Order 1024 dated December 17. The Ministry of Labor “overestimated” disabled people: experts on new criteria for disability
MINISTRY OF LABOR AND SOCIAL PROTECTION OF THE RUSSIAN FEDERATION
ORDER
ON CLASSIFICATIONS AND CRITERIA,
USED IN THE IMPLEMENTATION OF MEDICAL AND SOCIAL EXAMINATION
MEDICAL AND SOCIAL EXPERTISE
In accordance with subparagraph 5.2.105 of the Regulations on the Ministry of Labor and social protection Russian Federation, approved by Decree of the Government of the Russian Federation of June 19, 2012 N 610 (Collected Legislation of the Russian Federation, 2012, N 26, Art. 3528; 2013, N 22, Art. 2809; N 36, Art. 4578; N 37, Art. 4703; N 45, item 5822; N 46, item 5952; 2014, N 21, item 2710; N 26, item 3577; N 29, item 4160; N 32, item 4499; N 36, item 4868; 2015, N 2, item 491; N 6, item 963; N 16, item 2384), I order:
1. Approve the attached classifications and criteria used in the implementation medical and social expertise citizens by federal state institutions of medical and social expertise.
2. Recognize invalid the order of the Ministry of Labor and Social Protection of the Russian Federation of September 29, 2014 N 664n "On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination" (registered by the Ministry of Justice of the Russian Federation 20 November 2014, registration N 34792).
M.A.TOPILIN
Approved
order of the Ministry of Labor
and social protection
Russian Federation
CLASSIFICATIONS AND CRITERIA,
USED IN THE IMPLEMENTATION OF MEDICAL AND SOCIAL EXAMINATION
CITIZENS BY FEDERAL STATE INSTITUTIONS
MEDICAL AND SOCIAL EXPERTISE
I. General provisions
1. Classifications used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination determine the main types of persistent disorders of the functions of the human body caused by diseases, the consequences of injuries or defects, and the degree of their severity, as well as the main categories of human life and degree the severity of the limitations of these categories.
2. The criteria used in the implementation of the medical and social examination of citizens by federal state institutions of medical and social examination determine the grounds for establishing disability groups (categories "disabled child").
II. Classifications of the main types of persistent disorders
functions of the human body and the degree of their severity
3. The main types of persistent disorders of the functions of the human body include:
violations of mental functions (consciousness, orientation, intelligence, personality traits, volitional and incentive functions, attention, memory, psychomotor functions, emotions, perception, thinking, high-level cognitive functions, mental functions of speech, sequential complex movements);
violations of language and speech functions (oral (rhinolalia, dysarthria, stuttering, alalia, aphasia); written (dysgraphia, dyslexia), verbal and non-verbal speech; impaired voice formation);
violations of sensory functions (vision; hearing; smell; touch; tactile, pain, temperature, vibration and other types of sensitivity; vestibular function; pain);
disorders of neuromuscular, skeletal and movement-related (static-dynamic) functions (movements of the head, trunk, limbs, including bones, joints, muscles; statics, coordination of movements);
dysfunction of the heart vascular system, respiratory system, digestive, endocrine systems and metabolism, blood system and immune system, urinary function, function of the skin and related systems;
violations caused by physical external deformity (deformities of the face, head, torso, limbs, leading to external deformity; abnormal openings of the digestive, urinary, respiratory tract; violation of body size).
4. The degree of severity of persistent violations of the functions of the human body due to diseases, the consequences of injuries or defects, is estimated as a percentage and is set in the range from 10 to 100, in increments of 10 percent.
There are 4 degrees of severity of persistent violations of the functions of the human body:
I degree - persistent minor violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 10 to 30 percent;
II degree - persistent moderate violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 40 to 60 percent;
III degree - persistent pronounced violations of the functions of the human body due to diseases, consequences of injuries or defects, in the range from 70 to 80 percent;
IV degree - persistent, significantly pronounced violations of the functions of the human body, caused by diseases, the consequences of injuries or defects, in the range from 90 to 100 percent.
The degree of severity of persistent violations of the functions of the human body, caused by diseases, consequences of injuries or defects, is established in accordance with the quantitative assessment system provided for in the appendix to these classifications and criteria.
If the annex to these classifications and criteria does not provide for a quantitative assessment of the severity of persistent violations of a particular function of the human body due to diseases, consequences of injuries or defects that the person being examined, then the severity of persistent violations of the functions of the human body in percentage terms is established by federal government agency medical and social expertise in accordance with paragraphs three - six of this paragraph based on the clinical and functional characteristics of diseases, the consequences of injuries or defects that caused the above violations, the nature and severity of complications, the stage, course and prognosis of the pathological process.
In the presence of several persistent violations of the functions of the human body due to diseases, consequences of injuries or defects, the degree of severity of each of these violations in percentage is separately assessed and established. First, the maximum percentage violation of a particular function of the human body is established, after which the presence (absence) of the influence of all other persistent violations of the functions of the human body on the most pronounced violation of the function of the human body is determined. In the presence of this influence, the total assessment of the degree of dysfunction of the human body in percentage terms may be higher than the most pronounced violation of body functions, but not more than 10 percent.
Mass "recovery" of the disabled
Per last year the number of disabled people in the country decreased by almost 200 thousand people (according to other sources - by 500 thousand). Such "progress" seemed suspicious to many. Experts and public organizations associate it with the new rules for determining disability, which came into force in early 2015.
Since February 2016, under public pressure and with the intervention of the Ministry of Justice and the Federation Council, order No. 664n on medical and social examination, which caused a flurry of complaints, was replaced by a new one, No. 1024n, where some points were specified and clarified. However, according to parents of disabled children and human rights activists, the new document is almost the same as the previous one.
The Ministry of Labor claims that the decrease in the number of people with disabilities is in no way connected with a change in the rules for examination. Minister Maxim Topilin believes that the reason is the natural decline of the elderly population. On the other hand, Deputy Minister Grigory Lekarev stated at one of the press conferences that "it is not the number of established disabilities that is decreasing, but the number of people who apply for it."
The presence of a corruption component here was noted, in particular, Grigory Lekarev. “Distortions happen, and medical and social expertise ... is still built to a certain extent on the subjective opinion of experts. There may be distorted interpretations of acts, and direct disregard, and sometimes even a corruption component, which we intend to fight against,” he said.
“This whole classification is higher mathematics for ordinary people,” says the head of the League of Patients Alexander Saversky.
“It is important for us that all this be transparent, understandable and correct, so that the person who comes understands why this is so, and those who make the decision proceed from objective reasons, and not from the subjective “I see it this way”, “I I feel that way” or “I want it that way”, – said “Mercy.ru” Oleg Rysev, Deputy Chairman of the All-Russian Society of the Disabled. In his opinion, the point system should help to achieve just such a result. However, it will be possible to evaluate its effectiveness only after some time, he believes.
Disability and medication
What does disability status mean? Getting a free qualified medical care, compensation of expenses for housing and utilities in the amount of 50%, employment guarantee, annual leave of at least 30 calendar days, reduced working hours for disabled people of groups I and II, payment of pensions, allowances, various insurance sums, etc.
"To get disabled, you have to die"
Since the introduction of the new ITU rules, a strange trend has emerged: a child suffering serious illness, getting proper treatment, loses the status of a disabled person. Thus, he is deprived of free medicines and technical means, as well as rehabilitation. But the disease does not disappear.
Without rehabilitation measures the child's condition is deteriorating, and the ability to social adaptation decreases. Because of this, it is possible that the disability will be re-established. But the child will be thrown back in his development - both physical and social.
Recently, among the most popular blog entries was a story about girl with cerebral palsy from the Moscow region: “I have a goddaughter. She has cerebral palsy.<…>Bureau of Medical and Social Expertise No. 38 decided that the child was no longer disabled.<…>. And disability is free treatment in specialized clinics, benefits, free special shoes, the possibility of a free schedule at school. Now the child will not have all this. And there will be cerebral palsy. It’s just that the head of the commission, a young man of about thirty, a psychologist (!) By profession, found that the child had lost less than 30% of his mobility.
daughters Olga M. from Magnitogorsk doctors mistakenly removed thyroid gland. “Kristina was given the status of a disabled person, and in 2015 she was taken away. They said: "The patient is healthy." My daughter often bleeds from her nose and feels dizzy, she loses consciousness, cannot stand for a long time, gets tired quickly, her metabolism is disturbed. Christina has been on hormones for seven years. And in ITU we hear: “Her ailments are age-related,” says the mother.
“According to the logic of the ITU, in order to achieve the status of a disabled person for my son, I have to bring him half to death five times. Without disability, we will not survive. Just do not say that the regions will provide for children free medicines. They no longer provide,” he says. Marina Nizhegorodova, petitioner on Change.org. Her son has a congenital dysfunction of the adrenal cortex. To establish disability, doctors must record five crises a year.
Diabetes mellitus and phenylketonuria are weak links
Patients with phenylketonuria, diabetes mellitus, diseases of the endocrine and central nervous system were in the most difficult situation.
Thus, adolescents with type I diabetes mellitus have recently been increasingly denied disability, citing the fact that diabetes is not a diagnosis, but a “way of life”.
The criteria are drawn up in such a way that if a child is taken care of, then “getting those same 40% is unrealistic,” said an activist from the Khabarovsk regional public organization helping children with disabilities "Diabetes" Nina Sukhikh.
“Order No. 664n also stipulated that disability was given under the condition of three severe conditions of hypoglycemia for three days. They must be fixed by an ambulance. No normal mother would bring her child to such a situation,” she added. BUT new order expects that a teenager from the age of 14 can independently "control the course of the disease."
Parents of children with type I phenylketonuria state that the criteria required to establish disability suggest an advanced form of the disease. If the child receives the necessary treatment and nutrition in a timely manner, serious consequences can be avoided. However, according to parents, without a disability, this is much more difficult to provide.
"I mother of many children, - writes Olga Bazhenova. – I am raising three children, two of whom suffer from phenylketonuria. In May 2015, by order 664, we were denied disability ... This year, by order 1024, we were denied again. Even though in six months my children's health has deteriorated.<…>They said your children will have an IQ below 50, come. Let's give it."
Cancer and disability
As a result of order No. 1024n, women with breast cancer of stages from T1 to T2 pN0 M0 also suffered. If earlier they could count on II and Group III, now they are generally deprived of disability, even for the period of chemotherapy.
“The new order does not take into account how crippling treatment you are undergoing, the main thing is at what stage you were admitted for surgery. I have the second stage, no metastases were found in the excised lymph nodes, distant metastases were not recorded upon admission.<…>After completed treatment, I will be recognized by a new order as capable of performing labor activity. Although for now it just hurts me to live, not to mention appearance. <…>Dear friends, this is not possible, you need at least a year to recover, honestly, ”writes Irina Uspenskaya from Yekaterinburg.
However, the court only in rare cases reviews the decision of the ITU in favor of the patient. “To prove that the decision to remove or lower the disability group was made incorrectly is practically impossible today,” said the head of the country’s only Novosibirsk Center independent medical and social expertise Svetlana Danilova.
According to human rights activists, the impossibility of reviewing the ITU decision is due to almost total absence independent expertise. At the moment, this service is affordable only for a small circle of disabled people, its cost can reach 200 thousand rubles.
The courts usually resort to forensic medical examination, whose employees do not have the necessary experience and qualifications for disability assessment.
It is planned that in the future medical organizations will be able to conduct an independent examination, having received the appropriate licenses.
Ministry of Labor and Social Protection of the Russian Federation dated December 17, 2015 No. 1024n “On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination”. It was adopted instead of a similar document No. 664n, which had to be canceled due to numerous complaints: it turned out that many seriously ill people, primarily children, could not be recognized as disabled, and did not receive appropriate treatment and rehabilitation opportunities.
About what will change after the entry into force of the new document, and what results its use can give, the Mercy.ru portal was told Artur Kushakov and Lin Nguyen– employees of the legal department of ROOI “Perspektiva”:
“At one time, the order of the Ministry of Labor of Russia dated September 29, 2014 N 664n made changes to the concept of establishing disability, marking the transition from the medical and social model of establishing disability to an exclusively medical one. This approach had its positive and negative sides. Thus, the conduct of a medical and social examination, for example, in children was complicated by a serious difference in diseases in adults and children. It must be understood that some diseases are more easily tolerated by adults, but seriously affect the normal development of the child, and some of them do not occur in adults at all.
It also turned out that the document did not take into account some types of diseases ( diabetes, cystic fibrosis). In addition, a change in the approach to determining disability led to the fact that during the re-examination, not all people with disabilities remained in this status. This often caused resentment.
New Order of the Ministry of Labor of Russia dated December 17, 2015 N 1024n “On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination”, which comes into force on February 2, 2016. solves most of the previous problems - many diseases are included and clarified, which were not in the previous Order.
A detailed study of the formulations of the clinical and functional characteristics of persistent violations of body functions due to diseases, consequences of injuries or defects has been made. This means that now the subjective factor is excluded when conducting a medical and social examination and establishing disability.
For example, each person who applied to the medical and social examination authorities with an application for an examination can assess the prospects, as well as the correctness of establishing disability, by comparing the existing disease from the medical report with the application of the new Order, which clearly spells out a quantitative system for assessing the severity of persistent violations bodily functions. This means that the risk of corruption is minimized, and a uniform application of the classifications and criteria used in the conduct of medical and social expertise is introduced.
In our opinion, the new classifications and criteria correct many shortcomings of the previous formulations. However, only application in practice can show whether everything is taken into account in them and how a purely medical approach to determining disability is correct.”
After monitoring the application of classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination, approved. Order of the Ministry of Labor and Social Protection of the Russian Federation of September 29, 2014 No. 664n, in fact after a year of application, Order of the Ministry of Labor and Social Protection of the Russian Federation No. 1024n of December 17, 2015 approved new classifications and criteria used in the implementation of medical and social examination citizens by federal state institutions of medical and social expertise.
On February 2, the Order of the Ministry of Labor and Social Protection of the Russian Federation dated December 17, 2015 No. 1024n “On the classifications and criteria used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination” (Order No. 1024n) came into force.
A change in the approach to determining disability has led to the fact that during the re-examination, not all citizens with disabilities remained in this status. At the same time, the subjective factor was not excluded during the medical and social examination and the establishment of disability. It turned out that many seriously ill citizens, most of whom were children, were not recognized as disabled and did not receive appropriate treatment and rehabilitation opportunities.
The main purpose of issuing Order No. 1024n was to specify approaches to assessing the severity of impaired body functions and criteria for establishing disability, including for children, to clarify the wording of impaired functions, which should have eliminated their unequal interpretation in different regions and further objectified approaches to medical treatment. social expertise.
Order No. 1024n included such diseases and defects that occur in children, such as insulin-dependent diabetes mellitus, which occurs in childhood, cleft lip and palate (cleft lip and palate), phenylketonuria, bronchial asthma occurring in childhood.
The new Order No. 1024n defines the main types of persistent disorders of the functions of the human body caused by diseases, the consequences of injuries or defects, and the degree of their severity, as well as the main categories of human life and the severity of the limitations of these categories.
As in Order No. 664n, six main groups of types of persistent disorders of the functions of the human body have been identified: violations of mental functions; violations of language and speech functions; violations of sensory functions; disorders of neuromuscular, skeletal and movement-related functions; violations of the functions of the cardiovascular, respiratory, digestive, endocrine systems and metabolism, the blood system and the immune system, urinary function, the function of the skin and related systems; violations caused by physical external deformity.
The algorithm for estimating the severity of persistent impairments to the functions of the human body due to diseases, the consequences of injuries or defects has also been retained - as a percentage in the range from 10 to 100, with a step of 10%. There are still four degrees of severity of persistent violations of the functions of the human body - I degree - violations in the range from 10 to 30%, II degree - violations in the range from 40 to 60%, III degree - violations in the range from 70 to 80%, IV degree - violations in the range from 90 to 100%.
There is no fundamental difference in the establishment of disability groups. But, in Order No. 1024n there is no clear statement of the wording of the criteria that would be clear not only to an ITU specialist, but also to an ordinary citizen or doctor medical organization who referred the patient to ITU.
Suppose, according to paragraph 8 of Order No. 1024n, the criterion for establishing disability is a health disorder with II or more pronounced degree of persistent impairment of the functions of the human body (in the range from 40 to 100 percent), due to diseases, consequences of injuries or defects, leading to restriction 2 or 3 degrees of severity of one of the main categories of human life activity or 1 degree of severity of two or more categories of human life activity in their various combinations that determine the need for his social protection.
According to paragraph 9, the criteria for establishing disability groups are applied after the disability is established for a citizen in accordance with the criterion for establishing disability, provided for in paragraph 8 of this. And then specifically for disability groups, the categories of life activity corresponding to a particular disability group are not indicated.
So, in paragraph 10 it is stated: the criterion for establishing the first group of disability is a violation of human health with IV degree of severity of persistent violations of the functions of the human body (in the range from 90 to 100 percent), due to diseases, consequences of injuries or defects.
Clause 11 states: the criterion for establishing the second group of disability is a violation of human health with III degree of severity of persistent violations of body functions (in the range from 70 to 80 percent), due to diseases, consequences of injuries or defects.
Paragraph 12 states: the criterion for establishing the third group of disability is a violation of human health with II degree of severity of persistent violations of body functions (in the range from 40 to 60 percent), due to diseases, the consequences of injuries or defects.
In paragraph 13. The category "disabled child" is established if the child has II, III or IV degree of severity of persistent violations of body functions (in the range from 40 to 100 percent) caused by diseases, the consequences of injuries and defects.
That is, Order No. 664n clearly indicated the correspondence between the severity of persistent violations of the functions of the human body and the severity of restrictions on the categories of human life activity.
In Order No. 1024n there is no clear concept that the II degree of severity of persistent violations of body functions (in the range from 40 to 60 percent) can correspond to the 1st degree of severity of two or more categories of human life in their various combinations.
For example, when establishing the third disability group, persistent impairments of statodynamic functions of the II degree of severity (in the range from 40 to 60 percent) may correspond to the 1st degree of severity of the category of movement and self-service (or the 1st degree of severity of the category of labor activity and movement), etc.
It would be clearer if the old criteria were left in Order No. 1024n, adding only a range of percentages.
For children, as well as in Order No. 664, and in Order No. 1024n, there is also no clear concept for establishing the category of a disabled child.
Thus, according to paragraph 13 of the new Order No. 1024n, the category "disabled child" is established if the child has II, III or IV degree of severity of persistent violations of body functions (in the range from 40 to 100 percent) caused by diseases, consequences of injuries and defects. From which it can be understood that a child, like an adult, should have a disability group.
Order No. 1024n, as well as Order No. 664n, includes the most common diseases. But, in Order No. 1024n, they indicated that “if the annex to these classifications and criteria does not provide for a quantitative assessment of the severity of persistent violations of a particular function of the human body due to diseases, the consequences of injuries or defects present in the person being examined, then the severity of persistent violations functions of the human body in percentage terms is established by the federal state institution of medical and social expertise in accordance with paragraphs three - six of this paragraph based on the clinical and functional characteristics of diseases, the consequences of injuries or defects that caused the above violations, the nature and severity of complications, stage, course and prognosis pathological process. That is, it still remains unclear where to get the clinical and functional characteristics of diseases that are not in the List. Probably, as before, from the generally accepted classifications of dysfunctions adopted in clinical practice, of which there are many. That is, it turns out - again a subjective approach.
Thus, on the one hand, the New Classifications and Criteria corrected many shortcomings of the previous classifications and criteria. On the other hand, there are many questions that require clarification on the part of higher organizations on the part of federal institutions of medical and social expertise.
Cerebral vascular pathology is characterized by a significant polymorphism of clinical manifestations, including dyscirculatory, focal and cerebral disorders, which requires in most specific cases individual approach to a quantitative assessment of the severity of persistent dysfunctions of the human body caused by cerebrovascular diseases. Cerebrovascular diseases often occur on the basis of atherosclerosis, hypertension, complicated by chronic insufficiency cerebral circulation(encephalopathy), acute violation of cerebral circulation in the system of internal and vertebral arteries. In the development of cerebrovascular insufficiency, many factors are attached importance: atherosclerosis of cerebral vessels, aortic arch and brachiocephalic branches, stenosis, bends and deformities of extra- and intracranial sections carotid arteries, anomalies in the structure of cerebral vessels, etc. The methodological basis for assessing disability in people with cerebrovascular diseases is determined by a complex set of pathomorphological changes and pathophysiological mechanisms of cerebrovascular accident. The severity of the latter depends on the location and nature of the lesion of the vessel, the topic of the focus, its depth and extent, the degree of damage. nerve cells and pathways. Among the pathomorphological substrates, the following are of primary importance: vascular changes - atherosclerotic plaques, aneurysm, thrombosis, pathological tortuosity, vasculitis; changes in the substance of the brain - heart attack, hemorrhagic infarction, hemorrhage, edema, dislocation and wedging, cerebral scar, brain atrophy, cyst. Pathophysiological mechanisms are presented as:
changes in the vascular system - arterial hypertension, hypotension, angiospasm, vasoparesis, collateral circulatory failure, steal phenomenon, increased blood-brain barrier permeability, cardiovascular and respiratory failure, metabolic and regulatory disorders - hypoxia, hypercoagulability, tissue acidosis, isothermia, etc.
Flow vascular disease of the brain (progressive, stationary or stable, relapsing) is determined depending on the dynamics of the process, the rate of its progression, or the period of exacerbation. Vascular disease of the brain is often characterized by a progressive course, while it is necessary to take into account the rate of development of the vascular process. It is necessary to distinguish between a slowly progressive course with chronic cerebrovascular insufficiency and a rapidly progressive course with the development of II, III degree chronic insufficiency cerebral circulation with pronounced focal and cerebral changes. When assessing the nature of the recurrent course of cerebral vascular pathology it is necessary to take into account the frequency of exacerbations: rare exacerbations with an interval of more than a year; exacerbations of average frequency - 1-2 times a year; frequent exacerbations - 3-4 times a year. The duration of transient disorders of cerebral circulation is determined: short-term duration (seconds, minutes, up to one hour); medium duration(2-3 hours); long duration (from 3 to 23 hours). The clinical prognosis in vascular pathology of the brain is aggravated by emerging cerebral crises, transient disorders of cerebral circulation, strokes, i.e. manifold clinical course and outcomes of vascular pathology determine a diverse clinical prognosis (favorable, unfavorable, doubtful). The latter depends on many factors - the nature and course of a general vascular disease (atherosclerosis, hypertension), the state of the main and intracerebral arteries, the possibilities of collateral circulation, early diagnosis, the type and degree of dysfunction, etc.
Vascular pathology of the brain can lead to the following violations of the basic functions of the human body: violations of static-dynamic functions due to paralysis, paresis of the extremities, vestibular-cerebellar, amyostatic, hyperkinetic disorders and etc.; violations of sensory functions (reduced visual acuity, hemianopsia, concentric narrowing of the visual field, sensorineural hearing loss, etc.); visceral and metabolic disorders, eating disorders, blood circulation, respiration, etc.; disorders of mental functions (mnestic-intellectual decline, motor, sensory, amnestic aphasia, dysarthria, anartria, agraphia, alexia, disorders of praxis, gnosis, etc.).
The listed violations can be manifested in severity by all four degrees of severity of persistent violations of body functions: minor, moderate, pronounced, significantly pronounced.
Leading clinical manifestations vascular pathology of the brain are motor disorders (hemiplegia, hemiparesis, paraparesis lower extremities, vestibular-cerebellar, etc.), leading to varying degrees violations of static-dynamic function and limitations of the ability to move independently. When assessing the degree of restriction of movement of patients with this pathology, the following are taken into account:
a complex of clinical and functional indicators characterizing the degree and prevalence of disorders of the motor function of the lower extremities or their segments - the amplitude of active movements in the joints of the extremities (in degrees), the degree of decrease in muscle strength, the severity of the increase in muscle tone, statics, coordination of movements, the main function of the lower extremities, nature of gait, use additional funds supports when walking;
a complex of clinical and functional indicators characterizing the degree and prevalence of disorders of motor functions upper limb or its segments - the volume of active movements in the joints of the limb (in degrees), the degree of decrease in muscle strength, the severity of the increase muscle tone, coordination of movements, the main static-dynamic function of the upper limb - grasping and holding objects;
a set of indicators characterizing the functional state of the vestibular analyzer (caloric, rotational tests);
a complex of electromyographic signs indicating the nature and severity of changes in the bioelectrical activity of muscles;
a complex of biomechanical indicators (walking pace, double step duration, etc.) with the calculation of the walking rhythm coefficient as a general indicator of the degree of movement restriction severity.
