Carrying out rehabilitation activities. Complex of rehabilitation measures for disabled people. Work centers and family

Which help children with disabilities acquire the most fulfilling quality of life. The problematic nature of the issue is multifaceted.

Practical experience refutes the opinions of some doctors and teachers that such an effect is futile. Negative assessments are due to low awareness and lack of familiarity with innovative recovery systems for even neglected children. Such opinions must give way to painstaking and persistent work that will allow the baby to lead a normal life.

General concepts

If we consider the term from a medical point of view, its official interpretation will be slightly different. The complex concept implies that habilitation is:

• A multifaceted system of medical manipulations.
• Social support.
• Psychological help.
• Pedagogical and other events.

All manipulations are aimed at one goal - compensation for lost or impaired body function, stimulation of potential capabilities. A person must develop optimal adaptation skills in relation to society; during treatment, his social potential increases.

Habilitation is a set of measures that primarily applies to children born into the world with physical and mental disabilities. The manipulations of doctors, parents and teachers help develop a full-fledged personality of a child who has developed social potential. Such children are able to successfully realize themselves and exist in society among non-disabled children, and subsequently in adulthood.

Special organizations

Among the many social areas that exist in our country, a special place is occupied by those whose activities are aimed at solving issues of supporting people with disabilities. In many regions, habilitation centers are being created - specialized institutions that implement various methods for working with people with disabilities.

The role of institutions in the treatment process

The habilitation center, based on foreign and domestic experience, plays an important role in the child’s adaptation process, in particular:

• The institution acts as a kind of conductor of state policy aimed at meeting the social needs of children with disabilities.
• It is in the center that the child has the opportunity to receive comprehensive assistance. This includes psychosocial, biological support, and the implementation of various habilitation programs. Specialists appeal to the patient’s personality and practice a step-by-step approach to ongoing activities and influences.
• Habilitation of disabled people is a comprehensive measure that determines the maximum effectiveness of adaptation of a child suffering from any serious illness leading to disability.
• This is where the patient’s condition is assessed and intervention programs are coordinated based on the baby’s potential.
• Only in the center you can use the services of multidisciplinary specialists.
• External participants participate in the habilitation process, which eliminates one-sidedness in solving such important problems.

What is the essence of the impact?

The habilitation program depends on what disease the child suffers from. Most often these are various neural disorders of the brain acquired at birth or after injury, cerebral palsy, blindness, deafness, and delayed speech development.

A set of measures for children with cerebral palsy:

• Physiotherapy.
• Orthopedic procedures.
• Physiotherapy.
• Massage.
• Special styling.
• Pharmacological effects.
• Classes with a speech therapist.
• Outdoor, special, board games.

A set of measures for visually impaired and blind children:

• Training of hearing and skin perception.
• Formation of special forms of conditioned reflex activity.
• Involvement of residual vision, development of optical attention.

A set of measures for hearing-impaired and deaf children:

• Classes with a teacher of the deaf.
• Teaching dactylic speech.
• Development of remaining hearing.

Program for children with speech delay:

• Implementation of exercises that develop hand motor skills.
• Training for the development of auditory attention and voice formation.
• Speech therapy work - implementation of pre-speech and speech activities.
• Coordination of motor and speech development.

Work centers and family

If parents turn to special centers where multilateral habilitation is implemented, this will only benefit them. The family will never be left alone with their misfortune. Qualified specialists, together with moms and dads, are developing an action plan so that the future life of the social unit becomes clear and transparent. Parents are the first to receive the skills necessary to work with their child on a daily basis.

Doctors and psychologists note that habilitation of children can be effective only when mothers and fathers competently deal with the baby in the family (on a systematic basis). This is a difficult process that can only be overcome through joint efforts and work.

Habilitation and rehabilitation - what is the difference?

The system of measures implemented during habilitation is aimed at treating young children who are not yet adapted to existence in society. As the child grows and develops, he becomes a full-fledged member of society.

Rehabilitation is also a system of pedagogical and therapeutic measures. However, the range of actions is aimed at treating conditions that can lead to loss of performance. Thus, after a course of therapy, the patient gains the opportunity to live and work in normal conditions.

It is appropriate to talk about habilitation if the baby became disabled in early childhood or was disabled from birth (birth injuries of the brain and skull, intrauterine lesions of the central nervous system), that is, the child never had full motor activity, speech and other functions are impaired. Such children have no experience of social life and do not have self-care skills.

It is appropriate to talk about rehabilitation when the patient has experience of social life or any useful and beneficial activity. The course is aimed at treating older children and adults.

Social aspects

Social habilitation, if we consider the official terminology, is interpreted as a system of measures; during its implementation, a person begins to acquire skills and knowledge that help to live independently in a social environment. A person, receiving support, begins to adequately understand his limitations and capabilities, his own social role, he understands his responsibilities and rights, and improves his self-service skills.

These measures are most often aimed at adapting disabled children and families in crisis situations. We are talking about the formation in children of such abilities and functions that, against the background of normal development, develop without additional efforts on the part of the state and the people around them.

In children who have special needs, they develop only if they are exposed to special technical means and the targeted work of psychologists, teachers, doctors and parents is carried out.

What the child and family learn:

• Basic social skills.
• Adapting the home environment to the needs of a disabled person.
• Formation of independent living skills (the child receives pedagogical correction).
• Teaching stereotypes of safe behavior.
• Mastering skills that help defend your own interests and rights.
• Self-analysis training.
• Acquiring skills for positive perception of yourself and your own personality.

Instead of completion

Habilitation is a long and labor-intensive process. It is very important for parents to find a competent specialist to walk this path hand in hand. The task of a medical worker is to correctly perform the entire complex of procedures. The common goal between all participants in the process is to develop the baby’s intelligence, speech and other mental processes.

Treatment and preventive measures - include the organization of primary and periodic medical examinations, the organization of therapeutic and preventive nutrition.

Health is the most important property of a living organism; in relation to a person, it is a measure of spiritual culture, an indicator of the quality of life and at the same time the result of the moral codes of the state’s social policy.

Typically, rehabilitation treatment begins in a hospital and then continues at home. Rehabilitation treatment should begin when the patient is still in bed. Correct position, turns in bed, regular passive movements in the joints of the limbs, breathing exercises will allow the patient to avoid complications such as muscle weakness, muscle atrophy, bedsores, pneumonia, etc. Always maintain physical activity in the patient, as it strengthens the patient, and inaction weakens.

When providing restorative care to a patient, pay attention not only to his physical, but also to his emotional state. Remember that as a result of illness or disability, a person has lost the ability to work or participate in public life. A change in life situation can cause fear, anxiety, and lead to the development of depression. Therefore, it is important to create an atmosphere of psychological comfort around the patient.

The purpose of the work is to consider treatment, preventive and rehabilitation measures.

Research objectives:

2. Assess rehabilitation measures.

1. TREATMENT AND PREVENTIVE MEASURES

1.1. Basic elements of treatment and preventive activities

The main functions of treatment and preventive activities that closely interact with each other are:

Wellness (sanatorium-resort treatment);

Rehabilitation;

Preventive-valeological (prevention of a healthy lifestyle);

Recreational animation.

Each function requires its own specific technologies, which, however, should only be used in a comprehensive manner. In therapeutic functions, priority is given to natural healing factors and non-traditional methods aimed at expanding health reserves; in recreational functions - cycles of activities that increase the spiritual health and moral guidelines of society.

In sanatorium-resort institutions, the influence of medical procedures is combined with the powerful effect on the body of the entire sum of natural conditions. This includes a long stay in the air, the positive impact of the landscape, the aromas of surrounding flower beds, forests, an active motor mode (alternating rest and measured movement, walks, excursions, hikes).

Mandatory elements of sanatorium-resort treatment are morning hygienic gymnastics, therapeutic exercises, dosed walking, and outdoor sports games. As a rule, patients and vacationers take walks and excursions, and go boating. Other types of active recreation are also organized - tennis, scuba diving, fishing, hunting, rafting, hiking, jeeping, horseback riding; at mountain resorts - descent from the mountains, snowboarding, etc.

Numerous studies have established that the lack of the necessary minimum of movement leads to the development of a number of metabolic diseases (obesity, gout, cholelithiasis and kidney stones, etc.), functional and then organic disorders of cardiac activity develop.

Under the influence of physical exercise, mental, physiological, and biochemical processes unfold in the body that positively affect the functional state of the main systems and organs. The complex of processes that occur in response to physical activity depends on age, gender, training, characteristics of the disease, volume and intensity of exercise. At the same time, adaptive changes affect the entire body, ensuring more coordinated functioning of organs. During the classes, strength, mobility and balance of excitation processes in the central nervous system are improved, pathogenic inhibition is reduced or removed, new systems of temporary connections are formed that contribute to the formation of motor skills and reactions with a higher level of functioning of physiological systems. The cardiovascular system is most significantly affected. In the heart muscle, the intensity of oxidative processes increases, the use of energy sources brought by the blood increases, the elasticity of blood vessels increases, and contractions of the heart muscle increase.

Under the influence of physical exercise, coordination between ventilation of the lungs and blood circulation improves, breathing rate becomes optimal, and the body is better supplied with oxygen. Profound changes occur in other organs as well. In the liver, glycogen reserves increase, enzyme activity increases, the ligamentous apparatus is strengthened, and muscle mass and volume increase.

Thus, an active motor mode is an important factor in the normalization of the most important physiological processes that are disturbed or weakened as a result of illness or an irrational lifestyle, and a factor in restoring their normal regulation by the central nervous system. In this regard, physical activity acts in the same direction as training the mechanisms for regulating heat exchange in the body. Both of these factors contribute to the suppression of pathological connections created as a result of the disease and the restoration of normal reactivity of the body.

Walking is the most popular form of physical therapy; it develops the ability to cover long distances without fatigue. Walks do not require special preparation and can be used at any time of the year.

Sports games are the most difficult and responsible section of physical therapy work. The amount of load here depends on the state of health, the type of game and the number of actions.

Swimming is a special form of exercise therapy that allows you to widely vary the amount of load from staying in the water without moving to swimming at maximum speed. Volume is measured by the length of the distance and the duration of the swim. Intensity - the magnitude and nature of changes in the main systems of the body and swimming speed. For patients with a training regime, swimming is recommended at a water temperature of 20°C and above, gentle swimming - 24°C and above.

A properly constructed physical mobility regime creates a positive emotional mood in patients and vacationers and confidence in a favorable outcome of treatment.

Hiking in the mountains is characterized by: a large amount of physical activity on the body at low atmospheric pressure and high levels of solar radiation, the need to overcome obstacles using a variety of means and methods of movement and insurance, and special tactics for completing the route.

Hiking trips are conducted in almost all climate zones and geographic regions - from the Arctic tundra to deserts and mountains. Their attractiveness and main distinguishing feature is that it is accessible and useful to any practically healthy person, regardless of age and physical development, and provides great freedom in choosing a route in accordance with the aesthetic, cognitive and cultural needs of the travel participants. If there are a large number of various natural obstacles on the route, a hiking trip can turn into a combined one, for example, walking-water, mountain-pedestrian.

1.2.Management of treatment and preventive activities

In Russia, the federal executive body responsible for organizing treatment and preventive activities is the federal executive body, which, within its powers, exercises public administration, intersectoral and interregional coordination in the resort business, in accordance with the regulations approved by the Government of Russia. In the constituent entities of the Russian Federation, executive authorities in the resort sector are responsible for organizing treatment and preventive activities. Executive authorities in the regions of the constituent entities of the Russian Federation:

Exercise control over the provision of sanatorium and health services during the implementation of therapeutic and preventive activities;

Organize the study, development, rational use of medical and recreational areas;

Create the necessary conditions for the functioning of organizations and institutions carrying out medical and preventive activities;

Monitor compliance with regulations and industry standards by resort organizations.

The performance of work and the provision of services in the specialties of sanatorium and resort medical care are carried out in accordance with paragraph 04.

2. REHABILITATION MEASURES

Rehabilitation or restorative treatment is a process and system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or possibly more fully compensating for limitations in life caused by health problems with persistent impairment of body functions. Rehabilitation treatment is necessary when the patient has significantly reduced functional abilities, learning abilities, work activity, social relationships, etc. Rehabilitation treatment is part of your daily care for the patient. Usually, when caring for you, you wash, feed the patient, make his bed and perform other manipulations that ease the course of the disease. In rehabilitative care, your main goal is to help the patient become as functional and independent as possible, even though they may not be the same person they were before.

Restorative care reduces the effects of illness and, for people with disabilities, the effects of disability. In restorative care, help your patients, but do not do anything for them. If possible, try to have the patient independently follow the rules of general hygiene, for example, brushing teeth, washing, combing his hair, and eating. Before performing any care activities, ask the patient what he can do on his own and encourage him to do it. Do not forget that due to the disease and its consequences, patients may lose the daily living skills that they had before the disease. Involving the patient in activities will help him acquire the skills and abilities needed to overcome life's problems. Therefore, the patient must be gradually taught these skills and given the opportunity to adapt to the disease and live more fully. In cases where the patient's ability to express his needs and desires is limited, you need to help the patient increase his participation in learning skills. The patient needs to explain the task that he must complete.

Rules for working with patients

· Use short, specific sentences.

· Give clear instructions to the patient and ask him to repeat your instructions to see if he understood them.

· Sometimes the patient needs to demonstrate a particular procedure so that he can reproduce it.

· Be patient with the patient when teaching him skills.

· Always encourage his participation in learning skills.

· Encourage the patient to complete the task independently.

· Talk to the patient about his abilities and successes in completing the task; Don't focus on the shortcomings.

During the period of rehabilitation treatment, rehabilitation measures should be started as early as possible. For each patient, an individual rehabilitation program is drawn up, which is a list of rehabilitation measures aimed at restoring the patient’s abilities for everyday, social, and professional activities in accordance with his needs, range of interests, taking into account the predicted level of his physical and mental condition, endurance, etc. d. The rehabilitation program is drawn up and implemented only with the consent of the patient or his legal representative.

Principles for implementing a rehabilitation program

· Sequence (determining indications for rehabilitation, establishing the patient’s current condition during questioning and clinical examination, as well as during a psychological and social examination, determining the goals and objectives of rehabilitation, drawing up a rehabilitation plan, checking the effectiveness of rehabilitation and its correction, achieving the planned goals of rehabilitation, concluding a rehabilitation report team and its recommendations).

· Comprehensiveness (in the process of rehabilitation, issues of treatment, treatment and prophylactic plan, problems of determining the patient’s ability to work, his employment, labor training and retraining, issues of social security, labor and pension legislation, relationships between the patient and his family, and public life are resolved).

· Continuity (rehabilitation treatment is carried out from the moment the illness or injury occurs and until the person’s full return to society using all organizational forms of rehabilitation).

Stages of determining a rehabilitation program

· Carrying out rehabilitation expert diagnostics. A thorough examination of the sick or disabled person and the determination of his rehabilitation diagnosis serve as the basis on which the subsequent rehabilitation program is built. The examination includes collecting complaints and medical history of patients, conducting clinical and instrumental studies. A special feature of this examination is the analysis of not only the degree of damage to organs or systems, but also the impact of physical defects on the patient’s life activity, on the level of his functional capabilities.

· Determination of the rehabilitation prognosis - the estimated probability of realizing the rehabilitation potential as a result of treatment.

· Identification of measures, technical means of rehabilitation and services that allow the patient to restore impaired or compensate for lost abilities to perform everyday, social or professional activities.

Types of rehabilitation programs and conditions of implementation

· Stationary program. Carried out in special rehabilitation departments. It is indicated for patients who require constant monitoring by medical professionals. These programs are usually more effective than others, since in the hospital the patient is provided with all types of rehabilitation.

· Day hospital. The organization of rehabilitation in a day hospital comes down to the fact that the patient lives at home and is in the clinic only for the duration of treatment and rehabilitation measures.

· Outpatient program. It is carried out in rehabilitation therapy departments at clinics. The patient is in the clinic department only during rehabilitation activities, for example, massage or physical therapy.

· Home program. When implementing this program, the patient takes all treatment and rehabilitation procedures at home. This program has its advantages, as the patient learns the necessary skills and abilities in a familiar home environment.

· Rehabilitation centers. In them, patients participate in rehabilitation programs and take the necessary medical procedures. Rehabilitation specialists provide the patient and his family members with the necessary information, give advice regarding the choice of a rehabilitation program and the possibility of its implementation in various conditions.

Types of rehabilitation

Medical rehabilitation

· Physical methods of rehabilitation (electrotherapy, electrical stimulation, laser therapy, barotherapy, balneotherapy).

· Mechanical methods of rehabilitation (mechanotherapy, kinesiotherapy).

· Traditional methods of treatment (acupuncture, herbal medicine, manual therapy, occupational therapy).

· Psychotherapy.

· Speech therapy assistance.

· Physiotherapy.

· Reconstructive surgery.

· Prosthetic and orthopedic care (prosthetics, orthotics, complex orthopedic shoes).

· Spa treatment.

· Technical means of rehabilitation.

· Information and consultation on medical rehabilitation issues.

Social rehabilitation

Social and everyday adaptation

· Information and consultation on issues of social and everyday rehabilitation of the patient and his family members.

· Teaching the patient self-care.

· Adaptation training for the patient's family.

· Training sick and disabled people in the use of technical means of rehabilitation.

· Organization of the patient’s daily life (adaptation of living quarters to the needs of the sick and disabled).

· Providing technical means of rehabilitation (the program indicates the necessary measures to create the patient’s everyday independence).

· Audiovisual technology.

· Typhlotechnics.

· Technical means of rehabilitation

Social and environmental rehabilitation

· Conducting socio-psychological and psychological rehabilitation (psychotherapy, psychocorrection, psychological counseling).

· Providing psychological assistance to the family (teaching life skills, personal safety, social communication, social independence).

· Assistance in solving personal problems.

· Consulting on legal issues.

· Training in leisure and recreation skills.

Vocational Rehabilitation Program

· Career guidance (career information, career counseling).

· Psychological correction.

· Training (retraining).

· Creation of a special workplace for disabled people.

· Professional production adaptation.

Rehabilitation specialists

· Doctors - specialists (neurologists, orthopedists, therapists, etc.). They help diagnose and treat diseases that limit the life of patients. These specialists solve problems of medical rehabilitation.

· Rehabilitologist.

· Rehabilitation nurse. Provides assistance to the patient, provides care, and educates the patient and his family members.

· Physiotherapy specialist.

· Specialist in physical therapy.

· Specialists in vision, speech and hearing impairments.

· Psychologist.

· Social worker and other specialists.

Self-care skills training can also begin in the hospital. For bedridden patients, the recovery process can begin with teaching the patient the skills to wash, brush teeth, comb their hair, eat, and use cutlery. Patients who can sit should be taught to dress and undress independently. In restorative care, it is recommended to use technical rehabilitation aids that help the patient with walking, eating, bathing, going to the toilet, etc. For example, due to illness or disability, the patient may need to use devices to help him walk, such as canes, walkers, crutches, wheelchairs. The use of these devices gives a person the opportunity to move around and be independent of others. To make eating easier, you can use special dishes (plates, cups) and cutlery. There are also special devices that make it easier for the patient to take a bath and go to the toilet.

CONCLUSION

Thus, the functioning of the health complex directly affects the economic situation of the country as a whole, since, by restoring the working capacity of the working population, it reduces the costs of healthcare and social security.

Unfortunately, most Russian health resorts do not have specially trained balneologists on their staff. True, certain progress has begun: the Ministry of Education and Science of the Russian Federation has approved the corresponding medical specialty. In this regard, the need to organize a system of retraining of medical personnel (at medical universities or basic sanatoriums) is also obvious. Moreover, the heads of sanatorium and resort institutions have realized the relevance of this problem - it is not without reason that they strive to send their specialists for advanced training to various educational and methodological centers.

The Russian health resort complex is a huge health industry, which is materially represented by a powerful network of institutions. The leading role in it is, of course, occupied by sanatoriums, sanatoriums, balneo-mud baths, and health camps. And all of these are medical and preventive institutions, the main activity of which is, first of all, medicine aimed at prevention, and therefore reducing morbidity and disability.

BIBLIOGRAPHY

1. Federal Law of February 23, 2005 No. 26-FZ "On natural and medicinal resources, health-improving areas and resorts".

2. Decree of the Government of the Russian Federation dated December 7, 2006 No. 1426 “On approval of the Regulations on the recognition of territories as medical and recreational areas of federal significance.”

3. Decree of the Government of the Russian Federation of February 2, 2006. No. 101 "On the federal target program "Development of resorts of federal significance."

4. Barchukov I.S. Sanatorium and resort business. - M.: UNITY-DANA, 2006. 303 p.

5. Voloshin N.I. Legal regulation of tourism activities. - M.: "Finance and Statistics", 2008. P. 79

6. Dracheva E.L. Special types of tourism. Medical tourism: textbook. - M.: KNORUS, 2008. - 152 p.

7. List of resorts in Russia with justification for their uniqueness in terms of natural healing factors. Tourism. Economics and accounting. - 2008. - No. 3. - P. 70-98.

8. Sergienko V.I. New approaches to the organization of sanatorium-resort treatment at health resorts subordinate to the Federal Agency for Health and Social Development. Resort Gazette 2005, No. 4 (31)

9. Serebryakov S. Resorts through the prism of sociology. Tourism: practice, problems, prospects. - 2008. - No. 2. - P. 62-65.

10. Handbook of balneology and health resort therapy / Ed. Yu.E. Danilova, P.G. Tsarfis. - M.: "Medicine", 2007. - 648 p.

11. Encyclopedia of tourists / Ch. ed. E.I. There M. - M.: "Big Russian Encyclopedia", 2009. - 607 p.

1. Stationary program. Carried out in special rehabilitation departments. It is indicated for patients who require constant monitoring by medical professionals. This program is usually more effective than others, since in the hospital the patient is provided with all types of rehabilitation.

2. Day hospital. The organization of rehabilitation in a day hospital comes down to the fact that the patient lives at home and is in the clinic only for the duration of treatment and rehabilitation measures.

3. Outpatient program. It is carried out in rehabilitation therapy departments at clinics. The patient is in the clinic department only during rehabilitation activities, such as massage or physical therapy.

4. Home program. When implementing the program, the patient receives all treatment and rehabilitation procedures at home. The program has its advantages, since the patient learns the necessary skills and abilities in a familiar home environment.

5. Rehabilitation centers. They are multidisciplinary and comprehensive; their structure includes all types of rehabilitation: medical, social and vocational. Patients in these centers participate in rehabilitation programs and take the necessary medical procedures. Rehabilitation specialists provide the patient and his family members with the necessary information, give advice on choosing a rehabilitation program, and the possibility of its implementation in various conditions.

Typically, rehabilitation treatment begins in a hospital and then continues at home. Rehabilitation treatment should begin when the patient is still in bed. Correct position, turns in bed, regular passive movements in the joints of the limbs, breathing exercises will allow the patient to avoid complications such as muscle weakness, muscle atrophy, bedsores, pneumonia, etc.

Types of rehabilitation

1. Medical rehabilitation:

1) physical methods of rehabilitation (electrotherapy, electrical stimulation, laser therapy, barotherapy, balneotherapy);

2) mechanical methods of rehabilitation (mechanotherapy, kinesiotherapy);

3) massage;

4) traditional methods of treatment (acupuncture, herbal medicine, manual therapy, occupational therapy);

5) psychotherapy;

6) speech therapy assistance;

7) physical therapy;

8) reconstructive surgery;

9) prosthetic and orthopedic care (prosthetics, orthotics, complex orthopedic shoes);

10) sanatorium-resort treatment;

11) technical means of rehabilitation;

12) information and consultation on medical rehabilitation issues.

2. Social rehabilitation.

3. Social and everyday adaptation:

1) information and consultation on issues of social and everyday rehabilitation of the patient and his family members;

2) teaching the patient self-care;

3) adaptation training for the patient’s family;

4) training the sick and disabled person in the use of technical means of rehabilitation;

5) organization of the patient’s life at home (adaptation of living quarters to the needs of the sick and disabled);

6) provision of technical means of rehabilitation (the program indicates the necessary measures to create the patient’s everyday independence);

7) audio technology;

8) typhlotechnics;

9) technical means of rehabilitation.

4. Social and environmental rehabilitation:

1) conducting socio-psychological and psychological rehabilitation (psychotherapy, psychocorrection, psychological counseling);

2) providing psychological assistance to the family (teaching life skills, personal safety, social communication, social independence);

3) assistance in solving personal problems;

4) consulting on legal issues;

5) training in leisure and recreation skills.

5. Vocational rehabilitation program:

1) career guidance (career information, career counseling);

2) psychological correction;

3) training (retraining);

4) creation of a special workplace for a disabled person;

5) professional and industrial adaptation.

Rehabilitation specialists:

1) medical specialists (neurologists, orthopedists, therapists, etc.). They help diagnose and treat diseases that limit the life of patients. These specialists solve problems of medical rehabilitation;

2) rehabilitation specialist;

3) rehabilitation nurse. Provides assistance to the patient, provides care, educates the patient and his family members;

4) physiotherapist;

5) specialist in physical therapy;

6) specialists – ophthalmologists; otolaryngologists; audiologists;

7) psychologist;

8) psychotherapist;

9) social worker and other specialists.

Contraindications to medical rehabilitation:

Acute and subacute stages of the underlying disease requiring medical intervention;

Any paroxysmal and progressive diseases with a tendency to frequent exacerbations or relapses, diseases with frequent decompensations requiring hospital treatment;

Malignant neoplasms in the active phase, cachexia of any origin, active phase of tuberculosis, extensive trophic ulcers and bedsores, purulent-necrotic diseases, acute infectious and venereal diseases before the end of treatment.

Tasks of the state service of medical and social examination in the field of rehabilitation of disabled people.

The main tasks of the activities of the MSE service are determined by the Federal Law of the Russian Federation “On Social Protection of Disabled Persons in the Russian Federation”, Decree of the Government of the Russian Federation No. 965 of 08.13.96, which approved the “Regulations on recognizing a person as a disabled person” and “Model regulations on institutions of the state service for medical and social examination “other regulatory and instructional documents. The ITU service agencies are responsible for the following: tasks in the field of rehabilitation of disabled people:

· determination of the needs of disabled people for social protection measures, including rehabilitation, based on expert rehabilitation diagnostics;

· development of individual rehabilitation programs with the definition of specific types, forms, methods, performers and procedures for the implementation of rehabilitation measures;

· providing assistance to people with disabilities in the implementation of IPR;

· monitoring the implementation of rehabilitation measures in the form of dynamic monitoring of the completeness and quality of implementation of the IPR, as well as the final assessment of the effectiveness of the rehabilitation of disabled people based on the results of the implementation of the IPR;

· taking into account, generalization and analysis of the needs of people with disabilities in various measures of rehabilitation assistance and their provision, as well as the results of rehabilitation at the regional and municipal levels;

· carrying out information and educational work on the rehabilitation of disabled people;

· making proposals to legislative and executive authorities to study rehabilitation services for people with disabilities;

· participation in the development of comprehensive programs in the field of disability prevention, medical and social examination, rehabilitation and social protection of disabled people.

As part of expert rehabilitation work, as well as as an independent area of ​​activity, the ITU Bureau provides certain types of rehabilitation assistance to people with disabilities.

Rights of ITU institutions.

In accordance with clause 18 of the “Model Regulations on Institutions of the State Service for Medical and Social Expertise”, approved by Decree of the Government of the Russian Federation of August 13, 1996 No. 965, ITU institutions have the right to exercise their powers

To refer persons undergoing medical and social examination for examination in order to clarify their clinical and functional diagnosis and professional capabilities to treatment and preventive institutions of the state and municipal health care systems, rehabilitation and other state and municipal institutions operating in the field of medical and social examination and rehabilitation of disabled people;

Request and receive from organizations of all forms of ownership information necessary for making decisions and performing other functions assigned to institutions;

Conduct control examinations of disabled people for dynamic monitoring of the implementation of activities provided for by individual rehabilitation programs for disabled people;

Send specialists to organizations of all forms of ownership in order to study the working conditions of disabled people, monitor the implementation of rehabilitation measures and in other cases necessary to perform the functions assigned to the institutions.

Individual rehabilitation program for disabled people (IRP)– developed on the basis of a decision of the State Service for Medical and Social Expertise, a set of optimal rehabilitation measures for a disabled person, including certain types, forms, volumes, timing and procedures for the implementation of medical, professional and other rehabilitation measures aimed at restoring and compensating for impaired or lost body functions , restoration, compensation of a disabled person’s abilities to perform certain types of activities (Article 1 of the Federal Law of the Russian Federation “On the social protection of disabled people in the Russian Federation”).

The program contains both rehabilitation measures provided to a disabled person free of charge in accordance with the federal basic program for the rehabilitation of disabled people, and rehabilitation measures in the payment of which the disabled person himself or other persons or organizations participate, regardless of organizational, legal forms and forms of ownership.

The volume of rehabilitation measures provided for by the individual rehabilitation program for a disabled person cannot be less than that established by the federal rehabilitation program for disabled people.

The individual rehabilitation program is advisory in nature. A disabled person has the right to refuse one or another type, form and volume of rehabilitation measures, as well as the implementation of the program as a whole, and can independently decide on the choice and provision of specific technical and other means or type of rehabilitation, including cars, wheelchairs, prosthetic and orthopedic products, printed publications with a special font, sound amplifying equipment, signaling devices, video materials with subtitles, and other similar means.

If a technical or other means of rehabilitation or service provided for by an individual rehabilitation program cannot be provided to a disabled person, or if a disabled person has purchased the appropriate means or paid for the service at his own expense, then he is paid compensation in the amount of the cost of a technical or other means of rehabilitation, services that should be provided to disabled people .

Refusal of a disabled person or a person representing his interests from an individual rehabilitation program as a whole or from the implementation of its parts releases the relevant state authorities, local government bodies, as well as organizations, regardless of organizational and legal forms and forms of ownership, 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.

In accordance with Articles 11, 12, 16, 18, 20, 23 of the Federal Law of the Russian Federation “On Social Protection of Disabled Persons in the Russian Federation”, IPR is mandatory for the relevant government bodies, local governments, as well as organizations, enterprises, institutions, regardless of organizational – legal forms and forms of ownership, institutions of the state service for the rehabilitation of disabled people, non-state rehabilitation institutions, educational institutions, which are determined by the executors of specific rehabilitation measures.

Financing of an individual rehabilitation program.

Financing of the IPR is carried out from the federal budget, budgets of the constituent entities of the Russian Federation, state funds and other sources not prohibited by the legislation of the Russian Federation.

The federal budget funds the implementation of rehabilitation measures, the provision of technical equipment and the provision of services included in the federal basic program for the rehabilitation of disabled people.

In accordance with Article 13 of the Federal Law of the Russian Federation “On Social Protection of Disabled Persons in the Russian Federation,” medical rehabilitation activities are carried out within the framework of the federal basic program of compulsory health insurance of the Russian Federation at the expense of federal and territorial compulsory health insurance funds.

In accordance with Article 22 of the Federal Law of the Russian Federation “On Social Protection of Disabled Persons of the Russian Federation”, the creation of special jobs for persons who have become disabled as a result of an industrial accident or occupational disease. In this case, the disabled person is paid compensation in the amount of the cost of the rehabilitation measure, technical means, or provision of services that must be provided to him in accordance with the IRP. Financing of IPR is also allowed on the basis of cooperation of budgetary and extrabudgetary funds.

Procedure and conditions for the development and implementation of individual rehabilitation programs for disabled people.

The procedure and conditions for the development and implementation of an individual rehabilitation program for a disabled person are determined by the resolution of the Ministry of Labor and Social Development of the Russian Federation “On approval of the Model Regulations on an individual rehabilitation program for a disabled person” dated December 14, 1996 No. 14.

IPRs are developed by institutions of the State Service for Medical and Social Expertise. During the initial and repeated examination of citizens in order to determine disability, institutions of the state medical and social examination service must determine the need and expediency of rehabilitation measures.

Specialists of the State Service for Medical and Social Expertise are obliged to explain to the examined person the goals, objectives, predicted results and social and legal consequences of rehabilitation measures and make an appropriate entry in the examination report about the date of the interview.

The IPR must be developed by the institution of the State Service for Medical and Social Expertise no later than one month after the certified person is recognized as disabled.

The development of IPR consists of the following stages: conducting expert rehabilitation diagnostics, assessing rehabilitation potential, rehabilitation prognosis and identifying measures, technical means and services that allow a disabled person to restore impaired or compensate for lost abilities to perform everyday, social and professional activities.

The development of the IPR is carried out by specialists from the State Service for Medical and Social Expertise, with the involvement, if necessary, of specialists from healthcare institutions, employment services and other bodies and institutions operating in the field of rehabilitation, with the mandatory participation of the applicant. In cases requiring the use of complex types of expert rehabilitation diagnostics, a disabled person may be sent for the development or correction of an IPR to a higher institution of the State Service for Medical and Social Expertise.

The generated IPR is signed by the head of the State institution. Medical and Social Expertise Service and the disabled person, is certified by the seal of the institution of the State Medical and Social Expertise Service and issued to the disabled person. If a disabled person or his legal representative refuses to sign the compiled IPR, the program is attached to the examination report at the institution of the State Service for Medical and Social Expertise and is not given to the disabled person; a copy of the approved IPR is sent to the social protection authority within 3 days.

The implementation of IPR is carried out by organizations, enterprises, institutions, regardless of their organizational and legal forms and forms of ownership, institutions of the state service for the rehabilitation of the disabled, non-state rehabilitation institutions, educational institutions.

Coordination of the implementation of the IPR and provision of the necessary assistance to a disabled person is carried out by the social protection body.

The assessment of the results of medical, social and professional rehabilitation measures is carried out by specialists of the State Service for Medical and Social Expertise during the next examination of a disabled person or in the course of his dynamic observation. The final assessment of the results of the implementation of the IPR is made after a collegial discussion by the relevant specialists, approved by the head of the State Service for Medical and Social Expertise and carried out to the attention of the disabled person in a form accessible to him.

In case of disagreement with the content of the IPR, a disabled person may submit a written statement to a higher institution of the State Service for Medical and Social Expertise. The Main Bureau of Medical and Social Expertise of a constituent entity of the Russian Federation makes a final decision no later than one month after receiving the application.

Heads of enterprises, institutions, organizations that do not carry out the activities specified in the IPR are liable in accordance with the provisions of Articles 16, 21, 22, 24, 32 of the Federal Law of the Russian Federation “On the social protection of disabled people in the Russian Federation” and other legislative acts of the Russian Federation.

If a conflict situation arises between a disabled person and the executors of the IRP, the dispute is resolved in court at the request of the plaintiff.

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

The term is applied primarily 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 about the rehabilitation of persons with disabilities In the standard rules for ensuring equal opportunities for persons with disabilities (UN General Assembly Resolution 48/96, adopted at the forty-eighth session of the UN General Assembly on December 20, 1993), in the section “Basic concepts in policy regarding persons with disabilities”, formulates the commonly used concept of rehabilitation, based on the ideas of the World Program of Action for Persons with Disabilities. Rehabilitation is a process that aims to help people with disabilities restore and maintain their optimal physical, intellectual, mental and/or social levels of functioning by providing them with rehabilitative means to change their lives and expanding the scope of their independence.

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

1. Social rehabilitation, ensuring the rehabilitation of a person with disabilities as a social subject;
   2. Pedagogical rehabilitation, ensuring the rehabilitation of a person as a subject of activity;
   3. Psychological rehabilitation, which provides rehabilitation of a person with a disability at the personal level;
   4. Medical rehabilitation, which provides rehabilitation at the level of the human biological body. 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, it means that the child will not be able to develop all the functions necessary for a normal life, or perhaps the child's functionality will not develop as well as that 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 must be treated, first of all, as a child. The word “habilitation” comes from the Latin “habilis”, which means "to be capable of". Habilitate means “to make prosperous” 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 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 also applies to other people whose moral health is undermined (for example, convicts). Habilitation not only means trying to treat or modify physical or mental impairments, it also means teaching the child to achieve functional goals through alternative routes when habitual routes 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 severe speech delays begin to receive appropriate help 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 measures should begin already in the first year of life. Rehabilitation measures begin from the first days of illness or injury and are carried out continuously, subject to the stage-by-stage construction of the program.

Habilitation measures can begin with monitoring the condition of the expectant mother and nursing a child with developmental disabilities. Habilitation is a multifaceted process that simultaneously addresses various aspects to enable the child to lead a life that is as close to normal as possible. A normal life, in this context, means the life that a child would have in the absence of his functional limitations.

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

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

(see text in previous)

(as amended by Federal Law dated October 23, 2003 N 132-FZ)

(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 developing the abilities that disabled people lack for everyday, social, professional and other activities. Rehabilitation and habilitation of people with disabilities are aimed at eliminating or, as fully as possible, compensating for the disabilities of people with disabilities for the purpose of their social adaptation, including their achievement of financial independence and integration into society.

(part one in ed.

(see text in previous)

The main areas of rehabilitation and habilitation for people with disabilities include:

(as amended by Federal Law dated December 1, 2014 N 419-FZ)

(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, assistance in employment (including in special workplaces), industrial adaptation;

(as amended by Federal Law dated December 1, 2014 N 419-FZ)

(see text in previous)

social-environmental, socio-pedagogical, socio-psychological and sociocultural rehabilitation, social and everyday adaptation;

physical education and health activities, sports.

The implementation of the main directions of rehabilitation and habilitation of people with disabilities involves the use of technical means of rehabilitation by people with disabilities, the creation of the necessary conditions for unhindered access of people with disabilities to social, engineering, transport infrastructure and the use of means of transport, communication and information, as well as providing people with disabilities and their family members with information on rehabilitation issues , habilitation of disabled people.

(Part three as amended by Federal Law dated December 1, 2014 N 419-FZ)

Chepuryshkin I.P.

Society and the state today face the extremely important task of acting as a guarantor of the social protection of children with disabilities, taking upon themselves the responsibility of providing 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 education quality management system in a boarding school has shown that the idea of ​​habilitation of 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 addressing 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 “providing rights, opportunities, ensuring the formation of abilities” and is often used in child psychiatry in relation to persons suffering from an early age from any physical or mental defect.

In the medical literature, the concept of habilitation is often given in comparison with the concept of rehabilitation. According to L.O. Badalyan: “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 cases where 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 US National Institute for the Improvement of Urban Education notes that students learn and use their knowledge in different ways. However, the purpose of education is for all students to achieve a certain social status and assert their social significance. Inclusion is an attempt to give students with disabilities confidence in their abilities, which motivates them to go to school with other children: friends and neighbors. Children with special educational needs not only need special treatment and support, but also to develop their abilities and achieve success in school. The materials of the referenced manual emphasize that the latest edition of the US federal law “On the Education of People with Disabilities” supports the practice of inclusion. The new law on education advocates the inclusion of children with disabilities in the educational environment and their completion of the general education program. The conclusion of the advisory commission, when transmitted to the US Congress, explained the goals and objectives of legislators as follows: inclusion is “acceptance of every child and flexibility in approaches to learning.”

Summarizing the above and relying on the author’s work experience, we believe that a habilitation and educational space should be created in a boarding school for children with disabilities. In the context of the economic crisis in society, creating a sustainable education system that could integrate all 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, when entering into competition with a bright and colorful environment, replete with ultra-modern “values”, often fails.

And, as it seems to us, there is only one way out of this. First of all, it is necessary to improve the lives of children in the boarding institution itself; make it bright, emotional, saturate it with interesting, extraordinary events. Moreover, the school must be attractive to both children and adults; it should organically coexist traditionality and innovation, the absence of excessive guardianship and care. In this case, the school becomes competitive in the environment surrounding the child; and all the norms and values ​​put forward by the school infrastructure can become internal beliefs and their own norms for the child. Events of a cultural, sports or other nature taking place in the surrounding area are introduced into the life of the school community. At the same time, the implementation of the task of creating such a space faces the difficult task of habilitation of children with disabilities. This means that in this space the child must learn to do something that he was deprived of since childhood. In this question lies the contradiction. It would seem that the individual correctional activities of physicians should come first here. Based on this, many experts conclude that “full assistance to a child with disabilities should include not only a system of habilitation measures, but also 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 skills. functions in natural conditions. The tasks of organizing the child’s directed activity, creating motives for him to perform actions that cause difficulties, and to overcome his own difficulties fall into the sphere of pedagogy and psychology and are solved by building a special pedagogical space. The sooner a child, having received help, gets the opportunity to actively act in an adequately organized space, the better the result will be for his further development.

It should be noted that currently in Russia there is a transition to a new stage in the state’s attitude towards persons with disabilities.

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

The historical prerequisites for the formation of a modern education quality management system 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 abilities; secondly, the formation of habilitation centers that ensure an increase in 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 connections.

BIBLIOGRAPHY

1. Badalyan L.O. Neuropathology. - M., 2000. - P.337-347.
2. Chepuryshkin I.P. Modeling the educational space of boarding schools for children with disabilities: Author's abstract. dis...candidate of pedagogical sciences. - Izhevsk, 2006.- 28 p.
3. Improving Education.

   T he Promise of Inclusive Schools.

Bibliographic link

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

By and large, habilitation of the disabled is almost very similar to the rehabilitation we are already familiar with. In its purpose, habilitation differs from rehabilitation only in the subject - the person, the disabled person, in relation to 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 possessed before disability, then habilitation is the process of primary formation of such skills in a person who is disabled from childhood and who simply does not have the skills to live without disability.

The process of habilitation, like rehabilitation, includes both the development and training of the necessary skills in the disabled person himself (in this the differences can be very large, since new skills need to be taught to a person who has never possessed them at all), and 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 activities.

By the way, habilitation is not 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 last quarter of a century, these methods, it seems to me, have been lost, but experience and specialists still remain...

As for habilitation programs for such disabled people, I have not yet heard of any new provisions in this matter, and until now 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 disability assignment and is issued to the disabled person , his guardian or social worker at the time of disability assignment.

There is an acquaintance with an expert

What is “habilitation of a disabled person”?

Which disabled people does the new term apply to?
When will habilitation programs for people with disabilities be drawn up and issued? What is required under such a program?
Will funds be provided for habilitation, and what kind?

Disabled people constitute the largest numerical 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 everyday, social and professional activities. Rehabilitation is aimed at eliminating or possibly more fully compensating for life limitations caused by health problems with persistent impairment of body functions, for the purpose of social adaptation of disabled people, their achievement of financial independence and their integration into society. On social services for elderly citizens and disabled people: Federal Law of 02.08.1995 No. 122-FZ (as amended on 21.11.2011) // Collection of Legislation of the Russian Federation of 07.08.1995. - No. 32. - Art. 3198.

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

Rehabilitation for people with disabilities includes vocational training and employment, provision of mobility aids, provision of vehicles, prosthetic and orthopedic assistance. The state guarantees disabled people the implementation of rehabilitation measures, the receipt of technical means and services provided for by the federal list of rehabilitation measures, technical means of rehabilitation and services provided to the disabled person at the expense of the federal budget. Belousov M.S. Social security law / M.S. Belousov. - M.: Okay-book, 2009. - P. 77.

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

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

IPR includes a set of measures consisting of medical, professional and other measures aimed at restoration, compensation of impaired or lost body functions, restoration, compensation of the disabled person’s abilities to perform certain types of activities, and consists of three programs:

Medical rehabilitation is a process whose implementation is aimed at restoring and compensating, by medical and other methods, the functional capabilities of the human body that are impaired due to a birth defect, illness or injury. Consists of outpatient, inpatient and sanatorium-resort stages and is carried out in accordance with developed standards;

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

2) Medical-professional stage - “medical-professional rehabilitation”) - the process of restoring working capacity, which combines medical rehabilitation with the identification and training of professionally significant functions, selection of a profession and adaptation to it;

3) Professional stage - a system of measures (primarily educational) that provide the opportunity to get a suitable job or maintain the previous one and move through the service (work), thereby promoting his social integration and reintegration;

4) Labor stage - the process of employment and adaptation to a specific workplace;

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

The IPR is mandatory for execution by the relevant state authorities, local governments, as well as organizations, regardless of their organizational and legal forms and forms of ownership. Refusal of a disabled person from the IPR as a whole or from its individual parts releases these 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 of a recommendatory nature for a disabled person; he has the right to refuse any type, form and scope of rehabilitation measures.

In accordance with the IPR, educational institutions, together with social protection authorities and health authorities, provide pre-school, out-of-school care and education for children with disabilities; receiving secondary general and vocational education by disabled people.

Federal Law “On social protection of disabled people in the Russian Federation” On social protection of disabled people in the Russian Federation: Federal Law dated November 24, 1995 No. 181-FZ (as amended on July 2, 2013) // Collection of legislation of the Russian Federation dated November 27, 1995. - No. 48.- Art. 4563. established the provision that the state guarantees people with disabilities the necessary conditions for obtaining education and professional training (Article 9). Vocational training of disabled people is carried out in general and special educational institutions, 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 markets.

When entering secondary specialized or higher educational institutions, they enjoy certain benefits - their enrollment is carried out 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 use correspondence education, external practice, as well as home study. During the period of study, an increased stipend is paid.

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

Vocational training for disabled people can also be carried out directly at work. It has a number of advantages due to the presence at enterprises of a wide production base and opportunities to choose professions, a reduction in training time, and a higher level of material support during training. In general, all types of vocational training for people with disabilities are a necessary measure to provide them with a real opportunity to get a job, taking into account their 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 general preschool institutions, and if this is excluded due to their health, then special preschool institutions are created. If it is impossible to educate and educate disabled children in general or special preschool and general education institutions, education of disabled children with the consent of the parents is carried out at home according to a full general education or individual program. The maintenance of disabled children in preschool and general education institutions is carried out at the expense of the budget of the constituent entity of the Russian Federation.

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

For parents who have disabled children and raise and educate them at home independently, educational authorities compensate costs in the amounts 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 Disabled Persons”, On Vocational Rehabilitation and Employment of Disabled Persons (Concluded in Geneva on June 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. - pp. 2031-2035. establishes the principles of vocational rehabilitation of persons with disabilities and policies regarding their employment. These principles include the duty of the State, in accordance with national conditions, practices and capabilities, to develop a national policy in the field of vocational rehabilitation and employment of persons with disabilities, aimed at ensuring that appropriate vocational rehabilitation measures are extended to all categories of persons with disabilities, as well as promoting employment opportunities for persons with disabilities in a free labor market.

This policy is based on the principle of equality of opportunity for people with disabilities and workers in general; respect for equality of treatment and opportunity for men and women workers with disabilities; the adoption of special measures aimed at ensuring genuine equality of treatment and opportunity for persons with disabilities, who should not be considered discriminated against against other workers.

The employment of disabled people is guaranteed by a system of guarantees. These include:

1) implementation of preferential financial and credit policies in relation to special enterprises employing the work of disabled people;

2) establishing a quota for hiring disabled people;

3) reservation of jobs in professions most suitable for employing people with disabilities;

4) encouraging enterprises to create additional workers to employ disabled people;

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

6) creation of conditions for entrepreneurial activity;

7) organization of training for disabled people in new professions. Social Security Law: Textbook / Ed. K.N. Gusova. - M.: Welby, 2007. - P. 158.

Law of the Russian Federation “On Employment of the Population in the Russian Federation” On Employment of the Population in the Russian Federation: Law of the Russian Federation dated April 19, 1991 No. 1032-1 (as amended on July 2, 2013) // Collection of Legislation of the Russian Federation dated 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. Legislatively On the amendment and recognition as invalid of certain acts of the President of the Russian Federation: Decree of the President of the Russian Federation dated June 12, 2006 No. 603 (as amended on June 7, 2013) // Collection of Legislation of the Russian Federation dated June 19, 2006. - No. 25. - Art. 2700. A quota for hiring disabled people is also established.

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

Art. 223 of the Law of the Russian Federation “On social protection of disabled people 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 workplaces for employing disabled people are workplaces that require additional measures to organize work, 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 provided for by law, the administration is obliged to hire people with disabilities 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 entitled to a reduced working day (no more than 35 hours per week) and annual paid leave (at least 30 calendar days).

Workplaces for disabled people in enterprises and organizations must meet the special requirements for workplaces for disabled people depending on the disability group, this is established by the Resolution 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: Resolution of the Ministry of Labor of the Russian Federation dated September 8, 1993 No. 150 // Bulletin of normative acts of ministries and departments of the Russian Federation. - No. 11.

Social protection authorities are taking the necessary measures to realize the opportunity for people with disabilities to work from 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 home-based work for 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 people living in social service institutions in medical and labor activities”, special jobs are created in inpatient social service institutions for persons living in them and having residual ability to work. Therapeutic work activities of citizens in inpatient institutions are carried out under the guidance of labor instructors and worker training instructors in accordance with schedule plans and individual rehabilitation programs. On social services for elderly citizens and disabled people: Federal Law of 02.08.1995 No. 122-FZ (as amended on 21.11.2011) // Collection of Legislation of the Russian Federation of 07.08.1995. - No. 32. - Art. 3198.

Determination of the type and duration of medical and labor activity is carried out by a doctor at an inpatient institution specifically for each citizen, taking into account his wishes. The duration of medical work activity should not exceed 4 hours per day.

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

The legislation also establishes the right of disabled people to purchase a manually operated car. Cars are sold to disabled people if they have established medical conditions and there are no contraindications to driving, which are determined by MSEC. Sales are carried out on the basis of permission from the relevant social security authority in special stores at the place of permanent residence of disabled people.

In accordance with the Federal Law “On Veterans”, the Decree of the Government of the Russian Federation dated July 10, 1995 approved the “Procedure for assigning and paying certain categories of disabled veterans monetary compensation for expenses on gasoline or other types of fuel, repairs, maintenance of vehicles and spare parts for them, as well as for transport services."

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

Currently, the provision of these categories of citizens with means that make the lives of disabled people easier 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 dentures), prosthetic and orthopedic products, approved by government decree RF dated 04/07/2008 No. 240. On the procedure for providing disabled people 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 04/07/2008 No. 240 (as amended on 05/21/2013 ) // Collection of legislation of the Russian Federation dated April 14, 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 dated December 30, 2005 No. 2347-r. On the federal list of rehabilitation measures, technical means of rehabilitation and services provided to a disabled person: Order of the Government of the Russian Federation dated December 30, 2005 No. 2347-r (as amended on March 16, 2013) // Collection of legislation of the Russian Federation dated January 23, 2006. - No. 4. - Art. 453.

Prosthetic and orthopedic care is important for the social rehabilitation of disabled people. 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 general form and in Art. 27 Fundamentals of the legislation of the Russian Federation “On the protection of the health of citizens”. On the fundamentals 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 prosthetics, bandage products, etc.) is regulated by the Instruction “On the procedure for providing the population with prosthetic and orthopedic products, means of transportation and means that make life easier disabled people." 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 people with disabilities”: 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 make it easier life of disabled people have the right to free provision of prostheses at the expense of funds allocated from the budget for prosthetics. Moreover, every disabled person, depending on medical indications, has the right to receive prosthetic arms and legs, as well as to receive orthopedic shoes, orthopedic devices, leather trousers free of charge for 2 years; disabled war veterans 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 professional 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 (convalescence phase).

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

The significance of one or another aspect of rehabilitation measures is ambiguous in different periods of rehabilitation. In the phases of convalescence and convalescence, medical rehabilitation measures are leading; in the post-convalescence phase, professional and social aspects of rehabilitation come to the fore. For disabled people, the third phase of the recovery process is characteristic, due to which professional and social rehabilitation measures take priority.

A rational combination of various aspects of rehabilitation makes it possible to achieve high efficiency of the activities carried out.