On the relevance and directions of improving physical rehabilitation of people with disabilities
According to statistical surveys in Ukraine, 2 million people (according to the latest data - 2.5 million) are officially registered as persons with physical and mental disabilities. This means that almost every 20th citizen of Ukraine needs special support. Of these, only 16.7 thousand people are covered by physical rehabilitation work, which is less than 1% of the number of disabled people. In Transcarpathia, there are about 40 thousand people with physical disabilities (hereinafter disabled people), which is 3.1% of the total population of the region, including 4102 young disabled people who can earn a living under appropriate conditions.
According to the World Health Organization (WHO), the number of disabled people around the world is 10% of the total population of the planet. This indicator is sufficient to consider the study of the problem of returning to active life of people with physical disabilities relevant.
The problem of returning to active life for disabled people has deep historical roots. For the first time at the international level, it was considered in 1946 at the Washington Congress on Rehabilitation. Since then, the term “rehabilitation” (Latin rehabilitatio - restoration) has become widely used in medicine. Numerous organizations have been created that include the word “rehabilitation” in their names, among them the largest is the International Society for the Rehabilitation of Disabled People (SCRD) in 1960, etc. However, there was no single view of the essence of rehabilitation, its goals and objectives. Even today, some understand rehabilitation primarily as the restoration of health, others refer to the restoration of working capacity, and still others associate it with the restoration of a person’s social and legal status. Each of the separately taken areas of rehabilitation is a significant layer of work, therefore, the term “rehabilitation” today should be understood not as a separate independent area of work, but as a complex of social, legal, medical and physical education and health-improving measures that ensure the adaptation of a disabled person to the living environment. .
According to G. S. Yumashev and K. Renker (1973), rehabilitation is nothing more than the adaptation of a disabled person to new conditions of activity. It should be directed at the following aspects of his life:
firstly, adaptation at the previous workplace;
secondly, readaptation - work at a new workplace with changed working conditions;
thirdly, adaptation to a new place of work in accordance with the acquired new qualification, close to the previous profession, but with a lower workload;
fourthly, complete retraining with subsequent employment.
Obviously, the specified list of rehabilitation areas is not complete, since it does not take into account the adaptation of disabled people to everyday life, family, important aspects of which are the adaptation of the rehabilitator to self-service and participation in collective household management. This is the first step, without which his further rehabilitation is impossible. The mentioned areas do not take into account the peculiarities of the tasks of children's rehabilitation, the specificity and regularities of the adaptation processes of disabled people with various forms of nosologies, etc.
Recently, a number of important documents of international importance have been adopted that have contributed to the improvement of work with disabled people, including: the UN Resolution of December 9, 1975, the World Program of Action concerning Disabled Persons, and the UN Standard Rules for the Implementation of Equal Opportunities for Disabled Persons. The main goal is to restore the lost contact of people with disabilities with the environment, create the necessary conditions for their integration into society, participation in community service, and rehabilitation of physical abilities and social status. At the present stage, positive trends have emerged in our country regarding a humane attitude towards disabled people. In 1991, the Verkhovna Rada of Ukraine adopted the law “On the Fundamentals of Social Protection of Disabled People” and the corresponding state program. The number of state and non-state organizations concerned with the problems of disabled people began to grow and branch out. Thus, according to the data provided by L. Ogorelkova (2000), in Ukraine today there are about 600 full-time specialists in physical rehabilitation, 28 centers of “Invasport” operate, 56 branches of regional centers, mainly in large cities and 16 regions, 48 physical culture and health clubs for the disabled in 17 regions, 17 specialized children's and youth rehabilitation sports schools. In the Transcarpathian region, more than 20 state, public and charitable organizations concentrate their efforts on the rehabilitation of the disabled, including: the Medical and Social Rehabilitation Center “Optimist”, the Transcarpathian Center for Physical Culture and Sports for the Disabled “Invasport”, the Transcarpathian Regional Branch of the Fund of Ukraine for Social Protection of the Disabled, the Scientific and Practical Association “Rehabilitation” of the Ministry of Health of Ukraine and many others.
The growth in the number of organizations and individuals who have expressed a desire to care for the disabled in our country, in conditions of a chronic deficit of funding for these programs from the state, seems, at first glance, illogical. In addition, unlike developed countries, in Ukraine there are practically no people among the disabled who could sufficiently finance their own rehabilitation, as is the case in countries with a high standard of living. At the same time, working with the disabled requires significant time, energy, dedication, and basic training of those involved in their rehabilitation. In conditions of low material compensation, working with the disabled requires a certain level of motivation of specialists and volunteers. Therefore, identifying incentives and motives that push or attract people to this difficult work is important for improving the quality of training of physical rehabilitation specialists, social service workers, and volunteers.
The study of the problem of increasing attention to the disabled and people with limited physical abilities allowed us to formulate both objective and subjective reasons for this process. The following are considered to be objective reasons (stimuli):
a significant increase in the number of people with limited working capacity in Ukraine in general, and in Transcarpathia in particular, who need external assistance;
the inability of the state to fully provide disabled people with a decent pension and treatment, which does not allow them to be sufficiently independent and self-sufficient;
the financial and physical inability of most families to support one or more disabled people on their own, which forces them to seek external support;
the increase in the number of offers from foreign non-governmental associations for comprehensive assistance (organizational, material, consulting, etc.) to improve the situation of disabled people in post-socialist countries, and to involve local volunteers and specialists in this work;
consequences of "Chernobyl", the war in Afghanistan, natural disasters, which led to an even greater aggravation of the problem of disabled people and people with limited physical abilities;
insufficient preparation of state organizations and services for the specifics of working with disabled people and the inability to cover all areas of this work;
a small number of educational institutions that train relevant specialists who are able to organize work with disabled people at a professional level and with the lowest costs;
a tendency to reduce jobs at large enterprises and organizations, which leads to an increase in the number of unemployed citizens ready for professional retraining, to work with disabled people solely for the sake of earning money;
an increase in social and political activity of people with limited physical abilities, the integration of this category of people into societies, which substantiate clear requirements and rehabilitation programs.
According to the results of an anonymous survey, the following subjective reasons (motives) were attributed:
manifestations of pity, kindness, humanity, compassion, honor, decency (71.4% of respondents);
the desire to improve one's own image, to gain "political dividends" in the field of humanitarian work (14.8% of respondents);
innate altruism (4.6% of respondents).
Further analysis of the motives and incentives that encourage healthy people to work with the disabled shows that there are a sufficient number of disinterested and selfish, material and moral ones among them. Obviously, the harmonious combination of the two has led to the fact that the humane attitude towards the disabled in our country is in an active phase of its development. For Transcarpathia, taking into account the multinational composition of the population, established traditions, a high level of religiosity and the specifics of the geographical location of the region, this is even more characteristic.
However, practice shows that the part of volunteers and specialists who are guided in their work by moral incentives rather than material ones work better. Therefore, it was advisable to determine the peculiarities of motivations and the presence of innate altruistic character traits during testing for admission to work with the disabled, which are currently practically not taken into account when choosing a rehabilitation specialist. Meanwhile, the introduction of a system of preliminary professional selection of future specialists in social, medical and physical rehabilitation would help to identify those at the initial stages of their training who, due to their personal qualities, are unable to adapt to working with the disabled. The system of preliminary professional selection allowed to reduce the percentage of poor-quality “products” among graduates of special educational institutions and save money.
A significant contribution to the theory and methodology of professional selection of applicants was made by the team of teachers of the Department of Pedagogy and Psychology of UzhNU. But now, according to our data, their scientific and methodological developments are not used in practice. Considerable experience in preliminary professional selection of specialists of various professions has been accumulated abroad. Thus, in Russia, practically in all higher educational institutions of the Ministry of Defense and the Ministry of Internal Affairs, each applicant takes a set of professional and psychological tests before the entrance exams, according to the results of which he is enrolled in one of 4 groups of professional selection:
1. applicants with high professional and psychological suitability;
applicants with good professional and psychological suitability;
applicants with mediocre professional and psychological suitability;
professionally unsuitable applicants.
During such selection, two groups of indicators are studied using observations, surveys and testing, which characterize the level of adaptation to the profession (the presence of family traditions, recommendation materials, awareness of the future profession, self-assessment of one's own motivation, etc.), as well as the level of development of professionally important qualities (moral, psychological, intellectual, physical, etc.).
The results of such a study are taken into account by the admissions committees in the event of equality of other indicators, with the exception of the 4th group of professionally unsuitable applicants, whose candidacies are considered by the admissions committees personally.
The practice of professional selection of applicants has allowed universities to significantly reduce the number of cadets dropping out during their studies by more than 15% and reduce the number of military specialists who started work not according to their vocation by 5%, thus saving significant funds for their training, and most importantly, timely preventing cases of unsuccessful choice of future profession. This is especially true for a physical rehabilitation specialist, a person who, in addition to knowing the subject of his work, is obliged, just like a doctor, to cooperate with his patient. It has long been known that positive emotional contact between a doctor and a patient creates a favorable background for better recovery and further rehabilitation. Therefore, foreign and national experience of preliminary professional selection in the training of future physical rehabilitation specialists could be successfully used in our country.
The next no less important problem of disabled people is that their physical rehabilitation is usually taken care of by doctors. Its advantage is that the doctor who performed the operation or treatment knows better the features of the disease and the rehabilitation method. And the patient usually feels more trust in his doctor, which has a positive effect on the success of medical and rehabilitation measures.
But, in addition to the positive ones, there are other aspects of this problem. Physical rehabilitation, which requires much more time than the treatment of the acute period of the disease itself, distracts the doctor from specialized medical work. This leads to inhibition of specialized professional development of doctors. In addition, doctors do not have sufficient pedagogical knowledge and skills in working with physical exercises and sports equipment, which are important means of both individual and group physical rehabilitation.
It was the latter - the group method - that created the prerequisites for the separation of physical rehabilitation into a separate profession. It significantly reduced its cost, took it beyond the limits of the hospital, allowed to increase the number and quality of rehabilitation and treatment measures tenfold, made rehabilitation more effective through the use of sports equipment, the positive emotional background of physical education and health classes and healthy sports competition.
As the experience of the USA, Canada and other developed countries shows, it is advisable to separate the profession of a physical rehabilitation specialist from the profession of a doctor. The training of physical rehabilitation specialists should be directed towards a narrow specialization, for example, the rehabilitation of children, adults, mentally retarded people, people with hearing, vision, musculoskeletal system defects, disabled people in wheelchairs, etc. Of course, such specialists, along with doctors, must study the entire spectrum of medical disciplines, master modern methods of treatment and physical rehabilitation, but in addition they must be good psychologists, specialists in physical culture and sports. However, doctors should not remain aloof from the problems of disabled people. Their medical recommendations are necessarily taken into account by physical rehabilitation specialists, with whom they closely cooperate. Medical rehabilitation, which in some countries has been called rehabilitation therapy, is developing no less intensively. This is a separate independent direction of improving rehabilitation measures.
There are many common unexplored scientific problems among physical rehabilitation specialists and doctors. Thus, the impact on the body of disabled people of various forms of nosologies of standard sports exercises, which are performed in a state of significant emotional arousal when using competitive and game methods of conducting classes or sports events, has not been studied enough. The problem of managing the emotional states of disabled people during group classes, etc. is interesting.
Unlike the developed countries of Western Europe and America, in Ukraine a comprehensive and systematic approach to physical rehabilitation of disabled people has only just begun to take shape. People of various specialties who have undergone appropriate retraining are still being involved in the work. Professional training of young people in the state higher education system began 4 years ago, since the opening of the Faculty of Recreation, Physical Rehabilitation, Sports Medicine of the National University of Physical Education and Sports of Ukraine. Currently, there are 4 specialized educational units and dozens of departments of physical rehabilitation in the country's universities, which train the first generation of professionals, and it is planned to open new faculties.
In general, the following priority areas for the formation of our own national system of physical rehabilitation have been identified:
creation of a state basic program for preliminary professional and psychological selection of future physical rehabilitation specialists, which would allow to reveal their innate predisposition to work with the disabled;
expansion of the network of specialized educational institutions for training physical rehabilitation specialists, invasport trainers, scientists;
approval of full-time positions of physical rehabilitation specialists and Paralympic sports trainers in medical and sanatorium-resort institutions, sports clubs, schools, societies, educational institutions;
creation of a system of specialized regional physical rehabilitation centers, active physical rehabilitation camps and their branches in the districts;
opening of rehabilitation and sports schools for the disabled on the basis of “Invasport” centers (approved by the budget for 2000);
opening of specialized branches for training of sports reserve on the basis of boarding schools;
allocation of a mandatory quota of time for recreational activities with disabled people in all sports facilities, regardless of ownership, and their additional equipment with special devices, simulators, and devices;
creation of research centers on the problems of physical rehabilitation of disabled people, organization and holding of scientific seminars, conferences, symposiums, and congresses, publication of scientific and methodological publications;
periodic publication of a review of the sports movement of disabled people in accordance with clause 40 of the state target comprehensive program “Physical Education - Health of the Nation”;
popularization and expansion of the network of invasports competitions, which will be held annually with the involvement of disabled people of all forms of nosologies;
creation and state support of the invaindustry - enterprises that will manufacture domestic devices and equipment for disabled people.
Thus, physical rehabilitation of people with disabilities was undertaken by physical culture and sports specialists, who significantly expanded the boundaries of methods, means and areas of rehabilitation. In cooperation with doctors and social service workers, they laid the foundations of a national system of physical rehabilitation of people with disabilities.