Features of conducting classes with children with cerebral palsy. Psychological support program for a child with cerebral palsy

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Introduction

cerebral palsy child speech

Speech function is one of the most important mental functions of a person. In the process of speech development, higher forms of cognitive activity and the ability to conceptual thinking are formed. Mastering the ability to communicate verbally creates the prerequisites for specifically human social contacts, thanks to which the child’s ideas about the surrounding reality are formed and refined, and the forms of its reflection are improved.

Problems of impaired communication of a child with cerebral palsy with peers, difficulties of adaptation in a peer group in modern society are becoming increasingly socially important. For the full mental development of a child, not only the process of communication with adults, especially with parents, is important, but the role of communication with peers is also important. The development of communication skills and their importance for the general mental development of children with cerebral palsy have been studied much less than the communication of a healthy child with peers and with adults, and the need-motivational aspect of communication of a sick child with peers has attracted little attention from researchers.

Speech disorders to one degree or another (depending on the nature of the speech disorders) negatively affect the entire mental development of the child and affect his activities and behavior.

Recently in Russia there has been a growing trend in the number of children with musculoskeletal disorders. There are many reasons for this, from biological to social, and they cannot be considered separately from each other, since they are interconnected and interdependent.

Cerebral palsy (CP) is a collective term for a group of diseases that manifest primarily as disturbances in movement, balance, and body posture. Cerebral palsy is caused by a disorder of brain development or damage to one or more parts of the brain that control muscle tone and motor activity (movement). The first manifestations of damage to the nervous system may be obvious after birth, and signs of the formation of cerebral palsy may appear in infancy. Children with cerebral palsy are predominantly delayed in their motor development and later achieve motor development milestones such as rolling over, sitting, crawling and walking.

Purpose of the course work: analyze the main types of speech disorders in children with cerebral palsy and methods of correctional work with children with cerebral palsy.

1. Cerebral palsy

1.1 Definition, etiology, main forms

The term “cerebral palsy” is used to describe a group of chronic conditions that affect motor and muscle activity with impaired coordination of movements. The cause of cerebral palsy is damage to one or more parts of the brain either during fetal development, or during (or immediately after) childbirth, or in infancy/infancy. This usually occurs during a complicated pregnancy, which is a harbinger of premature birth. The word “cerebral” means “cerebral” (from the Latin word “cerebrum” - “brain”), and the word “paralysis” (from the Greek “paralysis” - “relaxation”) defines insufficient (low) physical activity. Cerebral palsy itself does not progress, because... does not give relapses. However, during the course of treatment, the patient’s condition may improve, worsen, or remain unchanged. Cerebral palsy is not a hereditary disease. They can never become infected or get sick. Although cerebral palsy cannot be cured (it is not “curable” in the generally accepted sense), constant training and therapy can lead to an improvement in the patient’s condition.

Cerebral palsy can be caused by most factors that impair brain development. The main reason is insufficient oxygen supply to the brain - hypoxia (intrauterine or in a newborn). The supply of oxygen can be interrupted by premature separation of the placenta from the walls of the uterus, malpresentation of the fetus, prolonged or rapid labor, and impaired circulation in the umbilical cord. Premature birth, prematurity, low birth weight, RH factor or group incompatibility of the blood of the fetus and mother according to the A-B-O system, infection of the mother with measles rubella or other viral diseases during early pregnancy - and microorganisms attack the central nervous system of the fetus - all these are also risk factors. In the USA, in particular, all research is aimed at studying the two main causes of cerebral palsy: rubella measles and incompatibility of the blood of the fetus and mother. So, the main causes of cerebral palsy are associated with the development of pregnancy and childbirth, and these conditions are not inherited: and such paralysis is often called congenital cerebral palsy (associated with intrauterine pathology or the process of childbirth). A less common type, acquired cerebral palsy, usually develops before the age of two (traumatic brain injuries due to accidents or brain infections).

Characteristic features of cerebral palsy are disturbances in motor activity, the muscular sphere is especially affected - there is a lack of coordination of movements. Depending on the extent and location of areas of brain damage, one or more forms of muscle pathology may occur - muscle tension or spasticity; involuntary movements; disturbance of gait and degree of mobility. The following pathological phenomena may also occur: abnormal sensation and perception; decreased vision, hearing and speech impairment; epilepsy; impaired mental function. Other problems include difficulty eating, decreased urinary and bowel control, breathing problems due to poor posture, bedsores and learning difficulties.

The following forms of cerebral palsy are distinguished:

Spastic (pyramidal) forms: increased muscle tone is the defining symptom of this type. The muscles are tense, tight (spastic), and movement is awkward or impossible.

Depending on which part of the body is affected, spastic forms of cerebral palsy are divided into: diplegia (both legs), hemiplegia (one side of the body) or tetraplegia (whole body). Spastic forms are the most common and account for about 70-80% of cases.

The dyskinetic (extrapyramidal) form is manifested by impaired coordination of movements. There are two main subtypes: The athetoid (hyperkinetic) form, which is characterized by slow or fast uncontrolled movements that can occur in any part of the body, including the face, mouth and tongue. Approximately 10-20% of cases of cerebral palsy are of this type. The atactic form is characterized by disturbances in balance and coordination. If such a patient can walk, then the gait is uncertain and shaky. Patients with this form have trouble performing fast movements and those that require fine control, such as writing. This form accounts for 5-10% of cases of cerebral palsy.

Mixed forms are a combination of different forms of cerebral palsy. It is common to combine spastic forms with athetodic or ataxic forms.

Many people with cerebral palsy have normal or above average intelligence.

Their ability to express their intellectual abilities may be limited due to difficulties in communication.

All children with cerebral palsy, regardless of the level of intellectual development, are capable of significantly developing their capabilities with appropriate treatment, physical rehabilitation and speech therapy correction.

1.2 Speech disorders in cerebral palsy

Dysarthria.

Within the framework of cerebral palsy, there are several types of dysarthric disorders:

WITH pastico-paretic . The leading neurological syndrome is spastic paresis, the most common form in children with cerebral palsy. Spastic paresis is associated with weakening or loss of innervation of various cranial nerves, and damage to the central neurons of these nerves can be both general and selective. Spastic paresis manifests itself in different ways:

inability to perform an articulatory movement,

inability to maintain the desired articulatory position for a long time,

in the impossibility of quickly switching from one articulatory pattern to another.

In some cases, the latent period may increase when starting to move and drooling of varying severity may appear. Physiological acts (biting, chewing, swallowing) are weakly expressed, slow, and uncoordinated.

Pronunciation speech is characterized by insufficient strength and sonority of the voice, and a decrease in the amplitude of language modulations. Due to pareticity of the muscles of the vocal folds, they do not close completely, unevenly, the vibrations are rare and arrhythmic. This operation of the vocal folds leads to the fact that voiced consonants are partially or completely deafened. When reproducing a voice, tension follows in the muscles of the larynx, vocal folds, and sometimes the root of the tongue, due to which vowel sounds acquire additional noise overtones that are not characteristic of them, so in speech the distinction between vowel and consonant sounds is erased. The prosodic side of speech is characterized by pronounced tempo-rhythmic disturbances. The pace of speech is usually slow. The inhalation is shallow, the exhalation of speech is exhausted, due to which the rhythmic structure of the utterance is disrupted, pauses appear that are not justified by the meaning of the utterance. In pronunciation, there is blurriness of almost all groups of sounds, especially fricative sounds and sonorations that are difficult to articulate. The amplitude of articulatory movements is reduced, the activity of all muscles of the tongue (transverse, longitudinal, vertical) is impaired, and deficiencies in labilization (movement of the lips forward) are noted. In cases where paresis of the soft palate is noted, the sound begins to be pronounced with a constant, free passage of air through the nose, which gives a nasal tone to the voice.

G hyperkinetic dysarthria . The leading neurological syndrome is hyperkinesis. There are no manifestations of spastic paresis; therefore, disturbances in the movements of the speech muscles are caused not by muscle weakness, but by the nature of hyperkinesis, the degree of their severity and form. The type of hyperkinesis is determined by the localization of the lesion in the extrapyramidal system. The process of speech formation is most negatively affected by athetotic hyperkinesis and myoclonus. Sometimes the degree of their manifestations is such that speech is almost impossible. In some cases, tongue hyperkinesis leads to forced opening of the mouth and throwing the tongue forward, thereby making it impossible to speak. In this case, hyperkinesis can manifest itself both at rest and during a voluntary attempt to perform a movement. In this form, physiological processes are significantly impaired, especially chewing and swallowing - they are difficult, sharply discoordinated (especially primoclonus). The pronunciation side of speech is characterized by a tense, intermittent, vibrating (changing in pitch and strength) voice. Voice modulation is sharply limited, hyperkinesis that occurs in the vocal muscles often leads to violent cries and groans during speech. The rate of speech is inconsistent, changeable, there is either excessive acceleration or slowing down of speech. The articulation of sounds is incomplete. Gradually developing or sudden stops in speech production are very characteristic. The prosodic component suffers.

WITH pastico-rigid form . The leading neurological syndrome is spastic paresis and rigidity (tension of the tone of agonist and antagonist muscles, in which the smoothness and coherence of muscle interaction suffers). It is characterized by manifestations of spastic paresis in combination with extrapyramidal disorders.

With symptoms of rigidity, the brain stem is constantly in an active state. Clinically, this is expressed in an increase in late reactions, muscle tone, which is caused by the continuous flow of pathological impulses from the brain stem. There is no long-term rest in the speech muscles due to the high threshold of sensitivity to various kinds of stimuli. A tense smile can be replaced by an instant spasm of the upper and lower quadratus labii muscles, a tense tip of the tongue can be replaced by a wide spread on the lower lip, which can be replaced by the tongue moving forward. The tone changes sharply. Movement of the soft palate may be sufficient. The muscles of the lower jaw, as a rule, are tense; even with passive movement, it is not possible to move the jaw forward, lower it down, or move it to the side. The tongue at rest is often tense, pulled back, the root is hypertrophied, which causes significant difficulties in moving the tongue forward. The tip of the tongue is not expressed; as a rule, only the simplest movements are available to it, which are little differentiated from each other. As a result, the pronunciation is primarily affected by the anterior lingual sounds, which require subtle differentiated movements. Tension of the root of the tongue often leads to the fact that when articulating a sound, a shade of back-lingual sounds is possible. Reflexes of oral automatism are sharply expressed. The amplitude of articulatory movements during sound articulation can gradually decrease, sometimes stop; when forced to stop, a breathing spasm may occur, followed by a slight inhalation, pause and speech until a new spasm (every 4-5 syllables). The voice during speech is tense, dull, the amplitude of voice modulation is reduced, which weakens the strength of the voice, the flight of vowel sounds is extremely small. The pace of speech is usually fast, the speech is abrupt. In some cases, there may be a slowdown in tempo with a gradual attenuation of the voice.

A tactical uniform . Usually found in atonic-astatic cerebral palsy. The leading neurological syndrome is ataxia (movements are performed disproportionately to the given task, the degree of contraction of the operating muscles does not correspond to the required one, coordination of movements is impaired). Dysmetric and asynergic disorders occur, which manifest themselves in disturbances in precise movements (loss of trajectory, disturbances in amplitude, swing volume, accuracy of hitting the closure site). The main manifestations are pronounced asynchrony between breathing, phonation and articulation. A characteristic symptom is a gross violation of the prosodic component, especially the tempo-rhythmic organization of speech (manifested in scanned speech). In pronunciation, sounds that require subtle differentiated, coordinated movements of the tongue (hissing, whistling, sonorants) and sounds that require sufficient muscle effort (stopping, plosive) are primarily impaired. Such sounds are either skipped altogether or replaced with lighter ones. Sometimes with this form, due to hypotonia of the muscles of the soft palate, a nasal tone of speech of varying degrees of severity may occur. The general tension of speech, ascertained by ear, also manifests itself in behavior, especially in children. When children speak, as a rule, in a tense posture, they speak with visible effort; speech is accompanied by vasomotor reactions and vegetative manifestations. Children very quickly get tired of their own speech and begin to abstain from it.

WITH pastico-atactic (combines signs of spastic paresis and ataxia).

WITH pastico-hyperkinetic (combines signs of spastic paresis and hyperkinesis).

WITH pastico-atactico-hyperkinetic (combines signs of spastic paresis, ataxia, hyperkinesis).

A tactical-hyperkinetic (combines signs of ataxia and hyperkinesis)

With cerebral palsy, not only dysarthric, but also anarthric disorders can be observed. At this degree, communicative activity is expressed by facial expressions, gestures, and vocal means. Based on the ability for pronunciation activity, the following groups can be distinguished:

people with minimal sound-syllable activity.

Representatives of the first two groups do not speak spoken language; alternative means are used to communicate with them. Representatives of the third group are able to pronounce 2-3 syllables. Their assets include syllables containing sounds that are grossly phonetically distorted (as a rule, semi-softened). Otherwise, all attempts at speech lead to poorly articulated sound complexes with various heterogeneous distortions that are not amenable to phonetic interpretation.

Alalia.

Alalia (3-8% of children with cerebral palsy) is considered a specific language disorder that occurs as a result of damage to cortical areas in the pre-speech period. It manifests itself in underdevelopment of all aspects of speech and disruption of its communicative functions.

In children with cerebral palsy, both motor and sensory alalia are noted, and motor alalia is often combined with dysarthria. Sensory alalia occurs predominantly in the hyperkinetic form of cerebral palsy.

The pathogenesis of alalia in cerebral palsy is determined by the following factors:

damage to the cortical mechanisms of speech under the influence of various exogenous hazards, which are also the cause of cerebral palsy

secondary underdevelopment of the cortical mechanisms of speech as a result of motor-kinesthetic deprivation or pathological afferentation from the peripheral parts of the speech system due to damage to the articulatory muscles.

In the structure of alalia, first of all, specific violations of vocabulary are distinguished. The shortcomings in the vocabulary of these children are explained by the peculiarities of their cognitive activity, the slow and peculiar formation of thought processes. Research by a number of authors indicates a significant predominance of passive vocabulary over active vocabulary, and the use of certain words by children with an insufficient or distorted understanding of their meaning (especially often words expressing spatial and temporal relationships). Studies often note that children with cerebral palsy have more difficulty remembering the names of actions due to imperfect mastery of movements. The study of vocabulary reveals in most children significant difficulties in mastering the lexical meanings of words, poor differentiation of these words according to their semantic characteristics. This is manifested in the confusion of a semantically actualized word with the lexical meaning of other words that are in a synonymous relationship with it, in the inability to use synonymous and antonymic means of language for a more precise expression of thought. The authors pay special attention to special cases of violations of lexical compatibility norms. Also in the dictionary of children with cerebral palsy there are unjustified semantic substitutions and a predominance of nouns and verbs (in total they make up about 90% of the vocabulary). Adjectives, adverbs, and pronouns are much less common. There are difficulties in determining the semantic content of polysemantic words, and the inability to independently reveal the figurative meaning of words. The dependence of lexical development on the form of cerebral palsy and on the degree of impairment of articulatory motor skills, oral praxis, and auditory differentiation of sounds was not revealed.

Among the violations of the grammatical structure of speech, difficulties in constructing sentences of various types, difficulties in using and omissions of prepositions, conjunctions, and function words are noted. When constructing phrases, children find it difficult to coordinate nouns with verbs and especially with adjectives in gender and number. These difficulties are associated with insufficient differentiation of morphemic features of nouns. Even greater difficulties arise when agreeing adjectives and nouns in case; in these cases, there is also no connection between grammatical forms and the morphological features of the noun. In addition, children experience significant difficulties in mastering verb forms.

Control, which is due to the immaturity of case-prepositional constructions, i.e. Children with cerebral palsy often cannot comprehend and generalize the morphological elements of a word, and agrammatisms that arise in their speech are persistent and difficult to correct.

1.3 Onspeech impairment due to differentx forms of cerebral palsy

WITH pastic diplegia and hemiparetic form .

It is based on damage to the same brain structures and motor pathways. The only difference is that with spastic diplegia the lesion is bilateral, and with the hemiparetic form it is unilateral.

Features of sound pronunciation disorders are determined by selective spastic paresis of speech muscles. First of all, the most subtle isolated movements suffer, primarily upward movements of the tip of the tongue; therefore, the anterior lingual sounds are more impaired than others. These sounds are either absent altogether or are replaced by others, with the tip of the tongue in a lower position. Synkinesis is characteristic of these forms. In milder cases, only the pace and volume of subtle differentiated movements of the muscles of the tip of the tongue are impaired, which manifests itself in the slow pronunciation of anterior lingual sounds, syllables and words with these sounds.

Disorders of sound pronunciation can also be caused by deficiencies in kinesthetic praxis; then, in pronunciation, consonant sounds suffer the most, especially the most difficult ones in articulation. A feature in these cases will be instability, the fickle nature of sound replacements, which is due to the search for correct articulation. Pronunciation disorders can be caused not only by disturbances in the kinesthetic organization of movement, but also in kinetic praxis. In these cases, switching from one articulatory movement to another is extremely difficult, which manifests itself in the omission of sounds during consonant combinations, rearrangements of sounds, and the addition of new sounds.

Also, with these forms, violations of vocabulary, grammatical structure of speech, reading and writing are noted

G hyperkinetic form .

Damage to the subcortical parts of the brain predominates and speech disorders manifest themselves primarily in the form of extrapyramidal dysarthria. Sound pronunciation disorders are caused by sudden changes in muscle tone, the presence of hyperkinesis, and disturbances of emotional-motor innervation, which leads to gross disorders of the prosodic component of speech. Kinesthetic dyspraxia is often noted, manifested in difficulties in voluntarily finding individual articulatory patterns.

Speech in such cases is blurred, difficult to understand for others, and the voice often has a nasal tint. During the utterance, there is often a gradual attenuation of the voice, turning into an unclear muttering. There are no stable problems with sound pronunciation.

The formation of the lexico-grammatical and semantic components of the language, as well as the acquisition of reading and writing are also disrupted. In some cases, pronounced deficiencies in phoneme differentiation and violations of phonemic analysis may be noted. Speech disorders are often combined with hearing impairment (10-15%).

A tonic-astatic form .

The cerebellum or its connections with other brain structures are predominantly affected. Coordination disorders in the speech muscles manifest themselves in the form of asynchrony of articulation, phonation and breathing. Sound pronunciation disorders manifest themselves in symptoms of atoxic dysarthria.

There is also a decrease in the need for verbal communication; in milder cases, with sufficiently high motivation, there is a lack of purposeful general speech activity. Children willingly make contact, but cannot consistently express their thoughts.

In this form, pseudoalalic disorders may also be observed.

2 . ReCheural therapy for children with cerebral palsy

2.1 Speech therapy work with children sufferingcerebral palsy

Speech therapy work with children with cerebral palsy is based on the age of the child, the severity of damage to the articulatory apparatus, the degree of delay in pre-speech and speech development, the age and intellectual characteristics of the child, and the general somatic and neurological condition. The effectiveness of working with very young children largely depends on how well the teacher-speech therapist is able to correctly organize not only special individual lessons, but also education and the development of pre-speech and speech activity at all scheduled moments. Early speech therapy work should be an integral part of overall comprehensive work with children with cerebral palsy.

2.2 Correctional and pedagogicalEnglish work in the pre-speech period

The goal of correctional and pedagogical work in the pre-speech period with cerebral palsy is the consistent development of the functions of the pre-speech period, ensuring the timely formation of the child’s speech and personality. The main directions of correctional and pedagogical work:

Normalization of the condition and functioning of the organs of articulation through differentiated and acupressure massage

Articulation gymnastics;

Development of visual and auditory perception;

Development of emotional reactions;

Development of hand movements and actions with objects;

Formation of the preparatory stages of development of speech understanding.

IV levels of pre-speech development in cerebral palsy are distinguished: absence of vocal activity, presence of undifferentiated vocal activity, humming, babbling.

The main task of correctional pedagogical work with children at the first pre-speech level of development is to stimulate vocal reactions. Work is carried out in the following areas:

vocalization of exhalation;

development of a “revitalization complex” with the inclusion of a vocal component;

development of visual fixation and tracking;

development of auditory concentration;

formation of visual-motor coordination.

In order to normalize muscle tone and motor skills of the articulatory apparatus, massage is performed. To increase the volume of inhaled and exhaled air with subsequent vocalization of exhalation, breathing exercises are used for 1-1.5 minutes 2-3 times daily. In order to form a “revitalization complex” and include a vocal component in it, the adult leans towards the child, speaks to him affectionately, melodiously, strokes him, and shows him bright toys. The appearance of a smile indicates the emergence of a child’s need to communicate with an adult. Stimulation of vocal reactions begins with vocalization of the child's exhalation. Against the background of emotionally positive communication between a child and an adult, vibration of his chest and larynx is carried out to evoke vocal reactions. Vocal reactions can also be evoked during light breathing exercises that increase the volume of inhaled and exhaled air, combined with vibration of the chest and larynx. The ability to vocalize the exhalation is strengthened by repeating this exercise many times throughout the day. To develop visual fixation and tracking, the child is presented with optical objects that are adequate from the point of view of his perceptual capabilities. To form auditory perception, choose the time when the child is in an emotionally negative state. The speech therapist leans towards the child, talks to him tenderly, trying to calm him down and attract his attention. Work on developing hand-eye coordination begins with normalizing the position of the hand and fingers.

The main task of working with children at the second pre-speech level of development is to stimulate humming. The main directions of correctional and pedagogical work:

normalization of muscle tone and motor skills of the articulatory apparatus;

an increase in volume and exhalation followed by vocalization, stimulation of humming;

development of stability of gaze fixation, smooth tracking;

developing the ability to localize sounds in space and perceive the differently intonated voice of an adult;

development of grasping function of the hands. Classes last 10-15 minutes and are individual in nature. In order to normalize muscle tone and motor skills of the articulatory apparatus, speech therapy massage is performed. Breathing exercises in the form of passive breathing exercises are aimed at increasing the volume and force of exhalation with its subsequent vocalization in order to train the depth and rhythm of breathing. The development of visual perception is aimed at increasing the mobility of the eyeballs, the smoothness of tracking a moving object, the stability of gaze fixation when the position of the head and body changes, and the formation of smooth tracking with the eyes while the position of the head remains unchanged. These exercises are carried out using bright, sounded toys. Further development of auditory attention goes in the direction of developing the ability to localize sounds in space and perceive differences in the intonations of an adult’s voice. For this purpose, they cause concentration on sounds that are adequate for a given child (loud, quiet, high, low). Sound stimuli are toys of varying sound quality. Preparation for the formation of an understanding of addressed speech begins with the development of perception of various voice intonations. The child, first of all, learns those intonations that are more often used by adults. It is necessary to ensure that the child not only perceives the intonations of the voice, but also responds adequately to them. To develop the grasping function of the hands, it is necessary to attract the child’s attention to his own hands and develop kinesthetic sensations in the hands.

The main task of working with children at the III pre-speech level of development is the stimulation of intoned vocal communication and babbling. Work is carried out in the following areas:

normalization of muscle tone and motor skills of the articulatory apparatus;

development of rhythmic breathing and movements of the child;

stimulation of babbling;

formation of a positive emotional attitude towards classes;

development of visual differentiation;

stimulation of kinesthetic sensations and the development of digital touch based on them;

development of an acoustic attitude towards sounds and voice;

development of auditory differentiation;

formation of preparatory stages of speech understanding.

Speech therapy massage is aimed at normalizing the muscle tone of the tongue and lips, weakening hyperkinesis, and developing afferentation of the oral muscles. Passive gymnastics helps increase the activity of the lips and tongue; The development of mobility of the lips and tongue is also carried out through active gymnastics. An important factor for the development of voluntary vocalization is the correct voluntary breathing of the child. For this purpose, more complex breathing exercises are performed compared to the exercises of the previous levels, which are aimed at developing the rhythm of movements and breathing. In order to stimulate babbling, they try to induce a “revival complex.” The child begins to smile, he begins to fix his attention on the articulation of the speech therapist, who bends low towards him, talks to him, and pronounces melodious sounds. Stimulation of emotional reactions involves the formation in children of a positive emotional attitude towards classes and the activation of vocal babble activity. The decisive role is played by the emotional state of the child during classes: only a positive emotional background contributes to the actualization of humming, babbling, etc. The main goal of the development of visual perception is the development of visual differentiation. During the lesson, the child’s attention is drawn not only to toys, but also to the surroundings: the child must learn to recognize those around him and be wary at the sight of his mother’s changed face.

The lack of kinesthetic sensations and the immaturity of the sense of touch under visual control due to motor pathology prevent the child from developing the simplest manipulation of objects, and therefore it is necessary to pay attention to this aspect of visual-motor coordination. Work continues to develop sensitivity in the fingertips. The development of auditory perception is aimed at the formation of an acoustic attitude towards the human voice and sounds and auditory differentiation. To develop an acoustic orientation towards sounds and voice, the child is offered various sound stimuli (sounds vary in pitch and sound intensity). When talking to a child, change the strength of the voice from loud to whisper, achieving concentration on the adult’s voice. To form auditory differentiation, they change the tone of the conversation from affectionate to strict and vice versa, while trying to evoke adequate reactions in the child. Any intonationally colored sound of a child serves as a means of expressing his state, desire, attitude towards the environment, feelings, which, in combination with expressive facial expressions, gestures, expressive eye movements, serves as a means of non-verbal contact with people around him and contributes to the formation of the preparatory stages of development of speech understanding.

The main task of correctional pedagogical work with children at the IV level of pre-speech development is the development of communication with adults through the intonation sounds of babbling and babbling words. Areas of work:

normalization of muscle tone and motor skills of the articulatory apparatus;

increasing the force and duration of exhalation;

stimulation of physiological echolalia and babbling words;

development of manipulative function of the hands and differentiated movements of the fingers;

formation of understanding of speech instructions in a specific situation.

To normalize muscle tone and motor skills of the articulatory apparatus, speech therapy massage is performed. Breathing exercises are aimed at increasing the strength and duration of exhalation. Along with passive ones, active breathing exercises are carried out with the inclusion of an element of imitation. At the same time, the required lip position is passively maintained. By attracting the child’s attention to the sound of his own voice, encouraging his activity, they try to cause repetition of sounds, i.e. autoecholalia, which contributes to the development of speech-motor and speech-auditory analyzers, babbling activity. The development of simple manipulation with objects is hampered not only by the child’s lack of kinesthetic sensations, but also by the immaturity of the sense of touch under visual control due to motor pathology. Much attention needs to be paid to the development of this side of hand-eye coordination. Work continues to develop sensitivity in the fingertips. Children who are at level IV of the pre-speech level of development understand speech addressed to them, therefore special attention is paid to involving the child himself in completing the task.

2.2 Logopediical work in the speech period

Speech therapy work during the period of speech development begins with learning to manipulate objects (toys), which stimulates the lexical side of speech. Before the start of classes, children are given a massage, articulation and breathing exercises, they activate their attention, perception and pronunciation of available sounds, their combinations, and simple words. When performing various tasks, the adult first shows the child what to do. This contributes to the accumulation of speech impressions and the development of the ability to imitate the speech of others. A child with cerebral palsy is encouraged to speak using techniques that are interesting and simple for him. Speech therapy classes begin with the creation of a certain sound base, for which they use massage and articulatory gymnastics. Next, the child is stimulated to communicate using sound reactions available to him, amorphous root words, and sentence words. After this - classes on the development of onomatopoeia. To stimulate speech development, classes on the formation of speech hearing, pitch, phonemic, auditory attention, perception of the tempo and rhythm of speech are important. To develop pitch hearing, children are taught to differentiate variations in pitch of an adult's voice in accordance with the emotional coloring of speech. This is achieved through expressive reading of fairy tales by role, recognition of the voices of children and adults, etc. Special games are aimed at developing auditory attention: “Whose voice?”, “Guess what sounds”, etc. The child should focus his gaze on the sounding toys. In preschool age, stimulation of speech development is aimed at expanding the vocabulary and developing the grammatical structure of speech. Children should be introduced to new objects and their verbal symbols every day. Speech development classes are gradual. They are based on learning to compose various types of sentences with a gradual complication of their syntactic structure. It is recommended to conduct special games-activities during which the child names objects, actions, and images in pictures. Visualization should be used as much as possible and rely on the joint subject-matter, practical and play activities of the speech therapist and the child. It is necessary to specially train children in methods of sensory examination of objects with the obligatory connection of a motor-kinesthetic analyzer. At the same time, words are introduced denoting the quality of the item. To master them, a comparison of objects with opposite properties is used. The child is offered objects in which the identified qualities are most clearly represented. In older preschool age, they develop the ability to more accurately select words that characterize the features and properties of objects. To consolidate and activate the vocabulary, descriptions of objects, solving riddles, didactic games and everyday communication with the child are used.

A special direction of work on the word, as a unit of language, ensures the development of the qualitative side of vocabulary. The child masters an understanding of the polysemy of words, synonyms and antonyms, and the ability to correctly use words in context. This work, which began in preschool age, is most intense at school. At school age, it is necessary to practically familiarize children with the simplest ways of forming the basic lexical and grammatical categories of words, which helps to overcome persistent language difficulties. It is necessary to constantly develop the motivation for speech utterance through nurturing the desire to communicate. Already at the initial stages of learning, to stimulate the development of coherent speech, children are given primary information about language, because conscious comprehension accelerates the development of relevant skills and abilities.

As already noted, dysarthria is most often observed with cerebral palsy, in most cases its pseudobulbar form. Speech therapy classes for dysarthria are structured taking into account the pathogenetic commonality of the structure of motor and speech defects. Thus, with pseudobulbar dysarthria in conditions of increased muscle tone in the speech muscles, classes begin with relaxing the muscles of the articulatory apparatus, for which they use techniques aimed at relaxing the muscles of the neck, labial muscles, tongue muscles, and a relaxing facial massage. Further work includes articulation and breathing exercises, voice development, articulatory praxis, and work on sound pronunciation.

Conclusion

Cerebral palsy affects thousands of infants and children every year. This is a non-communicable disease, i.e. they cannot be infected through contact with a sick person. The word cerebral means connection with brain function. The word paralysis indicates problems with coordination of movements and movement in space.

A child with CP experiences difficulties in controlling muscle activity, which is controlled by the brain by giving commands to each muscle. Due to the disruption of certain areas of the brain in CP disease, a child often cannot walk, talk, eat or play as other children do, depending on which area of the brain is affected.

Despite the advances of modern medicine, cerebral palsy remains an important problem. The number of people with cerebral palsy is increasing all over the world. This may be due to the fact that more premature babies survive. Now per thousand population there are on average 2-3 children with cerebral palsy. Cerebral palsy occurs equally frequently in both sexes and across ethnic and socioeconomic groups.

Despite the difficulties in speech development in children with cerebral palsy, timely correctional work allows children with cerebral palsy to form a sufficient vocabulary and acquire communication skills to communicate with peers and adults, gain an understanding of the surrounding picture of the world, and develop some creative abilities.

List of usesliterature and sources used

1. Povalyaeva M.A. Speech therapist's reference book. Rostov-on-Don 2006

2. www.children.cka.ru

3. www.superinf.ru

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PSYCHOLOGICAL ASSISTANCE FOR CHILDREN WITH CEREBRAL PALSY, ITS DIRECTION AND TASKS

The difficulties of rehabilitation treatment for children with cerebral palsy are caused not only by the severity of the motor NOGO defect, but mainly by the peculiar features of their mental and emotional-volitional development. Therefore, timely started psychological and pedagogical assistance is;| being one of the most important links in the system of their rehabilitation.

Currently, the issues of psychological assistance to children with cerebral palsy are far from sufficiently covered. The practical application of various psychotechnical techniques aimed at patients with cerebral palsy is often used by psychologists and teachers without taking into account the form of the disease, the level of development of intellectual processes and the characteristics of the emotional-volitional sphere. The lack of clearly developed differentiated methods of psychocorrection for children with cerebral palsy and inadequate selection of psychotechnical techniques can negatively affect the quality of mental development of a sick child, and also creates significant difficulties in the work of teachers and parents.

Our many years of experience show that correctly selected methods of psychological assistance, taking into account the individual psychological characteristics of patients, have a positive impact on the dynamics of their mental and personal development.

We consider psychological assistance to children and adolescents with cerebral palsy as a complex system of rehabilitation interventions aimed at increasing social activity, developing independence, strengthening the social position of the patient’s personality, forming a system of values and orientation, developing intellectual processes that correspond to the mental and physical capabilities of the sick child .

It is important to solve particular problems: elimination of secondary personal reactions to a physical defect, long hospital stay and surgical treatment.

The effectiveness of psychological assistance to children with cerebral palsy largely depends on high-quality psychological diagnostics.

It is recommended to divide the process of psychological diagnostics of children with cerebral palsy into the following areas: psychological diagnostics of the development of motor functions, sensory functions, mnemonic, intellectual, as well as characteristics of the motivational-need sphere and individual personal characteristics.

Clinical and psychological examination of children with cerebral palsy is extremely difficult. This is due to severe motor pathology, as well as the presence of intellectual, speech and sensory impairments in most children. Therefore, examination of children with cerebral palsy should be aimed at a qualitative analysis of the data obtained. The tasks presented to the child must not only be adequate to his chronological age, but also to the level of his sensory, motor and intellectual development. The examination process itself must be carried out in the form of a play activity accessible to the child. Particular attention should be paid to the motor abilities of a child with cerebral palsy. Taking into account the patient’s physical capabilities is very important during a psychological examination.

For example, with complete immobility, the child is placed in a position that is comfortable for him, in which maximum muscle relaxation is achieved.

The didactic material used during the examination must be placed in his field of vision. The examination is recommended to be carried out in a playpen, on a carpet or in a special chair. "■ the so-called “fetal position” (the child’s head is bent to the chest, the legs are bent at the knee joints and brought to the stomach, the arms are bent at the elbow joints and crossed on the chest). Then several rocking movements are made along the longitudinal axis of the body. After this, muscle tone decreases significantly, and the child is placed on his back. Using special devices (rollers, sandbags, rubber circles, belts, etc.), the child is fixed in this position. If involuntary unnecessary movements are severe - hyperkinesis, which interfere with grasping the toy, it is recommended to lead special exercises to help reduce hyperkinesis. For example, you can make cross movements with simultaneous bending of one leg and extension and bringing the opposite arm to this leg. Devices for fixing posture are especially important when examining a child with hyperkinesis (special belts, cuffs, gauze rings, helmets, etc. are used).

In children with cerebral palsy, mental development disorders are closely related to motor skills. \ swarms. The child's immobility largely prevents him from actively exploring the world around him. The situation of many children with cerebral ral paralysis is forced, they lie for a long time in one position, cannot change it, turn on the other side or on the stomach. Placed in a position on their stomach, they cannot raise and hold their head; in a sitting position, they often cannot use their arms, since they use them to maintain balance, etc. All this significantly limits the field of vision, preventing development hand-eye coordination.

When assessing a child’s motor capabilities for the development of his cognitive activity, it is necessary to take into account the condition

motor skills not only at the time of the examination, but it is important to pay attention to the time the child mastered certain motor skills (when he began to hold his head, grabbed a toy for the first time, began to move independently). The second important point in the study of motor functions in children with cerebral palsy is the assessment of their “functional adaptability” to their motor defect. In children with intact intelligence, it is quite pronounced, i.e., the child, despite severe hypertonicity, tries to grab an object and adapts to hold it, examine it, holding the object in his fist or between the middle and ring fingers.

A level approach is important when assessing the motor sphere of children with cerebral palsy, taking into account the peculiarities of the clinical and pathophysiological structure of abnormalities in the development of the motor sphere caused by insufficiency of various parts of the nervous system. For example, if the subcortical level of organization of movements is insufficient, disturbances in tone, rhythm, development of primary automatisms and expressive movements are observed. When the cortical level is damaged, strength, accuracy of movements, and the formation of objective actions are affected.

With cerebral palsy, there are disturbances in muscle tone, which plays a leading role in the pre-setting of movement, their resistance, stability, and elasticity. If the tonic function is insufficient at an early age, the formation of a number of reflexes that ensure holding the head, sitting, standing, and maintaining posture is disrupted. At an older age, muscle tone disorders have a negative impact on performance and learning. Vallon (1967) noted that pathological muscle tone in a child causes hand fatigue, rapid general fatigue, and impaired attention. Pathological hypertonicity with postural tension and insufficient plasticity also lead to rapid fatigue and decreased attention. This is especially clearly reflected in the child’s drawings and writing. Due to the constraint of movements, the line does not reach the end; the drawing is small in size and has intermittent lines. Impaired tone reflects a deficit of subcortical functions in children with cerebral palsy. Insufficiency of subcortical formations leads to

disruption in the formation of automatic movements. The child has! the synchronization of movements of the legs and arms when walking and turning the body suffers, underdevelopment of expressive movements is observed, V primarily facial expressions, especially important in the process of communication. A lag in the development of expressive movements in the early stages of childhood, when speech is not yet sufficiently developed, aggravates the delay in his mental development. For example, significant underdevelopment of expressive motor skills is observed in mental retardation. This is manifested in lack of expression, impoverishment, monotony of facial expressions, gestures, protective and automatic movements.

Pathology of the cortical level of movements creates a variety of symptoms of motor dysfunction.

If the nuclear zones of the sensorimotor regions are damaged, individual components of movement will suffer: its strength, accuracy and speed. grow, what is observed when a child’s limbs are paralyzed. In pathologies of both premotor and postcentral parts of the brain, disturbances of integral motor acts are observed, united by the general name of apraxia.

In the studies of N.A. Bernstein, and then A.R. Luria, it was shown that during normal development, premotor systems work as a kind of intermediaries that establish and maintain connections between the cortical and extrapyramidal systems (Bernstein N.A. ., 1947). This is reflected in the nature of the disorders. With a premotor defect, dysfunction of the “kinetic melody” of movement occurs (A. R. Luria, 1962). From smooth it turns into jerky, disautomated, consisting from separate elements not related to each other. At postcentral disorders of the cerebral cortex are observed \ is given the so-called afferent apraxia with insufficiency]*) of the cortical analysis of kinesthetic impulses, expressed | in difficulties in choosing the desired combination of movements (A. R. Luriya, 1962).

However, when analyzing movement disorders in a child, it is necessary to remember that in childhood the motor system, especially its individual aspects, are still in the process of formation. ] Therefore, children show less clarity than adults, lo-1

severity and isolation of movement disorders. With cerebral palsy, diffuse symptoms are observed, combining the phenomena of damage in the motor sphere with its underdevelopment.

Phenomena of underdevelopment include synkinesis: involuntary movements not related in meaning to voluntary movements. For example, when a child tries to raise one arm, he simultaneously raises the other; When you move the fingers of one hand, similar movements occur in the other. Synkinesias are also observed in healthy children, especially in the early periods, but with age they decrease and are no longer observed in adolescence. With cerebral palsy, they occur in a child and adolescent for a long time, and in severe cases they accompany a person throughout his life.

The second important direction in the psychological diagnosis of preschoolers with cerebral palsy is the assessment of their sensory-perceptual functions.

Cerebral palsy (cerebral palsy) is a disease of the nervous system in which coordination of speech and movement is impaired, intellectual development is delayed, and muscular and motor systems are disrupted. These disorders are secondary and appear against the background of brain abnormalities. Damage to the musculoskeletal system occurs in the womb, during childbirth or in the early postpartum period.

Infantile paralysis usually appears at an early age. Changes in the brain that can occur in adults for a variety of reasons have different consequences.

The main causes of cerebral palsy in children

There are many factors and causes that predispose children to cerebral palsy.

The main reasons are:

Genetic factors, heredity. Deviations in the genetic apparatus of parents contribute to the occurrence of cerebral palsy in children.
Oxygen starvation and impaired blood supply. They can occur during pregnancy and childbirth, with concomitant hemorrhage and vascular disorders.
Infectious cause. After birth, the child may suffer meningitis, encephalitis, arachnoiditis; due to these diseases, cerebral palsy may occur. In this case, the disease is quite severe. This is evidenced by poor test results in which pathogens are detected.
Toxic and poisonous drugs acting on the fetus. This is due to taking strong drugs during pregnancy, working in unfavorable conditions where the pregnant woman comes into contact with various chemicals and other harmful substances.
Physical factors. Irradiation and radiation affecting the body of the expectant mother subsequently negatively affect the mental and embryonic development of the child.
Mechanical factor. Damage to the baby's brain during childbirth or some time after it. By negligence, a pregnant woman can be injured before giving birth, which can also cause pathological changes in the child.

The appearance of this pathology in children is due to many factors. In this regard, there are 3 groups of cerebral palsy.

1 group. True, not acquired cerebral palsy. The disease is inherited and is primary; the child is born with the pathology. In this case, there are genetic changes in the brain and developmental disorders. The size and volume of the brain is small, the cerebral cortex is underdeveloped, and the study reveals pathological disorders in anatomical and functional terms. The child's brain is paralyzed and does not perform all basic functions.

2nd group. False, acquired cerebral palsy. The occurrence of acquired cerebral palsy is facilitated by a traumatic situation and hemorrhages in the child’s brain during childbirth. This leads to the death of certain areas of the brain. Also, acquired cerebral palsy can be caused by exposure to toxic substances, after severe infectious diseases, etc. As a result of all these signs, a severe picture of cerebral palsy is formed. Despite the fact that the brain and nervous system are affected, the child can move independently and is capable of self-care.

3rd group. False, acquired cerebral palsy. This group has another name - false or secondary cerebral palsy syndrome. Unlike other types, this type occurs quite often.

Before birth, the child is fully formed; from the point of view of biological and intellectual functions, he is full-fledged. Injuries received during childbirth contribute to the disruption of certain parts of the brain, which then lead to paralysis of certain of its functions. Children with false cerebral palsy syndrome are no different in appearance from others. They retain intelligence, which distinguishes them from other types of the syndrome. For such children there is every chance of further recovery.

Symptoms and signs of cerebral palsy

The main symptoms that indicate brain damage can be detected some time after birth, and they can gradually appear in infancy and older age.

The main signs of cerebral palsy include:

Rigidity
Tremor of limbs
Athetosis
Spasticity
Ataxia (impaired coordination)
Inability to maintain balance
When walking, stepping on your toes
Hearing and vision impairment
Anxiety and poor sleep
Trembling and convulsions
Epilepsy
Speech development disorder
Delayed emotional and mental development
Urinary system disorders

Signs of cerebral palsy can be noticeable to parents and others, and some of them can only be noticed by a specialist. Depending on where the pathological foci are located in the brain, the child has various signs and symptoms of cerebral palsy.

Both in infancy and in adulthood, the skills table can be used to determine the existing signs of cerebral palsy. Only a qualified specialist can make an accurate diagnosis.

Forms of cerebral palsy

Depending on the degree and location of the anomalies, several forms of cerebral palsy are distinguished. Based on the type of movement disorder, the following forms are distinguished:

Spastic
Dyskinetic
Ataxic
Mixed

In the spastic form, the shoulder and hand on one side of the body are affected. There may be disturbances in vision, attention, speech and mental development. Children suffering from this pathology begin to walk late and move mainly on their heels, since the tendons of the heels are stiff.

Spastic diplegia is characterized by damage to the muscles of the lower extremities of both legs. At an early age, contractures form, leading to anatomical pathology of the spine and joints.

The dyskinetic form occurs in children who have had hemolytic disease. This form is characterized by involuntary muscle movements that occur in different parts of the body. They are called dyskinesis. The child's movements are slow and stringy and may be accompanied by cramps with muscle contractions. At the same time, the children’s usual posture of individual parts of the body is disrupted. There are no changes observed in the mental and intellectual development of children. They can be fully trained in educational institutions; they are inclined to live a normal life in a children's group.

The manifestation of the ataxic form of cerebral palsy is characterized by a decrease in muscle tone and the presence of strong convulsive reflexes in the tendon. Children with the ataxic form have speech impairment. This is caused by paralysis of the vocal cords, laryngeal muscles, etc. Such children are mentally retarded and difficult to teach.

Depending on the damage to a particular motor system of the brain (cerebellar, pyramidal, extrapyramidal), a specific form of the disease is distinguished. When several forms and variants of diseases with damage to parts of the brain are combined, a mixed form of cerebral palsy occurs.

Diagnosis and treatment of cerebral palsy

Often, some symptoms in newborns are transient, and a definitive diagnosis cannot be made until a couple of years after birth.

Cerebral palsy can be determined by monitoring whether the child has any abnormalities in intellectual and physical development, test data, and magnetic resonance imaging.
To identify cerebral palsy syndrome, a number of measures are carried out:
Analysis of all available information about the child’s illnesses
Physical examination (hearing, vision, posture, etc.)
Detection of a latent form of the disease
To exclude any other diseases, additional brain tests are prescribed: ultrasound examination, tomography, questionnaires.

Carrying out all diagnostic measures to identify the form of the disease allows you to make a correct and final diagnosis.

Treatment of cerebral palsy is based on training that can reduce the severity of the defects. These are mainly psychophysical stress. Various types of therapy are used to improve muscle function. A speech therapist works with a sick child to develop speech. In order to maintain balance and walking, various orthopedic devices and special fixators are used.

In addition, treatment of infantile paralysis includes massage courses and physical therapy. Doctors recommend taking medications to improve microcirculation and nourish nerve tissue.

One of the successful methods in the treatment of cerebral palsy is dolphin therapy.

Dolphins establish contact with sick children. In turn, touching dolphins activates reflex zones in children, which are responsible for the nervous system. The hydromassage effect is created by the dolphin's fin, while the water trains the muscles and reduces the load on the joints.

For preventive purposes, the drugs Diazepam, Baclofen, Dantrolene, etc. are prescribed to relax muscles and contractures. Injecting Botox into the affected muscle has a beneficial effect. Anticonvulsants are used for seizures. Passivity of movements in the joint, i.e. contracture is treated surgically. The procedure of dividing the tendon is called tenotomy.

If you start a course of treatment and rehabilitation measures for children with cerebral palsy, you can avoid major developmental deviations.

Corrective work with children with cerebral palsy

The main directions and tasks of correctional pedagogical work with children in preschool age:

Formation and correction of temporal and spatial relationships
Development of emotional, play, speech and other types of activities with others
Development of motor coordination and functional abilities of the hands
Development of the speed of perception of objects and phenomena
Normalization of muscle tone and motility of the articulatory apparatus
Development of voice, prosody and speech breathing
Correction of pronunciation problems
Education for self-care and personal hygiene

For children with movement disorders, various light physical activities or therapeutic exercises are indicated, aimed at reducing spasticity and hyperkinesis, stimulating the function of paretic muscles, and increasing the mobility of the spine and joints. In addition, exercises and loads allow you to create a positive and emotional mood.

Exercises in a pool with balls and fitball gymnastics help relax muscles, and also increase their contractility, improve blood circulation and lymphatic drainage. The convexity ball is used to correct spinal deformities.

In corrective gymnastics, exercises with objects are often used. They develop strength, agility and coordination of movements. Some types of such exercises: climbing over a small fence while not letting go of the stick, quickly passing the ball behind your back, etc.

Corrective work helps to reduce small reflexes and increase range of motion.

Basic exercises for working with CPC children:

Exercises to stretch and strengthen muscles and
Exercises to develop muscle sensitivity
Training exercises for relaxation, relieving spasms, tension and cramps
Training exercises for learning to walk normally
Training exercises for the senses
Vertical lifting exercises
During physical activity, a special place is given to corrective and breathing exercises.

Complex sensory stimuli effectively influence motor abilities. Among them are:

Visual. Almost all exercises are performed in front of a mirror. Tactile. Stroking various parts of the body, resting on a surface that is covered with fabrics made of various materials, walking on sand, etc.
Proprioceptive. Resistance exercises, alternating them with open and closed eyes, etc.
It is useful to perform all exercises to music.
During physical exercises, not only the child’s age and his qualitative pathological changes in the body are taken into account, but mainly his psychological characteristics and the level of motor development.

Children with such a serious illness as cerebral palsy are promptly provided with medical, psychological, pedagogical, speech therapy and social assistance. Proper training in movements, the use of therapeutic exercises, hydrotherapy, massage and orthopedic means have a huge impact on the development of the child’s body. can be aimed at relaxing and strengthening the tongue and lips, neck muscles, facial and lip muscles. To do this, vibration and acupressure massage of the facial muscles is performed.

At the same time, the effectiveness of physiotherapeutic and speech therapy may increase with the simultaneous use of drug treatment.

In the attached video you can see an example of therapeutic exercises for children with cerebral palsy.

Correctional and therapeutic psychological work must be comprehensive. To do this, you should be guided by the actions of specialists in various fields and follow the appropriate recommendations. The sooner work begins with a person suffering from cerebral palsy, the better for him.

It is important to constantly monitor the child’s condition as his psycho-speech and physical development continues.

Larisa Basyrova
Guidelines for working with children with cerebral palsy

Preparatory group (6 - 7 years)

Children with musculoskeletal disorders usually include children with cerebral palsy (cerebral palsy).

Cerebral palsy is a group of motor disorders that arise as a result of damage to the motor areas and motor pathways of the brain.

The main feature of cerebral palsy is the existence of motor impairments from birth and their close connection with sensory impairments.

Due to motor impairments of varying degrees, the child becomes completely dependent on adults from birth. This negatively affects the emotional sphere of the child, he lacks initiative and develops passivity in actions.

A feature of mental development in cerebral palsy is not only its slow pace, but also its uneven nature, acceleration in the development of some functions, and the lag of others.

Disorders of attention and memory are manifested in increased distractibility, inability to concentrate attention for a long time, narrowness of its volume, predominance of verbal memory over visual and tactile.

Violation of spatial gnosis: manifests itself in the slow formation of concepts that determine the position items and parts of one’s own body in space, inability to recognize and reproduce geometric shapes, to put parts together into a whole.

The intellectual development of children with cerebral palsy may be intact, but somewhat reduced. According to E. S. Kalizhnyuk, children with cerebral palsy can be divided into two groups depending on the degree of intellectual impairment (mental retardation and atypical form of oligophrenia).

Children with cerebral palsy are characterized by underdevelopment of the highest forms of mental activity - abstract thinking.

Characteristic manifestations of speech disorders in such children are various disorders of the sound-pronunciation aspect of speech. That is why the speech of these children is slurred and difficult to understand for others. The severity of disturbances in the sound-pronunciation aspect of speech is enhanced by respiratory disorders: speech exhalation is shortened, during speech the child takes separate breaths, speech loses smoothness and expressiveness.

The letter shows errors in the graphic representation of letters, numbers, their mirroring, and asymmetry.

Almost all children with cerebral palsy are characterized by increased fatigue. During goal-directed activities that require the participation of mental processes, they become lethargic faster than their healthy peers, and they find it difficult to concentrate on the task. They may refuse to complete a task if they are unable to complete it and lose interest in it completely.

Personal development in pupils with cerebral palsy has its own characteristics. Emotional disturbances manifest themselves in the form of increased excitability, a tendency to mood swings, and the appearance of fears. The tendency to fluctuate mood is often combined with inertia of emotional reactions. So, once a child starts crying or laughing, he cannot stop. Increased emotional excitability is often combined with tearfulness, irritability, capriciousness, and protest reactions, which intensify in a new environment for the child and when tired.

An important development factor is also the child’s awareness of himself as part of a team that does useful work. Children are always most interested in activities that bring the greatest practical benefit to the team. This encourages them to engage in various types of socially useful work.

Children with cerebral palsy are very sensitive to the attitude of others towards them and react to any change in their behavior. Such children are very impressionable, they are easy to offend, cause them dissatisfaction or some kind of negative reaction.

1. Corrective work it is necessary to start as early as possible, since due to a violation of certain mental functions, other mental processes may be disrupted for the second time. Corrective measures should be carried out through a variety of games, since the leading activity at this age is play. The game contributes to the favorable development of the child’s psyche and speech, and the acquisition of various skills and abilities.

2. It is important to bring together children with different motor abilities during classes, as this promotes production desire to improve their motor skills and imitate those children whose skills are more developed.

3. It is important to competently organize the motor mode during the entire period of children’s stay in the preschool educational institution. It is necessary to select the most comfortable position for the child during desk work, games, sleep.

4. During a correctional lesson, it is important to carry out uniform dynamic pauses in a timely manner (after 10 minutes).

5. The duration of correctional classes, increasing the complexity of tasks, increasing the amplitude of actions should occur gradually, taking into account the individual capabilities of the child.

6. During the lesson it is important to activate operation of all analyzers(motor, visual, auditory, kinesthetic). Children should listen, watch, speak, and the use of music and dance has a beneficial effect on the development of motor skills in such children.

7. In the process of training and education, it is important for the teacher to pay attention to approval in case of failures, encouragement for the slightest success of such a child.

8. The teacher needs to know the positive character traits that can be relied upon in the process of educational activities, as well as the negative ones that require special attention from the teacher.

9. Develop a motor skill, as well as cultivate a correct idea of it through sensation movements: formation of self-service skills; development of practical activities and preparation of the hand for writing. It is important to remember that mastering motor skills occurs in stages and requires a lot of time and a lot of patience on the part of the adult. It is advisable to use the development of motor skills in the form of interesting and understandable games for children that correspond to their motor capabilities.

10. Pay special attention to the development of sensory standards.

11. To correct kinesthesia disorders, play games that help children identify objects by touch.

12. Manual skills need to be developed step by step: teach how to arbitrarily pick up and put down objects, transfer them from hand to hand, put them in a certain place, select objects.

13. Develop constructive abilities in various types of productive creative activities, while the teacher works with a child"hand in hand", gradually accustoming him to doing it independently.

14. Before moving on to the process of learning to read and write, it is important to teach your child how to construct asymmetrical letters from sticks and trace letters using a pencil.

15. Teach children spatial orientation in various directions and when an object is distant through games, including active games.

16. It is also necessary to include in classes exercises based on the visual or visual-tactile analyzer. For example, when mastering mathematical operations that require the child to count, use visual objects and manipulate them.

17. It is necessary to stimulate the child’s speech activity using description items, actions, making and guessing riddles. Use games and exercises to develop correct speech breathing and a strong air stream.

18. Use onomatopoeia games that promote correct speech pronunciation.

19. It is necessary to raise a child with cerebral palsy as a full-fledged member of society, no worse than others, and treat him accordingly!

Bibliography

1. Arbashina N. A. Cerebral motor disorders. Saratov: Privolzh. book publishing house, 2007.

2. Epifantseva T. B. Handbook for a teacher-defectologist. Rostov n/ D: Phoenix, 2006.

3. Children with developmental disabilities. Methodical. allowance. (Author – compiler N. D. Shmatko)- M.: "Aquarium LTD", 2001.

Publications on the topic:

Recommendation for teachers “Health-saving technology “Su-Jok therapy” with children of senior preschool age”(“Health-saving technology “Su-Jok therapy” with children of senior preschool age in the practical work of a speech therapist in preschool.

Using the “Pertra” play set in working with preschool children Preschool childhood is a very short period in a person’s life, only seven years. But they are of enduring importance as development proceeds.

The goal of the work is to form and develop in children the skills and abilities of safe behavior in the surrounding road transport environment. Tasks.

Basics of working with children with disabilities“... skillfully, intelligently, wisely, subtly, heartily touch each of the thousand facets, find the one that, if polished like a diamond, will sparkle.

Methodological recommendations for the project “Sounds of classical music around us” PROJECT ON THE TOPIC: "THE SOUNDS OF CLASSICAL MUSIC AROUND US". “A man became a man when he heard the whisper of leaves, the murmur of a spring stream.

Methodological recommendation for teachers

*Name and content of the block*	*Psychocorrectional tasks and techniques*	*Forms of cerebral palsy*
Motivational. The child’s inability to identify, understand and accept the goals of action	Formation of cognitive motives: - creation of problematic learning situations; - stimulating the child’s activity in class; - analysis of the type of family upbringing (with a dominant type, the child’s cognitive activity decreases). Techniques: - creation of game learning situations; - didactic and educational games	Delayed development in children with motor disorders due to socio-pedagogical neglect
Operational and regulatory. Inability to plan your activities in terms of time and content	Teaching a child to plan activities over time. Preliminary organization of orientation in the task. Preliminary analysis with the child of the means of activity used.	All forms of cerebral palsy in combination with mental retardation of cerebral-organic origin
Control unit. The child’s inability to control his actions and make necessary adjustments	Performance-based monitoring training. Training in control by method of activity. Training in control as the activity progresses. Techniques: - didactic games and exercises for attention, memory, observation; - training in designing and drawing from models	Delayed development in children with cerebral palsy

Features of conducting classes with children with cerebral palsy. Psychological support program for a child with cerebral palsy

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