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The concept of social rehabilitation of disabled children. Psychosocial rehabilitation of disabled people

The definition of habilitation for disabled people is given in Federal Law No. 181 of November 24, 1995. It sets out the principles of selection individual programs social, medical, psychological adaptation, and also a distinction is made between the terms “habilitation” and “rehabilitation”.

The concept of rehabilitation and habilitation of disabled people

Stage 3: Physical education and recreation activities

They are carried out on the basis of youth sports schools, physical education and sports clubs for the disabled, and include their involvement in participation in mass physical education and sports festivals, competitions, etc.

Regular sports activities have a beneficial effect on the general physical state a person, and also help to recover faster after illnesses and serious operations.

Stage 4: Social adaptation

By using social rehabilitation build relationships in family and society taking into account the needs of the disabled person himself.

Includes two components:

1. Social-environmental orientation. Helps a disabled person quickly adapt to new living conditions, taking into account his skills and abilities.

Help from psychologists and teachers is provided in the following cases:

in determining the opportunities available to a disabled person for self-realization;
assistance in enrollment in educational institutions and employment;
assistance in establishing contacts with relatives and others;
psychological assistance to the family.

2. Social and everyday habilitation. Helps the disabled person choose the most convenient pace of social and family life. To do this you need:

teach disabled people to care for themselves;
show the family the best option for living together and running a household, taking into account the skills of a disabled person;
prepare housing for persons with disabilities to live there.

Much attention is paid to introducing the mentee into an environment where like-minded people with similar interests are united: clubs, sections, creative groups, etc.

Comprehensive rehabilitation

It involves several specialists who help the disabled person regain the skills acquired before the injury.

Complexity is one of the principles of rehabilitation activities. It involves the use of various rehabilitation measures with the participation of both medical personnel and psychologists, teachers, exercise therapy specialists, lawyers, etc. Depending on the volume and complexity of the tasks solved by rehabilitation, on the conditions, possibilities and individual indications for its implementation, different systems rehabilitation, differing in the number of stages and duration of treatment.

The choice is made in favor of those rehabilitation measures that are most effective and ensure a speedy recovery of the victim.

Features of rehabilitation and habilitation of disabled children

For children with disabilities, there are specific features in carrying out rehabilitation activities. The sooner recovery procedures begin, the it will pass faster restoring lost skills or acquiring new ones.

For this purpose, the following types of rehabilitation and habilitation are used:

1. Medical. Includes massage, physical therapy and other types of health measures.

2. Household. Help in mastering new skills and abilities in everyday life.

3. Psychological. Various educational activities are held for children.

4. Sociocultural: excursions, theaters, concerts and other types of leisure.

The peculiarity of such events is their complexity. It is necessary to restore the child’s health and develop his physical and mental abilities to the maximum.

About financing habilitation programs

New procedure for determining disability

With the entry into force of the new law, the procedure for determining disability has changed.

Previously, mainly in the process of conducting an examination and establishing a disability group, only 2 criteria were used:

What is the disorder of body functions?
To what extent has the usual level of functioning been limited due to illness or injury?

one specific function is partially or completely lost;
Is it possible for a person to manage on his own or does he need regular medical and household care, etc.

Now the medical and social examination will be guided by only one criterion.

The basis for establishing a person’s disability is a health disorder with II or more severity of persistent impairment of body functions. Once a person has been identified as disabled, the criteria for establishing a disability group will be applied.

Medical and social examination also meets the principle of complexity. It is carried out on the basis of a comprehensive assessment of the body’s condition based on the following data:

Clinical and functional;
Social household;
Professional and labor;
Psychological.

If a person is officially recognized as disabled, then he will be assigned an individual rehabilitation or habilitation program, and its implementation will not only be prescribed, but also monitored.

Previously, the basis was taken as a person’s ability to communicate and learn, as well as to control his behavior. Now an objective assessment of the loss of body functionality will be given based on the results of a medical examination.

Last changes

The draft budget for 2018 allocated 29.3 billion rubles. for the purchase of rehabilitation equipment for disabled people. It is also planned to expand the provided list of TSR with a total volume of up to 900 million rubles.

Psychosocial rehabilitation: a modern approach
T.A. Solokhin

Definition of the concept of “psychosocial rehabilitation”,
its goals and objectives

The World Health Organization report on mental health (2001) states: “Psychosocial rehabilitation is a process that enables people who are frail or disabled as a result of mental disorders to achieve their optimal level of independent functioning in society.

To this definition we add that this is a constant, continuous process that includes a complex of medical, psychological, pedagogical, socio-economic and professional measures.

Psychosocial rehabilitation interventions vary depending on the needs of patients, the location where rehabilitation interventions are provided (hospital or community), and the cultural and socioeconomic conditions of the country in which mentally ill people live. But the basis of these events, as a rule, consists of:

· labor rehabilitation;
· employment;
· vocational training and retraining;
· social support;
· providing worthy living conditions;
· education;
· mental health education, including training on how to manage painful symptoms;
· acquisition and restoration of communication skills;
· acquisition of independent living skills;
· realization of hobbies and leisure, spiritual needs.

Thus, even from an incomplete list of the listed activities it is clear that psychosocial rehabilitation of mentally ill people is a comprehensive process aimed at the restoration and development of various spheres of human life.

Recently, the interest of scientists, practitioners, patients themselves and their families in psychosocial rehabilitation has increased. Currently, there are a large number of models of psychosocial rehabilitation and views on methods of its implementation. However, all scientists and practitioners agree that the result of rehabilitation measures should be reintegration(return) mentally ill people to society. At the same time, patients themselves should feel no less full citizens than other groups of the population. With that said, goal of rehabilitation can be defined this way: it is improving the quality of life and social functioning of people with mental disorders by overcoming their social alienation, as well as increasing their active life and civic position.

The Statement on Psychosocial Rehabilitation, developed by the World Health Organization jointly with the World Association for Psychosocial Rehabilitation in 1996, lists the following: rehabilitation tasks:

· reduction in severity psychopathological symptoms through the triad of medications, psychotherapeutic treatments and psychosocial interventions;
· increasing the social competence of mentally ill people by developing communication skills, the ability to overcome stress, as well as labor activity;
· reducing discrimination and stigma;
· support for families in which someone suffers from mental illness;
· creation and maintenance of long-term social support, satisfaction of at least the basic needs of mentally ill people, which include housing, employment, organization of leisure, creation of a social network (social circle);
· increasing the autonomy (independence) of mentally ill people, improving their self-sufficiency and self-defense.

B. Saraceno, head of the mental health department of the World Health Organization, commented on the importance of psychosocial rehabilitation as follows: “If we hope for the future of psychosocial rehabilitation, then it should be psychiatric care in the patients’ place of residence - accessible, complete, allowing mentally ill people to be treated and receive serious support. With this type of care, hospitals are not needed and the medical approach should be used only to a minor extent. In other words, the psychiatrist should be a valuable consultant to the service, but not necessarily its master or ruler.”

Brief historical background

In the history of rehabilitation of mentally ill patients, a number of important points who played a significant role in its development.

1. The era of moral therapy. This rehabilitative approach, which developed in the late 18th and early 19th centuries, was to provide more humane care to the mentally ill. The basic principles of this psychosocial impact remain relevant to this day.

2. Introduction of labor (professional) rehabilitation. In Russia, this approach to the treatment of mentally ill people began to be introduced in the first third of the 19th century and is associated with the activities of V.F. Sablera, S.S. Korsakov and other progressive psychiatrists. For example, as noted by Yu.V. Kannabikh, among the important transformations carried out by V.F. Sabler in 1828 at the Preobrazhenskaya Hospital in Moscow, include “... arrangement of gardening and handicraft work.”

Occupational therapy as a direction of modern domestic psychiatry began to be given Special attention, starting from the 50s of the last century. There was a network of therapeutic labor workshops and special workshops where mentally ill people undergoing inpatient and outpatient treatment could work. With the beginning of socio-economic reforms in the 90s of the last century, about 60% of institutions involved in labor rehabilitation (medical and industrial workshops, specialized workshops at industrial enterprises, etc.) were forced to cease their activities. However, even today, employment and occupational therapy are the most important components in psychosocial rehabilitation programs.

3. Development of community psychiatry. Shifting the emphasis in the provision of mental health care to out-of-hospital services and the recognition of the fact that the patient can be treated close to family and place of work has had great value to restore a sick person.

In the 30s of the last century, psychoneurological dispensaries began to open in our country and semi-stationary forms of assistance were created, which had enormous rehabilitation significance.

In the 50-60s, widespread development psychiatric rooms in clinics, central district hospitals and other institutions of the general medical network, at industrial enterprises, in educational institutions, day and night semi-hospitals, as well as other forms of assistance aimed at meeting the needs of mentally ill people.

In foreign countries (Great Britain, Japan, Canada, etc.) during this period, organizations of aid consumers and support groups began to be actively created.

The development of community psychiatry also involves the active identification of people in need of psychiatric care for early treatment and combating the consequences in the form of disability and social disadvantage.

4. The emergence of psychosocial rehabilitation centers. Their discovery began in the 80s of the twentieth century. The first centers (clubs) were created by the patients themselves (for example, Clubhouse in the USA), and their activities are aimed at helping patients cope with problems Everyday life, develop the ability to perform activities even in the presence of disability. Therefore, at first in such centers the emphasis was placed on activities that would help patients cope with life’s difficulties, not succumb to them, as well as on improving health, and not on getting rid of the symptoms of mental illness. Psychosocial rehabilitation centers have played a huge role in the development of such an area of knowledge as the rehabilitation of people with disabilities due to mental illness. Currently, this form of assistance is widely used in the USA, Sweden, and Canada; the number of rehabilitation programs in them varies significantly (from 18 to 148).

In Russia, similar centers (institutions) began to be created in the mid-90s of the twentieth century, but so far there are clearly not enough of them. As a rule, these are non-governmental institutions. An example is the Club House in Moscow, which existed until 2001. Currently, rehabilitation centers operating in our country specialize in a specific area - art therapy, corrective interventions, leisure, psychotherapy, etc.

5. Developing the skills necessary to overcome life's difficulties. The emergence of this direction is due to the fact that for effective solution problems arising, people suffering from serious mental disorders require certain knowledge, skills and abilities. The development of skills and abilities is based on methods developed taking into account the principles of social learning. In this case, methods of active-directive teaching are used - behavioral exercises and role-playing games, sequential formation of elements of behavior, mentoring, prompting, and also generalization of acquired skills is carried out. It has been proven that the development of skills and abilities develops the ability for independent living in people with severe mental disorders.

Modern approaches to psychosocial rehabilitation in Russia

The accumulation of scientific data on the rehabilitation of mentally ill people and practical experience have contributed to the fact that currently in our country, along with complex treatment, including drug and occupational therapy, physiotherapy, cultural, educational and leisure activities, the following types of psychosocial interventions have been developed as part of psychosocial rehabilitation:

· educational programs in psychiatry for patients;
· educational programs in psychiatry for relatives of patients;
· trainings to develop skills for daily independent living - training in cooking, shopping, drawing up a family budget, housekeeping, using transport, etc.;
· trainings on the development of social skills - socially acceptable and confident behavior, communication, solving everyday problems, etc.;
· trainings to develop mental state management skills;
· self- and mutual-help groups of patients and their relatives, public organizations of consumers of mental health care;
· cognitive behavioral therapy aimed at improving memory, attention, speech, behavior;
· family therapy, other types of individual and group psychotherapy.

Comprehensive psychosocial rehabilitation programs are provided in many regional mental health services, both institutionally and in the community. Let's give just a few examples.

In Tver, on the basis of the regional psychoneurological dispensary, a food shop has been opened, where mentally ill people work and the products are sold through a regular retail chain. In addition, in the same dispensary there is a ceramic workshop and a fabric painting workshop, where people suffering from mental illness successfully work. All products of these enterprises are in demand among the population.

At the Tambov Regional Psychiatric Hospital, the department of psychosocial rehabilitation conducts the following programs: educational in the field of psychiatry, art therapy, leisure, therapy for holidays, including personal ones (patients’ birthdays, etc.). The hospital has opened a “Home with Support”, where patients long time Those who are hospitalized, after discharge from it, receive independent living skills and only after that return home. In the community, with the participation of professionals, the theater “We” was opened, in which patients, their relatives, and students of the theater school perform.

Important rehabilitation work is carried out in many psychiatric hospitals in Moscow. For example, in hospitals No. 1, 10 and 14, art studios are open for patients, occupational therapy is used, educational programs on psychiatry are implemented for patients and their relatives, and trainings are organized to develop social skills and independent living skills.

In the Sverdlovsk region, interdepartmental cooperation teams have been created, which include employees of medical, educational, professional institutions, employment authorities and social protection institutions, which makes it possible to comprehensively solve the problems of mentally ill people and provides a multifaceted approach to their rehabilitation.

Questions about rehabilitation,
which are most often asked by patients’ relatives

Very often relatives of mentally ill people ask us: When can rehabilitation activities begin? Rehabilitation for patients with mental disorders, as well as for somatic diseases, is recommended to begin when the condition has stabilized and the pathological manifestations have weakened. For example, rehabilitation of a patient with schizophrenia should begin when the severity of symptoms such as delusions, hallucinations, thinking disorders, etc. decreases. But even if the symptoms of the disease remain, rehabilitation can be carried out within the limits of the patient’s ability to learn and respond to psychosocial interventions. All this is necessary to increase functional potential (functional capabilities) and reduce the level of social disability.

Another question: What is meant by social impairment and decreased functional abilities of the patient? A sign of social insufficiency is, for example, lack of work. For mentally ill people, unemployment rates reach 70% or higher. It's connected with a decrease in their functionality due to the presence of psychopathological symptoms and impaired cognitive (cognitive) functions. Signs of decreased functionality include low physical endurance and work tolerance, difficulty following instructions and working with other people, difficulty concentrating, solving problems, as well as the inability to adequately respond to comments and seek help.

The social deficiency of mentally ill people also includes the phenomenon of homelessness.

Unfortunately, our society is not yet able to completely solve the problems of employment and housing for patients with severe mental disorders and thereby reduce their social insufficiency. At the same time, psychosocial rehabilitation programs improve the patient’s competence, give him the opportunity to acquire skills for overcoming stress in traumatic situations and the difficulties of everyday life, skills for solving personal problems, self-care, and professional skills, which ultimately helps to increase functional potential and reduce social disability .

Which specialists deal with psychosocial rehabilitation? Patients and their families should be aware that psychosocial rehabilitation is provided by psychiatrists, psychologists, social workers, employment specialists, occupational therapists, nurses, as well as relatives and friends of mentally ill people.

Are there any special principles, methods, approaches in the work of specialists who are involved in the psychosocial rehabilitation of people with severe mental disorders?

All specialists involved in the rehabilitation of patients with mental disorders undergo training, which includes the development of special methods and techniques. The work of a rehabilitation therapist is complex, lengthy, and creative. It is based on the following principles:

· optimism about achieving results;
· confidence that even a slight improvement can lead to positive changes and improve the patient’s quality of life;
· the conviction that motivation to change one’s situation can arise not only due to special rehabilitation measures in relation to the patient, but also due to his own efforts.

What else, besides developing useful skills, can help a patient restore functionality?

At the beginning of the lecture we talked about integrated approach to rehabilitation. Let us once again list the aspects that are important for a person suffering from a severe mental illness:

· improvement of family relationships;
· labor activity, including transitional (intermediate) employment;
· expanding communication opportunities, which is achieved by participating in club activities and other special programs;
· socio-economic support;
· decent housing, including its protected forms.

What can the family do for the psychosocial rehabilitation of the patient?

The important role of the family in the psychosocial rehabilitation of a patient with severe mental illness has now been proven. This involves it performing different functions. First of all, it should be said that patients' relatives must be considered as allies in treatment. Not only do they have to learn a lot, but they themselves often have a large amount of knowledge and experience - this makes a significant contribution to the rehabilitation process. For a doctor, relatives can be a valuable source of information about the patient’s condition; sometimes they are more knowledgeable than specialists about certain aspects of his disease. Often the family acts as a link between the patient and the mental health care system. Relatives help other families whose lives have been affected by mental illness, providing advice and sharing their own experience in solving problems. All this allows us to say that relatives of patients are both teachers and educators for other families and even professionals.

The most important function of loved ones is to care for a sick person. Relatives should take into account that patients with schizophrenia feel best if there is a certain order, rules and constant responsibilities in the house for each family member. We must try to establish a regimen that suits the patient’s capabilities. Relatives can help patients instill the skills of personal hygiene, careful dressing, regular and careful eating, as well as correct intake medications, control side effects medicines. Over time, you can entrust the patient with some work around the house (washing dishes, cleaning the apartment, caring for flowers, taking care of pets, etc.) and outside the home (shopping in a store, going to the laundry, dry cleaning, etc.).

Family participation in mental health education programs is another important contribution to the psychosocial rehabilitation of a sick relative. The importance of family psychiatric education has already been discussed in previous lectures. Let us remind you once again that knowledge of the basics of psychiatry and psychopharmacology, the ability to understand the symptoms of the disease, and mastering the skills of communicating with a sick person in the family provide a real opportunity to reduce the frequency of exacerbations of the disease and repeated hospitalizations.

Protecting the rights of the patient. Family members can make a significant contribution to the fight against stigma and discrimination, as well as to improve legislation regarding people with mental illness and their families. However, for this, relatives must act together in an organized manner: create support groups and organizations of help consumers. In this case, they will not only gain the support of people facing similar problems, but will also become a force to be reckoned with by both professionals and government agencies responsible for providing quality mental health and social care.

In addition, working in a team, relatives of patients can themselves conduct psychosocial rehabilitation programs - leisure, holiday therapy, educational programs for the population in order to reduce stigmatization and discrimination of patients, and by teaming up with professionals - implement educational programs in the field of psychiatry, vocational training, development of social skills and many others.

In almost half of the regions of Russia, patients, relatives of patients and professionals have created support groups, public organizations that carry out active work on psychosocial rehabilitation directly in the community, relying on its resources, outside the walls of hospitals or dispensaries. The next section of the lecture is devoted to the contribution of public forms of assistance to the psychosocial rehabilitation of patients and their families.

Public forms of assistance

Goals and objectives of public organizations

Consumers of mental health care - patients and members of their families - have long been perceived as passive participants in the process of providing care. What types of help the patient needs were determined by professionals, without recognizing treatment needs and own desires the patients themselves and their relatives. In recent decades, the situation has changed, which is associated with the development of the movement of consumers of medical and psychiatric care, and the creation of public organizations by them.

For a long time now, in many countries, the significance of the contribution of the social movement to the development of psychiatric services and the implementation of psychosocial rehabilitation programs is beyond doubt.

It is noteworthy that the social movement in psychiatry abroad was initiated by one of its consumers - Clifford Byrnes (USA), who himself for a long time was a patient in a psychiatric hospital. Around this man, at the beginning of the last century, famous American doctors and representatives of the public united to achieve for the mentally ill better conditions treatment and care. As a result of such joint activities, the National Committee for Mental Hygiene was formed in 1909.

In Canada, the USA, England, Japan, Australia, India and many other countries, patients and their relatives satisfy part of their needs through numerous non-governmental - public organizations of care consumers, including national ones. For example, the World Fellowship for Schizophrenia and Allied Disorders has made significant progress in bringing patients and their families together.

In Russia, until 1917, there were public forms of care for the mentally ill, the main tasks of which included attracting the population to provide charitable assistance, providing psychiatric institutions with funds from donations, etc. The greatest activity in the development of such forms of assistance occurred during the period of zemstvo medicine, when night and day care centers were created shelters, shelters, free canteens were opened for the disadvantaged, and patronage forms of serving the mentally ill were organized.

In modern Russia, the activities of public organizations of mental health consumers have intensified only in the last 10-15 years, but by the end of the 90s of the last century there were several dozen organizations working in the field of mental health. In 2001, an all-Russian public organization of people with disabilities due to mental disorders and their relatives “New Opportunities” was created, the main goal of which is to provide practical assistance to such people with disabilities and improve their position in society. Today, within the framework of this organization there are more than 50 regional branches, the members of which are mainly patients and their relatives.

An analysis of the activities of various regional public organizations working in the field of mental health showed that the goals of many of them are similar - this is the integration into society of persons with mental health problems through their socio-psychological and labor rehabilitation, protection of their rights and interests, changing the image of a mentally ill person in society, mutual support for mentally ill people and their families, assistance in crisis situations, prevention of disability due to mental illness. In other words, the activities of public organizations are aimed at improving the quality of life of mentally ill people and their relatives.

Public organizations also provide the opportunity to communicate, exchange experiences, and develop a sense of belonging: relatives of patients see that they are not alone, that there are a lot of such families.

The functions of public associations are:

· creation of self- and mutual support groups;
Conducting group developmental work with patients of different ages, leisure programs;
· organization of painting workshops, decorative and applied arts, theater studios, summer recreation camps;
· Conducting training seminars for relatives, as well as for specialists working with mentally ill people.

Many organizations have developed interesting methods and accumulated a wealth of work experience.

International experience shows that in a number of countries the consumer movement has significantly influenced mental health policies. In particular, the employment of people with mental health disorders in the traditional mental health system, as well as in other social services, has increased. For example, in the Ministry of Health of the Province of British Columbia (Canada), for the position of director of alternative treatment a person with a mental disorder has been appointed and can now have a significant impact on mental health policy and services.

Protecting the rights of the mentally ill is important task many public organizations in our country. It is known that the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens during its provision” provides for a special article - No. 46 “Control of public associations over the observance of the rights and legitimate interests of citizens in the provision of psychiatric care.” This article of the law itself and the commentary to it note the importance of the activities of public associations for both patients and psychiatric institutions, define the obligation of the administration of these institutions to assist representatives of public organizations, provide them with the necessary information, and note the right of public organizations to appeal in court the actions of individuals who violated the rights and legitimate interests of citizens when providing them with psychiatric care. The right of representatives of public associations to be included in various councils, commissions of psychiatric institutions, health authorities created to monitor the quality of care for the mentally ill, the conditions of their detention, and improve the forms of work of psychiatric services has been introduced. The importance of joint activities of public organizations and state psychiatric institutions is noted to attract the attention of the media, health authorities, government circles and society as a whole to modern problems of psychiatry, changing the negative image of the mentally ill and psychiatric institutions.

As the movement of help consumers intensifies, the human rights function should be developed in terms of lobbying the interests of mentally ill people and members of their families among legislators, politicians, and public figures, and work with them should be constant.

Another aspect of the advocacy work of public consumer organizations may be related to the protection of psychiatric institutions themselves when, for example, they are threatened with funding cuts.

The role of professionals

We see it in the initiation of relatives and patients themselves to create public organizations or support groups. It is professionals who can play a vital role in the formation of such organizations.

Subsequently, professionals should assist the organization in developing its activities - constantly advising its leaders or support groups on issues of education in the field of psychiatry, including legal aspects.

Professionals can also help create strategic plans for an organization. Extremely useful assistance from professionals to public consumer organizations can be the publication of newspapers, booklets, and manuals for families of mentally ill people.

Thus, the development of a social movement of consumers of mental health care is becoming an important link in the modern system of mental health care, capable of meeting many of the needs of mentally ill people, their position in society, reducing the burden of the disease, and improving the quality of life of patients and their family members.

Activities of a public organization
"Family and Mental Health"

All authors of this manual are members of the public organization Center for Socio-Psychological and Information Support “Family and Mental Health”, which received legal status on June 6, 2002. The initiators of its creation are employees of the department of organization of psychiatric services Science Center mental health of the Russian Academy of Medical Sciences and parents of patients suffering from mental disorders.

In 1996, the first socio-psychological school in Moscow was opened to support families of mentally ill people, which formed the basis of our future organization. Thus, official registration was preceded by a six-year period of activity, during which extensive experience in the field of psychosocial rehabilitation of people with mental disorders and their relatives was accumulated.

Our members now include not only mental health professionals, but also people with mental health problems, their families and friends.

The social movement draws the attention of the authorities to the most actual problems, forces us to look for ways to solve them. Participation in the work of a public organization contributes to the formation of an active citizenship among patients with mental illness and members of their families, and stimulates them to search for ways to improve their position in society.

Why did we name our organization “Family and Mental Health”?
This name reflects two fundamental values of our lives - family and mental health.

Mental health is essential to the well-being of individuals, societies and countries. It is inseparable from physical health and has a huge impact on the cultural, intellectual, creative, productive and defense potential of any nation. The role of family in the life of a person suffering from a mental disorder is enormous. The family faces problems before the doctor mental illness- at a very early stage, and can promote or counteract its early recognition and effective treatment.

The family provides the sick person with care and emotional support that professionals often cannot provide.

Good relationships between family members are the key to favorable conditions for recovery, rehabilitation and compliance with medical recommendations.

In a family, each member is influenced by others and, in turn, influences them. If something is not going well in the family, it can interfere with its normal functioning. Therefore, one of the main tasks that we set for ourselves is socio-psychological and informational support for the family, as well as the harmonization of family relationships.

We perceive our organization as a large and friendly family, each member of which is ready to take care of others and come to the aid of those who need it. Therefore, not only people who have mental health problems, but also their families, friends, as well as doctors, teachers and psychologists, musicians and artists can become members of our organization. Our understanding of the family is not limited to the immediate environment of the patient - it also includes those who care about the fate of people with mental health problems.

The purpose of our organization and - improving the quality of life of families with mental health problems by overcoming their social alienation, involving them in the life of society, and developing an active civic and life position.

Main activities of the organization

1. Social-psychological and informational support.
2. Psychiatric education.
3. Psychosocial rehabilitation.
4. Conducting programs to reduce social stigma and discrimination against people with mental disorders and members of their families.
5. Participation in the development of a social movement in psychiatry.
6. Publication of popular scientific literature on problems of psychiatry and mental health.
7. Conducting conferences and seminars on mental health issues for professionals and consumers of mental health care.

Our organization conducts the following programs.

1. For patients with mental health problems:

· trainings to develop communication skills. The goal is to develop and improve communication skills and confident behavior in everyday life;

· educational program in psychiatry. The goal is to provide knowledge in the field of psychiatry, training in timely recognition of painful manifestations and control over them, awareness of the need for early seeking help;

· social skills training. The goal is to develop skills for independent living in society, including self-care, home economics, and daily living skills;

· art therapy. The goal is personality development, activation of imagination and creativity;

· group-analytical psychotherapy. The goal is to develop self-confidence, master the skills of living harmoniously with other people, and increase resistance to stress.

The Family and Mental Health Center has an art studio, an arts and crafts workshop, and a music studio. Treatment and advisory assistance is provided to correct treatment.

The results of comprehensive work with patients indicate the development of personality, the development of an adequate strategy for coping with the disease, the formation of responsibility for one’s own social behavior, restoring broken social contacts and increasing social competence.

2. For relatives of patients:

· psychiatric education program. The goal is information support, the formation of partnerships with medical personnel. Knowledge about mental illnesses and their treatment is provided, the peculiarities of communication with a mentally ill family member are discussed, as well as familiarization with the modern system of psychiatric, social and legal assistance;
· group-analytical psychotherapy. The goal is to develop skills in solving family problems, reduce stress associated with a family member having a mental illness, identify one’s own needs, and increase life satisfaction. Classes are conducted by experienced psychotherapists and psychologists;

· psychological counseling (individual and family). The goal is to improve the psychological state of relatives and provide them with emotional support.

3. For the family as a whole:

· leisure program. The goal is to improve leisure time and harmonize family relationships. Festive concerts and themed musical evenings are regularly held, which traditionally end with a family tea party. All members of the organization take an active part in the preparation and implementation of the program.
· educational program “Moscow Studies on Saturdays”. The goal is personal development, improvement of leisure and recreation. The program includes visits to museums, exhibition halls, and excursions around Moscow.

Concluding the lecture on issues of psychosocial rehabilitation, it is necessary to once again emphasize the invaluable contribution of this area to the recovery of mentally ill people, the activation of their civic and life positions, as well as to improving the quality of life of their family members.

Quote "Mental health: new understanding, new hope": a report on the state of global health. WHO, 2001.

ChapterI

A child with disabilities in modern conditions.

types of rehabilitation 5

1.2 Technologies for social rehabilitation of children with disabilities

health opportunities 22

1.3 Features of social rehabilitation of disabled children living outside the family 33

ChapterII

Modern approaches to the problems of disabled children.

2.1 Difficulties of socio-psychological rehabilitation

disabled children 41

2.2 Development of abilities to overcome difficulties of social rehabilitation 45

2.3 Practical solutions to problems of childhood disability 50

Conclusion 77

List of used literature 87

Application 90

Introduction.

According to the UN, there are approximately 450 million people worldwide with mental and mental disorders. physical development. This represents 1/10 of the inhabitants of our planet (of which about 200 million are children with disabilities).

Moreover, in our country, as well as throughout the world, there is a growing trend in the number of disabled children. In Russia, the incidence of childhood disability has doubled over the past decade.

In 1995, more than 453 thousand disabled children receiving a social pension were registered with the social protection authorities. But in fact there are twice as many such children: according to WHO estimates, there should be about 900 thousand of them - 2-3% of the child population

Every year about 30 thousand children are born in the country with congenital hereditary diseases, of which 70-75% are disabled.

Disability in children means a significant limitation in life activity; it contributes to social maladaptation, which is caused by developmental disorders, difficulties in self-care, communication, learning, and mastering professional skills in the future. The acquisition of social experience by disabled children and their inclusion in the existing system of social relations requires certain additional measures, means and efforts from society (these may be special programs, special rehabilitation centers, special educational institutions, etc.). But the development of these measures should be based on knowledge of the patterns, tasks, and essence of the process of social rehabilitation.

Currently, the process of social rehabilitation is the subject of research by specialists in many branches of scientific knowledge. Psychologists, philosophers, sociologists, teachers, social psychologists and other specialists reveal various aspects of this process, explore the mechanisms, stages and stages, factors of social rehabilitation.

Social policy in Russia, aimed at disabled people, adults and children, is built today on the basis of the medical model of disability. Based on this model, disability is considered as an illness, disease, pathology. Such a model, wittingly or unwittingly, weakens the social position of a child with a disability, reduces his social significance, isolates him from the “normal” children’s community, aggravates his unequal social status, and condemns him to the recognition of his inequality and lack of competitiveness in comparison with other children. The medical model also determines the methodology of working with a disabled person, which is paternalistic in nature and involves treatment, occupational therapy, and the creation of services that help a person survive, let us note - not live, but survive.

The consequence of the orientation of society and the state towards this model is the isolation of a child with disabilities from society in a specialized educational institution, and the development of passive - dependent life orientations in him.

In an effort to change this negative tradition, we use the concept "person with disabilities" which has become increasingly used in Russian society.

The traditional approach does not exhaust the full scope of the problems of the category of adults and children in question. It clearly reflects the lack of vision social essence child. The problem of disability is not limited to medical aspect, it is much more a social problem of unequal opportunities.

This idea radically changes the approach to the triad “child - society - state”. The essence of this change is as follows:

The main problem of a child with disabilities is the disruption of his connection with the world, limited mobility, poor contacts with peers and adults, limited communication with nature, inaccessibility of a number of cultural values, and sometimes even basic education. This problem is a consequence not only of a subjective factor, such as the state of the child’s physical and mental health, but also a result social policy and the established public consciousness, which sanction the existence of an architectural environment, public transport, and social services inaccessible to disabled people.

A child with a disability may be just as capable and talented as his peer who does not have health problems, but inequality of opportunities prevents him from discovering his talents, developing them, and using them to benefit society;

A child is not a passive object of social assistance, but a developing person who has the right to satisfy diverse social needs in cognition, communication, and creativity;

The state is called upon not only to provide a child with a disability with certain benefits and privileges, it must meet his social needs and create a system of social services that will help mitigate the restrictions that impede the processes of his social rehabilitation and individual development.

The purpose of this work is to characterize the social rehabilitation of disabled children, its significance and modern directions. To achieve this goal, it is necessary to solve the following tasks:

Describe the essence of the concepts of disability and rehabilitation, types of rehabilitation;

Consider modern trends and basic methods of social rehabilitation of disabled children

A child with disabilities in modern conditions

Social rehabilitation of persons with disabilities is one of the most important and difficult tasks of modern systems of social assistance and social services. The steady increase in the number of disabled people, on the one hand, increasing attention to each of them - regardless of his physical, mental and intellectual abilities, on the other hand, the idea of increasing the value of the individual and the need to protect his rights, characteristic of a democratic, civil society, on the third hand - all this predetermines the importance of social rehabilitation activities.

According to the Declaration of the Rights of Persons with Disabilities (UN, 1975) disabled person is any person who cannot independently provide fully or partially the needs of normal personal and (or) social life due to a deficiency, whether congenital or not, in his (or her) physical or mental capabilities.

In Recommendation 1185 to rehabilitation programs of the 44th session of the Parliamentary Assembly of the Council of Europe of May 5, 1992. disability determined as limitations in capabilities caused by physical, psychological, sensory, social, cultural, legislative and other barriers that do not allow a person with a disability to be integrated into society and take part in the life of the family or society on the same basis as other members society. Society has a responsibility to adapt its standards to the special needs of people with disabilities so that they can live independent lives.

In 1989, the UN adopted the text of the Convention on the Rights of the Child, which has the force of law. It enshrines the right of children with developmental disabilities to lead a full and dignified life in conditions that allow them to maintain dignity, a sense of self-confidence and facilitate their active participation in the life of society (Article 23); the right of a disabled child to special care and assistance, which should be provided whenever possible free of charge, taking into account the financial resources of the parents or other persons caring for the child, in order to ensure that the disabled child has effective access to educational, vocational training, medical care, and rehabilitation services , preparation for work and access to recreational facilities, which should contribute to

opportunities for the most complete involvement of the child in social life and the development of his personality, including cultural and spiritual development.

In 1971, the UN General Assembly adopted the Declaration of the Rights of Mentally Retarded Persons, which affirmed the need to maximize the rights of such persons with disabilities, their rights to adequate health care and treatment, as well as the right to education, training, rehabilitation and protection that allows them to develop their abilities and capabilities. The right to work productively or engage in any other useful activity to the fullest extent of one’s abilities is specifically stipulated, which is associated with the right to material security and a satisfactory standard of living.

Of particular importance for children with disabilities is the norm stating that, if possible, a mentally retarded person should live in his own family or with foster parents and participate in the life of society. The families of such persons should receive assistance. If it is necessary to place such a person in a special institution, it is necessary to ensure that new environment and living conditions differed as little as possible from the conditions of ordinary life.

In the International Pact about UN economic, social and cultural rights (Article 12) establish the right of every disabled person (both adults and minors) to the highest attainable level of physical and mental health. An integrative document covering all aspects of the life of persons with disabilities is the UN Standard Rules for the Equalization of Opportunities for Persons with Disabilities.

Svetlana Chirkina
Rehabilitation of children with disabilities in the Rehabilitation Center

The main problem of a child with disabilities lies in its connection with the world, in mobility restrictions, poor contacts with peers and adults, and access to cultural values. This problem is an expression not only of a subjective factor, such as social, physical and mental health, but also the result of social policy and the prevailing public consciousness.

A child, brought face to face with his parents, who have one dominant thing - his illness, is gradually isolated from society, and there is nothing about his upbringing, much less development mental processes there is no question. Child socialization occurs in microsociety (family) and in macrosociety (society).

As a result of exposure to objective adverse factors, more than 85% children in Russia(and according to some estimates, up to 93%) already at the moment of birth they fall into "risk zone", that is, they have a predisposition to the occurrence various kinds disturbances in the process of further mental development. Therefore, the growth in numbers should be considered as a constantly operating factor, requiring not individual, private, but systematic social decisions.

As is known, under rehabilitation in the broadest sense of the word understand the total of all costs and actions that contribute to the provision of people handicapped due to birth defects, diseases, or accidents, possibilities lead a normal life, find one’s place in society, and fully demonstrate one’s abilities.

A child with a disability is a part and member of society; he wants, should and can participate in all multifaceted life.

A child with a disability may be as capable and talented as his peers who do not have health problems.

A child is not a passive object of social assistance, but a developing person who has the right to satisfy diverse social needs in cognition, communication, and creativity.

An institution that was created to provide children and adolescents with disabilities, medical, social and pedagogical assistance, ensuring their fullest possible social life in society, in the family is the State Budgetary Institution of the Russian Federation (I) "RRC Neryungri""Republican rehabilitation center for children and adolescents with disabilities, Neryungri."

Introduction to Human Community children with disabilities is the main task of the entire system of activities Center. The main direction of psychological and pedagogical activity is an appeal to the individual disabled children, built on partnership techniques, active participation of such children in their own rehabilitation, versatility of efforts, unity and phasing of psychosocial and pedagogical influence.

Social rehabilitation, determining the child’s ability to disabilities adapt to changing living conditions, is an important mechanism for its integration into society.

Social rehabilitation plays a leading role in the system of psychological and pedagogical support children with disabilities and is carried out in the process of various types of activities.

The system of psychological and pedagogical support must include different kinds social rehabilitation: social and domestic, social and labor, social and cultural, etc.

They focus on practical training children to independent life; to develop their knowledge, skills and abilities of self-service, assistance in housekeeping, and to master the simplest cooking skills; the ability to use the enterprises of consumer services, trade, transport, medical care, that is, they contribute to full social adaptation children with disabilities.

A special role in the psychological and pedagogical process of our institution is given to socio-cultural. The main goal of correctional and developmental work in this direction is both socialization and communication; as a rule, children and parents who come to us do not know how to communicate with each other and others around them.

Sociocultural rehabilitation of childrenand adolescents is carried out in the following areas:

Music therapy;

Art therapy;

Fairytale therapy;

Biliotherapy;

Activities of the family club "Hope";

Conducting round tables on issues of integrated rehabilitation;

Participation in city, city and republican competitions and exhibitions.

Inclusion "special" children and teenagers in various shapes sociocultural rehabilitation has a socializing influence on them, expands possibilities for self-affirmation and self-realization. Our children have repeatedly been participants and winners of creative competitions, which allows us to ensure equal opportunities with peers, and plays important role for successful integration into society.

In conclusion, it should be said that the importance of social rehabilitation in the conditions of the Rehabilitation Center cannot be overestimated. Usage individual approach to the acquisition of social skills by children, the use of various innovative methods and techniques, the active participation of teachers, psychologists, parents in this - helps ensure the most effective social rehabilitation of children and adolescents with disabilities and leads to a decrease in the level of social deprivation in our students.

2.2.3 SOCIAL REHABILITATION PROGRAM

Activities for the social rehabilitation of a disabled child are aimed at helping the child develop his social status, achieve financial independence in the future, social adaptation and integration into society.

The implementation of services for the social rehabilitation of disabled children is carried out gradually and continuously in institutions of the relevant profile. The content and duration of the rehabilitation process are determined by the child’s need for each specific service.

The need for social rehabilitation measures for disabled children is determined based on the results of social diagnostics of the child and his family.

The systemic classification of social rehabilitation services is presented in GOST R 54738-2011 “Rehabilitation of disabled people. Services for social rehabilitation of disabled people".

Activities for social rehabilitation in the IRP of a disabled child include:

Social and environmental rehabilitation;

Social and pedagogical rehabilitation;

Social and psychological rehabilitation;

Sociocultural rehabilitation;

Social and everyday adaptation.

Physical education and health activities and sports.

Social and environmental rehabilitation is aimed at integrating a disabled child into society by providing him with the necessary set of technical means of rehabilitation, teaching him how to use them, and creating an accessible environment in the immediate environment of the disabled child.

Measures for the social and environmental rehabilitation of a disabled child consist of restoring (forming) or compensating for the following elements of activity and participation: in ordinary social relationships (meetings with friends, relatives, talking on the phone, etc.), involvement in these relationships, role position in family, ability to manage money, visit stores, make purchases, service establishments, make other calculations, etc.), ability to use transport, transport communications, overcome obstacles - stairs, curbs, ability to use communications, information, newspapers, reading books, magazines, leisure time, physical education, sports, creativity, the opportunity to visit cultural institutions and use their services.

Social and environmental rehabilitation services are provided to disabled children in the following composition and forms:

Training a disabled person and his family members in the use of technical means of rehabilitation;

Information and consultation on vital social issues; on rehabilitation issues, legal assistance on issues of discrimination against disabled children in different areas life;

Social skills training for housekeeping;

Assistance in planning and creating a family, training in family and marital relationships;

Training in solving personal problems;

Social communication training, etc.

In our opinion, in the section “social and environmental rehabilitation” of the IPR of a disabled child, a conclusion can be drawn up on the possibility of self-care and leading an independent lifestyle for disabled children upon reaching the age of 18 years living in inpatient institutions social services.

Social and pedagogical rehabilitation- restoration (formation) of lost social and environmental status through teaching the child appropriate educational programs, knowledge, skills, behavioral stereotypes, value orientations, standards that ensure the full participation of disabled children in generally accepted forms of social interaction. Social and pedagogical rehabilitation includes:

Social and pedagogical diagnostics;

Social and pedagogical consultation;

Pedagogical correction;

Correctional training;

Pedagogical education;

Social and pedagogical patronage and support.

Socio-pedagogical counseling consists of assisting a disabled child in obtaining educational services in order to make an informed decision on choosing the level, place, form and conditions of training/education, activities that ensure the development of educational programs at the optimal level, in the selection and use of the necessary teaching aids and technical teaching aids, educational equipment, taking into account the characteristics of the educational potential of a disabled person and the degree of learning disabilities.

Pedagogical correction is aimed at developing and correcting the mental and physical functions of a disabled child using pedagogical methods and means. Pedagogical correction is carried out in the process of individual and group lessons with a speech therapist, with a speech pathologist (typhlo-, deaf-, tiflo-surdo-, oligophrenopedagogues).

Correctional education includes teaching life skills, personal safety, social communication, social independence, the use of technical means of rehabilitation, sign language for people with hearing impairments and their family members, clear language for people with mental disabilities, restoration of social experience using special pedagogical methods that take into account existing the disabled person has impaired body functions and limited learning abilities.

Pedagogical education is the education of disabled people and members of their families, specialists working with disabled people, in the field of knowledge about disability, methods and means of rehabilitation and integration of disabled people into society.

Social and pedagogical patronage and support for disabled children and their families includes: supervision of the learning conditions of a disabled child in the family, opportunities for family members to help in the learning process of a disabled person, assistance in obtaining general and vocational education, information on issues of general and vocational education, organization of psychological - pedagogical and medical-social support of the learning process, assistance in the inclusion of disabled people in public organizations of disabled people.

Social and psychological rehabilitation of disabled children is aimed at restoring (forming) abilities that allow them to successfully perform various social roles (game, educational, family, professional, social and others) and have the opportunity to be actually included in various areas of social relations and life activities, to develop socio-psychological competence for successful social adaptation and integration of a disabled person into society.

Disabled children are provided with the following social and psychological rehabilitation services:

- psychological counseling oriented towards solving socio-psychological problems; is a specially organized interaction between a psychologist and a child (and/or his parent/guardian) in need of psychological help, with the aim of resolving problems in the field of social relations, social adaptation, socialization and integration;

- psychological diagnostics, which is to identify psychological characteristics a disabled person, determining the specifics of his behavior and relationships with others, the possibility of his social adaptation using psychodiagnostic methods and analysis of the data obtained for the purpose of socio-psychological rehabilitation;

- psychological correction, which consists of active psychological influence aimed at overcoming or weakening developmental deviations, emotional state and the behavior of a disabled person, as well as assistance in the formation of the necessary psychological and social skills and competencies of a disabled child, the natural formation of which is difficult due to limitations in life activity or characteristics of developmental conditions and the environment;

- psychotherapeutic assistance, which is a system of psychological influences aimed at restructuring the system of relationships between the individual of a disabled person, a deformed illness, injury or injury, and/or the parents of a disabled child and solving the problem of changing relationships, both to the social environment and to one’s own personality, as well as on the formation of a positive psychological microclimate in the family. Art therapy, psychodrama, family psychotherapy, bibliotherapy and other methods of therapy in group or individual form are widely used as methods of activating psychotherapeutic influence;

- socio-psychological training, which consists of an active psychological impact aimed at relieving a disabled child of the consequences of traumatic situations, neuropsychic tension, on the development and training of individual mental functions and personality traits, weakened due to illness, injury, injury or conditions of the social environment, but necessary for successful adaptation to new social conditions, to develop abilities that allow one to successfully fulfill various social roles (family, professional, social and others) and to be able to be actually involved in different areas of social relations and life activities in accordance with one’s age and stage of development;

- psychological prevention, which consists of assisting in the acquisition of psychological knowledge, increasing socio-psychological competence; formation of the need (motivation) to use this knowledge to work on oneself, on one’s problems of socio-psychological content; creating conditions for the full mental functioning of the personality of a disabled person, for timely prevention of possible mental disorders, due, first of all, social relations. Often necessary for parents of disabled children, as assistance in creating optimal conditions for the development and upbringing of the child;

- socio-psychological patronage, which consists of systematic monitoring of disabled people and the conditions of their development for the timely identification of situations of mental discomfort caused by problems of adaptation of a disabled person in the family, in society as a whole, and providing, if necessary, psychological assistance.

Sociocultural rehabilitation of disabled children is represented by a set of activities, the purpose of which is to help a disabled child achieve and maintain an optimal degree of participation in social relationships, required level cultural competence, which should provide the opportunity for positive changes in lifestyle and the fullest integration into society by expanding the scope of its independence.

The main goal of sociocultural rehabilitation of disabled children (as well as psychological and pedagogical) is to overcome or level out disharmonies in the mental development of children due to disabling diseases.

The peculiarity of determining the sociocultural rehabilitation measures indicated for a disabled child is that it is based on medical, social and psychological factors, that is, personality disorders, the level of social adaptation of a disabled child in the public environment, his cultural interests, spiritual values, and propensity for creative activity. Sociocultural rehabilitation programs are built taking into account differentiation by type of defect, personality disorders due to a disabling pathology, gender, psychophysical characteristics characteristic of a child at the appropriate age. Contraindicated factors are taken into account, for example, the use of products (glue, paper, etc.) that cause allergic reactions, piercing, cutting objects for epilepsy, etc.

A disabled child’s entry into the world of artistic culture, like a healthy child, occurs gradually. The following stages of the formation of a child’s personality subculture are distinguished:

1. “The world and artistic culture around me” - covers infancy and early childhood, characterized by familiarity with the world of artistic culture through communication and interaction with the objective world.

2. “I am developing in the world of artistic culture” - preschool age when artistic perception, action, communication and play are formed.

3. “I am learning the world of artistic culture” - age 7-14 years, when knowledge, including cultural values, dominates.

4. “The world of artistic culture in me and around me” - senior school age - a period of object-creative artistic activity, the need for ideological reflection, and the choice of a future profession.

Activities for the sociocultural rehabilitation of a disabled child include:

Teaching a disabled person how to spend rest and leisure;

Carrying out activities aimed at creating conditions for the full participation of disabled children in socio-cultural events that satisfy their socio-cultural and spiritual needs, to expand their general and cultural horizons, the sphere of communication (visits to theaters, exhibitions, excursions, meetings with literary and artistic figures, holidays, anniversaries, other cultural events);

Providing disabled children in institutions and assistance in providing disabled children served at home with periodical, educational, methodological, reference, information and fiction literature, including those published on tape cassettes, audio books and books with raised dot font Braille; creating and providing visually impaired people with the opportunity to use adapted computer workstations, the Internet, and Internet documents, taking into account the disabilities of a disabled child;

Assistance in ensuring accessibility for disabled children to visit theaters, museums, cinemas, libraries, the opportunity to familiarize themselves with literary works and information on the accessibility of cultural institutions;

Development and implementation of diverse leisure programs (informational and educational, developmental, artistic and journalistic, sports and entertainment, etc.) that contribute to the formation of a healthy psyche, the development of creative initiative and independence.

Sociocultural rehabilitation programs can also stimulate physical activity, develop and correct general and fine motor skills, incorrect pronunciation; develop speech, form the correct tempo, rhythm and intonation of speech; develop all types of perception - temporal and spatial ideas, ideas about the body diagram; develop graphic skills, prepare your hand for writing.

Either one or several institutions can be indicated as the executor of the IRP, based on where and what services the disabled child can receive. The program may simultaneously include activities that will be carried out by a social protection institution (for example, an orphanage) and a cultural and leisure institution

Technologies of sociocultural rehabilitation are currently not standardized and are largely determined real opportunities implementation of certain activities on the ground. The objectives of the technologies used include neutralizing and eliminating the causes of isolation of children with disabilities in the sociocultural sphere; introducing them to professional sociocultural activities, providing them with specific assistance in finding employment in accordance with their capabilities and interests; supporting children in the field of family leisure, intensifying their aspirations for leisure activities, taking into account ethnic, age, religious and other factors. Highly effective in the sociocultural rehabilitation of disabled children are various techniques creative psychotherapy: art therapy, isotherapy, aesthetic therapy, fairy tale therapy, play psychotherapy, bibliotherapy, literary therapy, music therapy, therapy for creative passion for physical education and sports, etc.

Social and everyday adaptation of disabled children is aimed at teaching a disabled child self-care, and also includes measures for arranging the home of a disabled person in accordance with existing disabilities.

Social and everyday adaptation is aimed at disabled children who do not have the necessary social and everyday skills and need comprehensive daily support in a microsocial environment.

The tasks of social and everyday adaptation of a disabled child are the formation (restoration) or compensation in the child of: the ability to carry out controlled excretion, personal hygiene, the ability to dress and undress, to eat, to prepare food, the ability to use electrical and gas appliances, to perform certain tasks household and garden work, mobility ability.

Social and everyday adaptation includes:

Teaching a disabled child and his family members the skills of personal hygiene, self-care, movement, communication, etc., including with the help of technical means of rehabilitation;

Information and consultation on issues of social and domestic rehabilitation;

Measures to arrange the home of a disabled person in accordance with existing life limitations.

Physical education and recreation activities and sports. Includes adaptive physical culture, physical rehabilitation of people with disabilities and people with disabilities, sports for the disabled (including the Russian Paralympic movement, the Russian Deaflympic movement, the Russian Special Olympics)

In general, adaptive physical culture (APC) is called upon, with the help of rationally organized physical activity, using preserved functions, residual health, natural physical resources and spiritual strength of a disabled person, to bring the psychological capabilities of the body and personality of self-realization in society as close as possible.

The essence of sports and recreational work with disabled people is continuous physical education, taking care of your health throughout your life. In the development of physical fitness and sports for people with disabilities, it is fundamental to formulate a disabled person’s conviction in the usefulness and expediency of sports and health activities, a conscious attitude towards the development of physical education, the development of motivation and self-organization of a healthy lifestyle.

Adaptive physical education traditionally includes four types: adaptive physical education (education); adaptive physical recreation; adaptive motor rehabilitation (physical rehabilitation); adaptive sport. Also, new directions have been identified in adaptive physical culture - creative (artistic and musical), body-oriented and extreme types of physical activity.

Limb amputations;

- consequences of polio;

- cerebral palsy;

- diseases and injuries of the spinal cord;

- other lesions of the musculoskeletal system (congenital malformations and defects of the limbs, limitations in joint mobility, peripheral paresis and paralysis, etc.)

- post-stroke conditions;

- mental retardation;

Hearing impairment;

Pathology of the organ of vision.

Absolute medical contraindications to adaptive physical education and sports are given by different authors (Table 7)

Table 7

Absolute medical contraindications to adaptive physical education and sports

Absolute contraindications(Muzaleva V.B., Startseva M.V., Zavada E.P. et al., 2008)

Absolute contraindications (Demina E.N., Evseev S.P., Shapkova L.V. et al., 2006).

Feverish conditions;

Purulent processes in tissues;

Chronic diseases in the acute stage;

Acute infectious diseases;

Cardiovascular diseases: ischemic disease heart, angina pectoris of exertion and rest, myocardial infarction, aneurysm of the heart and aorta, myocarditis of any etiology, decompensated heart defects, cardiac arrhythmias and conduction disorders, sinus tachycardia with heart rate more than 100 per minute; hypertension II and Stage III;

Pulmonary failure;

Threat of bleeding (cavernous tuberculosis, peptic ulcer stomach and duodenum with a tendency to bleeding);

Blood diseases (including anemia);

Consequences of an acute disorder cerebral circulation and spinal circulatory disorders (localized in cervical spine);

Neuromuscular diseases (myopathies, myosthenia);

Multiple sclerosis;

Malignant neoplasms;

Cholelithiasis and urolithiasis with frequent attacks, chronic renal failure;

Chronic hepatitis any etiology;

High myopia with changes in the fundus.

Any acute diseases;

Glaucoma, high myopia;

Tendency to bleeding and threat of thromboembolism;

Mental illnesses in the acute stage, lack of contact with the patient due to his serious condition or mental illness; (decompensated psychopathic syndrome with aggressive and destructive behavior);

Increased cardiovascular failure, sinus tachycardia, frequent attacks of paroxysmal or atrial fibrillation, extrasystoles with a frequency of more than 1:10, negative ECG dynamics, indicating worsening coronary circulation, atrioventricular block II and III degree;

Hypertension ( arterial pressure over 220/120 mmHg), frequent hypertensive or hypotensive crises;

The presence of severe anemia or leukocytiosis;

Severe atypical reactions of cardio-vascular system when performing functional tests.

For a detailed study of the main types and elements of physical culture and recreational activities and sports, indicated and contraindicated for people with disabilities with various pathologies, the information presented in the works of E.N. Demina, S.P. Evseev, L.V. Shapkova et al may be useful. , 2006.

Adaptive physical culture and sports activities are usually held in:

Rehabilitation centers for social rehabilitation of disabled people and disabled children of the social protection system;

Children and Youth Sports Adaptive Schools (YUSASH);

Departments and groups according to adaptive sports in institutions additional education children engaged in activities in the field of physical education and sports;

Schools of higher sports excellence, Olympic reserve schools, sports training centers that train high-class athletes in adaptive sports;

Clinics, hospitals, institutes, rehabilitation centers, children's homes run by health authorities;

Educational institutions;

Stationary social service institutions;

Sanatorium and cultural institutions, holiday homes, etc., under the jurisdiction of tourism and resort development authorities;

Physical education and sports clubs for people with disabilities and other physical education and sports organizations operating, including within the framework of public organizations.

Various bodies, institutions, organizations or the disabled person himself (legal representative) are indicated as executors in the program of psychological and pedagogical rehabilitation in the IRP of a disabled child. Indicative wording for entries in this section is presented in Table. 8.

Table 8

Indicative wording for entries in the section
Social rehabilitation measures for IPR of a disabled child

List of psychological and pedagogical rehabilitation activities

Possible performers

Social and environmental rehabilitation

Rehabilitation organization

Educational organization

Executive authorities of the subjects Russian Federation(in the field of social protection) and local governments (if the issue of arranging housing for a disabled child is being decided in accordance with existing life limitations)

Social and pedagogical rehabilitation

the child’s need is indicated (if necessary, its specific type)