Directions for social rehabilitation of disabled people with vision pathology. Social rehabilitation of people with visual impairments. Basic research methods

Children with impaired visual functions often do not know how to establish contact with people around them, they are helpless in front of strangers, and show painful internal constraint. Then blind and visually impaired children, in order to maintain internal balance, prefer to avoid contact. This behavior is social autism.

If people do not respond to children's desire to communicate, their need to experience their attention is not satisfied. This leads to discomfort and long-term psycho-emotional depression, which manifests itself as depressive states. Blind children stop believing in themselves and become alienated. This is especially pronounced in completely blind children. A disabled child, isolated due to a defect, is deprived of the opportunity to move freely and communicate.

They are helped out of the dead-end situation of loneliness and social deprivation by engaging in aesthetic creative activity. Children try to write poetry, make something with their hands, or write music. When a visually impaired child discovers the joy of aesthetic creativity, he not only changes his life position, but also the attitude towards your life, yourself and your flaw. He begins to look more optimistically at life and his surroundings. But, unfortunately, in most cases, after graduating from an educational institution, a visually impaired person again finds himself in the conditions of narrow family communication.

The main channel, the provider of various experiences that reflect a person’s life, is communication. It acquires special significance in the life of a visually impaired person when he is involved in creative aesthetic activity and finds himself in a team in which he finds a response to his creativity. But if blind people are not helped, their creative qualities may not develop. It is necessary to let them see those positive sides of their psyche that will help them find understanding, establish themselves in life and express themselves in society.

How a child feels in a boarding school directly depends on the form of organization and content of his life activities outside of school hours. Together with the children, the teacher tries to hold more varied events and do interesting things. Teachers use the following methods of working with visually impaired and blind children:

lectures;
conversations;
participation in competitions and concerts;
reading and discussing literature;
design of wall newspapers;
preparation of school-wide holidays;
self-care work;
socially useful work;
production of manuals.

When children work in teams, they develop social activity and creative skills. They learn to express their opinion, evaluate what has been done, take into account the opinions of others, and be responsible for the assigned work. These skills are developed during the preparation and conduct of various events.

When preparing school-wide events, work occurs in the following stages:

Selection of material. Children independently select skits, poems, games, interesting situations and monologues. The teacher needs to take into account their vision condition.
Drawing up and discussing the script. This stage must be done creatively. Children can make amendments, express wishes, and creatively process the material. Often children can make very significant comments and convince older people.
Distribution of roles. It is necessary to discuss with the children who is most suitable for which role. Some children want to play energetic characters, leading roles, and enjoy performing in public, while others prefer secondary roles, with few words and movements. Some can use their abilities to the fullest and sing and dance with pleasure. Others feel comfortable helping on stage. Some people can barely remember four lines, while others good memory, and he can run the program himself. When assigning roles, the personal characteristics, desires and health status of children should be taken into account.

It can be useful to teach children, when preparing an event, to listen to an expressive performance of a piece by a teacher. You should analyze live speech, work on stage movement, facial expressions and pantomime. There is a wide scope for initiative, creativity and independence.

After the child receives a positive assessment and experiences a feeling of joy from what the whole team has done, he feels involved in the common cause. He lights up with the desire to do good, good things, and expresses a wish to participate in a common cause next time. For children with visual impairments, it is fundamentally important that they are not overly patronized, understood and accepted as equals.

Social rehabilitation of visually impaired people is improved by occupational therapy. By doing any work, children learn to love it, become more diligent, persistent and purposeful. They take the initiative, learn to choose the best ways to perform actions, and strive to finish the job they start. Without such qualities, further life is impossible.

But before the child begins to do any work, he must receive a certain amount of knowledge and show how he will perform certain actions. So, for example, in order to make a craft, you must first collect and examine natural materials with visually impaired children. Then the teacher needs to show how to roll and fasten the leaves to the branches. Only after this can children perform such actions independently. It is important at the end of the work to evaluate the feasibility, originality and individuality of the work. Children must be praised and thanked for the work done.

In the process of psychological and pedagogical rehabilitation of children, the following points should be taken into account:

children's health status;
response to their requests and wishes;
person-centered approach;
the use of special methods and techniques of work, interesting forms of organizing extracurricular activities.

It is necessary to praise children more often, because this causes them positive emotions and a desire to do something good next time.

11390 0

The most important task of medical and social examination is the rehabilitation of disabled people.

Much attention is paid to the rehabilitation of the blind. Rehabilitation is included in the system of state socio-economic, medical, professional, pedagogical, psychological and other measures aimed at preventing diseases leading to temporary or permanent loss of ability to work and at returning sick and disabled people to society and to socially useful work.

When examining a patient, the VTEK forms individual program rehabilitation of a disabled person. In planning and carrying out rehabilitation measures The activities should involve not only medical and social assistance, but also enterprises, as well as disabled people themselves and their families.

Created scientifically based system medical and social rehabilitation blind and visually impaired persons includes a complex of medical, psychological, sociological, pedagogical, vocational and labor programs, the phased and interconnected application of which contributes to the restoration of health, ability to work and social integration blind people In the complex of rehabilitation measures, the leading role is played by rehabilitation treatment. Thanks to the achievements of modern ophthalmology, especially ophthalmic surgery, many thousands of blind people have had their sight restored.

Great importance There is also elementary rehabilitation of the blind - the development of mobility, sensory perception, mastering the skills of orientation in space, self-care, home economics, learning to write and read using the dotted Braille alphabet (which makes it possible to create 63 signs from a combination of 6 convex dots, sufficient to indicate letters of the alphabet, numbers, punctuation marks, as well as mathematical and musical symbols), mastery of the means of typhlotechnics (from the Greek typhlos - blind, techne - art - a branch of technology that develops devices, instruments and systems that compensate for partial or complete loss of vision, facilitating overcoming the psychological inferiority complex).

To carry out basic rehabilitation, there are special schools, as well as a special service at the boards and enterprises of societies for the blind. The vocational training or retraining of the blind, necessary for social and labor rehabilitation, is carried out in special technical schools, vocational schools, as well as directly at the enterprises of societies for the blind, where they acquire professions available to them.

Blind children undergo basic rehabilitation in special boarding schools, where they receive general secondary education. Training and education in these schools is structured taking into account the unique development of children with various forms of visual impairment. There are separate schools for blind and visually impaired children. Education in schools is conducted according to standard and special programs based on the principles of domestic typhlopedagogy. Boarding schools also provide labor training with a polytechnic focus. Graduates of boarding schools work in enterprises of blind societies or in other enterprises.

Some graduates continue their studies in higher or secondary specialized educational institutions and upon completion they work in various sectors of the national economy according to their specialty. The most important, final stage of rehabilitation is the return of the disabled person to professional work. The developed scientifically based system of employment for the blind ensures the provision of work that corresponds to the functional capabilities of the blind and does not affect negative influence on his state of health. Industrial training and work activities of the blind and visually impaired - disabled people of groups I and II are carried out at educational and production enterprises of blind societies, where the necessary working conditions have been created that take into account the functional capabilities of disabled people. Disabled people of group III, as well as a certain part of disabled people of groups I and II, work in general conditions production.

When determining the types, conditions and modes of work, it is necessary to take into account accessibility professional activity, as well as (most importantly) contraindicated factors of working conditions. In table Table 25 shows the main factors of working conditions that are contraindicated for disabled people with various forms of eye pathology, which are combined into eight categories.

Kovalevsky E.I.

· Pato psychological characteristics persons with disabilities

Hearing and vision

· Social and medical rehabilitation of the blind

· Social and medical rehabilitation of hearing impaired people

Pathopsychological characteristics of persons with hearing and vision impairment. When analyzing personality structure disabled adults with visual impairments since childhood must take into account the following characterological differentiation: the individuals of the inhibited circle make up 45%; excitable circle - 35%; mixed character - 20 %.

Among disabled people of the inhibited circle, isolation, low sociability, sensitivity, timidity, and indecision predominate. Disabled people of the excitable circle are characterized by increased excitability, irritability, excessive efficiency with loss of a sense of control over their actions, touchiness, stubbornness, and egocentrism. They are distinguished by thoroughness and pedantry. Many are prone to hysterical reactions. The vast majority of disabled people with visual impairments have had neurotic character traits since childhood. Moreover, such persons have a good memory, express their thoughts easily and freely, and have a fairly high general educational training. Many of them are characterized by a heightened understanding of moral principles and increased adherence to principles.

Pathopsychological changes and manifestations depend on the time of onset of the visual defect and its depth. Lack of vision from early childhood is not in itself a psychological factor, and the blind do not feel immersed in darkness. Blindness becomes a psychological fact only when a blind person enters into communication with sighted people who are different from him.

The depth and duration of the reaction to blindness depend both on the characteristics of the individual and on the rate of development of the visual defect, on its severity and time of appearance. The reaction of instantly blind people is more severe than that of those who gradually lost their sight.

Three stages of personal neurotic reaction to the onset of blindness are identified.

1. An acute reaction of emotional shock in the first days manifests itself in the form of emotional disorganization, depression, anxiety, fear, asthenia, and an exaggerated idea of one’s defect.

2. Reactive transition period with development neurotic state observed during the first three months. Psychopathological symptoms are determined by depressive, anxiety-depressive, hypochondriacal, hysterical, and phobic disorders.

3. With progressive vision loss, complaints of loneliness and helplessness are typical. Suicidal actions are possible. During this period, either adaptation to blindness occurs, or pathocharacterological changes in the personality structure develop.

Pathological development personality manifests itself primarily in four types: asthenic, obsessive-phobic, hysterical and hypochondriacal, autistic (with immersion in the world of internal experiences). Under unfavorable conditions, late-blind people may have impaired social connections, behavior change.

There are 4 phases in the process of adaptation to blindness: 1) a phase of inaction, which is accompanied by deep depression; 2) the activity phase, in which the visually impaired is involved in activities in order to distract from difficult thoughts; 3) the phase of activity, which is characterized by the desire to realize one’s creative potential; 4) the phase of behavior, when the character and style of activity of a blind person take shape, determining his entire future life path.

Psychological disorders in adults with hearing loss are in many ways similar to those observed with vision loss, since in both cases they are caused by sensory deprivation and isolation.

Adults with early acquired hearing impairment, under favorable socio-psychological conditions, can achieve good level socio-psychological adaptation with reduction of neuropsychic abnormalities. Several types of pathocharacterological development of personality are observed. Individuals with an asthenic personality type are characterized by feelings of anxiety, unstable mood, sensitivity, self-doubt, and fear of the difficulties of life and work. Reactively caused decompensations are accompanied by vegetative-vascular disorders, decreased mood, and perception disorders in the form of pathological sensations and illusory experiences, ideas of inferiority. Gradually, the dependence of the condition on traumatic situations is erased, and mental anomalies become a characteristic feature of the individual. The range of interests is narrowed to a concentration on one’s own well-being and experiences. Hypochondriacal, depressive moods, and fear of communication (social phobia) often occur. There is increased attention to self-perception and health issues. The formation of asthenic-depressive or hypochondriacal personality disorders is possible. Behavior shows increased punctuality, accuracy, and adherence to the daily routine.

Personality development of an excitable type is more often observed in disharmonious families, with hereditary burden. Such persons, against a background of infantilism, touchiness, vulnerability, and suspiciousness, show increased demands, intolerance towards others, pickiness, and irritability. They often have increased self-esteem, demonstrative behavior, a desire for excessive attention to themselves, and egocentrism.

With late hearing loss, in adulthood, this problem is perceived as severe psychological trauma. Personal response to hearing loss depends on many factors: personality characteristics, age, speed of hearing loss, psychological resistance to stress, social status, profession. Sudden loss hearing is perceived as a collapse of life and is accompanied by an emotional neurotic reaction. The psychological reaction to the gradual deterioration of hearing is less acute, as the person gradually adapts to changes in health. Hearing loss is accompanied by a violation of physical, mental and social well-being, and a disorder of biosocial adaptation. Attitudes towards hearing loss largely depend on age and social status. Young people perceive their defect more acutely. For them, the aesthetic, intimate components of the disease, the resonance of its defect on the part of friends and loved ones, the restriction of personal freedom, professional growth, and the occurrence of a certain social deprivation are more psychologically significant.

In old age, hearing loss is perceived less painfully, sometimes as a natural process of aging. In the mental state, along with the strengthening of previous traits or personality changes characteristic of the aging period, new traits also appear - emotional instability, frequent mood swings: from hope for improved health and life situation a person quickly moves to despair.

There is another category of people with the opposite attitude towards their illness - agnostic. They refuse to notice their defect, accuse others of speaking quietly or unintelligibly, and if those around them raise their voices, they declare that “there is no point in shouting, they are not deaf.”

The social positions of people who have lost their hearing are divided into three types: an adequate position corresponding to the real state of affairs; a position caused by an overestimation of the severity of one’s condition and characterized by a lack of faith in one’s capabilities, weakness of motives, and reluctance to actively participate in the rehabilitation process; a position of persistent reluctance to change one’s lifestyle in accordance with changed opportunities.

In a number of cases, young people who have recently lost their hearing themselves break off their previous connections and isolate themselves, because, in their opinion, they become inconvenient for communicating with old acquaintances and friends. In this regard, people with disabilities since childhood are positively different, they are adapted to their illness and limitations and are not inclined to build their self-image only on the basis of the presence of their defect.

The type of response to the disease will determine the patient’s behavior and, accordingly, the psychotherapeutic tactics of the doctor or social worker involved in the rehabilitation process.

Social and medical rehabilitation of the blind. Blindness in the medical sense is called complete absence the ability to perceive through vision not only the shape of objects and their rough outlines, but also light. In this condition, vision is completely absent, it is zero. If visual acuity is 0.04 or lower at better eye with the use of means for vision correction (glasses), the owners should be classified as blind. Persons with visual acuity in the better eye using conventional correction means from 5 to 40% are considered visually impaired. This makes it possible for the visually impaired to more regularly and systematically use an optical analyzer for visual work, such as reading and writing, as well as some others that do not place high demands on vision, but only in particularly favorable conditions.

Blindness is one of the important social problems. There are at least 20 million blind people in the world, if Blindness is defined as the inability to count fingers at a distance of 3 meters, that is, if we adhere to the definition of blindness recommended by the All-Russian Society of the Blind (VOS). According to the VOS, there are 272,801 visually impaired people in Russia, of which 220,956 are totally blind.

The main reasons contributing to the growth of visual disability: environmental deterioration, hereditary pathology, low level logistics medical institutions, unfavorable working conditions, an increase in injuries, complications after suffering severe and viral diseases and etc.

Both residual vision and vision of the visually impaired are not immutable. Progressive diseases include primary and secondary glaucoma, incomplete optic nerve atrophy, traumatic cataracts, retinal pigmentary degeneration, inflammatory diseases of the cornea, malignant forms of high myopia, retinal detachment, etc. Stationary types should include developmental defects, for example microphthal, albinism, as well as such non-progressive consequences of diseases and operations as persistent corneal opacities, cataracts, etc.

The age of onset of visual impairment and its nature determines the degree of disability. The main categories of impairments in the functioning of the blind include such as a decrease in the ability to see, identify people and objects, and maintain personal safety. Through visual analyzer a person receives up to 80% of all information. A blind or visually impaired person encounters many difficulties in the course of his life: low opportunities in education, employment, and income generation; the need for special equipment, devices that facilitate everyday self-care, medical and medical care. Many difficulties in life are caused not only by visual defects, but also by restrictions in the social environment and underdeveloped rehabilitation services. Disabled people are insufficiently equipped with auxiliary typhotechnical means (tape recorders, Braille paper, computers and special attachments for them, devices for cooking and child care, etc.) and vision correction devices (telescopic and spheroprismatic glasses, hyperoculars, magnifying attachments). Difficulties in moving on the street and in transport are associated with the “architectural” barrier. There is no special methodological literature on the issues of providing assistance to the visually impaired; There are not enough rehabilitation specialists.

Currently, the state is directing its efforts to create a social structure that would maximally provide for the needs and requirements of the blind and visually impaired in medical care, rehabilitation, and their possible participation in labor activity and cultural life of society, education, training, development of creative skills. Legislatively, the rights and benefits of persons with visual impairments are established in a number of international and Russian regulatory documents that are common to all categories of disabled people.

The main socio-economic and socio-demographic indicators characterizing the position of blind and visually impaired people in society are traditionally considered to be their participation in labor and social activities, the amount of wages and pensions, the level of consumption of durable goods, living conditions, family status, and education. This determines the priorities of the legal framework for the social protection of visually impaired people, which are aimed, first of all, at improving medical care and rehabilitation, solving problems of employment and vocational training, to improve the financial situation of disabled people and their families.

Public organizations of disabled people make a huge contribution to social protection. According to statistics, 92% of organizations involved in the rehabilitation of visually impaired people are non-governmental institutions. The most powerful of them are the All-Russian Society of the Blind (VOS) and RIT (Intellectual Workers). At this time, these enterprises and local primary organizations cannot provide assistance to the visually impaired in full. Currently in Russia there are four rehabilitation centers for the blind (Volokolamsk, St. Petersburg, Nizhny Novgorod, Biysk), where comprehensive rehabilitation is carried out:

Medical - aimed at recovery visual function, prevention of residual vision;

Medical and social - a complex of medical, recreational, cultural and recreational activities;

Social - a set of measures aimed at creating and ensuring conditions for the social integration of the blind, restoring lost social connections; to restore and develop basic self-care skills, orientation in the physical and social environment, and learning the Braille system;

Psychological - psychological restoration of the individual, the formation of personality traits in preparation for life in conditions of blindness;

Pedagogical - training and education;

Professional - professional guidance, vocational training and employment in accordance with health status, qualifications, personal inclinations;

Development and implementation of typhotechnical means, providing them to the blind.

A special role in the rehabilitation system belongs to medical and social rehabilitation disabled people.

Decisive moment in psychological rehabilitation - restoration of the social position of a visually impaired person, changing the attitude towards his defect and perceiving it as a personal quality, an individual characteristic.

IN pedagogical process A special place is occupied by training in the skills of using computer office equipment in work, the ability to navigate scientific information, and use it effectively to solve practical problems.

Well social rehabilitation provides mastery of the skills of independent orientation in space, social and everyday orientation and self-service, reading and writing in Braille, typing and other communication means. Blind people are taught the rules of using public transport, how to shop in a store, use the post office, etc.

Professional training includes training in certain specialties, crafts and training in the skills of running your own business. The range of specialties and crafts is determined by accessibility for the blind, public demand for these specialties and employment opportunities for the visually impaired.

Correctional The area of work with relatives and friends of visually impaired people includes socio-psychological assistance in solving intra-family problems.

Information and educational direction provides for the relatives and friends of a visually disabled person to receive the most complete information about the All-Russian Society of the Blind, the rehabilitation system in Russian Federation and abroad, the rights and benefits of visually impaired people, prevention and protection of residual vision, opportunities for rational employment, training in various educational institutions and much more.

Information and practical direction provides for the acquaintance of relatives and friends of a blind person with the basic techniques and methods of spatial orientation, rules for accompanying a blind person, auxiliary technical means for spatial orientation, with embossed dotted Braille and Gebold writing, i.e. writing in ordinary flat stenciled font, with techniques and methods of housekeeping in conditions of limited or no visual control.

Only the joint efforts of specialists and the immediate environment of a blind person can lead to positive results in his rehabilitation.

Social rehabilitation of hearing impaired people. According to the World Health Organization (WHO), about 300 million people have hearing impairment, which is approximately 7 - 8 % the entire population of the planet; about 90 million people have total deafness. In the Russian Federation, according to approximate VOG data, 12 million people have hearing impairments, of which more than 600 thousand people are children and adolescents.

The number of people with hearing loss in the population over 50 years of age is growing rapidly. The number of children with hearing impairments is constantly increasing. In the structure of diseases, hearing and vision impairments account for a total of 17% of all diseases that lead to childhood disability. The main causes of hearing diseases in children and adults are the consequences of inflammatory and infectious diseases (meningitis, typhus, influenza, mumps, scarlet fever, etc.), toxic lesions as a result of taking ototoxic drugs (drugs of the aminoglycoside series), mechanical injuries and concussion, defeat central departments auditory analyzer resulting from damage or diseases of the brain (encephalitis, traumatic brain injury, hemorrhage, tumor).

Exist various classifications according to the degree of hearing loss, among which the most common is the classification adopted by the World Health Organization (WHO) (Table 1).

Hearing disability is usually assigned to persons with complete hearing loss or hearing loss of III or IV degree.

After the diagnostic stage, they begin to implement medical, educational, psychological, social, labor and technical measures.

Rehabilitation services are provided by federal, regional and municipal organizations social sphere(systems of social protection of the population, education, healthcare, culture, sports, civil service employment), as well as non-governmental organizations.

According to the All-Russian Society of the Blind and Federal Bureau Medical and social examination requires 94% of visually impaired people for medical rehabilitation, 83% for professional rehabilitation, 65% for social-environmental and social-life rehabilitation, 93% for socio-cultural, and 100% for physical education and health.

1. Medical rehabilitation:

· drug treatment- complex treatment is prescribed, aimed at improving the nutrition of the retina and stimulating its function. Complexes of vitamins, ATP, aloe, vasodilators and other drugs are used.

Oxygen therapy – treatment with oxygen

· Physiotherapy

Active pleoptic and pleoptoorthoptic treatment

· Laser therapy - for conservative treatment;

LASER SURGERY

· treatment using special devices, simulators, performing exercises for vision development - VIDEO-COMPUTER VISION CORRECTION - a unique technology for the treatment of amblyopia in children and adults;

· Spectacle correction- early and correct selection glasses, dynamic monitoring of vision and systematic treatment.

· physiotherapy.

· Children are regularly examined by an ophthalmologist

1. Educational rehabilitation:

Preschool education children with visual impairments:

· Kindergartens, nursery schools and preschool groups for blind children (group capacity 10 people);

· Kindergartens, nursery schools and preschool groups for visually impaired children (group capacity is 10 people);

· Kindergartens, nursery schools and preschool groups for children with strabismus and amblyopia (group capacity 10-12 people);

· Special preschool institutions combined type

· Preschool educational institutions open advisory groups for children who do not attend kindergarten. These groups can also open at public organizations and private preschool educational institutions. The purpose of creating these groups is to help parents raise children with hearing impairments, teach them methods and techniques, monitor the dynamics of such a child’s development, etc.

Children from 2 to 7 years old are admitted to the nursery-kindergarten on the basis of a medical report and a psychological and pedagogical examination at the PMPK.

The purpose of these institutions is to provide treatment, possible restoration and the development of impaired visual functions in children, as well as the creation of correctional and compensatory conditions in order to prevent secondary deviations and eliminate deficiencies cognitive activity and undesirable personal qualities of the child.

Pedagogical work comes from training and education programs in mass kindergartens, on the basis of which special programs are developed. Developed special program for training and education of this category of children – L .AND. Plaksina.

General provisions organization of the correctional pedagogical process:

· The work always takes into account general and individual specific features visual impairment in children;

· Modify curricula and programs, increase the duration of training and redistribute the material, change the pace of its completion;

· Differentiated approach in conditions of reduced group occupancy;

· Work is being carried out on social and everyday adaptation and self-realization of the personality of a child with visual impairment;

· Ophthalmohygienic conditions are created in classrooms. Special requirements for illumination, for organizing a regime with maximum use of daylight.

All elements develop during the learning process visual perception:

ability to see near and far,

· observe moving objects,

· ability to distinguish the shape of objects, colors, look at pictures,

· navigate in space.

· The development of visual functions is complemented by the development of hearing and touch.

Various devices are being developed for the visually impaired: glasses, optical aids (magnifiers, projectors, lenses), telescopic glasses, textbooks with large print, notebooks with special lines.

- responsibility for healing process is borne by the Ministry of Health.

School education children with visual impairments

· Special correctional schools of type III for blind children with residual vision (0.08 – 0.04 and below). Class capacity is up to 8 people. The total duration of study is 12 years.

· Special correctional schools of type IV for visually impaired children with visual acuity (0.05 – 0.04 on the better seeing eye). Children with strabismus and amblyopia are also accepted for continued treatment. Class capacity is up to 12 people. The total duration of study is 12 years.

Schooling . – often combine 3 and 4 types.

Types of tasks schooling children with visual impairments:

· educational tasks;

· correctional and developmental;

· sanitary and hygienic;

· therapeutic and rehabilitation;

· social adaptation;

· career guidance.

The goal is to provide children with visual impairments with knowledge, skills and abilities within the scope of the general education program,

· provide prevention, treatment and development of residual vision,

· compensate to a certain extent for insufficient visual experience and psychological characteristics caused by diseases.

3 levels of education:

Stage I – primary general education (normative period of mastery is 4 years);

Stage II – basic general education (normative period of completion is 6 years);

III stage – secondary (complete) general education (normative period of development is 2 years).

At the boarding school, education is carried out using textbooks from the mass school:

· printed in a larger font and with specially transformed images that are accessible to the visual perception of a visually impaired child

· textbooks with raised dot font (Braille system) for the blind.

In order to compensate for the visual defect, typhlotechnical and audiovisual teaching aids are used: special writing instruments, converters of light signals into sound and tactile ones.

Graduates of a boarding school receive the same state-issued certificate of secondary education as in a public school and can, on a general basis, enter higher, secondary specialized and technical educational institutions in the specialties available to them or work in sectors of the national economy according to their physical capabilities.

2. Social and household rehabilitation visually impaired has significant specifics.

They need to learn to serve themselves without visual supervision or with minimal supervision. It includes basic elementary rehabilitation and orientation in closed and open spaces.

Basic elementary rehabilitation is related to the ability to take care of your appearance, eat, communicate according to the rules of etiquette, be independent in living (be able to find a fallen thing, use plumbing, prepare food, etc.) and the ability to navigate within the premises. as well as the ability to use household electrical appliances: stove, kettle, mixer, washing machine, etc.

Orientation in closed and open spaces involves the safe movement of a visually impaired person from their place of residence to an object (shop, post office, clinic...) and orientation within this object. Without the skills to independently navigate in space, the mobility of a disabled person will always depend on a sighted companion. Patients develop skills in using intact analyzers and optical means of spatial orientation, training in the complex perception of signals of different modalities, and the formation of orientation skills of the map-path and map-overview type. As well as mandatory training in movement techniques with the help of an orientation cane.

One more an important component social and everyday rehabilitation is computer literacy, which is currently becoming both a means of communication and a means of satisfying information and other needs for the blind.

Sociocultural rehabilitation provides access to cultural heritage humanity and the possibility of personal creativity, and also opens access to various types recreation and entertainment. This becomes possible thanks to learning to read and write using the Braille dot system.

Social services include family rehabilitation, involving assistance to the blind in creating a family, maintaining a favorable climate in it, and working with sighted relatives.

Topic: Structural and functional organization auditory sensory system.

1. The role of the auditory analyzer in human life - essay.

2. Anatomical structure auditory analyzer – updating knowledge, self-training of students.

3. Psychophysical indicators of hearing.

LECTURE 13

Features of medical and social rehabilitation of disabled people with hearing and vision impairments

hearing and vision

· Social and medical rehabilitation of hearing impaired people

Pathopsychological characteristics of persons with disordershearing and vision. When analyzing the personal structure of adult disabled people with visual impairments since childhood, it is necessary to take into account the following characterological differentiation: the personalities of the inhibited circle make up 45%; excitable circle - 35%; mixed character - 20 %.

Three stages of personal neurotic reaction to the onset of blindness are identified.

1. An acute reaction of emotional shock in the first days manifests itself in the form of emotional disorganization, depression, anxiety, fear, asthenia, and an exaggerated idea of one’s defect.

2. A reactive transition period with the development of a neurotic state is observed during the first three months. Psychopathological symptoms are determined by depressive, anxiety-depressive, hypochondriacal, hysterical, and phobic disorders.

Pathological personality development manifests itself mainly in four types: asthenic, obsessive-phobic, hysterical and hypochondriacal, autistic (with immersion in the world of internal experiences). Under unfavorable conditions, late-blind people may experience disruptions in social connections and behavior changes.

Psychological disorders in adults with hearing loss are in many ways similar to those observed with vision loss, since in both cases they are caused by sensory deprivation and isolation.

Adults with early acquired hearing impairment, under favorable socio-psychological conditions, can achieve a good level of socio-psychological adaptation with a reduction in neuropsychic abnormalities. Several types of pathocharacterological development of personality are observed. Individuals with an asthenic personality type are characterized by feelings of anxiety, unstable mood, sensitivity, self-doubt, and fear of the difficulties of life and work. Reactively caused decompensations are accompanied by vegetative-vascular disorders, decreased mood, and perception disorders in the form of pathological sensations and illusory experiences, ideas of inferiority. Gradually, the dependence of the condition on traumatic situations is erased, and mental anomalies become a characteristic feature of the individual. The range of interests is narrowed to a concentration on one’s own well-being and experiences. Hypochondriacal, depressive moods, and fear of communication (social phobia) often occur. There is increased attention to self-perception and health issues. The formation of asthenic-depressive or hypochondriacal personality disorders is possible. Behavior shows increased punctuality, accuracy, and adherence to the daily routine.

With late hearing loss, in adulthood, this problem is perceived as severe psychological trauma. Personal response to hearing loss depends on many factors: personality characteristics, age, speed of hearing loss, psychological resistance to stress, social status, profession. Sudden hearing loss is perceived as a collapse of life and is accompanied by an emotional neurotic reaction. The psychological reaction to the gradual deterioration of hearing is less acute, as the person gradually adapts to changes in health. Hearing loss is accompanied by a violation of physical, mental and social well-being, and a disorder of biosocial adaptation. Attitudes towards hearing loss largely depend on age and social status. Young people perceive their defect more acutely. For them, the aesthetic, intimate components of the disease, the resonance of its defect on the part of friends and loved ones, the restriction of personal freedom, professional growth, and the occurrence of a certain social deprivation are more psychologically significant.

In old age, hearing loss is perceived less painfully, sometimes as a natural process of aging. In the mental state, along with the strengthening of previous traits or personality changes characteristic of the aging period, new traits appear - emotional instability, frequent mood swings: from hope for an improvement in health and life situation, a person quickly moves to despair.

The type of response to the disease will determine the patient’s behavior and, accordingly, the psychotherapeutic tactics of the doctor or social worker involved in the rehabilitation process.

Social and medical rehabilitation of the blind. Blindness in the medical sense is the complete lack of ability to perceive through vision not only the shape of objects and their rough outlines, but also light. In this condition, vision is completely absent, it is zero. If visual acuity is 0.04 or lower in the better eye using vision correction devices (glasses), the owner should be classified as blind. People with visual acuity in the better eye using conventional correction means from 5 to 40% are classified as visually impaired. This makes it possible for the visually impaired to more regularly and systematically use an optical analyzer for visual work, such as reading and writing, as well as some others that do not place high demands on vision, but only in particularly favorable conditions.

The main reasons contributing to the growth of visual disability are: environmental deterioration, hereditary pathology, low level of material and technical support of medical institutions, unfavorable working conditions, increase in injuries, complications after severe and viral diseases, etc.

The age of onset of visual impairment and its nature determines the degree of disability. The main categories of impairments in the functioning of the blind include such as a decrease in the ability to see, identify people and objects, and maintain personal safety. A person receives up to 80% of all information through the visual analyzer. A blind or visually impaired person encounters many difficulties in the course of his life: low opportunities in education, employment, and income generation; the need for special equipment, devices that facilitate everyday self-care, medical and medical care. Many difficulties in life are caused not only by visual defects, but also by restrictions in the social environment and underdeveloped rehabilitation services. Disabled people are insufficiently equipped with auxiliary typhotechnical means (tape recorders, Braille paper, computers and special attachments for them, devices for cooking and child care, etc.) and vision correction devices (telescopic and spheroprismatic glasses, hyperoculars, magnifying attachments). Difficulties in moving on the street and in transport are associated with the “architectural” barrier. There is no special methodological literature on the issues of providing assistance to the visually impaired; There are not enough rehabilitation specialists.

Currently, the state is directing its efforts to create a social structure that would maximally meet the needs and requirements of the blind and visually impaired in medical care, rehabilitation, their feasible participation in work and the cultural life of society, education, training, and the development of creative skills. Legislatively, the rights and benefits of persons with visual impairments are established in a number of international and Russian regulatory documents that are common to all categories of disabled people.

The main socio-economic and socio-demographic indicators characterizing the position of blind and visually impaired people in society are traditionally considered to be their participation in labor and social activities, the amount of wages and pensions, the level of consumption of durable goods, living conditions, family status, and education. This determines the priorities of the legal framework for the social protection of visually impaired people, which are aimed, first of all, at improving medical care and rehabilitation, solving problems of employment and vocational training, and improving the financial situation of people with disabilities and their families.

Medical - aimed at restoring visual function and preventing residual vision;

Medical and social - a complex of medical, recreational, cultural and recreational activities;

Psychological - psychological restoration of the individual, the formation of personality traits in preparation for life in conditions of blindness;

Pedagogical - training and education;

Professional - professional guidance, vocational training and employment in accordance with health status, qualifications, personal inclinations;

Development and implementation of typhotechnical means, providing them to the blind.

A special role in the rehabilitation system belongs to medical and social rehabilitation disabled people.

Correctional The area of work with relatives and friends of visually impaired people includes socio-psychological assistance in solving intra-family problems.

Information and educationaldirection provides for the relatives and friends of a visually disabled person to receive the most complete information about the All-Russian Society of the Blind, the rehabilitation system in the Russian Federation and abroad, the rights and benefits of visually disabled people, the prevention and protection of residual vision, opportunities for rational employment, training in various educational institutions and much more. friend.

Information and practicaldirection provides for the acquaintance of relatives and friends of a blind person with the basic techniques and methods of spatial orientation, rules for accompanying a blind person, auxiliary technical means for spatial orientation, with embossed dotted Braille and Gebold writing, i.e. writing in ordinary flat stenciled font, with techniques and methods of housekeeping in conditions of limited or no visual control.

Only the joint efforts of specialists and the immediate environment of a blind person can lead to positive results in his rehabilitation.

The number of people with hearing loss in the population over 50 years of age is growing rapidly. The number of children with hearing impairments is constantly increasing. In the structure of diseases, hearing and vision impairments account for a total of 17% of all diseases that lead to childhood disability. The main causes of hearing diseases in children and adults are the consequences of inflammatory and infectious diseases (meningitis, typhus, influenza, mumps, scarlet fever, etc.), toxic lesions as a result of taking ototoxic drugs (drugs of the aminoglycoside series), mechanical injuries and contusions, damage central parts of the auditory analyzer, resulting from damage or diseases of the brain (encephalitis, traumatic brain injury, hemorrhage, tumor).

There are various classifications based on the degree of hearing loss, among which the most common is the classification adopted by the World Health Organization (WHO) (Table 1).

Hearing disability is usually assigned to persons with complete hearing loss or hearing loss of III or IV degree.

Table 1

Classification of hearing disorders

Level hearing impairment	Hearing loss, in dB	Degree of hearing loss (according to WHO)
Total loss hearing
Profound hearing loss	90 or more	IV degree hearing loss
Severe hearing loss		III degree hearing loss
Moderate hearing loss		Hearing loss II degree
Moderate hearing loss		Degree 1 hearing loss
Mild violation hearing		Normal speech is perceived

To establish the hearing disability group (deafblindness), the following indications are taken into account:

Violations sensory functions(vision, hearing);

Impaired ability to communicate - establish contacts between people by perceiving, processing and transmitting information;

Limitation of self-service;

Ability to study in general educational institutions, need for special regime educational process and (or) with the use of auxiliary means, with the help of other persons (except for teaching staff);

Ability to perform work activity: skill level or volume production activities, inability to perform work in one’s profession.

Social problems persons with impaired hearing. At all stages of life, deaf people face problems communicating with the outside world and obtaining information.

Objects of social, transport and engineering infrastructure of cities are not suitable for free access disabled people to information. For example, vehicles (buses, trolleybuses, commuter trains, etc.) are not equipped with ticker panels. Street telephones cannot be used by people with hearing impairments to communicate with different subscribers.

The lack of translation services in various regions of the Russian Federation, in other cases - a shortage of sign language interpreters, makes it difficult for deaf citizens to contact representatives of government authorities and justice, social protection organizations, education, healthcare, internal affairs departments, and their studies in various educational institutions.

The production on a limited scale of various models of text telephones and other technical means of communication (light optical signaling devices, electronic baby monitors, alarm clocks with a vibrator), operator telephone centers for the deaf leads to their information isolation.

Social journalistic, educational, youth, artistic, children's and other mass programs on television channels are not synchronously subtitled.

Criteria for the Deaf Community. From the point of view of the pathology of deafness in many countries With early 1980s Deaf people began to be viewed as a cultural-linguistic or sociological-linguistic minority. IN scientific works, media reports, the following terms are commonly used to refer to the deaf community: “linguistic minority”, “sociological-linguistic minority”, “cultural-linguistic minority”.

The deaf themselves view deafness as a factor that is associated primarily with social, linguistic, anthropological and cultural aspects. Deaf people prefer to be treated as equal members of society who can be integrated into the “hearing world” as members of the Deaf community. In 1987, the UN General Assembly agreed with the proposal of its experts that in every country “deaf people With severely hearing impaired shall be recognized as a linguistic minority who have the right to use their sign language as the first official language and as a means of communication and instruction, and to benefit from translation services.”

The main criteria by which membership in the deaf community is determined are:

1. Use of sign language. Sign language unites deaf people into one space that is separate from the majority of hearing people. Sign language is passed on from one generation to the next. In 1984, UNESCO adopted a resolution: “... Sign language should be recognized as a legitimate linguistic system and should have the same status as other linguistic systems.” In 1988, the Parliament of the Council of Europe called on EEC states to recognize national sign languages as official languages in their countries.

Sign language is noted in the constitution of such countries as Great Britain, Finland, Colombia, Portugal, Slovakia, Czech Republic, South Africa, Uganda, etc.

Sign language of the deaf in Australia, Belarus, Denmark, Canada, Lithuania, Norway, USA, Ukraine, Uruguay, Switzerland, Sweden, France and other countries is used in many areas public life and is close to official recognition by the state.

In Sweden, Norway, France and other countries, the right of deaf people to receive education in sign language is legally established.

2. Deafness as an identification criterion by which deaf people consider themselves to be a sociological and linguistic minority.

As Louise Kauppinen, President of the World Federation of the Deaf (WFD), writes in WFD News magazine: “Across the world, a certain self-awareness of deaf people has emerged, who have come to view themselves as a socio-cultural community with its own language, distinctive history, values, customs, means and organizations that reveal themselves in interaction with others, that is, “non-deaf.”

3. Behavioral norms and rules. Community members have certain rules and norms within which they live.

4. Marriages between deaf people. More than 90% of marriages of deaf people are to people who are deaf or hard of hearing. Marriages between graduates of the same school for deaf or hard of hearing children are more common.

Historical heritage. Deaf people are characterized by a sense of continuity. Each new generation of deaf people inherits the history taught in school and community. School educational institutions or public organizations of the deaf have museum collections about the development of the deaf community and its cultural and historical heritage.

Rehabilitation and social services for the hearing impaired.

Rehabilitation of the deaf is understood as a complex of social, medical, technical, educational, cultural and other activities, the purpose of which is the realization of equal rights and opportunities for the deaf in all spheres of life.

The following excerpts from the Declaration of Independence of the Disabled are important for understanding the nature of interactions between deaf and hearing members of society.

- Don't see my disability as a problem.

- I don't need support, I'm not weak as it seems.

- Do not treat me as a patient, as I am simply your compatriot.

- Don't try to change me, you don't have the right to do that.

- Don't try to lead me. I have the right to my own life, like any person.

- Don't teach me to be submissive, humble and polite. Don't do me a favor.

- Recognize that the real problem that people with disabilities face is their social devaluation and oppression, and prejudice against them.

- Support me so that I can contribute to society to the best of my ability.

- Help me know what I want.

- Be someone who cares, takes the time, and who fights to do better.

- Be with me even when we fight each other.

- Don't help me when I don't need it, even if it pleases you.

- Don't admire me. The desire to live a fulfilling life is not admirable.

- Get to know me better. We can be friends.

- Be allies in the fight against those who use me for their own gratification.

- Let's respect each other. After all, respect presupposes equality.

- Listen, support and act.

In the context of the social model of rehabilitation, appropriate correct terminology should be used when denoting a group of people with hearing loss: deaf, hard of hearing, hearing impaired since childhood, late-deafened person, person with hearing impairment.

It is recommended to include courses on working with hearing impaired people and learning sign language in the programs of secondary and higher educational institutions vocational education, training specialists in the field of social protection, education, health care and physical education and sports.

Of great importance is the guaranteed list of rehabilitation activities and services that should be provided to people with hearing impairments approved at the government level:

Free translation services when deaf people contact you various organizations, when teaching deaf people in educational institutions of secondary and higher vocational education;

Equipment of urban environment objects with technical means of communication (street text phones, telephones with telecommunications capabilities, etc.);

Providing hearing impaired people with special means of communication support (alarm clock with vibrator, wireless optical alarms, text telephones, etc.);

Organization of television programs with subtitles;

Creation of rehabilitation centers for the hearing impaired on the basis of social service centers or institutions of state social protection bodies;

Issue monetary compensation for the purchase of telephones (fax, text phone, cellular telephone for sending text messages, a telephone with a sound amplifier, a telephone with a ticker, a pager, a teleautograph, a fax modem);

Equipment of vehicles with a ticker board for notification of stops and other precautions.

The Federal Law of the Russian Federation “On social protection of disabled people in the Russian Federation” (Article 14) stipulates the right of deaf people to ensure unimpeded access to information for disabled people.

In addition, state educational authorities provide students with hearing impairments - free or on preferential terms - with special teaching aids and literature, and also provide them with the opportunity to use the services of sign language interpreters (Article 19).

The success of social rehabilitation of the deaf is determined by guaranteeing the availability of quality education (general and vocational), while expanding the range of specialties at all levels and changing public attitudes towards this group of people with special abilities and needs