Tell me, is my group working? Social insufficiency Causing the need for its social.

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

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

Conditions for recognizing a citizen as disabled are:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TO main types of dysfunctions of the human body include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Criteria for assessing disability in ITU institutions

Introduction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Limitation of the ability to orient according to severity:

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

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

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

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

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

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

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

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

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

1.1. THE CONCEPT OF DISABILITY AND ITS TYPES.

The UN Declaration on the Rights of Persons with Disabilities, adopted in December 1971 and ratified by most countries of the world, gives the following definition of the concept of “disabled person”: this is any person who cannot independently meet fully or partially his needs for a normal social and personal life due to a disability physical or mental capabilities. This definition can be considered as a basic one, which is the basis for developing those ideas about people with disabilities and disabilities that are inherent in specific states and societies.

In modern Russian legislation, the following definition of the concept “disabled person” has been adopted - this is a person who, due to limited life activity, due to physical and mental disabilities, needs social assistance and protection. Thus, according to the legislation of the Russian Federation, the basis for providing a disabled person with a certain amount of social assistance is the restriction of his life activity system, i.e., the complete or partial loss of a person’s ability to self-service, move, orientate, control his behavior and engage in work.

The concept of disability is defined differently by a number of authors, as defined by L.P. Khrapylina. “disability is a disharmony of a person’s relationship with the environment, manifested as a result of health problems in a persistent limitation of his life activity.”

According to the definition of the domestic sociologist E.R. Yarskaya-Smirnova: “disability is the result of social agreements, and the meaning of this concept changes depending on cultural traditions, social conditions and other status differences.”

The international movement for the rights of persons with disabilities considers the following concept of disability to be the most correct: “Disability is an obstacle or limitation in the activities of a person with physical, mental, sensory and mental disabilities caused by conditions existing in society under which people are excluded from active life.”

People with disabilities have functional difficulties as a result of illness, deviations or deficiencies in development, health, appearance, due to the inability of the external environment to their special needs, as well as because of society’s prejudices towards themselves. To reduce the impact of such restrictions, a system of state guarantees for social protection of people with disabilities has been developed.

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

The term “disabled person” goes back to the Latin root (volid – “effective, full-fledged, powerful”) and literally translated can mean “unfit”, “inferior”. In Russian usage, starting from the time of Peter I, this name was given to military personnel who, due to illness, injury or injury, were unable to perform military service and who were sent for further service to civilian positions.

It is characteristic that in Western Europe this word had the same connotation, that is, it referred primarily to crippled soldiers. From the second half of the nineteenth century. the term also applies to civilians who also became victims of war - the development of weapons and the expansion of the scale of wars increasingly exposed the civilian population to all the dangers of military conflicts. Finally, after the Second World War, in line with the general movement to formulate and protect human rights in general and certain categories of the population in particular, the concept of “disabled person” was formed, referring to all persons with physical, mental or intellectual disabilities.

Today, people with disabilities belong to the most socially vulnerable category of the population. Their income is well below average and their health and social care needs are much higher. They have less opportunity to receive an education and are often unable to work. Most of them have no family and do not want to participate in public life. All this suggests that people with disabilities in our society are a discriminated and segregated minority.

An analysis of the history of the development of the problem of disability indicates that, having gone from the ideas of physical destruction, isolation of “inferior” members of society to the concepts of attracting them to work, humanity has come to understand the need for the reintegration of persons with physical defects, pathophysiological syndromes, and psychosocial disorders.

In this regard, there is a need to reject the classical approach to the problem of disability as a problem of “inferior people” and present it as a problem affecting society as a whole.

In other words, disability is not a problem of one person, or even a part of society, but of the whole society as a whole. Its essence lies in the legal, economic, production, communication, and psychological characteristics of the interaction of disabled people with the outside world.

This genesis of social thought is explained by the corresponding development of economic opportunities and the level of social maturity of various historical eras.

“A disabled person,” says the Law “On Social Protection of Disabled Persons in the Russian Federation,” is a person who has a health disorder with a persistent disorder of body functions, caused by illness, consequences of injuries or defects, leading to limited life activity and necessitating his social protection.”

“Limitation of life activity,” the same law explains, “is a complete or partial loss of a person’s ability or ability to provide self-care, move independently, navigate, communicate, control one’s behavior, study and engage in work.”

Currently, there is a debate taking place at the international level, initiated by organizations of disabled people who advocate an interpretation of disability that would not be discriminatory. The Dictionary of Social Work defines a person with a disability as one "who is unable to perform specified duties or functions because of a special physical or mental condition or infirmity. Such a condition may be temporary or chronic, general or partial."

Blind, deaf, dumb, people with impaired coordination of movement, completely or partially paralyzed, etc. are recognized as disabled due to obvious deviations from the normal physical condition of a person. Persons who have no external differences from ordinary people, but suffer from diseases that do not allow them to work in various fields as healthy people do, are also recognized as disabled. For example, a person suffering from coronary heart disease is not able to perform heavy physical work, but he is quite capable of mental activity.

All disabled people are divided into several groups for various reasons:

1. By age - disabled children, disabled adults.

2. By origin of disability: disabled since childhood, war disabled, labor disabled, disabled from general illness.

3. By degree of ability to work: disabled people able to work and incapacitated, disabled people of group I (incapacitated), disabled people of group II (temporarily disabled or able to work in limited areas), disabled people of group II (able to work in benign working conditions).

4. Based on the nature of the disease, people with disabilities can belong to the mobile, low-mobility or immobile groups.

Depending on membership in a particular group, issues of employment and organization of life for disabled people are resolved. Low mobility disabled people (able to move only with the help of wheelchairs or crutches) can work from home or have them transported to their place of work. The situation is even more complicated with immobile disabled people who are bedridden. They cannot move without assistance, but are able to work mentally: analyze socio-political, economic, environmental and other situations; write articles, works of art, create paintings, engage in accounting activities, etc.

If such a disabled person lives in a family, many problems can be solved relatively simply. What if he's lonely? Special workers will be required who would find such disabled people, identify their abilities, help receive orders, conclude contracts, purchase the necessary materials and tools, organize the sale of products, etc. It is clear that such a disabled person also needs everyday care, starting with the morning toilet and ending with the provision of products. In all these cases, disabled people are helped by special social workers who receive wages for caring for them. Blind but mobile disabled people are also assigned workers paid by the state or charitable organizations.

The population of the planet must realize the presence of people with disabilities and the need to create normal living conditions for them. According to the UN, one in ten people on the planet has a disability, one in 10 suffers from physical, mental or sensory impairments, and at least 25% of the total population suffers from health disorders. According to the Social Information Agency, there are at least 15 million of them. Among the current disabled people there are many young people and children.

In the general contingent of disabled people, men make up more than 50%, women - more than 44%, 65-80% are elderly people. Along with the growth in the number of disabled people, there are trends in qualitative changes in their composition. Society is concerned about the increase in the number of disabled people among people of working age; they make up 45% of the number of citizens initially recognized as people with disabilities. Over the past decade, the number of disabled children has increased at an accelerated pace: if in the RSFSR in 1990. While 155,100 such children were registered with the social protection authorities, in the Russian Federation in 1995. this figure increased to 453,700, and in 1999 to 592,300 children. It is also alarming that, according to the Ministry of Health of the Russian Federation, every year in our country 50,000 children are born who are recognized as disabled from childhood.

In recent years, the number of people with disabilities due to war trauma has also been growing. Now their number is almost 42,200 people. Persons of retirement age account for 80% of the total number of disabled people; disabled people of the Great Patriotic War - more than 15%, group I - 12.7%, group II - 58%, group III - 29.3%.

The structure of the distribution of disability due to general disease in Russia is as follows: in the first place are diseases of the cardiovascular system (22.6%), followed by malignant neoplasms (20.5%), then injuries (12.6%), diseases of the respiratory system and tuberculosis (8.06%), in fifth place are mental disorders (2.7%). The prevalence of disability is generally higher among urban populations compared to rural residents.

The dynamics of disability growth in Russia is characterized by the following indicators:

 the age structure is dominated by disabled people of retirement age;

 according to nosology - most often disability is associated with diseases of the circulatory system;

 in terms of severity - disabled people of group II predominate.

The availability of statistical data on the number of disabled people in the country, forecasting and identifying the dynamics of growth in the number of disabled people, the causes of disability, developing a system of measures to prevent it, and determining the possible costs of the state for these purposes is important. The forecasts for the growth dynamics of the number of disabled people in the world, especially those of active working age, are alarming.

The growth of people with disabilities on an international scale is explained both by the growth of the indicator itself, indicating the deterioration of the health of the planet’s inhabitants, and by the expansion of the criteria for defining disability, primarily in relation to the elderly and especially children. The increase in the total number of disabled people in all developed countries of the world and, especially, the number of disabled children has made the problem of preventing disability and preventing childhood disability among the national priorities of these countries.

1.2. CURRENT PROBLEMS OF INTERACTION OF DISABLED PEOPLE AND SOCIETY.

The problem of socio-psychological adaptation of disabled people to living conditions in society is one of the most important facets of the general integration problem. Recently, this issue has acquired additional importance and urgency due to major changes in approaches to people who are disabled. Despite this, the process of adaptation of this category of citizens to the basics of society remains practically unstudied, and it is this process that decisively determines the effectiveness of those corrective measures taken by specialists working with people with disabilities.

The time has come to present disability not as a problem of a certain circle of “inferior people”, but as a problem of the entire society as a whole. Its essence is determined by the legal, economic, production, communication, and psychological characteristics of the interaction of disabled people with the surrounding reality. The most serious aspects of the disability problem are associated with the emergence of numerous social barriers that do not allow disabled people and people with chronic diseases, as well as children with social behavior disorders, to actively participate in the life of society. This situation is a consequence of incorrect social policy, which is focused only on part of the “healthy” population and expresses the interests of this category of citizens. That is why the structure of production and life, culture and leisure, social services remains unadapted to the needs of sick people.

The needs of disabled people can be divided into two groups: – general, i.e. similar to the needs of other citizens and special, i.e. needs caused by a particular illness.

The most typical of the “special” needs of people with disabilities are the following:

 in restoration (compensation) of impaired abilities for various types of activities;

 in movement;

 in communication;

 free access to social, cultural and other objects;

 the opportunity to gain knowledge;

 in employment;

 in comfortable living conditions;

 in socio-psychological adaptation;

 in material support.

Satisfying the listed needs is an indispensable condition for the success of all integration activities regarding people with disabilities. In socio-psychological terms, disability poses many problems for a person, so it is necessary to especially highlight the socio-psychological aspects of persons with disabilities.

The relationship between disabled people and healthy people is a powerful factor in the adaptation process. As foreign and domestic experience shows, disabled people often, even having all the potential opportunities to actively participate in the life of society, cannot realize them because other fellow citizens do not want to communicate with them; entrepreneurs are afraid to hire a disabled person, often simply due to established negative stereotypes. Therefore, organizational measures for social adaptation that are not prepared psychologically may be ineffective. The few studies devoted to this issue have revealed the following: representatives of various segments of the population generally admit (97%) that there are weak and vulnerable groups that need help from society, and only 3% of respondents said that when providing social assistance, preference should not be given to anyone . On the issue of the priority of assistance to certain groups of people, opinions were distributed as follows: more than 50% of citizens believe that disabled children are most in need of it, followed by elderly people living in nursing homes (47.3% of respondents), orphans (46 .4%), disabled adults (26.3%), Chernobyl survivors (20.9%), single mothers (18.2%), large families (15.5%), refugees, alcoholics, homeless people, drug addicts (according to 10%), WWII veterans (6.4%).

The idea of ​​social integration of disabled people into society is verbally supported by the majority, but in-depth studies have revealed the complexity and ambiguity of the attitude of the healthy towards the sick. This attitude can be called ambivalent: on the one hand, people with disabilities are perceived as different for the worse, on the other hand, as deprived of many opportunities. This gives rise to both rejection of unhealthy fellow citizens by other members of society and sympathy towards them, but in general there is an unpreparedness of many healthy people for close contact with disabled people and for situations that allow disabled people to realize their capabilities on an equal basis with everyone else. The relationship between disabled people and healthy people implies responsibility for these relationships on both sides. Therefore, it should be noted that disabled people in these relationships do not occupy an entirely acceptable position. Many of them lack social skills, the ability to express themselves in communication with colleagues, acquaintances, administration, and employers. Disabled people are not always able to grasp the nuances of human relationships; they perceive other people somewhat generally, evaluating them on the basis of only some moral qualities: kindness, responsiveness, etc.

Relationships between disabled people are also not entirely harmonious. Belonging to a group of people with disabilities does not mean that other members of this group will be treated accordingly.

The experience of public organizations of disabled people shows that disabled people prefer to unite with people who have identical diseases and have a negative attitude towards others. One of the main indicators of socio-psychological adaptation of persons with disabilities is their attitude towards their own lives. Almost half of disabled people (according to the results of special sociological studies) assess the quality of their life as unsatisfactory (mostly these are disabled people of group 1). About a third of disabled people (mainly groups 2 and 3) characterize their life as quite acceptable. Moreover, the concept of “satisfaction-dissatisfaction with life” often comes down to the poor or stable financial situation of a disabled person. The lower the income of a disabled person, the more pessimistic his views on one’s existence. One of the factors in one’s attitude towards life is the self-assessment of the disabled person’s state of health. According to research results, among those who define the quality of their existence as low, only 3.8% rated their well-being as good.

An important element of the psychological well-being and social adaptation of persons with disabilities is their self-perception. Surveys have shown that only every tenth disabled person considers himself happy. A third of disabled people considered themselves passive. Every third person admitted to being unsociable. A quarter of disabled people consider themselves sad. Data on the psychological characteristics of people with disabilities vary significantly in groups with different incomes. The number of “happy”, “kind”, “active”, “sociable” people was greater among those whose budget was stable, while the number of “unhappy”, “angry”, “passive”, “uncommunicative” people was greater among those constantly in need. Psychological self-assessments are similar in groups of disabled people of different severity. Self-esteem is most favorable among disabled people of group 1. Among them there are more “kind”, “sociable”, “cheerful”. The situation is worse among disabled people of group 2. It is noteworthy that among disabled people of group 3 there are fewer “unhappy” and “sad”, but significantly more “angry”, which characterizes disadvantage in socio-psychological terms.

This is confirmed by a number of deeper individual psychological experiments that reveal psychological disadaptation, a sense of inferiority, and great difficulties in interpersonal contacts among disabled people of group 3. There was also a difference in self-esteem between men and women: 7.4% of men and 14.3% of women consider themselves “lucky”, 38.4% and 62.8%, respectively, “kind”, 18.8% – “cheerful” and 21.2%, which indicates the high adaptive capabilities of women.

A difference has been noticed in the self-esteem of employed and unemployed disabled people: for the latter it is significantly lower. This is partly due to the financial situation of workers and their greater social adaptation compared to non-workers. The latter are withdrawn from this sphere of social relations, which is one of the reasons for extremely unfavorable personal self-esteem. Lonely disabled people are the least adapted. Despite the fact that their financial situation does not differ fundamentally for the worse, they represent a risk group in terms of social adaptation. Thus, they are more likely than others to negatively assess their financial situation (31.4% and on average for disabled people 26.4%). They consider themselves more “unhappy” (62.5%, and on average among disabled people 44.1%), “passive” (57.2% and 28.5%, respectively), “sad” (40.9% and 29 %), among these people there are few people who are satisfied with life. Traits of socio-psychological maladaptation of single disabled people exist, despite the fact that they have a certain priority in social protection measures. But, apparently, psychological and pedagogical assistance is needed for these people first. people. The deterioration of the moral and psychological state of people with disabilities is also explained by the difficult economic and political conditions in the country. Like all people, people with disabilities experience fear of the future, anxiety and uncertainty about the future, a feeling of tension and discomfort. for today's political, economic and socio-psychological conditions, along with material disadvantage, this leads to the fact that the slightest difficulties cause panic and severe stress among disabled people.

So, we can state that at present the process of social adaptation of disabled people is difficult because:

 life satisfaction among disabled people is low;

 self-esteem also has negative dynamics;

 significant problems face disabled people in the area of ​​relationships with others;

 the emotional state of disabled people is characterized by anxiety and uncertainty about the future, pessimism.

The most unfavorable group in the socio-psychological sense is the one where there is a combination of various unfavorable indicators (low self-esteem, wariness of others, dissatisfaction with life, etc.). This group includes people with poor financial situation and living conditions, single disabled people, disabled people of group 3, especially the unemployed, disabled people since childhood (in particular, patients with cerebral palsy).

In people with cerebral palsy, along with impaired motor functions, deviations in the emotional-volitional sphere, behavior, and intellect are observed. Emotional-volitional disorders are revealed in increased excitability, excessive sensitivity, anxiety (or lethargy), fussiness (or passivity), excessive disinhibition (or lack of initiative). Patients with cerebral palsy have been disabled since childhood, which means that they have not had the opportunity for full social development, since their contacts with the outside world are extremely limited.

Typically, a child with infantile paralysis does not have the opportunity to go through all the cycles of socialization, and his maturation is delayed. All this happens because adults do not provide proper socio-psychological adaptation to such a child. As a result, for the rest of his life he remains infantile, dependent on others, passive, feeling comfortable only with close people. The social consequences of this situation are manifested in the fact that these disabled people become a special socio-demographic group, separated from society. Research has found that people suffering from cerebral palsy most of all experience a feeling of self-doubt and realize that they are useless to society. Their income level is lower than that of people with other diseases, and their educational opportunities are lower. A small number of these people are employed; among patients with infantile paralysis, there are significantly fewer people who have their own families; the majority have no desire to engage in any useful activity. As the so far limited domestic experience shows, disabled people with cerebral palsy, even having the desire and opportunity to participate in the life of society, cannot realize them due to the negative attitude of others towards them, while young people are the most negatively inclined (for this category of young disabled people with a visible defect, contact with healthy peers is especially difficult). It is impossible not to say how young disabled people suffering from infantile paralysis themselves relate to the possibility of personal active participation in public life. To the question of the questionnaire, “In your opinion, should disabled people live, study and work among healthy people, or should they live separately, in special institutions?” All respondents answered, which indicates its relevance. Among those who oppose integration (43%) are those young people who often met with the disdain of others. Their opinion is: “Healthy people still won’t understand people with disabilities.” As a result of our research, it also turned out that disabled people living in rural areas are more often supporters of integration than young people living in large cities in the region. An interesting fact is that older disabled people (25-30 years old) have a positive attitude towards active and personal participation in the life around them. Among young people aged 14-24 there are significantly fewer such people. The greater the degree of damage in patients with cerebral palsy, the less socially active they are. We also noticed that young disabled people, whose families have a low material level and poor living conditions, also turned out to be among the opponents of the idea of ​​integration. This is probably due to the fact that people who have already failed in some way do not hope that life will be better under other conditions. Often, young people with cerebral palsy do not always have stable relationships with loved ones. Many prefer to communicate with peers by sitting “within four walls” under parental care. Approximately 30% of the surveyed young disabled people with cerebral palsy generally refuse contact with anyone (mainly girls aged 18-28 years with severe form of infantile paralysis). In the process of observations, it was noticed that in the families of these young people psychological problems of this kind arise extremely acutely: most parents have various negative feelings, they begin to feel awkward and ashamed in front of others for their disabled child and therefore narrow the circle of his social circles. contacts. It is important to dwell on the reason for the occurrence of such situations in more detail. When a child with disabilities appears in a family, it experiences, as it were, two crises: the birth of a child itself is a crisis in the life cycle of the family, since it sometimes leads to a rethinking of social roles and functions. At the same time, conflicting moments arise. When a child has signs of disability, then this crisis occurs with double severity. This extremely dramatically changes the socio-economic status of the family and disrupts social ties. Moral and psychological problems are becoming extremely acute. The vast majority of parents have a feeling of guilt, which is accompanied by a feeling of their own inferiority. Family life begins to take place in a psychotraumatic situation, when parents not only hide their sick child from others, but also try to isolate themselves from the world. Often these families break up, and the child, as a rule, remains with the mother. The family, which is one of the main guarantors of a child’s social adaptation, does not always retain the ability to perform this function. Relatives often lose self-confidence, are unable to properly organize communication and upbringing of the child, do not notice his real needs, and cannot correctly assess his capabilities. Therefore, it is quite reasonable that many young disabled people with cerebral palsy complain about parental overprotection, which suppresses any independence. This sharply reduces the ability of such disabled people to adapt. The majority of the young disabled people we surveyed - “oporniks” (56.7%) need to eliminate conflict situations in the family.

However, the current socio-economic situation is gradually forcing some young disabled people to change their lives. At the moment, their number is still small, but we can expect a further increase in the number of such people, and therefore, there is a need to think in advance about ways to realize their potential for social integration and the desire to independently improve their lives.

Our own observations and analysis of the socio-psychological characteristics of young people with cerebral palsy allowed us to identify four main types of adaptation of these disabled people to society:

The active-positive type is characterized by the desire to find an independent way out of negative life situations. Young disabled people belonging to this type have a favorable internal mood, fairly high self-esteem, optimism that infects others, energy and independence of judgment and action.

The passive-positive type is characterized by low self-esteem among young disabled people. With a passive-positive type of adaptation, the current situation in which the disabled person finds himself (for example, constant care of loved ones) suits him, so there is a lack of desire for change.

Passive-negative type. Young people are dissatisfied with their situation and at the same time lack the desire to improve it on their own. All this is accompanied by low self-esteem, psychological discomfort, a wary attitude towards others, and the expectation of global catastrophic consequences even from minor everyday troubles.

Active negative type. The psychological discomfort and dissatisfaction with one’s own life present here do not deny the desire to change the situation for the better, but this does not have real practical consequences due to the influence of various objective and subjective factors..

Unfortunately, among young people with the consequences of infantile paralysis, people with an active and positive life position are extremely rare. There are only a few of them, but they are the most socially active (including in terms of creating public organizations for people with disabilities). Most young disabled people with cerebral palsy either do not feel the desire to somehow change their lives, or consider themselves incapable of taking such an important step. As a rule, they are at the mercy of certain circumstances. Therefore, these individuals are especially in need of a clearly planned and scientifically based system of socio-pedagogical and psychological measures aimed at developing their independence of judgment and action, work skills and culture of behavior, a worthy spiritual and moral character, and the ability to live in society.

People with disabilities are not a homogeneous group; each person is an individual, different from everyone else. Features of communication and the degree of freedom of movement play an important role, because this group is differentiated by gender and age, social status and type of disability, education, and geography of residence.

As experience shows, disabled people living in cities and regional centers have more opportunities for integration into society, while disabled people from villages and small villages sometimes do not use the services intended for them at all and, apart from pensions, do not know anything. However, in large populated areas and metropolitan areas, people with disabilities are more likely to experience harassment and resentment in their everyday interactions with society.

The process of social rehabilitation is two-way and reciprocal. Society must meet people with disabilities halfway, adapting their living environment and motivating them to integrate into society. On the other hand, which is very important, people with disabilities should themselves strive to become equal members of society.