With severe impairment of vital functions. Main causes of kidney dysfunction: symptoms and treatment recommendations

What is the insignificance of the perfect? administrative offense?

If the administrative offense committed is of minor significance, a judge, body, or official authorized to resolve a case of an administrative offense may release the person who committed the administrative offense from administrative liability and limit himself to an oral remark (Article 2.9 of the Code of Administrative Offenses of the Russian Federation).

A minor administrative offense is an action or inaction, although formally containing the elements of an administrative offense, but taking into account the nature of the offense committed and the role of the offender, the amount of harm and the severity of the consequences, which does not represent a significant violation of protected public legal relations.

A minor offense occurs in the absence of a significant threat to protected social relations. Circumstances such as, for example, the identity and property status of the person held accountable, voluntary elimination of the consequences of the offense, compensation for the damage caused, are not circumstances indicating the insignificance of the offense. These circumstances, by virtue of Parts 2 and 3 of Art. 4.1 of the Code of Administrative Offenses of the Russian Federation are taken into account when imposing an administrative penalty.

It must be borne in mind that, taking into account the signs of the objective side of some administrative offenses, under no circumstances can they be considered insignificant, since they significantly violate protected social relations. These, in particular, include administrative offenses provided for:

a) Art. 12.8 of the Code of Administrative Offenses of the Russian Federation on driving a vehicle by a driver who is in a state of intoxication, transferring control of a vehicle to a person who is in a state of intoxication;

b) Art. 12.26 of the Code of Administrative Offenses of the Russian Federation on non-compliance by the driver vehicle requirements to undergo a medical examination for intoxication.

The insignificance of an administrative offense may be established by the court, in particular, when:

a) consideration of a case on bringing to administrative liability;

b) consideration of a case challenging the decision administrative body on bringing to administrative responsibility.

Having established the insignificance of the offense when considering a case on bringing to administrative liability, the reasoning part of the court decision must contain the following conclusions:

a) refusal to satisfy the demands of the administrative body;

b) on exemption from administrative liability due to the insignificance of the offense;

c) on the application of a measure in the form of an oral remark.

In this case, legal expenses incurred by a person released from administrative liability due to a minor offense are not subject to compensation to this person.

If the insignificance of the offense is established during the consideration of the case challenging the decision of the administrative body to bring to administrative responsibility, the court, guided by Part 2 of Art. 211 of the Arbitration Procedure Code of the Russian Federation and Art. 2.9 of the Code of Administrative Offenses of the Russian Federation, makes a decision to declare this resolution illegal and to cancel it.

When qualifying an administrative offense as minor, courts must take into account that Art. 2.9 of the Code of Administrative Offenses of the Russian Federation does not contain any reservations about its non-application to any offenses provided for by the Code of Administrative Offenses of the Russian Federation.

The possibility or impossibility of qualifying an act as minor cannot be established in the abstract, based on the structure of the administrative offense formulated in the Code of Administrative Offenses of the Russian Federation, for which liability is established. Thus, the qualification of an administrative offense as minor cannot be refused only on the grounds that in the relevant article of the Special Part of the Code of Administrative Offenses of the Russian Federation, liability is defined for failure to fulfill any obligation and is not made dependent on the occurrence of any consequences.

The classification of an offense as minor can only occur in exceptional cases and is made taking into account the above provisions in relation to the circumstances of the specific act committed by the person. In this case, the court’s application of the provisions on insignificance must be motivated (clause 18 of the Resolution of the Plenum of the Supreme Arbitration Court of the Russian Federation dated 02.06.2004 N 10 “On some issues that have arisen in judicial practice when considering cases of administrative offenses”).

EPIDEMIOLOGY OF DISABILITY

Indicators of disability, being an important medical and social criterion public health, characterize the level of socio-economic development of society, the ecological state of the territory, and the quality of the preventive measures taken.

The word “disabled” comes from the Latin invalidus – weak, infirm. Disabled it is generally accepted that a person who has a health disorder with a persistent disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of life activities and necessitating his social protection.

Under disability understand social insufficiency due to health problems with a persistent disorder of body functions, leading to limitation of life activity and causing the need for its social protection.

Thus, disability is a social deficiency. What is social disadvantage? Social disadvantage – This social consequences health disorders leading to limitation of life activity, inability (in whole or in part) to fulfill a person’s usual role in social life and necessitating social protection.

The cause of disability is a health disorder with a persistent disorder of body functions, i.e. impairment of physical, mental and social well-being due to loss, disorder, anomaly of the physical, mental or anatomical structure or function of the human body.

3.1. Main causes of disability :

1. Disability due to a general illness is the most common cause of disability, except for cases directly related to occupational diseases, work injury, military trauma, etc.

2. Disability due to work injury is established for citizens whose disability occurred as a result of health damage associated with an industrial accident.

3. Disability due to occupational disease established for citizens whose disability occurred as a result of acute and chronic occupational diseases.

4. Disability since childhood: a person under the age of 18 who is recognized as disabled is assigned the status of “disabled child”; upon reaching the age of 18 years or older, these persons are determined to have “disability since childhood.”

5. Disability among former military personnel is established for diseases and injuries associated with the performance of military duties.

6. Disability due to radiation disasters is established for citizens whose disability occurred as a result of the liquidation of accidents at the Chernobyl nuclear power plant, PA Mayak, etc.

The degree of dysfunction of the body is characterized by various indicators and depends on the type of functional disorders, methods for their determination, the ability to measure and evaluate the results. The following disorders of body functions are distinguished:

disorders of higher mental functions (mental disorders, other psychological disorders, speech, language disorders);

disturbance of the sense organs ( visual disturbances, auditory and vestibular disorders, disorders of smell, touch);

· movement disorders;

· visceral and metabolic disorders, nutritional disorders;

· disfiguring disorders;

· violations associated with general reasons.

· Based on a comprehensive assessment of various parameters, taking into account their qualitative and quantitative values, three degrees of dysfunction of the body are distinguished:

1st degree – slightly expressed dysfunction;

2nd degree – moderately severe dysfunction;

3rd degree – pronounced and significantly expressed dysfunction.

As follows from the definition, disability leads to limitation of life activities, i.e. to the complete or partial loss of a person’s ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work activities. Thus, the main criteria for life activity that disability limits are:

· ability for self-service, i.e. the ability to cope with basic physiological needs and use common household items;

· ability to move, i.e. the ability to walk, run, move, overcome obstacles, control body position;

· ability to learn, i.e. the ability to perceive knowledge (general education, professional, etc.), mastery of skills (social, cultural and everyday);

· ability to orient, i.e. ability to navigate independently environment through sight, hearing, smell, touch, thinking and adequately assess the situation using the intellect;

· ability to communicate, i.e. the ability to establish and develop contacts between people through perception, understanding of another person, and the possibility of exchanging information;

· the ability to control one’s behavior, i.e. the ability to sense oneself and behave correctly in everyday situations.

Depending on the degree of deviation from the norm of human activity due to health impairment, the degree of limitation of life activity is determined. In turn, depending on the degree of disability and the degree of impairment of body functions, a person recognized as disabled is determined by the degree of disability.

Administrative legislation not only determined the actual grounds for application and the system of penalties, but also provided for the real grounds and rules for their imposition.

If we are talking about the application of any administrative penalty, then it is based on a significant number of principles: legality, humanism, transparency, inevitability of punishment, and the like.

There is also such a concept as the insignificance of an administrative offense, which in its essence is not a significant violation, which will be discussed below

Article navigation

Application of administrative measures

The application of administrative liability measures should be based on a number of principles, one of which is the principle of inevitability. Its essence lies in the fact that every subject who has committed a punishable act must suffer a fair punishment.

However, in our time, for objective and subjective reasons, this principle does not always apply. The peculiarity of an administrative violation is that, unlike a criminal act, it is not characterized by a public danger.

Administrative offenses are socially harmful, that is, they cause or objectively can cause certain harm to protected social relations.

However, the amount of such damage, the possibility of its prevention or compensation in material offenses and the objective possibility of causing harm in formal offenses can also influence the type and extent of responsibility of the offender.

The nature of the offense is determined by the signs that characterize the objective side of the violation (action, method and instrument of committing the offense, time, situation).

Identification of the offender

No less important when applying penalties provided for by sanctions is such an aspect as establishing the identity of the offender.

It is clear that the commission of a violation is a consequence of such circumstances as, for example, the conditions of personality formation, interests, outlook on life, etc.

Therefore, when assigning punishment, all this data is taken into account and only then, after in-depth analysis, can a more acceptable measure of influence be prescribed.

It should be noted that administrative laws currently do not contain information about citizens that would be taken into account when imposing punishment.

Therefore, it is necessary to determine only some aspects of the range of information about the offender and document them. It should be noted that identifying mitigating circumstances is not enough to resolve the issue of taking into account the identity of the offender.

It is still necessary to develop proposals that, when imposing a penalty, would help to more accurately take into account the individual. To study the personality of the offender, it is necessary to determine information characterizing it social status, study psychological properties personality, as well as her physiological characteristics(presence of disability, etc.).

The second aspect when imposing an administrative penalty is taking into account the degree of guilt of the offender.

A formal approach to recognizing the presence or absence of a crime means a departure from the principle of humanism and criminal legal influence, a distraction from the fight against real crime. This was well understood in ancient Rome, where the postulate was in effect: de minimus non curat praetor. That is: the praetor (judge) does not deal with trifles.

The conditions under which an administrative offense can be considered insignificant are:

• When it should formally fall under the signs of an act provided for by a certain article of the Criminal Code. Other types may not fall under the concept of a minor act. They must be considered according to the norms of other areas of law: administrative, labor, civil, etc.
• When a minor act must not pose a public danger.

Definition of concepts and characteristics

Since a minor violation is not a crime, it is assessed as such by law enforcement officials. The decision is made taking into account all the features of a particular event.

As a rule, this is an intentional act that does not result in significant harm. This minor harm can be material (theft of private property for an insignificant amount), it can be organizational, etc.

The insignificance of an administrative offense is the qualitative and quantitative actions of a specific violation that deprive these actions of public danger or reduce them to a minimum (small material damage, insignificant manifestation from the objective side, uncertain purpose, motive, insignificant guilt of the offender, etc.).

To decide whether an act is a crime or a minor act, the characteristics of the subject of the action may be important.

There are also completely opposite considerations regarding the fact that the characteristics of the subject are not of fundamental importance, because justice exists on the basis of equality of citizens before the law and the court, which is only possible when the main thing in assessing the activities of a person is the act of the subject, and not one as a person with her positive and negative traits.

The main feature of a crime is its social danger, the infliction of serious, in many cases irreparable harm, or the creation of a threat of causing such harm.

The presence of these signs eliminates the question of the insignificance of the object of the encroachment (when speaking about the object, we mean the object of the encroachment, and not the object that was actually harmed by the encroachment).

If the act is aimed at causing significant or undetermined damage, but in reality minor harm was caused, we also cannot talk about the insignificance of the act. That is, the insignificance of an administrative offense can be discussed only when the encroachment was insignificant or the potential harm could be negligible.

The connection between the concept of insignificance and the concept of decriminalization

Minor acts are not criminal only when their insignificance is both objective and subjective, that is, in terms of the content of guilt, when the person intended to cause minor harm.

In the case between the intention of a person and the result actually achieved by her, responsibility must reflect the actual direction and guilt.

Considering that the object of the crime is social relations, we can say that where there is no encroachment on public relations or such an encroachment is of a minor nature, as a result of which no harm is caused to public relations, there is no crime.

The only exception is when the object becomes insignificant, that is, when it loses its social significance. Loss of significance may be due to various reasons: changes in values, economic conditions, political situation in the country, etc.

Thus, in this case, the concept of insignificance has a connection with such a concept as decriminalization.

It is important to define the concepts and characteristics of minor administrative offenses based on a generalization of the current administrative code of the Russian Federation, as well as to determine the conditions for exemption from administrative prosecution in the event of a citizen committing a minor offense.

The problems of the insignificance of an administrative offense in judicial practice have been the subject of research by many scientists, however, with the development of social relations and the increase in the number of administrative violations, they have not lost their relevance today.

Based on Art. 2.9 of the Code of Administrative Offenses makes it clear that only a government entity, endowed with the right to decide on the merits of the corresponding category of cases, has the right to release a citizen from administrative liability. This circumstance is indicated by the words “...the body authorized to decide the case...”.

That is, a subject that is not endowed with such a right, but is only authorized to open administrative proceedings, will release the violator from liability on the basis of Art. 2.9 of the Code of Administrative Offenses has no right.

The procedure for imposing administrative penalties

Making a decision on exemption from administrative liability is quite problematic for a number of reasons:

• Firstly, an objectively corresponding unlawful act has all the elements of an offense, that is, from a formal point of view, it is an administratively punishable act.
• Secondly, the legislator does not define such an offense and does not even name its characteristics.
• Thirdly, the legislation does not contain minor offenses, which may create the illusion that all formal administrative offenses are minor, but this is far from the case.

Minor administrative offenses are those acts that:

• are not a great public danger
• for which the offender sincerely repented; did not cause significant damage to public interests, civil rights or other legally protected values
• if the material damage caused by such a crime is insignificant and was voluntarily and in full compensated by the offender before a decision on the merits

The question of the necessity or inexpediency of releasing a person from liability if the violation is insignificant in each individual case is decided by the law enforcement agency.

The expediency of releasing a person from administrative liability

The advisability of releasing a person from administrative liability on grounds of insignificance may be indicated by those circumstances that mitigate liability, for example, the fact that the offender does not have established antisocial attitudes, which is confirmed by a positive reference from the place, service, study, residence, the absence of facts of committing illegal acts in the past, committing violations due to negligence and the like.

The need to use such measures of influence on citizens as a remark in judicial practice when an administrative offense is insignificant gives grounds to talk about the inevitability of the state’s response to each violation, in the real implementation of the principle of the inevitability of responsibility.

At the same time, the use of a remark as a way of responding to violations of the law does not mean the application of coercion to the offender, since, firstly, the person remains free to independently direct his behavior and stop or continue committing an illegal act with all its ensuing consequences. Secondly, unlike a warning, a verbal remark is not included among the types of punishments provided for in Art. 3.1 Code of Administrative Offences.

Exemption from administrative liability at the stage of consideration of the case, due to the insignificance of the violation in accordance with Art. 3.1 The Code of Administrative Offenses is not considered the responsibility of a legal body.

In this regard, the specified authorized body is obliged to consider all aspects of the violation committed, assess the situation and make sure that there is no significant damage.

How the humanization of criminal legislation will relieve the workload of the courts - on video:

What needs to be improved at the legislative level

It is also important to take into account the identity of the offender, the nature of the violation, the presence of factors mitigating liability, etc. Therefore, Art. 2.9 on administrative punishment should be stated as follows:

“If a person commits an administrative offense that did not and objectively could not cause significant damage to the rights and interests protected administratively, and provided that the violator realizes the illegality of his act and stops the illegal behavior, the authorized body may release him from liability. An oral reprimand is not an administrative punishment, but acts as a measure of educational influence, aimed at preventing the commission of offenses in the future and explaining to the offender the essence and consequences of his unlawful act.”

The use of an administrative definition when determining the insignificance of an administrative offense in judicial practice will not only simplify the application of Art. 2.9 of the Code of Administrative Violations, but will also reduce the number of abuses by officials when resolving administrative cases.

Submit your question in the form below

For the purposes of military medical examination, a classification of degrees of arterial hypertension (VNOK, 2010) and a three-stage classification of hypertension (WHO, 1996, VNOK, 2010) are used depending on the degree of dysfunction of the “target organs”.

Point “a” includes stage III hypertension, which is characterized by high performance blood pressure(at rest - systolic pressure is 180 mm Hg. and higher, diastolic - 110 mm Hg. and above), confirmed, among other things, by the results of 24-hour blood pressure monitoring. Blood pressure levels may be reduced in people who have had a myocardial infarction or stroke. IN clinical picture severe vascular disorders predominate, which are closely and directly related to the syndrome of arterial hypertension (large focal myocardial infarction, dissecting aortic aneurysm, hemorrhagic, ischemic strokes, generalized narrowing of the retinal arteries with hemorrhages or exudates and swelling of the nipple optic nerve, with impaired renal function with a serum creatinine level of more than 133 µmol/l and (or) creatinine clearance of less than 60 ml/min (Cockroft-Gault formula), proteinuria more than 300 mg/day.

If the diagnosis of stage III hypertension is established only in connection with a minor stroke and (or) small focal myocardial infarction, military personnel undergoing military service under the contract, are inspected under paragraph "b".

Point “b” includes stage II hypertension with arterial hypertension II degree (at rest - systolic pressure is 160 mm Hg and above, diastolic - 100 mm Hg and above), which does not reach optimal levels without constant drug therapy, confirmed, among other things, by the results of repeated 24-hour blood pressure monitoring and moderate dysfunction of target organs.

The clinical picture of stage II hypertension with moderate dysfunction of “target organs” is dominated by vascular disorders, which are not always closely and directly related to the hypertensive syndrome (myocardial infarction, persistent disturbances of heart rhythm and (or) conduction, the presence of atherosclerotic changes in the main arteries with moderate dysfunction, etc.). In addition, cerebral disorders are possible - hypertensive cerebral crises, transient ischemic attacks or discirculatory encephalopathy stage II with motor, sensory, speech, cerebellar, vestibular and other disorders, as well as angina pectoris II FC and (or) chronic heart failure II FC.

Point “c” includes stage II hypertension with arterial hypertension of I - II degrees (at rest - systolic pressure ranges from 140 to 179 mm Hg, diastolic pressure - from 90 to 109 mm Hg) with minor dysfunction "target organs" (chronic heart failure FC I, transient disturbances of heart rhythm and (or) conduction, dyscirculatory encephalopathy stage I) or without dysfunction of the "target organs", as well as stage I with increased performance blood pressure (at rest, systolic pressure ranges from 140 to 159 mm Hg, diastolic pressure ranges from 90 to 99 mm Hg). In stage I hypertension, a short-term increase in blood pressure to higher numbers is possible. There are no signs of target organ damage.

Stage II of hypertension is also characterized by left ventricular hypertrophy (detected by X-ray examination(cardiothoracic index > 50 percent), electrocardiography (Sokolow-Lyon sign > 38 mm, Cornell product > 2440 mm x ms), echocardiography (left ventricular myocardial mass index > 125 g/m2 for men and > 110 g/m2 for women) and 1 - 2 additional changes in other “target organs” - fundus vessels (generalized or local narrowing of retinal vessels), kidneys (microalbuminuria 30 - 300 mg/day, proteinuria and (or) creatinine level 115 - 133 µmol/l for men and 107 - 124 µmol/l for women; creatinine clearance 60 - 89 ml/min (Cockcroft-Gault formula) and main arteries (signs of arterial wall thickening (intima-media complex thickness) with ultrasound examination more than 0.9 mm) and (or) atherosclerotic plaques in them).

In the presence of high blood pressure syndrome, which is closely related to the presence of autonomic disorders (hyperhidrosis of the hands, “red” persistent dermographism, lability of pulse and blood pressure when changing body position, etc.), the examination is carried out on the basis of Article 47 of the disease schedule.

The presence of hypertension in persons examined under columns I and II of the disease schedule must be confirmed by examination in inpatient conditions and the results of documented previous dispensary observation for at least 6 months with mandatory repeated daily monitoring of blood pressure.

In each case of hypertension, a differential diagnosis With symptomatic hypertension. Examination of persons with symptomatic arterial hypertension is carried out according to the underlying disease.

When identifying associated hypertension diseases medical examination is also carried out on the basis of the relevant articles of the disease schedule.

Violation of the static-dynamic function of the hip joint

1. Mild violation characterized by a slight limitation of mobility in the joint, a slight (2-3 cm) relative shortening of one of the limbs if the patient has a residual subluxation or dislocation. X-rays may show signs of precoxarthrosis, stage 1 and 2 coxarthrosis.

A) In the stage of pain compensation. Lameness is practically absent, can be detected mild symptom Trendelburg, a slight decrease (up to 4 points) in muscle strength. If shortening is noted, it is fully compensated by pelvic distortion. The support loads on both limbs are equal or there is a slight decrease (up to 45%) in the support on the affected leg. The rhythmicity coefficient is 1.0.

B) In the stage of subcompensation, pain syndrome is noted when physical activity, a decrease in support on the affected limb by up to 40%, usually accompanied by a decrease in the rhythmicity coefficient to 0.89-0.8 and slight lameness of the patient during long walking, which decreases after rest and taking painkillers. Trendelburg's symptom is mild to moderate, that is, the main compensatory mechanisms are aimed at unloading the affected limb.

C) There is no stage of decompensation.

2. Moderate impairment of static-dynamic function is characterized by limited range of motion in hip joint in the sagittal plane up to degrees or by limiting extension to 155 degrees, limiting abduction and rotational movements; moderate shortening of at least one of the limbs, radiological instability of the hip joint and (or) radiological signs coxarthrosis stages 1-3.

A) The compensation stage is characterized by the same signs as with a slight violation of the static-dynamic function.

B) In the subcompensation stage, in addition to the above changes, there is moderate (2-3 cm) wasting of the thigh and lower leg muscles, a decrease in muscle strength up to 3 points. The skew and tilt of the pelvis compensates for the shortening of the limb by 2-3 cm. Patients are forced to use additional means of support (cane). Compensatory increased lumbar lordosis spine. Possible development of compensatory scoliosis, initial stages secondary osteochondrosis and arthrosis in the adjacent joint.

C) In the stage of decompensation, the supporting ability of the affected limb sharply decreases with a decrease in the supporting load of less than 40%, which is associated with incomplete compensation of shortening, skew and tilt of the pelvis. Lameness, as a rule, is pronounced, combined with a unilateral lesion with a decrease in the rhythmicity coefficient to 0.8 or less. Patients can use support aids when standing and walking. It is possible to develop secondary osteochondrosis with radicular and pain syndrome, changes in the axis of the lower extremities (most often valgus deformity of the knee joints). The strength of the thigh muscles decreases to 2-3 points, and there is pronounced wasting of the thigh and lower leg muscles (more than 3 cm).

3. A pronounced violation of the static-dynamic function is characterized by limited mobility (less than 30 degrees) in the sagittal plane in the hip joint or placing the limb in a flexion position at an angle of less than 155 degrees, which leads to the appearance of pronounced functional shortening (more than 6 cm), which is not fully compensated by distortion and pelvic tilt. The development of adductor contractures with the installation of the limb at an angle of less than 90 degrees and the absence of rotational movements in the hip joint are also characteristic. A pronounced violation of static-dynamic function should also include a combination of clinical and radiological instability in one of the hip joints.

A) The compensation stage practically does not occur.

B) The stage of subcompensation is characterized by the same changes as with moderate violation static-dynamic function.

C) The stage of decompensation, in addition to changes of the same type, with moderate impairment of static-dynamic function, is characterized by a pronounced Trendelburg symptom, a decrease in muscle strength to 1-2 points, and persistent pain.

1. Nature of violations of statodynamic functions

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 vertical posture of a person, improving stability and mobility by increasing the additional area of ​​support, unloading the diseased organ, joint or limb, normalizing weight loads, facilitating movement, maintaining a comfortable position.

The ability to maintain a vertical posture is assessed using special devices and certain parameters that characterize the process of standing, and 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 of recording and analyzing parameters characterizing the movement of the horizontal projection of the common center of mass (GCM) standing man.

The body of a standing person continuously makes oscillatory movements. Body movements while maintaining an upright posture reflect various reactions to control muscle activity. The main parameter by which muscle activity is regulated is the movement of the human central mass.

Stabilization of the position of the GCM is carried out due to stabilization of the body, which in turn is ensured on the basis of processing information about the position and its movement in space due to the receipt of information by the visual, vestibular, and proprioceptive apparatus.

Another technique, cephalography, is the recording and analysis of head movements while standing. This technique is quite widely used in clinical practice.

Changes in the vestibular apparatus significantly disrupt the provision of a vertical posture and are manifested in changes in the nature of the cephalogram, stabilogram and body movements aimed at maintaining a vertical posture.

In this condition of a person, an increase in additional support area is required due to aids rehabilitation.

In addition to disturbances in statistical functions, disturbances in the human walking function occur when the musculoskeletal system is damaged.

Clinical indicators of such musculoskeletal disorders are:

Limitation of joint mobility, severity and type of contracture;

Hypotrophy of the muscles of the lower extremities.

The presence of lower limb shortening (LLT) significantly affects gait structure and standing stability.

Stability of standing is characterized by the amplitude of oscillation of the general center of mass (GCM) and with slight and moderate shortening of the NC it is slightly disturbed. Even with pronounced shortening of the NC, a slight and moderate violation of stability is observed. In this case, no pronounced disturbance of GCM oscillations is observed, which indicates the effectiveness of compensation mechanisms aimed at maintaining stability. The consequence of shortening the lower limb is pelvic distortion. Shortening of more than 7 cm leads to significant changes in statodynamic functions. The study of such disorders is carried out using a special stand with a predominant distribution of the weight load on a healthy NK (more than 60% of body weight) using a shortened NK as an additional support with a pronounced metatarsal-toe position.

Restriction in joint mobility is expressed primarily in dysfunction in the hip, knee, ankle joints, and foot, and moderate and severe degrees of dysfunction can be determined.

Hip joint (HJ)

Reduced range of motion to 60º;

Extension – at least 160º;

Decreased muscle strength;

Shortening of the lower limb – 7-9 cm;

Locomotion speed – 3.0-1.98 km/h;

Limitation of mobility in the form of a decrease in the amplitude of movement in the sagittal plane - at least 55º;

During extension – at least 160º;

Severe flexion contracture - extension less than 150º;

Reduced strength of the gluteal and thigh muscles by 40% or more;

Locomotion speed is 1.8-1.3 km/h.

Knee joint (KJ)

1. Moderate degree of dysfunction:

Bending to an angle of 110º;

Extension up to 145º;

Decompensated form of joint instability, characterized by frequently occurring pathological mobility under light loads;

Locomotion speed is up to 2.0 km/h with pronounced lameness.

2. Severe degree of dysfunction:

Bending to an angle of 150º;

Extension – less than 140º;

Locomotion speed up to 1.5-1.3 km/h, severe lameness;

Shortening the step to 0.15 m with pronounced asymmetry of lengths;

Rhythmicity coefficient – ​​up to 0.7.

Ankle joint (AJ)

1. Moderate degree of dysfunction:

Limitation of mobility (flexion up to º, extension up to 95º);

Locomotion speed up to 3.5 km/h.

3. Severe degree of dysfunction:

Limited mobility (flexion less than 120º, extension up to 95º);

Locomotion speed up to 2.8 km/h.

Vicious position of the foot.

1. heel foot – angle between the axis of the lower leg and the axis calcaneus less than 90º;

2. equinovarus or equinus foot – the foot is fixed at an angle of more than 125º or more;

3. hallux valgus– the angle between the support area and the transverse axis is more than 30º, open inward.

4. valgus foot – the angle between the support area and the transverse axis is more than 30º, open outward.

With pathology of the hip joint, the thigh and gluteal muscles suffer; with pathology knee joint(KS) - muscles of the thigh and lower leg; with pathology of the ankle joint (AJ), hypotrophy of the lower leg muscles is noted.

Hypotrophy of the muscles of the lower extremities, reflecting the condition muscular system, has a certain influence on the structure of a person’s walking, in particular on the duration of the phases of support and transfer of the limbs, and with moderate and severe malnutrition, a pronounced violation of time parameters is observed.

Muscle wasting up to 5% is classified as mild, 5-9% as moderate, and 10% as a pronounced decrease in muscle strength.

A decrease in the strength of the flexor and extensor muscles of the hip, 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.

Decreased muscle strength with electromyography (EMG)

studies, is characterized by a decrease in the amplitude of bioelectrical activity (ABA) by 50-60% of the maximum with moderate dysfunction.

With severe dysfunction, AAA decreases significantly in the muscles of the distal limbs to 100 µV.

The choice of auxiliary means of rehabilitation should be carried out individually for each patient, with the help of which he can achieve relative independence (improving mobility in the apartment and on the street, independent self-care, participation in the production process, etc.).

Classification of the main types of dysfunction of the body when establishing disability

The main types of dysfunction of the human body, which are determined by medical and social examination, include:

Violations of mental functions (perception, attention, memory, thinking, speech, emotions, will);

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

Violation of static-dynamic functions (head, torso, limbs, mobile functions, statics, coordination of movements);

Violations of the function of blood circulation, respiration, digestion, excretion, metabolism and energy, internal secretion, immunity, etc.;

Speech disorders (not caused by mental disorders), violation of voice formation, language form - violation of oral (rhinolalia, dysarthria, stuttering, alalia, aphasia) and written (dysgraphia, dyslexia), verbal and non-verbal speech;

Disorders that cause distortion (deformation of the face, head, torso, limbs leading to external distortion, abnormal defects of the digestive, urinary, respiratory tracts, violation of the size of the torso).

The criteria for human life include the ability for self-care, movement, orientation, control of one’s behavior, communication, learning, performance labor activity.

The ability to move is the ability to move effectively in one’s environment (walking, running, overcoming obstacles, using personal and public transport).

Evaluation options: nature of walking, pace of movement, distance covered by the patient, ability to independently use transport, need for help from others when moving.

The ability to self-service is the ability to effectively perform social and everyday functions and satisfy needs without the help of others.

Evaluation options: the time interval through which the need for help arises: episodic help (less than once a month), regular (several times a month), constant help (several times a week - regulated or several times a day - unregulated help).

The ability to orientate is the ability to independently navigate in space and time, to have an idea of ​​​​the surrounding objects. The main orientation systems are vision and hearing (provided normal condition mental activity and speech).

Evaluation options: the ability to distinguish visual images of people and objects at a distance and in different conditions(presence or absence of obstacles, familiarity with the environment), the ability to distinguish sounds and oral speech (auditory orientation) in the absence or presence of obstacles and the degree of compensation for the impairment auditory perception oral speech in other ways (writing, non-verbal forms); the need to use technical means for orientation and assistance of other persons in various types of daily activities (at home, study, at work).

The ability to communicate (communicative ability) is the ability to establish contacts with other people and maintain social relationships (communication disorders associated with mental disorders are not considered here).

The main means of communication is oral speech, auxiliary - reading, writing, non-verbal speech (gesture, sign).

Evaluation options: characteristics of the circle of people with whom it is possible to maintain contacts, as well as the need for help from other people in the process of learning and work.

The ability to control one’s behavior is the ability to behave in accordance with the moral, ethical and legal norms of the social environment.

Evaluation options: the ability to be self-aware and adhere to established social norms, identify people and objects and understand the relationships between them, correctly perceive, interpret and adequately respond to traditional and unusual situations, maintain personal safety and personal hygiene.

Learning ability is the ability to perceive, assimilate and accumulate knowledge, to develop skills and abilities (everyday, cultural, professional and others) in a targeted learning process. Opportunity vocational training- the ability to master theoretical knowledge and practical skills and abilities of a specific profession.

Evaluation options: the opportunity to study in regular or specially created conditions (special educational institution or group, home training, etc.); volume of the program, terms and mode of training; the opportunity to master professions of various qualification levels or only certain types of work; need to use special means with the assistance of other persons (except the teacher).

The ability to work is the totality of a person’s physical and spiritual capabilities, which is determined by the state of health, which allows him to engage in various types labor activity.

Professional work ability is a person’s ability to perform high-quality work required by a specific profession, which allows employment in a certain area of ​​production in accordance with the requirements of the content and volume of the production load, the established work schedule and the conditions of the production environment.

Impaired professional ability to work is the most common reason social insufficiency, which may occur primarily when other categories of life activity are not impaired, or secondarily on the basis of limitation of life activity. The ability to work in a specific profession for disabled people with limitations in other life activity criteria can be preserved in whole or in part or restored by means vocational rehabilitation, after which disabled people can work in regular or specially created conditions with full or part-time working hours.

A conclusion on inability to work is prepared only if the disabled person agrees (except for cases where the disabled person is declared incompetent).

Evaluation options: preservation or loss of professional suitability, the possibility of working in another profession, which is equal in qualifications to the previous one, assessment of the permissible amount of work in one’s profession and position, the possibility of employment in ordinary or specially created conditions.

The degree of disability is the magnitude of deviation from the norm of human activity. The degree of disability is characterized by one or a combination of several of its most important criteria.

There are three degrees of disability:

Moderately expressed Limitation of life activity is caused by dysfunction of organs and systems of the body, leading to moderate limitation of the ability to learn, communicate, orientate, control one’s behavior, move, self-care, and participate in labor activities.

Expressed Limitation of life activity is caused by a violation of the functions of organs and systems of the body and consists of a pronounced impairment of the ability to learn, communicate, orientate, control one’s behavior, move, self-care, and participate in work activities.

Significant limitation of life activity occurs as a result of significant impairment of the functions of organs or systems of the body, which leads to the impossibility or significant impairment of the ability or possibility of learning, communication, orientation, control of one’s behavior, movement, self-care, participation in work activities, and is accompanied by the need for outside care (outside assistance ).

A person who is recognized as disabled, depending on the degree of dysfunction of the organs and systems of the body and the limitation of her life activity, is assigned disability group I, II or III.

Group I disability is divided into subgroups A and B depending on the degree of loss of health of the disabled person and the amount of need for constant outside care, assistance or care.

The criteria for establishing disability are determined by paragraph 27 of the Regulations on the procedure, conditions and criteria for establishing disability, approved by Resolution of the Cabinet of Ministers of Ukraine dated December 3, 2009 N 1317.

The causes of disability are established in accordance with paragraph 26 of the Regulations on the procedure, conditions and criteria for establishing disability, approved by Resolution of the Cabinet of Ministers of Ukraine dated December 3, 2009 N 1317.

When increasing the disability groups due to a general illness, an industrial accident, an occupational disease, injury, contusion, mutilation and other disease, in the event of a severe general illness, the cause of disability is determined at the patient's choice.

If one of the causes of disability is disability since childhood, MSEC in the conclusion on the examination of the disabled person indicates two causes of disability.

Re-commission of disabled people is carried out in accordance with paragraph 22 of the Regulations on the procedure, conditions and criteria for establishing disability, approved by Resolution of the Cabinet of Ministers of Ukraine dated December 3, 2009 N 1317.

Medical and social examination

Login via uID

catalogue of articles

DEGREES OF VIOLATION OF STATODYNAMIC FUNCTIONS OF THE HUMAN BODY IN PARESIS AND PLEGIAS OF THE LIMB

Federal State Institution "Main Bureau of Medical and Social Expertise in the Samara Region", Samara, 2011

Generalized experience presented neurological practice on the development of standards for compliance with the degree of impairment of limb functions in paresis and plegia and the degree of impairment of statodynamic functions, which can be used in the practical activities of neurologists both in the medical and social examination service and in medical and preventive institutions.

Key words: paresis of the limbs, plegia of the limbs, severity of disorders

In practice, every doctor-specialist in medical and social examination, including a neurologist, is guided by the classifications and criteria used in the implementation of medical and social examination of citizens by federal government agencies medical and social examination approved by order of the Ministry of Health and social development Russian Federation dated December 23, 2009 No. 1013n, which distinguish 4 degrees of severity of the main types of dysfunctions of the body:

I degree - minor violations;

II degree - moderate violations;

III degree - pronounced violations;

IV degree - significantly pronounced violations.

Based on more than 20 years of neurological experience in medical and social examination institutions, the authors propose for a unified assessment of the correspondence between the severity of paresis and plegia of the limbs and the degree of disturbance of statodynamic functions that the lesions lead to nervous system with focal organic symptoms, use the following approximate standards, presented in the form of tables, in the practice of medical and social examination (Table 1-5).

Disturbances of statodynamic functions in upper mono- and paraparesis

The severity of disturbances in static-dynamic functions

Classification of the main types of dysfunctions of the body and the degree of their severity

The degree of dysfunction of the body is characterized by various indicators and depends on the type of functional disorders, methods for their determination, the ability to measure and evaluate the results.

The following disorders of body functions are distinguished:

• disturbances of mental functions (perception, attention, memory, thinking, intelligence, emotions, will, consciousness, behavior, psychomotor functions)
• violations of language and speech functions (violations of oral (rhinolalia, dysarthria, stuttering, apalia, aphasia) and written (dysgraphia, dyslexia), verbal and non-verbal speech, voice formation disorders, etc.)
• disorders of sensory functions (vision, hearing, smell, touch, tactile, pain, temperature and other types of sensitivity);
• violations of static-dynamic functions ( motor functions head, torso, limbs, statics, coordination of movements)
• visceral and metabolic disorders (functions of blood circulation, respiration, digestion, excretion, hematopoiesis, metabolism and energy, internal secretion, immunity)
• disorders caused by physical deformity (deformations of the face, head, torso, limbs, leading to external deformity, abnormal openings of the digestive, urinary, respiratory tracts, disturbance of body size)

Based on a comprehensive assessment of various parameters characterizing persistent dysfunctions of the human body, taking into account their qualitative and quantitative values, FOUR degrees of their severity are distinguished:

1st degree - minor violations

2nd degree - moderate violations

3rd degree - severe disturbances

4th degree - significantly pronounced violations.

Disability leads to limitation of life activity, i.e. to a complete or partial loss of the ability or ability to carry out self-care, move independently, navigate, communicate, control one’s behavior, learn and engage in work.

In a comprehensive assessment of various indicators characterizing the limitations of the main categories of human life, 3 degrees of their severity are distinguished:

Self-care ability is a person’s ability to independently fulfill basic physiological needs, perform daily household activities, including personal hygiene skills:

1st degree - the ability to self-service with a longer investment of time, fragmentation of its implementation, reduction of volume, using, if necessary, auxiliary technical means

2nd degree - ability for self-care with regular partial assistance from other persons, using auxiliary technical means if necessary

3rd degree - inability to self-care, need for constant assistance and complete dependence on other persons

Ability to independent movement- the ability to independently move in space, maintain body balance when moving, at rest and changing body position, to use public transport:

1st degree - the ability to move independently with a longer investment of time, fragmentation of execution and reduction of distance using, if necessary, auxiliary technical means

2nd degree - ability to move independently with regular partial assistance from other persons, using assistive technical means if necessary

3rd degree - inability to move independently and need constant assistance from others

Orientation ability - the ability to adequately perceive the environment, assess the situation, the ability to determine the time and location:

1st degree - the ability to navigate only in a familiar situation independently and (or) with the help of auxiliary technical means

2nd degree - the ability to navigate with regular partial assistance from other persons using, if necessary, auxiliary technical means

3rd degree - inability to orientate (disorientation) and need for constant assistance and (or) supervision of other persons

The ability to communicate is the ability to establish contacts between people by perceiving, processing and transmitting information:

1st degree - ability to communicate with a decrease in the pace and volume of receiving and transmitting information; use, if necessary, assistive technical aids

2nd degree - ability to communicate with regular partial assistance from other persons, using assistive technical means if necessary

3rd degree - inability to communicate and need for constant help from others

The ability to control one’s behavior is the inability to self-awareness and adequate behavior taking into account social, legal, moral and ethical standards:

1st degree - periodically occurring limitation of the ability to control one’s behavior in difficult situations life situations and (or) constant difficulty in performing role functions affecting certain areas of life, with the possibility of partial self-correction;

2nd degree - a constant decrease in criticism of one’s behavior and environment with the possibility of partial correction only with the regular help of other people;

3rd degree - inability to control one’s behavior, inability to correct it, need for constant help (supervision) from other persons;

Ability to learn - the ability to perceive, remember, assimilate and reproduce knowledge (general education, professional, etc.), mastery of skills and abilities (professional, social, cultural, everyday):

1st degree - ability to learn, as well as to receive education at a certain level within the framework of government educational standards V educational institutions general purpose using special methods training, a special training regime, using, if necessary, auxiliary technical means and technologies;

2nd degree - ability to learn only in special (correctional) educational institutions for students, pupils with developmental disabilities or at home under special programs using, if necessary, auxiliary technical means and technologies;

3rd degree - learning disability

The most important thing in medical and social examination is the examination of a person’s ability to work, which determines:

• a person’s ability to reproduce special professional knowledge, skills and abilities in the form of productive and effective work;
• a person’s ability to carry out labor activities in a workplace that does not require changes in sanitary and hygienic working conditions, additional measures for organizing work, special equipment and equipment, shifts, pace, volume and severity of work;
• a person’s ability to interact with other people in social and labor relations;
• ability to motivate work;
• ability to adhere to work schedule;
• ability to organize the working day (organization of the labor process in a time sequence).

Assessment of indicators of ability to work is carried out taking into account existing professional knowledge, skills and abilities.

The criterion for establishing the 1st degree of limitation of the ability to work is a health disorder with a persistent moderate disorder of body functions, caused by diseases, consequences of injuries or defects, leading to a decrease in qualifications, volume, severity and intensity of the work performed, the inability to continue working in the main profession if it is possible to perform other types of lower-skilled work under normal working conditions in the following cases:

• when performing work under normal working conditions in the main profession with a decrease in the volume of production activity by at least 2 times, a decrease in the severity of work by at least two classes;
• when transferred to another job of lower qualifications under normal working conditions due to the inability to continue working in the main profession.

The criterion for establishing the 2nd degree of limitation of the ability to work is a health disorder with a persistent pronounced disorder of body functions caused by diseases, consequences of injuries or defects in which it is possible to carry out work activities in specially created working conditions, with the use of auxiliary technical means and (or) with the help of others.

The criterion for establishing the 3rd degree of limitation of the ability to work is a health disorder with a persistent, significantly expressed disorder of body functions, caused by diseases, consequences of injuries or defects, leading to complete inability to work, including in specially created conditions, or work activity that is contraindicated .

Depending on the degree of deviation from the norm of human activity due to health impairment, the degree of limitation of life activity is determined. In turn, depending on the degree of disability and the degree of impairment of body functions, a disability group is established. Criteria for establishing disability groups

The criterion for determining the FIRST GROUP OF DISABILITY is a person’s health impairment with a persistent, significantly pronounced disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of one of the following categories of life activity or a combination of them and necessitating his social protection:

1. self-service abilities of the third degree;
2. ability to move third degree;
3. orientation abilities of the third degree;
4. communication abilities of the third degree;
5. ability to control one's behavior to the third degree.

The criterion for establishing the SECOND GROUP OF DISABILITY is a person’s health impairment with a persistent severe disorder of body functions, caused by diseases, consequences of injuries or defects, leading to limitation of one of the following categories of life activity or a combination of them and necessitating his social protection:

1. self-service abilities of the second degree;
2. mobility ability of the second degree;
3. orientation abilities of the second degree;
4. communication abilities of the second degree;
5. ability to control one's behavior to the second degree;
6. learning abilities of the third, second degrees;
7. ability for work activity of the third, second degrees.

The criterion for determining the THIRD GROUP OF DISABILITY is a person’s health impairment with a persistent moderately severe disorder of body functions, caused by diseases, consequences of injuries or defects, leading to a limitation of the ability to work 1st degree or limitation of the following categories of life activities in their various combinations and necessitating his social protection :

1. self-care abilities of the first degree;
2. first degree mobility ability;
3. orientation abilities of the first degree;
4. communication skills of the first degree;
5. ability to control one's behavior first degree;
6. first degree learning abilities.

The examination of childhood disability is based on modern concept WHO, which believes that the reason for assigning disability is not the disease or injury itself, but the severity of their consequences, which manifest themselves in the form of violations of a particular psychological, physiological or anatomical structure or function, leading to limitation of life activity and social failure.

Indications for establishing disability in children are pathological conditions that arise from congenital, hereditary, acquired diseases or after injuries.

In accordance with adapted version The “International Nomenclature of Disabilities, Disability and Social Disability” category of disabled children includes children under 16 years of age who have significant disabilities leading to social maladaptation due to impaired development and growth of the child, loss of control over their behavior, ability to self-care, movement, orientation, training, communication, work in the future.

Medical indications for determining disability in children include three sections:

Section 1 - a list of pathological conditions leading to temporary limitation of life activity and social maladaptation of a child in the event of severe but reversible disorders of the functions of organs and systems and giving the right to be declared disabled for a period of 6 months to 2 years;

Section 2 - pathological conditions leading to partial limitation of life activity and social maladaptation of the child with the predicted possibility of full or partial restoration of the impaired functions of organs and systems. There are two groups of pathological conditions: 2A - with the right to establish disability for a period of 2 to 5 years, i.e. re-examination is carried out every 2-5 years; 2B - with the right to establish disability for a period of up to 5 years or more, i.e. re-examination is carried out no more often than after 5 years;

Section 3 - pathological conditions leading to significant limitation of life activity and social maladjustment of the child with pronounced irreversible dysfunction of organs and systems. Medical report on pathological conditions, regulated by section 3, is issued once until the age of 16.

The category “disabled child” is determined in the presence of disabilities of any category and any of three degrees of severity (which are assessed in accordance with the age norm), necessitating social protection.

Based on the expert decision of the ITU, a conclusion is drawn up in the form of an “ITU Certificate”, which is issued to the disabled person. The certificate indicates the group and cause of disability, work recommendations, and the deadline for the next re-examination. In addition to the certificates, ITU sends a notice of the decision to the institution within three days.

In cases where the examinee does not agree with by decision, he can submit a written application to the chairman of the ITU or the head of the district social protection department within a month.

The degree of limitation of the main categories of human life activity is determined based on an assessment of their deviation from the norm corresponding to a certain period (age) biological development person.

The disability group is established for citizens over 16 years of age. The examination of childhood disability does not provide for differentiation by group. When identifying a disability under the age of 16, the concept of “disabled child” is used.