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1. The significance of the problem.

10% of the world's population are disabled (in Belarus? 4.1% of the population are disabled).

25% of the population have various disorders that can lead to disability.

75-80% of disabled people in developed countries are involved in labor. In Belarus, 85% of disabled people do not work. Only a rich country will allow itself to increase the number of people with disabilities and socially dependent persons. For, the cost of paying benefits is greater than active medical rehabilitation in the early stages. Despite the fact that the cost-effectiveness of rehabilitation is large, it is 1: 7, 1:10.

1983-1992 The UN called the decade of persons with disabilities with the development of the "World Program of Action regarding Disabled Persons." WHO main objectives of medicine: health promotion; disease prevention; treatment; rehabilitation.

Trends in world practice.

• Work with physically disabled persons> Work with disabled people> Work with patients.

• Young patient instead of retirement> rehabilitation. An elderly patient instead of leaving> rehabilitation. Recreation + sanological mechanism> improving the body and adapting to the environment.

2. Terminology

The term "rehabilitation" (from legal) - restoration of the rights of a defiled person (Dictionary of the Russian language, 1987)

Rehabilitation is a system of state, socio-economic, medical, professional, pedagogical, psychological measures aimed at the prevention of diseases leading to temporary or permanent disability and the return of sick and disabled people to society and socially useful work (Prague, 1967) .

Rehabilitation is a process whose goal is to prevent disability during the treatment of diseases and to help the patient achieve the maximum physical, mental, professional, social and economic value that he will be capable of within the framework of an existing disease (WHO, 1963).

Rehabilitation (habere - to have, habilis - dexterous, habitalis - suitable, habitus - a set of characteristic features that affect behavior, appearance and activity) is a medical and social process, the ultimate goal of which is to restore optimal biological or social independence to an inferior person.

Rehabilitation includes all measures aimed at reducing disabling factors and conditions leading to physical and other defects, as well as providing opportunities for people with disabilities to achieve social integration (WHO, 1981).

In French-speaking countries, the term "readaptation" (adaptation to work). “Re-adaptation” is tertiary prevention.

Medical rehabilitation is a process aimed at restoring and compensating, with medical and other methods, the functional capabilities of the body that are impaired as a result of a birth defect, past diseases and injuries (Law of the Republic of Belarus On the Prevention of Disability and Rehabilitation of Persons with Disabilities, 1994). Purpose: restoration of the functional capabilities of the body. Tasks:

medical: - restoration of impaired functions,

- restoration of the self-genetic mechanisms of the body and its personal qualities.

non-medical: - social and domestic adaptation,

- Professional restoration.

3. Rehabilitation needs

According to WHO:

20-25% of inpatients require rehabilitation.

40-50% of outpatients require rehabilitation.

According to E.A. Valchuk needs more rehabilitation: 60-65% of inpatients and 53% of outpatients require rehabilitation, but only 25% of the need for sanatorium rehabilitation is satisfied.

The need for rehabilitation of women is greater than that of men; 60-69 years old the highest need,

According to needs:

1st place - BSK. (The state system of multi-stage rehabilitation of patients with myocardial infarction; 5 stages provide up to 60% - without disability groups).

2nd place - Diseases of the musculoskeletal system and connective tissues.

3rd place - Diseases of the digestive system.

In fact:

- injuries

- diseases of the musculoskeletal system,

- BSK.

Rehabilitation aspects:

- medical

- physical

- psychological

- professional,

- social

- economic.

Technological stages of medical rehabilitation.

The effect of the disease on the body:

- at the organ level

- at the body level

- at the social level.

Based on this, there are three levels of medical rehabilitation application:

• first> restore function,

• second> restoration of life criteria,

• third> social recovery of the patient.

Based on this, the technological stages of medical rehabilitation:

Stage 1 - restoration of functional ability:

- full recovery,

- partial recovery or compensation,

- substitution.

Stage 2 - restoration of adaptation to everyday and professional life:

- upbringing and functional treatment,

- occupational therapy.

Stage 3 - involvement of the patient in the labor process,

Stage 4 - medical examination of the rehabilitated.

The principles of rehabilitation:

1. Perhaps an earlier start of rehabilitation measures.
(Rehabilitation should be included in therapy, in the event of a threat of disability - this is prevention, if disability has occurred - this is the first stage of the fight against it).

2. continuity of rehabilitation.

3. the comprehensive nature of rehabilitation measures (sociologists, teachers, lawyers, etc.)

4. individuality of rehabilitation measures. (Rehabilitation is hard work with the patient (3-4 hours). The danger of increasing demands is less than the danger of understating - on the verge of functional risk).

5. The implementation of rehabilitation in mass collectives.

Selection for medical rehabilitation (criteria):

1) the high incidence of pathology as a cause of morbidity and disability;

2) "process control" - the availability of medical rehabilitation technology to prevent, mitigate or overcome the consequences of the disease.

Clinical and rehabilitation groups:

1st group of early rehabilitation

2nd group with persistent consequences of acute or chronic pathology

3rd group of disabled people

Directions of organization of the rehabilitation service:

1st — the integration of medical rehabilitation in the diagnostic and treatment process at all stages of the organization of medical care as an integral part of it.

2nd — the organization of the medical rehabilitation service itself:

- non-specialized - rehabilitation assistance to patients with different nosologies.

- specialized - depending on: type of disabling consequences (speech, hearing, vision, mental disorders); ethionosological factor (diabetes mellitus, arterial hypertension).


The Law "On Social Protection of Persons with Disabilities in the Republic of Belarus" (1994),

The Law "On the Prevention of Disability and the Rehabilitation of Persons with Disabilities" (1994),

“On the further development and improvement of the medical rehabilitation service in the Republic of Belarus”: order of the Ministry of Health of the Republic of Belarus No. 309 dated December 10, 1997.

“On the further development of medical rehabilitation of patients in the Republic of Belarus”: order of the Ministry of Health of the Republic of Belarus No. 203 dated August 21, 2000.

Organizational forms of Belarus:

• medical rehabilitation centers: single-industry and multi-industry;

• department (rooms) of medical rehabilitation in a clinic, hospital, sanatorium;

• home rehabilitation;

There are 200 outpatient medical rehabilitation departments in Belarus.

The structure of the medical rehabilitation unit is one. Offices: physiotherapy, occupational therapy, exercise therapy, mechanotherapy, reflexology, psychotherapy.

Methods of rehabilitation treatment:

1. physiotherapy

2. physiotherapy exercises,

3. occupational therapy,

4. drug treatment

5. surgical treatment,

6. psychotherapy

7. social rehabilitation.

Restructuring of the bed fund: 35% rehabilitation treatment, 30% intensive treatment, 20% long-term treatment of patients with chronic diseases, 15% medical and social assistance.
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