what to do in speech therapy

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Types of Speech Therapy

Different speech therapy approaches and techniques are used for various issues

• List of Types
• For Late Talkers
• For Apraxia
• For Stuttering
• For Aphasia
• For Swallowing

Frequently Asked Questions

Speech therapy is not one thing. There are different types of speech therapy, each of which involves approaches and techniques that are specific to the issue that needs addressing. That could be related to speech itself—e.g., therapy for people who stutter—or it could relate to problems with memory swallowing, and more.

A speech-language pathologist (SLP), often just called a speech therapist, will perform assessments to determine which type(s) of speech therapy is right for you.

This article reviews the different types of speech therapy and the various disorders each one can be used to treat.

Types of Speech Therapy Used by Speech Therapists

A speech-language pathologist can use different types of speech therapy to help people with problems related to:

• Fluency (e.g., stuttering, and cluttering)
• Speech (e.g., articulation)
• Language (e.g., ability; comprehension of spoken and written language)
• Cognition (e.g., attention, memory, ability to solve problems)
• Voice (e.g., characteristics of vocal tone)
• Swallowing (e.g., stroke, congenital disorders)

In addition to different speech therapy techniques, SLPs may also provide auditory habilitation & auditory rehabilitation for people with hearing problems or disorders.

Some SLPs specialize in other services including professional voice development, accent or dialect modification, transgender voice therapy , business communication modification, and voice hygiene.

Speech Therapy for Late Talkers

A common speech therapy method is used to help children who have reached the expected age for speech development but have not started talking .

If your infant or toddler should be talking by now but isn't, they may be referred to a speech therapist. The therapist will likely try different things to encourage your child to talk, including playing with him. Sometimes, withholding a favorite toy until a child asks for it motivates small children to talk, but this depends on the circumstance.

For some children, other types of communication, such as sign language or picture cards, might be introduced. Speech therapists may also refer your child for further evaluation, such as hearing tests if necessary.

Speech Therapy for Kids With Apraxia

Certain speech therapy techniques are helpful for kids with apraxia.

Children with apraxia of speech have difficulty saying certain syllables or making certain sounds. Your child knows what they want to say, but it doesn't seem to come out right. Speech therapists are qualified to evaluate children for apraxia by using several tests, including:

• Oral-motor assessment to check for muscle weakness in the jaw, lips, or tongue
• Melody of speech assessment during which the therapist listens to see if they can appropriately stress certain syllables and use pitch and pauses at the appropriate place in a sentence
• Speech sound assessment further determines how well the child can pronounce sounds, including vowels, consonants, and sound combinations. This includes determining how well others are able to understand the child's conversational speech

If your child is diagnosed with apraxia , they will probably need speech therapy on a one-on-one basis several times per week. This therapy will likely consist of intensively practicing their speech. The therapist will try to help your child understand auditory feedback as well as visual or tactile cues.

One way a therapist might do this is to have your child look at themselves in a mirror while speaking, or record them speaking and then playing it back. Many children enjoy this.

Since successful treatment for apraxia involves a lot of time and commitment, your therapist may give you assignments to practice with your child at home.

Speech Therapy for Stuttering

Speech therapy techniques can be applied to help treat stuttering.

Stuttering is a problem that typically develops during childhood but can develop during adulthood as well. Stuttering is usually considered a type of behavioral problem. Speech therapists will try to teach your child who stutters behavioral modification techniques that in turn may help control their stuttering.

A common method that may be used on your child is to teach them to control the rate of speech since speaking too quickly can make stuttering worse for some people. Practicing speech in a slower, more fluent manner can be helpful. It can also be helpful to monitor breathing.

Even after treatment, people who stutter may require follow-up sessions with their speech therapist to keep the problem from recurring.

Speech Therapy for Aphasia

Some speech therapy methods help people with aphasia . Speech therapy assessments can also help determine if someone has the condition.

Aphasia is a condition that causes difficulty speaking as a result of some sort of damage to the brain. The condition can also consist of difficulty listening, reading, and writing. Aphasia happens to many adults after they have experienced a stroke .

Speech therapists play a crucial role in diagnosing aphasia by evaluating an individual's ability to understand others, express themselves, and even swallow. There are many different things a speech therapist might do to help a person with aphasia, including:

• Drills to improve specific language skills
• Group therapy to improve conversational skills
• Gestures and writing to augment their communication skills

Speech Therapy for Swallowing Difficulty

Speech therapy techniques can also be used to help people who are not able to swallow when they eat or drink.

Your child may experience difficulty swallowing for a variety of reasons. A speech therapist may help your child with swallowing difficulty by assisting them with exercises to make her mouth strong, increase tongue movement, and improve chewing.

A speech therapist may also make recommendations about the consistency of food. For infants, a speech therapist may assist in coordinating her suck-swallow-breath pattern. As previously mentioned these are only some of the things that a speech therapist might do. There are many other conditions and methods used to evaluate those in need.

There are different types of speech therapy that can be used to treat various disorders affecting speech, hearing, and swallowing. Children and adults with speech delays, apraxia, swallowing problems, and certain medical conditions may benefit from working with a speech therapist.

A speech therapist evaluates, diagnoses, and treats speech issues and communication problems, as well as swallowing disorders. They provide various services, from teaching articulation and clear speaking to helping strengthen muscles used to talk and swallow.

The four types of articulation disorders are substitution, omission, distortion, and addition. Speech-language pathologists use the acronym SODA to remember them.

Childhood Apraxia of Speech: Treatment . Asha.org.

Chang S, Synnestvedt A, Ostuni J, Ludlow C. Similarities in speech and white matter characteristics in idiopathic developmental stuttering and adult-onset stuttering .  J Neurolinguistics . 2010;23(5):455-469. doi:10.1016/j.jneuroling.2008.11.004

Stuttering . Asha.org.

American Psychological Association. APA Dictionary of Psychology - Definition of Articulation Disorder .

Scope of Practice in Speech-Language Pathology . American Speech-Language-Hearing Association website.

Childhood Apraxia of Speech . American Speech-Language-Hearing Association website.

Feeding and Swallowing Disorders (Dysphagia) in Children . American Speech-Language-Hearing Association website.

By Kristin Hayes, RN Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.

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What Is Speech Therapy?

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Speech therapy is a form of healthcare that helps improve communication and speech. It can also help improve swallowing function and other behaviors related to feeding.

About one in 12 children in the United States has a speech or swallowing disorder. Disorders are most common in young children, but many adults have a related condition. For example, about one million adults in the United States have aphasia (difficulty expressing or comprehending written and verbal language).

Speech therapists (STs) or speech-language pathologists (SLPs) assess and treat people of all ages. They use various techniques to help people with challenges related to speech production, language comprehension, hearing, voice quality, fluency, and swallowing. 

What Does Speech Therapy Treat?

Speech therapy treats various disorders involving hearing, speech, language, literacy, social communication, voice quality, executive functioning (for example, memory and problem-solving), feeding, and swallowing.

Specific speech disorders include:

• Articulation disorders: Difficulty pronouncing words or sounds such as the “s” sound (for example, saying “thun” rather than “sun”). This can occur during childhood language development or with structural problems like tongue-tie. A tongue tie is when a small band of skin connects the tip of the tongue to the bottom of the mouth. It is congenital, meaning it's present at birth.
• Dysarthria: Slow, slurred, or unclear speech. This occurs with oral (mouth) muscle control decline due to neurological conditions (related to the brain or nervous system), such as multiple sclerosis (MS) —a condition that occurs when the immune system attacks myelin, the covering wrapped around nerve cells.
• Apraxia: Knowing what you want to say but having difficulty producing the correct sounds or words. Apraxia can cause slow, error-prone speech or the need to intentionally move your tongue and lips in order to produce sounds and words. Apraxia can be present at birth, but it can also occur as a result of brain injuries, brain tumors , or a stroke .
• Fluency disorders: Speech flow disruptions like stuttering. Stuttering is experiencing interruptions in speech and repeating sounds, syllables, or words. Researchers are still exploring possible causes of dysfluency, but they seem to include genetics, developmental components, neurological factors (how the brain processes), and brain injury. Many children outgrow fluency disorders, but they can persist into adulthood.
• Voice disorders: Vocal cord spasming (choppy voice), hoarseness, pitch problems, or voice fatigue are examples of voice disorders. This can result from infection, overusing the vocal cords, or neurological disorders. 

Language or communication disorders include:

• Aphasia : Aphasia is a language disorder in which you have difficulty expressing or comprehending written and verbal language. Receptive aphasia is difficulty understanding written or verbal words. Expressive aphasia is difficulty communicating thoughts and ideas with language components like vocabulary, grammar, and sentence formation. Aphasia can occur with childhood development, language impairment, autism spectrum disorder (ASD), brain injury, or neurological disorders.
• Pragmatic language disorder: This relates to social communication. Signs include misunderstanding social cues like eye contact, body language, and personal space. It can occur during childhood development or with underlying neurodivergence (brain variation), such as autism spectrum disorder (ASD) , a brain development condition that affects how a person perceives and socializes with other people.
• Accent or tone: While this is not a disorder, speech therapists can also work with people who wish to modify their accent or an unusual speech rhythm, pitch, or tone. For example, a high-pitched, sing-song, or robotic tone can occur with ASD.
• Executive functioning: Executive functioning challenges include difficulty with memory, planning, organization, problem-solving, and attention. This can occur due to brain injuries or conditions like ASD and attention-deficit hyperactivity disorder (ADHD) , a neurodevelopmental disorder characterized by inattention (being distracted), hyperactivity (feeling restless), and impulsivity (making hasty decisions).
• Auditory processing disorder: This is a neurological condition that makes it difficult to make sense of sounds. 

Feeding and swallowing disorders affect how you suck, chew, and swallow food and drinks. Difficulty swallowing is also known as dysphagia , which can result in choking during meals—and lung infections if food or liquid enters the airways.  It can occur with structural abnormalities, muscular weakness, or neurological conditions like a stroke.  

How Does Speech Therapy Work?

Speech therapy involves techniques like language practice, pronunciation exercises, voice therapy, and swallowing exercises. It begins with a thorough assessment, including observation of communication strategies, challenges, and frustrations.

Speech therapy for infants, toddlers, and children involves fun and engaging activities like play, language exercises, reading, picture cards, and modeling correct sounds. This helps make learning more enjoyable.  

Parents or caregivers often attend sessions and learn ways to support children at home. The ST or SLP will tailor the treatment plan to the child’s developmental stage. Early recognition and intervention (treatment) can help improve outcomes.

With adults, the ST or SLP will begin with an assessment to identify specific challenges. They will then create a specific care plan that addresses underlying concerns such as:

• Medical conditions
• Accent modification
• Voice challenges
• Pronunciation
• Conversational language
• Problem-solving
• Memory exercises

What To Expect During Speech Therapy

Speech therapy can occur in a class, small group, online, or one-on-one. Speech therapists typically assign exercises to practice at home in order to reinforce what you learn. Activities might include:

• Vocal warm-ups like humming 
• Tongue twisters to improve articulation
• Breaking words into syllables to improve clarity
• Contrasting word exercises—for example, "ship" versus "sheep"
• “Pausing” practice (for stuttering)
• Repetition after listening to a native speaker 
• Repetition exercises for sounds like “s” 
• Speech rate control—for example, by tapping hands to a beat
• Pitch exercises
• Breathing and posture exercises

Receptive language exercises include:

• Memory or problem-solving exercises
• Reading comprehension (similar to a book report)
• Speech supplementation (written, gestural, voice amplifier, speech-generating devices)
• Word association
• Communication partner exercises, such as practicing eye contact and active listening

Exercises for swallowing and feeding include:

• Diet modification (pureed to solid foods)
• Oral muscle strengthening (like tongue “push-ups”)
• Swallowing exercises

Benefits of Speech Therapy

One of the main goals of speech therapy is to enhance a person’s ability to express thoughts, ideas, and emotions effectively. This can lead to a greater sense of self-expression, meaningful interactions with others, and less frustration. Other benefits include:

• Greater self-confidence: Gaining more control over language and communication can increase confidence and boost self-esteem. As a result, you might be more willing and excited to engage in social activities. 
• Improved academic or professional performance: Clear speech and language can lead to enhanced skills in comprehension, reading, and writing. This can support academic success. Better articulation, language, and presentation abilities can help with career development.
• Greater independence: Speech therapy can lead to greater self-reliance, especially if you have severe communication challenges. For example, augmented and alternative communication (AAC) methods , such as speech-generating devices (SGDs), can allow you to express yourself more independently.

How Successful Is Speech Therapy?

Speech therapy's “success” depends on your goals. The meaning of success can vary based on your underlying communication or medical condition and its severity, as well as your motivation and commitment to therapy, the therapist's expertise, and your support systems. The time it takes to reach your goals also varies based on underlying factors like these.

For example, you may define success as improved pronunciation, or you may work towards more effective communication, more skilled accent modification, or swallowing without choking. If you stutter, your goal might be improved fluency or feeling more comfortable communicating openly with a stutter. For most people, what’s most important is to set realistic expectations and recognize that any improvement in communication is a success.

How To Find a Speech Therapist

A qualified speech therapist or speech-language pathologist holds a master's degree in speech-language pathology and state licensure to practice in your area. You can find speech therapists in settings like:

• Home health agencies
• Rehabilitation centers
• Private practice
• Telehealth (online)

You can also ask for recommendations from healthcare providers or school personnel who may know local speech therapists. The American Speech-Language-Hearing Association (ASHA) also offers an online directory of certified speech therapies to help you locate someone in your area.

Check with your health insurance provider to see if they cover speech therapy. They can provide you with information about your co-payments and deductibles. If your insurance doesn't cover the cost, the clinic or speech therapist may offer payment plans. Some children may also qualify for:

• Individualized education programs (IEPs) that cover speech therapy costs as a service from the school district
• Early intervention (EI) or Preschool on Preschool Special Education (CPSE) programs for infants and toddlers for little or no cost to families
• State and federal programs, like Medicaid
• Financial assistance programs from non-profit and advocate organizations

A Quick Review

Speech therapy is a specialized healthcare field in which trained professionals help improve speech, language, hearing, swallowing, and feeding for people of all ages. Speech therapists (STs) and speech-language pathologists (SLPs) thoroughly assess and develop specific treatment plans for a wide range of conditions including difficulty communicating or processing language, stuttering, and voice disorders.

Speech therapy takes place in locations like schools, hospitals, and private practice. It can be one-on-one or in a group setting. Success depends on underlying factors such as the severity of the condition. It also depends on personal goals and your definition of success—which can vary widely from person to person.

Many people who have speech therapy experience powerful benefits that affect them in nearly every aspect of life, including greater self-confidence and self-reliance.

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Krekeler BN, Weycker JM, Connor NP. Effects of tongue exercise frequency on tongue muscle biology and swallowing physiology in a rat Model . Dysphagia . 2020; 35 (6):918. doi:10.1007/s00455-020-10105-2

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American Speech-Language-Hearing Association. Dysarthria in adult

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American Speech-Language-Hearing Association. Help finding a professional .

Related Articles

Speech Therapy: What to Expect and How to Ask for What You Want

 6 min read

If a loved one has suffered a stroke or a brain injury, or has a neurological disease that affects communication, you may find yourself suddenly enrolled in speech therapy.

It’s something nobody wants to need, but if your loved one needs it, speech therapy quickly becomes something you can’t get enough of. Limited availability, caps on funding, and a front-loaded medical system can make families feel as though the time they spend in speech therapy is far too short.

Here are some tips for making the most of the time you have in speech therapy.

Join In or Wait Outside During Speech Therapy Sessions?

The first question that comes up when you take your partner to therapy is whether you should stay in the room for the session.

Most of the time, it’s best for you to stay. You’ll see what the therapist does and learn how to do the same thing at home. The clinician can verify that you have the right information, teach you strategies, and even train you to be a better communication partner.

It may be best to leave the room though if your loved one is distracted by your presence, always looks to you for answers, or doesn’t try to participate.

The first session or two will probably be filled with tests, and it’s important that you don’t help or speak during the assessments. If you can sit quietly, it should be okay to be there. Your therapist will let you know otherwise.

Being a caregiver can be exhausting, and an hour of speech therapy may seem like a great time for you to run errands. But you’ll both get far more out of the experience if you stick around. If you need time to yourself, look for an adult daycare, a volunteer, or a respite program that can give you the break you need.

“I personally am very glad that I was able to sit in and observe my husband’s speech therapy. It proved invaluable to me, as I would be the one to support him in his therapy at home. I learned so much from his Speech Therapist and was able to truly see where my husband was struggling. I can now recognize his frustration when he has trouble and we work through it.” – Theresa Romijn, wife of a stroke survivor

Why All the Tests?

Speech-language pathologists (SLPs) or Speech-language therapists (SLTs) often have to administer standardized tests to determine their clients’ eligibility for speech therapy. They also need to gather baseline data, to learn what the clients can do before starting speech therapy, and to know where to begin.

Unfortunately, many tests don’t allow any help or confirmation of correct answers. This can make these tests a bit nerve-wracking. Don’t worry—the tests will help the therapist understand your loved one’s needs. They won’t last long, and your partner can’t “fail” them. Once they’re over, your loved one can spend the rest of the speech therapy time focused on getting better.

Goal-Focused Speech Therapy

After the tests, the SLP will set goals to guide your loved one’s speech therapy.

Therapists set what are called  SMART goals . A SMART goal is:

• Specific —the goal is clear and unambiguous
• Measurable —the goal can be seen and measured in a concrete way
• Attainable —the goal is realistic; it may be challenging, but it’s not out of reach
• Relevant —the goal is worthwhile; it supports and is aligned with other goals, and team members buy into it
• Time-based —the goal has a specific target date. Figure 1. SMART goals are useful in many areas of life. When a goal is specific, measurable, attainable, relevant, and time-based, it creates a sense of optimism and urgency and gets you ready for success.

Unless a goal meets all five criteria (i.e., it’s specific, measurable, attainable, relevant, and time-based), it’s not likely to be helpful. You may not even know whether you’ve attained it.

When asked about their goals for speech therapy, clients and their families often say they want to “get back to normal.” While understandable, this is neither a specific nor a measurable goal for therapy. What does “normal” mean? How long will you wait before deciding whether you’re there? How will you know you’re there?

SMART goals for therapy might be something like:

• Client will use a first-letter self-cueing strategy when unable to think of a word in conversation at least 75% of the time within two weeks.
• Client will independently repeat unclear speech using a slower rate when not understood on 80% of occasions within three weeks. 

As a first step, your loved one should try to identify exactly what he or she wants to achieve in the next few weeks or months. Once you have a goal, you and your partner can develop a plan for reaching it. If you don’t know what’s realistic, ask your therapist for advice. As Antoine de Saint-Exupéry wisely said, “A goal without a plan is just a wish.”

It’s a Goal! Setting Patient-Centered Speech Therapy Goals for Aphasia Rehabilitation

 7 min read

What is Speech Therapy?

Speech therapy comes in many forms. A comprehensive therapy plan often includes four components:

Remediation

Compensation, participation.

Your loved one will probably be given exercises that  remediate , or help improve the underlying problem. These exercises are opportunities to practice—in a supportive environment—the exact things he or she has trouble with.

Your loved one will probably have to repeat these exercises many times before the brain or behavior will change. Expect  homework  between speech therapy sessions.

Some people think therapy should be dedicated solely to remediation. Depending on the nature of the problem, this isn’t always the best approach. Instead of restoring abilities, some forms of speech therapy focus on preserving other abilities, or on using intact skills to compensate for impairments.

Most speech therapy plans include  compensatory strategies , which help a person make up for lost abilities. These are meant to teach skills you and your partner can use when it becomes difficult to communicate or think clearly.

Whether we realize it or not, we all use compensatory strategies. Many of us write our appointments in calendars so we don’t forget them, mentally scan through the alphabet when we can’t think of someone’s name, or repeat what we’ve said a bit louder when someone doesn’t hear us.

In speech therapy, your loved one will learn and practice compensatory strategies specific to their needs.

Communication disorders are complex and emotional. A large part of speech therapy is therefore dedicated to education and counseling. Understanding the disorder and coming to accept its impact are important parts of the therapeutic process.

Your therapist may provide anatomical diagrams, brochures, websites, and other resources to help you and your partner understand what’s happening and why. He or she may also refer your loved one to other professionals or support groups that can help.

The end goal of therapy is to restore a person to full participation in life. Speech therapy therefore includes activities intended to help your loved one  generalize  or  transfer  (i.e., carry over) the skills learned in the therapy clinic into the outside world.

Once your partner has mastered speaking clearly in words, phrases, sentences, and conversations, for example, he or she may be asked to try speaking on the phone or speaking with strangers.

Working in partnership often results in the most effective speech therapy, so speak up! Although your SLP is highly trained, knowledgeable, and an expert in communication disorders, you and your partner are the experts in your partner.

The therapist should ask about your loved one’s goals before deciding what to work on. If you or your partner have questions about what’s going on, or disagree with something, don’t be afraid to speak up.

The therapist wants to help, and gains nothing by providing less than effective therapy. He or she is not a mind reader. Get the most from your sessions by communicating openly and working collaboratively with the therapist.

When you and your loved one set SMART goals, and talk about remediation, compensation, education, and participation, you and your therapist are all speaking the same language.

With a Tactus Therapy app, you can get more repetitions and practice in between speech therapy sessions—and this can help speed up your progress. We have a wide range of apps for speech therapy to cover many goals and abilities. Use our  App Finder  to find the right apps for you.

If you liked this article, Share It !

Megan S. Sutton , MS, CCC-SLP is a speech-language pathologist and co-founder of Tactus Therapy. She is an international speaker, writer, and educator on the use of technology in adult medical speech therapy. Megan believes that technology plays a critical role in improving aphasia outcomes and humanizing clinical services.

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What is speech therapy.

Created: August 12, 2020 ; Next update: 2023.

Speech therapy can help people who have difficulty speaking to communicate better and to break down the barriers that result from speech impediments. The goals of speech therapy include improving pronunciation, strengthening the muscles used in speech, and learning to speak correctly.

Speech therapy can be used for a lot of different speech problems and disorders, from smaller problems like a hoarse voice up to partial loss of speech due to brain damage. Depending on the type of disorder, other medical or psychological treatments may be used as well.

• What kinds of disorders can speech therapy treat?

Speech therapy can be used to treat language disorders, speech disorders and swallowing problems.

Language disorders

A childhood language disorder can affect the child’s ability to learn to speak, to name objects and build complete sentences. Although the causes of these disorders are often not clear, the main known risk factors include hearing problems, general developmental problems and disorders affecting the development of the brain.

Language disorders in adults are almost always the result of brain injury or disease. People who have had a stroke, for example, often have trouble forming sentences or remembering words. That type of disorder is called aphasia.

Speech disorders

People with speech disorders have difficulty producing the sounds of speech, saying words clearly or talking fluently.

Children often have trouble with pronunciation, and may have a lisp or swap certain sounds for others. Speech disorders may be the result of developmental disorders, but psychological factors might also play a role. Adults with neurological diseases sometimes have speech disorders too, often making it hard to understand them.

Another group of speech disorders, known as fluency disorders, involve problems with the flow or evenness of speech. People with this sort of disorder may stutter or “clutter,” for example. When people stutter, there are often silent pauses in their speech, or they repeat or lengthen certain sounds or syllables. Cluttering is abnormally fast speech that makes the pronunciation imprecise or leaves out sounds or parts of words.

Voice disorders (dysphonia)

A voice disorder is a persistent change in someone’s voice. They might sound hoarse, strained, raspy or nearly silent. Often the voice is somewhat weak – in other words, it cracks easily or the person is not able to speak loudly. Voice disorders may arise from speaking too much or too loudly, from using the wrong breathing technique, or from problems with the voice box (larynx) like vocal nodules. Psychological causes like depression or a reaction to a distressing event can change a person’s voice too.

Trouble swallowing

In people with swallowing problems, the movements of the muscles involved in swallowing are affected. This leads to problems transporting food through the mouth and throat. The cause is often a disease or disorder of the nervous system, such as Parkinson’s disease, multiple sclerosis, dementia, an infection like Lyme disease or tetanus, or a head injury. If food gets into the lungs because of a swallowing disorder, it can lead to life-threatening complications.

What treatments are used in speech therapy?

There are various speech therapy techniques for each of the areas described above – the ones that are considered depend on the particular disorder. A long series of treatment sessions is typically needed, with each lasting 30 to 60 minutes. They may take place in a group or one-on-one.

The treatment approaches used in speech therapy include:

• Perception exercises, for example to differentiate between individual sounds and syllables
• Exercises to produce certain sounds and improve the fluency of speech
• Exercises to improve breathing, swallowing and the voice
• Help with communication using things like sign language, communication boards and computer-assisted speech
• Advice for people who need speech therapy, their parents and other loved ones
• Support in implementing these measures in everyday life

For the treatment to help over the long term, it’s often important to also regularly practice the techniques at home.

• Where is speech therapy offered?

Speech therapy is offered at the following facilities:

• Speech therapy practices
• Rehabilitative care centers
• Special needs schools
• Children's day care facilities specializing in speech therapy

Besides speech therapists, there are a number of other specialists who also use similar methods. These include breathing, speech and voice coaches.

• Do statutory health insurers cover the costs of speech therapy?

Note: The procedures and requirements for applying for and receiving speech therapy may vary according to your country. This information describes the current situation in Germany.

To have outpatient treatment at a speech therapy practice, you need a prescription from a doctor. An initial prescription will generally include up to 10 treatments, each typically lasting 30 to 60 minutes. Appointments are usually offered one to three times per week.

For the medical conditions listed above, prescribed speech therapy is often covered by statutory health insurers (apart from a fixed amount that you have to pay yourself, known as a copayment). The copayment does not have to be paid when getting a treatment that has been prescribed for children. If speech therapy is given as a part of rehabilitative care, an accident insurer or pension fund will cover the costs.

The copayment that you have to pay for yourself is 10 euros per prescription plus 10% of the treatment costs. If each treatment costs 55 euros, for example, for ten treatments you would have to pay 65 euros (the basic fee of 10 euros per prescription plus 10 x 5.50 euros).

Some speech therapists may offer certain treatments without a prescription. You then have to pay for all of the costs yourself. In Germany, these are known as individual health care services ( individuelle Gesundheitsleistungen , or IGeL for short).

The German Federal Association of Speech Therapists (DBL) has a search function for speech therapists on their website (in German).

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• Deutscher Bundesverband für akademische Sprachtherapie und Logopädie (dbs). Der Verband [ dbs homepage ]. 2020.
• Deutscher Bundesverband für Logopädie (dbl). Logopädie . 2020.
• Gemeinsamer Bundesausschuss (G-BA). Richtlinie über die Verordnung von Heilmitteln in der vertragsärztlichen Versorgung (Heilmittel-Richtlinie/HeilM-RL) . July 1, 2020.
• Verband der Ersatzkassen (vdek). Rahmenvertrag zwischen LOGO Deutschland und den Ersatzkassen über die Versorgung mit Leistungen der Stimm-, Sprech- und Sprachtherapie. Anlage 1: Leistungsbeschreibung . June 1, 2017.

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How Speech Therapy Can Help Your Child

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Speech therapy focuses on receptive language, or the ability to understand words spoken to you, and expressive language , or the ability to use words to express yourself.

Speech therapy also addresses the mechanics of producing words, such as articulation, pitch, fluency, and volume.

When children need speech therapy, it often involves pursuing milestones that have been delayed.

Some children only need help with language, while others have the most problems with the mechanics of speech. Some kids need help with multiple facets of speech, language, and swallowing. 

Adults may need speech therapy after a stroke or traumatic accident, stroke, brain injury, or surgery that changes their ability to use language or their ability to swallow.

What Speech-Language Pathologists Do

The professional in charge of your child's speech therapy is called a speech-language pathologist (SLP). Older or less formal terms for these experts are speech therapists or speech teachers.

The speech-language pathologist has earned a master's degree from an accredited speech and language program, completed a clinical fellowship, and earned a certification to practice in the field.

Many states require licensure to practice in school districts. Speech assistants may be supervised by an SLP to perform some functions.

The SLP can perform testing to determine your child's needs and what approaches will work best. The SLP will work to find fun activities to strengthen your child in areas of weakness.

For mechanics, this might involve exercises to strengthen the tongue and lips, such as blowing on whistles or licking up Cheerios. For language, they might play games to stimulate word retrieval, comprehension, or conversation.

Types of Speech Therapy Services for Children

.Common types of speech therapy services children need include:

• Speech therapy for toddlers who are delayed in developing speech
• Speech therapy for apraxia, the difficulty with producing certain sounds and syllables
• Speech therapy for stuttering
• Speech therapy for aphasia, which is difficulty with language expression and understanding due to brain injury
• Therapy for difficulty with swallowing

Speech Therapy as Part of an IEP

If your child has an Individualized Education Plan (IEP), speech therapy may be provided by their school. The services should be provided by a therapist who is certified by the  American Speech-Language-Hearing Association  (ASHA).

Make sure you understand everything about your child's speech evaluation and recommended therapy before signing an IEP.

A speech therapist should be part of your child's IEP team , both for evaluating your child's speech and language abilities as well as deciding how therapy should be administered (be it in a group or individually, in class or as a pull-out, and once or twice a week or more).

You may also choose to get speech therapy outside of school. Some speech-language pathologists will come to your home for therapy sessions.

Ask questions at the start of and throughout the school year to monitor the service delivery. Be sure to check with both the therapist's office and your insurance to find out what kind of speech therapy and how much of it is covered.

U.S. Department of Education. A Guide to the Individualized Education Program .

By Terri Mauro Terri Mauro is the author of "50 Ways to Support Your Child's Special Education" and contributor to the Parenting Roundabout podcast.

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Speech-Language Therapy

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What Is Speech-Language Therapy?

Speech-language therapy is the treatment for most kids with speech and/or language disorders.

What Are Speech Disorders?

A speech disorder refers to a problem with making sounds. Speech disorders include:

• Articulation disorders: These are problems with making sounds in syllables, or saying words incorrectly to the point that listeners can't understand what's being said.
• Fluency disorders: These include problems such as stuttering , in which the flow of speech is interrupted by unusual stops, partial-word repetitions ("b-b-boy"), or prolonging sounds and syllables (sssssnake).
• Resonance or voice disorders: These are problems with the pitch, volume, or quality of the voice that distract listeners from what's being said. These types of disorders may also cause pain or discomfort for a child when speaking.

What Are Language Disorders?

A language disorder refers to a problem understanding or putting words together to communicate ideas. Language disorders can be either receptive or expressive:

• Receptive disorders are problems with understanding or processing language.
• Expressive disorders are problems with putting words together, having a limited vocabulary, or being unable to use language in a socially appropriate way.
• Cognitive-communication disorders are problems with communication skills that involve memory, attention, perception, organization, regulation, and problem solving.

What Are Feeding Disorders?

Dysphagia/oral feeding disorders are disorders in the way someone eats or drinks. They include problems with chewing and swallowing, coughing, gagging, and refusing foods.

Who Gives Speech-Language Therapy?

Speech-language pathologists (SLPs), often called speech therapists , are educated in the study of human communication, its development, and its disorders. SLPs assess speech, language, cognitive-communication, and oral/feeding/swallowing skills. This lets them identify a problem and the best way to treat it.

• at least a master's degree
• state certification/licensure in the field
• a certificate of clinical competency from the American Speech-Language-Hearing Association (ASHA)

An ASHA-certified SLP has passed a national exam and completed an ASHA-accredited supervised clinical fellowship.

Sometimes, speech assistants help give speech-language services. They usually have a 2-year associate's or 4-year bachelor's degree, and are supervised by an SLP.

What Do SLPs Do?

In speech-language therapy, an SLP works with a child one-on-one, in a small group, or in a classroom to overcome problems.

Therapists use a variety of strategies, including:

• Language intervention activities: The SLP will interact with a child by playing and talking, using pictures, books, objects, or ongoing events to stimulate language development. The therapist may model correct vocabulary and grammar, and use repetition exercises to build language skills.
• Articulation therapy: Articulation, or sound production, exercises involve having the therapist model correct sounds and syllables in words and sentences for a child, often during play activities. The level of play is age-appropriate and related to the child's specific needs. The SLP will show the child how to make certain sounds, such as the "r" sound, and may show how to move the tongue to make specific sounds.
• Oral-motor/feeding and swallowing therapy: The SLP may use a variety of oral exercises — including facial massage and various tongue, lip, and jaw exercises — to strengthen the muscles of the mouth for eating, drinking, and swallowing. The SLP may also introduce different food textures and temperatures to increase a child's oral awareness during eating and swallowing.

Why Do Some Kids Need Speech-Language Therapy?

Kids might need speech-language therapy for many reasons, including:

• hearing impairments
• cognitive (intellectual, thinking) or other developmental delays
• weak oral muscles
• chronic hoarseness
• cleft lip or cleft palate
• motor planning problems
• articulation problems
• fluency disorders
• respiratory problems (breathing disorders)
• feeding and swallowing disorders
• traumatic brain injury

Therapy should begin as soon as possible. Children who start therapy early (before they're 5 years old) tend to have better results than those who begin later.

This doesn't mean that older kids won't do well in therapy. Their progress might be slower, though, because they have learned patterns that need to be changed.

How Do I Find a Speech-Language Therapist?

To find a specialist, ask your child's doctor or teacher for a referral, check local directories online, or search on ASHA's website . State associations for speech-language pathology and audiology also keep listings of licensed and certified therapists.

Your child's SLP should be licensed in your state and have experience working with kids and your child's specific disorder.

How Can Parents Help?

Parents are key to the success of a child's progress in speech or language therapy. Kids who finish the program quickest and with the longest-lasting results are those whose parents were involved.

Ask the therapist what you can do. For instance, you can help your child do the at-home activities that the SLP suggests. This ensures the continued progress and carry-over of new skills.

Overcoming a speech or language disorder can take time and effort. So it's important that all family members be patient and understanding with the child.

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Speech Therapy at Home

Speech therapy at home can help eligible patients improve essential skills such as swallowing, processing information and communicating. Often, home health speech therapy patients are dealing with medical issues like stroke, dementia, cancer or brain injuries. Others may have speech issues related to changes in the vocal cords and muscles that often come with age.

If you’re struggling with any of these issues and are eligible for home health, there is no need to suffer in silence. Amedisys speech therapists can work with you, your caregivers and your doctor to create a treatment plan tailored to your needs. You’ll receive encouragement, support and tools to help you manage your condition, in the safety and comfort of home.

WHAT IS SPEECH THERAPY FOR ADULTS?

Speech therapy for adults involves assessing and treating swallowing issues, communication, cognition (thinking and understanding), language and speech disorders.

It is provided by speech-language pathologists (SLPs), also called speech therapists. These specialists have extensive education and training that qualify them to deliver speech therapy services. All Amedisys speech therapists are certified through the American Speech-Language Hearing Association.

With home health care speech therapy, a speech therapist comes to your home. This can be your private residence, a family member’s home, a group home or a senior living community. Our speech therapists can help you recover after an accident or surgery, or manage an acute or chronic illness. You’ll also learn healthy lifestyle tips and exercises you can do on your own to think, communicate, and eat or drink more effectively.

Is home health care right for your loved one?

AMEDISYS SPEECH THERAPY SERVICES

What do speech therapists do, and who does speech therapy help? Our in home speech therapy services depend on your needs and doctor’s orders. Some examples include:

• Assessment and treatment of cognitive, language, communication and swallowing disorders
• Care plans to address swallowing and communication problems and improve safety
• Education for patients and caregivers that may include oral motor and breathing exercises, safe swallow strategies and compensatory strategies
• Exercises to strengthen speech muscles and prevent deterioration
• Memory, reasoning, planning, attention, organization and problem-solving tasks
• Visual and auditory aids and other tools for patients with cognitive impairments
• Diet planning, feeding and hydration techniques, and positioning changes to help with swallowing problems
• Articulation, voice and resonance services to improve speech
• Language services such as writing, word-finding, reading and comprehension
• Alternative ways of communicating (verbal and nonverbal), such as special devices, computer, tablet and smartphone

TYPES OF CONDITIONS TREATED

Home based speech therapy can be used to treat a wide variety of conditions . If you’ve had a stroke, certain types of cancer, dementia, a brain injury or neurological condition, you may benefit from exercises to re-learn essential skills so you can stay independent at home. With home care speech therapy, we often treat patients with:

• Inability to talk or communicate
• Brain, throat or mouth cancer
• Parkinson’s disease
• Difficulty swallowing (dysphagia) or chewing, often as a result of stroke, progressive neurological conditions such as Parkinson’s and MS, head and neck cancer, pneumonia, dry mouth or other oral changes
• Difficulty finding the right words or using or understanding language, or halting or unclear speech (aphasia or other communication disorders, often related to stroke or brain disorder)
• Using words out of order or trouble forming words (apraxia, often due to stroke)
• Slow, slurred or difficult to understand speech (dysarthria, often related to Parkinson’s disease, multiple sclerosis (MS), amyotrophic lateral sclerosis or stroke)
• Weakened vocal cords and/or larynx muscles
• Alzheimer’s disease/dementia and related attention, memory, and problem-solving challenges
• Difficulty speaking, often caused by stroke or brain injury
• Articulation disorders, or the inability to form certain words
• Fluency disorders such as stuttering and cluttering
• Resonance disorders, often related to neurological disorders
• Receptive disorders, often related to hearing loss or head injury
• Expressive disorders, often related to head trauma, medical conditions and hearing loss
• Cognitive-communication disorders, often related to brain injury, stroke or a neurological condition
• High risk of falling , by assisting with cognition, screening for hearing loss, nutrition and hydration

If you meet eligibility requirements , speech therapy for adults may be covered by Medicare, Medicaid or other insurance and provided in the comfort of your home.

SPEECH THERAPY MAY HELP ELIGIBLE PATIENTS IN SITUATIONS LIKE THESE

Rose's Story

Rose’s voice is hoarse, raspy and hard to understand due to Parkinson’s disease. With speech therapy, she did exercises to maintain her strength and is now getting out of her room and feeling less depressed.

Don's Story

Don’s COPD makes it hard for him to coordinate his breathing and swallowing. His speech therapist helped him retrain on this skill through breathing techniques, teaching compensatory strategies and respiratory coordination.

Sherry's Story

Sherry has dementia. Through speech therapy, Sherry has practiced memory and problem-solving tasks.  Her caregiver daughter has learned how to help manage her mom’s symptoms and stimulate Sherry’s cognition so she can maintain her current level of cognition as long as possible.

HOW MUCH DOES SPEECH THERAPY COST?

Is speech therapy covered by insurance? If you’re  eligible for home health and your doctor orders it for you, the speech therapy cost is typically covered by Medicare , Medicaid and some private insurance plans.

Call an Amedisys home health agency today to learn more.

ARE YOU ELIGIBLE FOR HOME HEALTH SPEECH THERAPY?

If it’s difficult for you to leave home, you may qualify for home health. To be covered by Medicare, you must meet eligibility criteria for home health care . These include:

• You’re considered homebound. This means it’s difficult for you to leave home and you need the help of a supportive device (walker, wheelchair, etc.) or another person to do so; and
• You need part-time or intermittent skilled care. This may include speech therapy, skilled nursing, physical therapy or occupational therapy; and
• Your doctor orders home health for you.

99% of Amedisys home health care centers are rated 4+ Quality Stars.

If you don’t meet these home health criteria, speech therapy at home may be an option for you if you pay for it out of pocket or through private insurance. Speech therapy also may be available through an outpatient clinic, rehabilitation center, doctor’s office, private speech therapist practice or hospital.

SIGNS YOU MAY NEED SPEECH THERAPY

If you’ve never had speech therapy before, you may assume changes you’re experiencing are an inevitable and irreversible part of aging. But speech therapy services can greatly improve patients’ quality of life. Look for these signs that you may need speech therapy for adults:

• Have you noticed changes in your speech such as speaking in fragmented phrases, speaking slowly or saying words in the wrong order?
• Is swallowing difficult? Do you cough while eating or feel like something is stuck in your throat or chest?
• Do you find it difficult to request things you need or respond to questions?
• Do you worry about your ability to explain your feelings or needs in an emergency?
• Is it hard to understand others or speak in a way other people can understand?
• Have you stopped speaking as much as usual?
• Is your voice hoarse or raspy?
• Do you get frustrated or angry because it’s hard to understand others or express yourself?
• Do you have a hard time paying attention or solving problems?
• Are you having trouble managing finances or keeping doctor’s appointments because of difficulty communicating?
• Have you been injured (for example, as the result of a fall) or gotten into a dangerous situation?

These may be signs you would benefit from speech therapy at home. If you’re dealing with issues like these, ask your doctor if you meet the criteria for home health speech therapy.

HOW TO DO SPEECH THERAPY AT HOME

What can you expect from speech therapy home visits? What happens in speech therapy for adults, and how does speech therapy work?

With Amedisys, in-home speech therapy starts with an assessment. During the initial visit, we’ll get to know you and your environment and talk with your family/caregivers. We may ask you to do certain tasks or answer questions to help understand your needs.

Your home health SLP will develop a plan that includes the best exercises and tools to help address the tasks you’re having a hard time doing. They will also rule out other factors that may be causing or contributing to your challenges, such as medications or dehydration. You’ll work together to create goals of care and a visit schedule.

At each speech therapy home visit, your therapist may:

• Ask about your medications and any scheduled doctor’s appointments
• Ask if there have been any changes from your last visit
• Check your vital signs, such as your weight, pulse and oxygen saturation
• Educate you and your caregiver so you can be empowered to manage your condition and care at home
• Give you exercises to work on between visits so you can achieve your goals faster

After visits, your speech pathologist will report your progress back to the rest of the home health team and your physician to make sure everyone is up to date on how you’re doing.

HOW LONG DOES SPEECH THERAPY TAKE?  

How long speech therapy takes depends on your needs and doctor’s orders. In creating a care plan, your doctor will consider the type of speech issue, frequency of therapy and underlying medical conditions. The speech pathologist will adjust the length of the session and the tasks you focus on so that you feel challenged to develop new skills without feeling frustrated or fatigued.

HOME HEALTH SPEECH THERAPY GOALS

Speech therapy aims to help people maximize their abilities to speak, listen, read, write and swallow. Some of our home health speech therapy goals are to:

• Restore communication, when possible, or find compensatory techniques to maintain your current functionality and prevent further deterioration
• Improve eating and swallowing
• Maintain healthy nutrition and weight, and stay hydrated
• Reduce the risk of choking and aspiration
• Strengthen vocal cords to improve communication
• Increase independence
• Improve quality of life
• Teach family members/caregivers about your condition and appropriate exercises and treatment

After home based speech therapy, patients and caregivers feel more confident doing their exercises and better able to manage safely at home.

HOW DOES SPEECH THERAPY WORK

Speech therapy can be effective for a variety of health conditions. Most patients can hold onto the gains they make during speech therapy home visits by doing exercises as assigned by their speech therapist. Several factors can determine how helpful speech therapy is, including:

• The type of disorder being treated
• The severity of the impairment
• The patient’s age
• How early/late you start speech therapy after onset/injury
• Number and frequency of visits
• Whether the patient practices assigned exercises on their own

Results are typically best when speech therapy home visits begin soon after the injury or onset of your condition. However, you can make progress even if your injury or condition has existed for some time. In these situations, the home health speech therapy goals are typically to maintain your current level of function, prevent deterioration and learn how to manage your condition.

HOW IN-HOME SPEECH THERAPY HELPS

Many people feel home is the best place to receive speech therapy. In addition to being more comfortable, being at home can enhance the benefits of speech therapy for the elderly, so patients can get the most of each session. Here are some of the benefits of speech therapy at home with Amedisys:

• Home health SLPs learn about the patient’s home environment and can tailor therapy to the patient’s specific needs.
• The patient can use their own items in therapy, such as photos for memory tasks and silverware for swallowing tasks. This makes the therapist’s instructions relevant to the patient’s daily life and maximizes the effectiveness of each session.
• By avoiding driving time and expending energy getting to and from appointments, patients can focus their time and energy on therapy.
• Family members and/or caregivers can observe sessions and learn the exercises and techniques. This way, they can help their loved one practice in between sessions and continue to make progress.
• Home health therapy can improve quality of life by enhancing attention, memory, reasoning and problem-solving.
• Patients develop coping strategies, confidence in communicating with others, and better safety awareness and ability to stay independent at home.
• For some, home health therapy makes it possible to stop a feeding tube or start going out to dinner or family gatherings as swallowing improves.

Paula's Speech Therapy Plan

Paula is a 78-year-old who lives with her daughter. She has mid-stage dementia and has started forgetting close family members and recent events. With her worsening disorientation and depression, her daughter worries her mom will soon need more care than she can provide at home.

After talking with Paula’s doctor, Paula gets a referral for home health speech therapy. A speech therapist sets up an initial visit and works with Paula, her daughter and her doctor to develop a plan of care. Based on this plan, Paula will receive:

• An assessment of how she eats, drinks and swallows
• An assessment of her home environment and recommendations to help her adapt to her cognitive challenges
• Exploration of memory aids such as a memory book
• Education for Paula’s daughter about the most effective ways to maintain communication with Paula

The goals of care are to stimulate Paula’s cognitive ability and maintain as much function as possible.

How Speech Therapy Helped Jim After a Stroke

Jim had a stroke last week and has symptoms of aphasia, such as having trouble finding the right words. His speech is garbled and difficult to understand. Jim’s doctor referred him to home health and a speech therapist reached out to set up an initial visit. After a comprehensive assessment, Jim’s speech therapy care plan focuses on:

• Exercises to help him breathe while speaking so he can plan breathing pauses and more easily be understood by others
• Tongue strengthening exercises to make it easier to make the proper sounds to form words
• Practice on specific sounds (such as “ah” and “ay”) to improve his ability to form words as well as forming sentences

The goals of care are to get Jim back as close as possible to his previous level of functioning.

WHY SPEECH THERAPY FOR SENIORS?

Speech therapy can be helpful at any age, but it can be vital for older adults. Here are a few benefits of speech therapy for the elderly:

You may find yourself in an emergency situation if you can’t answer a question or ask for something you need.

The ability to communicate effectively makes it possible to talk with loved ones, make and share memories, and express yourself. Problems in this area can lead to social isolation and loneliness, which can cause both physical and mental health problems.

Speech therapy exercises can make it easier to complete daily tasks like eating and communicating.

Speech therapy for seniors focuses on issues that can interfere with your ability to stay independent.

In addition to addressing speaking abilities, speech therapy can help seniors with dementia preserve attention and problem-solving. Speech therapists can also work with family members and caregivers to improve communication with their loved one.

Speech therapy can help improve abilities that are fundamental to daily life. Being able to maintain healthy nutrition, socialize with loved ones and communicate needs to healthcare providers makes life easier and more fulfilling.

MISCONCEPTIONS ABOUT SPEECH THERAPY AT HOME

1. speech therapists just help people talk.

People sometimes wonder, “Why do I need speech therapy? I can talk just fine.” Helping people communicate is an important part of speech therapy. However, the best speech therapists can help with much more. We also work to restore patients’ ability to swallow, increase problem-solving ability, and improve memory, thinking, reading and writing skills.

2. Speech Therapy is Mainly for Children with Speech Issues

Many people think speech therapy is for children with a lisp, stutter or other speech issue, but speech therapists care for seniors and adults as well.

3. Speech Therapists are All the Same

Some speech therapists specialize in seniors, while others work with children. They may also have experience in particular settings; for example, home health, hospitals, outpatient clinics or nursing homes.

4. The Issues I’m Having are Just Part of Growing Old

Speech therapy for seniors can help with several issues that often come with age, such as loss of elasticity in the vocal cords and strength in the larynx muscles. Speech therapy can also help after a stroke, head injury or a condition like dementia or cancer, which are not an inevitable parts of growing older. Patients can see significant improvements in their ability to function every day.

WHERE CAN I FIND A SPEECH THERAPIST?

Since home health speech therapy requires a doctor’s order, many patients find speech therapy services through their healthcare provider. Ask your doctor if in home speech therapy could help you. Your doctor may refer you to a home health provider. You have the right to choose the company that best suits your needs . You can call an Amedisys home health agency near you to learn more about options and next steps.

Here are a few considerations when choosing the best speech therapist for your needs:

• What population does the therapist serve most often (e.g., seniors vs. children)?
• What is their area of specialization?
• Does the speech therapist have experience or specialized training in the issues you’re facing?
• Can they come to your home?
• Do you feel comfortable around them or feel confident you’ll be able to build a good rapport over time?
• Does the provider accept your insurance?
• Have you asked your doctor if you qualify for home health care?

Ask your doctor how to do speech therapy at home. Getting care as quickly as possible, especially after a stroke or other health event, can give you the best results.

Call the Amedisys home health agency near you to learn more. We’ll work closely with your doctor to provide speech therapy, as well as any other services as ordered by your doctor, to help you stay independent at home.

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Professional training of future speech therapists for work in the inclusive educational environment of a city

Natalia Kiseleva 1 * , Narine Serebryakova 1 , Gulnara Shashkina 1 and Maryia Skivitskaya 2

1 Moscow City University, Department of Speech Therapy, Moscow, Russia 2 Belarusian State Pedagogical University named after Maxim Tank, Institute of Inclusive Education, Minsk, Belarus

* Corresponding author: [email protected]

This article discusses the issues of training of future speech therapists for work in inclusive educational environment. One of the prioritized tasks of modern education is training of personnel for working with students with specific learning difficulties. In recent years due to modernization of the Russian education system the training of experts for work in inclusive educational environment becomes more and more important. However, the issue of analysis of professional competences of future speech therapists is insufficiently studied. This article is aimed at analysis of educational programs of training students in Moscow universities for work with children with specific learning difficulties on the basis of their knowledge and attitude to inclusive education. Aiming at analysis of competences of future speech therapists, the students were surveyed by various blocks: from knowledge of regulatory documents to personal attitude of students to foundations of inclusive education. The obtained results have confirmed the assumption that in general the students have positive attitude to inclusive education, the disputable issue concerns readiness of society for conditions of inclusive education and understanding of special demands of children with limited health capacities by teachers of educational entities. This article defines various approaches and trends of formation of tolerant attitude to students with specific learning difficulties, as well as the required professional competences corresponding to the requirements of Federal State Education Standard of higher education. Due to increased number of children with severe speech pathologies and expanded competences of speech therapists of educational entities, it would be reasonable to increase the number of disciplines expanding skills and habits of future speech therapists under conditions of inclusive education.

Key words: competences of special teacher / integration / quality of education in a city

© The Authors, published by EDP Sciences, 2021

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Physical Therapy

Physical therapy is a treatment or care to ease pain before or after surgery and helps you the recover faster and in better way. People going home after medical setback or Surgery to have at-home therapy has faster recover rate as per the research. Our therapists help to recover from injury/ surgery, pain management, movement maximization. Physical therapy can delay or even prevent from surgery and is often suggested/ prescribed by doctors.

Occupational Therapy

Followed by medical setback or Surgery, Occupational therapist help patient develop skill which will help patient in daily activities. Therapist help individual to relearn and regain skills which are needful to do daily activities. Through rehabilitation program we help patient with faster and successful recovery. Research says that after surgery like hip or knee replacement, patient is safe enough to go home and can continue recovery at home.

Speech Therapy

Speech Therapy help patient to diagnose and treat speech related disorders which includes language, stroke disorder cognitive disorder and many more. Speech therapist are needed when patient experience inability to speak/talk, swallowing, disorientations, memory loss. Speech therapy help individual to overcome all speech related problems and improve quality of life.

Psychiatric Therapy

We have Skilled and licensed therapist who diagnoses treat and manages Psychiatric disorders. Our psychiatric prescribe and manage medications of individuals like antidepressants, stimulants, sedatives, hypnotics, mood stabilizers and many more. Our psychiatric counsel of our patients and suggest them the best. Our team of psychiatric deal with conditions like Depression, Bipolar disorder,Personality disorders, Anxiety disorders, Sleep disorders, Substance use disorder, Gender dysphoria Eating disorders and many more.

Mobility Training

Mobility-training consist of plan designed by physician which is followed by our trained to achieve improvement in patients’ movement and motions. Training consists of exercise which help to achieve flexibility, range of motion, balance and strength. It is necessary to keep certain level on pressure on the joints so maintain that our trainers develop a personalized plan for each patient. Mobility training helps to prevent injury.

Online Therapy Session

Step 1: Our Physio will diagnose the cause of pain by a set of questions over video and create a treatment plan.

Step 2: According to your treatment plan your sessions will be conducted and our expert experts will guide you daily with proper form online while you perform exercise

Step 3: you progress will be reviewed by our Chief every 5 th week and changes will be made in your plan according to need.

Step 4: 24×7 Care & Your Physio Mobile App

Medication Management

We partner with patients doctor in order to make sure that medication given to patients provides best results. In order to achieve safe and speedy recovery it is necessary to take medication directed by doctor. Proper medication at right time and dosage is must. Medication-Management service includes reviewing medication, reviewing effects on patient, educating patient and family member regarding the medication.

Home Safety Assessment

It is an assessment which is done for the environment where patient is kept to eliminate all hazards, assessment is done by licensed healthcare professional. They provide a plan of action to be followed for patient and home environment. To Achieve good results, it is necessary to have complete home safety for patients. Our clinicians keep a check that home environment set is properly maintained in order to obtain safe and fast recovery for patient.

Skilled Nursing

Skilled Nursing is a service provided by licensed health professional (LVN’s, RN’s) to patient post-acute care. Healthcare professionals specialized in Skilled nursing perform wound care, injections, IV therapy and monitor vital sign. We have experienced RN’s and LVN’s, licensed and trained to perform jobs like patient- assessment, observation, training, treatment for successful recovery at home. Skilled Nursing ensures that an individual is met with all complex medical needs in time by professionals.

• Recognized as leading in-home rehab agency
• All Our staff are Licensed and Skilled.
• Provided dedicated case manager.
• Upmost care is taken of patient to provide best recovery.
• Covered by multiple insurance providers.
• Provide to point treatment to individual.
• Value for money for patient care.
• Try to connect with emotionally with patient and their families.
• We are here to serve our community with in market with financial discipline.

At Home Services

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Trusted by 20k+ Patients

Testimonials.

“I came to Lara with right knee pain. After therapy my pain has vanished. I am also delighted with the speed of recovery. Lara is very friendly and is always on point with best solutions. I Would strongly recommend at home service. It is value for money.”

“We have been looking for a good at home Speech therapist for my daughter Samantha. My daughter loves loves her therapist so much the morning when therapist is to come she jumps up and down from happiness. We have seen progress within 1 month with her speech. We feel lucky to trust them for your child. God bless.”

“I was clutched by the most common problem after covid, depression and anxiety. Many time I felt like I can’t do anything and went totally numb. I tried multiple medications and counselors but at last settled with___. There at home service help we to come out of my closet and open my mind. I recovered of this and will always be thankful to__”

speech and language therapy

We get worksheets to do at home, but we also supplement these with games from Orchard Toys that are super helpful - shopping list game, flash cards, farm heads and tails etc.

To bring on vocabulary, we narrate pictures and tell the story of what’s happening in the picture. Word-free picture books are great for this, and we sit together to narrate everything that’s happening and describe the picture. “Here is a girl, and she has a ball in her hand - the ball is red, and her hair is brown.” We demonstrate the words first and encourage him to engage and help describe too. As he got older and grew more confident in verbalising anything, he was able to describe the picture, even if some of the words were gobbledygook. We work on refining the gobbledygook over time.

As prep for ourselves as parents, we got “It Takes Two to Talk”, it’s a great guide for helping bring on our children’s speech and communication. You can get it from your local library as the book itself new is about €60!!

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23 Things to Do in Moscow, Russia

Please note: this article was originally written in 2015. I’m updating this in 2022 to state that — for obvious reasons — you should not be travelling to Russia at this time. If you are in Russia, you should leave immediately.

As the capital of the largest country on earth, Moscow is also larger than life. In a city adorned with palaces straight out of a fairytale, you won’t be shocked that even the metro system is full of opulent art.

At the center of Moscow is the iconic Red Square, home to the Kremlin and the spiritual heart of the city. But as you wander, the storied streets guide you to marvelous sites from ancient cathedrals to royal estates, the summer havens of the Tsars.

Wherever you look, you can see the footprints of old Russia, the Bolshevik Revolution and Stalin. Connecting all three is a rich culture, exceptional theater and a vibrant nightlife.  

Explore the Red Square

There’s so many layers to the story of Moscow that it can feel overwhelming. There’s really only one place to start this adventure, and that’s at the Red Square. Streaming out of the square is each of Moscow’s major streets, like ventricles feeding the rest of the body. It’s easy to see why this is both the historical and cultural centrepiece of the city.

The Red Square is home to several of the top landmarks in Moscow, from Lenin’s Mausoleum and the State Historical Museum to the iconic Kremlin. In times of victory and defeat, this has been the point of congregation for the community even when it lacked its modern day splendor back in the 15 th century. 

On regular days, there remains a fantastic atmosphere in Red Square as locals come and go and tourists explore with wide eyes. Although you’ll find ample stunning sites, you may be surprised to know that there’s only a single statue in the historic square. This statue shows Prince Dmitry Pozharsky and Kuzma Minin, who defeated the Polish invasion in 1612.

See St. Basil’s Cathedral

One of the most eye-catching sights in Red Square is St. Basil’s Cathedral. Its colorful onion domes stand atop a church of incredible variations. The cathedral was built in the 1500s under the request of Ivan the Terrible. The architects were Barma and Postnik who essentially combined nine different styles of churches, chapels and domes into one spectacular work of art.

As the legend goes, the architects were later made blind by Ivan the Terrible. This was so they couldn’t recreate the sheer magnificence of St. Basil’s. Under the early morning sunlight (or at dusk) the orange colors shine brightly, as if the cathedral was a grand bonfire accented by streaks of green, yellow and blue. 

It’s hard to imagine from the outside that St. Basil’s interior is exceptionally small. There are nine individual chapels that are intimately decorated with frescoes and icons, both of which lead your eyes up to the soaring domes above.

Go on a River Cruise

After visiting the Red Square, turn your attention to the Moscow River. A great way to take in the city’s sites is from the water, which offers a unique and quiet perspective away from the crowds. Public transport on the river will return in 2022, with the schedule increasing year by year. 

The Moscow River and its surrounding canals feature almost 50 bridges and showcase the city in a way that few can duplicate. A popular station for river transport can be found alongside Gorky Park. From the dock, you’ll head north through the heart of the city with the Red Square and all its highlights floating by on the left bank. Before the river swings and heads south towards the Danilovsky District.

While exploring the city on the Moscow River is a great way to see the sights and get around, it’s easy to turn it into a romantic experience. Moscow is even more spectacular under the evening light, something you can discover on a luxury river cruise.

Visit the Bolshoi Theatre

Within the illustrious city center, you’ll find grand architecture and history, with one of the best examples being the Neoclassical Bolshoi Theatre. The breathtaking six-tier hall is one of the oldest ballet and opera houses in all of Europe. 

Each renovation has remained faithful to the original design, allowing the grandeur of the Bolshoi Theatre to remain as it has since 1824. Catching a show here is one of the best things to do in Moscow, even if ballet or opera has never been your speed. The rigorous passion on display transcends fandom and will have you on the edge of your seat.

Some of the classic shows at the Bolshoi Theatre include Francesca da Rimini by Rachmaninoff and Tchaikovsky’s Mazeppa. Both iconic shows premiered right here. After entering the theater, take time to appreciate the opulence on display, from the multi-tiered chandelier to the gilded accents and red velvet walls. It’s grandiosity will have you ready for a night of high culture.

Spend Time at Tretyakov Gallery

The Tretyakov Gallery may have begun as a private collection among the Tretyakov brothers, but it has grown to be the most significant museum of Russian fine art on earth. The gallery is now home to well over 130,000 exhibits, including several iconic paintings known the world over.

Near to Red Square, the Tretyakov Gallery comprises an old and new building. The former is home to works dating back to the 11 th century, with the new building featuring contemporary and modern art. Some of the most renowned pieces include The Trinity, by Andrei Rublev and the Vladimir Mother of God, which is almost 1000 years old. While you could spend a number of hours admiring the worlds of Ilya Repin, a celebrated Russian realist painter.

Surrounding the Tretyakov Gallery are several sculptures to complement the experience. None more striking than the 280-foot (86m) statue of Peter the Great.

Roam the Moscow Kremlin

The Kremlin is an enormous complex whose sheer scale can only be appreciated from within its ancient walls. It’s the most recognizable landmark in Moscow, as it has been since opening in the 15 th century. Since that day, the Kremlin has gone onto be the home for a series of Tsars before becoming the official residence for the president of the Russian Federation.

Major government leaders may live elsewhere, but if anything, that lowers the red tape and opens up more of the grand palace. The Kremlin covers over 105,000 square miles (275,000 sq. km) and is surrounded by fortress walls. As you wander, it’s easy to place yourself in eras past as you gaze upon several opulent cathedrals, spellbinding palaces, and the ancient Armoury. 

The Armoury produced and stored weapons for centuries until in was converted into a museum in the early 19 th century. You can now explore the history of Russian, Western European and Asian weaponry along with resplendent works by jewelers and goldsmiths, including the museum’s Faberge egg.

Pay a Visit to Lenin’s Mausoleum

Vladimir Lenin was the founder and leader of Soviet Russia and eventually the Soviet Union. He remained in power until the day he died. Shortly after his passing, the mausoleum was created in Red Square. It was only supposed to be for a short period, but such was the popularity of the leader that Lenin has remained on display ever since.

He was removed from his original tomb into a permanent sarcophagus that now holds a central spot in the Red Square. The marble stairs that flank the mausoleum have also taken on a life of their own, as the spot for leaders to watch the many events that take place in the famed square. 

Almost a century removed from his passing, Lenin’s Mausoleum is still a popular attraction with regular lines to enter. But it’s well worth the wait for an eerie experience as you cross paths with the revolutionary leader, who lays peacefully within a bullet proof chamber.   

Visit the Cathedral of Christ the Savior

A few blocks from the colorful St. Basil’s is a no less opulent, but even more significant cathedral. The first Cathedral of Christ the Savior was demolished under the order of Stalin in the 1930s. He had plans to build the tallest skyscraper on earth, a dream that was later scrapped as the grounds became home to the massive Moscow Pool. This makes the new iteration, built in 2000, the youngest of the city’s many incredible churches.

The Cathedral of Christ the Savior has the classic onion domes atop what is the largest Orthodox church on earth. From the front, paved paths lined with lamp posts guide you towards the cathedral. From there you can appreciate the magnificence of its huge facade, featuring golden accents, archways and spires. As you wander inside, you’ll be taken aback by the mosaic floors, grand altar and intricate paintings. 

From the back of the church, admire the impressive Bolshoy Kammeny Bridge along with views of Red Square and Gorky Park.

Spend a Day at Gorky Park

Speaking of, head across the beautiful bridge and make your way to the city’s top park. Gorky Park is an expansive green area that runs along the banks of the Moscow River. It’s the biggest in the city, with something to offer for solo travelers, couples and families alike.

In the summer months, locals flock to Gorky Park in the evenings and on the weekends, where you’ll find all sorts of entertainment. In the morning hours, stumble upon yoga classes and dance lessons before joggers and cyclists arrive in equal numbers. If you have time, get about on foot to appreciate the manicured gardens along the walking path that guides you to Sparrow Hill. From the top, you can bask in exquisite views of the Moscow skyline.

Gorky Park is also home to the Muzeon Art Park, where you’ll find an unusual collection of over 700 sculptures. At night, Gorky Park plays host to an outdoor movie theater while live music is also a common treat.

Patriarshiye Prudy

A traditional home for artists and poets, Patriarshiye Prudy is a bohemian neighborhood with an eclectic mix of shops, restaurants and bars. Tucked away from the downtown, Patriarch Ponds is quieter than much of Moscow, yet remains an exciting pace to be. The charming ponds have been referenced in endless poems and depicted in notable pieces of art. You could spend a quaint morning watching the sun rise over the glistening water, which slowly begins the reflect the many beautiful buildings that surround the park. While in winter, the pond freezes, turning into a popular and scenic ice rink.

Along the surrounding streets you’ll discover one of Moscow’s foodie hotspots, with plenty of cozy cafes serving tasty treats and popular Uruguayan steak houses. As primarily a residential neighborhood, you’ll find the tables have turned. Away from the Red Square, visitors will enjoy a look into everyday life, while enjoying some of the best hospitality in town.

Take the Moscow Metro

It’s not in every city that you’ll want to explore the metro. But as we know by now, very few cities are like Moscow. The local subway system was developed under Stain in the 1930s, making them one of the oldest in the world. In typical Stalin fashion, each station is unique, with its own layer of grandeur.

Akin to underground palaces, each station is an attraction making getting around Moscow on the metro an aesthetically pleasing experience. Some of the top stations include Arbatskaya, which features striking bronze chandeliers and granite slabs. While Park Kutlury, next to Gorky park is laden with marble. The stops immediately surrounding Red Square are also easy on the eyes.

On a metro tour, you’ll visit the best 9 metro stations in the city and discover how and why they’re as beautiful as any famous landmark in Moscow.

Walk Down Old Arbat Street

After walking out of Arbatskaya metro station, you’ll find yourself in one of the most hip parts of Moscow. Arbat Street began as a prominent trading route on the outer edges of Moscow. But from those days in the 1400s to now, the city has expanded greatly to the point Arbat Street feels like the center of town.

The historic street is lined with lamp posts backed by upscale buildings harboring chic bars and hip cafes. One of the latter being a popular spot for Leo Tolstoy and Anton Chekhov to hang back in the day. But Old Arbat Street isn’t just famous for those two luminaries, it has long been a haven for artists and poets, including Alexander Pushkin and Bulat Okudzhava, whose statue is found along the pedestrianized street.

Once you’ve completed the mile-long walk, cross over the New Arbat Street where tourism and modern culture collide. Wander through antique shops or watch the street artists play live music or draw humorous caricatures.

Enjoy the Views from the Ostankino TV Tower

For the best views in the city, it’s hard to pass up an experience at the Ostankino TV Tower. The building was completed in 1967 and including the antenna spire it stands at over 1,770 feet (540m) tall. This makes the TV Tower the tallest in Russia and one of the tallest structures in the world.

Visitors can make their way to the observation deck 1,115 feet (340m) above the ground for expansive views of the entirety of Moscow. But to really get your heart racing, sign up for the glass floor experience that will have you feel like you’re flying over a thousand feet above the ground. Turn your trip into date night by reserving a table at the tower’s revolving restaurant. As you eat, the tower rotates 360 degrees, completing a full circle three times every hour.

Make your experience at the Ostankino TV Tower a breeze by getting Moscow’s hop-on hop-off bus pass that not only stops here, but all the top attractions around the city.

Explore the Tsaritsyno Palace

30 minutes on the train from the center of Moscow, Tsaritsyno Palace was once the home of Catherine the Great. The building first opened in 1775 and its lavish palace is surrounded by expansive grounds covering more than 400 acres.

The palace itself is predictably eye-catching. Its warm velvet bricks make way for towering arches and spires. To the left and right are musical fountains and its interior decor has undergone a complete refurbishment to bring it back to its heyday. As you wander through the palace, you’ll discover embellished staircases that lead to grand halls where royal meetings and parties took place.

Tsaritsyno Palace is now a museum, and alongside the storied halls you’ll find several fascinating exhibits. These explore the life and times of Catherine the Great, along with the history of the building. Other highlights include the palace’s own opera house. Afterwards, take a tour of the lush grounds and historic ruins.

Wander Through the VDNKh

What began as an exhibition has grown exponentially to become one of the top parks in Moscow. VDNKh opened in the 1930s as the host of an agricultural event. But in the decades since it continues to be improved upon. It’s now home to over 400 structures, from fountains to museums.

The expansive complex blurs the line between a park and open-air exhibit, with beautiful gardens punctuated by intricate architecture. As you wander around, you’ll find pavilions that represent former Soviet nations along with ample space to sit and admire the amazing Friendship of Nations Fountain. 

Two major attractions in VDNKh are the Memorial Museum of Cosmonautics, which celebrates the Russian space experience along with the city’s aquarium. But perhaps the park’s best feature is its lively atmosphere. As a common meeting point for Moscovians, you’ll find restaurants in abundance, the largest skate park in Europe, horseback riding and even the chance to zipline across the complex.

Experience the Memorial Museum of Cosmonautics

As you explore the VDNKh, save plenty of time to visit the Memorial Museum of Cosmonautics. While we all remember the moon landing in 1969, it’s easy to forget that Russia actually sent the first man into space. While the “Space Race” was an enormous factor in the Cold War between Russia and the U.S.

The museum is unmissable, thanks to its towering titanium pillar, affixed with its own rocket. It celebrates the story of Russian space exploration, from sending Yuri Gagarin into space to developing the sputnik. Visitors will be able to gaze upon the first suits worn in outer space and full sized rockets. 

On this private tour, you can learn more about the Cold War and the Space Race that fueled human ambition and lead to incredible feats. Your personal guide will meet at your hotel, where you’ll learn even more about the historic metro on your way to VDNKh. From there, receive valuable insight into the complex before taking a deep dive into Russia’s space exploration.

Shop ‘Til You Drop at GUM

After several days of jumping between cathedrals, parks and palaces, you may be seeking a little retail therapy. If you’re ready to take a break from architectural marvels and embark on some browsing, then make a beeline for GUM. The mall stands for main universal store and is your one stop shop for fashion in Moscow.

You’ll have your choice of over 200 shops, from local boutiques to high-end international brands, meaning you can literally shop ‘til you drop. When you do, you’ll find a great selection of upscale restaurants within the mall, so you don’t have to settle for a regular food court. To save time, head to the Soviet-style canteen for authentic local food.

Bored partners can say goodbye to their loved one and explore the historic mall, which opened in 1893. In keep with the times, it’s starkly different to your typical stale mall with its grand facades and overhanging glass roof that features 20,000 panels.

See the Novodevichy Convent

On the banks of the Moscow River, the Novodevichy Convent is a captivating monastery from the 16 th century. Once a prominent fortress, the convent features five domed cathedrals and a marvelous bell tower. Surrounded by historic walls and a series of guard towers, are lush grounds where former leaders once roamed. 

Thanks to its preservation (its last major renovation was in the 1600s), it’s easy to step back to those hallowed eras when the Novodevichy Convent was a hub of activity. Now a UNESCO World Heritage Site, visitors can explore the impressive Smolensky Cathedral, whose interior decor rivals any in Moscow.

In the 1600s, more chapels were added and feature distinct Muscovite Baroque architecture. But joining them all together is the 236-foot (72m) bell tower that was the tallest structure is Moscow upon completion. 

Enjoy a Culinary Walking Tour

Russia may be known more for its vodka than food, but no time in Moscow would be complete without exploring the local cuisine. Russian cuisine differs from much of Europe, owing to the diversity of a country that balances the pull of the West and East at the same time.

Modern Russian cuisine is very much an example of what was available to everyday people throughout the eras. As you explore the city, you’ll discover a range of dough-based dishes such as pies, rolls and blini, not to mention plenty of dumplings. Owing to its Orthodox heritage, there is also a great range of vegetarian dishes.

Meat dishes in Russia are a particular treat and this is because it was often prepared during the holidays. These celebratory recipes have been passed down through the generations and now form a part of everyday cuisine.

You can learn all about Russian cuisine as you sample local flavors on a food tasting tour.

Explore an Old Royal Estate at Kolomenskoye

From the 1300s to the Bolshevik Revolution, the Tsars and prominent members of Russian society spent their summers at the Kolomenskoye Estate. Covering 300 hectares, several adorned palaces and a 16 th century cathedral, the estate is now an expansive open-air museum.

Just out of downtown Moscow, uncover an abundance of history as you roam the famed grounds with views of the Moscow River. Within Kolomenskoye Estate, there are four significant sites that make up the museum. These include the captivating Palace of Tsar Alexei Mikhailovich. Such was the esteem held by the palace that it was seen as the Eighth Wonder of the World.

From the fairytale-like palace, explore the beautiful Church of the Ascension before making your way to Golosov Ovrag, known to be a portal into another dimension. Around the grounds, there are several spacious lawns to later sit back and take in the incredible sights.

Visit the Pushkin Museum of Fine Arts

A Romantic era playwright, poet and author, Alexander Pushkin, is one of the foremost historical figures in Russia. A man who is also known as the father of the modern Russian language. Despite these storied achievements, he has zero connection to the Museum of Fine Arts that carries his name.

However, all art lovers should make their way to the Pushkin Museum of Fine Arts, which hosts an expansive collection of European art. The museum is broken up into eras, including French Impressionism, the Dutch Golden Age and the Renaissance. Highlights include works by iconic luminaries such as Rembrandt, Botticelli and van Gogh. Along with Cezanne’s “Mardi Gras” and the “Young Acrobat on a Ball”, by the one and only Picasso.

After paying a visit to the Pushkin Museum of Fine Arts, wander across the street and find the Cathedral of Christ the Savior.

Join Locals at the Izmailovsky Market

When you think of the Moscow Kremlin, your mind immediately shifts to the landmark within Red Square. However, kremlin simply means fortress. In fact, you’ll visit many kremlins as you explore the city. One that stands out more than most is Izmailovo. 

Its fairytale setting looks like something straight out of a Disney film. Here, old Russian architecture collides with modern culture. The colorful buildings may very well be as captivating as any in Moscow. Beneath the resplendent spires and kaleidoscopic roofs is the best market in town.

Many travelers flock to New Arbat Street to pick up souvenirs, including the famed Russian dolls. But the Izmailovsky Market is less of a tourist trap while remaining kinder to your wallet. Within the kremlin is an enormous bazaar teeming with merchants selling high quality Russian dolls. If you’ve wandered down Arbat, you’ll quickly notice the difference. Among the dolls, you’ll discover a wide range of goods, such as traditional costumes, handcrafted chess sets, and plenty of memorabilia. Finish by wandering down the aisle of delectable street food.

Experience the Nightlife

Moscow’s nightlife goes into the early hours of the morning. For those seeking a night out on the town, you’ll have an endless list of bars and clubs to choose from. Patriashiye Prudy is one of the top nightlife hubs in Moscow. Here, you’ll find a row of casual bars and cocktail joints along with some smaller nightclubs, including the popular Clava.

Red October is a huge string of red-brick factories that are now home to some of the best and exclusive nightclubs in the city. One not to be missed is Gypsy, a rooftop club with beautiful nighttime views of Moscow skyline.

Keep in mind that most clubs have strict dress codes. Be sure to tick all the boxes before lining up in the cue. 

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Lauren Juliff

Lauren Juliff is a published author and travel expert who founded Never Ending Footsteps in 2011. She has spent over 12 years travelling the world, sharing in-depth advice from more than 100 countries across six continents. Lauren's travel advice has been featured in publications like the BBC, Wall Street Journal, USA Today, and Cosmopolitan, and her work is read by 200,000 readers each month. Her travel memoir can be found in bookstores across the planet.

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30 comments.

I loved Moscow – but then I’ve been obsessed with Russia for years and had a much calmer start to my time there than you! I have to admit that it’s not nearly as nice as the rest of Russia (is it just me or does everything seem a lot greyer in Moscow?), but it was definitely interesting. Apparently they’re considering taking Lenin out soon as his family want him buried, so hopefully you’ll get to go back and see him some day – and have a much better trip!

I’d been to St Petersburg before and I enjoyed it SO much more than Moscow. Awww no, I have to see dead Lenin!

Maybe some Russian vodka would’ve helped?

I find that getting lost is always a bit more entertaining when there is vodka involved…

Hahahaha, I’ll bear that in mind for the next time I get lost :-)

YES ITS JUST YOU!!!Of course moscow isnt for everybody (naive american backpackers)

*naive English backpacker.

hee hee…nice! :)

oh no! Sounds aweful! I am really looking foeward to seeing Russia

I’m sure you’ll have a great time! I LOVED St Petersberg, but just found that Moscow was not for me.

Come on now Lauren! You shouldn’t be judging a destination so quickly! You need to give it a few days to explore, soak up the culture, meet the people. Although, I feel this way about Barcelona. 4 days, and I just don’t see how its everyone’s favourite city in Spain. I think I have to go back and try again to see what’s so magical.

I know… I can’t help it! I decide if I like a place pretty much within a few hours. Maybe one day I’ll go back and give it another chance.

And I LOVE Barcelona!

It’s totally fair to judge a city by your first impression of it! I do it allll the time (both abroad and in my own country).

I do it all the time, too, but know I probably shouldn’t!

I love those Russian hats. What an interesting place to visit.

I love the hats too — I bought one the last time I was in Russia!

Sorry you had a bad time–some days are just like that wherever you are. And the hat’s a keeper anyway.

Feel free to contact me next time you’re going to visit Moscow if you’re looking for an unforgettable journey. )

I loooove Moscow!

I think there are a few reasons why you didn’t enjoy your time there. Well, first, 24 hours is not a whole lot of time to explore Moscow. There’s SO MUCH to see and impossible to see the majority of it in a day. Also, I’m sure you just wanted to relax for a bit and if you’re new to Russia and do not speak Russian… then that’s probably not going to happen.

In my experience, I found very little English speaking Russians and over all, they wern’t very helpful and often glared at me, lol. And yeah, taxis (both official and unofficial taxis) over charge foreigners. You have to basically fight with them to get a good price… but It’s hard to do that if you don’t speak Russian.

So I can see how the trip was super frustrating and not really enjoyed.

If you knew a little Russian or had a friend to help you around, I am POSITIVE you would have enjoyed yourself so much more!

Moscow is certainly my #1 city thus far. I even love it more than Vienna! Then again, I knew a little Russian, spent the weekend there with my Russian friends, and got to see much of the city.

Hmmm, maybe go back again on a relaxed journey?

We spent a week in Moscow back in March of 2013. We found a great apartment on Tverskaya Street just 150 meters from Red Square. People asked us why in the world would we go to Moscow in March (we found an airfare error and jumped on it), but in hindsight I wouldn’t want it any other way. Red Square, the National Historical Museum, St. Basil’s, Novodevichy Convent, etc, were incredibly beautiful in the snow (plus, I imagine all the dirt and grime is covered in the winter also). I probably won’t go back to Moscow, but definitely recommend it to all my friends, but only in the winter. If/when I return to Russia, I think it will be to Saint Petersburg, but that is a city I want to visit in the summer.

Thanks for sharing, Terry!

Your post made me laugh! I have been to both Moscow and St Petersburg and enjoyed both. Much preferred Moscow as we were lucky to stay with friends who’d been living there for a couple of years and they knew good local restaurants to visit and gave us lots of advice. Dead Lenin was also a highlight! St Petersburg, while beautiful, seemed more like a museum than a living city to me. We had a guide and were very carefully steered to all the main attractions and away from “real” Russian life. I find it a fascinating country but it’s not exactly relaxing to travel in. I’ve just discovered your blog, so look forward to reading more.

Thanks, Sandy! Happy you enjoyed my post! I can’t believe it’s been four years since I visited Moscow.

Had the same experience today. 16h connection used for doing a selfie in the red square . the impression from the city is exactly the same as yours. I won’t come back . The red square area is impressing , the snow is nice and there’s kind of Christmas atmosphere , but I felt this city is just a mix of bad things I’ve seen in other cities – big brand empty shops with poor people outside as in Beijing , traffic as Bangkok , prices as London , neglected as East Berlin , Heavy guarded as Jerusalem , cold as Kiev .

Thanks for sharing your perspective, Boten! I’d like to revisit Moscow one day to see if my opinions have changed, but it’s been six years since I was last there, so I guess I’m not making a huge effort right now!

Is it just you? If it’s anything like my experiences there, then yes and no, lol.

I’m a graduate of my uni’s Russian Studies program, and the first two trips I took to Russia, I have to admit I was miserable for the first 3 days or so after I got there. And that’s with knowing the language (and the cyrillic on the metro signs), so without would be understandably harder.

In my experience, Russia (and in particular, Moscow) can feel like a very unwelcoming place to arrive in, especially if you’re alone. People don’t smile at you in shops or on the street, speech and mannerisms can feel startlingly brusque if you’re not used to it, the weather can be harsh, even the smells all around you can be new and disorienting (a mix of indoor-smoking and iron and stone from the ubiquitous stairways). I think all those factors can subconsciously cause your mood to do some swan dives in the first few days, even if in your conscious mind you’re excited to be there.

As you noted with the hostel, there’s also sometimes a weird mix of impossibly complex bureaucracy and surprisingly huge margin of error, which can seriously make anyone visiting (and all the more so people who have to live there with it year-round) feel extremely frustrated and helpless.

On top of all that, there’s a strange mix of affluence and desolation pretty much all around you, both of which can feel hostile and off-putting when you’re looking for somewhere to settle in and combat jet-lag, homesickness, anxieties, or anything else you’re dealing with.

To be fair, a lot of people also simply hate Moscow. People who are from Russia, but from somewhere far away from the capital, often also find it cold and uninteresting. So it could be that you’re just not a fan, which is obviously fine too.

If you do go back though, having a longer time to hang out and explore could help. I sometimes have a hard time recommending what to do and see in Moscow, because honestly my favourite thing to do there is just to exist and spend time. In the summer it’s nice to get a snack from a cafe or grocery store and sit in one of the parks or by the river, or walk down the winding streets and happen upon a walled monastery with a little door in it that takes into into another world of incense and candles. Or use Moscow as a base, and take local electric trains to nearby sites with views of the countryside along the way. In the winter, take shelter in a cafe like Cafe Margarita (my favourite spot in Moscow, if not the world) where you can cuddle a cup of tea and listen to a trio of violins and a piano; or take the glorious metro system to the Izmaylovsky Market, and trudge through the snow among rows upon rows of vendors and old folks gathered around a fire playing chess.

It’s a daunting place, and to some people it’s not necessarily worth it. To me, even though when I first arrived I would have gladly accepted the first ticket someone had offered me out of there, I ended up finding a lot that I liked – but more importantly, I felt like for me it just took time to start feeling okay there.

Thank you so much for leaving such a helpful comment, Emma!

After spending two months studying in Moscow I am so sad you had such a horrible experience in my favorite city. Obviously, like Emma said already, Moscow is not for everyone. I urge you to revisit Moscow, and Russia in general, because they have modernized (and Anglicized) a lot in the past few years.

My favorite spots include Tsaritsyno Park (just a 5 minute walk from the Tsaritsyno station on the green metro line), Zurab Tseretali Musuem (the famous Georgian-Russian artist), and Strelka Bar (which overlooks the Moscow River and has great nighttime views of the city).

As for the metro, I have found the Moscow metro to be the easiest, most efficient metro I have ever used (NYC, Boston, Chicago, DC, and St. Petersburg included). The Moscow trains are typically now labeled both in Russian and in English. Also, most young Russians nowadays speak somewhat rudimentary English if you should ever need any assistance.

Like I said, Moscow may not have left you wanting more, but I encourage you to spend a little more time there if you are looking for a place steeped in history, full of culture, and teeming with amazingly hospitable people.

So sad to hear negative about my country. Your bad experience could happen in any place (I travel a lot, I know), don’t apply it to whole country. I live in beautiful Saint-Petersburg and invite you to show this place if you want. Travel with local friends and you avoid negative situations. Write me on email or instagram @filatov.aleksey (here you can see photos of my city) . Hope to be friends), hope to improve your meaning about Russia.

I love St Petersburg! :-)

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How “Therapy Speak” Can Backfire in Real Life, According to a Therapist

Useful in therapy—outside of therapy, not so much

Hannah Owens is the Mental Health/General Health Editor for Dotdash Meredith. She is a licensed social worker with clinical experience in community mental health.

Verywell Mind / Stocksy

Gatekeeping

No point of reference, pathologizing.

• Defining Others' Experiences

Inaccuracies

If you’re in therapy and feel like you’re making progress, you might be eager to show the people you love what you're learning about yourself. However, it’s important to consider the way you talk about yourself and others. 

Using “therapy speak” in everyday life—for example, terms like “ boundaries ,” “ attachment ,” or “ triggered ”—might have the opposite effect of what you intend. Let’s take a look at why using therapy terms in everyday life might be harmful.

When you use clinical terms with people who have not had the opportunity to learn those words in therapy themselves, it might be perceived as gatekeeping—purposefully excluding others from a particular experience. 

The people around you might feel as though you are being condescending and choosing to keep them from understanding what you are talking about in order to preserve your own private experience in therapy. 

To prevent people from feeling this way, try putting the “therapy speak” that you’re using into your own words and describe your experience rather than relying on clinical terms. This invites people into your world rather than implying (even accidentally) that it’s a world they won’t understand and to which they do not have access.

For example, rather than saying to an overbearing family member, “We need to adjust our boundaries,” explain what exactly that will look like to you. Try something like, “I don’t like it when you make me feel guilty for not calling you” instead. That way, you are still describing the work you’d like to do without making your loved one feel as though they are missing something.

When you use “therapy speak” with people who have not been a part of your therapy or mental health journey, they have no reference point for the terms you are using because you only defined and outlined those terms with your therapist. 

While you and your therapist might understand what you mean by phrases like “This event triggered me” because you’ve taken the time to talk through what “being triggered” looks like for you, your loved ones have not been privy to those conversations. Therefore, when you use shorthand like “triggered” rather than explaining what exactly was happening to you in your mind and body at the time, your friends and family don’t know what you are talking about. 

This can create distance between you and the people you are speaking to in a number of ways:

• They might not feel comfortable asking you questions about your experiences or the vocabulary you are using. 
• They might feel embarrassed that they don’t know what you are talking about.
• They might get the sense that you don’t actually want to talk to them about what you are experiencing because you aren't elaborating on what happened or how you felt. 

Instead, develop your own vocabulary with loved ones that accurately describes what you are experiencing with language that you’ve both agreed on and defined yourselves. So, instead of saying, “This event triggered me,” you could say, “This event brought back painful memories of X, Y, and Z.” That way, you are using phrases that everyone can understand while still expressing yourself.

Chances are, if you’re learning new terms in therapy to describe things you’re experiencing, you might be champing at the bit to apply them in real life. However, doing so with abandon can easily lead to pathologizing. 

“ Pathologizing ” means ascribing a clinical circumstance to something that might not be clinical at all—for example, describing someone unpleasant as a “narcissist” rather than “stuck-up” or “egotistical.” Whereas narcissistic personality disorder (or narcissism) is a personality disorder defined in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) , which requires the presence of very particular traits for diagnosis, anyone can be a self-absorbed jerk.

Throwing around “therapy speak” like this can lead to misunderstandings and an overly clinical view of the world that is often inaccurate. 

Pathologizing can also affect the way you think about your own circumstances or personality traits. You might find that it’s easier to think of a certain trait of yours as a clinical sign or symptom rather than a behavioral choice because pathologizing it takes the responsibility off of you and places it on the pathologized trait. 

For example, you might blame the fights you get into with your mother on your anxiety and be happy to leave it at that rather than taking the time and effort to examine your relationship and identify words or feelings that make you angry with her. This is a shortcut that doesn’t help anybody—it doesn’t help you and your mother communicate better, and it doesn’t help your anxiety (which might be very real) to use it as a scapegoat.

So before using “therapy speak” willy-nilly, really examine the situation you’re in and decide if other terms might be more appropriate.

Defining Others' Experiences

Because of your newfound therapeutic vocabulary, you might find yourself starting to use certain words to not only explain your own experiences but also the experiences of those around you. However, those kinds of words can and do mean different things to different people. Defining someone else’s experience with your own “therapy speak” can make those around you feel as though you're not taking the time to understand their perspectives, challenges, or symptoms from their point of view. 

Rather than assuming that you can accurately describe others through clinical terms, ask other people questions instead. You could say something like:

• “I’m noticing that you are describing x, y, and z. This is what that means to me. Is it the same for you?”
• “When I say x, this is what I mean. What do you mean when you say x?”
• “I’d usually use the word x to describe that feeling. What word would you use?”

Acknowledging that your “therapy speak” is probably different from that of others can only lead to greater empathy and understanding of the experiences of your loved ones and the people around you.

You might be so excited to use new therapy terms in real life that you use them incorrectly. This can create confusion not just for yourself but also for others who might not understand what you mean or what you are trying to say. 

For example, you might be learning about attachment styles in your therapy sessions and figuring out which attachment style you display . (“Attachment” describes how you approach relationships, usually based on how your parents interacted with you as a baby.) This might lead you to start “recognizing” that attachment style in others, even if it’s not an accurate assessment. You might not know enough about the different types of attachment, or you might be a little too eager to see your attachment style in those around you. 

This can lead to misunderstandings, especially if the people with whom you are using this “therapy speak” do not know anything about attachment styles themselves. So you teach them an inaccurate definition, which they then bring into their world, which might lead them to teach someone else the inaccurate definition, and so on. 

So, before introducing a new “therapy speak” term into your day-to-day life, make sure you fully understand it. 

Final Thoughts

“Therapy speak” has its time and place—namely, in your therapy sessions. But using it in real life can be tricky. It might be more useful for you to take the time to describe your feelings, experiences, and issues in layman’s terms to the people around you; that avoids the misunderstanding and resentment that might come with using clinical terms that your loved ones don’t understand. 

At the same time, teaching your friends and family the “therapy speak” words that ring most true to you can be a useful exercise in communication. By providing explanations rather than just using the terms without defining what those terms mean to you, you can successfully welcome others into your internal world, fostering compassion and understanding.

By Hannah Owens, LMSW Hannah Owens is the Mental Health/General Health Editor for Dotdash Meredith. She is a licensed social worker with clinical experience in community mental health.

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Gunmen Kill 60 at Concert Hall Outside Moscow, Russian Authorities Say

The Islamic State claimed the attack, the deadliest in the Moscow region in more than a decade.

By Valerie Hopkins ,  Ivan Nechepurenko ,  Aric Toler and Anton Troianovski

• Published March 22, 2024 Updated March 23, 2024, 2:50 a.m. ET

Several camouflage-clad gunmen opened fire at a popular concert venue on the outskirts of Moscow on Friday night, killing about 60 people and wounding more than 100, Russian authorities said, making it the deadliest attack in the capital region in more than a decade.

Hours after the mayhem began, the Russian national guard said its officers were still looking for the attackers. State media agencies reported that there had been up to five perpetrators.

As gunshots boomed through the building containing the concert hall, one of the largest and most popular music venues in the Moscow area, fire erupted in the upper floors of the structure, and the blaze intensified after an explosion, causing the roof to collapse.

The Islamic State, through an affiliated news agency, claimed responsibility. U.S. security officials, including a senior counterterrorism official, said they believed the attack was carried out by the Islamic State in Khorasan , a branch of the terrorist group that is active in Pakistan, Afghanistan and Iran. They spoke on the condition of anonymity because they were not authorized to discuss the matter publicly.

Multiple videos posted on social media and verified by The New York Times show several people entering Crocus City Hall, a sprawling shopping and entertainment complex in suburban Krasnogorsk, northwest of Moscow, and firing rifles. Other videos show people running past bloodied victims lying on the floor or screaming at the sound of gunshots, while photos show bodies lined up outside the building.

A woman who gave her name only as Marina said in a text message that she was standing in line for a concert outside, in the cold, about 8 p.m. when people without overcoats started running out of the building, saying they had heard shots.

“As soon as I heard automatic rifle shots, I started running, too,” she said.

The state news agency TASS reported that emergency services had dispatched helicopters to try to rescue people from the building’s roof, where flames and smoke could be seen billowing into the night sky.

At least 115 people were hospitalized after the attack, five of them children, according to the Russian minister of health, Mikhail Murashko. The injured include 60 adult patients in serious condition, the minister said. Another 30 people were treated and released.

The Russian leader, Vladimir V. Putin, made no immediate direct public statement, issuing only a statement through a deputy prime minister, Tatyana Golikova, that expressed hopes for the recovery of the injured and gratitude to the doctors treating them.

Russia’s Investigative Committee, the country’s equivalent to the F.B.I., said it had opened a criminal case into a terrorist act and dispatched its investigators to the site. RIA Novosti said that a special police unit was working inside the building.

John F. Kirby, a spokesman for President Biden’s National Security Council, told reporters that the White House had “no indication at this time that Ukraine or Ukrainians were involved.” Mykhailo Podolyak, a top adviser to Ukraine’s presidential office, said in a video statement that “Ukraine has absolutely nothing to do” with the attack.

On March 7, the U.S. Embassy in Moscow issued a security alert that warned that its personnel were “monitoring reports that extremists have imminent plans to target large gatherings in Moscow, to include concerts.” The statement, which did not say anything about the extremists’ affiliation, warned Americans that an attack could take place in the next 48 hours.

Pro-Kremlin voices seized on the U.S. Embassy’s warning to paint America as trying to scare Russians. On March 19, Mr. Putin called the statement “obvious blackmail” made with “the intention to intimidate and destabilize our society.”

The attack on Friday was connected to the March 7 warning, according to American officials briefed on the matter. They added that the United States alerted Russia privately at the time about intelligence it had about Islamic State activity.

Statements of condolence and outrage came from around the world, including the leader of China, Xi Jinping, and governments of the United States and other countries that are at odds with Russia. Yulia Navalnaya, the widow of the opposition leader Aleksei Navalny, who died in a Russian prison last month, said on social media, “All those involved in this crime must be found and brought to justice.”

The attack came on a day when 165 missiles and drones attacked Ukraine, constituting what the U.S. ambassador to Ukraine, Bridget Brink, said was “the largest attack against Ukraine’s energy grid since the start of Russia’s war.”

The attack began around 8 p.m. local time, minutes before a sold-out performance by the veteran rock band Piknik was scheduled to start. The concert hall has 6,200 seats, according to its website.

“At least three people in camouflage burst into the ground floor of Crocus City Hall and opened fire with automatic weapons” and threw incendiary devices, a correspondent for RIA Novosti reported from the scene. “There are definitely wounded.”

In videos filmed inside the concert hall, audience members are heard screaming and seen crouching as repeated gunshots echo outside the hall.

Russia’s emergency service said it had sent 130 vehicles to the scene and three helicopters to drop water on the blaze that gutted the upper floors. The fire was mostly extinguished shortly before 5 a.m. Saturday, according to the regional governor, Andrey Vorobyov.

Shootings are rare in Russia, where the state tightly regulates the possession of firearms. One of the deadliest ones occurred in 2022, when a gunman killed 18 people and wounded 23 others in a school in the town of Izhevsk.

However, attacks have struck across the Russia in recent decades, events that the authorities often described as terrorism. A 2011 suicide bombing at Moscow’s Domodedovo Airport killed 37 people, and two coordinated suicide bombings in Moscow subway stations in 2010 killed about 40 people.

In 2004, 172 people died in a siege at a Moscow theater by Chechen separatists. The police pumped a sedative gas into the theater to incapacitate the attackers, but the gas killed 132 hostages.

The complex where the attack took place on Friday was developed by the Azerbaijan-born billionaire Aras Agalarov, whose son, Emin, is a famous pop star. Former President Donald Trump held the Miss Universe pageant at the same complex in 2013, and world-famous performers like Eric Clapton, Dua Lipa and Sia have also performed there.

Alina Lobzina , Julian E. Barnes , Neil MacFarquhar and Victoria Kim contributed reporting.

Valerie Hopkins covers the war in Ukraine and how the conflict is changing Russia, Ukraine, Europe and the United States. She is based in Moscow. More about Valerie Hopkins

Ivan Nechepurenko covers Russia, Ukraine, Belarus, the countries of the Caucasus, and Central Asia. He is based in Moscow. More about Ivan Nechepurenko

Aric Toler is a reporter on the Visual Investigations team at The Times where he uses emerging techniques of discovery to analyze open source information. More about Aric Toler

Anton Troianovski is the Moscow bureau chief for The Times. He writes about Russia, Eastern Europe, the Caucasus and Central Asia. More about Anton Troianovski