Vol 26, No 2 (2023)

BACKGROUND: Despite the long-applied international classifications of diseases and disorders, in our country, no approved methodology has been approved for a comprehensive assessment of autism syndrome, considering categorical and dimensional approaches, age of the child, and polymorphism of symptomatology, which creates significant difficulties in diagnosis, determining the complex of rehabilitation measures, and assessing their effectiveness.

AIMS: To develop an algorithm for the expert rehabilitation diagnosis of autism spectrum disorders (ASDs) in children with disabilities according to the domains of the International Classification of Functioning, Disability, and Health (ICF).

MATERIALS AND METHODS: The study enrolled children recognized to have a disability for the first time due to autism in the St. Petersburg and Voronezh regions for 2016–2021. Data sources included state statistical reporting forms 7-D (sobes), acts and protocols of examinations, statistical maps, and data obtained from the Federal State Information System “Unified Automated Vertical Integrated Information and Analytical System”. The study is longitudinal and continuous. Analytical, documentary, data excavation, questionnaires, interviewing, statistical methods of research were employed. The methodology of the World Health Organization was used to study the functional profile according to the basic set for children with autism.

RESULTS: Data on functioning and life activity limitations of children with autism-related disability were analyzed taking into account the clinical form of autism, age of the child (0–3, 4–7, 8–14, and 15–17 years), and presence of comorbid symptomatology according to the ICD-10 criteria (1992) and IFC domains (2001). The main predictors of the severity of autism manifestations were identified depending on the age of the child: 0–3 years, rates of psychomotor and speech development in epicrisis terms; 4–17 years, degree of deficit of social communication/social interaction; and assessment of limited stereotypical forms of behavior. In children aged >3 years, comorbid symptomatology was also assessed, taking into account the use of psychometric scales and research methods approved in the Russian Federation. Predictors of autism severity were translated into expertly significant domains of the basic set of the ICF for ASDs. Quantitative assessment was performed in a unified format using ICF qualifiers comparable to the system of quantitative assessment adopted in medical and social expertise.

CONCLUSIONS: The results of the study allowed us to converge international and domestic standards of assessment of impaired functions and limitations of life activity in autism using the order of the Ministry of Labor of Russia № 585n as a ranking tool to translate the data on the functioning and life activity limitations of children with disability into the ICF determinants. The developed algorithm for expert rehabilitation diagnostics of autism syndrome is an important criterion for expert diagnostics, determining complex rehabilitation measures and evaluating the effectiveness of rehabilitation measures.

BACKGROUND: Speech dysfunction is noted in patients who have undergone hemiglossectomy or glossectomy for cancer of the oral cavity and oropharynx, including the pronunciation of sounds [k], [k’], [g], and [g’].

AIMS: To evaluate the effectiveness of correction of the pronunciation of posterior lingual sounds in patients with oral cavity and oropharyngeal cancers after surgical treatment.

MATERIALS AND METHODS: The objective and subjective assessments of speech allowed speech therapists to examine defects in the pronunciation of posterior lingual sounds [k], [k’], [g], and [g’] in patients with oral cavity and oropharyngeal cancer who underwent surgery. The effectiveness of correcting defects in the pronunciation of posterior lingual sounds was evaluated considering the extent of surgery. The study included 171 patients with stage II–IV oral cavity and oropharyngeal cancers. The age of the patients ranged from 24 to 70 years. The patients underwent hemiglossectomy, hemiglossectomy with reconstruction, or glossectomy with reconstruction. Combined modality treatment and postoperative speech rehabilitation were performed at the Department of Head and Neck Tumors of the Cancer Research Institute.

RESULTS: In all patients before starting the combined treatment, the pronunciation of posterior lingual sounds [k], [k’], [g], and [g’] corresponded to the norms in the Russian language. After surgery, the pronunciation of these sounds was impaired in most patients. In group III (after glossectomy with reconstruction), pronunciation defects were observed in 100% of the cases. The corrective speech therapy included a set of breathing and articulation exercises for the muscles of the cheeks, lips, and tongue using passive motor gymnastics as the basis for activating and coordinating the patient’s articulation apparatus.

CONCLUSION: The presented system of subsequent correction and automation of posterior lingual sounds allowed the correction of the pronunciation of these sounds in most patients.

BACKGROUND: The need and realization of the rights to rehabilitation of people with disability is a key guideline in building a system of rehabilitation and habilitation in the Russian Federation. The need for comprehensive rehabilitation for disorders of neuromuscular, skeletal, and movement-related functions (NSMFs) has not yet been fully studied.

AIM: To assess functioning indicators of persons with disability and impaired NSMFs based on the International Classification of Functioning, Disability, and Health (ICF) considering environmental barriers.

MATERIALS AND METHODS: A continuous controlled medical and social study was conducted. The study enrolled 257 respondents recognized as having a disability, which were divided into two groups. The target group (n=137) consisted of patients with NSMFs receiving rehabilitation services at a rehabilitation center, and the control group included 120 respondents with NSMFs who passed the initial examination at the Bureau of Medical and Social Expertise.

RESULTS: Despite the high need for comprehensive rehabilitation measures for people with disability and NSMFs of all age groups, patients with milder disease receive the preferential right to rehabilitation.

CONCLUSIONS: The results show that the use of ICF determinants in the description of functional and structural disorders and the main barriers at the stages of medical and social examination allows the identification of existing barriers in people with disability and more accurately and objectively determine the need for rehabilitation measures.

BACKGROUND: Mental disorders (including autism) in the Russian Federation rank first among all classes of diseases that form the primary disability in children. Analysis of the state and dynamics of the indicators of primary childhood disability due to this pathology, considering age-specific features, is the basis for further development of medical and social expertise, rehabilitation, and disability prevention.

AIMS: To analyze the state and dynamics of indicators of primary childhood disability caused by mental disorders and autism in St. Petersburg and the Voronezh Oblast.

MATERIALS AND METHODS: The study enrolled children who were recognized to have a disability for the first time caused by mental disorders and autism in St. Petersburg and Voronezh Oblast for 2016–2021. Data sources included statistical collections of the Federal State Statistics Service and forms of state statistical reporting 7-D (sobes). The study is longitudinal and continuous. Analytical, documentary, data copying, statistical, and graphic research methods were employed.

RESULTS: Indicators of primary childhood disability caused by mental disorders and autism are important criteria for the effectiveness of rehabilitation (habilitation) measures. The regional variability and growth of the number and level of IDD among the residents of the Russian Federation was revealed, reaching a maximum in St. Petersburg in 2021 (8.5 per 10 thousand pediatric population) and in the Voronezh region in 2019 (8.2 per 10 thousand pediatric population), which exceeded the all-Russian indicators. The level of autism-related primary childhood disability in 2016–2021 varied in the following ranges: from 0.5 to 0.7 in St. Petersburg (1.4-fold increase), from 2.4 to 1.2 in Voronezh Oblast (2-fold decrease), and from 1.4 to 2.0 per 10,000 children population (1.4-fold increase) in the Russian Federation. The results revealed the dependence of fluctuations in the rates of primary childhood disability caused by mental disorders and autism on changes in the normative legal framework for establishing disability.

CONCLUSION: The data obtained on the regional peculiarities of the dynamics and state of primary childhood disability caused by mental disorders and autism in St. Petersburg and Voronezh Oblast should be used to develop priority directions of medical and social assistance for the prevention of primary childhood disability at the level of regional healthcare organizations.