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Vol 24, No 3 (2021)

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Original study

Comparative analysis of the effect trunk-hip-knee-ankle foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy (case report)

Koltsov A.A., Aksenov A.Y., Dzhomardly E.I.


BACKGROUND: In children with spastic forms of cerebral palsy often prescribed difference type of trunk-hip-knee-ankle foot orthosis (THKAFO). At the same time, we have not found any significant reports in the world literature dedicated to the study of the influence of these orthosis on the gait biomechanical parameters.

AIM: To demonstrate the results of a comparative analysis of the effect of trunk-hip-knee-ankle-foot orthosis and ankle-foot orthosis on the gait biomechanical parameters in children with cerebral palsy.

MATERIALS AND METHODS: The study involved two 13-and 15-year-old children with a diagnosis of “cerebral palsy, spastic diplegia, GMFCS 3, MACS 2–3, Ashworth Scale 2–3”. Six studies were conducted ― three tests for each child (barefoot, in AFO and THKAFO) using the 3D video analysis system “Qualisys” (Sweden). The spatio-temporal and kinematic indicators of gait, as well as the gait index, were evaluated.

RESULTS: Analysis of the results in patient D. demonstrated that using the THKAFO in comparison with AFO led to a slight improvement in spatio-temporal gait indicators (from 4.0–12.5%), but to a deterioration in hip kinematics and a deterioration in the gait index (2.5–28.1%). Whereas in patient A., it was noted that the use of the THKAFO in comparison with AFO had a negative effect on the spatio-temporal parameters of gait (4.0–97.6%), on the kinematics of the knee and ankle joints, and on the improvement of the hip kinematics in the sagittal plane, but the effect on the gait index was not unambiguous. According to the totality of the analyzed data, patient D. was recommended to wear AFO instead of the THKAFO. Patient A. was also recommended to wear an AFO instead of a THKAFO, even despite the ambiguous results of the biomechanical research, since the final decision on the choice of the orthosis design took into account not only “accurate” changes in biomechanical parameters, but also a number of other factors, in particular social and household ones.

CONCLUSION: In patients with level GMFCS 3, for improve the biomechanical parameters of gait, it is advisable to give preference to shorter and functional orthoses before prescribing orthoses that capture two or more body segments.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(3):5-14
pages 5-14 views

Analysis of the needs of disabled people for employment in a special workplace in the Russian Federation and St. Petersburg

Karasaeva L.A., Goryainova M.V.


BACKGROUND: Employment of disabled persons of I and II groups with disabilities of the ability to work of the 2nd and 3rd degree involves the organization of special working conditions, including the creation of special jobs.

AIMS: Study of the need for people with disabilities in employment at a special workplace in the Russian Federation and St. Petersburg and the results of the IPRA on the creation of special jobs for 5 years (2015–2019).

MATERIALS AND METHODS: The object of the research is a set of disabled people in need of vocational rehabilitation in St. Petersburg. Sources ― certificates of examination, reporting form No. 7-social security. Research methods: analytical, expert assessment method, statistical.

RESULTS: In the dynamics from 2015 to 2019, a low indicator of the identified need for disabled people to create special jobs for the employment of disabled people was revealed both in the Russian Federation (7.3%) and in St. Petersburg (3.7%). It has been established that since 2018, in statistical form 7-sobes, the mandatory recommendations for the employment of disabled people with sensory impairments in special workplaces have been regulated. In this regard, the paper analyzes the needs for the organization of special workplaces for people with sensory disabilities, while in dynamics for 2018–2019. there was an increase in the indicator of the need to create special jobs for this contingent in the Russian Federation (from 17.4% in 2018 to 22.1% in 2019 for the visually impaired; from 0.3% in 2018 to 0.4% in 2019 for the disabled with simultaneous visual and hearing impairment) and a decrease in this indicator in St. Petersburg (from 56.2% in 2018 to 44.3 in 2019 for the visually impaired; from 4.0% in 2018 to 1.9% in 2019 for the disabled with simultaneous visual and hearing impairment).

CONCLUSION: The data obtained substantiate the relevance of studying this problem with the need to develop an optimal model for creating special jobs to increase the employment rates of disabled people of groups I and II.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(3):15-22
pages 15-22 views

Expertise and rehabilitation

Present problem of neurororehabilitology: methods for quantitative assessment of pathological increased muscle tone

Shunenkov D.A., Loginov A.A., Bosenko S.A., Saveliev O.G., Kovaleva N.Y., Vorobiev A.V., Lebedev A.S., Kanarskii M.M.


One of the urgent problems of neurorehabilitation is spasticity ― a motor disorder that depends on the rate of muscle stretching due to the enhancement of tonic stretch reflexes due to a violation of supraspinal inhibitory signals, which is manifested by intermittent or prolonged involuntary muscle activation. In addition to spasticity, the clinical forms of lesions of the upper motor neurons in the form of muscle hypertonicity include rigidity and dystonia.

Although spasticity is one of the most common occurrences, its precise definition and pathophysiology remain unclear.

Spasticity reduces the effectiveness of rehabilitation of patients with severe disabling diseases. With organic lesions of the brain, movement disorders are often caused by increased muscle tone, which makes it difficult to perform simple movements. For the correct setting of treatment goals for a patient with spasticity syndrome, including for the development of an individual rehabilitation program with a further assessment of its effectiveness, it is necessary to correctly determine the spasticity and its severity, differentiate from other forms of pathological changes in muscle tone (rigidity, plasticity, contractures), as well as to assess the impact on the active and passive function of the limb, daily life and quality of life of the patient.

An important issue in the rehabilitation process is the method of quantitative assessment of the pathological increase in muscle tone, for which the collection of complaints and anamnesis, physical neurological examination, scales and various options for instrumental examination are used.

The review article presents modern and traditional methods for quantifying muscle tone, as well as methods of therapy.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(3):23-34
pages 23-34 views

The problem of moral and psychological readiness of future specialists in social work to work with disabled people

Kokoreva M.E., Barkova V.L., Vorobtsova E.S., Shurygina Y.Y.


BACKGROUND: The article analyzes the issues of moral and psychological readiness of students-future professional social workers to work with the disabled. The article systematizes domestic and foreign approaches to the definition of the categories “readiness”, “psychological readiness”, “moral and psychological readiness” in relation to professional social work. Moral and psychological readiness is understood as an important and complex multicomponent category, a synthetic construct and a stable characteristic of the subject of educational and professional activity in its readiness for the successful implementation of the assigned professional functions and tasks.

AIMS: Assessment of the moral and psychological readiness of future professional social workers to work with the disabled.

MATERIALS AND METHODS: The data of the survey of 178 students studying in the direction of training “Social work” (bachelor’s and master’s degrees) in three universities of Russia are presented.

RESULTS: As a result of the conducted research, it was found out that despite the generally positive attitude of students towards disabled people, according to a subjective assessment, a fifth of students (22.5%) noted that they were not ready to work with such a category of people, which may be evidence of an imbalance in the theoretical and practical components of their training, as well as the moral and psychological unpreparedness of students for future professional social work.

CONCLUSION: In this regard, in our opinion, special attention should be paid to the formation of the moral and psychological readiness of future professional social workers to work with people with severe forms of health disorders, including the disabled.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(3):35-46
pages 35-46 views

The experience of organizing an observatory for monitoring patients with a new coronavirus infection on the basis of a social protection institution

Sirnikova B.A., Storozhenko D.V., Temirov K.V.


The first case of COVID-19 infection in Russia was recorded on March 1, 2020. The Government of the Russian Federation and the executive authorities of the constituent entities of the Federation, as well as health authorities, have taken unprecedented measures to prevent the spread of a new coronavirus infection in the country, but it has not been possible to fully avoid mass infection of the population.

The epidemic of coronavirus infection required large-scale decisions from the authorities of all countries to ensure the safety of the population. In conditions of limited time and material resources, flexible organizational models were needed that combined the efforts of healthcare and social protection of the population. All health care resources were involved. New permanent and temporary “covid” hospitals were put into operation as soon as possible. A significant number of health care facilities were repurposed to provide medical care to patients with a new coronavirus infection. Stationary institutions of social protection of the population have become an important reserve for the deployment of observators to monitor convalescents and contact persons in the city of Moscow. Observators were deployed at their base to isolate contact persons. The specifics of the contingent planned for placement in observatories and the organizational features of social protection institutions have led to a number of significant differences from similar departments in healthcare institutions.

Within 19 days, an observatory for 241 beds was organized and equipped on the basis of a large institution of social protection of the population of the city of Moscow of the State Budgetary Institution “Scientific and Practical Rehabilitation Center”. In the first wave of the rise in morbidity, 759 patients were observed in the observatory.

We present a detailed plan for the deployment of the observatory developed by the headquarters of the State Budgetary Institution “Scientific and Practical Rehabilitation Center”, which ensured its implementation and further functioning.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(3):47-56
pages 47-56 views

Features and innovations in teaching the discipline «Information Technology» in the framework of inclusive education

Popov S.A., Bastrykina T.S., Belyakovsky B.Y., Kiseleva E.V.


Based on the conclusions of the medical and social examination, people with confirmed disabilities should not have obstacles to receiving education in full.

Currently, a single educational space has developed in Russia, and integration has become the leading direction in the education and upbringing of children with disabilities, which is expressed by the convergence of mass and special educational systems. Today, the Institute of Inclusive Education is the only internationally recognized instrument for the realization of the rights of people with disabilities to education and a happy future. It has long been customary in the world to pay special attention to people with disabilities, their ability to receive a decent education and their needs for attention, understanding and care of adults.

Inclusive education is the organization of the learning process in which all children, regardless of their physical, mental, intellectual and other characteristics, are included in the general education system and study at their place of residence together with their peers without disabilities, in the same general education institutions ― schools of a general type that take into account their special educational needs and provide their students with the necessary special support.

Today we are talking about giving a new, socio-pedagogical meaning to the process of integrating children with disabilities in educational practice in the field of arts. Of particular importance is the organization of not only and not so much a joint leading activity for a certain age (gaming, educational), as a joint world of people’s lives.

The relevance of e-learning technologies is currently one of the innovative methods of modern education and has its pros and cons. Inclusion takes into account the needs, as well as the special conditions and support needed by the student and teachers to achieve success. Thus, for the success of integration in the educational space of the country, a well-organized and well-functioning infrastructure of specialized pedagogical and psychological assistance to special children studying in general education institutions should be formed and function.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(3):57-62
pages 57-62 views

For the practitioner

Clinical expert case with a combination of the Saul–Wilson and Rubinstein–Taybi syndromes

Riabokon A.G., Doronina O.E.


Saul–Wilson syndrome, like Rubinstein–Taybi syndrome, is classified as a rare genetic disease according to modern classification. So, to date, there are descriptions of 16 patients from different countries in literary sources.

The Saul–Wilson syndrome is characterized by a combination of nanism, pathology of long tubular bones, the spine and the organ of vision, typical dysmorphic facial features and radiological data; Rubinstein–Taybi syndrome has various skeletal defects (low height, dilation of the phalanges of the fingers, polydactyly on the legs, deformities of the face and skull, high arched palate, changes in the shape and position of the auricles, dilated phalanges of the fingers, lordosis, kyphosis, scoliosis), strabismus, anomalies refraction, disorders of internal organs, disorders of intellectual and physical development.

The article presents a complex clinical and expert case with a combination of two genetic diseases ― Saul–Wilson and Rubinstein–Taybi syndromes, typical manifestations of which were visible craniofacial dysmorphia, changes in the musculoskeletal system in the form of progressive bilateral coxarthrosis, instability of the thoracic spine, deformities of the feet, accompanied by pronounced disorders of neuromuscular, skeletal and statodynamic functions. The multi-system lesion of the body caused difficulties for specialists during the medical and social examination. These nosological forms are absent in the current classifications and criteria for establishing disability, and therefore the quantitative assessment of persistent functional disorders was carried out individually ― according to the degree of severity of impaired functions, their combination and influence on each other.

The use of modern diagnostic methods, including genetic studies, in hereditary diseases allows to establish a diagnosis at an early stage, to determine the tactics of managing children in order to ensure timely pathogenetic treatment, including surgical, prevention of the development of severe complications, functional disorders. The successes of medicine can not only significantly improve the quality of life of this category of children, but also increase their life expectancy. Since in most cases hereditary diseases involving the musculoskeletal system are accompanied by persistent disorders of the body’s functions and lead to disability, classifications and criteria for establishing disability should include a quantitative assessment of the degree of impaired functions in congenital anomalies and hereditary diseases.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(3):63-70
pages 63-70 views

Features for referring citizens 18 years and older with HIV-AIDS for medical and social examination (to help a practicing doctor)

Ugleva E.M., Yamshchikova T.Y.


The establishment of disability is entrusted to the federal institutions of medical and social expertise (ITU). A number of regulatory documents regulate the process of examination of patients in the ITU Bureau. A citizen is sent to the ITU by a medical organization, regardless of its organizational and legal form. It is necessary to refer the patient to the ITU bureau in the formation of persistent disorders of the body’s functions, which persist when an adequate and complete set of therapeutic and rehabilitation measures is carried out. A mandatory document in the examination process is “Referral for medical and social examination by a medical organization” (form No. 088/y).

The Ministry of Labor and Social Protection of the Russian Federation and the Ministry of Health of the Russian Federation, by joint Order No. 27n/36n, approved the procedure for filling out the referral to the ITU on Form No. 088/y. The new procedure comes into effect on January 1, 2022. The document analyzes and analyzes in detail each point of the referral to the ITU; specifies how the referral points should be filled in; specifies the timing of the transfer of the referral to the ITU territorial bureau; identifies cases when it is possible to issue a referral on paper; The procedure for sending foreign citizens to the ITU is stipulated.

The form 088/y has not changed, but from January 1, 2022, the direction will be formed in the form of an electronic document. If it is impossible to form an electronic version of the document and if there is no information system or access to it in the medical organization, the referral will be formed on paper.

An extremely important and responsible moment is filling out the form 088 /y by specialists of a medical organization, since when deciding on the establishment of disability, ITU doctors rely largely on the information recorded in this document.

Medical and Social Expert Evaluation and Rehabilitation. 2021;24(3):71-77
pages 71-77 views

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