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Vol 24, No 2 (2021)

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Expertise and rehabilitation

Vocational guidance and assistance system for the employment of persons with disabilities and persons with disabilities within the framework of the international movement “Abilimpix”

Ananyeva T.N., Ilyukhina G.I., Sazonova Y.V.

Abstract

Human health and well-being largely depend on a sufficient standard of living, educational opportunities and participation in social and social life, and successful professional activities. It should be recognized that in the surrounding society it is in these areas of life that people with disabilities and disabilities are especially disadvantaged, but not neglected by society and the state.

Currently, in the Russian Federation, the State programme “Accessible Environment” is being implemented to support and assist persons with disabilities and disabilities, with the aim of creating legal, economic and institutional conditions conducive to the integration of persons with disabilities into society and improving their quality of life. The programme contains three subprogrammes that are effectively implemented in modern society, namely: (1) Ensuring the accessibility of priority facilities and services in priority areas of life of persons with disabilities and other mobile populations; (2) Improvement of the system of comprehensive rehabilitation and habilitation of persons with disabilities; (3) Improvement of the state system of medical and social expertise.

The organizers of the Abilimpix social movement were able to demonstrate to people with disabilities their individual capabilities and prospects for accessibility to all types, forms and means of obtaining knowledge and professional skills, their effective application in practice.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(2):5-9
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Analysis of loss of professional employment and ability to perform labor activities in sufficiated

Barkovskaya O.S., Gudimov V.B.

Abstract

BACKGROUND: In medical and social expertise, to determine the degree of loss of professional working capacity and disability to victims of industrial accidents and occupational diseases, it is of fundamental importance to assess the possibility of continuing professional activity and the ability to work.

AIMS: To study the structure and dynamics of determining the degree of loss of professional ability to work, the dynamics of disability and the structure of disability groups, the structure of nosological forms among the victims.

MATERIALS AND METODS: The results of the medical and social examination in the FGI «The Main Bureau of Medical and Social Expertise in the Novosibirsk region» for the period 2013–2020 have been studied among 1528 victims of industrial accidents and occupational diseases. Of these, the loss of professional ability to work of varying degrees was established by 96.6% of the victims, disability with limited ability to work ― 36.2% of the victims.

RESULTS: The largest share (62.5%) was made up of victims with a loss of professional working capacity from 10 to 30 percent. Among the victims with disabilities, the largest proportion (75.2%) were disabled persons of the third group with limited ability to perform labor activities of the 1st degree. The dynamics of establishing the degree of loss of professional ability to work and disability with limited ability to perform labor activity in the study period was characterized by an increase to a maximum value in 2014, followed by an intermittent decrease to a minimum value in 2020. production and disability with limited ability to perform work activities, the largest number of persons with the consequences of injuries of the upper limb, the consequences of injuries of the lower limb and the consequences of spinal injuries. Among those injured as a result of occupational diseases, persons with sensorineural hearing loss, vibration disease and lung diseases prevailed. Disability with limited ability to perform work activities among victims of occupational diseases in the overwhelming majority of cases was established in persons with sensorineural hearing loss and lung diseases.

CONCLUSION: The decrease in the ability to perform professional activities and the limitation of the ability to perform work activities were more pronounced among victims of industrial accidents than among those injured as a result of occupational diseases.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(2):11-19
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Indicators of the need of disabled people for vocational rehabilitation activities

Goryainova M.V., Karasaeva L.A., Nurova A.A., Petrova O.N., Ugleva E.M., Ogay D.S.

Abstract

BACKGROUND: In the system of medical and social expertise and rehabilitation of disabled people, the solution of issues of employment, socialization, improvement of the level and quality of their life becomes obviously relevant.

AIMS: To study and analyze the needs of disabled people in vocational rehabilitation, including employment and the creation of special jobs, in a comparative aspect - in St. Petersburg and the Russian Federation.

MATERIAL AND METHODS. The materials of the study were data from Rosstat of Russia, official state statistical reporting: Forms 7-sobes "Information on medical and social expertise of persons aged 18 and older" for 2015–2019.

RESULTS: The article analyzes the indicators of primary disability and the needs of disabled people in vocational rehabilitation activities based on the study of the individual rehabilitation or habilitation program (IPRA) for disabled people in Saint Petersburg and the Russian Federation in dynamics over five years (2015–2019). An analysis of the needs for vocational rehabilitation measures, taking into account its structure in IPRA (vocational guidance and employment) and the disability group, was carried out. Since the greatest difficulties arise in the selection and organization of jobs for people with disabilities of groups I and II, the needs of people with disabilities in creating a special workplace have been studied. The necessity of solving organizational, methodological, and financial issues when creating special jobs for the disabled is emphasized.

CONCLUSION: The implementation of the state program "Accessible environment" and its subprograms aimed at creating models of employment of disabled people in the regions of the Russian Federation requires taking into account the territorial characteristics of the prevalence of primary disability and the specifics of the regional labor market in the employment of disabled people.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(2):21-27
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Possibilities of rehabilitation in atherosclerosis of arteries of the lower limbs in combination with diabetes

Spiridonova V.S., Sklyarenko R.T., Churzin O.A., Antonov D.V., Omarov M.S.

Abstract

BACKGROUND: According to the World Health Organization, more than 17 million people die from cardiovascular diseases every year in the world. Coronary heart disease is the leading cause of death in industrialized countries.

AIMS: To evaluate the immediate result of treatment by revascularization of the limb and organ-preserving surgical interventions for purulent-necrotic lesions of the feet, neuropathic form of diabetic foot with osteoarthropathy in chronic arterial insufficiency of the IV degree.

MATERIAL AND METHODS: In the paper, the authors investigated possible treatments with different limb lesions in patients diagnosed with diabetes mellitus. Since in this disease there are complications on the cardiovascular system, most people are diagnosed with obliterating atherosclerosis, which leads to slow necrosis of the limbs. This causes diabetes patients, not only severe pain and an aesthetically unsightly state of the body, but also noticeably worsens the quality of life.

RESULTS: With a consolidated approach to this problem, endocrinologists and cardiovascular surgeons developed and tested the method of endascular surgery. Patients diagnosed with obliterating lower extremity vascular atherosclerosis against the background of diabetes mellitus with trophic and necrotic lesions of the peripheral lower extremities underwent enduscular surgery to revascularize the limb, which showed not just positive immediate treatment results, but gave opportunities to preserve patients’ limbs.

CONCLUSION: Timely recognition and treatment of purulent-necrotic lesions of the feet, the neuropathic form of diabetic foot with osteoarthropathy requires an interdisciplinary approach and close cooperation of doctors of different specialties - endocrinologists, surgeons, podiatrists, orthopedists, general practitioners, etc. Only if these conditions are met, it is possible to achieve significant success and minimize the number of irreversible deformities and amputations of the feet, the weighting of disability groups.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(2):29-32
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The spectrum of vital activity restrictions in disabled people due to thyroid cancer

Pogosyan G.E., Grechko A.V., Puzin S.N., Shurgaya M.A., Memetov S.S.

Abstract

BACKGROUND: The most common malignant neoplasm of the endocrine system is thyroid cancer. In Russia, as in other countries of the world, the incidence rate is steadily increasing. Thus, it is extremely important to assess the problem of health disorders due to thyroid cancer within the framework of socially significant disability caused by malignant neoplasms in the Russian Federation.

AIMS: To analyze the spectrum of types and degree of disability in people with disabilities due to thyroid cancer.

MATERIAL AND METHODS: The article presents the results of the analysis of the spectrum of the main types of disability in the general contingent of disabled people due to thyroid cancer among the adult population of Moscow (2015–2019).

RESULTS: The dynamics of disability both in the contingent of first recognized and in the contingent of re-recognized disabled people (VPI and PPI) was characterized by an increase in the number of disabled people and the transformation of the structure of general disability. There is a clear change in the ratio towards an increase in the share of PPI from 55.1% in 2015. up to 68.0% in 2019, while the share of VPI decreased from 44.9% in 2015 to 32.0% in 2019. The predominant gender cohort was women, and the age category was the elderly. The main types of life restrictions were the restriction of the ability to self-serve (98.6% of the VPI and 97.9% of the PPI), to work (94.7% of the VPI and 94.6% of the PPI) and to move (21.3% of the VPI, 21.8% of the PPI). A low proportion of restrictions on the ability to control one’s behavior, learning, communication and orientation was revealed (0.3–1.2%). The first degree of disability prevailed in the contingents of VPI and PPI (p <0.0001). In the contingent of men, the proportion of disabled people with the third degree of disability was higher compared to the contingent of women.

CONCLUSION: Dynamic assessment of the degree of severity of functional disorders and associated life restrictions should be carried out at all stages of medical and social rehabilitation in order to monitor the effectiveness of medical and rehabilitation measures, assess the quality of life and prevent progression (secondary prevention of disability).

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(2):33-40
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Features of the organization of medical rehabilitation at the present stage

Sereda A.N., Puzin S.N., Memetov S.S., Kim V.V., Ilyukhin R.G.

Abstract

The development of rehabilitation at the present stage is one of the priorities in the field of health and social development. Not only medical organizations, but also other organizations can take part in carrying out medical rehabilitation activities. A prerequisite for the implementation of rehabilitation activities is the availability of a license for medical activity with an indication of medical rehabilitation work. Of great concern is the issue of staffing of medical organizations, especially primary care, by such specialists as a doctor of physical and rehabilitation medicine, a doctor of medical rehabilitation, a medical speech therapist, an ergorehabilitation specialist, etc. In the absence of these specialists in medical organizations, it is impossible to form interdisciplinary rehabilitation teams, and in their absence, the solution of medical rehabilitation issues is questionable.

The article contains an analysis of the current legal framework for medical rehabilitation. The stages of medical rehabilitation in medical organizations are reflected in accordance with the scale of rehabilitation routing. Four groups of medical organizations carrying out medical rehabilitation have been identified. The shortcomings of the current legal framework for medical rehabilitation are indicated, since a comprehensive rehabilitation system is currently being formed in the Russian Federation. For its successful development and implementation in the practical activities of medical organizations and social institutions, a regulatory and legal framework is being developed and improved.

The approved Procedure for the organization of medical rehabilitation will allow to systematize and organize this work at a qualitatively new level.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(2):41-46
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Original study

Results of wheelchair skills training among the disabled persons with lower limb loss of vascular origin

Khokhlova O.I., Vasilchenko E.M., Lyakhovetskaya V.V., Zhestikova M.G.

Abstract

BACKGROUND: Wheelchair skills training is an essential part of rehabilitation of the disabled persons with lower limb amputation (LLA) due to peripheral artery disease (PAD). However, nowadays this issue is poorly addressed in our country, there are no standardized technologies.

AIM: Investigation of dynamics of the extent of wheelchair usage among disabled persons with LLA due to PAD during adjustment to the wheelchair using the Wheelchair Skills Program (WSP, Canada).

MATERIALS AND METHODS: Altogether, 350 patients with lower limb stump [unilateral tibial stump ― 116 (33.1%), hip stump ― 223 (63.7%), bilateral tibial stumps ― 6 (1.7%), hip stump ― 5 (1.4%)] were examined in clinical settings at the Federal State Budgetary Institution “Novokuznetsk Scientific and Practical Centre for Medical and Social Expertise and Rehabilitation of Disabled Persons” Ministry of Labour and Social Protection of the Russian Federation. Male ― 268 (76.6%), female ― 82 (23.4%). Mean age 63.1±0.52 years. Cause of LLA: obliterative PAD (lower limb atherosclerotic arterial disease) ― 226 (64.6%), type 2 diabetes mellitus ― 124 (35.4%). WSP effectiveness was assessed in 227 disabled persons. Wheelchair skills retention in 1.1 (0.59–1.87) years was assessed in 48 persons, 25 persons have undergone training second time.

RESULTS: It was found that 86% of the disabled persons with LLA needed the wheelchair skills training. Upon the completion of the course the level of individual wheelchair skills was increased in all participants. This contributed to an increase in their activities and participation, which was indirectly evidenced by 1.8 fold increase in the proportion of those using the wheelchair outdoors by the time of second hospitalization.

CONCLUSION: The program provides an individual approach to training, based on the results of a study of the initial level of proficiency in wheelchair skills, the wishes of the user himself, his physical, somatic and psychological condition. Thanks to this, novice users were able to master basic skills, and relatively experienced ones ― more complex, and thereby increase their level of safe use of the wheelchair, as well as the degree of independence and everyday activity, which can indirectly be evidenced by a significant increase in the share of wheelchair users outside the house.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(2):47-57
pages 47-57 views

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