The State Budgetary Institution “Center for Speech Pathology and Neurorehabilitation of the Moscow City Health Department” operates in accordance with the state assignment for the provision of specialized medical care in the “psychiatry” profile.
Hospitalization at the Center is planned.
Treatment and neurorehabilitation are carried out according to specially developed programs for the provision of medical care in inpatient departments with round-the-clock stay of patients, in day hospital and hospital at home.
Initial consultation of patients is carried out in the conditions of the consultative and diagnostic department.
The decision on the possibility and advisability of hospitalization in an inpatient department with round-the-clock stay, in a day hospital or in a hospital at home is made by the selection committee.
After passing the selection committee, the patient is sent for planned hospitalization to the department, where complex interdisciplinary treatment is carried out, which involves doctors of different specialties (psychiatrist, psychotherapist, neurologist, therapist, exercise therapy doctor), speech therapists, medical psychologists, neuropsychologists. The duration of the course of treatment is determined individually (in a hospital with round-the-clock stay - on average up to 30 days).
Types of medical care: When providing pre-medical care in: nutrition, laboratory diagnostics, physical therapy and sports medicine, medical statistics, medical massage, radiology, nursing, pediatric nursing, physiotherapy, functional diagnostics.
When providing outpatient medical care, including: c) when providing specialized medical care in: dermatovenerology, cardiology, clinical laboratory diagnostics, quality control of medical care, physical therapy and sports medicine, manual therapy, neurology, public health and healthcare organization , otorhinolaryngology, ophthalmology, pediatrics, psychiatry. psychotherapy. radiology, reflexology, dentistry, therapy, ultrasound diagnostics, urology, physiotherapy, functional diagnostics, endocrinology.
When providing inpatient medical care, including: c) when providing specialized medical care in: dermatovenerology, dietetics, cardiology, clinical laboratory diagnostics, quality control of medical care, physical therapy and sports medicine, manual therapy, neurology, public health and healthcare organization , otorhinolaryngology, ophthalmology, pediatrics, psychiatry, radiology, reflexology, dentistry, therapy, ultrasound diagnostics, physiotherapy, functional diagnostics, examination of temporary disability.
Center bed capacity:
- Inpatient departments with round-the-clock stay – 230 beds (adults) and 25 beds (children’s, including 10 maternal beds)
- Day hospitals for adults – 80 places
- Day hospitals for children - 220 places
- Hospital at home – 100 beds
Denunciations against doctors. How the Center for Speech Pathology and Neurorehabilitation is being destroyed
State Budgetary Institution “Center for Speech Pathology and Neurorehabilitation” is a unique institution throughout the country. For more than 50 years, this Center has been the main salvation for people with speech disorders and cognitive impairments that appear due to stroke or traumatic brain injury; comprehensive rehabilitation is free for Muscovites. But at the end of last year, the new management of the center embarked on a path of fundamental changes that could turn the unique institution into an ordinary psychiatric dispensary, patients say.
The old team of the clinic was dispersed: many had to quit against their own will, “by agreement of the parties.” The quality of treatment has dropped noticeably. Patients and former employees of the center are confident that the new management has put in first place not the health of patients, but earnings from paid services, which are becoming more and more numerous.
Center for Speech Pathology and Neurorehabilitation
Anna Zimina, contacted Radio Liberty . Anna’s mother underwent rehabilitation at the clinic after a stroke, but this year the center’s commission told her that the next course would be her last, since the clinic was changing its profile to psychiatric. Last fall, psychiatrist Roman Cheremin became the new chief physician of the clinic. He replaced Yuri Fukalov in this post, who worked at the Center together with the founder of the clinic, Viktor Shklovsky.
Both Shklovsky and Fukalov still work at the clinic, but do not make key decisions
Shklovsky is a specialist in the field of clinical psychology, speech pathology and neurorehabilitation, president of the All-Russian National Association of Neurorehabilitation Scientists, academician of the Russian Academy of Education. But he is almost 90 years old. Both Shklovsky and Fukalov still work at the clinic, but are no longer in leadership positions and do not make key decisions. In the fall of this year, new leadership from the field of psychiatry came to the center, after which rumors immediately began to circulate about impending changes in work.
Anna Zimina, having learned about these changes, created a petition addressed to the Minister of Health of the Russian Federation, Veronika Skvortsova, demanding to stop the transformation of the clinic. Soon after this, a refutation of the information published by Anna appeared on the center’s website; the petition was called “a lie and a provocation”: the official message stated that the center would not be closed and the psychoneurological profile would not be changed. The management invited Zimina herself to a personal meeting, where they also promised that the volume and quality of services would not change. However, she soon began to learn from former employees of the center and patients that changes were still happening, and they were quite significant.
Doctors were given an unofficial order to transfer everyone to paid services
“The rehabilitation course and the number of sessions with specialists were reduced, and old employees were fired,” says Anna. – Doctors were given an unofficial order to transfer everyone to paid services. A number of services that were previously free are now available only for money. According to doctors, primary patients are mainly taken to a 24-hour hospital, but repeated rehabilitation is denied, and they are sent to a day hospital. Despite the fact that most patients are not able to reach them themselves. My mother, for example, won’t be able to do it herself.
After that, Anna created a group on Facebook, where people who were not indifferent to the fate of the center gathered. She also wrote an appeal to the Department of Health to figure out what was happening with the center. The department told her that the situation regarding re-hospitalizations would not change, and the number of services would not change either.
Former employees of the center told Radio Liberty that the new management is focusing on day care, apparently not fully understanding the specifics of the patients. Transferring to a day hospital certainly saves budget money, since it is quite expensive to keep patients in a 24-hour hospital for 45 days. However, due to illness, patients of the center are often unable to come there every day on their own. Former employees also believe that the new management did not delve into the specifics of the Center’s work and is simply carrying out the task of reorganizing the clinic.
A 70-year-old man returned to work after a severe stroke. He just flew like a bird
“My relative underwent a rehabilitation course in May 2021,” says Elena Ivanova . “About ten specialists worked with him at that time. A 70-year-old man returned to work after a severe stroke. He just flew like a bird. Then things got worse and I got back on the waiting list. In February of this year, they called us and warned us that the course now lasts not 45 days, but a month. This time only three doctors worked with him. He only got worse, I immediately wrote an appeal to the Ministry of Health, it was a cry from the heart. Just before the elections. All the men in his ward were deeply outraged by the ugly situation in the center. A month later we were discharged and offered to go to a day hospital for another two weeks. I realized that this was the result of my application - they were not offered to anyone else. We refused because he wasn't getting better and I couldn't quit my job to take him there every day.
In response to Elena Ivanova’s appeal, the Department of Health responded that the patient was provided with medical care in the required volume, no violations of the procedure for providing medical care were established and “there are no changes in the quantity and quality of medical services provided by the Center.”
Speech therapist Lyubov Yakovleva , who worked at the Center for 45 years, explained that a course of 45 days is a completely reasonable period. The examination of patients alone used to last about two weeks.
Now neither patients nor experienced specialists are needed
“We had very serious, difficult patients,” says Yakovleva. – It takes time to examine a person and write a good treatment program. And now neither patients nor old experienced specialists are needed. I hear from my former patients that they no longer want to come to our center because it is now pointless.
Reducing the course and number of specialists is not the only thing that worries patients. With the arrival of new management, rumors began to circulate that the center would change the profile of medical services from psychoneurological to psychiatric. Despite the fact that the management denied changing the profile of the institution, the center’s profile was recently changed on the website of the Moscow Department of Health. This is a significant change for patients, some of whom specifically avoided psychiatric institutions.
A technique designed for a stroke patient will never help a child with early autism
“Until the center declared itself completely psychiatric, people with severe mental illnesses never came there,” says Yulia Egorova , her three-year-old child underwent rehabilitation at the center last year. – In 2021, this was the reason for refusal to participate in the rehabilitation course, because the technique, which is designed for a stroke patient, will never help a child with early childhood autism. The method of this center is completely unsuitable for children with severe mental illness. Now the center is focusing on psychiatry. When we passed the commission this year, there was no longer a neurologist on it. Although my child has a neurological diagnosis, not a psychiatric one.
According to Yulia, free diagnostics at the center are gradually becoming paid. Despite the fact that before starting a rehabilitation course it is necessary to undergo an examination and doctors themselves recommend doing this, more and more services now need to be paid for independently.
Cleaning up the old team
According to the clinic's doctors, with the arrival of new management, the old employees began to survive. Some resigned employees told Radio Liberty how they were forced to leave the Center.
Speech therapist Elena T. (name changed - RS) became one of the first who had to leave the Center. Last December, she saw a petition written by Anna Zimina in defense of the clinic, signed it and sent a link to it to her colleagues. But the mailing list included a psychiatrist who reported this to the chief physician.
Cheremin theatrically said that I do not suit them for ethical reasons, because of the petition
“I was called to the head physician Cheremin, the entire administration was there,” says Elena. – Cheremin theatrically said that I did not arrange them for ethical reasons, because of the petition. I refused to sign the resignation letter because I don’t think I did anything shameful. I returned to the department and continued working. Almost immediately, my department leaders began to be called to see Cheremin. They returned from him sad and said that they were threatened with dismissal.
According to Elena, after this, the deputy chief physician for psychological and speech therapy work, Olga Serebrovskaya, began writing memos to her. In these denunciations there were no complaints about the quality of care provided to patients, but only comments regarding typos in the documentation: incorrect endings and so on. As the speech therapist says, such denunciations were written not only against her, but also against other doctors who were about to be fired.
I realized that our department would be terrorized until I left.
“I had to somehow respond to these denunciations,” says Elena. – Yes, there were these typos, but they appeared more likely from inattention or because of haste. It became clear to me that all this would gain momentum. I realized that our department would be terrorized until I left. And since people signed the petition that I sent out, management had to punish someone. In addition, it was hard for me to see how my teachers were fired and how attitudes towards patients changed. That's why I signed a letter of resignation.
Neurologist Victoria worked at the Center for seven years; in March of this year, she was forced to sign a document terminating her employment contract by agreement of the parties. According to her, since layoffs began at the clinic, complaints began to be filed against her regularly and monetary fines were imposed.
I didn’t see a chance to stay, because every second person gets fired at the drop of a hat
“They assigned me to another doctor’s office,” says Victoria. – My work schedule is from 9 o’clock to 16.40, and at 15.00 another doctor began to see me in my office. Everyone knew about this: both the manager and management. That’s why I came to work earlier and started seeing patients earlier. Sometimes, by three o’clock I had time to do everything in order to free up the office for another doctor. One day, when I left ahead of schedule, an inspection came and I was fined. Nobody cared at all that I started working earlier. Since the Center’s management had previously not responded to my requests to sort out unfair complaints and fines, I went to the Center’s founder, Viktor Markovich Shklovsky, and asked to help me. After that, the chief doctor called me and said: “You have two days, you are fired.” They explained to me that the main reason was not that I left work earlier, but that I went to Viktor Markovich. I was told to sign a document terminating the contract by agreement of the parties with payment of one salary and compensation for 24 days of vacation. I didn’t see a chance to stay there, because every second person was fired on a whim. By that time, I was already so exhausted by these conflicts that I decided to simply sign this document.
Psychiatrist Natalya Chebotareva worked at the Center for three years, and when she was told that she had to quit, she did not argue with the new management. Employees had already been fired before her, so when she was called to the chief doctor, she already knew the reason.
Every month a certain number of employees left. A department was taken, and employees were released from there
“Completely unexpectedly, on an ordinary working day, I was called to the chief doctor,” says Natalya. “He tells me with a very benevolent smile: “You will have to find another place of work. If you agree, we will pay you a bonus." Employees have been fired using the same scheme before; I was not the first. We were, in principle, ready for the cuts to begin: the institution is a budgetary institution, it was also affected by the healthcare optimization program. We just assumed that it would be fair. If we had been laid off due to layoffs, then there would have been more financial support. Every month a certain number of employees left, everything happened according to plan. A department was taken, and employees were released from there. Our first branch was closed this year.
Speech therapist Lyubov Yakovleva , who worked at the Center almost from its founding, quit the Center herself because it became unbearable to continue working under the new management.
We restored patients after Afghanistan, after Chechnya. And many of the guys later started families
“The situation was not the best: people were fired simply because they had worked there for a long time,” says Yakovleva. “I couldn’t stand it and left on my own.” But I left not because I wanted to, but because it became unpleasant for me to work there. The situation that developed with the arrival of the new leadership did not allow us to work. I left, but it hurts me so much that all this was destroyed in less than a year. We returned patients' relatives to work because our patients, after rehabilitation, could take care of themselves and could say something. We restored patients after Afghanistan, after Chechnya. And many of the guys later started families. The uniqueness of this Center was that it had a warm atmosphere for patients. We could often extend the course for a patient if we saw that he was doing well. Now I feel very sorry for our leader, Professor Shklovsky. This is his brainchild, which he has nurtured for many years. If I devoted 45 years to this work, then he devoted even more. He put his life into creating this Center, which is now destroyed.
The Moscow Department of Health did not respond to a request from Radio Liberty.
We believe that our patients cannot recover in either 45 or 90 days
“All the doctors mentioned in the material actually worked at the center, but their dismissal is due to the fact that their professional qualities do not meet the requirements now imposed on employees,” Roman Cheremin, . – About reducing the length of stay in the hospital. We believe that our patients cannot recover in either 45 or 90 days, so we are trying to build a system in which the patient must remain for the maximum period, which is calculated not in days, but in years. And depending on how the treatment progresses, a decision is made whether patients need further help from us or not. Nothing good will come from the fact that everyone will be in the clinic for 45 days: some need more, some less.
Relatives of patients who were treated at the clinic say that the famous center for speech pathology and neurorehabilitation no longer exists, and there is no worthy replacement for it.
speech pathology center
INTERACTION OF A Speech Pathologist WITH TEACHERS IN THE PROCESS OF USING THEATER GAMES The success and effectiveness of work on correcting children’s speech depends primarily on the cooperation of all teachers of a preschool institution. A teacher, a teacher-psychologist, a music director, a physical education instructor, and a director of arts activities take an active part in conducting classes on theatrical activities. Special credit goes to the music director in the selection of musical works and in the provision of musical instruments; to the teacher - in staging the play; to the head of art activities - in the production of scenery. Scheme of interaction between teachers of a preschool institution: Interaction in work begins with an examination, which is carried out by specialists of a preschool institution. The teacher’s work on speech development precedes speech therapy classes, creating the necessary motivational basis for the formation of speech skills. The teacher’s task also includes consolidating the results achieved in speech therapy classes - systematic monitoring of children’s speech in classes and during routine moments; continuous improvement of articulatory, fine and gross motor skills; assistance to the speech therapist in automating the sounds; inclusion of practiced grammatical structures in a situation of natural communication; formation of coherent speech (memorizing poems, nursery rhymes; acting out individual episodes of a fairy tale); preventive work, the main goal of which is to create a subject environment that promotes the development of children’s potential speech abilities. In addition, children’s knowledge of nursery rhymes and fairy tales can be used in classes to reinforce the correct pronunciation of sounds. For example: “Ladushki, ladushki” - to reinforce the sound [Ш], the song Kolobok from the fairy tale of the same name - to reinforce the sound [L], the fairy tale "Cow Burenka" - to reinforce the sound [R] (Appendix No. 7). Several areas can be distinguished in the interaction between a speech therapist and a teacher. Individual work with children. The teacher builds classes taking into account the speech capabilities of each child. Observation of the dynamics of sound production in children, which allows the teacher to visually monitor the state of sound pronunciation of all children. Based on conventions, the teacher offers the child only the speech material that he can handle. Speech therapy notes to help teachers. Selection of speech material for the correction of various components of speech activity. The speech therapist helps the teacher in selecting adequate speech material and also recommends appropriate information resources. An examination of children with speech disorders shows that, along with various deviations in phonetics, vocabulary, grammar and coherent speech, they have insufficiently developed mental processes such as perception, attention, and memory. Therefore, children attend classes with a teacher-psychologist, where all types of perception are formed, including phonemic, sustained auditory attention, short-term and long-term speech-auditory memory. All this serves as the basis for the formation of higher mental functions - thinking and speech. It is known that the level of development of children's speech is directly dependent on the degree of formation of subtle differentiated hand movements. Therefore, it is recommended to stimulate speech development by training finger movements, especially in children with speech pathology. Interesting forms of work in this direction are carried out by the director of visual activities. Since finger games and training in manual labor (for example, making simple toys) provide good training for the fingers, the development of visual and auditory perception, attention, the development of sensory representations, the formation of graphic abilities, the ability to hold a pencil, hatch and paint in different ways, and also create a favorable emotional background. In classes, the music director works on staging diaphragmatic-speech breathing, activating auditory perception and attention, developing the ability to convey a simple musical rhythmic pattern, orientation in space, developing coordination of speech with movement, which has a beneficial effect on the formation of non-speech functions in children with speech pathology. Children with speech impairments are often somatically weakened, physically intolerant, and get tired quickly. Undoubtedly, correctional work should be built taking into account the leading lines of speech development (phonetics, vocabulary, grammar, coherent speech) and ensure the integration of speech and physical development. Therefore, it is necessary to pay serious attention to physical education, strengthening motor skills with the help of outdoor games of varying complexity, exercises to develop coordination of speech with movement, relaxation, increasing motor activity, developing gaming skills, improving optical-spatial concepts and skills. Interaction between specialists is also carried out in such forms of work as consultations, seminars, joint conversations to sum up the results of correctional work and determine the prospects for further activities. Thus, the effectiveness of correctional work with children with speech disorders is determined by the clear organization of their stay in a preschool institution, the correct distribution of the load during the day and continuity in the work of the speech therapist and other specialists.
Correctional and developmental Tyumen st. Latitudinal 158 k. 2 8-961-210-58-69 https://rechevaya-mozaika.jimdo.com #mosaika72#bakieva_n_z#speech therapist#speech_development
A&B specialists
She has been working with children for over 20 years. From 1995 to 2021, she worked in a day hospital for children with systemic speech underdevelopment at the Center for Speech Pathology and Neurorehabilitation of the Moscow Healthcare Department as a speech therapist. Since 2021, she has been working at the AiB Speech Development Center. Conducts individual lessons with children with speech disorders of any complexity, and works with children with combined pathology. Performs differential diagnosis of systemic speech disorders and other disorders. In her work she uses the methods of Reznichenko T.S., Filicheva T.B., Tumanova T.V., Davidovich L.R., Chirkina G.V., Mastyukova E.S., Novikova–Ivantsova T.N., Tkachenko T. .A., Zhikhareva-Norkina Yu.B., the author’s own methods for working with non-speaking children. He is the author of several educational and methodological manuals
“Every child is a new page in my profession. Sometimes - a difficult task, a tough nut to crack, a lock that requires more than one pair of keys... Often - a challenge to all previous experience, many years of accumulated luggage... Sometimes - admiration, pleasure, joy from small joint victories!... No routine. Predictability. Peace. Only endless search, work, analysis, questions - such a profession and work. »
EDUCATION:
1995 - Lenin Moscow Pedagogical State University (with honors) Diploma qualification: teacher-speech therapist, teacher of Russian language and literature in schools for children with severe speech impairments
ADDITIONAL EDUCATION:
In 2010, she mastered the program of a training seminar on issues of social support for families with disabled children aged 3 to 18 years on the basis of the Charitable Foundation for Social Support of Citizens “Socintegration” in the amount of 54 hours. In 2011, on the basis of the Institute of Defectology and Medical Psychology, she took part in the seminar “Technology of differential speech therapy massage in the structure of an individual lesson on the correction of dysarthria” for 20 hours. In 2012, at the Institute of Defectology and Medical Psychology, I completed a 72-hour advanced training course on the topic “Fundamentals of Neuropsychology.” In 2012, at the Institute of Defectology and Medical Psychology, she completed a 72-hour advanced training course on the topic “Speech Pathology in Children.” In 2013, on the basis of the ANO “Speech Therapist Plus” of the Educational Center, she underwent advanced training on the topic “Formation of the syllabic structure of words in preschoolers” for 8 hours. In 2013, on the basis of the ANO “Speech therapist plus” of the Educational Center, she underwent advanced training on the topic “System of speech therapy work on the formation of coherent speech in children. Methodology recommended by the Ministry of Education and Science of the Russian Federation” in the amount of 8 hours. In 2013, she underwent professional retraining at the Institute of Defectology and Medical Psychology in the amount of 288 hours according to the program: 1. Speech pathology in children. 2. Fundamentals of neuropsychology. 3.Aphasia. 4.Dysarthria. 5. Voice disorder. Certificate issued. In 2014, under the additional professional program “Initial manifestations of neuropsychiatric disorders in children and adolescents,” she underwent advanced training at the State Budgetary Educational Institution of Additional Professional Education “Russian Medical Academy of Postgraduate Education” of the Ministry of Health of the Russian Federation in the amount of 144 hours. In 2015, at the Institute of Defectology and Medical Psychology, I completed a 72-hour advanced training course: “Dysarthria. Voice disorders." In 2015 was a participant in the VII international conference of the Russian Association of Dyslexia, received a certificate. In 2015, she attended a course of lectures in the amount of 14 hours. on the topic “From neuron to brain. Restoration of lost or altered functions” at the VII International Congress “Neurorehabilitation-2015”, received a certificate of participation Since 2013, she has been a member of the National Association of Neurorehabilitation In 2013, she was awarded a diploma from the Moscow Department of Health “For many years of conscientious work” In 2021, she took part in the scientific and practical conference “Mental Health Service: Quality of Polyprofessional Care for Children” for 16 hours. In 2017, at the Institute of Defectology and Medical Psychology, she took a 72-hour advanced training course: “Speech Pathology in Children” . In 2021, she took part in the International Congress dedicated to World Stroke Day. In 2021, on the basis of the ANO “Speech Pediatric Plus” Educational, she took advanced training courses on the topic “Methods of speech disinhibition. Correction of sensorimotor alalia, behavioral disorders, speech development in children with RDA" for 8 hours. In 2021, I attended a distance learning course in the educational program for specialists “Formation of learning behavior. Stimulating the speech of non-speaking children” Chernyak M.Yu. in the amount of 8 hours In 2021, took part in the interregional scientific and practical seminar “Innovative pedagogical technologies in special correctional education” In 2021, took part in the training practical seminar “Formation of coherent speech in children with systemic speech pathology” in the amount of 8 hours on the basis GBOU "Special (correctional) school 1708 In 2018, she participated in the round table "Neuro-logo-musical seminar" on the basis of a 9-hour training course. In 2021, she received a certificate of participation in the First Scientific and Practical Forum with international participation GLOBAL SPEECH FORUM (GSF) in the programs “Fundamental foundations of the neurobiology of speech and communication”, “Medical rehabilitation of speech and swallowing”, “Elocution” In 2021, she participated in the round table “Tandem “neurologist-speech therapist” on the basis of training in the amount of 9 hours In 2021, she took an intensive course “I play, I understand. Sensory games in rehabilitation work with children" in the amount of 16 hours. In 2021, she received a certificate of participation in the seminar "Starting speech - the view of a nutritionist and speech therapists" on the basis of training in the amount of 9 hours. In 2021, she took part in the practical training "Formation of the motivational component as basic prerequisite for communication in children with developmental disabilities" on the basis of LLC "Logomag" in the amount of 7 hours. In 2021, on the basis of the ANO "Speech therapist plus" Educational, she took advanced training courses on the topic "Severe disorders of speech development in children" by Wiesel T. G. in the amount of 16 hours
