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METHODOLOGICAL ASPECTS OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, LIMITATIONS OF LIFE AND HEALTH IN THE DEVELOPMENT OF INDIVIDUAL REHABILITATION PROGRAMS OR ABILITIES
Bodrova Rezeda1, Iksanov Khaidar2
1 Head of the Department of Rehabilitation and Sports Medicine, doctor of medical sciences, KSMA - a branch of FSBEIDPO RMANPO of the Ministry of Health of Russia, I Professor, Department of Rehabilitation and Sports Medicine, doctor of medical sciences, KSMA - a branch of FSBEI DPO RMANPO of the Ministry of Health of Russia,
Email address: [email protected]
To cite this article: Bodrov R.A., Iksanov H.V. - Methodological aspects of the International Classification of Functioning, Life Restrictions and Health in the Development of Individual Rehabilitation or Habilitation Programs//News of scientific achievements. Medicine and pharmacy. - 2019. - № 1. - S. 39-43. DOI: 10.36616/2713-1718-2019-1-39-43 URL: https://vestind.ru/journals/medicine/releases/2019-1/articles?pdfView&page=39
Received: November 17, 2019; Accepted: November, 20, 2019; Published: December 28, 2019
Abstract: The article considers the methodological aspects of the International Classification of Functioning, Disability and the development of individual rehabilitation and habilitation programs. In view of the growth of disability and an active personified approach, these support programs are actively developing.
Keywords: rehabilitation, habilitation, disabled person, ICF, IPRA.
Introduction
The Internati onal Cl assifi cati on ofFuncti oning, Disability and Health (ICF), developed in 2001 by the World Health Organization (WHO) and adopted with unanimous approval by all 191 member States of the World Health Organization at the 54th Session of the World Health Assembly as the basis for describing and measuring health and disability. The ICF is a new standard for describing and measuring health and disability at individual and population levels.
In the International Classification of Functioning, Restrictions on Life and Health (ICF), the terms «violations,» restrictions on life «and» social insufficiency «used in the 1989 International Classification of Violations, Restrictions on Life and Social Insufficiency (MCS) have a slightly different interpretation and there are substantial additions to them.
The term «violations» in the MCS refers to a concept that is part of the concept defined by the term «functioning» in the MCS. «Disorders» is only the part of the functioning of the body that shows itself to deviate from certain generally accepted population standards of biomedical status of the body and its functions, which are
defined in the ICF.
«Functioning» are problems that arise in functions or structures, such as material deviations or loss. Disorders are independent of etiology or how they develop; They may be part or manifestation of a health change, but they are not a mandatory sign of illness and do not mean that an individual should be considered sick. This understanding of the term «functioning» is the basis of the ICF concept of also forming individual rehabilitation or habilitation programmes (IPRA) based on it, which considers the status of the individual from a health perspective rather than a disease, in the interest of a health potential orientation.
Therefore, in the development of IPRA on the basis of the ICF, the importance of determining the signs of diseases by experts of ITU institutions is insignificant, the main importance is the consequences of these violations. The term «life restrictions» is part of a broader concept that includes concepts defined by the terms «activity» and «participation».
Activity is the performance of a task or actions by an individual. It represents the individual side of functioning. Activity limitations are possible
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- these are the difficulties in exercising activity that an individual can experience by overcoming individual malfunctions (disruption of structures and functions). Of the factors of health context, personal factors matter here. Restriction of activity can vary from mild to severe qualitative or quantitative deviation in activity performance, both in form and value, in comparison with people without changing health, which should be taken into account in the development of PDI.
Participation is the involvement of the individual in a life situation that develops in external conditions that facilitate or limit functioning and life. It represents the social aspects of functioning. There may be limitations to participation - these are problems that an individual can experience when engaging in life situations, overcoming barriers to the environment, external natural or cultural conditions. External context health factors matter here. The presence ofrestrictions on the possibility of participation is determined by comparison with the participation of the individual without restriction of vital activity in the given culture or society. Restrictions on participation lead to the need for social protection, which in the MCS was referred to as «social insufficiency», which is a major factor in the establishment of disability.
In order to fully and reasonably develop recommendations for the social and professional
ВЕСТИ НАУЧНЫХ ДОСТИЖЕНИЙ.
rehabilitation of persons with disabilities on the basis of the ICF, the executive authorities of the Russian Federation need to develop criteria for the degrees of restriction of activity and participation.
Thus, if MCH predominantly focused on what negative changes have occurred in the individual 's characteristics and life. The ICF, in the interest of actively overcoming negative changes, focuses on the positive what remains and is contained in the individual-personal properties of the person and in the socio-cultural and natural environment surrounding him (Table).
Methods
The development of this concept of ICF is a necessary methodological condition for the renewal, improvement of medical and social expertise and IPRA of persons with disabilities.
The ICF will undoubtedly be improved. In its first edition, the internal - personal, individual-typological - «context factor» of manifestations of health or unhealthy, disability, ability to overcome disability is named. But it is not disclosed, methodologically and technologically developed.
The development of the ICF towards its personal and humanistic purpose is an important aspect of its improvement. Thus, the ICF itself will be improved, but today it is the leading benchmark for finding new methodological and technological approaches to disability issues,
Table 1.
International Classification of Functioning, Limitations and Health (ICF)
Classes of functioning, life restrictions and health factors
Functions of an organism Structures of an organism Activity and participation Environment factors
1) intellectual 2) sensory and pain; 3) voices and speeches; 4) cardiac, blood, immune and respiratory systems; 5) digestive, endocrine systems and metabolism; 6) urogenital and reproductive; 7) neuro-muscular, skeletal and related to movement; 8) skin and related structures. 1) nervous system; 2) eye, ear and related structures; 3) participating in voice formation and speech; 4) cardiovascular, immune and respiratory systems; 5) related to the digestive system, metabolism and to endocrine system; 6) relating to Urogenital and reproductive system; 7) motion-related, skin and related structures. 1) training and application of knowledge; 2) general tasks and requirements; 3) communication; 4) mobility; 5) self-service; 6) household life; 7) interpersonal interactions and relationships; 8) the main spheres of life; 9) community life, social and civic life. 1) products and technologies; (2) the natural environment and changes in the environment made by man; 3) support and interconnections; 4) installations; 5) service, administrative systems and policy.
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both at the individual and social levels [1,2,3,4].
Results
In the activity of medical and social expertise, one of the priority tasks was the formation of an individual rehabilitation or habilitation programme for persons with disabilities (IPRA) as the main mechanism for the rehabilitation of persons with disabilities. At the same time, it is necessary to create a mechanism for effective monitoring of the implementation of recommended rehabilitation measures within the framework of the IPRA by the executive authorities of the regions of the Russian Federation.
The practice of implementing the recommended rehabilitation measures has highlighted a certain range of its details in the general problem of IPRA. Among them, the most important were the following [5,6,7,8].
1. Ensuring the popularity of IPRA, forming a positive attitude towards them on the part of persons with disabilities. This is due not only to the insufficient perfection of the rehabilitation technologies themselves (this may not suit the disabled person), but also to the general socioeconomic situation affecting the interests of the disabled person, the motives for his adoption of the recommended rehabilitation program.
2. Provision of the ultimate personal effect of the individual program of reabilation, connected with overcoming social insufficiency of the person, first of all, with vocational-labour, industrial rehabilitation.
This aspect of the problem depends on the need to coordinate the interaction of organizations different in their departmental affiliation, and most importantly, on the need to solve the issues of labour organization at work in the conditions of the existing shortage of jobs in the country as a whole.
3. To ensure the economic effect of the whole system of rehabilitation services - public and private investments in these services.
This aspect of the problem is related to the imperfections of the legal and economic conditions that stimulate the labour and productive activity of persons with disabilities.
Discussions
Rehabilitation of persons with disabilities is a system that requires significant financial investment. And fully and qualitatively carried out
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rehabilitation measures in many cases will give positive results only in 4-5 years. For example, in the United States, Sweden, and elsewhere, funds spent on rehabilitation for 5 years are returned to the state in a 12-multiple amount.
In this regard, the executive branch should effectively monitor the implementation of rehabilitation measures and the effective use of funds allocated for the rehabilitation of persons with disabilities.
Stressing the special relevance of the economic efficiency of successful implementation of rehabilitation measures, our domestic organizer of rehabilitation service K.G. Nirenburg stated that rehabilitation of disabled persons aims to transform a disabled person from a recipient of state subsidies into a taxpayer.
However, despite the positive effect of the comprehensive medical and social rehabilitation in general, many persons with disabilities have not undergone significant changes in their rehabilitation status in all directions in the past 5 years as a complex systemic defect, and the lack of an individual programme process.
In 2012, the Russian Federation ratified the United Nations Convention on the Rights of Persons with Disabilities.
The Convention introduces the concept of disability as follows: «Disability is an evolving concept and is the result of the interaction that takes place between persons with health disorders, relative and environmental barriers that prevent their full and effective participation in society on an equal basis with others». Therefore, Russia must move from our system of social protection for persons with disabilities to a policy of removing barriers and obstacles to the full and effective participation of persons with disabilities in society on an equal basis with others. This is certainly facilitated by the development and implementation of IPRA using ICF.
State support for persons with disabilities cannot be limited solely to pensions and social benefits. A critical challenge is to enable persons with disabilities to lead independent lives and participate fully in all aspects of life, to ensure equal access to the physical environment, transport, information and communication, including information and communication technologies and systems, as well as to other
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facilities and services open to or provided to the population, both in urban and rural areas. Timely and concrete implementation of measures to create a barrier-free environment and appropriate rehabilitation technologies will allow Russia to accelerate ratification of the UN Convention on the Rights of Persons with Disabilities [9,10,11].
One of the most fundamental and responsible functions of medical and social expertise institutions is that it is the creator and bearer of the information base, which represents an objective basis for the formation of a long-term comprehensive rehabilitation programme for persons with disabilities in the regions.
Conclusion
Qualitative and reasonable development of rehabilitation measures within the framework of IPRA is one of the most important tasks of medical and social expertise institutions. IPRA should improve in the direction of its personal content and have priorities for vocational and labour rehabilitation.
Full implementation of the recommended
ВЕСТИ НАУЧНЫХ ДОСТИЖЕНИЙ.
IPRA measures is possible only with the active participation of the rehabilitator himself. In order to create positive motivation for a disabled person to implement IPRA, the participation of psychologists and psychotherapists is necessary. In this regard, it is advisable to supplement the IPRA with a separate section on psychological rehabilitation.
The essence of rehabilitation is that it is not only the prevention and elimination of diseases, but the disclosure of all health potentials as a social quality of the person. One of the main tasks of the State authorities is to ensure the economic impact of the entire system of rehabilitation services for persons with disabilities.
Therefore, the problem of the disability 's IPRA methodology remains very relevant. In order to fully and reasonably develop recommendations for rehabilitation on the basis of the ICF, it is necessary to change the methodology of medical and social expertise and criteria for determining disability in accordance with contextual factors and parameters of characterizing aspects of conditions.
References
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rehabilitation programme based on the International Classification of Functioning, Restrictions and Health (ICF). Methodical manual. - Kazan. KGMA - 2010. - 32 p.
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©RA. Bodrov, H.VIksanov, 2019
