May exacerbate existing dysfunction. On the ambiguities in the criteria for determining the degree of violations of body functions during the MSE. Criteria for establishing the degree of limitation of the ability to work

For the purposes of military medical expertise, a classification of the degrees of arterial hypertension (VNOK, 2010) and a three-stage classification of hypertension (WHO, 1996, VNOK, 2010) are used, depending on the degree of dysfunction of the "target organs".

Item "a" refers to stage III hypertension, which is characterized by high blood pressure (at rest - systolic pressure is 180 mm Hg and above, diastolic - 110 mm Hg and above), confirmed, among other things, by the results daily monitoring of blood pressure. Blood pressure readings may be reduced in people who have had a myocardial infarction or stroke. The clinical picture is dominated by severe vascular disorders that are closely and directly related to the syndrome of arterial hypertension (large-focal myocardial infarction, dissecting aortic aneurysm, hemorrhagic, ischemic strokes, generalized narrowing of the retinal arteries with hemorrhages or exudates and edema of the optic nerve papilla, with impaired renal function with serum creatinine level more than 133 µmol/l and (or) creatinine clearance less than 60 ml/min (Cockcroft-Gault formula), proteinuria more than 300 mg/day.

If the diagnosis of stage III hypertension is established only in connection with a minor stroke and (or) small-focal myocardial infarction, military personnel undergoing military service under the contract are examined under paragraph "b".

Item "b" refers to stage II hypertension with arterial hypertension of the II degree (at rest - systolic pressure is 160 mm Hg and above, diastolic - 100 mm Hg and above), which does not reach optimal performance without a permanent drug therapy, confirmed, among other things, by the results of repeated daily monitoring of blood pressure and moderate impairment of the function of "target organs".

The clinical picture of stage II hypertension with moderate dysfunction of "target organs" is dominated by vascular disorders that are not always closely and directly related to hypertensive syndrome (myocardial infarction, persistent heart rhythm and (or) conduction disturbances, the presence of atherosclerotic changes in the main arteries with moderate dysfunction, etc.). In addition, cerebral disorders are possible - hypertensive cerebral crises, transient ischemic attacks or stage II dyscirculatory encephalopathy with motor, sensory, speech, cerebellar, vestibular and other disorders, as well as angina pectoris II FC and (or) chronic heart failure II FC.

Point "c" refers to stage II hypertension with arterial hypertension of I - II degree (at rest - systolic pressure is from 140 to 179 mm Hg, diastolic - from 90 to 109 mm Hg) with a slight dysfunction "target organs" (chronic heart failure I FC, transient disturbances in heart rhythm and (or) conduction, dyscirculatory encephalopathy stage I) or without impaired function of "target organs", as well as stage I with elevated blood pressure (at rest systolic pressure ranges from 140 to 159 mm Hg, diastolic - from 90 to 99 mm Hg). At stage I of hypertension, a short-term increase in blood pressure to higher numbers is possible. There are no signs of target organ damage.

Stage II hypertension is also characterized by left ventricular hypertrophy (detected by X-ray examination (cardiothoracic index > 50 percent), electrocardiography (Sokolov-Lyon sign > 38 mm, Cornell product > 2440 mm x ms), echocardiography (left ventricular myocardial mass index > 125 g / m2 for men and > 110 g / m2 for women) and 1 - 2 additional changes in other "target organs" - the vessels of the fundus (generalized or local vasoconstriction of the retina), kidneys (microalbuminuria 30 - 300 mg / day ., proteinuria and (or) creatinine level 115 - 133 μmol / l for men and 107 - 124 μmol / l for women; creatinine clearance 60 - 89 ml / min (Cockcroft-Gault formula) and main arteries (signs of thickening of the artery wall ( the thickness of the "intima-media" complex) during ultrasound examination is more than 0.9 mm) and (or) atherosclerotic plaques in them).

In the presence of a syndrome of high blood pressure, closely associated with the presence of vegetative disorders (hyperhidrosis of the hands, "red" persistent dermographism, lability of the pulse and blood pressure with a change in body position, etc.), the examination is carried out on the basis of article 47 of the disease schedule.

The presence of hypertension in persons examined according to columns I, II of the disease schedule must be confirmed by an examination in a hospital and the results of a documented previous dispensary observation for at least 6 months with the obligatory repeated daily monitoring of blood pressure.

In each case of hypertension, a differential diagnosis with symptomatic hypertension is carried out. Examination of persons with symptomatic arterial hypertension is carried out according to the underlying disease.

When identifying diseases associated with hypertension, a medical examination is also carried out on the basis of the relevant articles of the disease schedule.

The manual outlines the general aspects of arthrology (the structure and function of the joints, the classification of major joint diseases, the methods of diagnosis and therapy of joint diseases, the assessment of joint dysfunction), the features of the clinic, diagnosis, differential diagnosis of the most common osteoarticular pathology - osteoporosis, osteoarthritis, rheumatoid arthritis , ankylosing spondylitis, psoriatic arthritis, gout, paraneoplastic arthritis and periarticular lesions. The book reflects the features of articular pathology in old age. Modern literature data and a description of one's own experience of using traditional and non-traditional methods of pathogenetic therapy of the pathology under discussion are given, as well as the basics of medical and social expertise in diseases of the joints.

Book:

The severity of the violation of statodynamic function in the pathology of the musculoskeletal system

Moderate disturbances of statodynamic function are diagnosed in patients with moderate or severe joint contracture (decrease in range of motion by 21–34%), which, as a rule, is combined with damage to other joints and the spine without neurological manifestations. Constant, varying degrees of severity, lameness. When walking, the patient uses the support, but not constantly, without rest he can walk up to 1-1.5 km. Reducing the circumference of the thigh due to muscle hypotrophy by 3–5 cm. Reducing the pace of walking to 45–55 steps per minute.

For a pronounced violation of the statodynamic function, pronounced or significantly pronounced contractures of the joints (the amplitude is reduced by 35% or more), and dysfunction of the spine are characteristic. Patients are forced to constantly use additional support: a cane or crutches. Severe lameness, without rest you can walk 0.5 km. Reducing the circumference of the thigh due to muscle wasting up to 6 cm or more. Decreasing the pace of walking to 25-35 steps per minute.

Significantly pronounced violation of the statodynamic function is determined with a sharp violation of the function of the joints with difficulty in changing posture, when trying to get out of bed or chair on their own. It is possible to move with the help of other persons or in a wheelchair.

The kidneys are an important paired organ of the human urinary system. Despite their small size (the size of a fist), they perform two main vital functions. The first is the absolute filtration of blood and fluid from unnecessary substances, the second is its removal from the body simultaneously with harmful products and toxins. Violation of the kidneys can lead to serious pathologies and diseases. In order to prevent such consequences, it is necessary to understand the principle of operation of the mechanism, the causes of failure, symptoms and diagnostics, and also learn how to normalize the functioning of the system.

Causes of poor kidney function

Kidney dysfunction can be observed for various reasons, ranging from congenital to acquired. A congenital disorder is most often found in the hereditary transmission of the disease from mother to child or in violation of the formation of an organ at the time of intrauterine development.

On a note! Acquired pathologies are influenced by a lot of reasons, for example, lifestyle or other diseases that a person has.

The main and frequently encountered causes include the following causes that provoke and cause severe violations of kidney function:

1. Alcohol abuse. Alcohol contributes to dehydration of the body, from which the blood begins to thicken. As a result, the body receives an enormous load and is forced to work in emergency mode.
2. Smoking. Due to the fact that toxic substances enter the human body along with tobacco smoke, the kidneys are forced to take on a double blow and accelerate their performance in order to quickly purify the blood.
3. Obesity. People suffering from such a problem are more at risk of dysfunction, because certain components begin to form and release from excess fat tissue, which lead to a decrease in vascular tone. At this time, excess fat contributes to mechanical pressure on the organs of the urinary system, making it difficult to perform basic duties.
4. Rapid weight loss. Since the kidneys are located in a protective capsule of fat, a sharp weight loss leads to a thinning of this layer, which makes it vulnerable to external factors.
5. hypothermia. A common cause of acute
6. Diabetes. The exhaustion of the system leads to a large load due to high blood sugar.
7. Hypertension. High pressure has an unfavorable effect on the state of the renal vessels, from which they are damaged and lead to disruption of the entire urinary system.
8. Unhealthy food. Fast food, processed foods and soda are the main health pests.
9. Conducting a promiscuous sexual life. Without the use of contraceptive methods, incoming infections affect the entire existing system and lead to inflammation of the paired organ.
10. Late pregnancy. In the literal sense of the word, the kidneys do the work for two, hence the overload occurs, the expectant mother suffers from dysfunction and edema.

Manifested symptoms in dysfunction of the urinary system

Each person knows his usual state, the nature of the discharge, and any change should raise questions and suspicions.

Why are the kidneys not working? The following signs of poor kidney function are distinguished:

1. Pain in the lumbar region.
2. High blood pressure. The fact indicates that the body can not cope with the withdrawal of salt and water. This item applies to those who do not have problems with pressure.
3. Sleep disturbance. Insomnia is a companion of the poor functioning of the paired organ, it can act in tandem with cessation of breathing during sleep.
4. Apathy, loss of energy, lethargy. This is due to an increase in toxins in the blood vessels.
5. Deterioration of the skin condition. Paleness and dryness of the skin indicate a change in the condition of the kidneys, as the water and salt balance is disturbed.
6. Modification of the mode of urination. There is an increase or decrease in the amount of urine excreted.
7. The presence of blood in the urine.
8. Presence of foam. In connection with renal failure, it is revealed from which bubbles and foam form.
9. Decreased appetite, nausea and vomiting. These signs are justified by high intoxication.
10. puffy look. Caused by excess fluid and loss of protein.
11. muscle cramps. This happens due to the deprivation of the body of potassium and sodium.
12. Swelling of the legs.

Symptoms of kidney disease are expressed by a number of signs, and it is not always possible to predict their sequence. According to statistics, kidney pathologies are observed among 3.5% of the population.

Consequences of impaired renal function

If the kidneys do not work well, then the problem must be solved urgently and radically in order to prevent disastrous consequences. Some of them include:

1. Renal failure. It represents a complete or partial loss of the ability to form and excrete the urine produced. Hence, there are violations of the balance of water, salt, acid and alkali, from which other systems in the body are disturbed. It is customary to distinguish between acute and chronic kidney failure. The first is characterized by a sudden manifestation, namely the absence of urine. The second is a gradual decrease in the urinary portion to the absence.
2. Due to the problematic production of secreted fluid, the body is forced to accumulate toxins, which is fraught with poisoning by the products of its own vital activity. All this eventually kills an important organ. As soon as the work comes to naught, the patient loses his life.
3. Change in the shape of the ureters. The usual outflow of urine from the body is disturbed, toxic poisoning appears, decomposition of the kidneys and, as a result, the organ refuses to function.
4. In pregnancy, the importance of treatment is highest due to the risk of natural termination of pregnancy.
5. There is a high probability of acquisition, which delivers pronounced discomfort to the owner.
6. Spontaneous or.
7. Due to the presence of unnecessary impurities in the blood, the susceptibility to diseases such as and increases.
8. If treatment is ignored, then urine will stop flowing into the bladder. The body will not self-purify itself of toxins and waste products formed.

On a note! In order to avoid these consequences, you should carefully listen to the slightest changes in your body.

Diagnosis of the functioning of the kidneys

What to do with poor kidney function or what to do if

Recommendations for the treatment of diseases of the urinary system

It is worthwhile to deal with the treatment of kidney diseases under the supervision of experienced and qualified doctors who will know the characteristics of the patient's body. However, you can improve their condition on your own by following some recommendations:

1. Limit the consumption of salt, meat and exclude canned food, fast food.
2. Watch your weight, giving preference to a healthy diet.
3. Include more liquid in the diet in the form of water, tea, compote.
4. Give up bad habits and limit alcohol consumption.
5. Connect physical activity. If visiting the gym is impossible for any reason, then walking, refusing the elevator will be an excellent substitute.
6. Limit the use of painkillers.
7. Use protective agents against heavy metals, paints and solvents.
8. Dress warmly to avoid hypothermia.
9. Monitor your blood pressure, sugar and cholesterol levels.
10. Regularly take basic tests to monitor a healthy state.

1. Violation of psychological functions: perception, attention, thinking,

speech, emotions, will;

2. Violation of sensory functions: vision, hearing, smell, touch;

3. Violation of statodynamic functions: motor functions of the head, trunk, limbs, statics, coordination of movements;

4. Violation of the function of blood circulation, respiration, digestion, excretion,

metabolism and energy, internal secretion;

5. Disorders of language and speech functions: impaired oral speech (rhinolalia, dysarthria, stuttering, alalia, aphasia), written speech (dysgraphia, dyslexia), verbal and non-verbal speech, impaired voice formation.

6. Violations caused by physical deformities: external deformity (deformities of the face, head, trunk, limbs), abnormal openings of the excretory tracts (digestive, urinary, respiratory), violation of body size.

7.2.Classification of the main categories of life

1. Ability to self-service - the ability to independently satisfy basic physiological needs, perform daily household activities, and exercise personal hygiene;

Ability to move independently - the ability to move in space, overcome an obstacle, maintain body balance;

Ability to learn - the ability to perceive and reproduce knowledge (general educational, professional, etc.), mastering skills and abilities (social, cultural and household).

4. Ability to work - the ability to carry out activities in accordance with the requirements for the content, volume and conditions of work.

5. Ability to orientation - the ability to be determined in time and space.

6. Ability to communicate - the ability to establish contacts between people through the perception, processing and transmission of information

The ability to control one's behavior is the ability to self-awareness and adequate behavior, taking into account social and legal norms.

7.3. Classification of body dysfunctions according to severity

1 degree - minor or moderate dysfunction;

Grade 2 - severe functional impairment;

3 degree - significantly pronounced dysfunction.

7.4. Criteria for establishing the degree of limitation of the ability to work

Ability to work includes:

The ability of a person to reproduce special professional knowledge, skills and abilities in the form of productive and efficient work;

The ability of a person to carry out labor activities at a workplace that does not require changes in sanitary and hygienic working conditions, additional measures for the organization of labor, special equipment and equipment, shifts, pace, volume and severity of work;

The ability of a person to interact with other people in social and labor relations;

Ability to motivate work;

Ability to follow a work schedule;

The ability to organize the working day (organization of the labor process in time sequence).

Evaluation of indicators of the ability to work is carried out taking into account the existing professional knowledge, skills and abilities.

The criterion for establishing the 1st degree of limitation of the ability to work is a health disorder with a persistent moderately pronounced disorder of the body's functions, caused by diseases, the consequences of injuries or defects, leading to a decrease in the qualifications, volume, severity and intensity of the work performed.

With the I degree of limitation of the ability to work, a citizen cannot continue to work in the main profession, but can perform other types of work of a lower qualification under normal working conditions:

When performing work under normal working conditions in the main profession with a decrease in the volume of production activity by at least 2 times, a decrease in the severity of labor by at least two classes;

When transferring to another job of lower qualification under normal working conditions due to the inability to continue working in the main profession.

The criterion for establishing the 2nd degree of limitation of the ability to work is a health disorder with a persistent pronounced disorder of body functions caused by diseases, consequences of injuries or defects, in which it is possible to perform labor activities in specially created working conditions, using auxiliary technical means and (or) with the help of other persons.

The criterion for establishing the 3rd degree of limitation of the ability to work is a health disorder with a persistent, significantly pronounced disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a complete inability to work, including in specially created conditions, or contraindications to work.

Violation of the staticodynamic function of the hip joint

1. A mild disorder is characterized by a slight limitation of mobility in the joint, a slight (2-3 cm) relative shortening of one of the limbs if the patient has residual subluxation or dislocation. Radiographically, there may be signs of precoxarthrosis, coxarthrosis of stages 1 and 2.

A) In the stage of pain compensation. Lameness is practically absent, a slight symptom of Trendelburg, a slight decrease (up to 4 points) in muscle strength can be determined. If shortening is noted, it is completely compensated by the pelvic tilt. Support loads on both limbs are equal or there is a slight decrease (up to 45%) of support on the affected leg. The coefficient of rhythm is 1.0.

B) In the stage of subcompensation, there is a pain syndrome during physical exertion, a decrease in reliance on the diseased limb up to 40%, usually accompanied by a decrease in the rhythmicity coefficient to 0.89-0.8 and slight lameness of the patient during long walking, which decreases after rest and taking painkillers. Trendelburg's symptom is mild to moderate, that is, the main compensatory mechanisms are aimed at unloading the diseased limb.

C) There is no stage of decompensation.

2. Moderate impairment of the staticodynamic function is characterized by a limitation of the range of motion in the hip joint in the sagittal plane of up to degrees or a limitation of extension to 155 degrees, limitation of abduction and rotational movements; moderate shortening of at least one of the limbs, x-ray instability of the hip joint and (or) x-ray signs of stage 1-3 coxarthrosis.

A) The stage of compensation is characterized by the same signs as with a slight violation of the staticodynamic function.

B) In the stage of subcompensation, in addition to the above changes, there is a moderate (2-3 cm) hypotrophy of the muscles of the thigh and lower leg, a decrease in muscle strength up to 3 points. The skew and inclination of the pelvis compensates for the shortening of the limb by 2-3 cm. Patients are forced to use additional means of support (cane). Compensatory increased lumbar lordosis of the spine. Perhaps the development of compensatory scoliosis, the initial stages of secondary osteochondrosis and arthrosis in the adjacent joint.

C) In the stage of decompensation, the support ability of the affected limb sharply decreases with a decrease in the support load of less than 40%, which is associated with incomplete compensation of shortening, skew and inclination of the pelvis. Lameness, as a rule, is pronounced, combined with a unilateral lesion with a decrease in the rhythm coefficient to 0.8 or less. Patients can use supportive aids when standing and walking. It is possible to develop secondary osteochondrosis with radicular and pain syndrome, changes in the axis of the lower extremities (most often valgus deformity of the knee joints). The strength of the thigh muscles decreases to 2-3 points, hypotrophy of the muscles of the thigh and lower leg is pronounced (more than 3 cm).

3. A pronounced violation of the staticodynamic function is characterized by limited mobility (less than 30 degrees) in the sagittal plane in the hip joint or by placing the limb in a flexion position at an angle of less than 155 degrees, which leads to the appearance of a pronounced functional shortening (more than 6 cm), which is not fully compensated by the misalignment and pelvic tilt. Also characteristic is the development of adduction contractures with the installation of the limb at an angle of less than 90 degrees and the absence of rotational movements in the hip joint. A combination of clinical and radiological instability in one of the hip joints should also be attributed to a pronounced violation of the staticodynamic function.

A) The stage of compensation practically does not occur.

B) The stage of subcompensation is characterized by the same changes as with a moderate violation of the staticodynamic function.

C) The stage of decompensation, in addition to changes similar to that, with a moderate violation of the staticodynamic function, is characterized by a pronounced Trendelburg symptom, a decrease in muscle strength to 1-2 points, and persistent pain syndrome.

1. The nature of violations of static-dynamic functions

Auxiliary means of rehabilitation, such as support and tactile canes, crutches, supports, handrails, contribute to the performance of various statodynamic functions of a person: maintaining a person’s vertical posture, improving stability and mobility by increasing the additional support area, unloading a diseased organ, joint or limb, normalizing weight loads, facilitate movement, maintain a comfortable position.

An assessment of the ability to maintain a vertical posture is carried out using special devices and certain parameters that characterize the process of standing, an analysis of their changes under external and internal influences on a person. This approach underlies the methods of stabilography, cephalography, etc.

The method of stabilography is to register and analyze the parameters characterizing the movement of the horizontal projection of the common center of mass (MCM) of a standing person.

The body of a standing person continuously oscillates. The movements of the body while maintaining an upright posture reflect various responses to the control of muscle activity. The main parameter by which the regulation of muscle activity occurs is the movement of the human BCM.

Stabilization of the position of the CCM is carried out due to the stabilization of the body, which in turn is provided on the basis of processing information about the position and its movement in space due to the receipt of information by the visual, vestibular, proprioceptive apparatus.

Another technique - cephalography - is the recording and analysis of head movements when standing. This technique is widely used in clinical practice.

Changes in the vestibular apparatus significantly disrupt the provision of a vertical posture and are manifested in a change in the nature of the cephalogram, stabilogram, and body movements aimed at maintaining a vertical posture.

In this condition of a person, an increase in the additional area of ​​\u200b\u200bsupport is required due to auxiliary means of rehabilitation.

In addition to violations of statistical functions, there are violations of the walking function of a person with lesions of the musculoskeletal system.

Clinical indicators of such violations of the musculoskeletal system are:

Limited mobility in the joints, severity and type of contracture;

Hypotrophy of the muscles of the lower extremities.

The presence of shortening of the lower limb (LL) significantly affects the structure of walking and stability when standing.

The stability of standing is characterized by the amplitude of oscillations of the common center of mass (MCM) and is slightly violated with a slight and moderate shortening of the NC. Even with a pronounced shortening of the NC, a slight and moderate violation of stability is noted. At the same time, there is no pronounced violation of the CCM fluctuations, which indicates the effectiveness of compensation mechanisms aimed at maintaining stability. The consequence of the shortening of the lower limb is the distortion of the pelvis. A shortening of more than 7 cm leads to significant changes in the static-dynamic functions. The study of such disorders is carried out using a special stand with a predominant distribution of the weight load on a healthy LE (more than 60% of body weight) using a shortened LE as an additional support with a pronounced metatarsal-toe standing.

Restriction in joint mobility is expressed primarily in dysfunctions in the hip, knee, ankle joints, foot, while a moderate and severe degree of violation of their function can be determined.

Hip joint (HJ)

Decreased range of motion up to 60º;

Extension - not less than 160º;

Decreased muscle strength;

Shortening of the lower limb - 7-9 cm;

Locomotion speed - 3.0-1.98 km / h;

Restriction of mobility in the form of a decrease in the amplitude of movement in the sagittal plane - at least 55º;

When unbending - at least 160º;

Severe flexion contracture - extension less than 150º;

Reducing the strength of the gluteal muscles and thigh muscles by 40% or more;

Locomotion speed - 1.8-1.3 km / h.

Knee joint (KS)

1. Moderate degree of dysfunction:

Flexion to an angle of 110º;

Extension up to 145º;

Decompensated form of joint instability, characterized by frequent pathological mobility with minor loads;

Locomotion speed - up to 2.0 km/h with severe lameness.

2. Severe degree of dysfunction:

Flexion to an angle of 150º;

Extension - less than 140º;

Locomotion speed up to 1.5-1.3 km/h, severe lameness;

Shortening of the step up to 0.15 m with a pronounced asymmetry of lengths;

Rhythm coefficient - up to 0.7.

Ankle joint (AHJ)

1. Moderate degree of dysfunction:

Limitation of mobility (flexion up to º, extension up to 95º);

Locomotion speed up to 3.5 km/h.

3. Pronounced degree of dysfunction:

Limited mobility (flexion less than 120º, extension up to 95º);

Locomotion speed up to 2.8 km/h.

Vicious position of the foot.

1. heel foot - the angle between the axis of the leg and the axis of the calcaneus is less than 90º;

2. equino-varus or equinus foot - the foot is fixed at an angle of more than 125º or more;

3. valgus foot - the angle between the area of ​​support and the transverse axis is more than 30º, open inwards.

4. valgus foot - the angle between the area of ​​support and the transverse axis is more than 30º, open outwards.

Hip and gluteal muscles suffer in hip joint pathology, thigh and shin muscles in knee joint (CS) pathology, leg muscle hypotrophy in ankle joint (AJ) pathology.

Hypotrophy of the muscles of the lower extremities, reflecting the state of the muscular system, has a certain effect on the structure of human walking, in particular, on the duration of the phases of support and transfer of the limbs, and with moderate and severe hypotrophy, a pronounced violation of time parameters is observed.

Muscle hypotrophy up to 5% is classified as mild, 5-9% - moderate, 10% - a pronounced degree of muscle strength reduction.

A decrease in the strength of the muscles of the flexors and extensors of the thigh, lower leg or foot of the affected limb by 40% in relation to the healthy limb is regarded as mild; 70% - as moderate, more than 700% - as pronounced.

Decrease in muscle strength during electromyographic (EMG)

studies, is characterized by a decrease in the amplitude of bioelectrical activity (ABA) by 50-60% of the maximum with moderate dysfunction.

With a pronounced impairment of the ABA function, it decreases significantly in the muscles of the distal extremities to 100 microvolts.

The choice of rehabilitation aids should be carried out individually for each patient, with the help of which he will be able to achieve relative independence (improvement of mobility in the apartment and on the street, self-service, participation in the production process, etc.).

Classification of the main types of violations of body functions in the establishment of disability

The main types of violations of the functions of the human body, which are determined by medical and social expertise, include:

Violations of mental functions (perception, attention, memory, thinking, speech, emotions, will);

Violations of sensory functions (vision, hearing, smell, touch, pain, temperature and other types of sensitivity);

Violation of static-dynamic functions (head, trunk, limbs, mobile functions, statics, coordination of movements);

Violations of the function of blood circulation, respiration, digestion, excretion, metabolism and energy, internal secretion, immunity, etc.;

Speech disorders (not caused by mental disorders), impaired voice formation, forms of language - impaired oral (rhinolalia, dysarthria, stuttering, alalia, aphasia) and written (dysgraphia, dyslexia), verbal and non-verbal speech;

Violations that cause distortion (deformity of the face, head, torso, limbs, leading to external distortion, abnormal defects in the digestive, urinary, respiratory tracts, violation of the size of the body).

The criteria of human life include the ability to self-service, movement, orientation, control of one's behavior, communication, training, performance of labor activity.

Mobility - the ability to move effectively in one's environment (walking, running, overcoming obstacles, using personal and public transport).

Evaluation parameters: the nature of walking, the pace of movement, the distance that the patient overcomes, the ability to independently use transport, the need for the help of others when moving.

The ability to self-service - the ability to effectively perform social and household functions and meet needs without the help of others.

Evaluation parameters: time interval after which the need for assistance arises: episodic assistance (less than once a month), regular assistance (several times a month), continuous assistance (several times a week - regulated or several times a day - unregulated assistance).

Orientation ability - the ability to independently navigate in space and time, to have an idea of ​​\u200b\u200bthe surrounding objects. The main orientation systems are vision and hearing (under the condition of a normal state of mental activity and speech).

Evaluation parameters: the ability to distinguish visual images of people and objects at a distance and in different conditions (presence or absence of obstacles, familiarity with the situation), the ability to distinguish sounds and oral speech (auditory orientation) in the absence or presence of obstacles and the degree of compensation for impaired auditory perception of oral speech in other ways (writing, non-verbal forms); the need to use technical means to guide and help others in various types of daily activities (at home, at school, at work).

The ability to communicate (communicative ability) - the ability to establish contacts with other people and maintain social relationships (disorders of communication associated with a disorder of mental activity are not considered here).

The main means of communication is oral speech, auxiliary - reading, writing, non-verbal speech (sign, sign).

Evaluation parameters: characteristics of the circle of persons with whom it is possible to maintain contacts, as well as the need for the help of other persons in the process of learning and working.

The ability to control one's behavior is the ability to lead in accordance with the moral, ethical and legal norms of the social environment.

Evaluation parameters: the ability to be aware of oneself and adhere to established social norms, identify people and objects and understand the relationship between them, correctly perceive, interpret and adequately respond to traditional and unusual situations, observe personal safety, personal hygiene.

Learnability is the ability to perceive, assimilate and accumulate knowledge, to form skills and abilities (everyday, cultural, professional, and others) in a purposeful learning process. The possibility of vocational training is the ability to master theoretical knowledge and practical skills and the ability of a particular profession.

Evaluation parameters: the opportunity to study in ordinary or specially created conditions (special educational institution or group, learning at home, etc.); scope of the program, terms and mode of study; the possibility of mastering professions of various qualification levels or only certain types of work; the need to use special tools with the assistance of others (except the teacher) persons.

Ability to work - a set of physical and spiritual capabilities of a person, which is determined by the state of health, which allows him to engage in various types of work.

Professional ability to work - the ability of a person to perform the work provided for by a specific profession, which allows to realize employment in a certain area of ​​production in accordance with the requirements of the content and volume of the workload, the established mode of work and the conditions of the working environment.

Violation of professional ability to work is the most common cause of social insufficiency, which can occur primarily when other categories of life activity are not violated, or secondarily on the basis of disability. The ability to work in relation to a specific profession for disabled people with restrictions on other life criteria can be fully or partially preserved or restored by means of vocational rehabilitation, after which disabled people can work in normal or specially created conditions with full or part-time working hours.

A conclusion on the inability to work is prepared only if the disabled person agrees (except when the disabled person is recognized as incapacitated).

Evaluation parameters: preservation or loss of professional suitability, the possibility of working in another profession, which is equal in qualification to the previous one, an assessment of the permissible amount of work in one's profession and position, the possibility of employment in ordinary or specially created conditions.

The degree of limitation of life activity is the amount of deviation from the norm of human activity. The degree of disability is characterized by one or a combination of several of the most important of its criteria.

There are three degrees of disability:

Moderately pronounced limitation of life activity is caused by violations of the function of organs and systems of the body, leading to a moderate limitation of the possibility of learning, communication, orientation, control of one's behavior, movement, self-service, participation in labor activity.

Expressed limitation of life activity is caused by a violation of the functions of organs and systems of the body and consists in a pronounced violation of the possibility of learning, communication, orientation, control of one's behavior, movement, self-service, participation in labor activity.

Significant life restriction occurs as a result of significant violations of the functions of organs or systems of the body, which leads to the impossibility or significant impairment of the ability or possibility of learning, communication, orientation, control of one's behavior, movement, self-service, participation in labor activity, and is accompanied by the need for outside care (outside help ).

A person who is recognized as disabled, depending on the degree of dysfunction of the organs and systems of the body and the restriction of her life, is assigned I, II or III disability group.

Disability group I is divided into subgroups A and B, depending on the degree of loss of health of the disabled person and the amount of need for constant outside care, assistance or care.

The criteria for establishing disability are defined by paragraph 27 of the Regulations on the procedure, conditions and criteria for establishing disability, approved by the Resolution of the Cabinet of Ministers of Ukraine dated December 3, 2009 N 1317.

The causes of disability are established in accordance with paragraph 26 of the Regulations on the procedure, conditions and criteria for establishing disability, approved by the Resolution of the Cabinet of Ministers of Ukraine dated December 3, 2009 N 1317.

When increasing disability groups due to a general illness, accident at work, occupational disease, injury, concussion, injury and other disease, in the event of a severe general illness, the cause of disability is established at the choice of the patient.

If one of the causes of disability is disability since childhood, MSEK in the conclusion on the examination of the disabled person indicates two causes of disability.

The re-commission of disabled people is carried out in accordance with paragraph 22 of the Regulations on the procedure, conditions and criteria for establishing disability, approved by the Resolution of the Cabinet of Ministers of Ukraine dated December 3, 2009 N 1317.

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DEGREES OF DISTURBANCE OF STATODYNAMIC FUNCTIONS OF THE HUMAN BODY IN PARESIS AND PLEGIA OF THE LIMB

Federal State Institution "Main Bureau of Medical and Social Expertise for the Samara Region", Samara, 2011

The generalized experience of neurological practice in developing standards for the correspondence between the degree of limb dysfunction in paresis and plegia and the degree of impairment of statodynamic functions is presented, which can be used in the practice of neurologists both in the service of medical and social expertise and in medical institutions.

Keywords: paresis of the limbs, plegia of the limbs, severity of disorders

In practice, each specialist in medical and social expertise, including a neurologist, is guided by the classifications and criteria used in the implementation of the medical and social expertise of citizens by federal state institutions of medical and social expertise, approved by order of the Ministry of Health and Social Development of the Russian Federation dated December 23, 2009 No. 1013n, which distinguish 4 degrees of severity of the main types of violations of body functions:

I degree - minor violations;

II degree - moderate violations;

III degree - severe violations;

IV degree - significantly pronounced violations.

Based on more than 20 years of neurological experience in institutions of medical and social expertise, the authors propose to use medical -social expertise following exemplary standards, presented in the form of tables (Tables 1-5).

Violations of statodynamic functions in upper mono- and paraparesis

The severity of violations of static-dynamic functions

Classifications of the main types of violations of the functions of the body and the degree of their severity

The degree of impairment of body functions is characterized by various indicators and depends on the type of functional disorders, methods for their determination, the ability to measure and evaluate results.

The following violations of the functions of the body are distinguished:

• disorders of mental functions (perception, attention, memory, thinking, intellect, emotions, will, consciousness, behavior, psychomotor functions)
• violations of language and speech functions (disorders of oral (rhinolalia, dysarthria, stuttering, apalia, aphasia) and written (dysgraphia, dyslexia), verbal and non-verbal speech, voice formation disorders, etc.)
• violations of sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity);
• violations of static-dynamic functions (motor functions of the head, trunk, limbs, statics, coordination of movements)
• visceral and metabolic disorders (functions of blood circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity)
• disorders caused by physical deformity (deformities of the face, head, torso, limbs, leading to external deformity, abnormal openings of the digestive, urinary, respiratory tracts, violation of body size)

Based on a comprehensive assessment of various parameters that characterize persistent dysfunctions of the human body, taking into account their qualitative and quantitative values, FOUR degrees of their severity are distinguished:

1 degree - minor violations

Grade 2 - moderate violations

Grade 3 - severe violations

Grade 4 - significant violations.

Disability leads to a limitation of life, i.e., to a complete or partial loss of the ability or ability to carry out self-service, move independently, navigate, communicate, control one's behavior, learn and engage in work activities.

In a comprehensive assessment of various indicators characterizing the limitations of the main categories of human life, 3 degrees of their severity are distinguished:

The ability to self-service - the ability of a person to independently fulfill basic physiological needs, perform daily household activities, including personal hygiene skills:

Grade 1 - the ability to self-service with a longer expenditure of time, the fragmentation of its implementation, reducing the volume, using, if necessary, auxiliary technical means

Grade 2 - the ability to self-service with regular partial assistance from other persons using, if necessary, auxiliary technical means

Grade 3 - inability to self-service, the need for constant outside help and complete dependence on other people

The ability to move independently - the ability to independently move in space, maintain body balance when moving, at rest and changing body position, use public transport:

1 degree - the ability to move independently with a longer expenditure of time, fragmentation of performance and a reduction in distance using, if necessary, auxiliary technical means

Grade 2 - the ability to move independently with regular partial assistance from other persons using, if necessary, auxiliary technical means

Grade 3 - inability to move independently and needing the constant help of others

Orientation ability - the ability to adequately perceive the environment, assess the situation, the ability to determine the time and location:

1 degree - the ability to orient only in a familiar situation independently and (or) with the help of auxiliary technical means

Grade 2 - ability to orientate with regular partial help of other persons using, if necessary, auxiliary technical means

Grade 3 - inability to orientate (disorientation) and the need for constant help and (or) supervision of other persons

Ability to communicate - the ability to establish contacts between people through the perception, processing and transmission of information:

1 degree - the ability to communicate with a decrease in the pace and volume of receiving and transmitting information; use of auxiliary technical aids, if necessary

Grade 2 - the ability to communicate with regular partial assistance of other persons using, if necessary, auxiliary technical means

Grade 3 - inability to communicate and the need for constant help from others

The ability to control one's behavior is the inability to self-awareness and adequate behavior, taking into account social, legal and moral and ethical standards:

1 degree - periodically occurring limitation of the ability to control one's behavior in difficult life situations and (or) constant difficulty in performing role functions affecting certain areas of life, with the possibility of partial self-correction;

2 degree - a constant decrease in criticism of one's behavior and the environment with the possibility of partial correction only with the regular help of other people;

3 degree - inability to control one's behavior, the impossibility of its correction, the need for constant assistance (supervision) of other persons;

Ability to learn - the ability to perceive, memorize, assimilate and reproduce knowledge (general educational, professional, etc.), mastering skills and abilities (professional, social, cultural, everyday):

1 degree - the ability to learn, as well as to receive education of a certain level within the framework of state educational standards in general educational institutions using special teaching methods, a special training mode, using, if necessary, auxiliary technical means and technologies;

2 degree - the ability to study only in special (correctional) educational institutions for students, pupils with developmental disabilities or at home according to special programs using, if necessary, auxiliary technical means and technologies;

Grade 3 - learning disability

The most important in medical and social expertise is the examination of a person's ability to work, while determining:

• a person's ability to reproduce special professional knowledge, skills and abilities in the form of productive and efficient work;
• the ability of a person to carry out labor activities at a workplace that does not require changes in sanitary and hygienic working conditions, additional measures for the organization of labor, special equipment and equipment, shifts, pace, volume and severity of work;
• the ability of a person to interact with other people in social and labor relations;
• ability to motivate labor;
• ability to follow the work schedule;
• ability to organize the working day (organization of the labor process in time sequence).

Evaluation of indicators of the ability to work is carried out taking into account the existing professional knowledge, skills and abilities.

The criterion for establishing the 1st degree of limitation of the ability to work is a health disorder with a persistent, moderately pronounced disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a decrease in qualifications, volume, severity and intensity of the work performed, the inability to continue working in the main profession if it is possible to perform other types of work of lower qualification in normal working conditions in the following cases:

• when performing work under normal working conditions in the main profession with a decrease in the volume of production activity by at least 2 times, a decrease in the severity of labor by at least two classes;
• when transferring to another job of lower qualification under normal working conditions due to the inability to continue working in the main profession.

The criterion for establishing the 2nd degree of limitation of the ability to work is a health disorder with a persistent pronounced disorder of body functions, caused by diseases, the consequences of injuries or defects, in which it is possible to perform labor activities in specially created working conditions, using auxiliary technical means and (or) with help of other persons.

The criterion for establishing the 3rd degree of limitation of the ability to work is a health disorder with a persistent, significantly pronounced disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a complete inability to work, including in specially created conditions, or contraindicated™ work activity .

Depending on the degree of deviation from the norm of human activity due to a violation of health, the degree of limitation of life is determined. In turn, depending on the degree of disability and the degree of impairment of body functions, a disability group is established. Criteria for establishing disability groups

The criterion for determining the FIRST GROUP OF DISABILITY is a violation of the health of a person with a persistent, significantly pronounced disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to the restriction of one of the following categories of life activity or their combination and causing the need for his social protection:

1. ability to self-service of the third degree;
2. ability to move the third degree;
3. ability to orientation of the third degree;
4. ability to communicate of the third degree;
5. the ability to control one's behavior of the third degree.

The criterion for establishing the SECOND GROUP OF DISABILITY is a violation of the health of a person with a persistent, pronounced disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to the restriction of one of the following categories of life activity or their combination and causing the need for his social protection:

1. ability to self-service of the second degree;
2. the ability to move the second degree;
3. ability to orientation of the second degree;
4. communication skills of the second degree;
5. the ability to control one's behavior of the second degree;
6. ability to learn the third, second degrees;
7. ability to labor activity of the third, second degrees.

The criterion for determining the THIRD GROUP OF DISABILITY is a violation of the health of a person with a persistent moderately pronounced disorder of body functions, caused by diseases, the consequences of injuries or defects, leading to a limitation of the ability to work of the 1st degree or limitation of the following categories of life activity in their various combinations and causing the need for social protection :

1. ability to self-service of the first degree;
2. mobility of the first degree;
3. ability to orientation of the first degree;
4. communication skills of the first degree;
5. the ability to control one's behavior of the first degree;
6. first grade learning ability.

The examination of childhood disability is based on the modern concept of WHO, which believes that the reason for the appointment of disability is not the disease or injury itself, but the severity of their consequences, which manifest themselves in the form of violations of one or another psychological, physiological or anatomical structure or function, leading to a limitation of life and social disadvantage.

Indications for the establishment of disability in children are pathological conditions arising from congenital, hereditary, acquired diseases or after injuries.

In accordance with the adapted version of the "International nomenclature of disorders, disabilities and social insufficiency", the category of children with disabilities includes children under 16 years of age who have a significant disability, leading to social maladaptation due to impaired development and growth of the child, loss of control over their behavior, ability to to self-service, movement, orientation, training, communication, work in the future.

Medical indications for determining disability in children include three sections:

section 1 - a list of pathological conditions leading to temporary limitation of life and social maladaptation of the child in severe but reversible disorders of the functions of organs and systems and giving the right to establish disability for a period of 6 months to 2 years;

section 2 - pathological conditions leading to partial limitation of life and social maladjustment of the child with the predicted possibility of full or partial restoration of impaired functions of organs and systems. There are two groups of pathological conditions: 2A - with the right to establish disability for a period of 2 to 5 years, i.e. re-examination is carried out every 2-5 years; 2B - with the right to establish disability for up to 5 years or more, i.e. re-examination is carried out no more than after 5 years;

section 3 - pathological conditions leading to a significant limitation of life and social maladjustment of the child with pronounced irreversible dysfunctions of organs and systems. A medical report on pathological conditions regulated by Section 3 is issued once until the age of 16.

The category of "disabled child" is determined in the presence of life restrictions of any category and any of the three degrees of severity (which are assessed in accordance with the age norm), causing the need for social protection.

Based on the expert decision of the ITU, a conclusion is drawn up in the form of an “ITU Certificate”, which is issued to a disabled person. The certificate indicates the group and cause of disability, labor recommendations, the deadline for the next re-examination. In addition to the certificates, the ITU sends a notice of the decision taken to the institution within three days.

In cases where the examined person does not agree with the decision made, he can submit a written application to the chairman of the ITU or the head of the district department of social protection within a month.

The degree of restriction of the main categories of human life is determined based on the assessment of their deviation from the norm, corresponding to a certain period (age) of human biological development.

The disability group is established for citizens over 16 years of age. Examination of children's disability does not provide for differentiation by groups. When identifying a disability under the age of 16, the concept of a “child with a disability” is used.