Медицинский логопед в мультидисциплинарной реабилитационной команде. Практический опыт Клиники Института Мозга

Abstract

Background. In domestic and foreign publications, there are no descriptions of the principles of interaction between a medical speech therapist (MST) and other members of a multidisciplinary rehabilitation team (MDRT). Aim. To analyze our own experience in organizing the work of the speech therapy service of the regional neurorehabilitation Center. Materials and methods. We conducted a retrospective analysis of the activities of the division of MST of the interterritorial Center for Neurorehabilitation “Clinic of the Brain Institute“ (CBI) for the period 2015–2019. In the structure of the CBI, there is a 24-hour hospital with 45 beds, including a 9-bed intensive care unit, an 8-bed day hospital, a polyclinic with 50 visits per shift, and a telemedicine center. The speech therapy team of the MDRT consists of 8 specialists with higher education in the specialty “speech pathologist-defectologist“. Speech therapy examination consists of key blocks of clinical diagnosis of speech therapy syndromes: dysphagia, dysarthria, aphasia and prosoparesis. Each block represents a complex of a basic score scale and additional instrumental, including neurophysiological methods. The basis of speech therapy is voice training, articulation and probe massage and other standard procedures, combined in the concept of “basic techniques” for speech therapy syndromes. Drug and non-drug modulations are used to enhance the basic techniques. Results. In the period from 2015 to 2019, 5243 patients were treated in CBI after acute cerebral circulatory disorders and traumatic brain injuries, of which 4273 (81%) needed the help of clinical speech therapists. The most common problem was dysarthria – 55%. Speech breakdown in the framework of aphasia syndrome was noted in 26% of all hospitalized patients. Dysphagia was diagnosed in 30% of all hospitalized patients. During the hospitalization period of 14 days, each patient receives at least 45 minutes of daily individual training with a specialist and group articulation exercises, including weekends. The lesson is preceded by a modulating drug or non-drug procedure. For 5 years, 4273 patients were treated with speech therapy team. In 154 (11.6%) patients, speech therapy syndromes completely regressed, in 28% the severity of their manifestations decreased by 1–2 levels. Conclusion. At the early stage of rehabilitation, the speech therapist is called upon to solve priority tasks: achieving the maximum possible level of independence of the patient, at least staying at home with a minimum level of dependence on the help of a guardian. This is a prerequisite for the implementation of an individual comprehensive rehabilitation program. Despite many methodological and organizational problems, the MST is a key member of the MDRT, without which an effective rehabilitation process is impossible.