Impaired walking degree for MSE. Minor Violation

FROM THE COURTROOM:

About ambiguities in the criteria for determining the degree of violations of body functions when providing public service for conducting medical and social expertise

On September 3, 2012, my son once again applied for the state service on medical and social expertise (hereinafter referred to as ITU) to Bureau No. 5 of the Federal State Institution ITU for the Novosibirsk Region (hereinafter referred to as NSO). ITU Headquarters for NSO denied him recognition of the need for measures social assistance, protection and rehabilitation (in recognition of his disability) in the presence of a complex set of diseases: (list of diseases).

Section III of the Order of the Ministry of Health and Social Development of the Russian Federation No. 295n dated April 11, 2011 “On Approval of the Administrative Regulations for the Provision of State Services for Conducting Medical and Social Expertise” (hereinafter referred to as the “Regulations”) determines the timing and sequence of actions (administrative procedures) when conducting medical and social expertise in in order to improve the quality of the provision of public services and create comfortable conditions for its receipt.

Degree of dysfunction organism is characterized by different indicators and depends on kind functional disorders and methods their definitions.

First of all, in survey reports and decisions of Bureau No. 5, Compositions No. 4 and 2 of the FGU ITU for the Novosibirsk Region not defined p.p. 10.2-10.13 the degree of severity of disorders of body functions caused by a complex set of diseases (list of diseases), the symptoms of disorders are simply described in the acts.

To the main types of violations of the functions of the human body in accordance with clauses 3, 4 of the order of the Ministry of Health and Social Development of the Russian Federation No. 1013n of December 23, 2009 “On approval of classifications and criteria used in the implementation of medical and social examination of citizens federal agencies medical and social expertise" (hereinafter - "Order No. 1013n") include:

Violations of mental functions (perception, attention, memory, thinking, intellect, emotions, will, consciousness, behavior, psychomotor functions);

Violations of language and speech functions (disorders of oral (rhinolalia, dysarthria, stuttering, alalia, aphasia) and written (dysgraphia, dyslexia), verbal and non-verbal speech, voice formation disorders, etc.);

Violations of sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity);

Violations of statodynamic functions (motor functions of the head, trunk, limbs, statics, coordination of movements);

Violations of the functions of blood circulation, ... .. metabolism and energy, internal secretion, immunity;

Violation of body functions is determined by integrated assessment various indicators and is characterized by four degrees of their severity:

1 degree - minor violations,

Grade 2 - moderate violations,

Grade 3 - severe violations,

Grade 4 - significant violations.

On the basis of paragraph 7 of the "Order 1013n" the degree of limitation of the maincategories of human life is determined based on the assessment of their deviation from the norm, corresponding to a certain period (age) biological development person.

ITU certification reports contain information only on clause 10.1 about analysis of violations organism (minor disturbances) according to mental functions based on the application of the following objective methods: "10 words of Luria", "Schulz's table, the method of excluding objects, the projective method of Luscher.

Not in the acts analysis of other violations body functions p.p. 10.2-10.13 specified in clause 3 of Order No. 1013n, determination of any indicators of these disorders in a complex of diseases (list of diseases) , based on the assessment of the deviation from the norm of the biological development of a healthy person.

In acts methods that were used to determine quantitative and qualitative level severity indicators(minor, moderate, pronounced) any violations of the functions of the body p.p. 10.2-10.13 (except for violations of mental functions - clause 10.1) associated with diseases (list of diseases).

FOR EXAMPLE, when describing symptoms (complaints) of violations of body functions in acts: (list of symptoms of diseases) NOT DEFINED what violations these symptoms are (minor, moderate, severe), according to what rules their deviations are determined at (list of diseases), using what objective methods.

In acts is absent description existing norms(in particular, norms of presence (disease symptom), norms of quantity (symptoms of disease), norms of presence (symptom of disease) corresponding to the biological development (age of 26 years) of a person, and rating scales(minor, moderate, pronounced) function deviations organism, from these norms.

Secondly, on the basis of clause 56 of the “Regulations”, additional examinations were not carried out at the request of the son to determine the rehabilitation potential and forecast. In the direction (form No. 088 / y-06) Polyclinics No. .... these indicators are defined as short and doubtful. In 2011 Polyclinic No.…. in the direction of the ITU also indicated that the rehabilitation potential and the prognosis were “uncertain and doubtful”. In the acts of the ITU in 2011, the rehabilitation potential and the forecast were replaced by "favorable". In 2011, my son suffered (the disease) again in a severe form and, according to CT of the brain, he has new foci and neoplasms of a secondary nature that affect his health.

The question arises how the ITU commissions determine the expediency and necessity of a citizen in carrying out rehabilitation and social protection measures and develop individual rehabilitation programs (IPR) no definition rehabilitation potential and prognosis disease development?

According to the “Regulations”, the head of the GB ITU may invite an employment service specialist to a meeting of the Composition No. 2 of the GB ITU. According to his son, the specialist was not invited to the ITU commission. He was sent to the employment center for the selection of professions subject to contraindications for diseases, but in the direction to the employment center, ITU specialists did not indicate any diseases or contraindications for them. Therefore, in the conclusion of the employment center, a list of professions is defined without taking into account diseases and contraindications by them. The son sent a letter about this to the GB ITU. This claim about the definition of a list of professions without taking into account contraindications for diseases was left without attention. In turn, the employment center responded to such a claim and sent a letter to his son with an invitation to re-conduct the selection of professions, taking into account the order of the Ministry of Health and Social Development of the Russian Federation No. 302n of 04/12/2012.

The re-selection of professions determined that, despite the secondary specialized education (manager), the son was recommended professional activity in the field of specialties that do not require qualifications, by profession a packer, labeler, packer. At the same time, the mode of work (full or part-time), the level of tension and the amount of work performed are not defined.

"Order No. 1013n" determines that the ability to labor activity(in accordance with the requirements for the content, volume, quality and conditions of work) 1 degree - this is the ability to perform labor activities in normal working conditions with a decrease in qualification, severity, tension and (or) a decrease in the volume of work, inability to continue working in the main profession while maintaining the ability to perform labor activities of a lower qualification under normal working conditions.

Procedure requirements violated provision of public services for conducting ITU: not determining the rehabilitation potential and prognosis when establishing the need for measures of social assistance, protection and rehabilitation; determination of the ability to work and the selection of professions disregard for contraindications for diseases; the degree of severity of the violation of the functions of the body, items 10.2-10.13, has not been determined in connection with diseases (list of diseases); indicators are not specified, on the basis of which the severity of violations can be determined; no methods specified, with the use of which indicators and the degree of severity of violations of body functions can be determined.

Thirdly, during 2009-2012, Polyclinic No. ... .. when filling out the form No. 088 / u-06 of the referral to the MES, monitored the dynamics of the son's health, taking into account a complex set of diseases (list of diseases). In February 2011, in the direction to the ITU, it was indicated that the last attack was in 2007, despite the fact that the Polyclinic No. .... the son provided copies of the ambulance calls in 2010, in addition, in 2010 he had 75 seizures.

Conclusions of the Bureau No. 5, Compositions 4 and 2 of the GB ITU on NSO are not complex assessment of various indicators of body functions disorders, do not contain information about the severity disorders of body functions associated with a complex of diseases (list of diseases) based on existing norms corresponding to a certain period (age) of human biological development. Currently, the son cannot work due to the frequent manifestations of the above symptoms, he does not receive at the Polyclinic No. .... at the place of residence of any treatment conducive to his social adaptation and rehabilitation.

GB ITU response to NSO for numerous appeals does not contain answers on the merits of all the questions posed; on time copy not provided surveys by Composition No. 2; ITU decisions not clarified Composition 4 and 2 based on existing norms and methods for determining violations of body functions in a complex of diseases; not explained why additional examinations were not carried out to determine the rehabilitation prognosis and potential; re not determined a list of professions, taking into account contraindications for diseases and the degree of ability to work.

Violated the procedure for conducting public services in accordance with the "Regulations" and regulations - not defined(clauses 10.2-10.12) the degree of severity (minor, moderate, severe) of violations of body functions due to diseases; not defined rehabilitation potential and disease prognosis; the ability to work with taking into account contraindications for diseases (list of diseases).

Not defined existing norms corresponding to a certain period (age) of human biological development; not defined the degree of disability as a result of diseases based on an assessment of deviations from these existing norms corresponding to a certain period (age 26 years) of biological development.

Substantial answers not given to all questions of appeals concerning information about the state of health, methods of examination, the degree of impairment of body functions as a result of a complex set of diseases.

Copy of act survey by Composition No. 2 of the GB ITU for NSO provided only after two months, after the court sent a copy of the statement of claim to the GB ITU for NSO.

In order to transparency, objectivity ITU decisions and improve quality and efficiency medical and social expert services , scoring definitions the severity of diseases that lead to impaired body functions and restrictions on the main categories of life varying degrees was sent to court statement of claim on the recognition of the decision of the GB ITU on NSO illegal due to non-compliance with the requirements of the ITU.

To be continued…….

Shalamova Yu.V.,

Just a citizen who, after 4 years of disability, refused the humiliating procedure for another examination 5 times, because. I'm retiring in six months...

P.S. But this cannot be done by my son at the age of 26, sick from birth, having no qualified medical care, neither proper dispensary registration and rehabilitation, to recover, nor the right to social protection and rehabilitation.

In connection with the new and, one might say, unexpected amendments to the Schedule of Diseases, our specialists receive many questions. Still, after all, scoliosis of the 2nd degree with an arc up to 17 degrees has now become a completely invocative disease. We must immediately make a reservation, there is one “but”: they can still be drafted into the army with such a diagnosis only if there are no dysfunctions of the spine. We will try to figure out what such a function includes and how to determine the degree of violation.

As you know, the spine in human life performs protective, static and motor functions. The fitness category "B" will be established for a citizen suffering from the disease "scoliosis" in the event of at least a slight violation of this function. Examination of citizens subject to conscription this disease, regulates Article 66 of the Schedule of Diseases, in the explanations to which it is indicated that dysfunctions are assessed in the aggregate: protective, static and motor functions are taken into account. In other words, the assessment is complex.

As clarified by medical professionals, a comprehensive assessment of spinal function should be based on the interpretation protective function, then on the results of the study of static function, and, lastly, on the restriction of active movements in the spine ( motor function). Please note: the static function characterizes the ability of a person to maintain a certain position of the body for a long time, and the violation of the protective function characterizes neurological disorders. About the existence of a violation motor activity may indicate movement restrictions and associated pain.

So, what is a slight violation of the function of the spine in the disease "scoliosis"? For a slight violation of the function of the spine is characterized by:

Clinical manifestations in the form of incomplete loss of sensitivity in the area of ​​one neuromere, loss or decrease in tendon reflex, decrease in muscle strength of individual muscles of the limb with a general compensation of their functions;

The inability of the spine to carry a vertical load in the form of a pronounced pain syndrome after 5-6 hours of being in an upright position;

Limitation of the range of motion in the corresponding parts of the spine up to 20%.

How is dysfunction assessed and what research methods are used? Static function is examined by conducting myotonometry, electromyography and remote thermography of the back muscles. Neurological disorders are determined by magnetic resonance imaging or computed tomography, and the assessment of the neurological status is carried out by a neurologist.

Once again, we note that only the totality of the above manifestations of the disease gives grounds to determine the degree of dysfunction as insignificant.

If you have any questions, a medical specialist engaged by our lawyers will give you the necessary explanations and recommend the necessary types of research:

Auxiliary means of rehabilitation, such as support and tactile canes, crutches, supports, handrails, contribute to the performance of various statodynamic functions of a person: maintaining a person’s vertical posture, improving stability and mobility by increasing the additional support area, unloading a diseased organ, joint or limb, normalizing weight loads, facilitate movement, maintain a comfortable position.
An assessment of the ability to maintain a vertical posture is carried out using special devices and certain parameters that characterize the process of standing, an analysis of their changes under external and internal influences on a person. This approach underlies the methods of stabilography, cephalography, etc.
The stabilography technique consists in recording and analyzing the parameters characterizing the movement of the horizontal projection of the common center of mass (MCM) standing man.
The body of a standing person continuously oscillates. The movements of the body while maintaining an upright posture reflect various responses to the control of muscle activity. The main parameter by which the regulation of muscle activity occurs is the movement of the human BCM.
Stabilization of the position of the CCM is carried out due to the stabilization of the body, which in turn is provided on the basis of processing information about the position and its movement in space due to the receipt of information by the visual, vestibular, proprioceptive apparatus.
Another technique - cephalography - is the recording and analysis of head movements when standing. This technique is widely used in clinical practice.
Changes in the vestibular apparatus significantly disrupt the provision of a vertical posture and are manifested in a change in the nature of the cephalogram, stabilogram, and body movements aimed at maintaining a vertical posture.
In this state of a person, an increase in the additional area of ​​\u200b\u200bsupport is required due to aids rehabilitation.
In addition to violations of statistical functions, there are violations of the walking function of a person with lesions of the musculoskeletal system.
Clinical indicators Such ODA violations are:
- shortening of the limbs;
- limitation of mobility in the joints, severity and type of contracture;
- muscle hypotrophy lower extremities.
The presence of shortening of the lower limb (LL) significantly affects the structure of walking and stability when standing.
The standing stability is characterized by the amplitude of oscillations of the common center of mass (MCM) and is slightly violated with a slight and moderate shortening of the NC. Even with a pronounced shortening of the NC, a slight and moderate violation of stability is noted. At the same time, there is no pronounced violation of the CCM fluctuations, which indicates the effectiveness of compensation mechanisms aimed at maintaining stability. The consequence of the shortening of the lower limb is the distortion of the pelvis. A shortening of more than 7 cm leads to significant changes in the static-dynamic functions. The study of such disorders is carried out using a special stand with a predominant distribution of the weight load on a healthy LE (more than 60% of body weight) using a shortened LE as an additional support with a pronounced metatarsal-toe standing.

Restriction in joint mobility is expressed primarily in dysfunctions in the hip, knee, ankle joints, foot, while a moderate and severe degree of violation of their function can be determined.
hip joint(TBS)

- reduction of the range of motion up to 60º;
- extension - not less than 160º;
- decreased muscle strength;
- shortening of the lower limb - 7-9 cm;
- locomotion speed - 3.0-1.98 km / h;

- restriction of mobility in the form of a decrease in the amplitude of movement in the sagittal plane - at least 55º;
- at extension - not less than 160º;
- pronounced flexion contracture - extension less than 150º;
- decrease in the strength of the gluteal muscles and thigh muscles by 40% or more;
- locomotion speed - 1.8-1.3 km / h.
Knee joint (KS)
1. Moderate degree of dysfunction:
- bending up to an angle of 110º;
- extension up to 145º;
- decompensated form of joint instability, characterized by frequent pathological mobility with minor loads;
- locomotion speed - up to 2.0 km/h with severe lameness.
2. Severe degree of dysfunction:
- bending up to an angle of 150º;
- extension - less than 140º;
- locomotion speed up to 1.5-1.3 km/h, severe lameness;
- shortening of the step up to 0.15 m with a pronounced asymmetry of lengths;
- coefficient of rhythm - up to 0.7.
Ankle joint (AHJ)
1. Moderate degree of dysfunction:
- restriction of mobility (flexion up to 120-134º, extension up to 95º);
- locomotion speed up to 3.5 km/h.
3. Pronounced degree of dysfunction:
- restriction of mobility (flexion less than 120º, extension up to 95º);
- locomotion speed up to 2.8 km/h.
Vicious position of the foot.
1. calcaneal foot - the angle between the axis of the lower leg and the axis calcaneus less than 90º;
2. equino-varus or equinus foot - the foot is fixed at an angle of more than 125º or more;
3. valgus foot - the angle between the area of ​​support and the transverse axis is more than 30º, open inwards.
4. valgus foot - the angle between the area of ​​support and the transverse axis is more than 30º, open outwards.
In the pathology of TBS, the thigh muscles and gluteal muscles suffer, in the pathology knee joint(KS) - muscles of the thigh and lower leg, with the pathology of the ankle joint (AJ), hypotrophy of the muscles of the lower leg is noted.
Hypotrophy of the muscles of the lower extremities, reflecting the state of the muscular system, has a certain effect on the structure of human walking, in particular, on the duration of the phases of support and transfer of the limbs, and with moderate and severe hypotrophy, pronounced violation temporary parameters.
Muscle hypotrophy up to 5% is classified as mild, 5-9% - moderate, 10% - a pronounced degree of muscle strength reduction.
A decrease in the strength of the muscles of the flexors and extensors of the thigh, lower leg or foot of the affected limb by 40% in relation to the healthy limb is regarded as mild; 70% - as moderate, more than 700% - as pronounced.
Decrease in muscle strength during electromyographic (EMG)
studies, is characterized by a decrease in the amplitude of bioelectrical activity (ABA) by 50-60% of the maximum with moderate dysfunction.
With a pronounced impairment of the ABA function, it decreases significantly in the muscles of the distal extremities to 100 microvolts.
The choice of rehabilitation aids should be carried out individually for each patient, with the help of which he will be able to achieve relative independence (improvement of mobility in the apartment and on the street, self-service, participation in the production process, etc.).

The kidneys are an important paired organ of the human urinary system. In spite of small size(the size of a fist), they perform two main vital functions. The first is the absolute filtration of blood and fluid from unnecessary substances, the second is its removal from the body simultaneously with harmful products and toxins. Kidney failure can lead to serious pathologies and diseases. In order to prevent such consequences, it is necessary to understand the principle of operation of the mechanism, the causes of failure, symptoms and diagnostics, and also learn how to normalize the functioning of the system.

Causes of poor kidney function

Kidney dysfunction can be seen in different reasons ranging from congenital to acquired. A congenital disorder is most often found in the hereditary transmission of the disease from mother to child or in violation of the formation of an organ at the time of intrauterine development.

On a note! Acquired pathologies are influenced by a lot of reasons, for example, lifestyle or other diseases that a person has.

The main and frequently encountered causes include the following causes that provoke and cause severe violations of kidney function:

1. Alcohol abuse. Alcohol contributes to dehydration of the body, from which the blood begins to thicken. As a result, the body receives an enormous load and is forced to work in emergency mode.
2. Smoking. Due to the fact that together with tobacco smoke toxic substances penetrate into the human body, the kidneys are forced to take over Double punch and speed up your performance in order to quickly purify the blood.
3. Obesity. People suffering from such a problem are more at risk of dysfunction, because certain components begin to form and release from excess fat tissue, which lead to a decrease in vascular tone. At this time, excess fat contributes to mechanical pressure on the organs of the urinary system, making it difficult to perform basic duties.
4. Rapid weight loss. Since the kidneys are located in a protective capsule of fat, a sharp decline weight leads to a thinning of this layer, from which vulnerability to external factors is manifested.
5. hypothermia. A common cause of acute
6. Diabetes . Leads to exhaustion of the system huge pressure due to high rate blood sugar.
7. Hypertension. High pressure has an adverse effect on the condition renal vessels, from which they are damaged and lead to disruption of the entire urinary system.
8. Unhealthy food. Fast food, processed foods and soda are the main health pests.
9. Conducting a promiscuous sexual life. Without the use of contraceptive methods, incoming infections affect the entire existing system and lead to inflammation of the paired organ.
10. Pregnancy on later dates . In the literal sense of the word, the kidneys do the work for two, hence the overload occurs, the expectant mother suffers from dysfunction and edema.

Manifested symptoms in dysfunction of the urinary system

Each person knows his usual state, the nature of the discharge, and any change should raise questions and suspicions.

Why are the kidneys not working? Allocate the following signs poor kidney function:

1. Pain in the lumbar region.
2. Increased blood pressure . The fact indicates that the body can not cope with the withdrawal of salt and water. This item applies to those who do not have problems with pressure.
3. Sleep disturbance. Insomnia is a companion of the poor functioning of the paired organ, it can act in tandem with cessation of breathing during sleep.
4. Apathy, loss of energy, lethargy. This is due to an increase in toxins in the blood vessels.
5. Deterioration skin . Paleness and dryness of the skin indicate a change in the condition of the kidneys, as the water and salt balance is disturbed.
6. Modification of the mode of urination. There is an increase or decrease in the amount of urine excreted.
7. The presence of blood in the urine.
8. Presence of foam. In connection with kidney failure it comes to light, from which bubbles and foam are formed.
9. Decreased appetite, nausea and vomiting. These signs are justified by high intoxication.
10. puffy look. Caused by excess fluid and loss of protein.
11. muscle cramps. This happens due to the deprivation of the body of potassium and sodium.
12. Swelling of the legs.

Symptoms of kidney disease are expressed by a number of signs, and it is not always possible to predict their sequence. According to statistics, kidney pathologies are observed among 3.5% of the population.

Consequences of impaired renal function

If the kidneys do not work well, then the problem must be solved urgently and radically in order to prevent disastrous consequences. Some of them include:

1. Renal failure. It represents a complete or partial loss of the ability to form and excrete the urine produced. Hence, there are violations of the balance of water, salt, acid and alkali, from which other systems in the body are disturbed. It is customary to single out acute and chronic insufficiency kidneys. The first is characterized by a sudden manifestation, namely the absence of urine. The second is a gradual decrease in the urinary portion to the absence.
2. Due to the problematic production of secreted fluid, the body is forced to accumulate toxins, which is fraught with poisoning by the products of its own vital activity. All of this will kill over time. important organ. As soon as the work comes to naught, the patient loses his life.
3. Change in the shape of the ureters. The habitual outflow of urine from the body is disturbed, toxic poisoning appears, decomposition of the kidneys and, as a result, the organ refuses to function.
4. In pregnancy, the importance of treatment is highest due to the risk of natural termination of pregnancy.
5. There is a high probability of acquisition, which delivers pronounced discomfort to the owner.
6. Spontaneous or.
7. Due to the presence of unnecessary impurities in the blood, the susceptibility to diseases such as and increases.
8. If treatment is ignored in the future, urine will stop flowing into bladder. The body will not self-purify itself of toxins and waste products formed.

On a note! In order to avoid these consequences, you should carefully listen to the slightest changes in your body.

Diagnosis of the functioning of the kidneys

What to do when bad job kidney or what to do if

Recommendations for the treatment of diseases of the urinary system

Treatment of kidney diseases should be done under the supervision of experienced and qualified doctors who will know the characteristics of the patient's body. However, you can improve their condition on your own by following some recommendations:

1. Limit the consumption of salt, meat and exclude canned food, fast food.
2. Watch your weight, giving preference to a healthy diet.
3. Include more liquid in the diet in the form of water, tea, compote.
4. Refuse bad habits and limit alcohol consumption.
5. To plug physical exercise. If visiting the gym is impossible for any reason, then walking, refusing the elevator will be an excellent substitute.
6. Limit the use of painkillers.
7. Use protection against heavy metals, paints and solvents.
8. Dress warmly to avoid hypothermia.
9. Monitor your blood pressure, sugar and cholesterol levels.
10. Regularly take basic tests to monitor a healthy state.

The manual outlines the general aspects of arthrology (structure and function of the joints, classification of major joint diseases, methods for diagnosing and treating joint diseases, assessment of joint dysfunction), clinical features, diagnostics, differential diagnosis the most common bone and joint pathology - osteoporosis, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, gout, paraneoplastic arthritis and periarticular lesions. The book reflects the features of articular pathology in old age. Modern literary information and a description of their own experience in the use of traditional and non-traditional methods pathogenetic therapy of the discussed pathology, as well as the basics of medical and social expertise in diseases of the joints.

Book:

The severity of the violation of statodynamic function in pathology musculoskeletal system

Moderate violations statodynamic function is diagnosed in patients with moderate or severe joint contracture (decrease in range of motion by 21–34%), which, as a rule, is combined with damage to other joints and the spine without neurological manifestations. Constant, varying degrees expression, lameness. When walking, the patient uses the support, but not constantly, without rest he can walk up to 1-1.5 km. Reducing the circumference of the thigh due to muscle hypotrophy by 3-5 cm. Reducing the pace of walking to 45-55 steps per minute.

For a pronounced violation of the statodynamic function, pronounced or significantly pronounced contractures of the joints (the amplitude is reduced by 35% or more), and dysfunction of the spine are characteristic. Patients are forced to constantly use additional support: a cane or crutches. Severe lameness, without rest you can walk 0.5 km. Reducing the circumference of the thigh due to muscle wasting up to 6 cm or more. Decreasing the pace of walking to 25-35 steps per minute.

Significantly pronounced violation of the statodynamic function is determined with a sharp violation of the function of the joints with difficulty in changing posture, when trying to get out of bed or chair on their own. It is possible to move with the help of other persons or in a wheelchair.