at enterprises and the possibility of choosing professions, a reduction in training time, and a higher level of material support during training. In general, all types of vocational training for disabled people is a necessary measure to provide them with a real opportunity to get a job, taking into account the state of health and the degree of disability.

Disabled children of preschool age are provided with the necessary rehabilitation measures and conditions are created for staying in preschool institutions of a general type, and if this is excluded for reasons of their health, then special preschool institutions are created. If it is impossible to carry out the upbringing and education of disabled children in general or special preschool and general educational institutions, the education of disabled children with the consent of their parents is carried out at home according to a complete general educational or individual program. The maintenance of disabled children in preschool and educational institutions is carried out at the expense of the budget of the subject of the Russian Federation.

The basis for organizing homeschooling for a disabled child is the conclusion of a medical institution. Such training is carried out by an educational institution, as a rule, closest to the place of residence of a disabled child. For the period of study, the educational institution provides free textbooks, educational and reference literature available in the library of the educational institution; provides specialists from among the teaching staff, provides methodological and advisory assistance; carries out intermediate and final certification; issues a state document on the relevant education.

Parents who have disabled children and carry out their upbringing and education at home on their own, education authorities compensate for the costs in the amount determined by state and local standards for financing the costs of education and upbringing in a state or municipal educational institution of the appropriate type and type.

ILO Convention "On Vocational Rehabilitation and Employment of Persons with Disabilities", On Vocational Rehabilitation and Employment of Persons with Disabilities (Concluded in Geneva on 06/20/1983): Convention No. 159 of the International Labor Organization // Conventions and recommendations adopted by the International Labor Conference. 1957-1990. T. II. - Geneva: International Labor Office, 1991. - S. 2031-2035. establishes the principles of vocational rehabilitation of disabled people and policies regarding their employment. These principles include the obligation of the state, in accordance with national conditions, practices and capacities, to develop a national policy on vocational rehabilitation and employment of persons with disabilities, aimed at ensuring that appropriate vocational rehabilitation measures extend to all categories of persons with disabilities, as well as to promote employment opportunities for persons with disabilities. in the free labor market.

This policy is based on the principle of equality of opportunity for persons with disabilities and workers in general; observance of equality of treatment and opportunities for working men and women who are disabled; the adoption of special measures aimed at ensuring genuine equality of treatment and opportunity for persons with disabilities who should not be considered as discriminating against other workers.

Employment of persons with disabilities is guaranteed by a system of guarantees. These include:

1) implementation of a preferential financial and credit policy in relation to special enterprises employing the labor of disabled people;

2) setting a quota for hiring disabled people;

3) reservation of jobs in professions most suitable for the employment of disabled people;

4) stimulating the creation by enterprises of additional workers for the employment of disabled people;

5) creation of working conditions for the disabled in accordance with the individual rehabilitation program;

6) creation of conditions for entrepreneurial activity;

7) organizing training for disabled people in new professions. Social security law: textbook / Ed. K.N. Gusov. - M.: Velby, 2007. - S. 158.

Law of the Russian Federation "On employment in the Russian Federation" On employment in the Russian Federation: Law of the Russian Federation of April 19, 1991 No. 1032-1 (as amended on July 2, 2013) // Collected Legislation of the Russian Federation of April 22, 1996. - No. 17. - Art. 1915 obliges local authorities to ensure the creation of additional jobs and specialized enterprises for the employment of disabled people. Legislative On the amendment and invalidation of certain acts of the President of the Russian Federation: Decree of the President of the Russian Federation of June 12, 2006 No. 603 (as amended on June 7, 2013) // Collection of Legislation of the Russian Federation of June 19, 2006. - No. 25. - Art. 2700. A quota for the employment of disabled people is also established.

In solving the problems of employment of the disabled, an important role belongs to the municipal centers of social services. In accordance with Art. 28 of the Law of the Russian Federation “On Social Services for Elderly and Disabled Citizens”, they have the right to create workshops, production workshops, subsidiary farms and home-based industries specifically for the employment of disabled and elderly citizens. Such workshops, workshops and other industries are under the jurisdiction of the administrations of municipal social service centers. The bodies of social protection of the population are directly involved in the employment of disabled people.

Art. 223 of the Law of the Russian Federation "On the Social Protection of the Disabled in the Russian Federation" provides that all disabled people employed in enterprises, institutions and organizations must be provided with the necessary special working conditions in accordance with an individual rehabilitation program.

Special jobs for the employment of disabled people are jobs that require additional measures to organize labor, including the adaptation of basic and auxiliary equipment, technical and organizational, additional equipment and the provision of technical devices, taking into account the individual capabilities of disabled people. In cases stipulated by law, the administration is obliged to employ disabled people and, in accordance with medical recommendations, establish for them part-time work and other preferential working conditions. Disabled people of groups I and II are provided with a reduced working day (no more than 35 hours per week), annual paid leave (at least 30 calendar days).

Jobs for the disabled at enterprises and organizations must comply with the special requirements for jobs for the disabled depending on the disability group, this is established by the Decree of the Ministry of Labor "On the List of priority professions for workers and employees, the mastery of which gives disabled people the greatest opportunity to be competitive in regional markets labor." On the List of priority professions for workers and employees, the mastery of which gives disabled people the greatest opportunity to be competitive in regional labor markets: Decree of the Ministry of Labor of the Russian Federation of 08.09.1993 No. 150 // Bulletin of normative acts of ministries and departments of the Russian Federation. - No. 11.

Bodies of social protection of the population take the necessary measures to realize the possibility of disabled people to work at home. At present, when the problems of employment in general and the employment of disabled people in particular have become more acute, there is a need to expand the home work of disabled people.

In accordance with the Decree of the Government of the Russian Federation “On Approval of the Procedure for the Participation of Elderly Citizens and Disabled Persons Living in Social Service Institutions in Medical Labor Activities”, special jobs are created in stationary social service institutions for persons living in them and having residual working capacity. The medical and labor activity of citizens in stationary institutions is carried out under the guidance of labor instructors and instructors for training workers in accordance with schedules and individual rehabilitation programs. On social services for the elderly and the disabled: Federal Law No. 122-FZ of August 2, 1995 (as amended on November 21, 2011) // Collected Legislation of the Russian Federation of August 7, 1995. - No. 32. - Art. 3198.

The determination of the type and duration of medical and labor activity is carried out by a doctor of a stationary institution specifically for each citizen, taking into account his desire. The duration of medical and labor activity should not exceed 4 hours a day.

Another important condition for the social rehabilitation of disabled people is to provide them with vehicles and special means of transportation, the possibility of returning to an active lifestyle. The Federal Law “On Veterans” provides for the right of disabled war veterans to receive, if there are established medical indications (disabled people of group I for vision or without both hands - without medical indications), free use of a motorized wheelchair or a car.

Legislation also establishes the right of persons with disabilities to purchase a manual car. Cars are sold to disabled people in the presence of established medical indications and the absence of contraindications to driving a car, which are determined by MSEC. Sale is carried out on the basis of the permission of the relevant social security authority by special shops at the place of permanent residence of the disabled.

In accordance with the Federal Law “On Veterans”, the Decree of the Government of the Russian Federation of July 10, 1995 approved the “Procedure for the Appointment and Payment of Certain Categories of Disabled Veterans of Cash Compensation for the Cost of Gasoline or Other Fuels, Repair, Maintenance of Vehicles and Spare Parts for Them, as well as transport services.

The current legislation provides for the provision of disabled people not only with vehicles, but also, in certain cases, with special means of transportation: bicycle carriages and wheelchairs.

At present, the provision of these categories of citizens with means that make life easier for disabled people is carried out in accordance with the Rules for providing, at the expense of the federal budget, technical means of rehabilitation for disabled people and certain categories of citizens from among veterans with prostheses (except for dentures), prosthetic and orthopedic products approved by a government decree RF dated 07.04.2008 No. 240. On the procedure for providing disabled persons with technical means of rehabilitation and certain categories of citizens from among veterans with prostheses (except dentures), prosthetic and orthopedic products: Decree of the Government of the Russian Federation dated 07.04.2008 No. 240 (as amended on 21.05.2013 ) // Collection of Legislation of the Russian Federation of 14.04.2008. - No. 15. - Art. 1550. In accordance with this resolution, disabled people are provided with technical means of rehabilitation provided for by the federal list of rehabilitation measures, technical means of rehabilitation and services provided to a disabled person, approved by Decree of the Government of the Russian Federation of December 30, 2005 No. 2347-r. On the federal list of rehabilitation measures, technical means of rehabilitation and services provided to a disabled person: Decree of the Government of the Russian Federation of December 30, 2005 No. 2347-r (as amended on March 16, 2013) // Collection of Legislation of the Russian Federation of January 23, 2006. - No. 4. - Art. 453.

Prosthetic and orthopedic care is of great importance for the social rehabilitation of the disabled. Currently, the number of citizens in need of various types of prosthetic and orthopedic care in the Russian Federation is more than 1 million people.

The Federal Law “On Social Protection of Disabled Persons in the Russian Federation” secured the right of disabled people to free provision of prosthetic and orthopedic products. The rights of disabled people to prosthetic and orthopedic care are enshrined in a general form and in Art. 27 Fundamentals of the legislation of the Russian Federation "On the protection of the health of citizens." On the basics of protecting the health of citizens in the Russian Federation: Federal Law of November 21, 2011 No. 323-FZ (as amended on July 23, 2013) // Collection of Legislation of the Russian Federation of November 28, 2011. - No. 48. - Art. 6724.

The specific procedure for providing disabled people with all types of prosthetic and orthopedic products (prostheses, orthopedic devices, orthopedic shoes, shoes for prostheses, bandages, etc.) is regulated by the Instruction "On the procedure for providing the population with prosthetic and orthopedic products, vehicles and means that make life easier invalids." On approval of the Instruction "On the procedure for providing the population with prosthetic and orthopedic products, means of transportation and means that make life easier for the disabled": Order of the Ministry of Social Security of the RSFSR dated February 15, 1991 No. 35. Pensioners and disabled people in need of prosthetic and orthopedic products, as well as means that facilitate life of the disabled, have the right to free provision of prostheses at the expense of funds allocated from the budget for prosthetics. At the same time, each disabled person, depending on medical indications, has the right to provide prosthetic hands and feet, as well as to receive orthopedic shoes, orthopedic devices, leather trousers free of charge for 2 years; war invalids suffering from vascular lesions of the lower extremities - one pair of orthopedic shoes per year; disabled children - two pairs of shoes per year.

The multidimensionality of vocational rehabilitation, as well as medical and social rehabilitation aspects, requires coordination of measures.

The physiological patterns of the recovery process are characterized by three main phases or periods of rehabilitation.

The first period is a period of stabilization, consolidation (convalescence phase).

The second is the period of mobilization (the phase of convalescence).

The third is the reactivation period, or supportive (post-convalescence phase).

The significance of this or that aspect of rehabilitation measures is ambiguous in different periods of rehabilitation. In the convalescence and convalescence phases, medical rehabilitation measures are leading, in the post-convalescence phase, professional and social aspects of rehabilitation come to the fore. Disabled people are characterized by the third phase of the recovery process, due to which professional and social rehabilitation measures become a priority.

A rational combination of various aspects of rehabilitation makes it possible to achieve high efficiency of the measures taken.

On January 1, 2016, the law on the habilitation of persons with disabilities came into force. A new concept has appeared, consonant with the term "rehabilitation" familiar to us. However, there is still a difference between them. In short, habilitation (lat. habilis - to be capable of something) is the initial formation of an ability to do something.

The term is applied mainly to young children with developmental disabilities, in contrast to rehabilitation - the return of the ability to do something lost as a result of illness, injury, etc.

General concepts of the rehabilitation of persons with disabilities In the standard rules for ensuring equal opportunities for persons with disabilities (Resolution of the UN General Assembly 48/96, adopted at the forty-eighth session of the UN General Assembly on December 20, 1993), in the section "Basic concepts in policy towards persons with disabilities", a commonly used concept of rehabilitation based on the ideas of the World Program of Action for Persons with Disabilities has been formulated. Rehabilitation is a process whose purpose is to help persons with disabilities restore and maintain their optimal physical, intellectual, mental and/or social levels of activity by providing them with rehabilitation means to change their lives and expanding the scope of their independence.

From this international definition of “rehabilitation”, a certain analytical scheme of the rehabilitation process itself follows, which includes the following components (rehabilitation constructs):

Social rehabilitation, which ensures the rehabilitation of a person with a disability as a social subject;
2. Pedagogical rehabilitation, which ensures the rehabilitation of a person as a subject of activity;
3. Psychological rehabilitation, which provides rehabilitation of a person with a disability at the individual level;
4. Medical rehabilitation, which provides rehabilitation at the level of the human biological organism. All of the above components constitute an ideal model of the rehabilitation process.

It is universal and can be used in the strategic planning of any center or institution for the rehabilitation of a person with a disability, which aims to provide the most complete range of rehabilitation services.

What does the term "habilitation" mean?

When a child is born with a functional limitation, this means that he will not be able to develop all the functions necessary for a normal life, or perhaps the functionality of this child will not be developed in the same way as the functionality of his peers. A child, no matter what, remains a child: with the need for love, attention and education according to his unique nature, and he must be treated, first of all, as a child. The word "habilitation" comes from the Latin "habilis", which means "to be capable of". To habilitate means "to make wealthy" and is used instead of the word "rehabilitate", which is used in the sense of restoring a lost ability.

That is, habilitation is a process whose goal is to help acquire or develop still unformed functions and skills, in contrast to rehabilitation, which offers the restoration of lost functions as a result of injury or disease. Hence it turns out that this process is most relevant in relation to children with disabilities. Although it applies to other people whose moral health is undermined (for example, convicts). Habilitation means not only seeking to treat or modify physical or mental disorders, it also means teaching the child to achieve functional goals in alternative ways when the usual ways are blocked, and to adapt the environment to compensate for missing functions.

It should be noted that habilitation started late may be ineffective and difficult to implement.

This may be the case, for example, if children with cerebral palsy and gross delays in speech development begin to receive appropriate assistance only at the age of eight to eleven years. The experience of recent years suggests that a complex of therapeutic, pedagogical, speech therapy and other activities should be started already in the first year of life. Rehabilitation activities begin from the first days of illness or injury and are carried out continuously, subject to a staged program construction.

Habilitation activities can begin with monitoring the condition of the expectant mother and nursing a child with developmental disabilities. Habilitation is a multi-faceted process that addresses various aspects at the same time to enable the child to lead a life that is as close to normal as possible. Normal life, in this context, means the life that a child would have in the absence of their functional limitations.

Habilitation and rehabilitation is a set of measures aimed at adapting to society and overcoming the pathological conditions of people with disabilities. The task of both habilitation and rehabilitation is to help people with disabilities socialize as successfully as possible, arrange both personal and professional life.

Article 9. The concept of rehabilitation and habilitation of disabled people

(see text in previous)

(as amended by Federal Law No. 132-FZ of October 23, 2003)

(see text in previous

Rehabilitation of disabled people is a system and process of full or partial restoration of the abilities of disabled people for everyday, social, professional and other activities. Habilitation of disabled people is a system and process of formation of disabled people's abilities for everyday, social, professional and other activities. Rehabilitation and habilitation of disabled people are aimed at eliminating or, as far as possible, fuller compensation for the limitations of the life of disabled people for the purpose of their social adaptation, including their achievement of material independence and integration into society.

(part one in ed.

(see text in previous)

The main directions of rehabilitation and habilitation of disabled people include:

(as amended by Federal Law No. 419-FZ of December 1, 2014)

(see text in previous)

medical rehabilitation, reconstructive surgery, prosthetics and orthotics, spa treatment;

Federal Law of December 1, 2014 N 419-FZ)

(see text in previous)

vocational guidance, general and vocational education, vocational training, employment assistance (including special jobs), industrial adaptation;

(as amended by Federal Law No. 419-FZ of December 1, 2014)

(see text in previous)

socio-environmental, socio-pedagogical, socio-psychological and socio-cultural rehabilitation, social adaptation;

physical culture and recreation activities, sports.

The implementation of the main directions of rehabilitation, habilitation of the disabled provides for the use of technical means of rehabilitation by the disabled, the creation of the necessary conditions for the unimpeded access of the disabled to the objects of social, engineering, transport infrastructure and the use of means of transport, communications and information, as well as providing the disabled and their families with information on rehabilitation , habilitation of the disabled.

(Part three as amended by Federal Law No. 419-FZ of December 1, 2014)

Chepuryshkin I.P.

Today, society and the state are faced with an extremely important task to act as a guarantor of social protection for children with disabilities, to assume the obligation to provide them with conditions for a normal life, study and development of inclinations, professional training, adaptation to the social environment, that is, for their habilitation. An analysis of the historical prerequisites for the formation of a modern system of education quality management in a boarding school showed that the idea of habilitating children with disabilities, as a process of restoring their physical and mental abilities, has a rather long history and dates back several centuries.

The concept of "habilitation" also has ambiguous interpretations. To date, there is no agreement among authors referring to this concept. The concept of "habilitation" is close in meaning to the concept of normalization used in Denmark and Sweden. Translated from Latin, habilitation literally means “granting rights, opportunities, ensuring the formation of abilities” and is often used in child psychiatry in relation to persons suffering from some physical or mental defect from an early age.

In the medical literature, the concept of habilitation is often given in comparison with the concept of rehabilitation. According to L.O. Badalyanu: “Habilitation is a system of therapeutic and pedagogical measures aimed at preventing and treating those pathological conditions in young children who have not yet adapted to the social environment, which lead to a permanent loss of the opportunity to work, study and be a useful member of society. We should talk about habilitation in those cases when a pathological condition that disables the patient arose in early childhood. This child does not have self-care skills and has no experience of social life.

In the materials of the manual "Improving education". The National Institute for the Advancement of Urban Education in the United States noted that students learn and use the acquired knowledge in different ways. However, the goal of education is to achieve a certain social status for all students and assert their social significance. Inclusion is an attempt to give students with disabilities self-confidence, which motivates them to go to school with other children: friends and neighbors. Children with special educational needs need not only special treatment and support, but also development of their abilities and success in school. The materials of the referenced manual emphasize that the latest version of the US federal law "On the Education of People with Disabilities" supports the practice of inclusion. The new law on education advocates for the inclusion of children with disabilities in the educational environment, for their passage of a general education program. The conclusion of the advisory commission, when submitted to the US Congress, explained the goals and objectives of legislators as follows: inclusion is "acceptance of each child and flexibility in approaches to learning."

Summarizing the above and based on the experience of the author, we believe that a habilitation and educational space should be formed in a boarding school for children with disabilities. Within the framework of the economic crisis in society, the creation of a sustainable education system that could integrate all the impacts on children is almost impossible. The existing reality clearly demonstrates that even a special boarding school with the latest education system, humanistic relations, various creative activities, competing with a bright and colorful environment full of ultra-modern "values", often fails.

And there seems to be only one way out of this. First of all, it is necessary to improve the lives of children in the boarding school itself; make it bright, emotional, saturate it with interesting, extraordinary events. Moreover, the school must be attractive to both children and adults; traditionalism and innovation, the absence of excessive guardianship and care should organically coexist in it. In this case, the school becomes competitive in the space surrounding the child; and all the norms and values put forward by the school infrastructure can become internal beliefs and own norms for the child. Events of a cultural, sporting or other nature, taking place in the surrounding space, are introduced into the life of the school team. At the same time, the implementation of the task of creating such a space faces the difficult task of habilitating children with disabilities. This means that in this space the child must learn to do something that he has been deprived of since childhood. There is precisely a contradiction in this question. It would seem that here the individual corrective activity of physicians should take the first place. Based on this, many experts conclude that “full-fledged assistance to a child with disabilities should include not only a system of habilitation measures, but also a comprehensive psychological, medical and pedagogical work to build such a space of life and activity that will best encourage the child to use the acquired functions in natural conditions. The tasks of organizing the directed activity of the child, creating motives for him to perform actions that cause difficulties, to overcome his own difficulties are included in the sphere of pedagogy and psychology and are solved by building a special pedagogical space. The sooner the child, having received help, will be able to actively act in an adequately organized space, the better the result will be for his further development.

It should be noted that at present in Russia, in relation to the state towards persons with disabilities, there is a transition to a new stage.

The quality of education in a boarding school for children with disabilities is considered as a pedagogical problem and a direction of educational policy.

The historical prerequisites for the formation of a modern system of education quality management in a boarding school for children with disabilities were: firstly, the development and implementation of projects to create a common integrated school that unites students with different educational opportunities within its walls; secondly, the formation of habilitation centers that ensure the growth of the quality of life of children with disabilities, and the creation of inclusive schools in which all students have equal access to the learning process during the school day and equal opportunities to establish and develop important social ties.

BIBLIOGRAPHY

Badalyan L.O. Neuropathology. - M., 2000. - S.337-347.
Chepuryshkin I.P. Modeling the educational space of boarding schools for children with disabilities: Abstract of the thesis. thesis ... cand.ped.sciences. - Izhevsk, 2006.- 28s.
Improving Education.
T he Promise of Inclusive Schools.

Bibliographic link

Chepuryshkin I.P. HABILITATION OF CHILDREN WITH LIMITED HEALTH OPPORTUNITIES // Successes of modern natural science. - 2010. - No. 3. - P. 53-54;
URL: http://natural-sciences.ru/ru/article/view?id=7865 (date of access: 06/05/2018).

By and large, the habilitation of disabled people is almost very similar to the rehabilitation we already know. According to its purpose, habilitation differs from rehabilitation only in the subject - a person, a disabled person, in respect of whom it is carried out.

This term means the adaptation of disabled people to life in conditions of disability in an environment that is unsuitable or poorly adapted for this. But if rehabilitation provides for the return to a person of the opportunities lost due to disability that he previously had before disability, then habilitation is the process of primary education of such skills in a person who is a disabled child who simply does not have the skills to live without disability.

The process of habilitation, as well as rehabilitation, includes both the development and training of the necessary skills in the disabled person himself (the differences can be very large in this, since it is necessary to teach new skills to a person who has never possessed them at all), and the adaptation of his environment to more acceptable conditions for him - the so-called creation of an "accessible environment" - this is a whole complex of social, medical, technical, legal and other measures.

By the way, habilitation is not at all as new as it seems. Back in Soviet times, disabled children with birth defects that prevented them from living a normal life were quite successfully taught the necessary skills. There were special methods even for teaching deaf-blind children, and they were very effective. True, over the past quarter century, these methods, it seems to me, have been lost, but experience and specialists still remain ...

As for the habilitation programs for such disabled people, I have not yet heard of any new provisions on this issue, and so far this process has proceeded in the same way as when developing a rehabilitation program - the program is developed on the basis of medical indications during the period of assignment of disability and is issued to a disabled person , his guardian or social worker at the time of assignment of disability.

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What is "Habilitation for the Disabled"?

Which disabled people are covered by the new term?
When will they draw up and issue habilitation programs for people with disabilities? What is required for such a program?
Will funds for habilitation be issued, what kind?

On January 1, 2016, a law came into force that defines what habilitation of disabled people is, the conditions for individual programs, and also establishes its differences from the traditional term “rehabilitation”. These concepts are consonant, but there is a difference between them: rehabilitation is a set of actions aimed at restoring abilities due to illness or injury. Habilitation is the initial formation of any abilities. Mostly this concept is applied to children at an early age who have deviations, developmental disorders.

Rehabilitation and habilitation - is there a difference?

Habilitation of the disabled - what is it and how does it differ from rehabilitation measures? First you need to determine what rehabilitation involves, the restoration of intellectual, mental, social, mental activity. This is not only their return, but also support, the return of normal life. From the international definition it follows that this is a whole complex, which includes the following components:

social to ensure the restoration of a disabled person as a subject of society;
pedagogical to return a person to normal activities;
mental, used for the rehabilitation of the individual;
medical, providing restoration at the level of biology, that is, returning normal vital activity to the body.

A model that includes all of these components is called ideal, it is suitable for use in the strategic planning of a rehabilitation center.

Habilitation and rehabilitation have a big difference - in the first case, abilities are formed for a disabled person, and in the second, conditions are created for maximum restoration of the lost functionality. Habilitation programs suggest that a person learns to achieve various functional goals through alternative paths when habitual ones are blocked.

Such measures are applied mainly to children, since they are difficult to implement and ineffective in case of late treatment. For example, for children suffering from speech delays, help provided at 11 years old will be late. A positive result will bring only habilitation, started at an early age. These are speech therapy, pedagogical and other activities from the 1st year of life.

Establishing Disability: Major Changes

According to studies, as of January 1, 2015, there were about 13 million disabled people in Russia, of which 605,000 were children (what kind of assistance does the state provide to disabled children?). Previously, when determining disability, 2 criteria were used:

disorder of body functions;
the level of disability (commissions used such concepts as complete, partial with the loss of the ability to independently organize self-service, loss of motor function, learning ability, etc.).

This procedure was established by the Law on the Protection of Persons with Disabilities (Article 1), but from 01.01.2016 only one criterion will be used, according to which a person is recognized as disabled, after which he is assigned an individual program for the restoration of life. Since 2016, the degree of disability is determined on the basis of the severity of functional disorders, and not on the degree of limitation. The difference is very big:

Under the old order, a subjective assessment was used, that is, the ability to learn, communicate, control behavior (according to the ITU Classifications and Criteria, Section III).
The new system implies an objective assessment of the loss of body functionality, which is detected on the basis of a medical examination.

The concept of "Habilitation of the disabled"

The system for determining disability, adopted since 2016, is more advanced, it allows not only to make a diagnosis, but also to clarify the nature of individual assistance to a person. Law No. 419-F3 introduces such a new concept as habilitation, that is, a system for the formation of skills that were previously absent from a disabled person.

The main components of the habilitation of disabled people in 2016 are the following activities: prosthetics, orthotics, as well as reconstructive surgery, career guidance, spa treatment, exercise therapy, sports events, medical rehabilitation and others.

One of the main features of the new law is an individual program for the rehabilitation and habilitation of persons with disabilities, in accordance with the Law on the Protection of Persons with Disabilities, art.11. The recovery scheme will be developed and then implemented according to the rules that are set strictly individually. The program will be developed by ITU specialists (bureau of medical and social expertise), in accordance with paragraph 1 of the relevant Procedure.

As individual schemes for restorative measures are developed, extracts from such programs will be sent by the Bureau of the SME to state institutions that provide relevant services and measures (Article 5 of the Federal Law No. 419, clause 10). performers responsible for habilitation will have to report to the bureau. In turn, the federal institutions of the SME must transfer the received data to special authorities responsible for promoting the employment of people with disabilities (Federal Law No. 419, article 1, clause 2).

The advantages of the new system are obvious, the developers of the new Federal Law No. 419 are confident that it is precisely such measures that are able to increase the compulsion and effectiveness of the habilitation and rehabilitation measures taken. E. Klochko, who is one of the authors of the bill, believes that only the new scheme is able to more carefully and fully treat the program for the rehabilitation and protection of the disabled, including children who were not previously provided with assistance in the required amount.

Financing the habilitation program

After defining the concepts of “rehabilitation and habilitation of the disabled”, what it is exactly and what are the differences, it is necessary to touch on the issue of funding. If earlier technical means and many recovery processes, including expensive treatment, were paid for by parents and the funds created by them, now a certain amount is allocated from the state budget for such purposes. According to Order No. 2782-r dated December 31, 2015, earmarked funds in the amount of 9.3 billion rubles will be allocated in 2016. from the social security fund.

The distribution of funding is controlled by the Government of the Russian Federation, which is determined by the new norm (part 8, article 7 of the Federal Law "On the budget of the Social Insurance Fund of the Russian Federation"). In accordance with the law, funds can be redirected to provide disabled people with technical equipment, services required to restore health and certain functions of the body. The signed Order determines that the funds from the Social Insurance Fund are directed to the following purposes:

provision of technical means and services for rehabilitation and habilitation (7.7 billion rubles);
provision of subventions to the budgets of the constituent entities of the Russian Federation for similar purposes (in the amount of 1.6 billion rubles).

The adopted new program makes it possible to significantly improve the mechanism for distributing assistance and determining its volume, to facilitate the restoration of normal life for people with disabilities who need help, successful socialization, and arrangement of professional and personal life.

The real grief for the family is when a child is born with certain developmental disabilities. Each such case requires careful examination in order to determine the degree of damage and the possibility of developing skills that can make such a child a member of social society. In such cases, they say that the habilitation of the child is necessary.

What is habilitation?

This word has Latin roots. Habilis can be translated into Russian as "to be capable of something, wealthy in some kind of activity."

Habilitation is a whole complex of various therapeutic and pedagogical measures aimed at the most complete treatment of those pathological conditions in young children who do not yet have the skills and experience of living in society, which, without due attention of doctors and teachers, will lead to a permanent loss of the opportunity to study and work. and be ever a useful member of society.

Habilitation is most often a long process, the ultimate goal of which is the acquisition or development of skills and abilities that have not yet been formed.

What is the meaning of rehabilitation?

Rehabilitation is also a set of activities that have as their ultimate goal the restoration of any skills and abilities previously lost due to an injury or illness. That is, a person was previously a full-fledged member of society, but due to some traumatic factor, he lost his ability to work. Restoring it is rehabilitation.

Thus, habilitation and rehabilitation have much in common and are aimed at helping patients acquire some skills and abilities that will later allow them to become full-fledged members of the social environment, to study, work and serve themselves.

Components of rehabilitation

According to international concepts, rehabilitation means a fairly extensive set of activities aimed at restoring a number of very different opportunities and activities: social, intellectual, mental, mental. Such an aspect as social habilitation involves the restoration of a disabled person as a full-fledged subject of society. The pedagogical factor is designed to return the individual to normal activity.

The purpose of the mental aspect is the restoration of personal qualities. The medical component of an integrated approach, ideally, should ensure the restoration of biological parameters, i.e., return the body's vital functions to normal.

A model that includes all of the above factors can be considered ideal. It can be safely used in the strategic planning of a rehabilitation center for children and the disabled.

Are there differences?

Undoubtedly, there are differences between the two terms. As mentioned earlier, in the case of habilitation, skills and abilities are formed under the influence from outside - from health workers, teachers and psychologists. Rehabilitation is aimed at restoring to the maximum extent the functionality lost in the process of some events.

Thus, habilitation is a process that is most often talked about, referring to children under the age of 1 year who were born with any abnormalities. While they talk about rehabilitation in relation to older and adolescent children who have lost their functionality due to lesions of the central nervous system, provoked by injuries of the brain and spinal cord, diseases of an infectious and inflammatory nature (encephalitis, arachnoiditis, meningitis, poliomyelitis).

However, the term "habilitation" is applicable not only to children, but also to people with disabilities of different ages.

Habilitation of the disabled

Since 2016, a new, more advanced system for establishing the fact of disability comes into force in the Russian Federation, which allows not only to make a diagnosis, but also to more fully determine what kind of individual assistance each individual patient needs. Thus, such a new wording is being put into effect - the habilitation of disabled people. What does this concept include?

The key, most important components of this type of habilitation include prosthetics, orthotics, the use of reconstructive surgery, various options for vocational guidance, treatment in a sanatorium, the use of physiotherapy exercises, and various sports events.

New Law on Habilitation of the Disabled

The main and most important distinguishing feature of the new bill is an individual program for the habilitation of disabled people. Its essence lies in the fact that a scheme for restoring or acquiring new functions should be developed and then implemented according to the rules and directions that will be established strictly individually, based on the state of human health. The development of such a program or scheme of activities is the prerogative of the employees of the ITU bureau (medical and social expertise).

As individual recovery programs are developed, extracts from these documents will be distributed by the ITU Bureau to government agencies authorized to provide such services. Direct executors conducting habilitation of patients will have to submit reports to the ITU bureau.

The drafters of the new bill are convinced of the advantages of the new system.

Such an approach to the problem will make it necessary to pay more attention to the protection and rehabilitation of the disabled (including children), who were previously deprived of assistance at all, or it was not provided in the required amount.

Financing a new project

The financial support of such a program as habilitation is a rather serious issue. Previously, all the costs of restoring lost functions or acquiring previously absent ones, as a rule, lay an unbearable burden on the shoulders of parents or the assistance funds they created. But treatment of this kind is almost always expensive. In addition, a variety of technical means and restoration processes also required considerable investment.

Now, according to the new law, a certain amount is allocated from the budget for such events. As for 2016, the amount of funds for these purposes is 9.3 billion rubles, and they will be allocated from the social insurance fund.

An official document signed by the country's leadership determines that these financial flows can be used in two ways. Firstly, this is the provision of technical means and services for habilitation and rehabilitation (the volume is 7.7 billion rubles). Secondly, this is the provision of financial assistance to local budgets from the state (subventions) for such events (the amount is 1.6 billion rubles).

Is the time factor important?

Yes, this is very, very important. I must say that the late habilitation of disabled people (which was described above) is likely to give a minimal effect or be difficult to implement. Based on this, we can conclude that habilitation is most effective for young children with disabilities.

In general, the essence of this process is not only to treat and modify the existing disorders of the physical or mental plane, but also to achieve the goal (i.e., improve functionality) using alternative methods, if the usual paths are blocked. Or there is another way - adaptation of the environment to such a level that the missing functions are compensated.

Rehabilitation measures begin to be carried out almost from the first days of illness or injury. All actions are carried out continuously and in stages. As for habilitation, here activities can start from the moment when the health status of the future mother and fetus was monitored, or from the moment the baby with developmental disabilities was born.

So…

Habilitation is, in fact, a multi-stage and multilateral process, which is designed to provide the patient with the opportunity to lead a life as close as possible to normal in its universal human understanding. By this way of life, we mean the one that a child or an adult would have if he did not have certain deviations and functional limitations.

The new habilitation program is the best and most effective way to help a person with disabilities become a full-fledged subject of society, arrange their professional, and sometimes personal life.

And the direct duty of all full-fledged members of the social environment is to create the most favorable treatment and encourage such people to achieve their goals.

Rehabilitation is a purposeful complex system of medical, social, psychological and other measures aimed at preventing the development of severe consequences of diseases and injuries, restoring or compensating for functional defects that have occurred, and social and labor adaptation of patients. The rehabilitation trend in medicine has its own history, but its formation into an independent science that combines biological and social aspects has been carried out only in the last 30 years. This was facilitated by the need to restore and adapt to work and life of a large army of invalids of the Second World War, who received various and severe injuries. The task of the most effective and complete recovery of the patient in his former social and professional position requires the involvement of representatives of various medical and related specialties in solving this problem. At the same time, two main components of rehabilitation are distinguished - medical-biological and medical-social, organically related and complementary to each other. Depending on the nature and severity of a physical defect, the clinical features of the disease against which it developed, a system of medical and biological influences is developed aimed at overcoming the defect, its restoration or compensation. To solve this specific problem, employees of various medical specialties (therapists, surgeons, neuropathologists, physiotherapists, physiotherapy specialists, orthopedists), as well as related disciplines (psychologists, speech therapists, teachers, etc.) are involved. Depending on the degree of restoration of impaired functions and the level of their compensation, medical and biological effects are supplemented by a system of medical and social measures that provide the most adequate adaptation of the patient to the existing defect and return him to work.

The biomedical aspect of rehabilitation is based on methods of therapeutic action, which are combined under the name of biological therapy. As mentioned, this includes, first of all, physiotherapy exercises, massage, physiotherapy, drug therapy. At the same time, based on the tasks of rehabilitation and the clinical condition of the patient, the emphasis from drug therapy, which is used especially intensively in the acute period of the disease, is shifted to methods of physical treatment that have a reflex and activating effect on the main vital systems of the body (blood circulation, respiration, metabolic processes). They contribute to the elimination of the consequences of hypodynamia in the acute period of the disease, when strict bedding and rest, necessary to stabilize the acute painful process, cause forced motor starvation, which has its own adverse consequences.

The sequential inclusion of physiotherapy exercises, massage, and later physiotherapy creates conditions for activating the patient, raising his general tone, as well as the possibility of a local effect on the violations of individual functions developed in the acute period of the disease (motor, sensory, vegetative, etc.). However, as the experience of treating patients with severe protracted diseases shows, biological methods of therapy alone are not enough for their full recovery. Their effectiveness is increased by combining them with methods of psychosocial influence, which primarily include psychotherapy. This purely human method, based on the effect of a word on the personality of the patient, based on its preserved qualities, allows to achieve an increase in emotional tone in lethargic, asthenic patients, who sometimes have lost faith in recovery, create a therapeutic perspective for them, outline a specific plan for returning to work.

In this aspect, the use of occupational therapy is also important, which, on the one hand, has an activating, training effect, contributing to the restoration of professional skills lost or reduced as a result of illness, on the other hand, it has a psychotherapeutic value, creating a real prospect for the patient to return to work. activities.

Thus, in the program of rehabilitation measures, it seems an organic combination of biological and psychosocial methods already at the early stages of rehabilitation treatment. With the improvement of the physical condition of a patient who has suffered a serious illness or injury, leaving consequences in the form of certain defective functions, it becomes necessary to further restore patients in the surrounding social environment, in the workforce. The leading role here is acquired by medical and social forms of rehabilitation, in which various methods of influencing the personality of the patient are used in order to create in him a sober attitude towards the defect that has arisen as a result of the disease, which has reduced his ability to work. In parallel, ways are being sought to most effectively compensate for the defect in order to adapt to the performance of the previous work, or to master new, easier labor processes. From the point of view of means correcting the defect, orthopedic care for patients, various forms of prosthetics, including the creation of working prostheses, which allow patients to adapt to the previous or other available work activities, are of great importance. At the same time, a whole complex of various purely social problems arises - issues of pension provision, the supply of special vehicles for patients with lesions of the lower extremities, household equipment, including housing, concern for creating an adequate attitude towards the patient (disabled person) in the family, in the work team, organization leisure in order to maintain the necessary emotional tone. The solution of such a multifaceted problem as rehabilitation requires the doctor and all medical personnel involved in this area to study all those life difficulties that may arise for a patient who has had a serious illness. At the same time, in addition to the physiological, the psychological state of the patient, his social and economic conditions are taken into account. Only when using all the possibilities of influencing the processes of recovery and compensation, the ultimate goal is achieved - the return of the patient to society as a full-fledged citizen. Limiting rehabilitation to its first link - restorative treatment - does not achieve the main task of this problem and detracts from the work that is expended on treating a patient in the acute and early residual periods of the disease.

An important condition for achieving full-fledged rehabilitation is the observance of its basic principles when building a program of rehabilitation measures. Already at the earliest stages of rehabilitation, it is necessary to put into practice the principle of partnership between the doctor and the patient. Compliance with this principle allows for targeted psychological preparation of the patient for rehabilitation treatment, the success of which depends largely on the degree of activity of the patient himself. Meanwhile, patients who have suffered a severe life shock due to illness or injury after prolonged bed rest in the acute period of the disease often find it difficult to adjust to the need to switch from passive to active forms of treatment. The inclusion of such seriously ill patients in an active struggle with the disease is possible only with constant support and guiding advice from the doctor, who deeply penetrates into all his life problems and provides him with effective assistance in overcoming them. In the implementation of this responsible position of rehabilitation, an important link is the nursing staff, who, directly communicating with the patient, must be aware of all the life circumstances of the patient and strive to support his will to overcome the difficulties that have arisen in connection with the disease.

The principle of cooperation between the patient and medical personnel with the leading and guiding role of the latter contributes to the active involvement of the patient in the recovery process. A significantly higher productivity of rehabilitation treatment was noted if the patient had a conscious attitude to recovery, his active cooperation with the staff and the involvement of family members who, having received the appropriate attitudes from the doctor, can have an effective influence on the patient both in terms of his activation in treatment, and in the further creation of favorable living conditions. To implement the principle of partnership, it is important to study the characteristics of the patient's personality. At the same time, it is necessary to take into account the characteristics of the premorbid (premorbid) state of the patient, which makes it possible to identify the degree of those changes in the structure of the personality that developed as a result of the disease (or were a reaction to the disease) and exert an appropriate corrective effect on them. The study of the personality of patients is carried out by methods of clinical and experimental psychological research. Clinical and psychological methods include methods based on information obtained through direct contact of a doctor, psychologist, or nursing staff with a patient, his relatives during clinical observation, conversations. Experimental methods complement and reinforce the data of clinical and psychological research, they are carried out using special techniques. Along with a doctor and a psychologist, nurses may be involved in conducting experimental psychological research in rehabilitation institutions.

The psychological contact that is established between the patient and the medical staff allows, on the one hand, to outline the most effective ways of recovery, on the other hand, to diversify them, taking into account the individual characteristics of the patients. The principle of partnership requires great tact, endurance, delicacy on the part of medical personnel. Only when mutual trust is established between the patient and medical personnel can significant success be achieved in the rehabilitation treatment and further rehabilitation of patients.

In connection with the need to involve the patient in active participation in rehabilitation activities, it is mandatory to establish close contact between patients and the attendants of the rehabilitation department, and first of all, paramedical workers. Such contact is achieved through a constant thoughtful, attentive attitude of the department staff to all the problems relevant to the patient, not only purely medical, but also in a wider area of social relations, including family, professional aspects, retraining, employment, contacts with colleagues, etc. e. Such a deep penetration into the interests of the patient implies a more active role of the nursing staff of the rehabilitation department compared to the functions performed by nurses in ordinary hospitals or polyclinics: they cease to be only a passive executor of the attending physician's prescriptions and become his active assistant, taking part in the development and implementation a specific program for restoring the patient's social position in society. The peculiarity of the approach to patients in the process of rehabilitation treatment requires special versatile training of nursing staff. To this end, in rehabilitation departments, doctors organize classes on the basics of medical psychology, psychotherapy, and medical deontology. This allows you to create a system of relations between the patient and the staff that meets the basic principles of rehabilitation and facilitate the organization of appropriate regimens.

To implement a full-fledged rehabilitation program, it is necessary to implement the principle of versatility of efforts, which provides for taking into account all aspects of the problem of rehabilitation for each individual patient. Its basis is the implementation of medical-pedagogical and medical-rehabilitation tasks, subject to the restructuring of the relationship of the patient's personality in the direction necessary for rehabilitation purposes.

The third principle is the unity of psychosocial and biological methods of influence. Directed impact on the personality of the patient does not detract from the importance of the clinical side of rehabilitation. At the same time, one of the main conditions is the complexity of the application of medical and rehabilitation measures. Their choice is determined by the clinical characteristics of the underlying disease, the severity of violations of various functions, the characteristics of the patient's personality and the nature of reactive experiences. Understanding the physiological and pathophysiological essence of the disease and its complications makes it possible to exert a regulatory influence on the processes of recovery, adaptation and compensation. The complexity of rehabilitation measures, therefore, provides for a system of pathogenetically substantiated combined effects of various therapeutic methods not only on the defective function, but also on the underlying pathological process, as well as on the patient's personality in order to mobilize its resources to correct pathological reactions to the disease and related neuropsychiatric disorders.

Compliance with the basic principles of rehabilitation, in turn, puts forward the task of individualizing treatment programs, differentiated in accordance with the above criteria.

To draw up adequate individual rehabilitation programs, it is important to correctly assess the physical and mental state of the patient, taking into account the restrictions that the underlying disease and its consequences impose on treatment, as well as concomitant diseases. At the same time, the existing contraindications to active restorative treatment should be borne in mind. It is important to draw up a program that would take into account the real possibilities of the patient and contribute to the most rapid onset of certain successes, thereby inspiring him to further treatment, with a corresponding increase in workload. The composition of individual rehabilitation measures varies in accordance with the clinical manifestations of the disease and the psychological characteristics of patients.

Combinations of restorative treatment methods cannot be stable and change in accordance with the dynamics of the patient's functional state. This provision is a prerequisite for the stage-by-stage appointment of remedial measures, which is formulated as the fourth principle - the gradation (transition) of the impacts.

In addition to the gradual transition from one method of treatment to another, this refers to the creation of special transitional regimens. The principle of grading served as the basis for delimiting the system of rehabilitation measures into 3 main stages.

The first stage - restorative therapy - involves the use of measures that prevent the development of a defect, disability, as well as the elimination or reduction of these phenomena. At the first stage, the psychological preparation of the patient for rehabilitation treatment is carried out, an action plan is drawn up that corresponds to the nature of the disease, the severity of the defect, taking into account the psychological characteristics of the patient, his professional experience before the illness, his intra-family relationships, etc. Patients who have severe physical defects, especially motor , respectively, medical procedures are prescribed, aimed at restoring elementary movements. At the same time, already at this stage, the patient must train self-service and professional skills, in order to cultivate a focus on achieving its final goals from the very initial period of rehabilitation - adaptation to full-fledged life and active work. Taking into account the unfinished pathological process, against the background of which certain dysfunctions occurred, the significant severity of the latter, at the first stage, biological, including medicinal forms of treatment still occupy a significant place in the recovery complex. The selection of medications and other therapeutic effects is based on the data of an objective study of the patient, which should be comprehensive, carried out according to a certain scheme and, in addition to clinical, includes various instrumental methods and experimental psychological studies.

The second stage, denoted by readaptation, provides for the adaptation of the patient to environmental conditions. At this stage, psychosocial methods are dominant. Psychotherapy is widely used as a method of mediating and potentiating all other restorative measures. As the activity of patients increases, group forms of psychotherapy become leading. In patients with persistent disorders of certain functions, purposeful autogenic training is used.

Special educational work is carried out with patients and their relatives in order to create correct intra-family relations after the patient returns from the hospital. A particularly important place is given to occupational therapy, which in the conditions of a rehabilitation hospital should contribute to the training of retained professional skills, the restoration of lost ones, labor training and retraining if it is impossible to compensate for a professional defect.

At this stage, occupational therapy is mainly carried out in specially equipped labor workshops. The complex of occupational therapy for patients with significant movement disorders includes the restoration and training of self-care skills.

The second stage is characterized by an increase in the volume and expansion of the tasks of other restoration activities. Physical therapy classes, as general motor skills improve, include training complex motor acts in defective limbs, coordination exercises, learning and training self-service skills that allow patients to be completely freed from caring for them after discharge. In addition to targeted gymnastic exercises, the complex of physical therapy includes sports games, swimming, outdoor walks, and skiing. Group physiotherapy exercises are the leading form at the second stage. Individual classes are held with patients who have significant defects in certain functions. As motor skills are revived and local defects are corrected, patients are more widely involved in employment therapy and various cultural events (watching movies, attending concerts, etc.). Physiotherapy and massage are used depending on clinical indications. Drug therapy is predominantly corrective in nature.

The third stage is rehabilitation in the truest sense of the word. The tasks of this stage are the everyday adaptation of patients, professional orientation and the restoration of their premorbid (premorbid) social position in the family and society as a whole. The activities of the third stage are predominantly social in nature, they are carried out after the patient is discharged from the rehabilitation hospital.

Disabled patients with severe physical defects are included in domestic work, those with less severe functional impairments perform socially useful work at home, in medical and industrial workshops, in special workshops for disabled people at work. Persons who have well restored or compensated for defective functions return to work in their former profession. In order to maintain the general and emotional tone of the patient, restore and train impaired functions, patients continue systematic exercise therapy at home with periodic repeated courses of directed therapeutic exercises according to indications in the clinic. Drug and physical therapy - preventive and supportive. At this stage, an important part of the rehabilitation program is dispensary observation of patients, home visits, and work with relatives. A responsible role in out-of-hospital forms of rehabilitation belongs to the nursing staff.

Out-of-hospital work involves visiting patients by special patronage nurses, whose duties are to establish close contact with the patient's relatives, to assist them in the correct organization of the patient's daily routine at home. Nurses assist in drawing up the daily routine, the list of duties assigned to the patient, and the correct distribution of the workload. Patronage nurses also carry out examination of patients in the conditions of production activities. The work of a patronage nurse is that link in the rehabilitation system that contributes to the restoration of the patient's social and social value. It is the responsibility of the medical staff of rehabilitation institutions at the out-of-hospital stage to organize the correct attitude towards patients on the part of those around them, not only in the family, but also in the former work team. Cultural therapy retains its significance even after discharge from the hospital. At the out-of-hospital stage, its forms should be diversified. Club work, in particular, is of great importance. In the conditions of a club organized for patients, there is an opportunity for them to communicate with each other, organize outdoor activities, walks, various forms of extra-labor employment in the form of circle work, lectures, visits to theaters, cinemas, etc. It is advisable to organize a club for patients at a polyclinic rehabilitation department, where patients could simultaneously receive the necessary medical advice.

Rehabilitation treatment can be carried out for all patients, however, its level and the degree of permissible load is determined by the clinical condition of the patient. Therefore, when referring patients to a rehabilitation hospital and drawing up an individual program of rehabilitation measures, factors affecting their effectiveness should be taken into account. The age of patients is important for the outcome of rehabilitation treatment, the latter proceeds more successfully in younger people, after 50 years the effectiveness of rehabilitation treatment decreases. The nature of the course of the underlying disease (vascular process, infection, etc.) and the severity of the damage caused by it matter. In severe forms of vascular, traumatic, inflammatory lesions, the indicators of restorative treatment are significantly lower than in persons with a compensated course of the underlying disease. Recovery of defective functions is directly dependent on their initial severity. The effectiveness of rehabilitation is reduced in the presence of a combined impairment of various functions: for example, a combination of motor disorders with speech disorders, a violation of the muscular-articular feeling. Secondary complications worsen the prognosis of rehabilitation (arthralgia, contractures, bedsores), mental disorders, concomitant somatic diseases. The age of the formed defect is less important for the outcome of rehabilitation. The effectiveness of rehabilitation is influenced by the characteristics of the personality of patients and the activity of their participation in rehabilitation measures, which should be taken into account when drawing up a treatment plan.

Thus, the system of therapeutic measures, based on the main principles of rehabilitation, allows you to restore not only physical health, but also the social and labor status of patients in society. In the process of complex, differentiated, individually selected rehabilitation treatment, not only the nature of the disease process and its consequences is taken into account, but also the characteristics of each patient as a person for whom the disease creates new life problems that require assistance in resolving them. Such an approach to the preparation of a rehabilitation program contributes to the most complete functional compensation, which ensures the return to the labor system even for people with severe physical defects.

All the described activities have the ultimate goal of restoring the social and labor status of the patient. Limitation of restorative measures by influencing the defective function does not solve the main problem of rehabilitation and reduces its effectiveness.

A large role in the organization and implementation of medical and rehabilitation measures is given to paramedical personnel. A correct understanding and fulfillment of the tasks and duties assigned to him contributes to a more effective rehabilitation of patients.

To ensure full-fledged rehabilitation, the work of medical personnel is not limited to the hospital, it also extends to the out-of-hospital area. Assistance to the patient in adapting to work and life is a responsible and important task that ensures the achievement of the ultimate goal of rehabilitation.

Demidenko T. D., Goldblat Yu. V.

"Rehabilitation measures for diseases of the nervous system" and others