Medical rehabilitation

It is carried out for certain diseases of the internal organs, congenital and acquired diseases of the musculoskeletal system, the consequences of severe injuries, mental illnesses, etc. Rehabilitation in children with mental retardation , with hearing , speech , vision defects, etc. is of particular importance.

Rehabilitation is a system of medical and educational measures aimed at preventing and treating pathological conditions that can lead to temporary or permanent disability. Rehabilitation aims to restore, as soon as possible, the ability to live and work in an ordinary environment.

About rehabilitation should be talked about in cases where the patient already had experience in social life and socially useful activities.

Rehabilitation involves medical and pedagogical correction of the motor, mental and speech spheres in relation to older children and adults. There are a number of pathological factors that invalidate the patient and raise the question of the need for habilitation or rehabilitation. Among such factors are various intrauterine lesions of the nervous system, birth traumatic brain injuries. In older children, injuries of the brain and spinal cord , infectious and inflammatory diseases (consequences of encephalitis , arachnoiditis , meningitis , polio ), degenerative diseases of the nervous and neuromuscular systems can lead to disabling lesions of the nervous system. In adults, the most common cause of disabling conditions is vascular disease with impaired cerebral circulation.

At all stages, complex treatment is used, which provides for the restoration of impaired functions with the help of physiotherapy , massage , physiotherapy , orthopedic procedures, and medications. In Western Europe, and in particular in Germany, an important element of an integrated approach to rehabilitation is the use of hardware that facilitate the work and expand the capabilities of specialists in the field of physiotherapy and physiotherapy, which allows to improve the final result of rehabilitation. These are devices designed to train walking or restore the function of the hand and hand ^[3] . Of great importance is the implementation of active corrective and educational work and the provision of necessary logopedic assistance provided by a speech therapist (under the supervision and with the participation of a doctor) in health care and educational institutions for people (mainly children) with speech disorders, in order to correct the latter ^[4] . The number of persons adapted to work activities may increase due to properly implemented rehabilitation measures. An effective organization of the whole complex of medical-pedagogical and social (in the broad sense) measures is necessary. It is important to ensure the continuity of the stages of rehabilitation measures. Treatment should be timely and long. A detailed neurological , psychological, pedagogical and speech therapy examination of children with severe lesions of the nervous system, persistent and painstaking work of rehabilitation specialists aimed at restoring impaired functions, neuromotor re-education allow partial or complete adaptation of disabled children and adults in society.

In modern medicine, different scientific schools use the same concepts in different meanings. For example, in healthcare, the term “rehabilitation” is used by some specialists as a purely medical task, and by others as a complex of medical, psychotherapeutic and social tasks. Conversely, when using different terms, identical tasks are posed. For example, “ rehabilitation treatment ” and “medical rehabilitation”.

Philosophical Aspect

^{[ neutrality? ]} Understanding the essence of rehabilitation is directly related to the formulation of the concepts of “health” and “disease”. A clear definition of the primary sign of ill health is required in order to begin to restore health. A different look at such fundamental concepts of medicine leads to contradictions and the terms “medical rehabilitation”, “comprehensive rehabilitation”, “rehabilitation treatment”, and “rehabilitation medicine”.

Professor V. M. Bogolyubov, academician of the Russian Academy of Medical Sciences, points to this problem in his article “Medical rehabilitation or restorative medicine?” Published in the journal “Physiotherapy, Balneology and Rehabilitation” No. 1, 2006.

“Over the past 7-8 years, a critical situation has developed in the Russian Federation with a number of medical specialties, primarily related to medical rehabilitation, balneology, physiotherapy, physiotherapy, manual therapy, reflexology, and rehabilitation medicine”

An even more categorical remark is made by the Honored Doctor of the Russian Federation, Professor N. F. Davydkin in the article “Medical rehabilitation, restorative medicine - what is this?”

“Practice shows that new concepts without their clear definition are introduced in order to cause confusion in thoughts, and then use it to achieve certain goals. Moreover, these goals can remain veiled for a long time or even hidden. We called these actions: “terminological terrorism.” ”

Since the word "rehabilitation" means "restoration of ability", the legitimate term for the restoration of health can be "valeorehabilitation". In this form, this term accurately indicates the area of ​​use and the relationship with health, and not with medicine in general or another area of ​​application of the term "rehabilitation". In addition, the term “valeorehabilitation” can be a full substitute for the term “health recovery,” which has recently come to be often used in the form of the term “health recovery technologies”. Together with the term "health-restoring technologies" the term "health-preserving technologies" is often used. By analogy, this not entirely convenient term could be replaced by the term “valeoprotection”. The introduction of the terms “valeorehabilitation” and “valeoprotection” requires some discussion in medical, social and psychological circles. It should be borne in mind that the harmony of terms has a positive impact on the audience when appropriate.

Legal Aspect

^{[ neutrality? ]} Doctor of Medical Sciences NF Davydkin believes that the value of terminology will increase in connection with the complexity of economic and legal relations.

In this context, he continues the chain of judgments about improving and clarifying the terminological base in medicine. Using the terms “rehabilitation” and “medical rehabilitation” as an example, Davydkin explains that these terms are included in compulsory medical insurance programs, according to which the doctor must conduct medical and rehabilitation measures, which means that he bears legal responsibility.

Practitioners require a clear definition of what their activities should be interpreted as “Medical care”, “Treatment”, “Medical rehabilitation”, “Rehabilitation” or “Rehabilitation treatment”, since the source of financing for the medical service they provide depends on it.

In another controversial polemic dispute with Dr. Semenov, Davydkin notes:

The introduction of the concept of “medical rehabilitation” without a clear definition of it in interaction with the term “treatment” takes it beyond the scope of article 41 of the Constitution of the Russian Federation. Therefore, the discussion of the terms “treatment” and “medical rehabilitation” is not a “scholastic dispute”, but a vital question for the patient: “Who will pay for the treatment?”

A clear distinction should be made between the terms “medical rehabilitation” and “valeorehabilitation”:

1) medical rehabilitation - applies to patients undergoing treatment in medical institutions that are part of the health insurance system;

2) valeorehabilitation - in relation to people restoring their health by drug-free methods in health-improving, preventive, rehabilitation and adaptation institutions (or among specialists with appropriate professional training) who are not part of the health insurance system.

Individual Rehabilitation Program

When conducting a medical and social examination, an individual rehabilitation program for a disabled person is developed or, in the case of a minor, an individual rehabilitation program for a disabled child. Article 11 of the Federal Law on Persons with Disabilities of 2011 -Individual Program for the Rehabilitation of a Disabled - developed on the basis of a decision of an authorized body managing federal medical and social examination institutions, a set of rehabilitation measures that are optimal for a disabled person, including certain types, forms, volumes, terms and the procedure for implementing medical, professional and other rehabilitation measures aimed at restoring, compensating for impaired or lost body functions, restoring copulating, compensation abilities of the disabled to perform certain activities. IPR includes:

• The list of limitations of the main categories of life - the ability to self-care, the ability to move, the ability to orientate, the ability to communicate, the ability to learn, the ability to work, the ability to control your behavior.
• The list of medical rehabilitation measures is Reconstructive surgery, Restorative therapy, Sanatorium-resort treatment, Prosthetics and orthopedics.
• Events - vocational rehabilitation - Vocational guidance, Vocational training and retraining, Assistance in finding a job, Vocational adaptation.
• Recommendations on contraindicated and affordable working conditions.
• Social rehabilitation measures - social and environmental rehabilitation, socio-psychological rehabilitation, socio-pedagogical rehabilitation, sociocultural rehabilitation, social and domestic rehabilitation, sports and recreational activities and sports.
• Rehabilitation equipment and rehabilitation services.
• Conclusion on the implementation of IPR - Assessment of the results of medical rehabilitation, assessment of the results of professional rehabilitation, Assessment of the results of social rehabilitation, assessment of limitations of the main categories of life, Special notes on the implementation of IPR.

There is also an IPR for a disabled child, which also includes measures of psychological and pedagogical rehabilitation (Preschool education, General education, correctional class), conditions for general education, class schedule. Getting a vocational education - type of educational institution, form of education.

Consequences of Multiple Interpretations

As a result of different interpretations of terms in the legislation of the Russian Federation, paradoxical phenomena arose when the concepts used in the legislation could not be unambiguously read ^{[ who? ] [ when? ]} .

For example:

Order of the FMBA of Russia dated 20.02.2009 No. 101 “On the procedure for sanatorium-resort and rehabilitation and rehabilitation treatment in institutions of the sanatorium-resort profile subordinate to the Federal Medical and Biological Agency”

or

Order of the Moscow Department of Health on August 6, 2010 No. 1235 “On the organization of the department of rehabilitation treatment and rehabilitation in the structure of the Research Institute of Emergency Pediatric Surgery and Traumatology of the Moscow Department of Health”

A variety of terminology leads to a misunderstanding of the subject, and therefore, the possibility of erroneous actions increases.

Possible Solution

In 2003 were published:

• Order of the Ministry of Health of the Russian Federation of July 1, 2003 No. 297 (On the Doctor of Restorative Medicine)
• Federal Law of October 23, 2003 N 132-ФЗ (On Amendments to Certain Legislative Acts of the Russian Federation on the Rehabilitation of Persons with Disabilities).

In the Order of one of the tasks is determined:

4. Restorative medicine doctor - on the basis of available methodological recommendations and manuals for doctors, develops individual rehabilitation and rehabilitation programs that provide for the integrated use of predominantly non-drug methods aimed at increasing the functional reserves of a person’s health, restoring his optimal working capacity, and in the presence of identified diseases, at an early speed recovery, prevention of recurrence of the disease and restoration of patients' disability;

The Federal Law interprets the concept of rehabilitation:

Rehabilitation of the disabled is a system and process of full or partial restoration of the ability of disabled people to domestic, social and professional activities. The rehabilitation of persons with disabilities is aimed at eliminating or possibly more fully compensating for the disabilities caused by health problems with persistent dysfunction of the body in order to socially adapt people with disabilities, achieve material independence and integrate them into society.

Thus, rehabilitation is presented as a systemic process in a certain branch of medicine - restorative medicine.

• Habilitation
• Rehabilitation in Rheumatology
• Rehabilitation equipment
• Fast Rehabilitation Surgery (Fast Track)
• Physical rehabilitation

• Badalyan L.O. Neuropathology. - M .: Education, 1982. - S.307-308.
• Encyclopedic dictionary of medical terms. In 3 volumes / Editor-in-Chief B.V. Petrovsky . - Moscow: Soviet Encyclopedia , 1982 . - T. 3. - S. 29. - 1424 p. - 100,000 copies.
• Popov S.N. Physical rehabilitation. 2005 .-- S.608.
• Epifanov V.A. Medical rehabilitation Guide for doctors.- M .: MEDpress-inform, 2005. - P.328.
• Skumin V. A. Psychotherapy and psychoprophylaxis in the rehabilitation system of patients with prosthetic heart valves. Methodical recommendations of the Ministry of Health of the Ukrainian SSR. Kiev, 1980 .-- 16 p. [one]
• Bogolyubov, Medical rehabilitation (manual, in 3 volumes). // Moscow - Perm. - 1998.
• Chuprov, L.F. Terminological Dictionary of Speech Therapy and Neuropsychology. - M.: Book Crossroads, 2012 .-- S. 129.

• Electronic publication of the book “Victors of Fate”
• N. F. Davydkin Medical rehabilitation, restorative medicine - what is it?
• http://pem.esrae.ru/pdf/2013/1.sr/8.pdf