Principles of medical rehabilitation. Psychological rehabilitation of the disabled

“Currently, rehabilitation occupies a very significant place in the healthcare sector. Despite the fact that there are more and more definitions of the meaning of rehabilitation, the definition given by the WHO Expert Committee on Medical Rehabilitation in 1958 is still the most accurate: “Rehabilitation is a process whose goal is to prevent the development of preventable disability during the treatment of diseases and help persons with disabilities in achieving the maximum physical usefulness for which they are fit within the framework of an existing disease or bodily ailment. one

In essence, rehabilitation is similar to treatment. But unlike treatment, the purpose of which is the medical and biological restoration of the body, rehabilitation involves medical and social restoration, where connections with labor, educational and other activities are not lost” [K.S. Bakharev. Psychological rehabilitation in childhood, p.6].

Excerpt from the book: Zborovsky, K.E. Self-help groups in the technology of social rehabilitation of disabled people. / K.E. Zborovsky. - MN.: Public organization "Belarusian Association of Social Workers", 2008 - 156 p.

The disease does not always go unnoticed. Often there are residual effects in the form of pain, asthenia, fear of a return of the disease. There may be social consequences: a decrease in physical activity, a change in profession, etc. In order to restore a pre-morbid state of health, there is a system of rehabilitation measures aimed at restoring the physical (biological) , mental and social status of a person who has had an illness, on the development of qualities in him that help optimal adaptation to the environment.

All rehabilitation work is based on fundamental principles. Let us present in many respects intersecting and complementary lists of principles proposed by both foreign (Wright, 1981) and domestic (Kabanov M.M., 1976) researchers. The principles proposed by American authors include:

1) improving the competence of survivors;

2) optimization of the conduct of victims in the environment necessary for them;

3) eclecticism in the use of various methods;

4) increasing the working capacity of persons with disabling disorders;

5) an essential part of the rehabilitation process is the hope for the best;

6) a deliberate increase in the patient's dependence may ultimately lead to an increase in the degree of his independent functioning in a different environment and at a different time;

7) the two main types of rehabilitation interventions are the development of patient skills and the organization of support from the environment;

8) long-term drug treatment is often necessary, but rarely a sufficient component of a rehabilitation intervention.

To the principles of rehabilitation developed at the Leningrad Psychoneurological Institute. V.M. Bekhterev, include:

The principle of partnership. The patient is an equal and active partner in the restoration of functions and social ties disturbed by the disease;

The principle of versatility (diversity) of efforts. In various spheres of life: professional, family, social, study, leisure, etc.;

The principle of unity of psychosocial and biological methods of treatment;

The principle of stepwise effort. From simple occupational therapy, individual surgeries to complex skills and social integration.

MM. Kabanov also identifies the stages of rehabilitation:

rehabilitation therapy - prevention of the development of undesirable consequences with the help of environmental therapy, stimulation of activity;

Readaptation - adaptation to life in out-of-hospital conditions, taking into account the flaws caused by the disease. Includes:

Teaching a new specialty, employment and entertainment therapy, educational work with patients and their relatives, supporting drug therapy;

Rehabilitation or resocialization - restoration of the individual and social value of the patient through rational life and employment, expansion of social contacts.

As can be seen from the foregoing, the psychological aspect of rehabilitation throughout its entire duration provides not only for the prevention or overcoming of negative reactions of the individual arising in connection with the disease and its consequences in various spheres of existence, but also for increasing the individual's ability to successfully cope with difficulties. Rehabilitation programs are aimed at restoring personal and social status by revealing, enriching and using the psychological potential of the patient's personality, the treatment environment and his microsocial environment. The implementation of these goals is carried out with the help of various psychotherapeutic approaches.

The phased tasks of psychological impact during rehabilitation are as follows:

1) normalization of understanding of health and disease, adequate to them

attitude;

2) achievement of the "true" desire to be treated;

3) psychotherapeutic explanation of treatment methods;

4) supporting psychotherapeutic effect for complete stabilization at all stages of the treatment and recovery process.

5) preparation of the patient for the possibilities of coexistence with individual manifestations of his illness.

It is necessary to provide a person with disabilities with the awareness of their usefulness as a member of society, regardless of the presence of certain painful manifestations and even a defect, to restore self-esteem and usefulness for others, to eliminate low self-esteem and increased dependence.

It is important for a doctor (psychologist), social work specialist to know how a person in a situation of illness, in real social conditions, is able to perceive his position and how it effectively affects the social environment. This is included in the concept of social competence (H. Schroder, M. Vorwerg, 1978),

The personality traits that are essential for social competence are: sociability, the ability to assert oneself, to make decisions and form a correct idea of oneself. In a disease situation, features of the patient's interpersonal communication may appear, making it difficult or easier for medical and social workers to cooperate with him in the rehabilitation process (contact with extroverts is easier than with introverts). Important for cooperation with the patient is to take into account in the communicative properties of the personality, the tendency to independence or dominance, to dependence or the desire to be warded. In the first case, patients, the disabled are distrustful, critical and pretentious towards the ongoing therapeutic measures, take a defensive position regarding the assistance presented to them, and react negatively to the leading attitude of the specialist. Some of them are convinced. illness frees them from all their former duties, puts them in a privileged position. Rehabilitation work with such patients is quite difficult, it requires huge efforts to involve them in labor processes and active interaction with the social environment. For patients with a tendency to addiction and the need for care, another extreme can be characteristic - shifting to a social work specialist, doctor, psychologist to solve all their problems, strengthening the role of the patient. This should be counteracted by increasing the patient's autonomy in making life decisions.

Another, deeper level of solving psychological problems

rehabilitation is to take into account the needs and motives of patients. Disease

or disability and its consequences activate (sometimes reduce) needs such as the need for security, recognition, emotional contact, being needed by other people, self-affirmation and self-realization. Knowledge of these needs allows a social work specialist, a doctor or a psychologist to solve specific psychological goals of rehabilitation, achieving an increase in the patient's low self-esteem, deepening the patient's knowledge of himself and the people around him, respect for himself and others, interest in work and spiritual values, activity and responsibility. , strengthening and development in the patient of a stable faith in recovery.

Of great importance for the psychological rehabilitation of patients and disabled people is the therapeutic environment - a rationally directed system of relations between patients and the environment (according to M.M. Kabanov, 1977). The behavior of service personnel, their relationship with a person with disabilities, should be based on two important principles:

Firstly, do not support inadequate stereotypes of the patient's behavior (dependence, lack of sociability or aggressiveness);

Secondly, to promote the optimal self-expression of the rehabilitator, adequate forms of his behavior, his activity and responsibility in the rehabilitation process.

One of the principles of rehabilitation - the principle of versatility of efforts - requires the joint participation in the rehabilitation program of various specialists (doctor, psychologist, social work specialist, etc.), who coordinate their actions according to a single, agreed upon rehabilitation plan for the client. Each specialist has professional knowledge in his field and can best apply it. Without a psychologist, it is impossible to correctly assess the patient's psychological deviations, find out the motives of behavior, the characteristics of relationships, etc., without a social work specialist, it will be difficult to find an adequate job for the patient, defending his interests, training social skills, etc.

The microsocial environment, with the right approach to the patient, can also play the role of a therapeutic environment, and with the wrong approach, it can interfere with the rehabilitation process. From the above it follows the need to increase the level of knowledge of family members about the disease, its consequences, how to behave with a sick relative. A specialist in social work, a psychologist should, if possible, manage relationships in the patient's family, direct them in the direction that is most conducive to recovery, in particular, so that there is neither inattention (indifference) nor overprotection. It is also important to prepare a sick or disabled person for a correct understanding of the interests of other family members, their aspirations, needs, requirements for his position. A person with disabilities should feel like a full-fledged member of the family, and this is achieved by the support of relatives in him of self-esteem, the need for it, faith in recovery. Creating a favorable climate in the family is often decisive in achieving sustainable social and labor recovery of a disabled person or a person at high risk of developing disability.

In the process of rehabilitation, the most important task is to restore the patient's ability to work. Psychological preparation is necessary for returning to working life. At the same time, it is important to take into account the socio-psychological characteristics of a person with disabilities, his value orientations, family situation, the validity and timing of returning to work, and, if necessary, a change in profession. Not all people with a good functional recovery from illness seek to return to work. Some have a fixation on health issues, while others have rental attitudes towards receiving disability. If it is possible for a person with disabilities to work from a social work specialist, a psychologist, persistent work is required to create an attitude to work as an activity that improves physical well-being, psychological stability and social prestige.

It is impossible to ignore the complex problem of the effectiveness of treatment and rehabilitation measures. The effectiveness of treatment and rehabilitation measures is assessed, firstly, in three dimensions.

1) somatic;

2) psychological;

3) social.

Secondly, they should allow assessment not only from the point of view of objective observation, but also include subjective assessment from the standpoint of the patient himself.

Thirdly, these criteria should be sufficiently independent of each other.

If in the somatic sphere the therapeutic result is obvious (for example, a decrease in blood pressure, joint mobility, etc. in the social sphere, it is also tangible (for example, the return of working capacity, professional growth, etc.), then in the psychological one to determine the effectiveness of rehabilitation measures is difficult. Different researchers introduce different criteria, depending on the theoretical attitudes of the authors. So, even Z. Freud (1923) believed that the main criteria for recovery were "the ability to enjoy" and performance.

R. Knight (1941) singled out three main psychological criteria:

1. Criteria for symptomatic improvement;

2. Criteria for improving intellectual functioning, including:

acquisition of insight concerning children's sources of conflict, the role of psychotraumatic factors, methods of protection that caused certain personality changes and the specific nature of the disease;

The development of control of their drives, not accompanied by anxiety;

Development of the ability to understand oneself as one is, with weaknesses and virtues;

The acquisition of relative freedom in tense situations and situations of frustration;

Management of aggressive energy necessary for self-preservation, success, competition and protection of rights.

3. The criterion for improving adaptation to the environment, which includes:

More constant and loyal interpersonal relationships with people;

Freer development of their productive abilities;

sublimation improvement;

Normal heterosexual functioning.

According to N. Miles et al. (1951), the heading "recovery" includes patients whose symptoms have disappeared, the stereotype of behavior has changed in areas in which difficulties were previously noted, and fewer unproductive reactions are detected when faced with difficult situations.

B.D. Karsarsky (1975) developed a system of four criteria:

assessment of the effectiveness of treatment and the depth of treatment and rehabilitation effects:

Symptomatic improvement experienced by the client subjectively;

The degree of understanding by the patient of the psychological mechanisms of the disease;

The degree of reconstruction of disturbed personality relationships;

The degree of restoration of the patient's social functioning at work, in the family, in society.

Having carefully looked at the listed criteria for the effectiveness of therapeutic and rehabilitation effects, one can notice that the elimination of the disease or adequate adaptation to its consequences, the acquisition by the patient of the ability to competent behavior in the family, at work, in society is carried out in full only when the core principle of rehabilitation is implemented - appeal to the person's personality.

psychological rehabilitation

Psychological rehabilitation is a set of measures of a corrective-diagnostic and restorative nature, the purpose of which is to restore mental health and correct deviations in the personality of clients. Psychological rehabilitation in the center is carried out in the following areas:

restoration and development of individual intellectual functions (psychomotor, memory, thinking, etc.);

smoothing (liquidation) of local emotional disorders (excitability, anxiety, fears, emotional instability);

development of communication skills and optimization of the level of communication readiness in general;

formation of an adequate attitude to one's own "I", one's capabilities, disease (defect);

formation of adequate ideas about interpersonal relationships;

development of mental self-regulation skills, ability to volitional efforts;

development of inclinations and abilities, the formation of adequate self-esteem;

development of skills of creativity, creative self-expression.

All measures for psychological rehabilitation are based on the results of psychodiagnostics, which predetermine their content and direction, act as objective indicators of the need for their implementation and assessment of the results (effectiveness) achieved. Based on the results of psychodiagnostics, an individual psychological rehabilitation card is filled out for each client, which reflects the whole range of corrective and developmental measures. The main methods of psychological rehabilitation are: psychological consultation (conversation), psychological training, psycho-correctional sessions in the sensory room.

1. Psychological consultation (conversation) is a method of psychological influence on a person, produced directly on the basis of personal contact between a psychologist and a client. Psychocorrectional conversations allow constructively to resolve all sorts of psychological conflicts that prevent the establishment of normal relations with their social environment. Conversations play a crucial role in terms of psychoprophylaxis of possible deviations in the behavior of clients.

2. Psycho-corrective sessions in the sensory room.

The sensory room is an environment organized in a special way, consisting of many different kinds of stimulants that affect the organs of vision, hearing, smell, touch and vestibular receptors. In the conditions of this room, you can remove fears, neurotic states, conduct behavior correction. It can be used for special classes or just used for relaxation. Sessions in the sensory room are included in the complex system of rehabilitation of patients with musculoskeletal pathology, mental retardation, delays in psychomotor and emotional development, neuroses, visual, hearing, and speech disorders, which significantly increases the effectiveness of the treatment.

3. Psychological training is a purposeful restoration, development, formation of individual mental functions, abilities, skills and personality traits that have been lost or "weakened" due to illness, the lack of formation of which prevents successful and effective self-realization in various social conditions, life situations. Trainings are aimed at solving the problems of cognitive, psychomotor, social, personal development of clients.

At the final and generalizing stage of psycho-corrective measures, the effectiveness of the work carried out is assessed, psychological and pedagogical recommendations for educators are drawn up, and the results of the work carried out are discussed with psychiatrists and teachers.

Evaluation of the effectiveness of the work carried out with clients can be different, depending on who makes this assessment: the client, that is, directly the one to whom the work was directed; a teacher or other interested person (doctors, administration of the institution) who has addressed a request for help to a psychologist; the psychologist himself.

From the point of view of the client, the work will be successful and effective if he receives emotional satisfaction during the classes and, in general, both during the work and at the end of it, he will experience positive emotions about his participation in group and individual classes. For teachers, the work done is effective if the request is satisfied as a result of it. For a psychologist, the criterion for the effectiveness of the work done and the effectiveness of the correctional program is the degree to which the goal of the correction and the solution of the tasks set are achieved. The assessment of the effectiveness of the effect produced is carried out by the psychologist by re-diagnosing those aspects of the psyche and personality of clients that were the subject of correction. To assess the stability of the effect obtained, it is necessary to monitor the behavior of the client and retest.

Example: a group of girls 24 people. During the initial diagnosis, it was revealed that 5 people suffer from a sleep disorder, 8 people have signs of nervous excitement and anxiety, 5 people show signs of aggressiveness, and only 6 people have indicators according to the above criteria are within the normal range.

Based on the data obtained during the psychodiagnostic study, an individual plan of psychocorrectional measures was drawn up for each client, which included the following measures:

1. Relaxing music therapy, aromatherapy, light therapy in the sensory room;

2. Trainings for the correction of the emotional sphere, behavioral difficulties (aggression and anxiety) and character.

3. Relaxation exercises.

Based on the results of the psycho-correctional work, the clients were re-tested, during which the following results were obtained:

sleep disorders - 1 person;

signs of nervous excitement and anxiety - 3 people;

signs of aggressiveness - 3 people;

the norm is 17 people.

Conclusion: the data obtained testify to the effectiveness and efficiency of psycho-corrective measures.

Rehabilitation (French rehabilitation from Latin re apart + habilis convenient, adapted) in medicine - a set of medical, psychological, pedagogical, professional and legal measures to restore autonomy, working capacity and health of persons with physical and mental disabilities as a result of the transferred (rehabilitation) or congenital (habilitation) diseases, as well as as a result of injuries.

Rehabilitation is a system of state medical, ψ, pedagogical, etc. measures aimed at preventing the development of pathological processes leading to temporary or permanent disability. That is, these are measures that contribute to an early return to society and to socially useful work. Ψ - which rehabilitation is the humanizing factor of medicine.

Principles:

1. the unity of biological and psychosocial methods of influence.

2. the principle of partnership. Appeal to personality.

3. the versatility of the cited influences aimed at different aspects of the patient's life: phi, family, social.

The basis of the rehabilitation system is the restructuring of the system of personal relations and the adaptation of the individual to the main aspects of life.

4. stepping principle

Stages of rehabilitation.

1. rehabilitation treatment. Tasks - elimination or mitigation of the manifestations of the disease, prevention of the formation of a defect, disability; strengthening of compensatory mechanisms, restoration of disturbed functions and social ties. It is characterized by the use of a combination of biological therapies with various psychosocial interventions. Treatment by the environment, employment, psychotherapy, exercise therapy, physiotherapy.

2. readaptation. Tasks: adaptation of the patient to the conditions of the external environment - life and work. Psychosocial influences predominate, among which the stimulation of social activity is in the first place. Psychotherapy is carried out both with the patient and with relatives.

3. proper rehabilitation. The task is to restore the rights, individual and social value of the patient; restoration of pre-painful relationship with the social environment.

The patient's medical rehabilitation program includes:

physical methods of rehabilitation (electrotherapy, electrical stimulation, laser therapy, barotherapy, balneotherapy, etc.)

mechanical methods of rehabilitation (mechanotherapy, kinesitherapy.)

· massage,

traditional methods of treatment (acupuncture, herbal medicine, manual therapy and others),

occupational therapy,

psychotherapy,

speech therapy help

· physiotherapy,

reconstructive surgery,

prosthetic and orthopedic care (prosthetics, orthotics, complex orthopedic shoes),

· Spa treatment,

technical means of medical rehabilitation (colostomy bag, urinal, simulators, devices for introducing food through the stoma, parenterally, other technical means),

informing and consulting on medical rehabilitation issues

Other events, services, technical means.

Psychotherapy in the work of a nurse

Psychotherapy is a therapeutic method of influencing the patient's psyche to improve his well-being, physical condition and increase the effectiveness of other methods of treatment. The main "tool" of psychotherapy is the word (having a semantic content and emotional coloring).

Psychological foundations of rehabilitation. Principles, stages, methods.

Principles:

1. the unity of biological and psychosocial methods of influence.

2. the principle of partnership. Appeal to personality.

3. the versatility of the cited influences aimed at different aspects of the patient's life: phi, family, social.

The basis of the rehabilitation system is the restructuring of the system of personal relations and the adaptation of the individual to the main aspects of life.

4. stepping principle

Stages of rehabilitation.

3. proper rehabilitation. The task is to restore the rights, individual and social value of the patient; restoration of pre-painful relationship with the social environment.

The patient's medical rehabilitation program includes:

physical methods of rehabilitation (electrotherapy, electrical stimulation, laser therapy, barotherapy, balneotherapy, etc.)

mechanical methods of rehabilitation (mechanotherapy, kinesitherapy.)

· massage,

traditional methods of treatment (acupuncture, herbal medicine, manual therapy and others),

occupational therapy,

psychotherapy,

speech therapy help

· physiotherapy,

reconstructive surgery,

prosthetic and orthopedic care (prosthetics, orthotics, complex orthopedic shoes),

· Spa treatment,

technical means of medical rehabilitation (colostomy bag, urinal, simulators, devices for introducing food through the stoma, parenterally, other technical means),

informing and consulting on medical rehabilitation issues

Other events, services, technical means.

Psychotherapy in the work of a nurse

In the process of psychological rehabilitation, the psychologist clearly defines the goals and main tasks of rehabilitation. Of particular importance, in our opinion, psychological rehabilitation acquires in childhood, because it is for this age that the intensive development of mental cognitive and emotional-volitional processes is characteristic. The sooner this or that defect is detected, the more effective the rehabilitation measures will be.

Considering the main tasks of psychological rehabilitation, it is necessary to note the general systematization of the tasks of V. I. Lubovsky within the framework of special psychology, which combined these tasks in terms of scientific content and practical orientation. The first group of tasks is general scientific theoretical tasks that relate to the problems of the development of the psyche of an abnormal child:

Disclosure of patterns of development and manifestation of the psyche common to normal and abnormal children;

Disclosure of general patterns of development that are characteristic of all abnormal children;

Disclosure of specific patterns of development and manifestations of the psyche of various groups of abnormal children;

Establishment of the dependence of the development and manifestations of the psyche on the nature, mechanisms and severity of the anomaly.

The second group of tasks is the study of anomalies in the formation and development of specific forms of mental activity and its mental processes in different groups of abnormal children, that is, the study of the patterns of personality formation, mental activity, speech, perception, memory.

The third group of tasks is to identify ways to compensate for the defect and develop the psyche as a whole.

The fourth group of tasks is the development of scientific foundations, methods and means of teaching various groups of abnormal children, the theoretical substantiation of specific ways of teaching them.

One of the areas of psychological assistance to children with developmental disorders is psychological correction. According to I. I. Mamaychuk, when formulating the tasks of psychological correction, it is advisable to single out three main psycho-corrective blocks that are interconnected. This is a diagnostic, actually corrective and prognostic block.

The diagnostic block includes the diagnosis of the mental development of the child and the diagnosis of the social environment. Diagnostics of the child's mental development includes:

o a comprehensive clinical and psychological study of the personality of the child and his parents, the system of their relations;

o analysis of the motivational-demand sphere of the child and his family members;

o analysis of the development of sensory-perceptual and intellectual processes and functions.

Diagnosis of the social environment requires an analysis of adverse factors in the social environment that injure the child, disrupting his mental development, the formation of the personality's character, and social adaptation.

The correction block includes the following tasks:

o correction of inadequate methods of raising a child in order to overcome her microsocial neglect;

o help a child or teenager in dealing with traumatic situations;

o the formation of productive types of relationships between the child and others (in the family, in the classroom);

o increasing the social status of the child in the team;

o developing a child or adolescent's competence in matters of normative behavior;

o formation and stimulation of sensory-perceptual, mnemonic and intellectual processes in children

o development and improvement of communicative functions, emotional and volitional regulation of behavior;

o the formation of adequate parental attitudes to the illness and socio-psychological problems of the child by actively involving parents in the psycho-corrective process;

o creation in the children's team where a child with special needs studies, an atmosphere of acceptance, goodwill, openness, mutual understanding.

The prognostic block of psycho-correction is aimed at designing the psycho-physiological, mental and socio-psychological functions of the child. During the correction, the psychologist faces the following tasks:

o designing possible changes in the development of cognitive processes and the personality as a whole;

o determining the dynamics of these changes.

The general goal when working with children with disabilities is the restoration and development of cognitive and emotional-volitional processes, ensuring the most complete psychological adaptation of the individual in society. Let us note some tasks of psychological rehabilitation, which can be set in accordance with the disturbed functions of the organism of children.

I. I. Mamaychuk considers psychological assistance to children and adolescents with cerebral palsy as a complex system of rehabilitation effects aimed at increasing social activity, developing independence, strengthening the social position of the personality of a patient with cerebral palsy, forming a system of value attitudes and orientations, developing intellectual processes that meet mental and physical capabilities of a sick child. Of great importance is the solution of particular problems: the elimination of secondary personal reactions to a physical defect, a long stay in a hospital and surgical treatment. The effectiveness of psychological care for children with cerebral palsy largely depends on high-quality psychological diagnostics. The process of psychological diagnosis of children with cerebral palsy is recommended to be divided into the following areas: psychological diagnosis of the development of motor functions, sensory functions, mnemonic, intellectual, as well as features of the motivational-need sphere and individual personality characteristics

The main directions of correctional and pedagogical work with children with cerebral palsy of early and preschool age, scientists S. P. Duvanova, T. F. Pushkina, N. B. Trofimova, N. M. Trofimova consider the following:

o development of emotional, speech, subject-effective and game communication with others;

o stimulation of sensory functions. Formation of spatial and temporal representations, correction of these violations;

o development of prerequisites for intellectual activity (attention, memory, imagination);

o formation of mathematical representations;

o development of visual-motor coordination and functionality of the hand and fingers, preparation for mastering writing;

o education of self-care and hygiene skills. The tasks of psychological rehabilitation in work with children with disorders of the musculoskeletal system are:

o psychological diagnostics and correction of the cognitive and emotional-volitional spheres of the personality;

o stimulation of the body's sensory functions;

o the formation of language, subject-effective and game communication in children with others;

o psychological adaptation to changing conditions; Psychological and pedagogical rehabilitation of children with mental disorders, according to L. Nizhnik and A. Sagirov, is carried out on the basis of a dynamic functional connection between the preserved elements of the personality and medical and pedagogical influence. At the initial stage of planning corrective work, it is necessary to include compensatory mechanisms in action, to differentiate disorders of mental functions from the preserved core of the personality. The forms and means of leakage are determined by the nature of mental changes and the severity of pathological actions. It is necessary to take into account the main individual characteristics, personality structure, pathological changes in a sick child:

o what are the main pathological changes in a sick child;

o what are the main mental disorders in a sick child, subject to correction through psychological and educational work;

o on which positive aspects of such a child's personality and residual possibilities it is possible to build influence;

o which restraining factors - psychological and educational means - can be the most in the process of corrective work with each child;

o dynamically track the state of mental processes in the course of psychological and pedagogical rehabilitation;

o the need for long-term exercises, not only in relation to impaired functions, but also to the whole personality.

They also believe that when deciding on the organization, choice of means and forms of influence, it is necessary to take into account the peculiarities of the reactivity of children with mental disorders, their altered psyche. When building corrective work, it is necessary to take into account the following factors:

1. Inclusion in educational and pedagogical general classes is slow, the adaptation of children to a particular type of activity takes a long time.

2. Training sessions are conducted in two directions. On the one hand, they are carried out as a form for obtaining knowledge, on the other hand, the educational process itself and educational forms direct, develop, correct the processes of thinking, attention, and direct behavior.

3. Work to correct violations is individualized for each child and each group of the disease.

Many years of experience of M. M. Ilinoi and I. I. Mamaychuk shows that correctly selected methods of psychological assistance, taking into account the individual psychological characteristics of children and adolescents with developmental problems, affect the dynamics of their mental and personal development. They consider psychological assistance to children and adolescents with developmental problems, including those with mental retardation (MPD), as a complex system of clinical, psychological and pedagogical influences, including both general and particular tasks. Common tasks include:

o development of the gnostic processes of a child with mental retardation, which correspond to her physical and mental capabilities;

o strengthening the social position of the personality of a child with mental retardation in a group of peers and in the family;

o formation of adequate self-esteem, independence and activity in children with mental retardation.

The solution of particular problems is also of great importance:

o elimination of secondary personal reactions to an existing defect;

o diagnosis and correction of the style of family education;

o preventing the development of hospitalism or its consequences, and so on.

The tasks of psychological rehabilitation in work with children with intellectual disabilities and mental illnesses are:

o psychological diagnostics and correction of the cognitive sphere;

o psychological diagnosis and development of the emotional-volitional sphere of the personality;

o the formation of positive personality traits and the development of the communicative sphere of personality.

Considering the tasks of psychological rehabilitation in working with children with hearing impairments, such scientists as T. G. Bogdanova, L. S. Vygotsky, T. V. Rozanova, I. M. Solovyov, N. D. Yarmachenko and others pay attention to the originality of the mental development of children with impaired auditory function and the establishment of ways to compensate for violations of varying complexity. The foundations of the psychological rehabilitation of children with hearing impairments are based on the disclosure of the tasks that deaf psychology sets for itself. A number of authors, N. M. Trofimova, S. P. Duvanova, N. B. Trofimova, T. F. Pushkin, distinguish the following tasks:

o identify patterns of mental development of people with hearing impairment;

o to study the features of the development of certain types of cognitive activity of the individual;

o develop methods for psychodiagnostics and psychocorrection of relevant disorders;

o to study the problems of integrated education and the integration of people with hearing impairments into society.

The tasks of psychological rehabilitation in working with children with hearing impairments are:

o development of the communicative sphere of the individual;

o the formation of adequate self-esteem and the level of claims;

o formation of positive personality traits;

o establishing opportunities and ways to compensate for violations of varying complexity.

The task of psychological rehabilitation with children with visual impairments is based on the main task of tiflopsychology - the study of the psyche of the blind and visually impaired. This task should be solved in a number of aspects:

o disclosure of the main patterns of development and manifestations of the psyche, characteristic of both persons who see normally and persons with visual impairments;

o disclosure of specific patterns of mental phenomena inherent only to the blind and visually impaired;

o establishing the dependence of the development and manifestations of the psyche on the degree and nature of the pathology of vision and the time of occurrence of the defect

o identification of ways and mechanisms of compensation and correction of secondary deviations;

o theoretical substantiation of pedagogical influences (methods and means of training and education) on children with anomalies of the visual analyzer.

In addition to these tasks, the leading scientist A. G. Litvak believes that the main task of rehabilitation work with the aim of integrating the visually impaired in society is the establishment or restoration of social contacts, that is, socio-psychological adaptation (in the case of the blind - reintegration).

The tasks of psychological rehabilitation in working with children with visual impairments are:

o psychological diagnostics and correction of the cognitive, emotional and volitional spheres of the personality;

o the formation of adequate self-esteem and the level of claims;

o formation of positive personality traits;

o establishing opportunities to compensate for violations by intensifying the work of other analyzers;

o the formation of a "sense of obstacles";

o identification of ways and mechanisms of compensation and correction of secondary deviations.

The basis of effective rehabilitation of a cancer patient, as S. A. Misyak notes, is creativity, spirituality, they not only restore his health, but also provide her with an evolutionary path of development. Prevention of the further development of the tumor process is a difficult goal to achieve - both for the patient and for doctors and social workers. But it is the creative and spiritual aspects that make it possible to simplify the goal by conditionally breaking it into several fragments. The patient needs to be helped to determine his development strategy - constructive, related to the restoration of bodily health and the development of psychological health, with the pursuit of humanistic goals, the formation of spiritual culture.

The tasks of psychological rehabilitation in working with children with disorders of the internal organs are:

o psychological diagnostics and correction of the cognitive, emotional and volitional spheres of the personality;

o removal of conflict emotional states;

o removal of mental traumatism in connection with medical procedures (operations) due to the inconsistency of the child's hope for quick treatment;

o psychological adaptation to changing conditions.