Vol 23, No 4 (2020)

Background. In the Sverdlovsk Region in 2017–2018, a pilot project was implemented to develop approaches to the formation of a comprehensive rehabilitation and habilitation system for people with disabilities, including children with disabilities. To assess the starting positions of the regional system of rehabilitation and habilitation of disabled people, including disabled children, a SWOT analysis was carried out. Based on its results, platforms have been developed to solve the identified problems: conceptual, regulatory, resource, organizational and technological and digital (information and analytical). Aim: analysis of the results of the formation of a comprehensive rehabilitation and habilitation system based on a comparison of the initial state of the system and its characteristics after transformation within the framework of a pilot project. The work used SWOT analysis. In assessing the results, the method of comparative analysis of the system before the implementation of the change and after the pilot project was used. The results of SWOT analysis of the system of rehabilitation and habilitation of disabled people in the Sverdlovsk region at the beginning of 2017 made it possible to objectify the state of systemic factors influencing the formation of a system of comprehensive rehabilitation and habilitation of disabled people in the region, and to outline the directions of transformation. The final assessment of the system of comprehensive rehabilitation and habilitation of disabled people in the Sverdlovsk region showed an increase in indicators from 7.1 to 8.9 points, which reflects a qualitative shift in the system - from the need to form a regional system (less than 7.2 points) in 2018 to the formation of a system and the need its improvement (from 7.2 to 13 points) in 2019, respectively. Conclusions. Significant positive results have been achieved not only in an increase in the number of organizations participating in the system, in the formation of human resources, but also in an innovative, technological and methodological breakthrough in all areas of rehabilitation, as well as in the formation and establishment of new mechanisms of interdepartmental interaction.

Background. The process of rehabilitation services of disabled people in Russia began in 90s, when National standards (GOSTs) were developed on the basis of ISO international quality standards, however, the issue of the availability of standards is still relevant. The aim: development of approaches to the formation of a system of comprehensive rehabilitation and habilitation of disabled people, including disabled children, in the Perm Region during the implementation of a pilot project in 2017–2018. Materials and methods. During the process of implementation in the Perm region in 2017–2018 a pilot project the group of experts had to implement the methodological materials of the Ministry of Labor of the Russian Federation including standards of rehabilitation and habilitation of disabled children and adults. Two groups of disabled people of working age were selected for testing – one is with motor disorders (n = 21) and other is with mental disorders (n = 25). Evaluation using standardized diagnostic scales was carried out at the beginning and at the end of the rehabilitation course, when each client filled out a client feedback questionnaire, and specialists — a specialist feedback questionnaire. The duration of the rehabilitation course was 21 days. Results. Comparison of the results obtained with the data on the effectiveness of clients’ rehabilitation according to the existing rehabilitation programs showed the advantage of the developed standards, which was expressed by a significant improvement in the assessed indicators, as well as more accurate assessment of the rehabilitation results. Conclusions. The results of the standards development and implementation showed the possibility of creating medical and social services in rehabilitation that would make possible to put into practice the idea of a biopsychosocial model of rehabilitation through the use of the International Classification of Functioning, Disabilities and Health (ICF) as a methodology.

Background. Cerebral palsy (CP) is an important medical and social problem due to the high frequency of childhood disability and a significant prevalence of the disease. One of the features of cerebral palsy is the formation of secondary orthopedic complications, for the correction of which, along with surgery and botulinum therapy, technical rehabilitation devices and orthoses in particular are used.

Aim: To analyze world experience in orthotics in children with cerebral palsy. World literature review in open electronic databases PubMed and Elibrary for the last 30 years. The most of publications focuses on ankle-foot orthoses as the most commonly used in foreign clinical practice. A minimal number of papers cover the problem of orthopedic footwear, despite on its prevalence in Russia. There are no works analyzing the frequency characteristics of orthoses used, including the likelihood of their reuse and rejection. There is no unified, generally accepted terminology and classification of orthoses. We found no articles covering the effectiveness of combined use of several types of orthoses. To date, no clinical guidelines for orthotics in children with cerebral palsy have been developed; therefore, in many cases, orthoses are prescribed empirically.

Conclusion. Thus, further research of the role of orthotics in the medical rehabilitation of children with cerebral palsy appears to be an urgent task.

The prevalence of diabetes is high and continues to grow. Patients with diabetes make up 3.12% of the population of Russian Federation. Economic losses from diabetes accounted for 1.8% of the world’s gross domestic product. There are no effective treatments for diabetes. The goals of patient care are control homeostasis indicators and prevent complications. The Russian Federation has created a multi-level system of care for patients with diabetes. Social protection institutions take part in comprehensive rehabilitation of patients with diabetes. In 2015–2019 years the state budgetary institution of the city of Moscow “Scientific and practical rehabilitation center” conducted inpatient rehabilitation of 10.4 thousand disabled people. The prevalence of diabetes among them was 19.5%. Rehabilitation of patients with diabetes in the rehabilitation center has a number of features: planned nature, the possibility of individual and group work of doctors with patients, the state of physical and psychological comfort of patients, the use of climate therapy.