The degree of impairment of body functions. What is the insignificance of a committed administrative offense? Identification of the offender
· Minor violations:
1. reduction in muscle strength to 4 points with a full range of active movements;
2. shortening of the limb by 2-4 cm;
3. muscle wasting up to 5% of normal;
4. a slight increase in tone (with cerebral palsy) of the spastic type, incoordination of movements in the hyperkinetic form, which does not significantly affect the walking pattern;
5. electromyographic decrease in integrated (total) activity when walking by 10-25%.
· Moderate violations:
Difficulties in independent movement are identified, the duration of walking without fatigue is limited, the time spent on walking increases, which is due to
1. moderate (up to 3 points) decrease in muscle strength (for the gluteal and calf muscles up to 3 points);
2. muscle wasting by 5-9% of normal;
3. limitation of the amplitude of active movements in the hip, knee and ankle joints (15-20°);
4. moderate increase in muscle tone of the spastic type or muscle hypotonia with pathological (flexion, extension, adduction) settings in the joints during verticalization and walking, incoordination of movements in the hyperkinetic form, but with the ability to rely on a limb without auxiliary devices;
5. reduction (redistribution) of bioelectrical activity of muscles when walking by 25-50%;
6. moderate (30-40%) decrease in step length, walking tempo and rhythmicity coefficient;
7. the presence of shortening of the limb from 4 to 6 cm, failure of the osteoarticular system, necessitating the use of special orthopedic devices that improve the static-dynamic abilities of the affected limb.
For moderate functional impairments, additional support on a cane is possible.
· Expressed disorders.
With severe functional impairments, walking is usually possible either with outside help or with the use of special orthopedic devices, which is due to:
· Shortening of the limb by 7-9 cm;
· limitation of active movements in the hip (7-10%), knee (8-12%), ankle (6-8%) joints with a pronounced decrease in muscle strength up to 2 points;
· a pronounced increase (or decrease in flaccid paresis) of tone, leading to pathological settings and deformations (flexion, flexion-abduction or adduction contracture of the hip joint over (15-20°), extension at an angle over 160°, flexion-extension contracture of the knee joint more than 30 °, ankylosis of the joint in a vicious position of varus, valgus over 20-25°, equinus deformity of the foot at an angle of over 120°, calcaneal deformity of the foot at an angle less than 85°), pronounced discoordination with hyperkinesis. Ability to walk using complex orthopedic devices and additional support on crutches, walkers, or with assistance.
· A decrease in bioelectrical activity when walking by more than 55-75%, a decrease in step length by more than 50-60%, a decrease in walking tempo by more than 70%, and a decrease in rhythm coefficient by more than 40-50%.
· Significantly expressed disorders.
With significantly pronounced dysfunctions caused by flaccid or spastic paralysis, significant (over 50-60°) contractures of the joints, their ankylosis in vicious positions, verticalization of the patient and independent walking with outside help and the use of modern prosthetics is impossible. Electromyographic and biomechanical studies are not advisable.
EPIDEMIOLOGY OF DISABILITY
Disability indicators, being an important medical and social criterion of public health, characterize the level of socio-economic development of society, the ecological state of the territory, and the quality of preventive measures taken.
The word “disabled” comes from the Latin invalidus – weak, infirm. Disabled it is generally accepted that a person who has a health disorder with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of life activities and necessitating his social protection.
Under disability understand social insufficiency due to health problems with a persistent disorder of body functions, leading to limitation of life activity and causing the need for its social protection.
Thus, disability is a social deficiency. What is social disadvantage? Social disadvantage – these are the social consequences of a health disorder, leading to limitation of life activities, the inability (in whole or in part) to fulfill a person’s usual role in social life and causing the need for social protection.
The cause of disability is a health disorder with a persistent disorder of body functions, i.e. impairment of physical, mental and social well-being due to loss, disorder, anomaly of the physical, mental or anatomical structure or function of the human body.
3.1. Main causes of disability :
1. Disability due to a general illness is the most common cause of disability, except for cases directly related to occupational diseases, work injury, military trauma, etc.
2. Disability due to work injury is established for citizens whose disability occurred as a result of health damage associated with an industrial accident.
3. Disability due to occupational disease established for citizens whose disability occurred as a result of acute and chronic occupational diseases.
4. Disability since childhood: a person under the age of 18 who is recognized as disabled is assigned the status of “disabled child”; upon reaching the age of 18 years or older, these persons are determined to have “disability since childhood.”
5. Disability among former military personnel is established for diseases and injuries associated with the performance of military duties.
6. Disability due to radiation disasters is established for citizens whose disability occurred as a result of the liquidation of accidents at the Chernobyl nuclear power plant, Mayak PA, etc.
The degree of dysfunction of the body is characterized by various indicators and depends on the type of functional disorders, methods for their determination, the ability to measure and evaluate the results. The following disorders of body functions are distinguished:
· disorders of higher mental functions (mental disorders, other psychological disorders, speech, language disorders);
· disorders of the senses (visual disorders, auditory and vestibular disorders, disorders of smell, touch);
· motor disorders;
· visceral and metabolic disorders, nutritional disorders;
· disfiguring disorders;
· violations associated with general reasons.
· Based on a comprehensive assessment of various parameters, taking into account their qualitative and quantitative values, three degrees of dysfunction of the body are distinguished:
1st degree – slightly expressed dysfunction;
2nd degree – moderately severe dysfunction;
3rd degree – pronounced and significantly expressed dysfunction.
As follows from the definition, disability leads to limitation of life activity, i.e. to the complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work activities. Thus, the main criteria for life activity that disability limits are:
· ability for self-service, i.e. the ability to cope with basic physiological needs and use common household items;
· ability to move, i.e. the ability to walk, run, move, overcome obstacles, control body position;
· ability to learn, i.e. the ability to perceive knowledge (general education, professional, etc.), mastery of skills (social, cultural and everyday);
· ability to orient, i.e. the ability to independently navigate the environment through vision, hearing, smell, touch, thinking and adequately assess the situation using the intellect;
· ability to communicate, i.e. the ability to establish and develop contacts between people through perception, understanding of another person, and the possibility of exchanging information;
· the ability to control one’s behavior, i.e. the ability to sense oneself and behave correctly in everyday situations.
Depending on the degree of deviation from the norm of human activity due to health impairment, the degree of limitation of life activity is determined. In turn, depending on the degree of limitation of life activity and the degree of impairment of body functions, a person recognized as disabled is determined by the degree of disability.
Auxiliary means of rehabilitation, such as support and tactile canes, crutches, supports, handrails contribute to the performance of various statodynamic functions of a person: maintaining a vertical posture of a person, improving stability and mobility by increasing the additional area of support, unloading the diseased organ, joint or limb, normalizing weight loads, facilitating movement, maintaining a comfortable position.
The ability to maintain a vertical posture is assessed using special devices and certain parameters that characterize the process of standing, and analysis of their changes under external and internal influences on a person. This approach underlies the methods of stabilography, cephalography, etc.
The stabilography technique consists of recording and analyzing parameters characterizing the movement of the horizontal projection of the general center of mass (GCM) of a standing person.
The body of a standing person continuously makes oscillatory movements. Body movements while maintaining an upright posture reflect various reactions to control muscle activity. The main parameter by which muscle activity is regulated is the movement of the human central mass.
Stabilization of the position of the GCM is carried out due to stabilization of the body, which in turn is ensured on the basis of processing information about the position and its movement in space due to the receipt of information by the visual, vestibular, and proprioceptive apparatus.
Another technique, cephalography, is the recording and analysis of head movements while standing. This technique is quite widely used in clinical practice.
Changes in the vestibular apparatus significantly disrupt the provision of a vertical posture and are manifested in changes in the nature of the cephalogram, stabilogram and body movements aimed at maintaining a vertical posture.
With this condition of a person, an increase in additional support area is required due to auxiliary means of rehabilitation.
In addition to disturbances in statistical functions, disturbances in the human walking function occur when the musculoskeletal system is damaged.
Clinical indicators of such musculoskeletal disorders are:
- shortening of limbs;
- limitation of mobility in joints, severity and type of contracture;
- wasting of the muscles of the lower extremities.
The presence of lower limb shortening (LLT) significantly affects gait structure and standing stability.
Stability of standing is characterized by the amplitude of oscillation of the general center of mass (GCM) and with slight and moderate shortening of the NC it is slightly disturbed. Even with pronounced shortening of the NC, a slight and moderate violation of stability is observed. In this case, no pronounced disturbance of the GCM oscillations is observed, which indicates the effectiveness of compensation mechanisms aimed at maintaining stability. The consequence of shortening the lower limb is pelvic distortion. Shortening of more than 7 cm leads to significant changes in statodynamic functions. The study of such disorders is carried out using a special stand with a predominant distribution of the weight load on a healthy NK (more than 60% of body weight) using a shortened NK as an additional support with a pronounced metatarsal-toe position.
Restriction in joint mobility is expressed primarily in dysfunction in the hip, knee, ankle joints, and foot, and moderate and severe degrees of dysfunction can be determined.
Hip joint (HJ)
- reduction in the amplitude of movement to 60º;
- extension – at least 160º;
- decreased muscle strength;
- shortening of the lower limb – 7-9 cm;
- locomotion speed – 3.0-1.98 km/h;
- limitation of mobility in the form of a decrease in the amplitude of movement in the sagittal plane - at least 55º;
- during extension – at least 160º;
- severe flexion contracture - extension less than 150º;
- reduction in the strength of the gluteal and thigh muscles by 40% or more;
- locomotion speed – 1.8-1.3 km/h.
Knee joint (KJ)
1. Moderate degree of dysfunction:
- bending to an angle of 110º;
- extension up to 145º;
- decompensated form of joint instability, characterized by frequently occurring pathological mobility under minor loads;
- locomotion speed – up to 2.0 km/h with pronounced lameness.
2. Severe degree of dysfunction:
- bending to an angle of 150º;
- extension – less than 140º;
- locomotion speed up to 1.5-1.3 km/h, severe lameness;
- shortening the step to 0.15 m with pronounced asymmetry of lengths;
- rhythmicity coefficient – up to 0.7.
Ankle joint (AJ)
1. Moderate degree of dysfunction:
- limitation of mobility (flexion up to 120-134º, extension up to 95º);
- locomotion speed up to 3.5 km/h.
3. Severe degree of dysfunction:
- limited mobility (flexion less than 120º, extension up to 95º);
- locomotion speed up to 2.8 km/h.
Vicious position of the foot.
1. calcaneal foot – the angle between the axis of the tibia and the axis of the calcaneus is less than 90º;
2. equinovarus or equinus foot – the foot is fixed at an angle of more than 125º or more;
3. valgus foot – the angle between the support area and the transverse axis is more than 30º, open inward.
4. valgus foot – the angle between the support area and the transverse axis is more than 30º, open outward.
In case of hip joint pathology, the thigh and gluteal muscles suffer; in case of knee joint (KJ) pathology, the thigh and lower leg muscles suffer; in case of ankle joint pathology (AJ), hypotrophy of the lower leg muscles is noted.
Hypotrophy of the muscles of the lower extremities, reflecting the state of the muscular system, has a certain influence on the structure of a person’s walking, in particular on the duration of the support and transfer phases of the limbs, and with moderate and severe hypotrophy, a pronounced violation of temporal parameters is observed.
Muscle wasting up to 5% is classified as mild, 5-9% as moderate, and 10% as a pronounced decrease in muscle strength.
A decrease in the strength of the flexor and extensor muscles of the hip, leg or foot of the affected limb by 40% in relation to the healthy limb is regarded as mild; 70% as moderate, more than 700% as pronounced.
Decreased muscle strength with electromyography (EMG)
studies, is characterized by a decrease in the amplitude of bioelectrical activity (ABA) by 50-60% of the maximum with moderate dysfunction.
With severe dysfunction, AAA decreases significantly in the muscles of the distal limbs to 100 µV.
The choice of auxiliary means of rehabilitation should be carried out individually for each patient, with the help of which he can achieve relative independence (improving mobility in the apartment and on the street, independent self-care, participation in the production process, etc.).
In connection with new and, one might say, unexpected amendments to the Schedule of Diseases, our specialists are receiving many questions. Of course, because scoliosis of the 2nd degree with an arc of up to 17 degrees has now become quite a disease. We must immediately make a reservation, there is one “but”: they can still be drafted into the army with such a diagnosis only if there are no spinal dysfunctions. Let's try to figure out what this function includes and how to determine the degree of violation.
As you know, the spine performs protective, static and motor functions in human life. Fitness category “B” will be assigned to a citizen suffering from the disease “scoliosis” if there is at least a slight impairment of this function. The examination of citizens subject to conscription for this disease is regulated by Article 66 of the Schedule of Diseases, the explanations to which indicate that dysfunctions are assessed in the aggregate: protective, static and motor functions are taken into account. In other words, the assessment occurs comprehensively.
According to the explanations of medical specialists, a comprehensive assessment of spinal function should be based on the interpretation of the protective function, then on the results of a study of static function, and, lastly, on the limitation of active movements in the spine (motor function). Please note: the static function characterizes a person’s ability to maintain a certain position of the body for a long time, and a violation of the protective function is characterized by neurological disorders. The presence of impaired motor activity may be indicated by limitations in movement and associated pain.
So, what is the manifestation of a slight dysfunction of the spine in the disease “scoliosis”? Minor spinal dysfunction is characterized by:
Clinical manifestations in the form of incomplete loss of sensitivity in the area of one neuromere, loss or decrease in the tendon reflex, decrease in muscle strength of individual muscles of the limb with general compensation of their functions;
Inability of the spine to bear a vertical load in the form of severe pain after 5-6 hours of being in an upright position;
Limiting the range of motion in the corresponding parts of the spine to 20%.
How is dysfunction assessed and what research methods are used? Static function is examined by performing myotonometry, electromyography and remote thermography of the back muscles. Neurological disorders are determined by magnetic resonance imaging or computed tomography, and the neurological status is assessed by a neurologist.
Let us note once again that only the totality of the above manifestations of the disease gives grounds to determine the degree of dysfunction as insignificant.
If any questions arise, a medical specialist engaged by our lawyers will give you the necessary explanations and recommend the necessary types of research:
What is the insignificance of a committed administrative offense?
If the administrative offense committed is of minor significance, the judge, body, or official authorized to resolve the case of an administrative offense may release the person who committed the administrative offense from administrative liability and limit himself to an oral remark (Article 2.9 of the Code of Administrative Offenses of the Russian Federation).
A minor administrative offense is an action or inaction, although formally containing the elements of an administrative offense, but taking into account the nature of the offense committed and the role of the offender, the amount of harm and the severity of the consequences, which does not represent a significant violation of protected public legal relations.
A minor offense occurs in the absence of a significant threat to protected social relations. Circumstances such as, for example, the identity and property status of the person held accountable, voluntary elimination of the consequences of the offense, compensation for the damage caused, are not circumstances indicating the insignificance of the offense. These circumstances, by virtue of Parts 2 and 3 of Art. 4.1 of the Code of Administrative Offenses of the Russian Federation are taken into account when imposing an administrative penalty.
It must be borne in mind that, taking into account the signs of the objective side of some administrative offenses, under no circumstances can they be considered insignificant, since they significantly violate protected social relations. These, in particular, include administrative offenses provided for:
a) Art. 12.8 of the Code of Administrative Offenses of the Russian Federation on driving a vehicle by a driver who is in a state of intoxication, transferring control of a vehicle to a person who is in a state of intoxication;
b) art. 12.26 of the Code of Administrative Offenses of the Russian Federation on the failure of the driver of a vehicle to comply with the requirement to undergo a medical examination for intoxication.
The insignificance of an administrative offense may be established by the court, in particular, when:
a) consideration of a case on bringing to administrative liability;
b) consideration of a case challenging the decision of an administrative body to impose administrative liability.
Having established the insignificance of the offense when considering a case on bringing to administrative liability, the reasoning part of the court decision must contain the following conclusions:
a) refusal to satisfy the demands of the administrative body;
b) on exemption from administrative liability due to the insignificance of the offense;
c) on the application of a measure in the form of an oral remark.
In this case, legal expenses incurred by a person released from administrative liability due to a minor offense are not subject to compensation to this person.
If the insignificance of the offense is established during the consideration of the case challenging the decision of the administrative body to bring to administrative responsibility, the court, guided by Part 2 of Art. 211 of the Arbitration Procedure Code of the Russian Federation and Art. 2.9 of the Code of Administrative Offenses of the Russian Federation, makes a decision to declare this resolution illegal and to cancel it.
When qualifying an administrative offense as minor, courts must take into account that Art. 2.9 of the Code of Administrative Offenses of the Russian Federation does not contain any reservations about its non-application to any offenses provided for by the Code of Administrative Offenses of the Russian Federation.
The possibility or impossibility of qualifying an act as minor cannot be established in the abstract, based on the structure of the administrative offense formulated in the Code of Administrative Offenses of the Russian Federation, for which liability is established. Thus, the qualification of an administrative offense as minor cannot be refused only on the grounds that in the relevant article of the Special Part of the Code of Administrative Offenses of the Russian Federation, liability is defined for failure to fulfill any obligation and is not made dependent on the occurrence of any consequences.
The classification of an offense as minor can only occur in exceptional cases and is made taking into account the above provisions in relation to the circumstances of the specific act committed by the person. In this case, the court’s application of the provisions on insignificance must be motivated (clause 18 of the Resolution of the Plenum of the Supreme Arbitration Court of the Russian Federation dated 02.06.2004 N 10 “On some issues that have arisen in judicial practice when considering cases of administrative offenses”).
