REHABILITATION

• Occupational Therapy
• Production Workshops
• Retraining
• Quotas and tax benefits for employers  
• support of employment

Task: Anyone who can work is working.

Long-term residence. We offer the most important thing:

Specialized homes for disabled military trauma instead of PNI 

This is a separate standard:

• Medical care
• A Decent Environment
• Employment in the Territory
• Participation in society

This must be done through a federal act.

Outline of social integration

• Patriotic Marathons
• Paradelfic Games
• Sports Disability War
• Volunteer Movements  

This returns the status.

MANAGEMENT MODEL

Federal level

• regulatory framework
• Standards
• financing of trajectories
• a Single Digital Platform

Regional level

• Clusters (Kozhino — pilot)  
• Operations Management

Personal level

• Every Veteran Has a Curator
• Single “Recovery Passport”
• individual plan

FINANCIAL LOGIC

Not funding “services”, but financing: RESULTS.

KPI:

• % restored functionality
• % of those who received prosthetics on time
• % of Trainees
• % of employed
• Reducing repeated crises

If there are no metrics, the system will collapse.

LEGISLATIVE PACKAGE (NUCLEAR)

Support positions from your proposals:

• Add-on 181-FZ (Spiritual support)
• adjustment 306-FZ (Payments to families)
• extension 5-FZ (motor transport, dental prosthetics)
• status of “disabled person having merits to the Fatherland”
• Comprehensive Rehabilitation System Act

These are not corrections. This is the formation of a separate institution.

RISK FACTORS

• Bureaucratic resistance.
• Inter-agency competition.
• Lack of managers.
• Weak digital circuit.
• Trying to turn the system into “budgeting”.

We need strong central management.

STRATEGIC CONCLUSION. We are now forming: not a center, not a fund, but a new state norm for attitude to the veteran.

The draft federal program is a working state instrument. 

The Memorandum for the highest level is a strategic signal.

PART I. DRAFT FEDERAL PROGRAMME

Title: Federal Program: "Return. System of complex rehabilitation and integration of veterans. Basis: materials of the Concept of the RCC (Kozhino)   

The purpose of the program is to create a unified state system of recovery, support and social integration of veterans of hostilities and disabled military trauma.

Strategic objectives

• Formation of a federal network of full-cycle cluster centers.
• Introduction of a lifelong tracking trajectory.
• Establishment of the institute of long-term residence of disabled military trauma.
• Integration of medical, social, professional and spiritual and moral rehabilitation.
• Development of a digital support platform.

Program Architecture

Federal level

• Single focal point
• Methodology and standards
• Trajectory funding
• Legislative package

Regional level

• Cluster Centers 
• Full cycle rehabilitation
• Production Workshops
• Long-term accommodation

Municipal level

• Primary support points
• Psychological assistance
• Social Routing

Main modules of the program

Module 1. Medical rehabilitation

• in-depth medical examination
• Prosthetics
• Restorative Medicine
• Regenerative technologies (after clinical approbation)  

Module 2. Psychological sustainability

• PTSD Protocols
• Family Therapy
• Crisis programs
• Sociocultural integration  

Module 3. Work and role

• Occupational Therapy
• vocational retraining
• Quotas and tax incentives for employers  
• support of employment

Module 4. Long-term accommodation

• Specialized homes for disabled people I group
• A Decent Environment
• Continuous care
• Participation in public life

legislative package. The basis is the proposals set forth in the concept. Includes:

• extension 181-FZ
• adjustment 306-FZ
• extension 5-FZ
• Drafting of the law on integrated rehabilitation system
• the Institution of the Commissioner

The financial model. Sources:

• OMS
• Social Fund
• the Federal Budget
• Regional subsidies
• PPP
• Grants

Principle: Financing the trajectory, not the services.

KPI programs

• % completed rehabilitation course
• % of employed
• Reduction of clinical scales of PTSD
• % provided with prosthetics
• % of families without repeated crises

PART II. HIGH-LEVEL MEMORANDUM

Topic: On the formation of the state system of lifelong support of veterans

Problem. The current system is divided between departments. There is no single tracking path.

historical context. The Russian tradition provided special houses for mutilated warriors. The modern system should restore this norm at a new technological level.

Proposal. Create:

• The Federal "Return" Program
• a Network of Cluster Centers
• Standard of long-term residence of disabled military trauma
• the Institute of Commissioner

Strategic effect

• Social sustainability
• Personnel reserve
• Reduction of criminalization
• Building confidence in the state

Conclusion: A veteran should not look for a system. The system must accompany the veteran.

IMPROVE THE SCIENTIFIC CONTOUR TO THE FEDERAL PROGRAM

Scientific and technological support of the program

Purpose. Creation of evidence-based, replicable and scalable rehabilitation system based on domestic scientific developments.

Tasks:

• Development and approval of clinical protocols
• Formation of a unified rehabilitation database
• clinical testing of innovative technologies
• Integration of Military Medicine and Civil Health
• Training of scientific personnel

Structure of the scientific contour

Federal Scientific Coordination Center

Functions:

• Methodology
• Clinical studies
• Biostatistics
• Publishing activity
• International Expertise

Areas of research

Regenerative medicine

• Tissue Engineering
• Peptide complexes
• nanodelivery of active substances
• Accelerated tissue repair

Neurorehabilitation and PTSD

• Neuroimaging
• Digital cognitive protocols
• Neurofeedback
• VR-rehabilitation

Biomechanics and prosthetics

• Sensory prostheses
• Robotic support
• Domestic means of mobility

THE CONCEPT OF THE FEDERAL SCIENTIFIC CENTER FOR MILITARY REHABILITATION

• Clinical
• Biotechnological
• Neurocenter
• Engineering (prosthetics)
• Analytical (Big Data)

Results from 5 years:

• Rehabilitation standards
• Clinically Validated Technologies
• publications in international journals
• the National School of Military Rehabilitation

ROAD CARD OF VALIDATION "FENIX". Reason — description in the project 

Stage 1. Scientific expertise (0–6 months)

• Toxicological assessment
• Safety Protocol
• laboratory studies

Stage 2. Pilot clinical trial (6–18 months)

• 2–3 clinical databases
• Control group
• Objective scales of assessment

Stage 3. Registration and implementation (18–36 months)

• Approval of methodological recommendations
• Inclusion in Federal Standards

STRATEGIC EFFECT

Addition of science:

• Increases legitimacy
• Reduces criticism
• Provides long-term financing
• Builds export potential

If we are building a state rehabilitation system, it should be based not on one medicine, but on a complex of sciences. Below is a systematic list of scientific areas with a brief functional description of their role in the program. 

MEDICAL SCIENCES

Military medicine. It studies the traumas of combat operations, the features of mine-explosive, firearms and combined lesions. Form specialized treatment and rehabilitation protocols.

Rehabilitation. The science of restoring body functions after injuries and diseases.

The basis of the entire system is individual recovery programs.

Regenerative medicine. It studies tissue repair at the cellular level. Includes cellular technologies, peptide complexes, nanodelivery of active substances (including technologies of the type "FENIX" after clinical validation).

Neurorehabilitation. Restoration of CNS functions after TBI, concussion, PTSD. Uses neuroimaging, neurofeedback, VR therapy.

Psychiatry and Clinical Psychology. Work with PTSD, anxiety disorders, depression, aggression, addictions. It builds resilience and reduces the risks of social maladjustment.

Physical therapy and physical therapy. Functional restoration of the musculoskeletal system. The basis of daily rehabilitation practice.

Prosthetics and Orthopedics. Development and adaptation of bionic prostheses, mobility tools, robotic motion support systems.

BIOLOGICAL SCIENCE

Cell Biology. Investigates the mechanisms of regeneration, cellular aging, tissue repair.

Biochemistry. Analysis of metabolic processes in trauma and recovery.

Immunology. It studies inflammatory reactions, autoimmune processes after injuries and burns.

ENGINEERING AND TECHNOLOGY SCIENCES

Biomechanics Examines body movement and load on joints and prostheses.

Medical Engineering. Development of rehabilitation devices, sensors, neural interfaces.

Robotics. Creation of exoskeletons, robotic simulators.

Nanotechnology. Targeted delivery of substances, biomaterials.

Information technology and AI

• Big Data Analysis
• Risk forecasting
• Digital twins of the patient
• monitoring progress

SOCIAL SCIENCES

Sociology. Study of the social integration of veterans.

Social work. Development of models of support and family support.

Health Economics. Evaluate the effectiveness of rehabilitation programs.

Management (Public Administration). Models of inter-agency coordination.

HUMANITARIAN BLOCK

Ethics and Bioethics. Ensures that the rights of the patient are respected when introducing new technologies.

Religious Studies and Cultural Studies. Scientific support of spiritual and moral support without violating the secular nature of the state 

History of Medicine. The use of the scientific heritage of Soviet military medicine 

LEGAL SCIENCE

Medical law. Regulation of clinical protocols.

Social law. Development of legislative package (181-FZ, 5-FZ, 306-FZ and others.) 

ENVIRONMENTAL AND NATURAL SCIENCE

Human ecology. The impact of the living environment on recovery.

Animal therapy (within the framework of zoology and behavioral biology). Scientific justification of therapeutic work with animals 

SYSTEMIC FINDINGS. Veteran rehabilitation is: medicine and:

• Biology
• Engineering
• Psychology
• Social Sciences
• Law
• Technology

If at least one block is removed, the system will become incomplete.

The next level of depth:

To form the structure of the Scientific Council with the distribution of sciences by sections. Develop a model of interdisciplinary integration. Create a map of the interaction of sciences.

STRUCTURE OF THE SCIENTIFIC COUNCIL OF THE FEDERAL PROGRAMME

Status. The Scientific Council is the highest expert body of the Return program.

Functions: methodology, standards, clinical validation, strategic development.

Council Architecture

Presidency

• Chairman (authority in military/rehabilitation medicine)
• Deputy for the clinical part
• Deputy for Technology
• Deputy for Social Integration
• Main biostatistics

the Scientific Council Section

Clinical Medicine Section

• Military Medicine
• rehabilitation
• Physiotherapy
• Neurorehabilitation
• psychiatry

• Cell Biology
• Tissue Engineering
• Nanotechnology
• Biochemistry
• Immunology

Task: Clinical testing of innovations (including “FENIX” after research).

Engineering Solutions Section

• Prosthetics
• Biomechanics
• Robotics
• Medical Engineering

• Clinical Psychology
• Sociology
• social work
• Behavioral Economics

• Medical Law
• social law
• Bioethics

Task: legal purity of technology and programs implementation.

THE INTERICIPLINARY INTEGRATION MODEL

The system should not be a set of parallel sciences. It should work as a single mechanism. The principle of "One clinical case". Each veteran is considered: not as a patient! not as a disabled person, but as a complex system. The case involves:

• Doctor
• Psychologist
• Prosthetic Engineer
• Social Curator
• Data Analyst

Integration mechanism

A single digital profile

• medical indicators
• psychometrics
• dynamics of recovery
• Work trajectory

Interdisciplinary consultation. Once every 30 days - revision of the plan.

General KPI. All sections work on the same indicators:

• functionality
• Independence
• labour integration
• Quality of life

Flow of work (example)

Trauma → Clinical diagnostics → Neurorehabilitation → Prosthetics → Psychotherapy → Occupational therapy → Employment → Monitoring 12 months

These are not stages of different departments. This is a single trajectory.

Organizational Algorithm

• The decision of the Scientific Council on the introduction of technology.
• Pilot.
• Clinical Assessment.
• Correction.
• Scaling.

Key rule

No innovation is implemented without scientific validation. No rehabilitation is carried out without an interdisciplinary plan.