Academician Konstantin Lyadov will work at Medsi. Academician K.V.

Konstantin Viktorovich Lyadov(born December 23, 1959, Moscow) - Russian physician, surgeon and rehabilitation specialist. Academician of the Russian Academy of Sciences (2016, Corresponding Member of the Russian Academy of Medical Sciences since 2004), Doctor of Medical Sciences (2000), Professor (2003). Honored Doctor of the Russian Federation (2014).

Biography

Elected Academician of the Russian Academy of Sciences on October 28, 2016 in the Department of Medical Sciences (Clinical Rehabilitation). Member of the working group on cardiac rehabilitation of the European Society of Cardiology. Under the supervision of K.V. Lyadov, 10 candidate and 6 doctoral dissertations were prepared.

Member of the editorial boards of the journals “Physical Therapy and Sports Medicine”, “Clinical Medicine”, “Physiotherapy, Balneology, Rehabilitation”, the editorial board of the journal “Bulletin of Restorative Medicine”.

He was awarded the medals “In Memory of the 850th Anniversary of Moscow” (1999), “For Services to Domestic Healthcare” (2003), the Ministry of Emergency Situations of Russia (2011), as well as the badge “Excellence in Healthcare” (1999).

Links

• Profile of K. V. Lyadov on the official website

Academician, professor, doctor of medical sciences Konstantin Viktorovich Lyadov will head the MEDSI Inpatient Cluster. Previously, since 2006, Konstantin Lyadov served as director of the Federal State Budgetary Institution “Treatment and Rehabilitation Center” of the Ministry of Health of the Russian Federation.

Konstantin Viktorovich Lyadov was born in Moscow in 1959, graduated from the First Moscow Medical Institute named after I.M. Sechenov. Since 1997, he worked as the chief physician of the Moscow Central Clinical Basin Hospital, later as director, executive director of the National Medical and Surgical Center named after. N.I. Pirogov. Konstantin Viktorovich is a member of the working group on cardiac rehabilitation of the European Society of Cardiology and the editorial board of the journal “Bulletin of Restorative Medicine”, the author of more than 300 scientific articles and 12 monographs. Academician K.V. Lyadov is a leading expert in the rehabilitation of patients after stroke and myocardial infarction with damage to the musculoskeletal system and the rehabilitation of patients with injuries. He is rightfully considered one of the pioneers of introducing new modern technologies in rehabilitation.

At MEDSI, Konstantin Lyadov will develop the MEDSI Inpatient Cluster project, which will include the Clinical Hospital in Otradnoye, the Otradnoye Sanatorium, the Clinic in Shchelkovo, the Clinic in Stupino, the Clinic in Krasnogorsk, the Clinic in Otradnoye, the Clinic in Mitino, and the Ambulance Service. help, Polyclinic on Solyanka. The successful implementation of the MEDSI Inpatient Cluster project will allow the company to strengthen its position in the market for the provision of outpatient, inpatient and rehabilitation services.

Together with Konstantin Lyadov, a strong team of specialists from various fields of medicine came to MEDSI, including Professor, Doctor of Medical Sciences Tatyana Vladimirovna Shapovalenko, chief physician of the MEDSI Clinical Hospital in Otradnoye, who previously held the position of Deputy Director for Medical Work of the Federal State Budgetary Institution "Treatment and Rehabilitation Center" » Ministry of Health of the Russian Federation. Tatyana Shapovalenko is the author of numerous publications in domestic and foreign medical publications on the issues of restorative medicine and medical rehabilitation, and is also known as the presenter and chief physician of the series of television programs “Give Yourself Life” on the Rossiya TV channel, dedicated to a healthy lifestyle.

“The arrival of specialists of this level to the MEDSI team will allow us to expand the company’s competencies, combine all stages of medical care and strengthen the direction of medical rehabilitation,” said Pavel Bogomolov, medical director of Medsi Group of Companies JSC, Candidate of Medical Sciences.

As Vademecum found out, academician Konstantin Lyadov is leaving the Medsi Group of Companies to take up his own medical project. He intends to organize a hospital with a rehabilitation center called “Lyadov Clinics”. The investor of the project will be the main owner of Pharmstandard, Viktor Kharitonin.

As Konstantin Lyadov told Vademecum, we are talking about creating a multidisciplinary clinic with a hospital and a rehabilitation center in Moscow. “The business model of the project takes into account the specifics of working in the compulsory medical insurance system. I sincerely believe that it is possible and necessary to provide medical care effectively within the framework of the state guarantee program, without excluding paid services,” he explained.

The site for the Lyadov Clinic has already been selected. The area of ​​the future medical center will be 14 thousand square meters. m. Lyadov refused to name the volume of investments in the project.

He is currently obtaining patents for new technologies for inpatient rehabilitation: “I hope we will be able to organize full-fledged rehabilitation within the compulsory medical insurance tariffs that exist.” It is planned to scale this part of the project through the sale of rights to use technologies to regional partners.

Earlier, Konstantin Lyadov presented a system for remote rehabilitation of patients at home under the supervision of a doctor - via telemedicine connection. This project, according to Vademecum, is already being tested in pilot regions.

Since February 2017, Konstantin Lyadov has headed the Otradnoe business unit at Medsi Group, which includes a multidisciplinary hospital and a number of clinics in Moscow and the Moscow region. He will continue to take part in the group’s work for some time until the launch of a new project.

“The management of Medsi Group thanks Konstantin Viktorovich for the work done. In record time, including thanks to his participation, the clinical hospital on Pyatnitskoye Highway became one of the leading assets of the network. Konstantin Viktorovich has assembled a unique team of specialists who will continue to work in the group. We consider it a logical and consistent step for him to create his own clinic,” Medsi commented on the departure of one of the group’s key managers.

“I believe that the project has prospects - Konstantin Lyadov has extensive experience in combining the sale of government and commercial services. By positioning the clinic as an inexpensive hospital, it is possible to obtain quotas for both operations and a basic set of rehabilitation care, and make money on sales of additional medical services,” says Vladimir Geraskin, managing partner of DMG.

Information about two new companies controlled by Konstantin Lyadov appeared in the Unified State Register of Legal Entities on June 15. These are LLC “Multidisciplinary Medical Center “Lyadov Clinics” and LLC “Moscow Center for Restorative Treatment”. Lyadov owns 10% of them, and MIG LLC owns 90% each. This company is 70% owned by Viktor Kharitonin.

At the same time, MIG LLC registered several more companies - “Innovation Clinic”, “Nuclear Medical Technologies”, “High Technologies”, “Clinic Group”. The IPT Group, which manages Viktor Kharitonin’s medical projects, did not disclose the appointment of new legal entities.

The Main Investigation Department of the Investigative Committee accused Fazalidin Khasanov of committing crimes under Art. 105, art. 209 and art. 222 of the Criminal Code (murder, banditry and illegal weapons trafficking). According to investigators, he was an active member of the GTA gang, organized by his fellow countryman Rustam Usmanov.

The latter lived in the back room of a house in the village of Udelnaya, Ramensky District, registered to the mother of the chief business executive of the Prosecutor General’s Office, Alexei Staroverov, and helped their housekeeper with housework. Near the same back room, Usmanov, who was shooting back at the special forces with a Walther pistol with a worn-out number, was eliminated on November 6.

In relation to Mr. Staroverov, the first deputy chairman of the Investigative Committee, Vasily Piskarev, based on the results of the search, during which a weapon was found, opened a criminal case under Art. 222 of the Criminal Code, but Deputy Prosecutor General Viktor Grin recognized the corresponding resolution as illegal and unfounded.

The housekeeper, but already in the house of the physician Lyadov, turned out to be a Kyrgyz, Fazalidin, who bears the same surname as the prosecutor’s housekeeper, namely Khasanov. According to media reports, Mr. Lyadov previously lived in Udelnaya, and then sold the house there, buying a new one for his son in the Krasnogorsk district. Khasanov also moved there. As a result, he turned the back room into a workshop for converting traumatic pistols into combat pistols, which were then used to commit murders in Moscow and the Moscow region. Spikes, the so-called crow's feet, were also made there, which criminals scattered on the highways to stop the cars of their victims. In the workshop, according to official representative of the Investigative Committee Vladimir Markin, a gang member even managed to make a sniper rifle using a small lathe. In total, more than 20 firearms and ammunition were seized from the gang's hiding places. The examinations have already confirmed that the guns were used to kill car owners.

Yesterday, the Basmanny District Court, satisfying the request of the Investigative Committee, arrested Fazalidin Khasanov for a month and a half - until December 22. Earlier, another member of the GTA was detained in the pre-trial detention center - a native of Tajikistan, Abdumukim Mamadchonov, as well as an unnamed militant. Three more suspects are awaiting arrest. In total, the gang, according to Mr. Markin, included a dozen militants - detaining the rest is a matter of the near future.

The Investigative Committee noted that members of a dangerous gang, liquidated by employees of the Ministry of Internal Affairs and the FSB, committed attacks solely for selfish purposes. “They killed indiscriminately, regardless of nationality and social status, often being content with even small amounts of money that they found from the dead,” Mr. Markin said. According to him, versions that GTA members could commit crimes based on national, religious or any other “selfless motives” have not been confirmed.

In total, this gang is responsible for at least 14 murders, but the investigation does not exclude that other episodes may appear in the case.

Kommersant was unable to obtain comments from Konstantin Lyadov. The Ministry of Health refrained from doing so.

K.V. Lyadov is one of the leading Russian rehabilitation specialists. He considers this specialty, which appeared on the horizon of domestic and world healthcare relatively recently, to be the profession of the future. And if 15–20 years ago it was not very clear why such doctors were needed, now rehabilitation has taken its special place among other medical specialties - such as surgery, therapy and resuscitation, and has become their indispensable assistant. Indeed, without modern rehabilitation, the efforts of all other doctors sometimes turn out to be useless. We are talking about what this specialty is, how it has changed in recent years and what awaits us in the future.

Konstantin Viktorovich, you didn’t start out as a rehabilitation specialist. And your doctoral dissertation was devoted to stomach ulcers.

In those years when I started, rehabilitation in our current understanding did not exist. In all the multidisciplinary hospitals and clinics of the First Medical Institute, where I started working, there were departments of physical therapy and physiotherapy, but this was not an important, main specialty that you pay attention to.

- And why?

When we used to come to the hospital, there were such patients whom we now discharge home. Because they usually didn't survive. There was no scope for serious rehabilitation. For example, when we now talk about rehabilitation with problems of the musculoskeletal system after endoprosthetics, we must understand that 30 years ago this area was just beginning to develop, and patients with lesions of the hip or knee joints could count mainly on drug treatment and a little on physiotherapy. When I started, surgery, oncology, and gynecology were developing at a rapid pace, but as they developed, they left a large number of problems, which they began to think about solving as patients with these problems appeared.

From my point of view, in our country, rehabilitation in the modern sense began with cardiology, with post-infarction patients, when thrombolysis, stenting, successful cardiac surgery appeared, and then they began to understand that in some cases it is not enough to just perform an operation. We also need to think about how to restore these patients after surgery. And the fact that rehabilitation as a system began to develop in our country is a great merit of Evgeny Ivanovich Chazov, who always drew attention to the need for an integrated approach to the treatment of patients. Undoubtedly, work was constantly going on both in neurorehabilitation and in other areas.

- When did you become interested in rehabilitation as a field of medicine?

When I was already the chief physician of the Moscow Basin Hospital, I first paid attention to this area, since it was at the intersection of sciences. There was a contingent of patients who needed constant rehabilitation to maintain their professional qualities. It was very interesting. We worked with rescue teams, and my doctoral dissertation was devoted to the diagnosis of certain borderline states, when a person becomes not very functionally capable. That is, he feels fine, but we understand that he will not be able to withstand the entire shift or the entire shift, he will not be able to fully fulfill his duties. This was the first part we started doing. And the second part is what to do so that he can do all this.

- Did you understand this?

We realized that there is a need to organize restoration activities. We started traveling around to see what was being done on this topic in the world - Germany, Switzerland. This was 1998–99. The understanding came that we did not have the rehabilitation that had already begun to develop abroad during these years at all. Then everywhere there were the same departments of physical therapy and physiotherapy, there were sanatoriums, for example, the Herzen sanatorium of the Presidential Administration or the famous Goluboye sanatorium of the Third Directorate, and now the FMBA, where, if a person was lucky, he could go after a stroke, a craniocerebral or spinal injury, and there they began to deal with it. But there was practically no systematic approach specifically in hospitals.

We began to develop primarily neurorehabilitation in our hospital, however, it soon became clear that almost all areas need rehabilitation.

Subsequently, when colleagues came to us, they were surprised why the center was so diverse. After all, it is traditionally believed that one center deals with neurorehabilitation, another with cardiac patients, and a third with cardiac surgery. Moreover, the approaches are different after open cardiac surgery and endovascular interventions. Rehabilitation is necessary in both cases, but there are specificities.

- And in the case of endoprosthetics?

Not all colleagues agree with me, but I think that we are still right when we talk about the rehabilitation of patients after endoprosthetics. Destruction of the hip or knee joint is painful for the patient. He cannot walk and is in constant pain. And suddenly he is given some kind of pain relief, be it intravenous, endotracheal anesthesia or conduction anesthesia, the joint is changed - and the pain disappears. And the man himself became different. He doesn't have to be afraid to step on that joint. The main problem here is psychological. The work of a psychologist who knows how to convince the patient of this is extremely important. That's why we play a huge role in patient schools. There are a lot of fears. Unlike strokes, which occur suddenly, this has a different specificity. It was my knee, but it's no longer mine. The patient lies, does not sleep, he feels that his leg now seems to “live” separately from him. Here our research runs parallel to the research of our foreign colleagues. Meeting at congresses and discussing these topics, we see that the situations are similar and we try to solve them together. The same English scientists to whom we like to refer, studied the problem thoroughly and came to the same conclusions as us. It turned out that we were absolutely right in insisting that the patient be put on his feet on the day of joint replacement surgery. Why? Because if this is not done, then he will get up much later.

- Will he be afraid?

Yes. And then he doesn’t have time to remember all his fears. As soon as the anesthesia wears off, the instructor comes to him and says: “Get up! Go!" And the next day he still has this feeling that he can walk. If we gave him the opportunity to lie down, sleep, and wake up with the feeling of his problem, that he has a “foreign” hip or knee, then the duration of his hospitalization will be longer. This is already a proven fact. It takes two days to convince him that it’s not scary.

- Does this apply to all rehabilitation patients?

Very many. There is such a concept - multidisciplinary teams. This is an understanding of how exercise therapy, physiotherapy, a psychologist, a nutritionist, and so on can relate to surgery. But the work of all these specialists must be organized, their place and time in the rehabilitation process must be determined and paid. By the way, I had to give interviews more than once, explaining that telemedicine is the same work of a doctor as a regular appointment. This takes up his time, the consultation must be included in the work schedule and must be paid. The misconception is that I called and everyone answered me right away. It doesn't happen that way.

It's the same here. It was necessary to find all these specialists and money to pay for their work. Understand at what point they need to connect. Introduce group classes. Then we moved to schools, realizing that in principle it is much easier to gather 20-30 patients before surgery, while they can still come themselves, explaining to them in advance what problems they may encounter and how to solve them. And then after the operation there will only be 2-3 patients who do not know all this. This makes the job much easier. But we had to start from scratch, because, again, the concept of rehabilitation did not exist. And gradually an understanding came of how to work and which patients to cover.

Why did you have to cover all patients - neurological, orthopedic, and cardiac? Is this right?

Now this would be wrong. Of course, patients should be cared for by specialized medical centers. But we were pioneers, so the coverage was very wide. We had departments of neurorehabilitation, cardiac rehabilitation, orthopedic rehabilitation...

- What about oncology?

Necessarily. Oncological rehabilitation has been and remains. However, oncologists have only recently begun to recognize rehabilitation. For a long time they did not understand why it was needed. Wonderful oncologist surgeons told me: “Why? The main thing is the operation, it was performed competently, radically and everything is in order.” This is what used to happen in all other areas of surgery: you perform an operation and everything should somehow form by itself.

- This is wrong?

This is not entirely true. Oncological rehabilitation now, from our point of view, is no longer the rehabilitation of women after a mastectomy or patients with colostomies after rectal surgery. This was 20 years ago. If we now see such patients, then we believe that these are errors and incorrect treatment before the person came to us, because modern combined treatment does not involve traumatic major operations that would lead to such consequences.

- However, they exist.

Yes, they are. Patients with the consequences of severe traumatic interventions come to us, and we help them to the best of our ability. But still, after a radical mastectomy with lymph node dissection, it is difficult to achieve an ideal effect. Swelling and lymphostasis remain. This is bad because these patients are an example of what should not be done. It is for this reason that women are afraid to go for a mammogram: they will find something on me - and then it will be like this. All the same, there is no life, no chest, my arm doesn’t bend, my husband left, I can’t go to work. And indeed, her hand is like a deck. The woman is deeply disabled. Therefore, they think: I’d better not go, I’ll be patient, maybe it’ll go away on its own.

- And for the same reason, everyone is afraid to go for a colonoscopy and all other studies. How should it be?

And there must be a competent combination treatment, correctly selected chemotherapy in accordance with the individual assessment of the tumor. We now know several dozen types of tumors of the breast alone. They are grouped into large complexes, and in each case specific complex treatment is required, in some cases genetic therapy. And here a completely different rehabilitation comes to the fore - rehabilitation between courses of chemotherapy, which is usually poorly tolerated, causes a number of side effects, and these effects often force a woman to abandon chemotherapy altogether, and the work of psychologists is important. This usually occurs after the third or fourth course of chemotherapy. The first and second passes easily - then problems begin. Moreover, men refuse chemotherapy less often than women. Apparently they are less emotional. They tolerate loss of sensitivity or nausea more easily. They don't care that much. The woman perceives all this dramatically, she doesn’t want to hear that one or two more courses, an operation - and that’s it, you’re healthy. Be patient for another six months - and life lies ahead. She doesn't want to listen and gives up everything. And it is very important that during these intervals we carry out a number of correct measures aimed at reducing depression, returning sensitivity, and changing a number of parameters that interfere with life.

- Or baldness, for example.

This is just the least that worries patients during the treatment process. Yes, many people worry before starting treatment, but then these fears subside. Because the hair will grow back, but real health problems are present during courses of chemotherapy or radiation therapy: anemia, neuropathy, post-radiation cystitis, colitis. Our main task is to select complexes of drug therapy, physiotherapy, and psychological correction to stabilize the patients’ condition. Our task today is to help the patient undergo a long course of treatment as comfortably as possible. Well, rehabilitation after surgical treatment also remained. But she, too, is changing.

- What exactly has become different?

Let's return to breast cancer. If a gentle operation was performed, it is not at all so traumatic. This is either a subcutaneous mastectomy or even radical resection. If the surgeon carefully approaches the scope of lymph node dissection, the consequences will also be much less pronounced. There are also problems there, but they are different, less pronounced.

Unfortunately, we have very few sources of conveying information to the masses. We know this ourselves, but it is difficult to convey to citizens that everything has changed. Everything has changed. Come for mammography, fluorography, colonoscopy, gastroscopy, ultrasound and screening studies, donate blood for tumor markers, because cancer today can be cured radically, completely, and you can forget about the disease forever. Rehabilitation also became different. Our efforts are combined with the efforts of other doctors and psychologists, and we see the results of our joint work.

Konstantin Viktorovich, for many years you worked in large state medical institutions, holding leadership positions there. And suddenly, a year and a half ago, you went to MEDSI - the very first and largest network of private medical clinics in Russia today, where you manage the inpatient part. Why did you need to go to MEDSI?

Yes, this is one of the largest medical associations in our country. Only a small part of it was under my leadership - the clinical hospital and the adjacent Otradnoe clinics. And all this happened for a completely understandable reason. Many of my colleagues know the feeling that you can do more, but you are caught up in the routine of leadership work. There is simply no time left for anything else. I then came to Veronica Igorevna Skvortsova, who literally six months earlier had signed me an indefinite contract as head of the treatment and rehabilitation center of the Ministry of Health, and said that I would still like to try to implement my ideas and developments. It was impossible to do all this in this busy environment.

- Did she understand you?

Yes, she understood me, and we continue to contact her, she supports our developments at the level of the Ministry of Health, and this helps us a lot.

However, here too you have a leadership position, and quite a responsible one. Isn't there a lot of turnover here?

In this sense, everything here is organized very successfully. I was given the opportunity not to engage in routine activities. I do strategic work. I am learning how to work in outpatient departments. This is a new direction for me. But my main task is strategy, and therefore there is time to implement ideas, bring them to the desired condition, patent them and get results.

- What developments seem most relevant to you?

We have long wanted to bring to life a new type of rehabilitation complex, and in November 2017 we opened it. This complex is our attempt to bridge the gap between the patient’s condition when we discharge him and when he ends up at home. Since we have been involved in home rehabilitation for a long time, we have seen over and over again: what the patient could do in the hospital, suddenly stops doing all this at home. He refuses to get up, walk, and do some things that he clearly did with us. And the following happens. When a person gets sick and ends up in a hospital, especially in such a difficult situation as a stroke or traumatic brain injury, everyone there helps him. And it is right. But you get used to it very quickly. And you get used to it, not even in terms of the fact that you want to be a dependent, but in terms of the fact that you can’t do something, say, put on a shirt - nothing, they will help you. And this moment was missed. So they lifted him up, stood him up, and he walked away. But we are close all the time. Doctors, nurses, relatives, staff. And a person gets used to the fact that he will always be helped. But then he finds himself at home - and there he is faced with a whole series of things that he does not understand how to do on his own. We needed a complex that would bring us as close to reality as possible. Yes, it's a simulator. But this is reality, recreating situations close to life. We tried to take into account all the situations that a person may encounter when he finds himself at home, on the street, on public transport, in a store, etc.

- Where did you start?

We started with clothes. Indeed, when we help a patient get dressed, we cannot understand what is wrong with him. Therefore, clothing is one of the main tasks.

In this case, the instructor and operator are behind the glass. They see him. They can come to the rescue at any time. This is a 100% safety guarantee. But they are not nearby. The patient does everything himself. And this is extremely important. We have a special fixation system, but, nevertheless, he must do everything alone.

- How much time do you give to complete the task?

We look at the time and if we see that within, say, three minutes a person cannot put on a jacket, then he will not bother for an hour. We understand that he is not succeeding, and we begin to work through the task together with the instructors. We change the task parameters.

Often we cannot understand what is happening in the brain of a sick person. Even a healthy brain can’t figure it out. It seems to us that everything is fine, but before going home, he must first select the things he needs on the TV screen. By completing this task, we understand how he copes with the tasks of recognition, recognition, what a neuropsychologist should pay attention to, because we are releasing him into life, and he must be able to navigate it independently. After all, if he cannot understand something, he begins to withdraw. First there is aggression - then he hides in his “shell”. “I’m not going anywhere.” - "Why?" - "Will not go". And we promote them with the help of psychologists and psychotherapists. It turns out that we must teach them to understand what is needed for taking a shower, for going to the store, for cooking.

- In your complex, considerable attention is paid to virtual reality. But it will not replace life.

Yes, everyone is really into virtual reality now. But if he presses on the wallet on the screen, then in real life he will not recognize it. Because he was taught to put pressure on his wallet. Therefore, our second task is to choose the right items. He managed it. But in real life he is helpless. Therefore, the door opens on the screen - and he goes out into real life. This is an imitation of a store where there are real, real items: a carton of milk, a can of peas, bread, butter, cheese. Or a pharmacy where he needs to buy medicine. Or just a walk. What's the weather like there? Should I take an umbrella or not? He must provide for all this. This is all a complex of various tasks, which is a “smart” rehabilitation room. Yes, this is not an apartment or a store, but it is a construction set that simulates a number of tasks that it encounters in real life.

- What else is important?

Sounds. We don't pay attention to the fact that the hospital is quiet. A person in a hospital is focused on walking, on completing tasks. And then he finds himself at home - and suddenly withdraws. We begin to communicate with relatives, find out when the short circuit occurred, and it turns out that he went outside. And there is the noise of cars, barking dogs, voices. He turned and left. Because we did not teach him to react to sounds and concentrate despite this. That is, he performs his movement, although there is noise around him.

We began to understand the reasons for our patients' falls. The thing is that at the first stage of rehabilitation we teach you to look at your feet. And when he goes out and is distracted by something, he forgets about his legs. And he was used to feeling support under his feet. And the task of this “smart” hall is this: a certain image appears in front, and here he slowly walks along the path and at the same time completes the task. We need to count how many red cars passed in front of him. He must forget about looking at his feet. And when we layer all the layers of reality on top of each other, we understand what we were missing.

- Which task was the most difficult?

One of the most difficult tasks, as it turned out, was the escalator. And specifically getting off the escalator. Do you understand why?

- Lack of support?

Yes. The path has ended, there is nothing to hold on to. And he falls. Getting off the escalator turned out to be the biggest problem for patients. And in Moscow, for example, escalators are everywhere - in the metro, in shopping centers. And they were simply afraid to go to them. This problem also had to be solved. We specifically removed the simulator support so that patients could be left without it. And they didn't fall. We teach them to maintain balance. Gradually they stop being afraid of this, although at first there is panic.

- What about the entrance to the bus or tram?

They don't think about it at all. And when we started asking the patients’ relatives, it turned out that this was a whole problem. Where do they put the stick when they have to get on a tram or bus? He has paresis, his arm doesn’t work well, his leg doesn’t move well, but he walks and is active. He needs to go to the pharmacy or the store. And then he approaches the tram. The wand is in his left hand. With it he grabs the turnstile. The stick falls. He is lost. Trying to lift her... That's it. The tram has left. Or they pick him up and lift him onto the tram. But this is not very pleasant for him either. Next time he won't get on the tram.

- How to solve this problem?

We teach him: the cane can be hung on the other, poorly functioning hand. You can hang it on a coat button. There are different options, and they also need to be worked out. There is no need to be shy or afraid of anything - everything can be learned. You hang the stick on your sore hand, pull yourself up with your healthy hand, get up, take the stick with your healthy hand - and go about your business.

- Have you foreseen everything or are you constantly discovering new problems that have not been covered?

In the course of work, new and new problems constantly emerge that we must learn to solve. Let's say different types of surfaces. Slippery, rough. A person may fall because the street is slippery. Or is there paving stones there - how to walk on them? We teach him to navigate and make decisions on how to behave in a given situation. Don't be shy, don't be afraid of it.

We were at the opening of the “smart” hall four months ago. We talked with the first patient, who seemed to be a very positive person. Time has passed. Is it possible to draw any conclusions?

You know, after classes in this room they all become much more positive. We are very pleased with this effect: it means that the patient realized that working in this room means another step towards a normal life. Many of them could no longer imagine this. But it happens. They overcome phobias and fears and learn to live fully. Then such a patient breaks out of the corridor space into the space of real life and realizes that it continues to work. There is a feeling that life is getting better. And before it often seemed to them that life was over, they were simply living out their lives.

- The patient I spoke with suffered a stroke four years ago. This also seemed very unusual.

What’s even more interesting is that all these four years he did not take public transport. He went out into the yard, walked, but did not approach the stops, because he did not understand how he could go somewhere.

- And now?

Now he travels almost every day. We continue to contact him, as with other patients. A person lives an active life, takes care of himself.

What also seems incredibly important: he underwent rehabilitation completely free of charge. In a private clinic. And not only him. It turns out that there is a certain government program under which people who have suffered a stroke and have disabilities can undergo rehabilitation for free, even within the walls of a private clinic, which is MEDSI.

The program we are talking about is currently only valid in Moscow. This is a program of the capital's Department of Social Protection, and this is an extremely important thing. At MEDSI, about 300 people underwent rehabilitation within the framework of this program this year alone, and several thousand in Moscow. This is a large-scale program that is developing, expanding and producing amazing results. We work with adults, but there are huge programs for children. These include exercise equipment, rehabilitation centers, and sanatoriums. A very large-scale work that is actually being carried out in Moscow. In other regions there is no such systematic work yet. But this is a huge support both for the person himself and for the family.

- What are your future plans?

Our next topic that we are currently working on is that, within the framework of free rehabilitation under compulsory medical insurance, we want to make it as full of procedures as possible. Limited tariffs cannot give a person everything he needs. We are trying to solve this problem with the help of simulators, computer programs, and modern digital technologies.

An incredibly important topic now is public-private partnership. MEDSI provides us with an example of a successful example of this kind. After all, people for the most part do not know that it is possible to undergo free treatment in a commercial clinic.

Many are surprised that this is so.

But most don't even know. However, it turns out that there are a number of programs within which this is possible. In what other areas does MEDSI cooperate with the state?

Patients with acute coronary syndrome, endovascular surgery, stenting, oncology and chemotherapy, joint replacement, some surgical and gynecological operations, which are quite complex and high-tech - we do all this within the framework of the state program and at the expense of the state. We can and should do this, talk about it so that people know and are not afraid to come to us.

- Are there any obstacles and problems in this direction?

Undoubtedly. Rehabilitation of seriously ill patients in intensive care units is a “black hole” of our medicine. Nobody wants to take on such patients, because it’s a cheap rate, but very hard work. Constant care and very specific procedures. It is easier and more profitable to take a person for an operation. Much in organizing such work depends on the combined efforts of enthusiasts and regional leadership. An example of effective interaction is the Clinical Brain Institute of Yekaterinburg, headed by Professor A.A. Belkin, the highest enthusiast and professional.

- We wrote about the Clinical Brain Institute.

Yes, but there are only a few such examples. In most cases, no one wants to do this for the reasons I mentioned.

At the same time, it is important to understand that rehabilitation is not just about helping people who find themselves in difficult life situations. You return them to normal life, give them the opportunity to work, do housework, and not be a burden to themselves and others.

Yes, that's definitely true. Rehabilitation is now in great demand all over the world because we see the results. No one would pay so much attention to this if it were otherwise. I remember well the time when it was not very clear to us why complex neurosurgical interventions were performed. Doctors saved a man's life - and left him in a condition requiring constant care. The concept of “rehabilitation” did not exist then. Now a real revolution has taken place here. We have learned to rehabilitate the most severe patients after strokes and heart attacks, after oncological interventions, chemotherapy and radiation therapy, total joint replacement, and this is not just caring for people who cannot be left to their fate. We have learned to give them back to society.

Conducted the conversation Natalia Leskova