The spiral model as a methodological basis for the rehabilitation of individuals with cognitive disorders living in a social psychoneurological residential institution

Objective. To provide a theoretical and methodological justification for the application of the spiral model of the rehabilitation process as a conceptual framework for organizing long-term care for individuals with cognitive disorders residing in social psychoneurological residential institutions.

Materials and methods. The study is theoretical and methodological in nature. The key methodological tool is logical and structural modeling aimed at adapting the spiral model proposed by B. Boehm (1986) to the specific context of the rehabilitation process in psychoneurological residential institutions. The modeling defines the stages of the rehabilitation cycle, mechanisms for transition between cycles, principles of risk management, and criteria for adapting individual rehabilitation programs. The conclusions are based on the analysis of scientific evidence and regulatory requirements rather than empirical data.

Results. It is demonstrated that the traditional linear, stage-based rehabilitation model has limited applicability in psychoneurological residential institutions due to the chronic nature of mental illnesses, long-term residence, and progressive cognitive decline. The spiral model ensures iterativity, cyclicality, and flexible adaptation of rehabilitation programs to the changing conditions of residents. Each turn of the rehabilitation spiral includes stages of assessment, planning, implementation, and monitoring of effectiveness. The model enables risk management and consideration of uncertainty related to the progression of cognitive disorders and comorbid conditions,  while also integrating interdisciplinary and intersectoral approaches. The adapted model aligns with the biopsychosocial paradigm and international recommendations and can be incorporated into the existing regulatory framework of the Republic of Belarus, making it suitable for practical implementation. Key conditions for implementation are identified, including the need for an intersectoral rehabilitation team, regular assessments, systematic documentation, and evaluation of dynamics in accordance with international standards. Limitations related to resource constraints and the risk of professional burnout are also identified.

Conclusion. The spiral model of the rehabilitation process represents a methodologically grounded and practically feasible approach to organizing long-term care in psychoneurological residential institutions. It ensures continuity, flexibility, personalization, and a riskoriented approach to rehabilitation and is consistent with the biopsychosocial model of functioning. The application of this model contributes to the development of a systemic, dynamic, and interdisciplinary rehabilitation strategy aimed at maintaining the highest possible level of functioning and quality of life of residents. The proposed concept may serve as a foundation for further empirical, clinical, and applied research.

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