Rehabilitation system needs rehabilitation

As Galina Ivanova, Chief Specialist for Medical Rehabilitation of the Ministry of Health of Russia, Head of the Research Center for Medical Rehabilitation of the Federal Center for Brain and Neurotechnology of the FMBA of Russia, told, today a new model of medical rehabilitation in three global areas is being built with the country: in a hospital, a specialized center and an outpatient center. But the main problem, according to Ivanova, is that not all doctors understand that medical rehabilitation is the recovery of the most difficult patients, which has nothing to do with sanatorium-resort treatment: “This is the main problem that prevents you from building a proper rehabilitation process.” Rehabilitation is intended for the most difficult categories of patients, and today high technologies allow saving lives and correcting serious conditions. But many doctors continue to insist on physical therapy, which has not been proven effective and which is not in any clinical recommendation.”.

The expert noted that there are a number of advanced regions. For example, in Moscow clinics there is no physiotherapy and physical therapy, but in other regions, massage rooms survived, and “they decided that this is the third stage of rehabilitation, which should be paid from the MHI.”.

Another serious problem is the composition of rehabilitation teams in the country. They rarely have specialists such as clinical psychologists or speech therapists. So far, therapists in the regions are saying: why are they? Although many severe patients develop clinical depression. In the world, the range of specialists in the rehabilitation team is 3 points larger than ours. For 50 years, the world has been working like this -- and it's been doing amazing work. We're in trouble with specialists. The rehabilitation team should have specialists in violation of voice and speech, violation of urination, etc. We need to improve the work of these teams, Ivanova says.

According to Inna Zheleznyakova, Deputy General Director of TsEKMP, the Ministry of Health of Russia, the problem is that the country does not have a clear understanding of which patients receive medical rehabilitation, for which 100 billion rubles are allocated annually (and next year - already 150 billion). For example, an analysis of the last two years showed that the percentage of stroke patients who received rehabilitation is much lower than the target, and in some regions it is close to zero. As noted by Galina Ivanova, experts were surprised to study the lists of patients of the neurorehabilitation department in a number of regions in which there are no (!) patients after strokes. “In outpatient conditions, 50% of children are rehabilitated, I can assume that in fact this is physiotherapy after SARS,” Zheleznyakova says. The expert believes that it is necessary to plan the indicators of patients for rehabilitation, based on those baked in the hospital.

Meanwhile, modern technologies that are used in rehabilitation work wonders. As Natalia Suponeva, Director of the Institute of Neurorehabilitation and Rehabilitation Technologies, Head of the Laboratory for the Creation of Neurorehabilitation High-Tech Devices, Chief Researcher, Neurologist, Professor of the Russian Academy of Sciences, Corresponding Member of the Russian Academy of Sciences, said, We live in an amazing time when technologies, AI have reached a high level, and we are already actively implementing them in the rehabilitation of patients - they allow to speed up recovery, shorten the period of stay on bed. Professor Suponeva listed the most breakthrough developments that have appeared in medical practice today.

First of all, it is non-invasive neuromodulation, which allows you to select programs personalized to a specific patient and a specific task. The method allows, without damaging the tissue, to change the activity of nerve cells - to strengthen or weaken it to correct the disorders that underlie a disease.

The next breakthrough technique is the “Interface-brain computer” – a system that reads brain activity and converts it into commands for external devices: computers, robotic prostheses, exoskeletons or other digital tools. As noted by Suponeva, thanks to the research conducted at us, foreign and Russian guidelines for the most difficult patients have come out. It is shown that the method improves recovery and neuroplastic processes.

Multimodal complex for correcting violation of swallowing functions (Vibrational stimulation of the pharyngeal masculature of the tongue)

Another breakthrough technology that has emerged recently has filled a niche that used to be virtually free. Natalia Suponeva notes that there are prospects for implementing the technology and replicating it to all medical centers in the country.

Finally, virtual reality balance training platforms are popular today, bringing patients to a new level of balance and helping to prevent falls.

“We are experiencing a new era in the whole of healthcare, when rehabilitation technologies are becoming more affordable and truly life-saving,” concluded Galina Ivanova. Experts expressed hope that in the coming years it will be possible to build a single outline for the whole country.