V.V. Vinogradov, candidate, president of Regional Public Organization of Disabled “Moscow city Federation of physical culture, sport and tourism of persons with orthopedic injuries”
Moscow state Academy of physical culture, the Moscow region, Malakhovka

Key words: handicapped with orthopedic injuries, social adaptation and rehabilitation of the handicapped via physical culture and sport, structural-functional components of adaptation.

Relevance. Effectiveness of social adaptation and rehabilitation of handicapped persons is an integral indicator, which includes an assessment of mental and social functions of an individual, his functional state, emotional and volitional spheres and the general quality of life, and these estimates are both subjective and objective, one or more indicators can not be a sufficiently reliable indicator of effectiveness of rehabilitation measures. In addition, none of the individual methodologies can cover all the parameters characterizing social adaptation and rehabilitation. In this regard, some integral, comprehensive indicator is required, specifically obtained, but technically executable when we mean mass examinations. Currently there is no comprehensive methodology for assessing the effectiveness of social adaptation and rehabilitation of the handicapped that would take into account the dynamics of different structural-functional components of social adaptation. Such a methodology exists neither in the experience of rehabilitation of the handicapped, nor in psychology or medical science. This issue is particularly relevant for public organizations of physical education and sports with the purpose of social adaptation and rehabilitation of the handicapped. The effectiveness of social adaptation and rehabilitation is, in turn, the main criterion of the effectiveness of the organizational activities. However, the criteria of effectiveness of management and operation of a sports organization under modern conditions are certainly important but clearly insufficient to assess the reached level of social adaptation and rehabilitation of the handicapped: results of its work, that is the number of people systematically engaged in various training programs or participating in sports and fitness and health events, the number of sports teams and their performance results, the number of the handicapped who had made it to the teams and their performance at competitions of different levels, the number and quality of physical education and sports services provided to the population by the organization, etc. [4]. Moreover, while the number is a quite clear and obvious indicator, the quality of the services requires specification and guidelines of assessment methods.

The purpose of the study was scientific justification of the method of estimation of efficiency of social adaptation and rehabilitation of the handicapped with orthopedic injuries (OI) based on the use of means and methods of physical culture and sport.

Research methods. The method of evaluation of effectiveness of social adaptation and rehabilitation of persons with disabilities was designed using the method of theoretical analysis of medico-social and psycho-pedagogical literature sources to identify the most crucial criteria of social adaptation of the handicapped and effectiveness of rehabilitation measures. The criteria were selected according to four parameters including: emotional state, emotional-volitional sphere, individual psychological characteristics and functional state. At the first stage 250 handicapped people aged 18 to 45 years old were examined to identify the following objective and subjective indicators [1,2,3,4,5]: the level of personal and state anxiety, accentuations of personality traits, viability, self-actualization, coping strategies, social and psychological adaptation, the level of social frustration, quality of life, functional limitations profile, index of adaptive capacity of the cardiovascular system, type of reaction of the cardiovascular system to physical load. At the second stage a correlation analysis was carried out in order to determine reliable relations between the obtained parameters, thus determining the importance of each indicator and overall validity and “working efficiency” of the developed technique.

Research results. In the works of the leading Russian psychologists [2, 3, 7] social adaptation of a person is considered in the context of creating a social adaptation model of the integrative type. The following components (they are also known as the criteria of adaptation) are identified in the social adaptation structure of a person: outcome variables of activity of an individual, degrees of integration of an individual with both macro- and micro-environments, the extent of realization of personal potential, emotional well-being. Using these indicators as criteria of adaptation four main adaptation levels of a person can be allocated: high excessive, high optimal, low and maladaptive. A.A. Rean suggests replacing “the extent of realization of personal potential” with “the need for self-actualization”, since the latter is a dynamic parameter that corresponds to the procedural nature of social adaptation to a greater extent.

So, any method of diagnostics of the structure of social adaptation and rehabilitation processes of the handicapped is based on some model of the process. Using the model of A.N. Zhmyrikov in the interpretation of A.A. Rean as a template, we have developed an original model of social adaptation and rehabilitation of the handicapped with OI that includes the following functional components: anxiety, accentuation of personality traits, viability, self-actualization, coping strategies, social frustration, quality of life, reintegration into normal life, functional limitations profile, adaptive capacity of the cardiovascular system, the type of reaction of the cardiovascular system to physical load []. This model includes social, psychological, medical and biological levels of adaptation and rehabilitation. Functional components of social adaptation and rehabilitation are characterized by the following individual features of a handicapped person:

1)  Anxiety characterizes the emotional and volitional spheres and determines the rehabilitation potential of a handicapped person: the higher the level of anxiety, the lower the potential for rehabilitation. However, this is true for state anxiety, it is the dynamics of its level that is an important diagnostic indicator, since trait anxiety is associated with neurodynamic and temperamental characteristics of a personality that are less dependent on the environment.  

2) Accentuation of personality traits is one of the most important parameters that determines the person’s ability to adapt and the degree of his adaptation in the society, which is a disharmony of character development, hypertrophied severity of its individual features, resulting in increased vulnerability of the individual in relation to particular kinds of impact and making it difficult to adapt in some specific situations []. Frank accentuations may determine the course of disease and attitude towards disability, often impeding rehabilitation.

3) Viability is a system of beliefs about the world, oneself and the relationship with the world. A high level of viability in a handicapped person is an indicator of his/her involvement in the life of society, getting pleasure out of his/her activities, having control over his/her life, acceptance of risk in everyday life.

4) Self-actualization - by this term Abraham Maslow defined a comprehensive and continuous development of creative and spiritual potential of a person, the maximum realization of all his/her abilities, adequate perception of others, the world and his/her place in it, plentifulness of emotional and spiritual spheres, a high level of mental health. A low level of self-actualization. Achieving self-actualization is a very important stage in the adaptation process for a handicapped person, as very often a person who has become disabled as a result of an injury, while on the stage of denial of his/her disability, projects his/her future life not taking into consideration the disability factor, postpones important things till “when I recover”, as if “putting his/her life on pause”, which, of course, does not contribute to social adaptation.

5) Coping strategies - the term “overcoming behavior” (coping behavior) refers to social behavior or a complex of conscious adaptive actions (cognitive, affective, behavioral) that help a person to cope with inner stress and discomfort by means that are adequate to personal characteristics and situations. Rehabilitation measures should be aimed at formation of adaptive behavior of a disabled person that is conditioned by the use of specific coping strategies.

6) Frustration is one of the key social determinants of health and quality of life that should be regarded as a consequence of the inability of a person to realize his/her relevant social needs [4]. Prolonged exposure to socially frustrating factors creates tension in adaptive mechanisms of the body and may lead initially to temporary maladjustment, and in the absence of effective psychological protection and adequate coping strategies to sustained maladjustment and, as a consequence, to reduced quality of life.

7) Quality of life is satisfaction of a person with his/her physical, mental and social well-being, the ability to function in a society in accordance with his/her situation and receive satisfaction from life in all its manifestations. It is an indicator that is often used for subjective assessment of the effectiveness of rehabilitation measures in the practice of medical rehabilitation.

8) Reintegration into normal life refers to the degree of adaptation of a person to the constraints imposed by disability.

9 Functional limitations profile - the indicator is used to evaluate how disability restricts human activity subjectively or objectively.

10) Adaptive capacity of the cardiovascular system is an objective physiological indicator of the functional state of the cardiovascular system, physiological adaptation that is calculated taking into account blood pressure, heart rate, height and weight.

11) The type of response of the cardiovascular system to physical exercise is an indicator of physical performance, the level of body adaptation to physical activity.

The diagnostics was carried out at the beginning and at the end of rehabilitation that included active physical exercises (at least once a week), regular participation in sports events (at least 3-4 times per year) and/or competitions.

Measurements carried out before rehabilitation activities using a total numerical score for all parameters resulted in a profile of social adaptation and rehabilitation of the handicapped (PrSAR). The same indicator after the rehabilitation is carried out represents the potential of social adaptation and rehabilitation of the handicapped (PoSAR). As a result, the person under test receives a total score for all indicators; the higher the score, the larger the potential for adaptation and rehabilitation. If the calculation method of a specific parameter implies reverse scoring technique (the best result with the smallest number of points), these scores are deducted.

The integrative assessment of the effectiveness of social adaptation and rehabilitation of the handicapped is carried out based on the comparison of achieved results with the initial ones, adjusted by a coefficient of disability evidence (DE) designed taking into account the severity of the disability and calculated by the following formula [6]:

                                                                  DE=100-(PrSAR / MPAR*100) (%), where

DE is disability evidence measured in %.

PrSAR is the amount of points based on the results of initial measurements (before rehabilitation);

MPAR is the maximum potential of adaptation and rehabilitation, i.e. the maximum number of points that can be obtained in all parameters. 

The effectiveness of social adaptation and rehabilitation (EAR) is assessed based on the following formula:

                                                   EAR=(PrSAR-PoSAR) / MPAR*100 (%),

where EAR is the effectiveness of social adaptation and rehabilitation;

PrSAR is the total amount of points before rehabilitation; PoSAR - is the total amount of points after rehabilitation;

MPAR is the maximum potential of adaptation and rehabilitation.

The indicator of the effectiveness of social adaptation and rehabilitation is ranked with the allocation of 4 levels: no changes, low level, medium level, high level. 

The maximum number of points that can be obtained is 507; the minimum score is 127.

Disability evidence is ranked as follows: significant evidence is from 75 to 100 %; expressed is 50-74 %; moderate is 25-49%; slight is 10-24%.

Obtained results are assessed adjusted for the disability evidence.

Table 1. Effectiveness of social adaptation and rehabilitation of the handicapped with OI

References

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2. Vodop’yanova, N.E. Psychodiagnostics of stress / N.E. Vodop’yanova. – St. Petersburg: Piter, 2009. – 336 P.: illustr. – (Series "Workshop”).
3. Leontiev, D.A. Viability test / D.A. Leontiev, E.I. Rasskazova. – Moscow: Smysl, 2006. – 63 P. (In Russian)
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6. Patent - 2405434 RF, IPC A61B5/16. The method of evaluation of effectiveness of comprehensive rehabilitation of persons with disabilities / V.A. Bronnikov, State Educational Institution of Higher Professional Education "Perm State Medical Academy named after academician E.A. Wagner" Federal Agency for Health and Social Development. – № 2009126944/14; Decl. 13.07.2009; Publ. 13.07.2009. (In Russian)
7. Rean, A.A. Psychology of personality adaptation: educational scientific edition / A.A. Rean, A.R. Kudashev, A.A. Baranov. – St. Petersburg: Meditsinskaya pressa, 2002. – 352 P. (In Russian)

Corresponding author: sportpoda@yandex.ru