RU2391899C1 - Method of evaluating limitation of vital activity of children with psychoneurological profile - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology. Evaluation of limiting vital activity of children with psychoneurological profile is carried out of the basis of determination of degree of functional disorder expression by testing in accordance with types of functional disorders, evaluation of obtained indices in points and further determining coefficient of functional state. As types (B) of functional disorders taken into account are locomotive (Ld), including kinds (i) of disorders: muscular force, muscular tone, volume of active movements, pose and position of extremity segments, coordination of movements, hyperkinesis characteristic; mental disturbances (Md), including disturbances (i): emotional-volitional sphere, thinking, mental development, retardation of intellectual sphere; speech disorders (Sd). Each kind (i) included into functional disorders is divided into five levels (j) in accordance with severity of disorder manifestation and are evaluated in point scale (bj) from bj=0 - severe degree of disorder manifestation, if j=1 to bj=1 - absence of disorder if j=5. Coefficient of functional state (C) is calculated by formula

where n is number of disorders in each type of functional disorder; m is total number of evaluated disorders; B is type of functional disorder, Ld, Md or Sd; Bi is presence of disorder kind: yes - 1, no - 0; bj is evaluation point, which with j=1, b1=0; j=2, b2=0.25; j=3, b3=0.5; j=4, b4=10.75; j=5, b5=1. If C is higher than 75% light degree of vital activity limitation is fixed, if C is from 50 to 75% - medium degree, and if C is from 0 to 49% - severe degree of vital activity limitation.

EFFECT: method allows to give an objective evaluation of vital activity limitation of children with psycxhoneurological profile, increase efficiency of performed course of therapeutic measures, elaborate strategy and plan of further measures in case if repeated rehabilitation cycles are administered.

3 tbl, 2 ex

Description

The invention relates to medicine, specifically to neurology, and can be used in specialized institutions in order to objectify the assessment of functional disorders in children with a neuropsychiatric profile, the effectiveness of the course of treatment, the development of a strategy and plan for further measures in the appointment of repeated rehabilitation cycles, in particular for children with cerebral palsy.

Against the background of the dynamic improvement and development of the legislative framework to ensure the rights and interests of children with disabilities, a growing number of rehabilitation institutions, improving their material and technical base in children's rehabilitation, there are many unresolved problems. One of them is the lack of an objective system for assessing the disability of children, which allows them to characterize the level of their functional skills and determine the effectiveness of rehabilitation of children with a neuropsychiatric profile. According to many authors, there are neither theoretical nor practical developments of qualified indicators of the medical and social plan, objectively reflecting not only qualitative, but also quantitative assessment of the potential of a particular patient (Modern rehabilitation technologies in pediatrics. Edited by E.T. Lilin "ODI international "M. - 2000; Shipitsina L.M., Mamaichuk I.I. Cerebral Palsy, St. Petersburg, M. - 2001).

As a rule, the methods that evaluate the patient’s life limitation take into account no more than one or two functional disorders of the child, without considering the life limitation as a whole. Giving an assessment of one or two types of functional disorders, it is impossible to objectively assess the severity of functional disorders of the child, the level of his social adaptation.

There is, for example, a method for evaluating the effectiveness of speech therapy work with children with cerebral palsy. Based on the point system for assessing speech disorders from 1 - normal to 5 - significant deviations. Depending on the age of children, from 24 to 31 examination indicators are used (Comprehensive rehabilitation of children with cerebral palsy. Methodological recommendations / K.A.Semenova, E.I. Tanyukhina, V.P. Shestakov, S.A. Stetsenko. E. M. Starobina, T. A. Nilova, A. A. Dyskin, E. N. Demina // Ministry of Labor and Social Development of the Russian Federation. - M., St. Petersburg., 1998. - S.146-193).

A point assessment of the psychoemotional sphere of a child with cerebral palsy is proposed based on the coefficient of motivational readiness for activity (Simonova T.N. / abstract of diss. "Evaluation of the effectiveness of the transdisciplinary approach to the rehabilitation of children with cerebral palsy", Ph.D. in medical sciences. - Saratov, 2002 , 27 p.). To assess psycho-emotional activity, a motivational readiness survey is carried out with a determination of its coefficient by 4 parameters, each of which was evaluated on a 5-point scale: stability of the emotional sphere, motivation, anxiety, and cognitive activity. It is believed that the motivational readiness coefficient (KMG) most adequately reflects the child's readiness for corrective actions and various types of activities. However, it is noted that it is reliably applicable only to children with severe and moderate functional disorders, since the level of motivation in these children is directly related to the development of communication, self-care and sitting skills.

In the patent of the Russian Federation No. 2070816 (IPC A61H 23/00), the effectiveness of the rehabilitation of children with damage to the central and peripheral nervous system, including cerebral palsy, is evaluated by indications of only motor and mental activity three and six months after the start of treatment. The group of indicators of motor activity included: a change in the tone of spastic and paretic muscles, the appearance of previously absent arbitrary purposeful movements with increasing degree of physiology, volume and strength, and the group of indicators of mental activity included: the appearance of intellectual and emotional contact; the appearance and development of speech; development of sustainable positive emotions; approximation of the mental development of the child to the corresponding age group.

Closest to the proposed evaluation method is a method of expert evaluation of the disability of children with cerebral palsy, described in the work "Comprehensive rehabilitation of children with cerebral palsy." Methodical recommendations / K.A.Semenova, E.I. Tanyukhina, V.P. Shestakov, S.A. Stetsenko, E.M. Starobina, T.A. Nilova, A.A.Dyskin, E.N. Demina // Min. labor and social development of the Russian Federation. - M., St. Petersburg., 1998 .-- S. 85-93. The method takes into account six types of disability with an assessment of each of them on a 6-point scale from 0 (no limit) to 6 (complete inability to act even with the assistance of others and auxiliary means). To assess disability, two types of functional disorders are used: psychological, including three types of such disorders, namely a decrease in the ability to behave appropriately, a decrease in the ability to communicate with others and a decrease in the ability to care for oneself, and motor, including also three types of disorders: a decrease in the ability to move ; decreased ability to act with hands; decreased ability to own a body in solving everyday problems. All identified types of violations are examined and the contribution of each violation to life limitation is expertly evaluated. Then, the leading violation is selected and the effectiveness (E) of the rehabilitation measures taken is assessed in relation to the assessment of the leading functional violation before and after rehabilitation. With an E value of 2.0 or more, a significant violation is indicated, 1.2-1.99 - an improvement, 1.06-1.19 - a slight improvement, 0.95-1.05 - unchanged and with an E less than 0 , 95 - deterioration.

However, the method is based on the use of only two types of functional disorders: motor and psychological nature, it does not allow to draw a conclusion about the severity of functional disorders of the child, the level of social adaptation.

Thus, the search among the sources of information known to the applicant did not reveal solutions aimed at both objectification of the assessment of the disability of a single whole, and objectification of the effectiveness of the course of rehabilitation measures, which allows to quickly monitor the dynamics of the functional state of children and adjust the rehabilitation process in order to optimize it for specific patient and increase the effectiveness of rehabilitation measures.

The objective of the present invention is to develop a new integrated and objective method for assessing the disabilities of children with a neuropsychiatric profile based on assessing the severity of functional disorders of the child, taking into account all the main types of functional disorders.

The problem is solved by a method of assessing the disability of children of a neuropsychiatric profile on the basis of determining the severity of functional disorders by testing by types of functional disorders, evaluating the obtained indicators in points and then determining the coefficient of functional state, while the following types of disorders are considered as functional disorders: motor (Dn ), including the following types of (i) disorders: muscle strength, muscle tone, volume of active movement eny, posture and position of the extremities of segments of motor coordination, characteristic hyperkinesis; disorders of mental functions (Mon), including disorders (i): emotional-volitional sphere, thinking, mental development, underdevelopment of the intellectual sphere; speech disorders (pH). Each of the types of functional impairment (i) is divided in accordance with tables 1-3 into five levels (j) according to the severity of the manifestation of the disorder and is evaluated on a point scale (bj) from bj = 0 - the strong manifestation of the disturbance at j = 1 to bj = 1 - no violation at j = 5, evaluate the coefficient of functional state (K) according to the formula

where n is the number of violations in each type of functional violation, m is the total number of assessed violations; B - type of functional impairment of Dn, Mon or Rn; Bi - type of violation: yes - 1, no - 0; bj is the estimated score, which for j = 1, b1 = 0; j = 2, b2 = 0.25; j = 3, b3 = 0.5; j = 4, b4 = 0.75; j = 5, b5 = 1, and with a K value of more than 75%, a slight degree of limitation of vital activity is recorded, at K from 50 to 75%, an average degree is recorded, and at K from 0 to 49%, a strong degree of limitation of vital activity is recorded.

The proposed method for assessing the degree of disability of children of a neuropsychiatric profile by the coefficient of the functional state of the child allows you to objectively assess the level of functional capabilities of the child, its ability to integrate into society. In addition, by evaluating the coefficient of the functional state before and after the rehabilitation measures, the method allows you to objectively evaluate the effectiveness of the measures taken as a whole, and for certain types of functional disorders.

The technical result of the invention is to identify a reliable objective indicator of the severity of functional disorders based on the coefficient of functional state, allowing us to distinguish three degrees of disability:

I degree (slight limitation of vital activity) - more than 75%. Children with mild neurodynamic and speech impairment, normal intelligence, or mental retardation practically did not need outside help. They moved independently, served themselves, their actions and actions were conscious, speech understood by others. Older children could use public transport on their own.

II degree (average restriction) - from 50-75%. In connection with severe violations in the field of motor capabilities, problems in mastering everyday and general educational skills, cognitive or intellectual disorders, children needed some help from outsiders. Some of the children used additional technical means of transportation.

III degree (severe limitation) - from 0-49%. This group includes children with gross disorders in the motor sphere, formed by pathological muscle tone and apraxia, orthopedic pathology or pathology of the formation of sitting, standing, and moving skills. Most children had severe speech impairment. The same group included children with moderate motor impairment, but expressed sensory, intellectual, behavioral or cognitive impairment, which needed constant outside care.

The applicant’s proposed gradation of the degree of disability of children with a neuropsychiatric profile on the basis of the functional state coefficient is based on many years of practical work experience, which led to the conclusion that it is necessary to comprehensively take into account all the main types of functional disorders that occur in all disabled children with cerebral palsy, namely motor disorders (Days), mental disorders (Mon), speech disorders (pH), and offer a universal, objective assessment of the degree of restriction of life, enabling quantitative assessment of the expression, and the ability to compare data over time.

To achieve this goal for three years on the basis of the State Institution “Regional Center for Reconstructive Medicine and Rehabilitation” (hereinafter referred to as the Center), a study was conducted on the process of rehabilitation of disabled children with cerebral palsy. By the method of continuous sampling, 913 children with cerebral palsy from the age of 6 months were included in the experiment. up to 18 years old, registered at the Center. There were 512 boys (56%), 401 girls (44%). All children with a diagnosis and disability. The main group consisted of 547 (59.9%) children and adolescents, the control group - 366 (40.1%).

The main criterion in the formation of the main group was the regularity of these children undergoing a 3-week comprehensive course treatment at the Center with a multiplicity of 2-4 courses per calendar year. Rehabilitation measures were carried out in accordance with the Program of medical-social and psychological-pedagogical rehabilitation, taking into account the age, form and severity of the disease. Children of the control group were not treated regularly, without software. Each group was divided into four age subgroups: 6 months - 2 years 11 months; 3 years - 6 years 11 months; 7 years - 12 years 11 months; 13 years - 17 years 11 months

The division of children into these age groups is dictated by the use of different types, methods and techniques of rehabilitation appropriate for age, with a single (strictly individual) approach to rehabilitation treatment of children with disabilities.

Assessment of the condition of children with disabilities under our supervision was carried out taking into account the persistent disabilities they had in four main types of disorders (B) (motor sphere, mental state, level of psychological development, speech sphere), including a different number of types of disorders that characterize these types .

Movement disorders are a leading defect in patients with cerebral palsy. They exist from birth, are interconnected with sensory disorders, lack of sensations of their own movements. In children with cerebral palsy, the formation of all motor functions from retention of the head, sitting and standing skills to walking and manipulative activity is delayed or impaired. Wrong movement patterns in children with cerebral palsy can be fixed and lead to the formation of pathological postures of the positions of the body and limbs, which becomes an even more serious obstacle to the development of movements, self-care skills, mastery of subject-practical activity. Movement disorders in children with cerebral palsy are rarely isolated, as a rule, they are accompanied by a violation of intellectual, speech, perceptual and communicative functions. The presence of a physical defect complicates the process of the overall development of the child, affects its cognitive sphere and leads to a significant originality in the formation of personality. The most common types of speech disorders in cerebral palsy are dysarthria. A feature of dysarthria in cerebral palsy, reflecting the commonality of disorders of the skeletal and speech muscles, is the lack of kinesthetic perception. The child not only performs movements with difficulty and in a limited volume, but also weakly senses the position and movement of his limbs and articulation organs, which makes it difficult to carry out purposeful actions and intensifies violations of sound pronunciation. The relationship between disturbances in general and speech motility in cerebral palsy is also manifested in the fact that the severity of articulation motility disorders usually correlates with the severity of impaired hand function.

An assessment scale for the functional state of children was developed, which is a point estimate of the level of functional skills by types of disorders (B), presented in tables 1-3, where “*” corresponds to a point estimate of the severity of the identified type of violation. The proposed rating scale reflects in percentage terms the physical abilities of a given child to normal indicators at a given age.

Table 1 Scale for assessing motor impairment (B = Day) i Type of functional impairment Points (bj) 0 0.25 0.5 0.75 one (j = 1) (j = 2) (j = 3) (j = 4) (j = 5) one Muscle impairment - lack of active muscle contractions * - light muscle contractions * - limited active movements * - slight decrease in strength * - muscle strength is normal * 2 Muscle tone disorders - dynamic contracture * - sharp hypertonicity (25% of the normal volume of passive movements) * - moderate hypertonicity (50% of the volume of passive movements) * - slight hypertonicity (75% of the volume of passive movements) * - muscle tone is normal * 3 Violation of the volume of active movements - corresponds to 10% of the normal volume * - corresponds to 25% of the normal volume * - corresponds to 50% of the normal volume * - corresponds to 75% of the normal volume * - meets the norm * four Violation of the position and position of limb segments - persistent preservation of the pathological installation * - partial active exit from the pathological installation * - full active exit to the physiological position without holding it during movements * full active exit to the physiological position with its retention under conscious control * - lack of pathological installation * 5 Characterization of hyperkinesis - pronounced, common, persistent hyperkinesis * - an arbitrary opportunity to reduce the severity of hyperkinesis * - arbitrary long-term suppression of hyperkinesis only at rest * - arbitrary prolonged suppression of hyperkinesis at rest and with arbitrary movements * - lack of hyperkinesis * 6 Lack of coordination of movements - severe ataxia of the limbs and trunk * - significant discoordination of arms and legs * - moderate discoordination in the arms and light in the legs * - easy discoordination in the hands * - lack of discoordination *

table 2 Assessment scale for mental disorders (B = Mon) i Type of functional impairment Points (bj) 0 0.25) 0.5 0.75 one (j = 1) (j = 2) (j = 3) (j = 4) (j = 5) one. Violations of the emotional-volitional sphere - psychopathic behavior, constant conflict situations, not amenable to correction * - Expressed emotional-volitional disorders. Frequent conflict situations are difficult to correct * - Expressed emotional-volitional disorders are expressed moderately. Rare conflict situations are partially corrected * - mild correctable disorders of the emotional-volitional sphere * - no violations * 2. Impaired thinking - only the simplest generalizations are available * - only specific thinking is developed * - the level of development of abstract logical thinking lags behind age * - slight limitation of abstract logical thinking * - meets the norm * 3. Mental developmental disorders - gross delay in psycho-speech development * - pronounced mental retardation with spatial disorders * - moderate mental retardation with impaired one or two higher cortical functions * - slight mental retardation * - meets the norm * four. Intellectual Underdevelopment - gross violations of intelligence (idiocy) * - expressed violations of intelligence (imbecility) * - moderate impaired intelligence (debility) * mild debility * - meets the norm *

Table 3 Speech Disorder Assessment Scale (B = pH) i Type of functional impairment Points (bj) 0 0.25 0.50 0.75 one (j = 1) (j = 2) (j = 3) (j = 4) (j = 5) Nobody understands the patient, speech is completely illegible * Only the mother understands the patient
the closest people * The patient’s speech is dysarthria, but although it is difficult to understand it, all around * The patient’s speech is somewhat dysarthria, but is understandable to others * No speech impairment *

Tables were filled out collectively: neurologist, psychiatrist, psychotherapist, physician for physiotherapy. culture, psychologist, speech therapist. The information entered into the tables reflects the true initial state of the child or the level of skills assigned to him at the time of the examination. The survey was conducted for all children of the main and control groups on the basis of guidelines for generally accepted methods. (Comprehensive rehabilitation of children with cerebral palsy. Methodical recommendations / K.A.Semenova, E.I. Tanyukhina, V.P. Shestakov, S.A. Stetsenko. E.M. Starobina, T.A. Nilova, A. A.Dyskin, E.N. Demina // Ministry of Labor and Social Development of the Russian Federation. - M., St. Petersburg, 1998; Research Methods in Pediatric Neurology / edited by V.P. Zykov - M .: - Triad- X, 2004. - 112 p .; Methods for determining and indicators of the quality of life of adolescent children: a manual for doctors / A.A. Baranov, V.Yu. Albitsky, S.A. Valiullina and others - M., 2005. - S.23-29 .; Shipitsina, L.M. Cerebral Palsy / Shipitsina L.M. I.I. Mama ychuk .-- St. Petersburg: Didactics Plus, 2001 .-- 271 p.)

The method allows each of the types of functional disorders to be considered both in combination with other disorders, and in isolation, while receiving a different degree of limitation of life, but only a comprehensive account of all types allows you to objectively assess the degree of limitation of vital activity as an indicator of the true condition of the child, his ability to integrate into society .

The method is as follows.

Specialists in this field carry out a point assessment of the state of the child in four types of functional disorders: motor sphere, mental state, level of psychological development, speech sphere, including the claimed types of disorders based on the proposed rating scale (Table 1-3), which reflects the physical abilities of this child to normal rates at a given age.

The coefficient (K) of the functional state of the child is calculated by the proposed formula, the value of which shows the severity of functional disorders.

Carrying out a similar procedure with the calculation of the value (K) after the rehabilitation measures carried out allows us to conclude about the effectiveness of rehabilitation, assess the dynamics of rehabilitation in general, and, if necessary, adjust the rehabilitation process based on the data received on the type of functional impairment.

An improvement in K by one rating scale makes it possible to transfer a child to a group of children with a lesser degree of severity.

Below are examples of the implementation of the proposed method

Example 1

Roman A., 4 years old. I first turned to the Center for help in September 2005 about cerebral palsy, right-sided hemiparesis. A child from a prosperous family. The 32-year-old mother had an urgent delivery with a long, anhydrous period and stimulation of labor. In a year, parents noticed that the child does not lean heavily on his right leg and takes objects mainly with his left hand. The clinic was growing, at the age of 3 the child was diagnosed with cerebral palsy. The child was examined: no abnormal changes were detected on computed tomography of the brain, periodically recorded convulsive readiness was observed on the EEG. There were no convulsive attacks.

From the year at the place of residence (Partizansk, Primorsky Krai), the child received medication common for this disease (nootropics, cerebrolysin, vitamins) and physiotherapy (massage, exercise therapy, laser therapy). He was brought up at home.

Upon admission to the Center for Restorative Medicine and Rehabilitation, the child hardly makes contact, is closed. The right arm is brought to the body, bent at the elbow joint, supination is limited, active abduction of the right shoulder is 45 °, moderate hypertonicity of the extensor flexor muscles. When walking, it drags the right leg, the right foot is rotated inward, in the area of the right lower leg and foot there are areas of reduced sensitivity. Walking up the stairs with difficulty, holding on to the handrail. The boy has an erased form of pseudobulbar dysarthria, speech is difficult, but understandable to others. Moderate mental retardation.

Initial assessment of a child’s disability:

1. В = Дн, n = 4 (muscle strength, muscle tone, volume of active movements; forced position of limb segments: b _j = 0.5; there were no violations of coordination of movements and hyperkinesis in the child - the parameters were not taken into account).

2. B = Mon, n = 4 (Violations of the emotional-volitional sphere - b _j = 0.25; violations of mental development, thinking and the intellectual sphere: b _j = 0.5).

3. B = Rn, n = 1, the patient’s speech is dysarthritic, speech is difficult, but understandable to others, and b _j = 0.5.

m = 9.

Thus, at the time of the study, the coefficient of limitation of the vital activity of the child was equal to:

During the year, the child underwent three courses of comprehensive rehabilitation. When assessing the performance of the motor sphere, there was a slight decrease in strength, a slight increase in muscle tone, gait was almost normal, active movements in the joints of the limbs became possible in full, but without keeping them under conscious control. In the field of psychological development and social adaptation of the child, his thinking, spatial and temporal representations and fine motor skills improved to values that correspond to the norm, emotional reactions, expressive speech and motivation improved. In the field of mental disorders, a positive shift in all indicators of observation occurred to the level of a slight delay in mental development. Speech recovered completely.

The coefficient K after rehabilitation was 66.6%. The child is placed in a kindergarten. Mother plans to go to work.

Recommendations In order to consolidate the achieved results and improve the indicators of functional development, the child is shown further comprehensive rehabilitation treatment and rehabilitation at the Center. It is necessary to conduct classes at home, in accordance with the recommendations received in the institution.

Example 2

Olga, 17 years old. The family is prosperous. Parents have higher education. Diagnosis: cerebral palsy, hyperkinetic form, spastic-hyperkinetic dysarthria. She was treated in hospitals, sanatoriums, a clinic at the place of residence. She completed several massage and acupuncture courses in China. Positive dynamics was practically not observed.

In neurological status: permanent hyperkinesis such as choreathetosis with an athetoid component in the fingers, extending to the lower and upper limbs, trunk muscles. Hyperkinesis is aggravated by movement, conversation, and emotional stress, while hyperkinesis of the facial muscles is expressed. Indoors, adhering to the rail or wall, can take up to 15 steps. When walking, balances with his hands, poorly holds his balance. The right arm with flexion contractures in the right elbow and wrist joints is slightly laid back. In the Romberg position is unstable, does not walk on the street. She doesn’t eat, does not comb her hair, cannot dress, writes with difficulty, and quickly gets tired. Intelligence is above the norm. The girl speaks English, she graduated from secondary school at 4 and 5. Cranial nerves without pathology. Tendon and periosteal reflexes from the lower and upper extremities are high. Babinsky's symptom is positive on both sides. On the EEG with the preservation of the main cortical rhythm and a sufficient amplitude of cortical potentials, theta rhythms were found, especially in the central departments, signs of pathological activity of diencephalic structures.

The total coefficient of the initial functional state of the girl (K):

1. B = Dn, n = 6 (muscle strength, range of active movements in the joints, position of limb segments, coordination of movements b _j = 0.75; muscle tone b _j = 1; presence of hyperkinesis b _j = 0.5).

2. B = Mon, n = 0, no mental disorders were found in the girl.

3. B = Pn, n = 1, only mother and the closest people understand speech and bj = 0.25.

Thus, at the time of the study, the coefficient of limitation of the girl’s vital activity was equal to:

During the year, the girl went through 4 courses of comprehensive rehabilitation measures. After the second course of treatment, the intensity of hyperkinesis in the facial muscles of the face and in the muscles of the hands decreased, their dependence on the emotional background decreased. Posture and gait improved, began to walk indoors without support, with less balancing by hands. I learned to slowly, but fully serve myself. The emotional background has improved, communication with others has ceased to be shy. The speech has become quite understandable. Writing became better without the same fatigue. After a year of treatment, hyperkinesis began to appear only with excitement, expressed emotions. I started walking alone on the street, using public transport. Friendly hand movements appeared while walking. She eats and dresses herself, helps her mother when cleaning the apartment. The clinical results were persistent, the girl entered the institute.

The coefficient of functional state after rehabilitation (K) corresponds to: B = Dn, n = 6 (muscle strength, muscle tone and position of limb segments b _j = 1; volume of active movements, hyperkinesis and coordination of movements b _j = 0.75); B = pH, b _j = 0.5

The girl is set to the first degree of disability.

Recommendations The girl was removed from the dispensary in connection with the achievement of 18 years of age. We hope that the high level of her intellectual development and the increased motivation for treatment will not allow her to stop classes in accordance with our recommendations.

So, the use of a system for calculating the degree of limitation of vital functions developed by us is quite simple, convenient and affordable. It is advisable to use the proposed rating scales in rehabilitation institutions for the rapid assessment of the functional state of a disabled child in order to timely carry out correction of the rehabilitation process.

Claims (1)

A method for assessing the disability of children of a neuropsychiatric profile based on determining the severity of functional disorders by testing according to the types of functional disorders, evaluating the obtained indices in points and then determining the coefficient of functional state, while motor types (B) are taken into account as types of functional disorders (B), including types (i) of disorders: muscle strength, muscle tone, range of active movements, posture and position of limb segments, coordination Vision, characteristic hyperkinesis; disorders of mental functions (Mon), including disorders (i): emotional-volitional sphere, thinking, mental development, underdevelopment of the intellectual sphere; speech impairment (Rn), each of the types of functional impairment (i) is divided into five levels (j) according to the severity of the impairment and is evaluated on a point scale (b _j ) from b _j = 0 - a strong degree of impairment when j = 1 to b _j = 1 - no violation at j = 5, calculate the coefficient of functional state (K) according to the formula

where n is the number of violations in each type of functional disorder; m is the total number of assessed violations; B - type of functional impairment of Dn, Mon, or Rn; B _i - the presence of the type of violation: yes - 1, no - 0; b _j is the estimated score, which for j = 1, b1 = 0; j = 2, b2 = 0.25; j = 3, b3 = 0.5; j = 4, b4 = 10.75; j = 5, b5 = 1; and with a value of K more than 75%, a slight degree of limitation of vital activity is recorded, with K from 50 to 75% - an average degree and with K from 0 to 49% - a strong degree of limitation of vital activity.