Psychological rehabilitation of patients with disease or damage to the nervous system. Psychological Rehabilitation of Patients with Consequences of Stroke in Conditions of Rehabilitation Treatment: Stages and Methods

Quite often in our life there are situations after which we lose interest in life, feel oppressed, unnecessary, sometimes even without a desire to live on. To restore the former attitude to life, to establish contact with the world, psychological rehabilitation will help to achieve, the purpose of which is to rethink the person of his path, restore ties with the outside world, productive interaction.

Psychological foundations of rehabilitation

They consist in adjusting the emotional state, which will reduce the time of recovery and adaptation, family psychology and therapy, and expanding the information space. The task of such rehabilitation is to accept a new self, to realize the lost functions, to adapt to the outside world. Restoration of the personal and social status of a person.

Psychological rehabilitation has a broad concept. It is the final stage in general treatment, primarily in terms of restoring the social and personal status of a person. It is carried out using psychological methods that are aimed at eliminating various defects obtained during illness or in some situation (not necessarily physical). It includes treatment, prevention, adaptation to life and work after illness. In general, there is medical, psychological, professional and social rehabilitation.

Basic methods of socio-psychological rehabilitation

Summing up, it is worth noting that the methods of psychological rehabilitation should be aimed at achieving a high result. Constant counseling of patients will help in its implementation. Social rehabilitation allows them to adapt to the changed conditions of family and social life. These are activities aimed at improving the quality of life, creating equal opportunities for full participation in society. Thus, we must understand that, along with drug treatment, the psychological recovery of a person is of no small importance. Do not neglect them.

Psychological rehabilitation of children with disabilities is one of the leading tasks, the solution of which is provided, as you know, in rehabilitation centers. Its relevance is determined by the fact that in the overwhelming majority of cases, children have various disorders and disorders of a psychological nature, disharmony in mental development, which significantly impede the possibility of their successful social integration.

Psychological rehabilitation is understood as a system of special and purposeful measures, due to which the restoration (formation, development) of various types of mental activity, mental functions, qualities and formations takes place, allowing the disabled person to successfully adapt in the environment and society, accept and perform appropriate social roles, achieve high level of self-realization.

Preceding any measures for psychological rehabilitation is the stage of psychodiagnostics, during which, by assessing the characteristics of the actual mental development of the child, predicting the possibilities of his development, not only indications for psychological

rehabilitation, but also the goals of rehabilitation measures are formulated, their content is clarified, the optimal options for methodological methods and means of rehabilitation are determined. Based on its results, the preparation of a program of psychological rehabilitation is based. At the same time, relevant clinical and physiological information characterizing the dynamics and prognosis of the course of the disease, information about the social status of the child and his family play an important role in ensuring the adequacy, prospects, and targets of psychological rehabilitation.

Thus, at the diagnostic stage of comparing an individual rehabilitation program, indications for psychological rehabilitation are determined, which primarily include:

- disturbances in the development of mental functions (perception, memory, attention, thinking, psychomotor, etc.);

- pathological disorders at the level of personality (neurosis-like or psychopathic);

- disorders of the emotional and motivational sphere (increased excitability, emotional instability, anxiety, etc.);

- general disorders of intellectual, mental development (mental retardation, mental retardation);

- inadequate attitude to the disease, physical (external) defect, causing behavioral disorders.

The second class of indications should include those features of the child's psychological development that are not pathopsychological, but nevertheless can significantly impede the possibility of his social integration. These include:

- insufficient assimilation of communication skills, low level of communicative activity;

- inadequacy of the level of claims, self-esteem, criticism;

- the narrowness of the circle of interests, the lack of social mediation of value orientations;

- excessive psychological dependence on the immediate environment, social infantilism.

The third class of indications is determined by the conditions of the social environment, intra-family relations, which directly affect the characteristics of the mental development of the child. These include:

Disharmonies in intra-family relations in general, in the dyads "child - mother", "child - father", in particular;

Various kinds of neuropsychiatric disorders detected in parents;

Antisocial behavior of family members;

The irrationality of the dominant forms of family education (typical here is overprotection);

The irrationality of the attitude of parents to various rehabilitation measures, the inadequacy of their assessment of the life prospects of the child.

One of the important tasks to be solved during the diagnostic stage is the determination of the psychological rehabilitation potential, which is understood as the level of preservation of psychological abilities and inclinations, the mechanisms of mental functions that make it possible, under certain conditions, to compensate or restore psychological disorders.

When implementing measures for psychological rehabilitation, a special role belongs to the control and summarizing its intermediate results.

The final stage of psychological rehabilitation is the assessment of its effectiveness and summarizing the overall results.

The actual methodological apparatus of psychological rehabilitation includes activities for psychological counseling, psychotherapy, psychocorrection and psychological training. So with regard to psychological counseling, it can be noted that, as a method of psychological rehabilitation, it is the most universal, can include elements of diagnostics, psychotherapy and psychocorrection, does not have any contraindications and, on the contrary, is indicated in almost all cases. In principle, psychological counseling should be carried out at the initial stage of diagnosing a child's illness. Children themselves can, as a rule, act as counselors from the age of 12-14, before that parents consult.

The use of psychotherapeutic methods of rehabilitation is indicated for systemic disorders at the personality level (neurosis-like and psychopathic), various psychosomatic dysfunctions, behavioral disorders, emotional and motivational disorders. Their effective application can be difficult in situations of severe intellectual impairment, in the early stages of ontogenesis, when the child does not yet possess the necessary communication and behavioral skills. As experience shows, the real involvement of the child in the psychotherapeutic process is observed approximately from the age of 4. There are many psychotherapeutic techniques: rational psychotherapy, psychosynthesis, gestalt therapy, positive psychotherapy, behavioral psychotherapy, art therapy, aesthetic therapy, neurolinguistic programming. In working with children, it is most expedient to use playful, emotionally rich forms of psychotherapy, as well as art therapy (music therapy, dance therapy, etc.). It should also be noted here that conducting family psychotherapy is possible both with the active involvement of only parents in its process, and parents together with their children. Psychotherapy can be either individual or group.

Psychocorrection, in contrast to psychotherapy, for example, is more focused not on pathopsychological, but

on "normal", but insufficiently adequate for successful self-realization psychological manifestations of the individual (see above indications for psychological rehabilitation of the second class). But at the same time, psychotherapeutic techniques themselves can be widely used in its course. One of the significant limitations of the use of psycho-corrective methods is also the age of the child, and its most effective use is in a playful way.

Psychological training solves more local problems compared to other methods of psychological rehabilitation. Depending on the nature of the disorders, training of psychomotor functions, training of memory, attention, training of reactivity, communicative training, auto-training, etc. are distinguished. Psycho-training sessions, as a rule, make little demands on the intellectual and cultural qualifications of the child and can be used at relatively earlier stages of ontogenesis. In some cases, it is advisable to teach parents the methods of training exercises in order to conduct them at home.

Almost all measures for psychological rehabilitation (with the exception of consultations) imply cyclicity, the sequence of classes, exercises, sessions. Their effectiveness in some cases requires up to several months of purposeful work. The conditions of the RC, as a rule, meet this requirement, for example, it is possible to carry out activities in a day hospital. As experience shows, a number of rehabilitation activities (training, corrective) can be successfully carried out by specialists of the center at the child's home.

Individual programs of psychological rehabilitation may imply the need to use a combination of different methods (therapeutic, corrective, training). This also necessitates a certain specialization of psychologists and psychotherapists responsible for the implementation of these programs. At the same time, psychodiagnostic work also requires special training. All of the above allows us to consider it expedient to allocate a special psychological department in the RC, whose employees will be focused on carrying out a certain range of necessary activities.

It is essential to evaluate the effectiveness of psychological rehabilitation. It can be carried out by means of control psychodiagnostic examinations or psychodiagnostic assessments of the child's behavioral reactions. In this case, the preferred option is to assess the effectiveness of psychological rehabilitation based on the degree of solution of its conceptual, rather than local tasks, namely, based on the success of the child mastering various types and forms of activity, the adequacy and success of including him in various areas of social relations that correspond to age standards. .

It is advisable to carry out such an assessment no more than 1-2 times a year, and not only specific psychological, but social and behavioral indicators should be used as its parameters.

In conclusion, we should probably point out the specific role, the special place of psychological rehabilitation in the overall complex of rehabilitation measures. It is due, firstly, to the fact that not only a disabled child, but also his family, his immediate environment act as an object of rehabilitation. Secondly, in many cases, the results of psychological rehabilitation directly and directly determine the success of rehabilitation treatment, general and vocational training, and household rehabilitation, i.e. ensure the effectiveness of other rehabilitation measures. Thirdly, it is the results of psychological rehabilitation that predetermine one or another social effect of various rehabilitation measures.

Pedagogical rehabilitation

Pedagogical rehabilitation, having as its main goal the education, upbringing and development of the child to prepare for life in society and professional activities, for children with developmental disabilities involves the solution of general and specific problems by special methods and means. Pedagogical rehabilitation is the restoration, correction and compensation of lost and impaired functions in the process of education (both general and special) by methods of training, education and development.

In the process of educating children with disabilities, in addition to the general goals of education and upbringing, the tasks of correcting and compensating impaired functions are also solved. The purpose of pedagogical rehabilitation work is to normalize, correct (develop) the mental and physical functions of the child in the process of his general education, preparation for life and work and includes remedial education, upbringing and development.

Correctional education involves the assimilation of social experience by special methods that take into account the shortcomings of the mental and physical development of the child. Correctional education is the education of typological

properties and qualities of a personality that are invariant to the subject specificity of activity (cognitive, labor, aesthetic, etc.), allowing one to adapt in the social environment. Corrective development achieves correction (overcoming) of developmental deficiencies, improvement of physical and mental functions, intact sensory sphere and neurodynamic mechanisms of defect compensation.

Compensation for the defect by pedagogical measures is implemented with the help of special manuals, didactic material, and special devices.

Taking into account the complexity and variety of tasks and means of pedagogical rehabilitation, as well as their dependence on the nature of the pathology, the specifics of developmental deviations, the process of pedagogical rehabilitation is preceded by the stage of diagnosis and development of the pedagogical aspect of a comprehensive rehabilitation program.

During the diagnostic process, the following tasks are solved:

- the level of knowledge about the surrounding world and orientation in space and time, the level of knowledge and skills in the program material (Russian language, mathematics, other subjects), the degree of learning ability, attitude to learning, speech defects, social and everyday adaptation and attitudes are revealed;

- a psychological examination is performed (peculiarities of perception, memory, thinking, emotional-volitional sphere, behavior are revealed;

- information is collected about the parents, the family of the child, the conditions of education.

Based on this comprehensive survey, the issue of the necessary set of rehabilitation measures, the timing of control is decided. A decision is made on the need to send the child to one or another specialized educational institution and on the measures taken in the conditions of the rehabilitation center, depending on the areas of pedagogical activity carried out here.

As a rule, in rehabilitation centers there are children who are brought up in kindergartens, studying in general schools and at home. Also, specialized groups of a kindergarten, a school or a branch of a school with specialized classes can be organized in rehabilitation centers, taking into account the characteristics of the contingent of disabled children.

Speech therapy classes are organized, various developing circles on interests and labor education (circle work can be organized according to a single system), classes with a typhlo-, deaf-, oligophrenic teacher for the development of visual, auditory functions, intelligence, social and labor integration, extracurricular work ( clubs, excursions, summer holidays, holidays). The system of circle work should have a corrective focus: the development of motor skills, hearing, vision, speech, social adaptation, professional orientation.

The following circles can be organized in the rehabilitation center: drawing, modeling, musical and choral, needlework, sewing, making art products (from leather, birch bark, straw, wood, ceramics), weaving, computer technology (currently there are many interesting and effective correctional computer programs for the development of speech, hearing, vision, intelligence). The system of circle work can be built in stages in accordance with the program of labor training for general educational correctional educational institutions (kindergartens and schools).

Stage 1 (3-10 years) - training in manual labor and elementary labor skills, self-service.

Stage 2 (10-14 years old) - general labor training.

Stage 3 (14-17 years old) - pre-professional and vocational training.

When developing the content of circle work, sections of the indicated labor training programs can be used.

For children with developmental disabilities at a rehabilitation center, it would be advisable to organize a cycle of socio-psychological classes that contribute to their social adaptation and integration into society. This cycle involves the following tasks:

- promotion of self-knowledge, self-regulation of the individual;

- formation of the image of one's own "I", the formation of adequate self-esteem and self-regulation training;

- enrichment of the content and forms of education;

- orientation in the main types of social activity, the formation of social culture;

- formation of a healthy lifestyle, training in first aid skills.

The level of implementation of these tasks varies depending on the age and contingent. The cycle is carried out by the joint efforts of teachers, psychologists, doctors, social workers.

When organizing kindergarten and school groups, pedagogical activities are organized in accordance with the current training and education programs. Extra-curricular and out-of-school activities are organized in accordance with the provisions set out above.

Determining the effectiveness of rehabilitation pedagogical measures is evaluated as follows. The results of training, education and development are evaluated by identifying the level of assimilation by each child of the content of training and education programs (in the case of organizing groups of kindergarten and school) to determine the possibility of the most rational further progress in the study of program material or based on the results of the implementation of the pedagogical aspect of the rehabilitation program.

In preschool education, the assessment of the level of assimilation of the program is assessed at three levels: above the norm, norm and below the norm. Evaluation is carried out three times a year: at the beginning of the year, in the middle (in order to adjust individual education programs) and at the end of the year to summarize the final results for the year and decide whether it is possible to transfer to another group or educational institution (general or specialized) for more effective rehabilitation, for sending to school.

Evaluation of the results is carried out in the process of taking into account academic performance (current, final, in exams) in points (marks from 5 to 1). Marks reflect the level of assimilation of the program, which involves training, education, correction, by determining the quality of knowledge, skills, the formation of qualities and personality traits, the norms of student behavior in accordance with the standards established by the educational standard.

The results of educational and out-of-school work are evaluated according to the degree of achievement of the intended results according to the rehabilitation program at three levels and can be expressed in points: 5 - above the norm, 3 - the norm, 1 - below the norm. The effectiveness of learning outcomes and pedagogical correction is determined by the level of assimilation of program material in comparison with the standards (embedded in the program), which is expressed in conditional points: "5" - complete deep assimilation of program material, including additional material; "4" - complete assimilation of the program material with minor gaps in the additional material; "3" - assimilation of the program at a minimum level; "2" - significant gaps in the assimilation of the program; "1" - the program is not mastered.

The total result is determined by the average score. With an average score below three, a radical revision of the individual rehabilitation program is necessary. An average score above 4.5 indicates a high efficiency of rehabilitation.

Based on the assessment of the effectiveness of rehabilitation pedagogical measures, a decision is made to adjust the program (in case of ineffective implementation) or continue its implementation. At the end of each stage of the program, the next stage is concretized, replenished with real measures and terms. All Solutions about adjustment and further development of the pedagogical aspect of the rehabilitation program are taken in coordination with other specialists of the center.

The pedagogical aspect is of great importance for the entire rehabilitation process as a whole, for the most complete realization of the rehabilitation potential, the integration of the child into society and makes a significant contribution to improving the effectiveness of complex rehabilitation. First of all, this is the correction and compensation of deviations in development (hearing, vision, intelligence, movement disorders, psychological disorders) using pedagogical methods of correctional pedagogy. Also, it is in the process of education and upbringing that socialization, the accumulation of life experience, knowledge, preparation for active participation in all spheres of activity, and the reduction of existing social insufficiency take place. In a severe course of the disease, methods of therapeutic pedagogy can distract the child from the disease.

The optimal results of upbringing and education affect the effectiveness of other aspects of rehabilitation: the restoration and compensation of lost functions, their correction (medical aspect), the development of intelligence and the correction of psychological disorders (psychological aspect), and the solution of social problems. And it is no coincidence that not a single rehabilitation institution can do without a pedagogical service. And the better and wider this service is organized, the more effectively the rehabilitation and integration of the child into society is carried out.

Psychological foundations of rehabilitation. Principles, stages, methods.

Rehabilitation (French rehabilitation from Latin re apart + habilis convenient, adapted) in medicine is a complex 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 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).

Lecture #1

"General Foundations of Rehabilitation"

teacher Ryzhikova L.I.
Term "rehabilitation" from Latin origin (re-repeated, renewed actions, counteractions, (habilis - convenient, adapted) according to the WHO definition, rehabilitation is the combined and coordinated use of social, medical, pedagogical and professional activities with the aim of preparing and retraining the individual to achieve his working capacity. A powerful impetus for the development of physiotherapy and occupational therapy was at the beginning of the last century World War I, then World War II completed the formation of a new discipline involved in restorative treatment - rehabilitation.

Rehabilitation is engaged in the restoration of the status of the individual. Rehabilitation is a direction of modern medicine, which in its various methods relies primarily on the personality of the patient, actively trying to restore the functions disturbed by the disease, as well as his social ties. This is the final stage of the general treatment process, where it is important to evaluate the effectiveness of treatment, the effect on the body.

Preserving the health of people is the most important task of any state. At present, the health of the working-age population is deteriorating sharply in Russia. Every year, 3 million people do not go to work due to illness, and 20-25 million people at work are in a pre- or post-morbid condition. More than 70% of the working population suffers from various diseases by retirement age, it should be taken into account that Russian citizens retire 5-10 years earlier than in developed countries. Therefore, the main goal of the healthcare system in Russia is to improve the level and quality of public health.

An assessment of the current state and trends in the health of the population indicates a serious problem that can lead to deterioration quality of life population, a significant limitation in the implementation of their biological and social functions. concept quality of life includes physical health, his psychological status, level of independence, characteristic features of the environment.

The whole complex of rehabilitation measures is divided into:

1. 
   medical rehabilitation, using various methods of drug therapy, physiotherapy, exercise therapy, clinical nutrition, surgical correction, etc.
2. 
   psychological rehabilitation including measures for the timely prevention and treatment of mental disorders, for the formation of conscious active participation in the rehabilitation process in patients.
3. 
   vocational rehabilitation , the main tasks of which are the restoration of relevant professional skills or retraining of patients, solving issues of their employment.
4. 
   social rehabilitation, including the development, adoption at the state level of relevant regulatory legal acts that guarantee the disabled certain social rights and benefits.

STAGES AND OBJECTIVES

The stages of medical and psychological rehabilitation include:

stage of emergency rehabilitation - maintaining or restoring the working capacity of special contingents in the zone and focus of an emergency.

stationary (hospital) stage - rehabilitation therapy is carried out in a hospital, hospital or other medical institutions.

sanatorium - readaptation in the relevant sanatorium-resort institutions, outpatient stage - continuation or completion of rehabilitation activities in a clinic or dispensary.

Tasks of medical and psychological rehabilitation are determined by its stage at the inpatient (hospital) stage - this is to develop the most rational program with ensuring its continuity at subsequent stages. Determination of the adequacy of the medical - motor regimen; study of the psychological state of the patient and his attitude to his disease; the formation of an adequate idea of ​​the disease or injury in the patient and his relatives; explanation to the patient of the need to comply with the mode of physical activity throughout the stationary period of rehabilitation (one of the most important conditions for the prevention of complications).

The main tasks of the sanatorium stage is to further increase the efficiency of patients through the implementation of a program of physical rehabilitation using natural preformed physical factors, preparing patients for professional activities, preventing the progression of diseases, its exacerbations by conducting drug therapy against the background of spa treatment.

To the main tasks of the outpatient stage rehabilitation include: dispensary dynamic observation, secondary prevention; rational employment of patients

Tasks of the emergency rehabilitation stage (behind him is the future) - the forefront of medical and psychological rehabilitation and its tasks are relevant and significant forecasting and analysis of possible pathological conditions in appropriate situations; development of methods for the differentiated use of means to prevent the occurrence of pathology and quickly eliminate the violations that have appeared.

Rehabilitation measures are an integral part of the treatment process from the first days of the disease.

Medical rehabilitation combines 3 areas of influence on a person. Each of them, both independently and together with others, provides health restoration:

1. 
   medical direction - uses the effect of one or more medicinal substances in a certain complementary set.
2. 
   non-drug direction - combines various types of physical influence: reflexology, physiotherapy exercises are successfully used in almost all types of pathology. It has not only general training, but also a special therapeutic effect, stimulating adaptation to physical activity. A special place is occupied by sanatorium treatment. In the resorts, all types of non-drug treatment are changed using natural resort healing climate factors, balneotherapy and mud therapy.
3. 
   instrumental direction :

radiation therapy through an endoscope

plasma and lymphatic

ultrasonic phonophoresis and others

In this regard, at present, it is advisable to evaluate the effectiveness and cost-effectiveness of various methods of treatment not only by the criteria of survival and life expectancy, but also by indicators of the quality of life, which are increasingly used in practice and are included in special methods.

Rehabilitation is closely related to the medical, sociological and philosophical concept of quality of life. Rehabilitation, according to WHO, can have a very positive impact on the quality of life.

General indications for medical rehabilitation:

1. Significantly reduced functional abilities of the body.

3.Special exposure to environmental influences.

4. Violation of social relations.

5. Violation of labor relations.

General contraindications for medical rehabilitation:

1. Accompanying acute inflammatory diseases.

2. Acute infectious diseases.

3. Acute diseases in the period of decompensation.

4. Oncological diseases.

5. Psychological and neurological diseases of the central nervous system and intellectual disorders.

“Currently, rehabilitation occupies a very significant place in the healthcare sector. Despite the fact that there are more and more new 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 to 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 gradation of applied efforts. 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 above, the psychological aspect of rehabilitation throughout its entire duration provides not only for the prevention or overcoming of the 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 consciousness 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, 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, and e in the social sphere 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) "identified 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 category “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 patient's acquisition 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.