Specialists from the Bureau of Medical and Social Expertise recognized 20-year-old Muscovite Ekaterina Prokudina, who has suffered from cerebral palsy since birth and cannot move independently, as a disabled person of the second group, effectively depriving her of the opportunity to undergo annual sanatorium-resort treatment, the girl’s mother, Marina Prokudina, told RIA Novosti.

In accordance with the rules for recognizing a person as a disabled person, approved by a decree of the Government of the Russian Federation of February 20, 2006, recognition of a citizen as a disabled person is carried out during a medical and social examination based on a comprehensive assessment of the state of the citizen’s body based on an analysis of his clinical, functional, social, everyday, professional, labor and psychological data using classifications and criteria approved by the Ministry of Health and Social Development of the Russian Federation.

Conditions for recognizing a citizen as disabled are:

Impaired health with a persistent disorder of body functions caused by diseases, consequences of injuries or defects;
- limitation of life activity (complete or partial loss by a citizen of the ability or ability to carry out self-service, move independently, navigate, communicate, control one’s behavior, study or engage in labor activities);
- the need for social protection measures, including rehabilitation.

The presence of one of these conditions is not a sufficient basis for recognizing a citizen as disabled.

Depending on the degree of disability caused by a persistent disorder of body functions resulting from diseases, consequences of injuries or defects, a citizen recognized as disabled is assigned disability group I, II or III, and a citizen under the age of 18 is assigned the category “disabled child.”

Disability of group I is established for 2 years, groups II and III - for 1 year.

If a citizen is recognized as disabled, the cause of disability is indicated as a general illness, work injury, occupational disease, disability since childhood, disability due to injury (concussion, mutilation) associated with combat operations during the Great Patriotic War, military injury, illness received during military service, disability associated with the disaster at the Chernobyl nuclear power plant, the consequences of radiation exposure and direct participation in the activities of special risk units, as well as other reasons established by the legislation of the Russian Federation.

Re-examination of disabled people of group I is carried out once every 2 years, disabled people of groups II and III - once a year, and disabled children - once during the period for which the child is assigned the category "disabled child".

Citizens are assigned a disability group without specifying a period for re-examination, and citizens under 18 years of age are assigned the category “disabled child” until the citizen reaches the age of 18:

No later than 2 years after the initial recognition as disabled (establishment of the category “disabled child”) of a citizen who has diseases, defects, irreversible morphological changes, dysfunctions of organs and body systems according to the list according to the appendix;
- no later than 4 years after the initial recognition of a citizen as disabled (establishment of the category “disabled child”) if it is revealed that it is impossible to eliminate or reduce during the implementation of rehabilitation measures the degree of limitation of the citizen’s life activity caused by persistent irreversible morphological changes, defects and dysfunctions of organs and systems of the body.

The list of diseases, defects, irreversible morphological changes, dysfunctions of organs and systems of the body for which the disability group (category “disabled child” until the citizen reaches the age of 18) is established without specifying the period for re-examination:
1. Malignant neoplasms (with metastases and relapses after radical treatment; metastases without an identified primary focus when treatment is ineffective; severe general condition after palliative treatment, incurability (incurability) of the disease with severe symptoms of intoxication, cachexia and tumor disintegration).
2. Malignant neoplasms of lymphoid, hematopoietic and related tissues with severe symptoms of intoxication and severe general condition.
3. Inoperable benign neoplasms of the brain and spinal cord with persistent severe impairments of motor, speech, visual functions and severe liquorodynamic disorders.
4. Absence of the larynx after its surgical removal.
5. Congenital and acquired dementia (severe dementia, severe mental retardation, profound mental retardation).
6. Diseases of the nervous system with a chronic progressive course, with persistent severe impairment of motor, speech, and visual functions.
7. Hereditary progressive neuromuscular diseases, progressive neuromuscular diseases with impaired bulbar functions (swallowing functions), muscle atrophy, impaired motor functions and (or) impaired bulbar functions.
8. Severe forms of neurodegenerative brain diseases (parkinsonism plus).
9. Complete blindness in both eyes if treatment is ineffective; a decrease in visual acuity in both eyes and in the better-seeing eye up to 0.03 with correction or a concentric narrowing of the field of vision in both eyes up to 10 degrees as a result of persistent and irreversible changes.
10. Complete deaf-blindness.
11. Congenital deafness with the impossibility of hearing endoprosthetics (cochlear implantation).
12. Diseases characterized by high blood pressure with severe complications from the central nervous system (with persistent severe impairment of motor, speech, visual functions), heart muscles (accompanied by circulatory failure IIB III degree and coronary insufficiency III IV functional class), kidneys (chronic renal failure stage IIB III).
13. Coronary heart disease with coronary insufficiency III IV functional class angina and persistent circulatory impairment IIB III degree.
14. Diseases of the respiratory system with a progressive course, accompanied by persistent respiratory failure of II III degree, in combination with circulatory failure of IIB III degree.
15. Liver cirrhosis with hepatosplenomegaly and portal hypertension of III degree.
16. Unremovable fecal fistulas, stomas.
17. Severe contracture or ankylosis of large joints of the upper and lower extremities in a functionally disadvantageous position (if endoprosthesis replacement is impossible).
18. End-stage chronic renal failure.
19. Unremovable urinary fistulas, stomas.
20. Congenital anomalies of the development of the musculoskeletal system with severe persistent impairment of the function of support and movement with the impossibility of correction.
21. Consequences of traumatic injury to the brain (spinal cord) with persistent severe impairment of motor, speech, visual functions and severe dysfunction of the pelvic organs.
22. Defects of the upper limb: amputation of the shoulder joint area, disarticulation of the shoulder, shoulder stump, forearm, absence of the hand, absence of all phalanges of four fingers of the hand, excluding the first, absence of three fingers of the hand, including the first.
23. Defects and deformations of the lower limb: amputation of the hip joint area, disarticulation of the thigh, femoral stump, lower leg, absence of the foot.

Medical and social examination a citizen is carried out at the bureau at the place of residence (at the place of stay, at the location of the pension file of a disabled person who has left for permanent residence outside the Russian Federation).

At the main bureau, a medical and social examination of a citizen is carried out if he appeals the bureau’s decision, as well as upon the direction of the bureau in cases requiring special types of examination.

In the Federal Bureau, a medical and social examination of a citizen is carried out in the event of an appeal against the decision of the main bureau, as well as in the direction of the main bureau in cases requiring particularly complex special types of examination.

A medical and social examination can be carried out at home if a citizen cannot come to the bureau (main bureau, Federal Bureau) for health reasons, as confirmed by the conclusion of an organization providing medical and preventive care, or in a hospital where the citizen is being treated, or in absentia by decision of the relevant bureau.

The decision to recognize a citizen as disabled or to refuse to recognize him as disabled is made by a simple majority vote of the specialists who conducted the medical and social examination, based on a discussion of the results of his medical and social examination.

A citizen (his legal representative) can appeal the decision of the bureau to the main bureau within a month on the basis of a written application submitted to the bureau that conducted the medical and social examination, or to the main bureau.

The bureau that conducted the medical and social examination of the citizen sends it with all available documents to the main bureau within 3 days from the date of receipt of the application.

The Main Bureau, no later than 1 month from the date of receipt of the citizen’s application, conducts a medical and social examination and, based on the results obtained, makes an appropriate decision.

If a citizen appeals the decision of the main bureau, the chief expert in medical and social examination for the relevant constituent entity of the Russian Federation, with the consent of the citizen, may entrust the conduct of his medical and social examination to another group of specialists from the main bureau.

The decision of the main bureau can be appealed within a month to the Federal Bureau on the basis of an application submitted by the citizen (his legal representative) to the main bureau that conducted the medical and social examination, or to the Federal Bureau.

The Federal Bureau, no later than 1 month from the date of receipt of the citizen’s application, conducts a medical and social examination and, based on the results obtained, makes an appropriate decision.

Decisions of the bureau, the main bureau, the Federal Bureau can be appealed to the court by a citizen (his legal representative) in the manner established by the legislation of the Russian Federation.

Classifications and criteria, used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination, were approved by order of the Ministry of Health and Social Development of December 23, 2009.

The classifications used in the implementation of medical and social examination of citizens determine the main types of dysfunctions of the human body, caused by diseases, consequences of injuries or defects, and the degree of their severity, as well as the main categories of human life and the severity of the limitations of these categories.

The criteria used when carrying out medical and social examination of citizens determine the conditions for establishing disability groups (the category “disabled child”).

TO main types of dysfunctions of the human body relate:

Violations of mental functions (perception, attention, memory, thinking, intelligence, emotions, will, consciousness, behavior, psychomotor functions);
- violations of language and speech functions (violations of oral and written, verbal and non-verbal speech, disorders of voice formation, etc.);
- disturbances of sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity);
- violations of static-dynamic functions (motor functions of the head, torso, limbs, statics, coordination of movements);
- dysfunctions of blood circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity;
- disorders caused by physical deformity (deformations of the face, head, torso, limbs, leading to external deformity, abnormal openings of the digestive, urinary, respiratory tracts, violation of body size).

In a comprehensive assessment of various indicators characterizing persistent dysfunctions of the human body, four degrees of their severity are distinguished:

1st degree - minor violations,
2nd degree - moderate violations,
3rd degree - severe disturbances,
4th degree - significantly pronounced violations.

The main categories of human life include: the ability to self-service; ability to move independently; ability to orientate; ability to communicate; the ability to control one's behavior; ability to learn; ability to work.

In a comprehensive assessment of various indicators characterizing the limitations of the main categories of human life, 3 degrees of their severity are distinguished:

Self-care ability- a person’s ability to independently fulfill basic physiological needs, perform daily household activities, including personal hygiene skills:

1st degree - the ability to self-service with a longer investment of time, fragmentation of its implementation, reduction of volume using, if necessary, auxiliary technical means;
2nd degree - the ability to self-care with regular partial assistance from other persons using auxiliary technical means if necessary;
3rd degree - inability to self-care, need for constant outside help and complete dependence on other persons.

Ability to move independently- the ability to independently move in space, maintain body balance when moving, at rest and when changing body position, to use public transport:

1st degree - the ability to move independently with a longer investment of time, fragmentation of execution and reduction of distance using, if necessary, auxiliary technical means;
2nd degree - the ability to move independently with regular partial assistance from other persons, using auxiliary technical means if necessary;
3rd degree - inability to move independently and need constant assistance from others.

Orientation ability- the ability to adequately perceive the environment, assess the situation, the ability to determine the time and location:

1st degree - the ability to navigate only in a familiar situation independently and (or) with the help of auxiliary technical means;
2nd degree - the ability to navigate with regular partial assistance from other persons using, if necessary, auxiliary technical means;
3rd degree - inability to navigate (disorientation) and the need for constant assistance and (or) supervision of other persons.

Ability to communicate- the ability to establish contacts between people by perceiving, processing and transmitting information:

1st degree - ability to communicate with a decrease in the pace and volume of receiving and transmitting information; use, if necessary, assistive technical aids; in case of isolated damage to the organ of hearing, the ability to communicate using non-verbal methods and sign language translation services;
2nd degree - the ability to communicate with regular partial assistance from other persons, using auxiliary technical means if necessary;
3rd degree - inability to communicate and need for constant help from others.

Ability to control your behavior- the ability to self-awareness and adequate behavior taking into account social, legal and moral ethical norms:

1st degree- periodically occurring limitation of the ability to control one’s behavior in difficult life situations and (or) constant difficulty in performing role functions affecting certain areas of life, with the possibility of partial self-correction;
2nd degree- constant reduction of criticism of one’s behavior and environment with the possibility of partial correction only with the regular help of other people;
3rd degree- inability to control one’s behavior, the impossibility of correcting it, the need for constant help (supervision) from other persons.

Learning ability- the ability to perceive, remember, assimilate and reproduce knowledge (general education, professional, etc.), mastery of skills and abilities (professional, social, cultural, everyday):

1st degree- the ability to learn, as well as to obtain a certain level of education within the framework of state educational standards in general educational institutions using special teaching methods, a special training regime, using, if necessary, auxiliary technical means and technologies;
2nd degree- the ability to learn only in special (correctional) educational institutions for students, pupils, children with disabilities or at home according to special programs using, if necessary, auxiliary technical means and technologies;
3rd degree- learning disability.

Ability to work- ability to carry out work activities in accordance with the requirements for the content, volume, quality and conditions of work:

1st degree- the ability to perform work activities in normal working conditions with a decrease in qualifications, severity, intensity and (or) a decrease in the volume of work, the inability to continue working in the main profession while maintaining the ability to perform lower-skilled work under normal working conditions;
2nd degree- the ability to perform labor activities in specially created working conditions with the use of auxiliary technical means and (or) with the help of other persons;
3rd degree- inability to perform any work activity or impossibility (contraindication) of any work activity.

The degree of limitation of the main categories of human life activity is determined based on an assessment of their deviation from the norm corresponding to a certain period (age) of human biological development.

Criteria for assessing disability in ITU institutions

Introduction

The radical political and socio-economic transformations that have occurred in Russia over the last decade have led to fundamental changes in the state's social policy towards people with disabilities and contributed to the formation of new approaches to solving the problems of disability and social protection of people with disabilities.
The main provisions of state policy in relation to people with disabilities are reflected in the Federal Law “On Social Protection of People with Disabilities in the Russian Federation” (No. 181 of November 24, 1995), which contains new interpretations of the concepts of “disability” and “disabled person”, new positions for the definition of disability .
The implementation of this Law required the development of a modern concept of disability, the creation of a new methodological basis for its definition and assessment, and the transformation of the medical and labor examination service into a medical and social examination.
In 1997, “Classifications and temporary criteria used in the implementation of medical and social examination” developed by CIETIN employees were published, approved by Resolution of the Ministry of Labor and Social Development of the Russian Federation and the Ministry of Health of the Russian Federation No. 1/30 of January 29, 1997, as well as methodological recommendations for their use for employees of institutions of medical and social examination and rehabilitation (Moscow, 1997, Central Scientific Research Institute, Issue 16).
In the period 1997-2000. new approaches to defining disability have been widely introduced into the practice of ITU institutions. Their practical application has shown significant advantages of modern positions of medical and social expertise for improving the social protection of people with disabilities.
At the same time, the fundamental difference between the criteria of medical and social examination and the criteria of medical and labor examination, the stereotype of previous thinking, and some imperfections of new methodological approaches caused certain difficulties in the practical work of the ITU bureau.
In 1999-2000 CIETIN staff studied the initial experience of applying the “Classifications and temporary criteria used in the implementation of medical and social examination” in the practice of 72 ITU bureaus of general and specialized profiles of different constituent entities of the Russian Federation and all clinical departments of CIETIN, where the data of expert rehabilitation diagnostics of 654 examined persons
Comments and suggestions made by specialists from ITU services and CIETIN staff, as well as representatives of public organizations of people with disabilities, doctors from medical institutions, scientists from research institutes, etc. were carefully analyzed and, taking them into account, the necessary adjustments and additions were made to the basic concepts and classifications , criteria and methodology for assessing disabilities when carrying out medical and social examination, which are presented in these guidelines.

1. Basic concepts
1.1. A disabled person is a person who has a health impairment with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of life activity and necessitating his social protection.
1.2. Disability is a social insufficiency due to a health disorder with a persistent disorder of body functions, leading to limitation of life activity and the need for social protection.
1.3.Health is a state of complete physical, mental and social well-being, and not just the absence of illness and physical defects.
1.4.Impaired health - physical, mental and social ill-being associated with loss, anomaly, disorder of the psychological, physiological, anatomical structure and (or) function of the human body.
1.5. Disability is a deviation from the norm of human activity due to a health disorder, which is characterized by a limitation in the ability to carry out self-care, movement, orientation, communication, control over one’s behavior, learning, work and play activities (for children).
1.6. Social disability is the social consequences of a health disorder, leading to limitation of a person’s life activity and the need for his social protection or assistance.
1.7. Social protection is a system of state-guaranteed economic, social and legal measures that provide people with disabilities with conditions for overcoming, replacing, and compensating for limitations in life activities and aimed at creating equal opportunities for them to participate in the life of society as other citizens.
1.8. Social assistance is periodic and (or) regular activities that help eliminate or reduce social disadvantage.
1.9. Social support - one-time or occasional short-term activities in the absence of signs of social insufficiency.
1.10. Rehabilitation of disabled people is a system of medical, psychological, pedagogical, socio-economic measures aimed at eliminating or possibly more fully compensating for limitations in life activity caused by health problems with persistent impairment of body functions. The goal of rehabilitation is to restore the social status of a disabled person, achieve financial independence and social adaptation.
1.11. Rehabilitation potential is a complex of biological, psychophysiological and personal characteristics of a person, as well as social and environmental factors that allow, to one degree or another, to compensate or eliminate his limitations in life.
1.12. Rehabilitation prognosis is the estimated probability of realizing the rehabilitation potential.
1.13. Clinical prognosis is a scientifically based assumption about the further outcome of the disease based on a comprehensive analysis of the clinical and functional characteristics of the health disorder, the course of the disease and the effectiveness of treatment.
1.14. Specially created conditions for labor, household and social activities - specific sanitary and hygienic, organizational, technical, technological, legal, economic, microsocial factors that allow a disabled person to carry out labor, household and social activities in accordance with his rehabilitation potential.
1.15. Special workplaces for employing disabled people are workplaces that require additional measures to organize work, including adaptation of basic and auxiliary equipment, technical and organizational equipment, additional equipment and provision of technical devices, taking into account the individual capabilities of disabled people.
1.1.16. Auxiliary means are special additional tools, objects, devices and other means used to compensate or replace impaired or lost body functions and facilitate the adaptation of a disabled person to the environment.
1.17. Full working capacity – working capacity is considered full if the functional state of the body meets the requirements of the profession and allows performing production activities without harm to health.
1.18. Profession is a type of work activity (occupation) of a person who has a complex of special knowledge, skills and abilities acquired through education, training, and work experience. The main profession should be considered work of the highest qualification or performed for a longer period of time.
1.19. Specialty - a type of professional activity improved through special training; a certain area of ​​work, knowledge.
1.20. Qualification is the level of preparedness, skill, degree of suitability to perform work in a certain profession, specialty or position, determined by rank, class, rank and other qualification categories.
1.21. Constant outside help and care
– provision by an outsider of constant systematic assistance and care in meeting the physiological and everyday needs of a person.
1.22. Supervision is observation by an outsider, necessary to prevent actions that could cause harm to the disabled person and the people around him.
2. Classification of violations of the basic functions of the human body:
2.1. Disorders of mental functions (perception, memory, thinking, intelligence, higher cortical functions, emotions, will, consciousness, behavior, psychomotor functions).
2.2. Language and speech disorders – disorders of oral and written, verbal and non-verbal speech that are not caused by mental disorders; disorders of voice formation and speech form (stuttering, dysarthria, etc.).
2.3. Impaired sensory functions (vision, hearing, smell, touch, vestibular function, tactile, pain, temperature and other types of sensitivity; pain syndrome).
2.4. Violations of static-dynamic functions (motor functions of the head, torso, limbs, statics, coordination of movements).
2.5. Visceral and metabolic disorders, nutritional disorders (circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity).
2.6. Disfiguring disorders (structural deformations of the face, head, torso, limbs, severe external deformity; abnormal openings of the digestive, urinary, respiratory tracts; disturbance of body size: gigantism, dwarfism, cachexia, excess weight).
3. Classification of violations of the basic functions of the human body according to severity
A comprehensive assessment of various qualitative and quantitative indicators characterizing persistent impairment of body functions provides for the identification of predominantly four degrees of impairment:
1st degree - minor functional impairment
2nd degree - moderate dysfunction
3rd degree - severe dysfunction
4th degree - significantly pronounced dysfunction.

4. Classification of the main categories of life activity and limitations of life activity according to the degree of severity.
4.1. Self-care ability- the ability to independently satisfy basic physiological needs, perform daily household activities and personal hygiene skills.
The ability for self-care is the most important category of human life, presupposing his physical independence in the environment.
Self-care abilities include:
satisfaction of basic physiological needs, management of physiological functions;
maintaining personal hygiene: washing the face and entire body, washing and combing hair, brushing teeth, trimming nails, hygiene after physiological functions;
dressing and undressing outerwear, underwear, hats, gloves, shoes, using fasteners (buttons, hooks, zippers);
eating: the ability to bring food to the mouth, chew, swallow, drink, use cutlery and cutlery;
fulfilling everyday household needs: purchasing food, clothing and household items;
cooking: cleaning, washing, cutting food, cooking it, using kitchen utensils;
use of bed linen and other bedding; making the bed, etc.;
washing, cleaning and repairing linen, clothing and other household items;
use of household appliances and appliances (locks and latches, switches, taps, lever devices, iron, telephone, household electric and gas appliances, matches, etc.);
cleaning the premises (sweeping and washing the floor, windows, wiping dust, etc.).

To realize the ability for self-care, the integrated activity of practically all organs and systems of the body is required, violations of which in various diseases, injuries and defects can lead to a limitation of the ability to self-care.
Parameters when assessing limitations in the ability to self-care may be:
assessment of the need for auxiliary aids, the possibility of correcting the ability to self-care with the help of auxiliary aids and adaptation of the home;
assessment of the need for outside help in meeting physiological and everyday needs;
assessment of the time intervals through which such need arises: periodic need (1-2 times a week), long intervals (once a day), short (several times a day), constant need.

Limitation of the ability to self-care according to severity:
I degree - ability for self-care with the use of aids.
The ability to self-service and independently perform the above actions with the help of technical means, adaptation of housing and household items to the capabilities of a disabled person is retained.
II degree – the ability to self-care with the use of aids and with partial assistance from other persons.
The ability to self-service with the help of technical means, adaptation of housing and household items to the capabilities of a disabled person is retained with the mandatory partial assistance of another person, mainly to fulfill everyday needs (cooking, buying food, clothing and household items, washing clothes, using some household appliances, cleaning the premises and etc.).
III degree – inability to self-care and complete dependence on other persons (the need for constant outside care, assistance or supervision). The ability to independently perform most of the vital physiological and household needs, even with the help of technical means and adaptation of housing, is lost, the implementation of which is possible only with constant help other persons.

4.2. Ability to move independently– the ability to independently move in space, overcome obstacles, maintain body balance within the framework of everyday, social, and professional activities.

The ability to move independently includes:
- independent movement in space: walking on level ground at an average pace (4-5 km per hour for a distance corresponding to average physiological capabilities);
- overcoming obstacles: going up and down stairs, walking on an inclined plane (with an inclination angle of no more than 30 degrees),
- maintaining body balance when moving, at rest and when changing body position; the ability to stand, sit, get up, sit down, lie down, maintain the adopted posture and change the position of the body (turns, bending the body forward, to the sides),
- performing complex types of movement and movement: kneeling and rising from the knees, moving on the knees, crawling, increasing the pace of movement (running).
- use of public and personal transport (entry, exit, movement within the vehicle).
The ability to move independently is achieved through the integrated activity of many organs and systems of the body: musculoskeletal, nervous, cardiorespiratory, organs of vision, hearing, vestibular apparatus, mental sphere, etc.
When assessing ambulation ability, the following parameters should be analyzed:
- the distance a person can move;
walking pace (normally 80-100 steps per minute);
walking rhythm coefficient (normally 0.94-1.0);
duration of double step (normally 1-1.3 sec)
movement speed (normally 4-5 km per hour);
need and ability to use auxiliary aids.
Limitation of the ability to move independently according to severity:

I degree – the ability to move independently with the use of aids with a longer investment of time, fragmentation of execution and a reduction in distance.
The ability to move independently is retained when using assistive devices with a decrease in speed when performing movement and movement, with a limitation in the ability to perform complex types of movement and movement while maintaining balance.
In the first degree, the ability to move is characterized by a moderate decrease in speed (up to 2 km per hour), pace (up to 50-60 steps per minute), an increase in the duration of the double step (up to 1.8-2.4 seconds), a decrease in the coefficient rhythm of walking (up to 0.69-0.81), reduction in movement distance (up to 3.0 km), fragmentation of its implementation (breaks every 500-1000 m or 30-60 minutes of walking) and the need to use aids.
II degree – the ability to move independently with the use of aids and partial assistance from other persons.
The ability to move independently and move with the help of assistive devices, adapt housing and household items to the capabilities of a disabled person, and involve another person when performing certain types of movement and movement (complex types of movement, overcoming obstacles, maintaining balance, etc.) is retained.
In the second degree - the ability to move is characterized by a pronounced decrease in speed (less than 1.0 km per hour), walking pace
(less than 20 steps per minute), increasing the duration of a double step (less than 2.7 seconds), decreasing the rhythmicity coefficient of walking (less than 0.53), the fragmentation of its execution, reducing the distance of movement mainly within the apartment if it is necessary to use aids and partial assistance other persons.
III degree – inability to move independently, which is possible only with the help of other persons.

4.3. Learning ability– the ability to perceive and reproduce knowledge (general education, professional, etc.) and master skills and abilities (professional, social, cultural, everyday).
The ability to learn is one of the important integrative forms of life, which depends, first of all, on the state of mental functions (intelligence, memory, attention, clarity of consciousness, thinking, etc.), the preservation of communication systems, orientation, etc. Learning also requires the use the ability to communicate, move, self-care, determined by the psychological characteristics of the individual, the state of the locomotor system, visceral functions, etc. The ability to learn is impaired in diseases of various body systems. Of all the life activity criteria, learning disabilities have the greatest social significance in childhood. It is equivalent to impaired ability to work in adults and is the most common cause of social disability in a child.

Characteristics of educational activities include:
content of training (obtaining education at a certain level and in a certain profession);
teaching aids (including special technical means for training, equipment for training places, etc.);
the learning process, including forms of learning (full-time, part-time, part-time, at home, etc.), teaching methods (group, individual, interactive, open, etc.);
learning conditions (in terms of severity, intensity and harmfulness);
terms of study.

When assessing the degree of learning disability, the following parameters should be analyzed:
education, availability of professional training;
volume of training according to general or special state educational standards;
the opportunity to study in a general educational institution or in a correctional educational institution;
terms of study (normative-non-normative);
the need to use special technologies and (or) educational aids.
the need for assistance from other persons (except training personnel);
the level of cognitive (mental) activity of a person in accordance with the age norm;
attitude towards learning, motivation for learning activities;
the possibility of verbal and (or) non-verbal contact with other people;
state of communication systems, orientation, especially sensory, motor functions of the body, etc.;
the state of visual-motor coordination for mastering writing techniques, graphic skills, and manipulative operations.
Learning disability by severity

I degree - the ability to learn, master knowledge, skills and abilities in full (including obtaining any education in accordance with general state educational standards), but in non-standard terms, subject to a special regime of the educational process and (or) using auxiliary means.
II degree – the ability to learn and acquire knowledge, skills and abilities only according to special educational programs and (or) educational technology in specialized educational and educational correctional institutions with the use of aids and (or) with the help of other persons (except for teaching staff).
III degree – learning disability and inability to acquire knowledge, skills and abilities.

4.4. Ability to work– a state of the human body in which the totality of physical and spiritual abilities allows for the implementation of a certain volume and quality of production (professional) activity.
Ability to work includes:
- The ability of a person, in terms of his physical, psychophysiological and psychological capabilities, to meet the requirements imposed on him by industrial (professional) activities (in terms of the complexity of work, conditions of the working environment, physical severity and neuro-emotional tension).
- The ability to reproduce special professional knowledge, skills and abilities in the form of production (professional) labor.
- A person’s ability to carry out production (professional) activities in normal production conditions and in a normal workplace.
- A person’s ability for social and labor relationships with other people in the work team.

Limitation of ability to work according to severity
I degree – the ability to perform professional activities in normal production conditions with a reduction in qualifications or a decrease in the volume of production activities; inability to perform work in the main profession.
II degree – ability to perform work activities
in normal production conditions with the use of auxiliary equipment, and (or) at a special workplace, and (or) with the help of other persons;
in specially created conditions.

III degree – inability or impossibility (contraindication) to work.

4.5. Orientation ability– ability to be determined in time and space
The ability to orient is carried out through direct and indirect perception of the environment, processing the information received and adequately defining the situation.
Orientation ability includes:
- The ability to determine time based on surrounding signs (time of day, time of year, etc.).
- The ability to determine location based on the attributes of spatial landmarks, smells, sounds, etc.
- The ability to correctly locate external objects, events and oneself in relation to temporal and spatial reference points.
- The ability to realize one’s own personality, mental image, diagram of the body and its parts, differentiation of “right and left”, etc.
- The ability to perceive and adequately respond to incoming information (verbal, non-verbal, visual, auditory, gustatory, obtained through smell and touch), understanding the connection between objects and people.
When assessing orientation limitations, the following parameters should be considered:
state of the orientation system (vision, hearing, touch, smell)
state of communication systems (speech, writing, reading)
ability to perceive, analyze and adequately respond to information received
the ability to realize, identify one’s own personality and external temporal, spatial conditions, and environmental situations.

Limitation of the ability to orient according to severity:

I degree - ability to orientate, subject to the use of aids.
The ability to locate oneself in place, time and space is retained with the help of auxiliary technical means (mainly improving sensory perception or compensating for its impairment)
II degree – the ability to navigate, requiring the help of other persons.
The possibility of awareness of one’s own personality, one’s position and definition in place, time and space remains only with the help of other persons due to a decrease in the ability to understand oneself and the outside world, understand and adequately define oneself and the surrounding situation.
III degree – inability to navigate (disorientation) and the need for constant supervision.
A condition in which the ability to orient oneself in place, time, space and one’s own personality is completely lost due to the lack of ability to understand and evaluate oneself and the environment.

4.6. Ability to communicate– the ability to establish contacts between people by perceiving, processing and transmitting information.

When communicating, the interaction and interaction of people takes place, the exchange of information, experience, skills, and performance results occurs.
In the process of communication, a community of feelings, moods, thoughts, and views of people is formed, their mutual understanding, organization and coordination of actions are achieved.
Communication is carried out mainly through means of communication. The main means of communication is speech, the auxiliary means are reading and writing. Communication can be carried out using both verbal (verbal) and non-verbal symbols. In addition to the preservation of speech, communication requires the preservation of orientation systems (hearing and vision). Another condition for communication is the normal state of mental activity and psychological characteristics of the individual.
Communication abilities include:
the ability to perceive another person (the ability to reflect his emotional, personal, intellectual characteristics)
the ability to understand another person (the ability to comprehend the meaning and significance of his actions, actions, intentions and motives).

The ability to exchange information (perception, processing, storage, reproduction and transmission of information).
- the ability to develop a joint interaction strategy, including the development, implementation and monitoring of the implementation of the plan, with possible adjustments if necessary.

When assessing the limitations of the ability to communicate, the following parameters should be analyzed, characterizing primarily the state of the communication and orientation systems:
ability to speak (smoothly pronounce words, understand speech, pronounce and produce verbal messages, convey meaning through speech);
ability to listen (perceive oral speech, verbal and other messages);
the ability to see, read (perceive visible information, written, printed and other messages, etc.);
ability to write (encode language into written words, compose written messages, etc.);
ability for symbolic communication (non-verbal communication) - understand signs and symbols, codes, read maps, diagrams, receive and transmit information using facial expressions, gestures, graphic, visual, sound, symbols, tactile sensations).

Possibility of contacts with an expanding circle of people: family members, close relatives, friends, neighbors, colleagues, new people, etc.

Limitation of the ability to communicate by severity
I degree – the ability to communicate, characterized by a decrease in speed, a decrease in the volume of assimilation, reception, transmission of information and (or) the need to use auxiliary means.
The possibility of communication remains when the speed (tempo) of oral and written speech decreases, the speed of assimilation and transmission of information decreases in any way while understanding its semantic content.
II degree - the ability to communicate using aids and the help of others.
It remains possible to communicate using technical and other auxiliary means that are not typical for the usual establishment of contacts between people, and the assistance of other persons in receiving and transmitting information and understanding its semantic content.
III degree - inability to communicate and the need for constant outside help.
A condition in which contact between a person and other people is impossible, mainly due to the loss of the ability to understand the semantic content of received and transmitted information.

4.7. Ability to control your behavior– the ability to understand and behave appropriately, taking into account moral, ethical and socio-legal norms.
Behavior is a person’s inherent interaction with the environment, mediated by his external (motor) and internal (mental) activity. When control over one's behavior is violated, a person's ability to comply with the legal, moral, aesthetic rules and norms officially established or established in a given society is violated.
The ability to control one's behavior includes:
The ability to understand oneself, one’s place in time and space, one’s social status, state of health, mental and personal qualities and properties.
The ability to evaluate one’s own actions, actions, intentions and motives of another person with an understanding of their meaning and meaning.
The ability to perceive, recognize and adequately respond to incoming information.
Ability to correctly identify people and objects.

The ability to behave correctly in accordance with moral, ethical and socio-legal norms, to observe the established public order, personal cleanliness, order in appearance, etc.
- The ability to correctly assess the situation, the adequacy of the development and selection of plans, achieving goals, interpersonal relationships, and performing role functions.
- The ability to change your behavior when conditions change or behavior is ineffective (plasticity, criticality and variability).
- Ability to understand personal safety (understanding external danger, recognizing objects that can cause harm, etc.)
- The usefulness of using tools and sign systems in managing one’s own behavior.
When assessing the degree of limitations in the ability to control one's behavior, the following parameters should be analyzed:
presence and nature of personal changes
degree of preservation of awareness of one’s behavior
the ability for self-correction, or the possibility of correction with the help of other persons, therapeutic correction;
the direction of the impairment of the ability to control one’s behavior in one or more areas of life (industrial, social, family, everyday life);
duration and persistence of violations of control over one’s behavior;
stage of compensation for behavioral defect (compensation, subcompensation, decompensation);
state of sensory functions.

Penza region, Penza State Institution SPN Penza Regional Center for Rehabilitation of Disabled People
Yu. A. Vasyagina

Occupational therapy is aimed at the rehabilitation of persons with disabilities, i.e. those who have completely or partially lost the ability to carry out self-care,
move independently, navigate, communicate, control one’s behavior, study and engage in work activities, and have a good rest. The goal of occupational therapy is to achieve maximum autonomy and independence for people with disabilities.
Its main method is the practical implementation by patients of various activities related to one or another type of activity.
This article presents some areas of occupational therapy that have been used in the Penza Regional Rehabilitation Center since 1999 and have proven their effectiveness.

Testing

Before starting rehabilitation activities, the occupational therapist assesses the person’s disability. With the help of special techniques, tests, simulators that simulate various aspects of human activity, violations of the components and components of human life are identified. Based on the assessment, the specialist, together with the client, determines the goals, methods and plan of occupational therapy sessions. The Penza Regional Rehabilitation Center uses a number of tests that help identify the patient’s problems caused by disorders of the upper limbs, visual impairments, and determine the type and nature of activity he needs. Some of them are listed below:

Test 1: Determining the capture method

The test is used for patients with hemiparesis and paraparesis and is intended to determine the ability to grasp large and small objects. A needle, nail, key, sheet of paper, beads, pencil are used as small items for testing; larger ones - a cube with a side of 4 cm, a rolling pin, a book, a bag with a handle, a knife, a ball with a diameter of 6 cm. The patient is asked to grab the listed objects one by one, starting with the smaller ones, with one hand and then with the other. The grip can be carried out either with or without the use of an orthosis. The results are assessed on a 4-point scale:
4 - correct grip and hold;
3 - correct grip without holding;
2 - incorrect grip, but retention is possible;
1 - incorrect grip, holding is impossible;
0 - capture is impossible.

Test 2. Assessment of fine motor skills

The test is used for patients with hemiparesis and upper paraparesis if the test to determine the method of capture gives a positive result. Dexterity of movements, speed of task completion, and number of operations are assessed. The patient can perform the task either with each hand in turn, or with both hands. For this, two sets of devices are used. 1st set - for patients who are able to grasp small objects and hold them. It includes a board with holes, bolts, washers and nuts. 2nd set - for patients who are able to grasp small objects, but cannot retain them. It includes a board with holes, counting sticks, and caps from felt-tip pens.
When conducting a test with the 1st set, the patient must insert as many bolts as possible into the holes of the board in a minute, put washers on them and tighten the nuts. In the second case, during the same time, you need to insert as many counting sticks as possible into the board and cover them with caps from felt-tip pens.

Test 3. Points, rays

The test is intended for patients with visual impairments (stroke, traumatic brain injury, cerebral palsy).
There are two options for conducting the test. For the first, a template form is used with 8 rays located on it at a certain angle and 8 separate forms, on which one ray is depicted in the same place as on the template. The therapist offers the patient a template form, and then alternately lays out forms with single beams in front of him. The patient’s task is to show where the beam proposed by the therapist is located on the template. For the second version of the test, a template form is used with 9 dots depicted on it in a certain sequence and 9 separate forms, each of which shows one point in different places in accordance with the template form. The therapist places a template form in front of the patient, and then alternately lays out the forms with separately located dots. The patient needs to determine where this or that point is located on the template.

Test 4. Broken line

The test is used to identify disorders of coordination of movements of the upper extremities (stroke, traumatic brain injury, cerebral palsy).
The patient is offered a form on which various types of broken lines are depicted. He must draw a line with a pencil close to the contour of the broken line.
The quality of the task is assessed.

Selecting training methods for the patient

To develop a plan for working with a patient, it is also necessary to comply with a number of requirements for choosing the type of activity. Determining an occupation that suits the individual with a disability is a complex process that requires great skill and experience from the occupational therapist. It should be remembered that classes must be feasible, meaningful for the patient, and consistent with his interests and life roles. When choosing classes, you should be guided by the following principles:
- any activity and occupation must take into account the gender of patients, some of whom may believe that certain types of activity are performed only by persons of a certain gender. For example, some men may refuse to participate in cooking because they consider it a “woman’s job,” while others enjoy it, are good cooks, and may even do it professionally. When drawing up a plan of rehabilitation measures, it is better for the occupational therapist to rely on the patient’s opinion in these matters rather than to impose his point of view on him;
- the choice of activity should correspond to the cultural characteristics of the patient’s environment; a person is more likely to find an activity appropriate for himself if it reflects the norms and values ​​of his cultural group;
- the lesson should take into account the age characteristics of the patient. He may refuse activities that he considers inappropriate for his age. For example, an elderly person will not play with dolls, but may be interested in building a dollhouse for his granddaughter, because it corresponds to his role as a grandfather;
- it is important to choose activities that are adequate to the usual ones, especially in cases where the patient is within the walls of a medical institution. The role of the occupational therapist is then to enable the patient to maintain a balance between self-care, leisure and productive activities in a manner that promotes independence and autonomy;
- when choosing activities, it is necessary to take into account both the strengths and weaknesses of the patient, as well as the nature of the activity. The occupational therapist should choose an activity that maximizes the patient's strengths and challenges the patient's weaknesses. To overcome functional impairments, it is necessary to help the patient make the most of his strengths to compensate for his weaknesses, as well as adapt the conditions of activity so that the patient can successfully engage in it, despite the limitations;
- it is necessary to gradually increase the level of complexity of the exercises, for which it is necessary to determine the duration of their implementation, the intensity of physical and mental effort, the number of stages, the complexity of the implementation, the number of people with whom the patient has to contact, the scope of responsibilities, and the amount of assistance required. It is important that this process is consistent with the patient's real life conditions and aspirations;
- the activity should take place in an environment in which it is most likely to be performed by the patient. If this is a hospital ward, then its specifics may not reflect all the features and requirements of the patient’s natural environment. For example, a patient may be able to cope well with transferring from a wheelchair to a bed while in the hospital, but may have difficulty transferring from a wheelchair to a bed due to different conditions at home. In such cases, it is recommended to create an artificial environment that is closest to the patient’s real life. Such imitation may concern the spheres of self-care, productive activity and leisure.

Methods of social and everyday adaptation of disabled people

I. Self-care techniques A

These techniques are used for patients with hemiparesis, paraparesis, various types of ataxia, apraxia, and hyperkinesis.
1. Use of aids in the patient’s personal hygiene Purpose:
- familiarize the patient with the available aids;
- select the aids required for a particular patient;
- train the patient in the use of selected aids.
Lesson 1. Talk about available aids and demonstrate them.
Lesson 2. Selection of necessary funds.
Lesson 3. Subsequent step-by-step training in the use of auxiliary aids.
2. Training in dressing/undressing Purpose:
- teach the patient how to dress/undress independently.
Before starting classes, it is necessary to determine the position of the patient that is most favorable for dressing/undressing.
Lesson 1. Putting on a pullover/shirt
Patients with hemiparesis and upper paraparesis are taught to dress in this way: in a sitting or standing position, you need to insert your arms into the sleeves, then lift them up, stick your head into the neckline. If the patient cannot raise his arms, you need to pass the head first, but in this case it will be difficult to get your hand into the armhole. It is much more difficult to learn how to put on clothes while lying down.
Lesson 2. Putting on trousers/skirts
For patients with hemiparesis, upper paraparesis, tetraparesis, lower paraplegia, the type of lesion determines the dressing method.
If the patient is sitting in a chair, he bends down to insert his legs into the trouser legs and raise them to the hips, then stands up to bring them to the waist. If the patient is lying on his back, he lifts one leg, then the other to pull the trousers up to the hips, then lifts the pelvis to pull them up to the waist. If the patient is unable to lift the pelvis, rolling from side to side is necessary to put on clothes.
Lesson 3. Undressing: pullover/shirt
If the patient can move the shoulder backward, he releases the shoulder from the opposite side with the help of his dominant hand. If not, he grabs the top edge of the pullover from the back with one or two hands, puts his chin into the neck of the pullover, bends down and pulls the pullover, letting his head pass, and then freeing his hands. This requires good fixation of the head and torso. Undressing can be carried out in a standing position, sitting on a chair, sitting cross-legged on the carpet. For patients who cannot maintain a sitting position, it is very difficult to offer a specific undressing technique; you need to adapt to their capabilities (when undressing, it is enough to use a palm grip, which should be quite strong).
Lesson 4. Undressing: trousers/skirt

In a standing position, the patient lowers his trousers to his hips, then sits down to free his lower legs.
In a prone position, he releases the buttocks, lowers the trousers one by one from each leg, then removes the trousers completely.
Lesson 5. Learning to fasten buttons
It is used for patients with hemiparesis, paraparesis, and lower paraplegia.
Learning to fasten is a long and difficult process. Fastening requires a good grip with the thumb and index finger of your dominant hand.
First, the patient is taught to insert buttons (oblong wooden, cardboard) into the holes, then to fasten and unfasten the buttons, starting with the largest ones, while the loops should be slightly larger than the required size. The next stage is teaching the patient to button up his own clothes placed on the table in front of him, then to button up the clothes on himself. Wool clothing is preferred for training; the loops should be larger than on his normal clothing.
Lesson 6. Training in shoeing and lacing. Used for patients with hemiparesis and paraparesis.
The most optimal positions for putting on shoes:
- sitting on a chair, feet on the floor, body tilted forward;
- sitting on a chair, legs on a stand, at a height slightly lower than the chair;
- sitting on the floor, knees bent.
When learning to lace, it is necessary to develop a grip with the thumb and forefinger. If there are any problems, then first practice on wooden shoes (model), using laces of different colors to make it easier to remember the lacing mechanism. The laces should have a thick tip. Then laces of the same color are used. The patient laces up the shoes placed in front of him on the table with the heel facing him. In case of difficulties with lacing, you must repeat the operation from the beginning each time.
To tie a lace with a knot, it is necessary to teach the patient to cross the laces, forming a circle, passing one end of the lace inside this circle.
Lesson 7. Training in the use of aids when dressing/undressing. Used for patients with hemiparesis, paraparesis, rheumatoid polyarthritis, amputation of one of the upper limbs.
Goal: learning to use a stick with a hook.
A demonstration of putting on clothes using a stick is performed. First, the patient is taught how to properly grip the stick, then, helping him, they grab the clothes and pull them on. The patient then tries to perform this operation on his own.
Goal: learning to use devices for putting on tights and socks.
Used for patients with lower paraplegia.
Demonstrate to the patient the sequence of putting on tights and socks. First, tights are pulled onto the device located on the knees, then it is lowered down, holding it by the ribbons, and pulled onto the legs along with the tights put on it.

II. Methods of teaching productive activities

These techniques are used to teach kitchen work skills to patients using a wheelchair, patients with hemiparesis, rheumatoid polyarthritis, paraparesis, and also with minor mental disorders.
1. Working in the kitchen
The goal is to teach independent cooking, eating, and cleaning.
Lesson 1. Introduction to kitchen equipment (furniture, household appliances, dishes)
Patients who have difficulty moving must be taught to actively move around in the kitchen and be provided with unhindered access to kitchen equipment.
Lesson 2. Safety rules when working in the kitchen
A conversation is held about the fact that when using electrical appliances, attention and certain knowledge are required. The patient should remember the following rules:
- do not touch a working electrical appliance with wet hands;
- do not keep switched on appliances (refrigerator, oven) open for a long time;
- fill the electric kettle with water to the specified level, and place it on a flat surface for heating;
- when using a key to open cans, be careful not to injure your hands with the cutting surface;
- when working with water, to prevent injury, ensure that as little water is splashed as possible;
- move vessels with hot water with extreme caution.
Lesson 3. Learning to use kitchen appliances
A conversation is held about the purpose of household appliances: electric stove, refrigerator,
electric kettle, key for opening cans. Demonstrate and explain the purpose of the refrigerator compartments, the rules for loading it; matching the selected stove heater disc to the adjustable handle teaches the correct use of a can opener. Then the patient is asked to independently perform this or that action.
Lesson 4. Table setting
Those moving in a wheelchair are recommended to use devices for moving dishes on their knees; if one half of the body is affected, use a table on wheels for this.
The patient is explained and shown how to set the table for breakfast, lunch, etc. Then the patient tries to perform the necessary actions independently.
Lesson 5. Training in cutting food (bread, vegetables) using special devices
Using a cutting board with spikes, they demonstrate cutting boiled vegetables and bread. The patient then tries to perform these actions independently. If necessary, the patient uses a knife with an adapted handle or with a hand strap.
Lesson 6. Learning to peel vegetables Explain the procedure:
- washing vegetables;
- placing vegetables on a device for securing them;
- cleaning boiled vegetables;
- peeling raw vegetables.
Then, together with the patient, they proceed to perform these actions.
Lesson 7. Training in preparing salads Procedure:
- selection of the right ingredients;
- washing vegetables;
- peeling vegetables;
- slicing, chopping vegetables on a grater;
- salad dressing.
Preparation is carried out jointly with the patient or group of patients.
Lesson 8. Selection and training in the use of cutlery
In accordance with the pathologies, cutlery is selected: attachments for knives, forks, spoons, cutlery with curved handles, hand straps to facilitate the use of cutlery, plate rims, mats made of non-slip material for cutlery, mugs with two handles.
Over the course of several classes, work is carried out on teaching the use of cutlery.
Lesson 9. Training in preparing hot drinks
In accordance with the pathologies, the patient is recommended to have a certain modification of the kettle (electric kettle, regular kettle of smaller volume).
Procedure:
- fill the kettle with water;
- deliver it to the stove in a convenient way;
- turn on either the electric kettle or the stove;
- prepare tea using a device that makes it easier to pour hot liquid.
Lesson 10. Washing dishes The patient is taught:
- place used dishes in the sink in a manner accessible to him;
- clean the dishes from food residues;
- use a sponge or brush with a curved or thick handle to wash dishes;
- put the dishes in the closet.
2. Teaching writing
The technique is recommended for patients with hemiparesis, paraparesis, and rheumatoid polyarthritis. Goal: to teach the patient to write independently.
Lesson 1. Selection of technical means for writing
In accordance with the pathology, the patient is offered the following devices: a hand strap, attachments of various diameters, a device for attaching a pen, a stand for securing paper when writing.
Stages of preparation for writing:
Lesson 2. Using stencils.
Lesson 3. Using templates.
Lesson 4. Drawing free-form lines using a ruler.
Lesson 5. Drawing freeform figures.
Lesson 6. Working with copybooks.
Lesson 7. Rewriting the text.

Methods for developing hand functions using simulators

This technique (Fig. 1) is used for hemiparesis, paraparesis of various etiologies, and rheumatoid polyarthritis.
Target:
- increasing and maintaining the range of motion in the wrist, elbow and shoulder joints;
- independent control over the correct grip during movement;
- meaningful selection of the desired slot shape.
The patient is asked to raise the plate to the possible height. Using the correct grip, rotating the hand, he must match the slots of the plate with the “tree branches”. With repeated exercises, you should increase the height of the “tree” and the duration of the lesson.

The technique (Fig. 2) is indicated for hemiparesis, paraparesis of various etiologies, rheumatoid polyarthritis, and impaired coordination of movements.
Target:
- increased range of motion in the wrist, elbow and shoulder joints;
- control over coordination of movements.
Before starting a lesson, it is necessary to determine the location of the simulator for a given patient. The patient is asked to smoothly put the ring on the cone standing in front, to the right or to the left. To complicate the movements, they suggest throwing the ring onto a cone.

The technique (Fig. 3) is used for hemiparesis, paraparesis of various etiologies, and for disorders of surface sensitivity.
Target:
- grab objects of various sizes and shapes;
- be able to identify an object by touch by its shape.
The patient puts his hand into a chest made of opaque material. Without removing your hand from the chest, you need to name the object. Then you need to remove the item from the chest.

4. Mosaic
The technique is used for hemiparesis, paraparesis of various etiologies, and for cognitive impairment.
Target:
- grab mosaic tiles with three fingers;
- be able to draw a drawing according to the chosen template.
Before the lesson, the size of the mosaic tiles is individually selected for each patient. The patient is asked to first assemble a simpler drawing, then move on to more complex ones.

The technique (Fig. 4) is indicated for patients with hemiparesis, paraparesis of various etiologies, and cognitive impairment.
Target:

- application of effort in accordance with the movements performed;
- the ability to independently arrange the components of the “picture” in accordance with the time of year.
The simulator is a panel with components of various sizes attached to it (leaves, mushrooms, grass, etc.). The patient is asked to remember the location of the component parts of the picture, and then reconstruct it from memory.

This technique (Fig. 5) is used for hemiparesis, paraparesis of various etiologies, and rheumatoid polyarthritis.
Target:
- master grasping a clothespin with three fingers;
- learn to apply appropriate finger forces to overcome the resistance of the clothespin spring.
The patient is asked to place the clothespins on a flat circle, applying some effort. If there are difficulties, it is first recommended to use a small number of clothespins with a weak spring, then move on to clothespins with stronger springs. Gradually increase the number of movements.

7. Roulette
The technique is used for hemiparesis, paraparesis of various etiologies, and cognitive impairment.
Target:
- finger dexterity training;
- memory and counting training.
The patient is asked to rotate the roulette top and coordinate the movements of the hand so that they are smooth. This lesson is indicated for conducting in a group of patients, which stimulates competition. The one who scores the most points during the game wins.

The technique (Fig. 6) is indicated for hemiparesis, paraparesis of various etiologies, impaired coordination of movements, rheumatoid
polyarthritis.
Target:
- improvement of grip;


For carrying out the following are used: a board with holes, counting sticks, caps from felt-tip pens. The patient must insert the counting sticks into the holes of the board, then put a cap on each stick.

9. Cubes
The technique is used for hemiparesis, paraparesis of various etiologies, and rheumatoid polyarthritis.
Target:
- improvement of grip;

The patient is offered different types of cubes: simple, “Numbers-letters”, “Fairy tales”, “Animals” cubes. Using simple cubes, classes are conducted to increase the range of motion of the upper limbs. Classes can be conducted on planes of varying heights; the patient is also asked to take cubes from the hands of the therapist, who can vary the height.

The technique (Fig. 7) is used for hemiparesis, paraparesis of various etiologies, and rheumatoid polyarthritis.
Target:


The activity involves moving discs of various thicknesses in a semicircle. They start by transferring a thicker disc, then move on to thinner ones.

11. Lego
The technique is indicated for hemiparesis, paraparesis of various etiologies, and rheumatoid polyarthritis.
Target:
- improvement of grip;
- increase in muscle strength of the upper limbs.
Before the start of the lesson, an individual selection of the size of the components of the designer is carried out. During the lesson, the patient must apply force to fasten the components of the construction set. First, the patient works with a construction set consisting of large parts, assembling a figure according to the easiest model. As the grip improves, the patient moves on to using a construction set consisting of smaller elements, increasing the complexity of the assembled figure.

The technique (Fig. 8) is recommended for hemiparesis, paraparesis of various etiologies, impaired coordination of movements, and rheumatoid polyarthritis.
Target:
- increase in muscle strength of the upper limbs;
- improved coordination of movements;
- improvement of grip.
The patient is offered a chessboard with adhesive tape glued to its surface and a set of improvised chess. The patient must “glue” the chess to the board, while he can work with one hand or alternate movements of the right and left hands.

The technique (Fig. 9) is used for hemiparesis, paraparesis of various etiologies, and rheumatoid polyarthritis.
Target:
- increasing the range of movements of the upper limbs;
- improvement of grip.
The patient is offered a board with a pattern consisting of geometric shapes cut into its surface. He must trace the contours of these figures using a special device, starting with the simpler ones. The lesson time gradually increases.

The technique (Fig. 10) is recommended for impaired coordination of movements, rheumatoid polyarthritis, hemiparesis, paraparesis.
Target:
- improved coordination of movements;
- improvement of grip.
The patient is offered transparent cups made of lightweight material. He must fill his glass with a bulk substance, focusing on the proposed sample or the therapist’s verbal recommendations. Then they move on to filling the cups with the colored liquid.

15. Chestnuts, buttons, cereals

Target:


Before the start of classes, each patient is selected the material with which he will work. The patient is offered a “field” with cells, which he must fill in with the selected material. As the patient's grip improves, he moves from chestnuts to smaller objects. The duration of classes gradually increases. The patient can perform actions with one hand or alternating the right and left.

16. Beads, beads
This technique is used for hemiparesis, paraparesis, and rheumatoid polyarthritis.
Target:
- improvement of fine motor skills of the hands.
Before the lesson, each patient is selected the size of the material with which he will work. The patient is asked to string first beads and then beads onto the fishing line. As your grip improves, the duration of the lesson increases.

The technique (Fig. 11) is indicated for hemiparesis, paraparesis, and rheumatoid polyarthritis.
Target:
- improvement of fine motor skills of the hands;
- preparation for learning how to fasten.
The patient is offered figures made in the form of chickens. The figure consists of two parts: a button is sewn on one side, and a slot for the button is made on the other. To learn how to button up, use large buttons first.

The technique (Fig. 12) is recommended for impaired coordination of movements, hemiparesis, paraparesis, rheumatoid polyarthritis.
Target:
- improvement of fine motor skills of the hands;
- improvement of coordination of movements of the upper limbs.
The technique is used before teaching the patient how to lace his own shoes. The lesson is conducted using a mock-up of a boot.

The technique (Fig. 13) is used for hemiparesis, paraparesis,
rheumatoid polyarthritis.
Target:
- increasing the range of movements of the upper limbs;
- improvement of grip.
Before the start of the lesson, a certain diameter of the cord is selected for each patient. The set includes a stand with cords attached to it. Weaving is done by crossing the cords. After mastering the simplest weaving, they move on to mastering the weaving of macrame knots.

The technique (Fig. 14) is used for impaired coordination of movements, hemiparesis, paraparesis, and rheumatoid polyarthritis.
Target:
- increasing the range of movements of the upper limbs;
- improvement of grip;
- improved coordination of movements.
The patient is offered a “field” and skittles. First you need to place the pins on the field and then knock them down using a ball attached to a pole.

21. Screws
The technique is indicated for hemiparesis, paraparesis, rheumatoid polyarthritis, and impaired coordination of movements.
Target:
- improvement of grip;
- improvement of fine motor skills of the hands;
- improvement of coordination of movements of the upper limbs.
The patient is offered a board with holes into which screws are inserted, then washers are put on them and nuts are tightened. The patient must fill all the holes in the board.

22. Architect
This technique is used for hemiparesis, paraparesis, rheumatoid polyarthritis, and impaired coordination of movements.
Target:
- improvement of grip;
- improvement of coordination of movements of the upper limbs;
- increased range of motion of the upper limbs.
The patient is offered a constructor for building a city according to the proposed scheme.

23. Stencil
The technique is used for hemiparesis and paraparesis.
Target:
- improvement of grip;
The patient receives stencils depicting animals, vegetables, and insects. He must trace the contours of the depicted objects. This is a preparatory step in learning to write.

The technique (Fig. 16) is used for rheumatoid polyarthritis, hemiparesis, paraparesis.
Target:
- increased range of motion of the upper limbs.
A transparent glass on a stand is placed between the patient and the therapist. The therapist moves the “butterfly” along the surface of the glass on his side, and the patient tries to repeat the movements of the butterfly with his hand.

25. Bags on target
The technique is used for impaired coordination of movements, hemiparesis, paraparesis, and rheumatoid polyarthritis.
Target:
- improved coordination of movements;
- improvement of grip;
- increased range of motion of the upper limbs.
The patient is offered a field with digital targets depicted on its surface. The patient must hit the target from a certain distance with a bag filled with a granular substance, gaining the maximum number of points.

Developmental techniques

This group of techniques is used in cases of impairment of cognitive and higher cortical functions due to organic lesions of the central nervous system, vascular diseases of the brain, traumatic lesions of the central nervous system, and cerebral palsy.

1. Puzzles
Target:
- improving concentration;

The patient is asked to assemble a picture according to a given pattern from component parts of various sizes.

2. Learning to read
Target:
- memory training;
- development of visual-figurative thinking.
The patient is offered a set of cards with letters and cards with pictures. The patient needs to learn to correlate letters with the corresponding image in the picture, as well as form words based on the proposed pictures.

3. Learning to count
Target:
- memory training;
- development of visual-figurative thinking.
The patient is offered a set of cards with numbers and arithmetic symbols and cards with pictures. He must be able to match the numbers with the number of objects shown on the picture cards. After the patient has mastered counting skills, he is asked to perform simple arithmetic operations using cards.

4. Professions
Target:
- development of attention;
- development of visual-figurative thinking.
The patient is offered cards with images of representatives of a number of professions and cards with the attributes of a particular profession. The patient must correlate the profession with its attributes.

5. Stencils
Target:
- memory training;
- development of visual-figurative thinking.
The patient is offered stencils depicting vegetables, fruits, domestic and wild animals, and insects. He must be taught to recognize the depicted object by the outline of the stencil.

The purpose of the technique (Fig. 17):
- development of visual and effective thinking. The device is a construction set consisting of simple geometric figures: 2
large triangles, 2 small triangles, a square, a medium-sized triangle and a parallelogram. The patient must put together a figure from these components. As a sample, a complex version is offered (the figure is depicted without division into its component parts) and a simpler one (with division into its component parts).

7. Cubes
Target:
- development of concentration;
- development of visual and figurative thinking.
The patient is offered two types of cubes: simple ones - “Animals” and plot ones - “Fairy Tales”. Simple cubes consist of 9 elements with a simple design, plot cubes - of 20 elements with a large number of small details of the design. The patient needs to fold the cubes according to a given pattern.

8. Counting sticks
Target:
- development of visual-figurative thinking.
For classes, sticks of 3 colors are used - red, blue, green. They are needed for memorizing colors and learning to count (each stick means a unit). Sticks can be used to solve simple arithmetic operations.

9. Nikitin cards
The purpose of the technique (Fig. 18):
- development of visual-figurative thinking;
- development of attention.
For the lesson, cards with geometric shapes depicted on them (circle, square, triangle) are used. Figures in 2 sizes (large and small), 4 colors (red, yellow, green, blue):
- 4 large circles of all colors;
- 4 small circles of all colors;
- 4 large triangles of all colors;
- 4 small triangles of all colors;
- 4 large squares of all colors;
- 4 small squares of all colors.
The patient is asked to collect cards:
- by color;
- in the shape of a geometric figure;
- according to the size of the geometric figure;
- by size and color;
- in shape and size.

Correction of disorders of superficial and deep sensitivity

The technique is used in cases of violation of superficial and deep sensitivity of various etiologies to increase the range of movements and muscle strength, and improve coordination.
The purpose of the technique:
- improve voluntary motor command, preventing the development of hemiparesis.
The technique is based on neuromotor relief techniques. The improvement goes from the fingers to the spine (the hand is considered a functionally important unit, especially the thumb).
Typically, special simulators are used to correct sensitivity disorders within the framework of the technique:
1) for the upper limbs;
2) for the lower extremities;
3) universal exercise machines for the upper and lower extremities.

Exercise equipment for upper limbs

Trainer 1(Fig. 19) is horizontal
located board, on the surface of which a curved block with a scale is installed at a certain angle. The scale of the bar corresponds to 3 positions of the hand: maximum flexion at the wrist joint, medium flexion and when the hand is fully extended at the wrist joint. The instructor explains to the patient the meaning of these positions, then names one of them, and the patient must reproduce it with his eyes closed.

Trainer 2(Fig. 20) is represented by a set of special plates, on the surface of some there is a large three-dimensional pattern with clearly defined edges, others - a small pattern. Large drawings - the letters "T" and "H" with different thicknesses of the component parts. Small drawings - the letter "H" and various wavy lines. First, the patient must visually determine the differences between the drawings, while simultaneously tracing the contours of the drawings with the index finger (visual information is compared with sensory information). Then, with the help of a therapist, the patient traces the contours of the drawing with his eyes closed and determines its content by touch.

Trainer 3(Fig. 21) is a horizontal board on which there is a vertical frame with a hole for the thumb and a scale. The scale divisions correspond to the following positions of the thumb: maximum, average and minimum abduction. The instructor explains to the patient the meaning of these positions, then names one of them, and the patient, with his eyes closed, must move his thumb to the desired position.

Trainer 4(Fig. 22) is a horizontal board on which there is a semicircular vertical frame with a scale having eight positions corresponding to the positions of abduction of the hand. First, three main positions are selected, the instructor instructs the patient to bring the wrist into one of them. As the patient masters these positions, others are added to them.

Trainer 5(Fig. 23) is a swinging board attached to a horizontal surface. The angle of the board changes. To determine the angle of inclination by the patient, metal barrels of various weights (6 pieces) are used. The angle of inclination of the board corresponds to the positions of the hand - flexion and extension at the wrist joint. The therapist first selects three main positions (to do this, he places one of the barrels under the free edge of the board): maximum flexion at the wrist joint, medium flexion, and when the limb is fully extended at the wrist joint. The patient needs to determine the positions called by the therapist with closed eyes. As the patient masters these positions, the therapist offers three intermediate positions for mastering.

Trainer 6(Fig. 24) consists of two vertical planes, 60 cm high, fastened together. On one of them there is a scale from 1 to 14. On the other there is a drawing (wavy, broken lines). The first plane scale positions correspond to the shoulder rotation positions. First, the therapist invites the patient to master those positions that he can do. The therapist names a number on the scale, and the patient must bring the limb to this position with his eyes closed. As the range of motion of the limb increases, the instructor uses a second vertical plane with a pattern. The drawing is conventionally divided into three positions, the therapist names one position or another, and the patient matches the limb with it.

Trainer 7(Fig. 25) is a horizontal plane on which two movable boards with loads of the same weight are fixed at a certain angle. The instructor sets a certain weight on each of the boards, and the patient, with his eyes closed, must determine the difference in weight on the boards by touching them one by one with his index finger.

Trainer 8(Fig. 26) is a metal arrow attached to a wooden surface. Opposite the arrow, a sheet of paper with a pattern is placed in a special frame. The pattern can be a broken line, a wavy line, etc. The pattern is divided into three positions that correspond to the positions of shoulder rotation. The therapist names one or another position of the drawing, and the patient, with his eyes closed, needs to repeat the desired section of the drawing.

Exercise equipment for lower limbs

Trainer 1(Fig. 27) consists of two vertical planks, between which rotating wooden rollers are fixed, along which a horizontal plate moves. On one of the vertical boards there is a scale consisting of three positions corresponding to the positions of knee flexion: maximum flexion, average and minimum. The therapist names this or that position, and the patient, with his eyes closed, needs to move the limb to the desired position. When conducting a lesson, it is necessary that both legs are at the same level, so the other limb is placed on a special stand.

Trainer 2(Fig. 28) consists of two stands with springs inside. It is designed to teach the patient how to transfer body weight from one leg to the other.

Trainer 3 similar to exercise machine 2, designed for the upper limbs (Fig. 20), but in this case the scale on the beam corresponds to three positions of shin flexion: maximum, average and minimum.
The instructor names one of the positions on the scale, and the patient, closing his eyes, must bring the limb to the desired position.

Trainer 4 similar to simulator 5 for the upper limbs (Fig. 23), but is used to determine the position of flexion of the lower leg. The procedure for determining the desired position is the same as when working with a brush.
Trainer 5 similar to exercise machine 6 for the upper limbs (Fig. 24), but when used for the lower limbs it must be installed horizontally. The scale marks here correspond to knee flexion positions. The procedure for determining the desired position is the same as when working with the upper limb.

It should be noted that most of the above simulators are not complicated from a technical point of view; they can be made independently.

Literature

1. Proceedings of the 6th conference ENOTHE 26.10.00 Paris;
2. Materials of the 6th Congress ERGO 2000 27-29.10.00 Paris;
3. “Occupational Therapy” Tanya. L. Parker, Terry Krup, publication of the Russian-Canadian Cooperation Project in the field of health and social development;
4. “Ergotherapie” L. Pierquin, J-M. Andre, P. Farcy, Paris, New York, Barcelona, ​​1980;
5. “International Classification of Functioning, Disability and Health.” Final project. World Health Organization 2001;

People with disabilities in Russia are most often called disabled; this is an established term that is also used in regulatory legal acts. One of the ways to rehabilitate disabled people is to employ them. The state provides employers with certain benefits in relation to disabled employees, such as, for example, reduced rates of insurance premiums for payments in favor of this category of employees. At the same time, certain requirements are imposed on the working conditions of disabled people. What are the main legal provisions governing the employment relationship of persons with disabilities? What points should employers who employ people with disabilities pay special attention to?

Legal regulation of the work of disabled people

Legal regulation of the work of disabled people is carried out mainly in accordance with the norms of the Labor Code of the Russian Federation and Federal Law of November 24, 1995 No.181‑FZ “On social protection of disabled people in the Russian Federation”(Further - Federal Law No.181‑FZ).

According to Art. 1 Federal Law No.181‑FZ A disabled person is a person who has a health disorder with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of life activity and necessitating his social protection. Limitation of life activity is understood as the complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, study and engage in work activities. Depending on the degree of disorder of body functions and limitations in life activity, persons recognized as disabled are assigned a disability group, and persons under the age of 18 are assigned the category “disabled child.” Recognition of a person as disabled is carried out by the federal institution of medical and social examination in accordance with By Decree of the Government of the Russian Federation dated February 20, 2006 No.95 “On the procedure and conditions for recognizing a person as disabled”. A citizen recognized as disabled is issued a certificate confirming the fact of disability, indicating the disability group, as well as an individual rehabilitation program - these documents confirm that the person has a disability, including for the employer.

The state is called upon to provide social protection for people with disabilities, which is a system of state-guaranteed economic, legal and social support measures that provide people with disabilities with conditions for overcoming, replacing (compensating) disabilities and aimed at creating equal opportunities for them to participate in society with other citizens.

Rehabilitation of disabled people

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 of disabled people is aimed at eliminating or, as fully as possible, 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.

The main areas of rehabilitation of disabled people include:

Restorative medical measures, reconstructive surgery, prosthetics and orthotics, spa treatment;

Vocational guidance, training and education, assistance in employment, industrial adaptation;

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

Physical education and recreation activities, sports.

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

Providing employment for people with disabilities

Disabled people are provided with guarantees of employment by federal government bodies and government bodies of constituent entities of the Russian Federation through the following special events that help increase their competitiveness in the labor market:

Establishment in organizations, regardless of organizational and legal forms and forms of ownership, quotas for hiring people with disabilities and a minimum number of special jobs for people with disabilities;

Reservation of jobs in professions most suitable for employing people with disabilities;

Stimulating the creation by enterprises, institutions, and organizations of additional jobs (including special ones) for the employment of people with disabilities;

Creation of working conditions for disabled people in accordance with individual rehabilitation programs for disabled people;

Creating conditions for entrepreneurial activity of disabled people;

Organizations of training for disabled people in new professions.

As for establishing a quota for hiring disabled people, for organizations with more than 100 employees, the legislation of a constituent entity of the Russian Federation establishes a quota for hiring disabled people as a percentage of the average number of employees (but not less than 2% and not more than 4%). Public associations of disabled people and organizations formed by them, including business partnerships and societies, the authorized (share) capital of which consists of the contribution of a public association of disabled people, are exempt from mandatory quotas of jobs for disabled people ( Art. 21 Federal Law No.181‑FZ).

Special workplaces for employing disabled people are workplaces that require additional measures to organize work, including adaptation of basic and auxiliary equipment, technical and organizational equipment, additional equipment and provision of technical devices, taking into account the individual capabilities of disabled people. The minimum number of special jobs for employing disabled people is established by the executive authorities of the constituent entities of the Russian Federation for each enterprise, institution, organization within the established quota for hiring disabled people.

Employers have the right to request and receive information necessary when creating special workplaces for the employment of people with disabilities. Employers, in accordance with the established quota for hiring disabled people, are obliged to:

Create or allocate jobs for the employment of people with disabilities;

Create working conditions in accordance with the individual rehabilitation program for a disabled person;

Provide, in accordance with the established procedure, information necessary for organizing the employment of people with disabilities.

Note:

Article 5.42. Code of Administrative Offenses of the Russian Federation establishes liability for violation of the rights of persons with disabilities in the field of employment and employment. Thus, an employer’s refusal to hire a disabled person within the established quota entails the imposition of an administrative fine on officials in the amount of 2,000 to 3,000 rubles.

The rules on job quotas for disabled people do not apply to “simplified” workers, since according to pp. 15 clause 3 art. 346.12 Tax Code of the Russian Federation Organizations and individual entrepreneurs whose average number of employees for the tax (reporting) period, determined in the manner established by Rosstat, exceeds 100 people, cannot apply the simplified tax system.

Regarding the possibility of applying this special tax regime, I would like to note that the limitation on the share of participation of other organizations of 25% does not apply to organizations whose authorized capital consists entirely of contributions from public organizations of disabled people, if the average number of disabled people among their employees is at least 50 %, and their share in the wage fund is at least 25% ( pp. 14 clause 3 art. 346.12 Tax Code of the Russian Federation). Thus, organizations established by public organizations of disabled people, if the specified conditions are met, can apply the simplified tax system in accordance with Ch. 26.2 Tax Code of the Russian Federation.

For your information:

If an employee becomes disabled while already hired, the employer is obliged to transfer him to the work necessary for him in accordance with the medical report. An employee’s refusal to transfer to another job, which is necessary for him according to a medical certificate issued in the manner established by federal laws and other regulatory legal acts of the Russian Federation, or the employer’s lack of relevant work, is subject to clause 8 art. 77 Labor Code of the Russian Federation grounds for termination of the employment contract.

Working conditions for disabled people

Regardless of whether there is an obligation to fulfill quotas, organizations and individual entrepreneurs, including “simplified workers,” employ people with disabilities. Disabled people employed in organizations, regardless of organizational and legal forms and forms of ownership, are provided with the necessary working conditions in accordance with an individual rehabilitation program.

It is not allowed to establish in collective or individual labor contracts the working conditions of disabled people (wages, working hours and rest periods, the duration of annual and additional paid leave, etc.), which worsen the situation of disabled people in comparison with other employees.

Note:

For disabled people of groups I and II, a reduced working time of no more than 35 hours per week is established while maintaining full pay.

Disabled people and employees with disabled children may be involved in night work only with their written consent and provided that such work is not prohibited for them due to health reasons in accordance with a medical report. In this case, these employees must be informed in writing of their right to refuse to work at night ( Art. 96 Labor Code of the Russian Federation).

Involving disabled people in overtime work is also possible only with their written consent and provided that this is not prohibited for them due to health reasons in accordance with a medical report. In this case, disabled people must be familiarized with their right to refuse overtime work ( Art. 99 Labor Code of the Russian Federation). The duration of overtime work should not exceed four hours for each employee for two consecutive days and 120 hours per year. The employer is required to ensure that each employee's overtime hours are accurately recorded.

Involvement of disabled people to work on weekends and non-working holidays is permitted only if this is not prohibited for them due to health reasons in accordance with a medical certificate. At the same time, they must also be informed, upon signature, of their right to refuse to work on a day off or a non-working holiday. Employees are recruited to work on weekends and non-working holidays by written order of the employer.

Moreover, in accordance with Art. 128 Labor Code of the Russian Federation for family reasons and other valid reasons, an employee, upon his written application, may be granted leave without pay, the duration of which is determined by agreement between the employee and the employer. At the same time, the employer is obliged, on the basis of a written application from the employee, to provide unpaid leave to working disabled people - up to 60 calendar days per year.

Disabled persons are granted annual leave of at least 30 calendar days ( Art. 23 Federal Law No.181‑FZ).

Thus, the current labor legislation and Federal Law No.181‑FZ establish a number of benefits for disabled people in relation to the performance of labor duties.

Labor protection for disabled people

Responsibilities of the employer in organizing labor protection for disabled people

Labor protection for disabled people is carried out on the basis Sanitary rules SP 2.2.9.2510‑09 “Hygienic requirements for working conditions for people with disabilities”, approved Resolution of the Chief State Sanitary Doctor of the Russian Federation dated May 18, 2009 No.30 , which have been in effect since August 15, 2009.

The professional selection of disabled people is based on classifications of disorders of the basic functions of the human body and the main categories of life activity established by the Government of the Russian Federation. Determination of compliance of working conditions of persons with reduced working capacity (disabled persons) with the current sanitary legislation is carried out by organizations and institutions by Rospotrebnadzor.

According to the current regulatory framework, the employer provides:

Creation of necessary working conditions and work schedule in accordance with current legislation, general and individual rehabilitation programs for disabled people;

Selection of special technological processes and products taking into account the use of work of disabled people and their professional skills and health status;

Development and use of various means of small-scale mechanization to facilitate labor, and, if necessary, equipping a disabled person’s workplace on an individual basis;

Employment of disabled people in accordance with the conclusion of a medical and social examination;

Organization of medical supervision of disabled people in production and monitoring of compliance with sanitary and hygienic conditions in production and non-production premises;

Drawing up a schedule and work schedule for disabled people, taking into account their illnesses and recommendations on the length of the working day;

Production control over compliance with sanitary rules and hygienic standards;

Availability of sanitary and epidemiological conclusions on the raw materials used, manufactured products, implementation of hygienic assessment of technological processes;

Taking necessary measures in the event of emergencies and accidents at work, including appropriate first aid measures.

When employing disabled people, the requirements of the nature and working conditions correspond to the functional capabilities of the body, qualifications, and the degree of preservation of professional skills. It is preferable to maintain a profession with a light work schedule. Specific measures to make work easier are carried out by the employer based on the recommendations of the territorial bodies of Rospotrebnadzor and the medical institution.

Special requirements for organizing production for people with disabilities

The design and equipping of special workplaces for disabled people must be carried out taking into account the profession, the nature of the work performed, the degree of disability, the nature of functional impairments and limited ability to work, the level of specialization of the workplace, mechanization and automation of the production process. When designing, reconstructing and operating special workplaces for disabled people, one should be guided by the current legislation of the Russian Federation.

A special workplace for a disabled person must ensure labor safety, work with minor or moderate physical, dynamic and static, intellectual, sensory, emotional stress, and exclude the possibility of deterioration of health or injury to the disabled person. Working conditions characterized by the presence of harmful production factors that exceed hygienic standards and have an adverse effect on the worker’s body are contraindicated for the employment of disabled people.

and/or his offspring, and working conditions, the impact of which during a work shift (or part thereof) creates a threat to life, a high risk of severe forms of acute occupational injuries, namely:

Physical factors (noise, vibration, air temperature, humidity and air mobility, electromagnetic radiation, static electricity, illumination, etc.);

Chemical factors (dust, air pollution in the working area);

Biological factors (pathogenic microorganisms and their metabolic products);

Physical, dynamic and static loads when lifting and moving, holding heavy objects, working in uncomfortable forced positions, long walking;

Neuropsychic stress (sensory, emotional, intellectual stress, monotony, night shift work, long working hours).

Working conditions in the workplace for disabled people must comply with the individual rehabilitation program for the disabled person, developed by the Bureau of Medical and Social Expertise.

Space-planning and design solutions for industrial premises, buildings and structures, newly built and reconstructed enterprises, individual production workshops and areas where the labor of disabled people is used are taken in accordance with the current sanitary legislation.

According to current sanitary standards, production, auxiliary and sanitary premises should be located in one- and two-story buildings. When industrial premises are located above the second floor, low-speed passenger elevators are provided. Auxiliary, special and sanitary premises are located in the same building with production workshops or are connected to it by a warm passage.

Note:

It is not allowed to place permanent workplaces for disabled people in basements, ground floors, or in buildings without natural light and air exchange.

At enterprises intended for the employment of disabled people, recreation rooms with an area of ​​​​0.3 square meters are equipped. m per employee, but not less than 12 sq. m depending on the group of production processes. The distance from production premises to recreation areas should not exceed 75 m. It is recommended to organize canteens, buffets, and meal rooms at enterprises, providing workers with hot meals. In addition, such enterprises must be equipped with a health center, including a doctor’s office, a treatment room and a room where disabled people can stay in the event of a sharp deterioration in health.

Special requirements are imposed on the arrangement of equipment and furniture in the workplaces of disabled people; it must ensure safety and comfort at work. The arrangement of machines, equipment and furniture in a workplace intended for the work of a disabled person who uses a wheelchair for movement must provide the ability for a wheelchair to approach and turn around, and in the workplace of a blind and visually impaired person - the ability to work without interference from the movements of other workers in the premises. In order for a blind worker to conveniently find his/her workplace, machines, equipment or furniture must be equipped with tactile landmarks. Office equipment for workplaces for disabled people (desks, workbenches, shelving, cabinets) must correspond to the anthropometric data of the performer.

All elements of stationary equipment intended for use by disabled people must be firmly and securely fastened. Fastening parts of equipment, regulators, electrical switches, etc. should not protrude beyond the plane of the element being fastened.

Special requirements have been established for lighting workplaces of people with disabilities. When organizing artificial lighting for a disabled person’s workplace, the requirements for safe and favorable working conditions should be taken into account. When choosing rational light sources, one should take into account the light output of the source, the color of the light, and when installing, the light distribution, which ensures the formation of contrasts on the object of visual observation and weakens the reflected brightness. The installation of luminaires should ensure rational light distribution: the best direction of light, increasing contrasts and reducing glare, is achieved when the light falls on the workplace mainly from the side, obliquely and from behind.

For visually impaired people, for example, there are special requirements for workplace lighting. Artificial lighting of the work area and workplaces of disabled people with residual vision should be organized most carefully, providing general and local lighting. Local lighting should be provided by incandescent lamps. Cabinets or racks included in the equipment of the workplace of a disabled person with residual vision must have built-in lamps that automatically turn on when the cabinet doors are opened. Local lighting should be stable (flicker-free), adjustable in brightness and spectrum depending on the eye disease. The level of illumination on the working plane is set depending on the nature of the work and the characteristics of the disability.

Special requirements for working conditions are established depending on the type of disease that led to disability. For example, the workplaces of people with disabilities due to cardiovascular diseases, if they are located in close proximity to windows, should be protected from overheating in the summer by sun protection devices. In the same way, workplaces for disabled people with vision diseases must be protected from glare by special sun-protection devices. This rule does not apply to windows oriented to the north side, as well as to windows oriented to the western quarter of the horizon, when disabled people work only in the first half of the day.

Thus, the current legislation establishes special requirements for the organization of working conditions for disabled people, depending on existing diseases.

In conclusion, I would like to note that the state provides social protection for people with disabilities, for which a system of economic, legal and social support measures is provided, aimed at creating opportunities for professional self-realization equal to those of other citizens.

Employers are obliged to provide special working conditions for disabled people, while fulfilling the requirements established by current legislation. This is not an easy task for the employer, as is compliance with all the norms of the current labor legislation in relation to this category of workers, but this is the social responsibility of society.

Learn to prepare management reporting in our new. Owners are willing to pay more for management reports than for tax reports. We'll give you an algorithm for setting up reports and show you how to integrate them into your daily accounting.

Distance learning. We issue a certificate. for the course “Everything about management accounting: for accountants, directors and individual entrepreneurs.” For now for 3500 instead of 6000 rubles.

Limitation of life activities

Limitation of life activities (LLD)- complete or partial loss of a person’s ability or ability to carry out the basic components of daily life.

In this classification, the consequences of diseases are considered in the form of sequential conditions:

1. illness - internal pressure;
2. disorders - external manifestation of the disease in the form of disorders of the body or anatomical structure;
3. ADL - the inability to perform the basic components of daily life (or the ability to perform only partially);
4. social incapacity - a deficiency in which a person can only perform limitedly or cannot perform at all his usual role in society (inability to live independently - physical dependence, inability to integrate into society, inability to ensure economic independence).

Main types of dysfunctions of the human body

• Violations of mental functions (perception, attention, memory, thinking, intelligence, emotions, will, consciousness, behavior, psychomotor functions).
• Disorders of language and speech functions
  • Oral speech disorders (rhinolalia, dysarthria, stuttering, alalia, aphasia)
  • Written speech disorders (dysgraphia, dyslexia)
  • Verbal and nonverbal speech disorders
  • Voice disorders, etc.
• Impaired sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity).
• Violations of static-dynamic functions (motor functions of the head, torso, limbs, statics, coordination of movements).
• Violations of the functions of blood circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity.
• Disorders caused by physical deformity (deformations of the face, head, torso, limbs, leading to external deformity, abnormal openings of the digestive, urinary, respiratory tracts, disturbance of body size).

OJD categories and degree

There are four degrees of severity of dysfunctions of the human body:

• minor impairments (no restrictions on life activity),
• moderate impairment (1st degree of disability),
• severe impairments (2nd degree of disability),
• significantly pronounced impairments (3rd degree of disability).

Self-care ability

Self-care ability is a person’s ability to independently fulfill basic physiological needs, perform daily household activities, including personal hygiene skills.

1st degree - the ability to self-service with a longer investment of time, fragmentation of its implementation, reduction of volume using, if necessary, auxiliary technical means.

2nd degree - the ability to self-care with regular partial assistance from others, using auxiliary technical means if necessary.

3rd degree - inability to self-care, need for constant outside help and complete dependence on other persons.

Ability to move independently

The ability to move independently is the ability to independently move in space, maintain body balance when moving, at rest and when changing body position, and to use public transport.

1st degree - the ability to move independently with a longer investment of time, fragmentation of execution and reduction of distance using, if necessary, auxiliary technical means.

2nd degree - the ability to move independently with regular partial assistance from other persons, using auxiliary technical means if necessary.

3rd degree - inability to move independently and need constant assistance from others.

Orientation ability

Orientation ability - the ability to adequately perceive the environment, assess the situation, the ability to determine time and location.

1st degree - the ability to navigate only in a familiar situation independently and (or) with the help of auxiliary technical means.

2nd degree - the ability to navigate with regular partial assistance from other persons, using auxiliary technical means if necessary.

3rd degree - inability to navigate (disorientation) and the need for constant assistance and (or) supervision of other persons.

Ability to communicate

The ability to communicate is the ability to establish contacts between people by perceiving, processing and transmitting information.

1st degree - ability to communicate with a decrease in the pace and volume of receiving and transmitting information; use, if necessary, assistive technical aids; with isolated damage to the organ of hearing, the ability to communicate using non-verbal methods and sign language translation services.

2nd degree - the ability to communicate with regular partial assistance from other people, using auxiliary technical means if necessary.

3rd degree - inability to communicate and need for constant help from others.

Ability to control your behavior

The ability to control one’s behavior is the ability to self-awareness and adequate behavior taking into account social, legal, moral and ethical standards.

1st degree - periodically occurring limitation of the ability to control one’s behavior in difficult life situations and (or) constant difficulty in performing role functions affecting certain areas of life, with the possibility of partial self-correction.

2nd degree - a constant decrease in criticism of one’s behavior and environment, with the possibility of partial correction only with the regular help of other people.

3rd degree - inability to control one’s behavior, inability to correct it, need for constant help (supervision) from other persons.

Learning ability

2nd degree - ability to learn only in special (correctional) educational institutions for students, pupils, children with disabilities or at home according to special programs using, if necessary, auxiliary technical means and technologies.

3rd degree - learning disability.

Ability to work

Ability to work - the ability to carry out work in accordance with the requirements for the content, volume, quality and conditions of work.

1st degree - the ability to perform labor activities in normal working conditions with a decrease in qualifications, severity, intensity and (or) a decrease in the volume of work, the inability to continue working in the main profession while maintaining the ability to perform labor activities of a lower qualification under normal working conditions.

2nd degree - the ability to perform labor activities in specially created working conditions with the use of auxiliary technical means and (or) with the help of other persons.

3rd degree - inability to perform any work activity or impossibility (contraindication) of any work activity.

see also

Links

• Order of the Ministry of Health and Social Development of the Russian Federation dated December 23, 2009 N 1013n “On approval of classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination” and appendix.

Wikimedia Foundation. 2010.

See what “Limitation of life activity” is in other dictionaries:

Limitation of life activities- complete or partial loss of a person’s ability or ability to perform self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work. Depending on the… … Official terminology

disability- 3.2 disability: Complete or partial loss of a person’s ability or ability to perform self-care, move independently, navigate, communicate, control one’s behavior, learn and engage... ...

Limitation of life activities- complete or partial loss by a person (disabled person) of the ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work... Administrative law. Dictionary-reference book

LIMITATION OF LIFE ACTIVITIES Glossary of terms on social statistics

Limitation of life activities- Complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work activities. Art. 1 federal... Vocabulary: accounting, taxes, business law

LIMITATION OF LIFE ACTIVITIES- – complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in labor activities... Social statistics. Dictionary

Limitation of life activities- complete or partial loss of a person’s ability or ability to perform self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work. The federal law… … Dictionary of legal concepts

Limitation of human activity- – complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in labor activities. *... Glossary of terms on general and social pedagogy

limitation- 2.43 restriction: A situation where a service (2.44) does not meet the availability conditions specified in the service agreement (2.45). Note Restrictions can be planned or unplanned. Source … Dictionary-reference book of terms of normative and technical documentation

GOST R 51079-2006: Technical means of rehabilitation of people with disabilities. Classification- Terminology GOST R 51079 2006: Technical means of rehabilitation of people with disabilities. Classification of the original document: [disabled people]: System of medical, psychological, pedagogical, socio-economic measures... Dictionary-reference book of terms of normative and technical documentation

Books

• Integration of academic and avant-garde schools of painting: pedagogical aspects, Bogustov Alexey Pavlovich. 80 pp. This work is a study of the state and prospects for the development of art education in the post-Soviet period. A study is being carried out on some practical...
• Introduction to systemic riskology, V. B. Zhivetin. Systemic riskology is a science whose function is the development and theoretical systematization of objective (reliable) knowledge about the risks and safety of system activities... eBook