RU2462187C1 - Method of estimating degree of life activity limitations in children in category ability to control their behaviour - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to methods of estimating degree of life activity limitations. Elaborated is point system of estimating degree of impairment of ability of control their behaviour in children of different age. Each criterion is evaluated by 4-point system, testing is carried out for three age periods, previous to child's age at the moment of examination. Correspondence of criterion to age period in norm is evaluated as 3 points. Lack of correspondence of criterion to age period in norm or delay in performance by one age period is evaluated as 2 points. Delay in performance by two age periods is evaluated as 1 point, and delay by three age periods is evaluated as 0 points. Obtained points are summed up, total number of points, obtained in testing serving as estimation of degree of life activity limitations in said category in each age period. Deviation from maximal sum of points is calculated in percent and reduction of number of obtained points by 0-4% is classified as absence of life activity limitations, reduction by 5-24% - as insignificant limitations 1 degree, reduction by 25-49% - as moderately expressed limitations - 2 degree, reduction by 50-95% - as severe limitations - 3 degree, by 96-100% - as absolute limitation of life activity.

EFFECT: method makes it possible to determine degree of impairment of ability to control their behaviour in children of different age.

1 tbl, 3 ex

Description

The invention relates to medicine, specifically to methods for assessing the degree of disability in the category of “ability to control their behavior” in children of different ages, and can be used to conduct medical and social examination when establishing the status of “disabled child” and to draw up an individual rehabilitation program and evaluating the effectiveness of its implementation in dynamic observation.

Life restriction (OZD) - a complete or partial loss by a person of his ability or ability to carry out the basic components of everyday life.

In 2001, the World Health Organization (WHO) approved the International Classification of Functioning, Disability and Health (ICF), which is a revision of the 1976 International Classification of Disorders, Disability and Social Disability (MCS).

Three degrees of disability are distinguished: minor violations - no disability, moderate violations - 1 degree of OZD, expressed violations - 2 degree of OZD, significantly expressed violations - 3 degree of OZD. Grade 1 - a periodically arising restriction of the ability to control one’s behavior in difficult life situations and (or) a constant difficulty in performing role-playing functions affecting certain areas of life, with the possibility of partial self-correction. Grade 2 - a constant decrease in criticism of one’s behavior and environment, with the possibility of partial correction only with regular help from others. Grade 3 - the inability to control their behavior, the impossibility of its correction, the need for constant assistance (supervision) of other persons.

There is a method for determining the rehabilitation potential of a disabled person, when during the medical examination they measure values and quantitatively assess the partial indicators of the syndromic manifestations of all the functional disorders of the disabled person, after which they calculate the severity of these functional disorders with the definition of the leading type of disorders, calculate the products of scaled assessments of various types of severity of restrictions vital activity corresponding to the calculated degrees of severity of various disturbed functions, the values of assessing the probability of eliminating the syndromic manifestation of a given disorder in the corresponding degree of its severity, the life limitation corresponding to the maximum value of the aforementioned work is taken as the leader, and the product of the severity of the leading life limitation and the probability of eliminating the syndromic manifestation of the leading function violation the rehabilitation potential of a disabled person (RF Patent No. 2310392).

There is a method of assessing disabilities in post-stroke patients (RuNoSkoK), which includes a scoring of their functionality, followed by gradation of the total score according to the severity of functional limitations and the preservation of functionality. According to the method, the quantitative value of the degree of severity of vital signs is evaluated according to each criterion: self-service, which depends on the preservation of the functions of the upper extremities (Ru), the ability to move and walk, depending on the functions of the lower extremities and the coordinate-static sphere (But), the safety of sensory functions, in including speech difficulties, ensuring the sociability of the patient (C), the preservation of cognitive functions and the emotional-volitional sphere of the personality (Co), quality of life (K), on a 5-point scale: 5 - normal, 4 - slight restrictions, 3 - moderate violations, the need for the use of assistive devices, 2 - severe disorders, the need for periodic assistance, 1 - gross restrictions, the inability to perform functions without assistance. The first four criteria are considered by medical personnel, the last - by the patient himself. Summarize the scores and evaluate the health-related disabilities according to the following scale: 25 - high, fully preserved functional capabilities, 20-24 - mild disabilities, 15-19 - moderate disabilities, 10-14 - severe disabilities, 5 -9 - gross disability and extremely low functionality (RF Patent No. 2325099).

The disadvantage of this method is that it does not provide for the examination of children of different ages, taking into account the stages of formation of various functions in children.

The method we have chosen as a prototype.

In the Russian Federation, when establishing the category of “disabled child”, one of the considered categories of life is “the ability to control one’s behavior”, i.e. ability to self-awareness and adequate behavior, taking into account socio-legal and moral and ethical standards.

The ability to control your behavior includes:

- the ability to realize 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 their own actions, actions, intentions and motives of another person with an understanding of their meaning and meanings;

- the ability to perceive, recognize and respond adequately to incoming information;

- the ability to correctly identify people and objects;

- the ability to behave properly in accordance with moral, ethical and socio-legal norms, to observe the 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, performing role functions;

- the ability to change their behavior when changing conditions or ineffective behavior (plasticity, criticality and variability);

- the ability to realize personal safety (understanding of external danger, recognition of objects that can cause harm, etc.);

- the full use of tools, sign systems in the management of their own behavior.

The objective of the invention is to develop a reliable way to assess the degree of disability in the category of "ability to control their behavior" in children.

The technical result aimed at solving the problem is to establish the degree of impaired ability to control their behavior in children of different ages during medical and social examination in order to establish the status of a “disabled child” and to draw up an individual rehabilitation program and evaluate the effectiveness of its implementation under dynamic observation .

The problem is solved by assessing the degree of violation of the criteria characterizing the ability to control their behavior, based on the use of a scoring system for assessing existing disorders that reflect mental functions in each age period, while at the time of the survey, the table contained in the description evaluates the criteria, each criterion is evaluated according to a 4-point system, testing is carried out for three age periods previous to the child's age at the time of the examination, in the first year of the child’s life one age period say six months of life: the first and second half of the year, and at the age of 6 months of assessment of acquired skills held for the past 6 months, at the age of 12 months - over the past 12 months - 2 age periods; from 1 to 7 years - annually: 2, 3, 4, 5, 6, 7 years, at the age of 7 years - 5, 6 and 7 years; from 8 to 10 years - for the three, previous to the time of the survey, age periods: at the age of 10 years - 6, 7, 10 years, while the criterion for matching the age period is normally estimated at 3 points, the criterion for not matching the age period for normal or lagging in the norm performance for one age period is estimated at 2 points, lag in performance for two age periods is estimated at 1 point, and lag for three age periods is 0 points, summarized points are obtained, while the total number of points scored during testing serves as an estimate of step no life restrictions in this category in each age period, the deviation from the maximum points is calculated as a percentage and a decrease in the number of points scored by 0-4% is classified as the absence of life limitations, a decrease of 5-24% as minor restrictions - 1 degree, reduction 25-49% - as moderately expressed restrictions - 2 degree, reduction by 50-95% as severe restrictions - 3 degree, by 96-100% - as an absolute limitation of life.

Consider "general interpersonal interactions" and "specific interpersonal relationships."

In the component “general interpersonal interactions”, it is necessary to consider the following criteria: basic interpersonal interactions, i.e. the ability to interact with people in accordance with the situation and in a socially acceptable form, for example, paying attention and respect in appropriate cases or responding to the feelings of others, and complex interpersonal interactions, i.e. the ability to maintain and manage interactions with people in accordance with the situation and in a socially acceptable form, for example, control over emotions and impulsive impulses, verbal and physical aggression; independence in social interaction; behavior in accordance with social norms and rules.

Evaluation of the criteria characterizing the ability to control their behavior should take into account the child’s age and the stages of the formation of various functions that ensure the person’s ability to control his behavior in various situations. The considered aspects of life are characterized by various variants of a series of indicators related to the violation of the complex of various body functions, the influence of the combination of violations of which on the child’s ability to control their behavior is often difficult to take into account.

We have developed a point system for assessing the degree of violations in the category of “ability to control one’s behavior” in children of different ages, see the Table.

Assessment of the degree of impaired ability to control their behavior is carried out according to the following criteria, corresponding to different age groups of children.

6 months (first half)

- Fading or focusing on sounds or visual fixation on an object (object or face of a person).

- A smile at the sight of the mother.

- Vocalization.

- Well-pronounced “revitalization complex” in contact with an adult.

1 year (second half of life)

- The child responds positively (manifestation of satisfaction) to the affectionate and cordial attitude of loved ones to him.

- He is in positive contact with loved ones.

- Reacts screaming at the ill-treatment of him.

2 years

Fading or concentration with sounds or visual fixation on an object (object or face of a person).

Smile at the sight of mother.

Vocalization.

The “revitalization complex” is clearly expressed in contact with an adult.

The child responds positively (manifestation of satisfaction) to the affectionate and cordial attitude of those close to him.

He is in positive contact with loved ones.

Reacts with a cry to ill-treatment.

Distinguishes between “strangers” and “friends”

Interested in communicating with an adult.

Carries familiar actions to toys.

Pays attention to appearance (dirty hands, face).

Finishes the game started (achieves the final result).

3 years

The child responds positively (manifestation of satisfaction) to the affectionate and cordial attitude of those close to him.

He is in positive contact with loved ones.

Reacts with a cry to ill-treatment.

Distinguishes between “strangers” and “friends”

Interested in communicating with an adult.

Carries familiar actions to toys.

Pays attention to appearance (dirty hands, face).

Finishes the game started (achieves the final result).

Contact with people in accordance with the situation.

Actively participates in games and unites in them with other children.

Creates friendships with other children.

Adequately refers to the attitude of parents to themselves.

He not only distinguishes between “strangers” and “friends”, but also treats them accordingly to the situation.

Contact with people in accordance with the situation.

Words outlines their actions and intentions.

Speech is becoming the main means of communication not only with adults, but also with children.

Demonstrates his talents to an audience.

4 years

Distinguishes between “strangers” and “friends”.

Interested in communicating with an adult.

Carries familiar actions to toys.

Pays attention to appearance (dirty hands, face).

Finishes the game started (achieves the final result).

Contact with people in accordance with the situation.

Actively participates in games and unites in them with other children.

Creates friendships with other children.

Adequately refers to the attitude of parents to themselves.

He not only distinguishes between “strangers” and “friends”, but also treats them accordingly to the situation.

Contact with people in accordance with the situation.

Words outlines their actions and intentions.

Speech is becoming the main means of communication not only with adults, but also with children.

Demonstrates his talents to an audience.

Develops relationships with other children (active in games with other children).

He is actively mastering the regulation of social-role relations with other children.

5 years

Contact with people in accordance with the situation.

Actively participates in games and unites in them with other children.

Creates friendships with other children.

Adequately refers to the attitude of parents to themselves.

He not only distinguishes between “strangers” and “friends”, but also treats them accordingly to the situation.

Contact with people in accordance with the situation.

Words outlines their actions and intentions.

Speech is becoming the main means of communication not only with adults, but also with children.

Demonstrates his talents to an audience.

Develops relationships with other children (active in games with other children).

He is actively mastering the regulation of social-role relations with other children.

He shows attention and respect in response to these relations from others, in accordance with the situation and in a socially acceptable form.

Shows satisfaction and gratitude in response to these relationships from others, in accordance with the situation and in a socially acceptable form.

It responds with a physical touch and can answer it in relations with others, in accordance with the situation and in a socially acceptable form.

6 years

Develops relationships with other children (active in games with other children).

He is actively mastering the regulation of social-role relations with other children.

He shows attention and respect in response to these relations from others, in accordance with the situation and in a socially acceptable form.

Shows satisfaction and gratitude in response to these relationships from others, in accordance with the situation and in a socially acceptable form.

It responds with a physical touch and can answer it in relations with others, in accordance with the situation and in a socially acceptable form.

Fulfills the rules arising from the role assumed.

A role-playing game is replaced by a game with rules.

Ready for meaningful collaboration with an adult.

There is arbitrary behavior, i.e. behavior is mediated by rules and regulations set by adults.

7 years

He shows attention and respect in response to these relations from others, in accordance with the situation and in a socially acceptable form.

Shows satisfaction and gratitude in response to these relationships from others, in accordance with the situation and in a socially acceptable form.

It responds with a physical touch and can answer it in relations with others, in accordance with the situation and in a socially acceptable form.

Fulfills the rules arising from the role assumed.

A role-playing game is replaced by a game with rules.

Ready for meaningful collaboration with an adult.

There is arbitrary behavior, i.e. behavior is mediated by rules and regulations set by adults.

May express the opposite opinion or disagreement and response to criticism from others, in accordance with the situation and in a socially acceptable form.

It can create and maintain certain relations on a formal basis with people who have power or have a higher social position (for example, with a teacher in school or with a teacher in kindergarten).

Can create and maintain relationships with other children in the family.

Can create and maintain relationships with his parents.

Can create and maintain relationships with other relatives.

10 years

Fulfills the rules arising from the role assumed.

A role-playing game is replaced by a game with rules.

Ready for meaningful collaboration with an adult.

There is arbitrary behavior, i.e. behavior is mediated by rules and regulations set by adults.

May express the opposite opinion or disagreement and response to criticism from others, in accordance with the situation and in a socially acceptable form.

It can create and maintain certain relations on a formal basis with people who have power or have a higher social position (for example, with a teacher in school or with a teacher in kindergarten).

Can create and maintain relationships with other children in the family.

Can create and maintain relationships with his parents.

Can create and maintain relationships with other relatives.

Accepts someone else's behavior and responds to tolerance on the part of others, in accordance with the situation and in a socially acceptable form.

Can make hints and signs in response to the hints of others that arise in social interactions.

Starts and supports interactions with people in accordance with the situation and in a socially acceptable form.

It can stop interacting with people in accordance with the situation and in a socially acceptable form.

Able to regulate emotions and impulses, verbal and physical aggressiveness in interactions with other people in accordance with the situation and in a socially acceptable form.

It can independently behave in interactions with other people, in accordance with social norms and in accordance with its role, position or other social status.

Able to be aware and respect the distance allowed between himself and people in accordance with circumstances, surroundings and culture.

Can establish temporary contacts and contacts with strangers that pursue certain goals, for example, asking about the direction of movement or when making purchases.

It can create and maintain certain relations on a formal basis with people who have a lower social position (for example, being the head of the class, communicating with classmates).

It can create and maintain certain relations on a formal basis with people of equal social status (for example, with classmates).

Creates and maintains relationships with other people, such as casual relationships with people living in the same community or place of residence, with classmates, students, friends, people of the same social level or profession.

Creates and maintains friendships characterized by mutual respect and common interests.

Creates and maintains informal relationships with people living in the neighborhood or on the same territory.

Can create and maintain informal relationships with acquaintances who are not friends.

It can create and maintain informal relations for various reasons or for different purposes with people living in the same house or in a place of residence with private or public administration (for example, in the courtyard of the house).

Can create and maintain informal relationships with people of the same age, interests, or having something in common (for example, classes in interest groups).

Correspondence of the criterion to the age period is normally assessed at 3 points, non-compliance of the criterion with the age period is normal or the lag for one age period is assessed at 2 points, the lag in fulfillment for two age periods is estimated at 1 point, and the lag for three age periods at 0 points.

The International Classification of Functioning (ICF) defines a decrease in capacity by 0-4% as the absence of restrictions, by 5-24% as minor restrictions, by 25-49% as moderately severe restrictions, by 50-95% as severe restrictions, by 96-100% - as absolute restrictions (International Classification of Functioning, Disability and Health. // Translation by G.D.Shostka, V.Yu. Ryasnyansky, A.V. Kvashin et al. / WHO, Geneva. 2001, 342 from.).

The method is as follows.

An assessment is made of the degree of violation of the criteria characterizing the “ability to control one’s behavior” based on the use of a point system for assessing existing disorders that reflect mental functions in each age period.

Clinical examples of the method

Example 1. Boy D., 3 years 8 months. Diagnosis: type 0 glycogen disease.

Testing criteria The number of points The child responds positively (manifestation of satisfaction) to the affectionate and cordial attitude of those close to him. 0 He is in positive contact with loved ones. one Reacts with a cry to ill-treatment. one Distinguishes between “strangers” and “friends” 2 Interested in communicating with an adult. one Carries familiar actions to toys. 2 Pays attention to appearance (dirty hands, face). one Finishes the game started (achieves the final result). one Contact with people in accordance with the situation. 2 Actively participates in games and unites in them with other children. 3 Creates friendships with other children. 2 Adequately refers to the attitude of parents to themselves. 3 He not only distinguishes between “strangers” and “friends”, but also treats them accordingly to the situation. 2 Contact with people in accordance with the situation. 2 Words outlines their actions and intentions. 2 Speech is becoming the main means of communication not only with adults, but also with children. 3 Demonstrates his talents to an audience. 2 Total: thirty Conclusion During testing, the child scored 30 points out of the maximum possible 40, which is 75%. The ability to control your behavior is reduced by 25%, i.e. there are disabilities in the category “ability to control one’s behavior”, which are classified as moderate restrictions of the 2nd degree.

Example 2. Girl P., 10 years old. Diagnosis: chronic gastroduodenitis.

Testing criteria The number of points Fulfills the rules arising from the role assumed. one A role-playing game is replaced by a game with rules. one Ready for meaningful collaboration with an adult. one There is an arbitrary behavior, that is, behavior is mediated by the rules and norms set by adults. one May express the opposite opinion or disagreement and response to criticism from others, in accordance with the situation and in a socially acceptable form. 2 It can create and maintain certain relations on a formal basis with people who have power or occupy a higher social position. 2 Can create and maintain relationships with other children in the family. 2 Can create and maintain relationships with his parents. 2 Can create and maintain relationships with other relatives. 2 Accepts someone else's behavior and responds to tolerance on the part of others, in accordance with the situation and in a socially acceptable form. 2 Can make hints and signs in response to the hints of others that arise in social interactions. 3 Starts and supports interactions with people in accordance with the situation and in a socially acceptable form. 2 It can stop interacting with people in accordance with the situation and in a socially acceptable form. 3 Able to regulate emotions and impulses, verbal and physical aggressiveness in interactions with other people in accordance with the situation and in a socially acceptable form. 3 It can independently behave in interactions with other people, in accordance with social norms and in accordance with its role, position or other social status. 3 Able to be aware and respect the distance allowed between himself and people in accordance with circumstances, surroundings and culture. 3 Can establish temporary contacts and contacts with strangers that pursue certain goals, for example, asking about the direction of movement or when making purchases. 3 It can create and maintain certain relations on a formal basis with people who have a lower social position (for example, being the head of the class, communicating with classmates). 3 It can create and maintain certain relations on a formal basis with people of equal social status (for example, with classmates). 3 Creates and maintains relationships with other people, such as casual relationships with people living in the same community or place of residence. 3 Creates and maintains friendships characterized by mutual respect and common interests. 3 Creates and maintains informal relationships with people living in the neighborhood or on the same territory. 3 Can create and maintain informal relationships with acquaintances who are not friends. 3 Can create and maintain informal relationships for various reasons or for different purposes with people living in the same house or in the place of residence (for example, in the courtyard of the house). 3 Can create and maintain informal relationships with people of the same age, interests, or having something in common (for example, classes in interest groups). 3 Test scores 60 The maximum possible number of points in 10 years 62 Conclusion: During testing, the child scored 60 points out of the maximum possible 62, which is 96.8%. The ability to control one’s behavior is reduced by 3.2%, i.e. There are no life restrictions in the category “ability to control one’s behavior”.

Example 3. Boy K., 7 years old. Diagnosis: cerebral palsy

Testing criteria The number of points He shows attention and respect in response to these relations from others, in accordance with the situation and in a socially acceptable form. one Shows satisfaction and gratitude in response to these relationships from others, in accordance with the situation and in a socially acceptable form. 0 It responds with a physical touch and can answer it in relations with others, in accordance with the situation and in a socially acceptable form. one Fulfills the rules arising from the role assumed. one A role-playing game is replaced by a game with rules. one Ready for meaningful collaboration with an adult. one There is an arbitrary behavior, that is, behavior is mediated by the rules and norms set by adults. one May express the opposite opinion or disagreement and response to criticism from others, in accordance with the situation. 2 It can create and maintain certain relations on a formal basis with people who have power or have a higher social position (for example, with a teacher in school or with a teacher in kindergarten). 2 Can create and maintain relationships with other children in the family. 2 Can create and maintain relationships with his parents. 2 Can create and maintain relationships with other relatives. 2 Test scores 16 The maximum possible score in 7 years 26 Conclusion: During testing, the child scored 16 points out of the maximum possible 26, which is 61.5%. The ability to control one’s behavior is reduced by 38.5%, i.e. there are disabilities in the category “ability to control one’s behavior”, which are classified as moderate restrictions of the 2nd degree.

The point system can be an objective criterion for assessing the degree of disability in the category of “ability to control one’s behavior” in children of different ages and be used in conducting medical and social examinations in order to establish the status of a “disabled child” and to draw up an individual rehabilitation program and evaluate the effectiveness of its implementation under dynamic observation.

Claims (1)

A method for assessing the degree of disability in children in the category of ability to control their behavior, including assessing the degree of violation of the criteria characterizing the ability to control their behavior, based on the use of a point system for assessing existing disorders that reflect mental functions in each age period, characterized in that they assess the degree of violation criteria at the time of the survey according to the Table contained in the description, with each criterion being evaluated on a 4-point system, test Testing is carried out for three age periods preceding the child’s age at the time of the examination; in the first year of a child’s life, for one age period, consider the half year of life: the first and second half of the year, and at the age of 6 months, the assessment of acquired skills is carried out for the past 6 months, at the age of 12 months - over the past 12 months - 2 age periods; from 1 to 7 years old - annually: 2, 3, 4, 5, 6, 7 years old, at the age of 7 years old - 5, 6 and 7 years old, from 8 to 10 years old - for the three previous moments of the examination of the age period: aged 10 years: 6, 7, 10 years, while the compliance of the criterion with the age period is normally estimated at 3 points, the criterion’s mismatch with the age period is normal or the gap in performance for one age period is estimated at 2 points, the gap in performance for two age periods is estimated at 1 point, and a lag of three age periods - 0 points, summarize the points received, while the total The number of points scored during testing serves as an assessment of the degree of disability in this category in each age period, the deviation from the maximum score is calculated as a percentage, and a decrease in the number of scored points by 0-4% is classified as a lack of disability, a decrease of 5-24 % - as minor restrictions - 1 degree, a decrease of 25-49% - as moderately severe restrictions - 2 degrees, a decrease of 50-95% - as severe restrictions - 3 degrees, by 96-100% - as an absolute restriction of life tee.