Children with severe forms of cerebral palsy are children with multiple disorders, including the leading ones - motor and sensitive (sensory) disorders. This is a very difficult contingent. Correctional and developmental work can be quite productive if in the classes much attention is paid to working with the body and body-oriented therapy techniques are used. The child in classes is always the subject of the process and relationships, so children come to classes with pleasure and feel successful. Starting group work with the needs of the body of each individual child, relationships of cooperation and mutual respect are built in which children acquire the necessary social experience, as a result of which their behavior and self-esteem change.
Psychophysical rehabilitation of children with cerebral palsy of middle, senior and school age has its own characteristics, since by this time children have already formed pathological stereotypes of postures and movements. The pace of obtaining positive dynamics as a result of physical culture and health work is sharply slowed down, which negatively affects the further development of their cognitive activity and limits the possibilities of their social adaptation. The process of restructuring pathological postures and movements in children with cerebral palsy, as a rule, takes a long time and is difficult, since the old, fixed pathological “body scheme” is convenient and familiar for them, and any attempt to normalize a vicious position causes a feeling of discomfort and a new unusual action. Specialists working with the body (physical therapy teachers, adaptive physical education specialists, psychologists who use body-oriented methods in their work, etc.) are faced with the child’s negative emotions, his reluctance to take an active and even passive part in the restructuring of the fixed pathological stereotype.
A specially organized environment in the sensory room, filled with a variety of stimuli, allows you to improve and develop not only the sensorimotor skills of a child with cerebral palsy, but also significantly stabilize the psycho-emotional state, create conditions for stimulating speech activity, form a more positive self-esteem, and significantly improve the quality of life.
A particularly important point is the ability to unite children into groups and conduct group classes. During group classes, children's inclination to imitate is realized, and the elements of competition present in classes push the child to master new motor skills that require significant active volitional efforts. These abilities are especially clearly manifested when constructing a lesson in the form of a game that stimulates motor activity, which is most appropriate for children of preschool and school age.
As is known, the developing brain has great compensatory capabilities. In its structural and functional maturation, among other factors, the leading role of the endogenous mechanism - motor afferentation - is confirmed. This, first of all, determines the need for constant use in the complex of rehabilitation measures for cerebral palsy of psychophysical exercises, body-oriented psychocorrection techniques, as a pathogenetically based method of correctional, developmental and therapeutic work with an emphasis on the active participation of the child himself in the rehabilitation process.
Provided that a relationship based on empathy and cooperation is established between the specialist and the child, it becomes possible to develop his conscious attitude towards the rehabilitation process and interest in achieving positive results. Then the child's volitional efforts can be aimed at correcting motor defects using various means.
Motor disturbances, physical inactivity and stiffness in children with cerebral palsy often create the false impression that they have severe mental retardation. However, during observation and communication, intellectual integrity and differentiation of emotions are revealed, deep personal reactions are noted - touchiness, experiencing one’s defect, and in the process of psychocorrectional work, positive dynamics in psycho-emotional development are noted.
Under the influence of psychophysical exercises, nerve impulses arise in muscles, tendons, and joints, traveling to the central nervous system and stimulating the development of motor areas of the brain. In the process of working with the body, postures and position of the limbs are normalized, muscle tone decreases, and violent movements are reduced or overcome. The child begins to correctly sense the position of various parts of the body and his movements, which is a powerful stimulus for the development and improvement of motor functions and skills.
The use of body-oriented methods aims to influence the nature of sensory corrections. A special role is given to movement as a psychocorrectional factor. At the same time, psychophysical exercises are a nonspecific stimulus that affects the mental and physiological mechanisms involved in the development and manifestation of the disease. Therefore, working with the body helps to process the child’s traumatic psycho-emotional experience. Let us refer to the words of L. Burbo (2001): “The body is the best friend and adviser.” The child has all the necessary resources at any time. However, certain methods are needed to awaken them and teach him to consciously use them. The concept of a psychological “body diagram” was introduced by P. Schilder to describe a person’s system of ideas about the physical side of his own “I”, about his body - a kind of bodily-psychological “map”. Neurophysiologically, the corresponding primary or projection zones of the cerebral cortex (the primary sensorimotor zone - the precentral gyrus of the frontal lobe, the primary somatosensory area - the postcentral gyrus of the parietal lobe), as well as secondary, associative zones that perform integrative functions (the inferior parietal gyrus - zone of two-dimensional-spatial cutaneous sensitivity and the inferior parietal gyrus - the region of the primary brain circuit of the body). In the modern view, the body diagram is created on the basis of the functional unification of various parts of the brain, responsible both for sensory-discriminatory processes (listed above), and for cognitive-evaluative and motivational-emotional processes. (Quoted by M. Sandomirsky, 2007).
As M. Feldenkreiz states, “every person moves, feels, thinks and speaks in his own way, that is, in a way corresponding to the self-portrait that he continues to paint throughout his life. To change his way of acting, he must change the self-portrait that he carries within himself. Often our ideas about ourselves, expressed in our “body diagram,” are distorted or incomplete...” The essence of the Feldenkraitz method is to awaken within yourself the ability to find your own ways of moving, expanding your range of movements through experimental testing of different options. Thus, bodily sensitivity noticeably improves, and the “body diagram” can be significantly refined and expanded. The nervous system and the musculoskeletal system are closely related to each other. Any activation of the nervous system is accompanied by a change in the state of the muscles, and the brain, in turn, constantly receives information about every change in body position, joints, muscle tension, etc. This interconnection of systems allows, on the one hand, to recognize the internal state of the nervous system by muscle tension, and, on the other hand, to influence the nervous system through muscles and joints. Muscle tension is an external, visible picture of the state of the nervous system. Every thought and every feeling finds its expression in movement. Strong emotions, such as rage and fear, cause noticeable changes in the muscles of the body.
External changes lead to internal changes. Next, we present the conclusions that M. Feldenkreiz draws, and on the basis of which we build our work on body-oriented psychocorrection with children with severe motor pathology:
All muscular activity is movement;
The nervous system is primarily concerned with movement;
Movements reflect the state of the nervous system;
The quality of movement is most easily determined from the outside;
The movements bring great experience;
Sensations, feelings and thoughts are based on movements;
Movement is the basis of self-awareness.
Thus, Feldenkraitz considered movement the most effective means of achieving fundamental changes in human life in general.
Body language is a universal language for all people, including those with severe motor impairments. It is likely that the involuntary, unconscious movements of a child with cerebral palsy are a consequence of the reaction of parts of the brain, nervous system and body to the psycho-emotional or physical trauma experienced during childbirth (89% of parents of children with cerebral palsy indicate birth trauma) or in infancy. Working with unconscious, reflexive (spasticity, hyperkinesis) movements and translating them into conscious, controlled ones helps to harmonize the interaction between the brain and body. According to Robert Masters, “We do not know how to connect movements, sensations, thoughts and feelings, and we do not know how the interaction of mind and body determines who we are and what capabilities we really have.”
Involuntary movements (hyperkinesis and spasticity) of a child with cerebral palsy suggest that he once needed these movements for something! “Every process strives for completion,” says Arnold Mindell. Movement is a process. Therefore, every movement strives for completion. Helping the child work with these movements, which are completely natural for him, feel and complete the process that once began, but was not completed, transform unconscious movements into conscious, regulated, controlled ones - this is the task that we set in our classes in the sensory room when working with the body.
Such work is always productive; at the first stage it leads to an improvement in the child’s motor sphere: a decrease in muscle spasticity, a decrease in hyperkinesis, and in case of muscle rigidity, an increase in muscle tone and the development of arbitrariness in movements. Also, and, in our opinion, this is a very important factor, the child’s attitude towards himself changes, his own capabilities are assessed in a new way, the child begins to experiment and move differently than before. In the process of working with the body, other problems are also solved: behavior improves, motivation for activity and cooperation appears, and the emotional state significantly improves. The situation of success and the acquisition of new bodily experience helps to discover resources that were not previously used by the child himself.
Thus, body-oriented psychocorrection with children with severe motor pathology, in our opinion, is an important link in correctional and developmental work that allows us to optimize the entire process of correction and development of such children and make it more successful and productive.
The presence of a parent in classes is very important. After all, it is necessary not only to teach the child to move and treat himself in a new way, but also to show the parent what the child can do, to teach him to perceive him in a new way. Parents learn to interact correctly with the child, learn to work with the body and continue this work at home. It is always pleasant to watch how the shyness of mothers and fathers passes, they rejoice at the achievements of their child and begin to be proud of him.
Working with children with severe forms of cerebral palsy has a number of features. Most often, these children cannot speak, and the specialist cannot get an answer to any of his questions. But body language speaks louder than any other language. If a specialist organizes the work correctly, based on the needs of this particular child, then the child cooperates with pleasure: plays games with his legs, arms, etc.
In any work with the body, the basis is the differentiation by a person of sensations of tension and relaxation of the whole body, its parts or some muscle group. But how can you explain to a child what tension and relaxation are if his body is in constant tension and relaxes only during night sleep, and he does not know how this happens, since this process is not conscious to him? How to teach him to be aware of what is happening in his body, arm, leg? How to teach control of involuntary movements?
A differentiated approach in correctional and developmental work is, first of all, working with the potential that each individual child has, taking into account his characteristics and his capabilities. It is very important to go from the child, his movements, his needs. Therefore, we begin working with the body by studying the capabilities of the body of each individual child. First of all, the presence of voluntary movements is of interest to any specialist. But in children with severe forms of cerebral palsy, voluntary movement is practically absent or is very difficult. Work with the body in such cases begins with involuntary movement - hyperkinesis or strong spasticity. Simply put, we work with what we have, turning the whole process of working with the body into a fun game.
Communal
government agency
"Secondary school named after R. Marsekov"
government agency
"Department of Education of the Ulansky District"
Teacher-psychologist of a comprehensive school: Ashkanova I.A.
Explanatory note
Features of development of children with cerebral palsy (CP)
Cerebral palsy (CP) is a disease of the central nervous system with primary damage to the motor areas and motor pathways of the brain.
Motor disorders in this disease are the leading defect and represent a unique anomaly of motor development, which, without appropriate correction and compensation, has an adverse effect on the entire course of formation of the child’s neuropsychic functions.
Damage to the motor sphere in cerebral palsy can be expressed to varying degrees: motor impairments can be so severe that they completely deprive children of the opportunity to move freely; with a sufficient range of movements; with mild disturbances in muscle tone, dyspraxia is observed; children have difficulty mastering self-care skills.
A weak sense of one's movements and difficulty in acting with objects are the causes of insufficiency of active touch and recognition by touch (stereognosis). This, in turn, further complicates the development of purposeful practical actions and affects the mental development of children.
Motor disorders that limit practical activities and complicate the development of independent movement and self-care skills often make a sick child completely dependent on his immediate environment.
Features of the development of the children's brain, its plasticity and ability to compensate for impaired functions determine the importance of early correctional and developmental work in cerebral palsy.
The formation of motor functions, including fine hand movements, occurs in the process of the child’s interaction with the surrounding objective world.
Manipulative actions with objects are mastered by the child through learning in the process of his communication with adults. Thus, the child develops objective thinking (I.M. Sechenov), thinking in action (I.P. Pavlov). In addition, the child’s motor activity, his object-manipulative activity, which contributes to the development of fine movements of the hands and fingers, has a stimulating effect on the child’s speech function, on the development of his sensory and motor aspects of speech (M.M. Koltsova).
The purpose of this program is - consistent development and correction of hand movements, the formation of fine motor skills, which ensures the timely development of speech, the child’s personality, and adaptation in society.
Basic principles for constructing correctional and developmental work:
Corrective and developmental work is based on a thorough study of impaired and intact functions. A differentiated approach during classes involves taking into account the child’s capabilities and building a system of exercises located in his zone of proximal development.
The use of kinesthetic stimulation in the development and correction of hand movements.
Creative use of such basic didactic principles as an individual approach, systematicity and consistency in the presentation of material, activity and visibility. These teaching principles are related to each other and interdependent, but must be used taking into account the specific characteristics of children suffering from CP.
Organization of classes within the framework of leading activities.
The main requirement for teachers is compliance with the protective regime.
Under the influence of psychophysical exercises, nerve impulses arise in muscles, tendons, and joints, traveling to the central nervous system and stimulating the development of motor areas of the brain. In the process of working with the body, postures and position of the limbs are normalized, muscle tone decreases, and violent movements are reduced or overcome. The child begins to correctly sense the position of various parts of the body and his movements, which is a powerful stimulus for the development and improvement of motor functions and skills.
Diagnosis: cerebral palsy, atonic-astatic form of moderate severity. Hyperkinesthetic syndrome. Pseudobulbar dysarthria, OHP level 3. Complex genesis of mental retardation, equinus foot, disabled child.
Calendar-thematic lesson plan
(first year of correction and development)
№ lesson
date
carrying out
Finger drawing.
Game "Guess by touch".
Lacing circles.
Game "Guess by touch".
Self-massage. Finger games.
Stencil drawing.
Game "What's in the bag?"
Self-massage. Finger games.
Tying ribbons into a knot.
Game "What's in the bag?"
Self-massage. Finger games.
Drawing straight lines using a ruler.
Game "Body figures".
Self-massage. Finger games.
Leaves applique.
Game "Guess by touch".
Self-massage. Finger games.
Blotography.
Game "Guess by touch".
Self-massage. Finger games.
Application “Apple” (colored paper).
Game "Body figures".
Self-massage. Finger games.
Exercises "Thread writing".
Game "What has changed?"
Self-massage. Finger games.
Making crafts from Balls threads.
Game "What has changed?"
Self-massage. Finger games.
Making crafts from "Rug" threads.
Game "Find the object".
Self-massage. Finger games.
Mosaic from seeds.
Game "Guess by touch".
Self-massage. Finger games.
Mosaic made of cotton balls.
Game "Find the object".
Self-massage. Finger games.
Mosaic made of paper balls.
Game "Shop".
Self-massage. Finger games.
Construction from ready-made forms.
Game "Shop".
Self-massage. Finger games.
Braiding.
Game "Memorize and find".
Self-massage. Finger games.
Twisted threads.
Game "Memorize and find".
Self-massage. Finger games.
Drawing with plasticine.
Game "Remember the couple".
Self-massage. Finger games.
Drawing with plasticine.
Game "Remember the couple".
Self-massage. Finger games.
Salty dough. Modeling.
Game “Patch the Rug”.
Self-massage. Finger games.
Salty dough. Modeling.
Game “Patch the Rug”.
Self-massage. Finger games.
Salty dough. Modeling.
Self-massage. Finger games.
Origami from circles.
Game "Gather beads into garlands."
Self-massage. Finger games.
Origami.
Game "Columbus Egg".
Self-massage. Finger games.
Origami.
Game "Columbus Egg".
Self-massage. Finger games.
New Year cards.
Game “Name the Same One”.
Self-massage. Finger games.
New Year cards.
Game “Name the Same One”.
Self-massage. Finger games.
New Year's toys "chain".
Game "Experiments".
Self-massage. Finger games.
New Year's toys "Flashlight".
Game "Experiments".
Self-massage. Finger games.
New Year's toy "Christmas tree".
Exercise "Choose quickly."
Self-massage. Finger games.
3 1
Modeling from matches.
Exercise "Choose quickly."
Self-massage. Finger games.
Modeling from matches.
Exercise “Find the extra letter.”
Self-massage. Finger games.
Broken applique.
Exercise “What is common and how is it different?”
Self-massage. Finger games
Broken applique.
Self-massage. Finger games.
Thread graphics.
Self-massage. Finger games
Broken applique.
Exercise "Fourth odd".
Self-massage. Finger games.
Exercises “Make sentences”.
Self-massage. Finger games.
Postcards using the isothread technique.
Self-massage. Finger games.
Exercise "Orientation in space."
Self-massage. Finger games.
Toy with moving parts (tying).
Exercise "Fly".
Self-massage. Finger games.
Symmetrical cutting.
Exercise "Fly".
Self-massage. Finger games.
Symmetrical cutting.
Self-massage. Finger games.
Crafts from cones.
Exercise “Attentive drawing”.
Self-massage. Finger games.
Crafts from cones.
Exercise "Cryptographers".
Self-massage. Finger games.
Exercise "Cryptographers".
Self-massage. Finger games.
Paper craft “Book with butterflies”.
Exercise "Caring".
Self-massage. Finger games.
Exercise "Caring".
Self-massage. Finger games.
Making cardboard tubes.
Exercise "Shop".
Self-massage. Finger games.
Crafts from newspapers.
Exercise “What has changed?”
Self-massage. Finger games.
Crafts from newspapers.
Exercise “Lay out the letters.”
Self-massage. Finger games.
Modeling from buttons.
Exercise “Lay out the letters.”
Self-massage. Finger games.
Modeling from buttons.
Exercise with a ball.
Self-massage. Finger games.
Fabric applique.
Exercise with a ball.
Self-massage. Finger games.
Fabric applique.
Exercise with a ball.
Self-massage. Finger games.
Fringe cutting.
Exercise “Choose a word.”
Self-massage. Finger games.
Fringe cutting.
Exercise “Choose a word.”
Self-massage. Finger games.
Drawing according to the diagram.
Exercise “Four Elements”.
Self-massage. Finger games.
Drawing according to the diagram.
Exercise “Four Elements”.
Self-massage. Finger games.
Drawing according to the diagram.
Self-massage. Finger games.
Exercise “Look around.”
Self-massage. Finger games.
Collage of various materials.
Exercise “Look around.”
Self-massage. Finger games.
Crafts made from plasticine.
Self-massage. Finger games.
Crafts made from plasticine.
Exercise “Be attentive to words.”
Self-massage. Finger games.
Painting patterns.
Exercise "Guess".
Self-massage. Finger games.
Painting patterns.
Exercise "Guess".
Self-massage. Finger games.
Painting patterns.
Exercise “Say it in one word.”
Self-massage. Finger games.
Exercise “Remember the pair.”
Self-massage. Finger games.
Modeling using natural materials.
Exercise “Remember the pair.”
Self-massage. Finger games.
Calendar and thematic planning of correctional and developmental classes (art techniques) second year of correction and development
Technology
Materials
Samples
the date of the
Drawing from diagrams and stencils
Watercolors, pencils, album, felt-tip pens, blank diagrams.
Modeling from salt dough.
Salty dough
Appendix No. 1
Paper plastics
color paper, cardboard, scissors, glue.
Appendix No. 2
Spirelli technique
Weaving templates, threads, scissors.
Appendix No. 3 
Fabric applications
Templates, pieces of fabric, scissors, glue, cardboard
Appendix No. 4
Ribbon weaving
Satin ribbons
Appendix No. 5
Weaving on a frame
Frame, thread, scissors, needle.
Appendix No. 6.
Nylon dolls
Nylon tights, scissors, half fiber, threads, needle, eyes, pieces of fabric.
Appendix No. 7
1. During classes it is necessary to observe the motor mode:
fixation in a special chair that holds the child in an upright position while sitting or standing;
the use of weights for children with sweeping hyperkinesis (violent movements) that complicate grasping an object (pen, book, etc.) or other educational activities (for example, reading, since hyperkinesis interferes with fixation of gaze and line tracing);
a mandatory break in class for physical education.
2. It is advisable to include in each lesson an exercise on spatial and temporal orientation (for example, put the pen to the right of the notebook; find today's date on the calendar, etc.).
3. For children with increased drooling, monitoring assistance from the teacher is required with a reminder to swallow saliva in order to form a stable habit in the child - control of drooling.
4. It is necessary to pay attention to the state of the child’s emotional-volitional sphere and take it into account during classes (children with cerebral palsy are characterized by increased anxiety, vulnerability, and resentment; for example, hyperkinesis and spasticity can intensify from a loud voice, sharp sound, and even difficulty in performing task or attempt to complete it).
5. For children with severe hand motor impairments (almost always associated with severe speech impairment), an individual selection of tasks in test form is necessary, allowing the child not to give a detailed verbal response.
6. During the lesson, a special speech regime is required: clear, intelligible speech without a sharp rise in voice, the required number of repetitions, emphasized articulation.
7. It is necessary to adapt the volume and nature of educational material to the cognitive capabilities of students, for which it is necessary to significantly detail the system for studying one or another section of the program: educational material should be presented in large portions, it should be complicated gradually, it is necessary to find ways to make difficult tasks easier.
8. To successfully master educational material, pedagogical correctional work is necessary to normalize their activities, which should be carried out in lessons in any subject.
9. A special place should be occupied by lessons in manual labor and drawing, since activity based on a visual object model occupies a significant place in them, which allows the formation of generalized techniques of mental work.
10. It is necessary to teach children to check the quality of their work, both as it progresses and in the final result; At the same time, you need to develop the need for self-control and a conscious attitude towards the work being performed.
11. In cases where, due to his mental state, a student is unable to work in a given lesson, the material should be explained in individual and group lessons.
12. To prevent rapid fatigue or relieve it, it is advisable to switch children from one type of activity to another, to diversify the types of activities.
13. Maintain interest in classes and a good emotional mood of students using colorful didactic material and introducing game moments.
14. The teacher’s soft, friendly tone, attention to the child, and encouragement of his slightest success are extremely important.
15. Each parent must be given recommendations on upbringing, training, and correction of developmental deficiencies, taking into account the age, individual and psychophysical capabilities of their children.
Development of fine motor skills of hands
The personal immaturity of a child suffering from cerebral palsy manifests itself in weakness of volitional attitudes and emotional immaturity. Persistent failures when trying to reproduce the desired movement or action can lead to abandonment of classes. Therefore, any activity should be offered in a playful form that will arouse his interest and, due to positive emotional stimulation, will help to increase mental tone, and, consequently, improve performance.
Massage is one of the types of passive gymnastics. Under its influence, impulses arise in the receptors of the skin and muscles, which, reaching the cerebral cortex, have a tonic effect on the central nervous system, as a result of which its regulatory role in relation to all systems and organs increases.
stringing rings on braid;
work with manuals on fastening zippers, buttons, buttons, hooks, locks of various sizes;
coin sorting;
too much cereal;
working with matches;
working with paper;
modeling (clay, plasticine, dough);
lacing on special frames, boots;
tying knots on a thick rope, cord, thread;
winding thin wire in a colored winding onto a reel, onto your own finger (you get a ring or a spiral);
tightening screws and nuts;
games with construction sets, cubes;
drawing in the air;
drawing with various materials (pencil, pen, chalk, paints, charcoal, etc.);
needlework.
You can start your classes with self-massage:
An exercise in which children will stretch their hands themselves. “Hands are frozen”;
Exercise “Putting on gloves” - pull a glove on each finger;
We rub each finger from the base to the nail;
An exercise in which children are asked to draw with each finger in the air;
Bend each finger in turn;
Straighten each finger in turn;
Children pull their thumb up, and all the rest are clenched into a fist - “flag”;
In this exercise, one hand should be bent into a fist, and the other hand should cover this fist horizontally - a “table”;
Also, bend one hand into a fist, and rest the other with your palm horizontally - “chair”;
Invite the children to press their palm firmly against the table or another palm, and take each finger away in turn - “the fingers are stuck”;
In this exercise you need to connect the thumb, index, middle and ring fingers, and extend the little finger upward - “dog”;
To begin with, cross your fingers, then raise your hands up and spread your fingers - you get “sun rays”;
Perform the exercises one at a time - clench your hand into a fist, then place your palm with an edge on the table, then press your palm to the table. You can gradually speed up the pace of execution - “fist, edge, palm.”
“Fingers say hello” - first you need to reinforce the names of each finger with the children. Then, with the tip of your thumb, touch each tip of the other fingers in turn (hereinafter, first perform the exercise with your leading hand, then with your second hand, and then with both hands, from the thumb to the little finger, and vice versa);
The fingers of one hand simultaneously “hello” the fingers of the second hand;
Exercise “Wasp” - straighten your index finger and rotate it;
“Goat” - straightening the index finger and little finger;
Form two circles by connecting the tips of your thumb and index finger;
“Bunny” or “Ears” - clench your fingers into a fist and straighten only the index and middle fingers;
“Trees” - all fingers are widely spaced.
Outline any figure or object;
Draw an object by dots;
Draw strokes in different directions using stencils;
Draw a pencil along a narrow path and do not move it to the side;
“Double drawings” is a very interesting type of exercise in which children draw different things with both hands; these can be various geometric shapes, or an artistic drawing (it is suggested to draw either two identical objects at the same time, or one drawing with both hands, as if complementing it).
To develop and improve coordination of hand movements, it is recommended to perform the following exercises:
The exercise is performed by counting, with the pace gradually accelerating, and strictly following the verbal instructions:
Make a fist with your left hand, unclench your right hand, and vice versa;
Place the right palm on the edge, bend the left palm into a fist;
Tasks for the development of tactile sensations
Game "Guess by touch"
Prepare planar geometric shapes cut out of wood, plastic, cardboard. Invite your child to play the following game: “Let’s feel this figure together. This is how we run our finger along the edge of the square. This is a corner, it’s sharp, turn it, now move your finger down, again a corner.
Ask your child every time what this figure is. When he has practiced on each figure (circle, square, triangle, rectangle, oval), invite his mind to do the same, but with his eyes closed.
After this, ask the child to find all the circles, all the squares, etc. with his eyes closed. (the selection of figures is made from a variety of figures of different shapes).
Game "What's in the bag?"
Place various toys and small objects (buttons, balls, pine cones, dolls, animals, acorns, etc.) in a bag.
Invite your child to play: “Look what I took out of the bag. Now you get something.” When the child takes out and names all the objects, put everything back and offer to do the same, but with closed eyes, by touch, and name each object. And then let the child take the object out of the bag at the request of the adult (by touch).
Games and exercises to develop tactile-kinesthetic sensitivity.
Game "Body figures"
The adult draws geometric shapes on the child’s palm or back, the child guesses what the adult drew, then the adult and child change places.
Tasks for correction and development of attention
Game "What has changed?"
The child must carefully look at the drawing (2 objects) and answer the question, what has changed?
Quest "Find the object"
Among 8 drawings you must find the same object as the standard.
Memory games
Game "Shop"
You can send your child to the “store” and ask him to remember all the items that need to be bought. They start with 1-2 items, gradually increasing their number to 5-7. in this game it is useful to change roles: both an adult and a child can take turns being a son (or daughter), a mother (or father), and a seller who first listens to the buyer’s order and then goes to pick up the goods. Stores can be different: “Bakery”, “Milk”, “Toys”, etc.
Game "Memorize and find"
To play, you need tables with images of objects and geometric shapes. Show it to your child for 5-10 seconds. a card with images of objects and ask them to remember them so that they can then find them among others at the bottom of the table. The same goes for geometric shapes.
Game "Remember the Pair"
Forms with figures are required for memorization and reproduction.
Explain to your child how he will have to remember the shapes. He looks at the 1st form and tries to remember the proposed pairs of images (figure and sign). Then the form is removed and he is offered a 2nd form - for reproduction, on which he must draw the corresponding pair in the empty cells opposite each figure.
Games for the development of imaginative thinking, the formation of mental operations
Task “Patch the rug”
From four options, choose the appropriate patch for each rug.
Game “Gather beads into garlands”
Offer to connect the beads into garlands, paying attention to the alternation of bead colors, after the adult reads the poem:
Santa Claus walked through the forest past maples and birches,
Past the clearings, past the stumps, walked through the forest for eight days,
He walked through the forest and decorated the Christmas trees with beads.
This night, New Year's Eve, he will take them down for the guys.
Game "Columbus Egg"
Instructions: “Let's try to restore the broken testicle. You have fragments from the “magic egg” and a drawing according to which you can correctly and accurately fold the egg.”
Relaxation exercises
Sketch “From seed to flower”
The adult “gardener” invites the child to turn into a small wrinkled seed (shrink into a ball on the floor, remove his head and cover it with his hands). The gardener treats the seeds very carefully, waters them (strokes them on the head and body), and takes care of them. With the warm spring sun, the seed begins to slowly grow (rise). Its leaves open (arms hang from the head and stretch upward), a stem grows (the body stretches), branches with buds appear (arms to the sides, fingers clenched). A joyful moment comes, and the buds burst (the fists unclench sharply), the sprout turns into a beautiful strong flower.
Breathing exercise “Singer”
Deep breath. At the same time, the arms slowly rise up through the sides. Hold your breath while inhaling.
Exhale with an open strong sound A-A-A. We slowly lower our hands.
Inhale. The arms are raised to shoulder level through the sides. Holding your breath.
Slow deep breath. Raise your arms to chest level. Holding your breath.
Exhale slowly with a strong O-U-U sound. At the same time, the arms are lowered down, the head is on the chest.
Exercise "Fly"
Imagine that you are lying on the beach, the sun is warming you, you don’t want to move. Suddenly a fly flew in and landed on my forehead. To drive away a fly, move your eyebrows. A fly circles near your eyes - blink them, flies from cheek to cheek - inflate each cheek in turn, sits on your chin - move your jaw.
Exercise "Snowman"
Imagine that we found ourselves outside in winter, snow fell and fell on us, and soon we turned into snowmen. (Children spread their tense arms to the sides, puff out their cheeks, make a sad face and stand motionless.) Our snowman stood like that all winter, but then spring came, the sun warmed up, and the snow began to melt. (Children gradually relax, lower their arms, “go limp, turn their faces to the sun” and squat down.)
Exercise “Sunshine”
We played and played and got a little tired. They sat down to rest and dozed off. But here's a ray of sunshine:
touched your eyes - open your eyes;
touched your forehead - move your eyebrows;
touched your nose - wrinkle your nose;
touched your lips - move your lips;
touched your chin - move your jaw;
touched your shoulders - raise and lower your shoulders;
touched your hands - shake your hands;
touched your legs - lie on your back and bounce your legs.
A ray of sunshine played with you and disappeared.
Exercise "Snowflake"
Imagine that snowflakes are falling from the sky, and you catch them with your mouth. And now the snowflake:
lay on your right cheek - inflate it;
lay on your left cheek - inflate it;
lay on your nose - wrinkle your nose;
lay on your forehead - move your eyebrows;
lay on your eyelids - blink your eyes and open them.
The snowfall has ended.
Physical education minutes
“We’ll tell you and show you”
Let's walk happily together
And we bend our knees.
We'll clench our fingers into a fist
And we'll take it behind your back.
Hands to the sides, forward,
And turn right.
Hands to the sides and down
And turn left.
"Two bears were sitting..."
Two bears were sitting
On a thin bitch:
(Squat)
One was reading a newspaper,
(Stretch your arms forward, clench your fists, slightly turn your head to the right and left).
Another was kneading flour.
(Press their fists against each other, make rotational movements)
One peek-a-boo, two peek-a-boo
They both fell into the flour.
(Fall onto the carpet)
Finger games
"My family"
Here's grandpa
Here's grandma
Here's daddy
Here's mommy
Here is my baby
And here is my whole family.
Bend one by one to the palm, starting with the big one, and with the words “Here comes the whole family,” with the other hand, cover the entire fist.
"Our Baby"
This finger is grandpa
This finger is grandma
This finger is daddy
This finger is mommy
This finger is our baby.
Bend your fingers into a fist, then straighten them one by one, starting with the thumb.
"Fingers"
The fingers went out for a walk.
One two three four five -
They hid in the house again.
Extend all fingers one by one, starting with the little finger, then bend them in the same order.
"Fingers say hello"
I say hello everywhere -
At home and on the street.
Even “hello!” I say
I'm the neighbor's chicken.
Using the tip of the thumb of your right hand, alternately touch the tips of your index, middle, ring and little fingers. Do the same with your left hand.
"I met a hedgehog"
I met a hedgehog:
“Hello, brother! How are you?"
At the same time, use the tips of the thumbs of your right and left hands to alternately touch the tips of your index, middle, ring and little fingers.
"Hello!"
Hello, golden sun!
Hello, blue sky!
Hello, free breeze,
Hello, little oak tree!
We live in the same region -
I greet you all!
Use the fingers of your right hand to “hello” the fingers of your left hand in turn, tapping each other with their tips.
Finger game “Our walk”
One two three four five,
(the child bends his fingers one at a time, starting with the little finger)
We went out into the yard for a walk.
(the child “walks” along the table with his index and middle fingers, the other fingers are tucked in)
They sculpted a snow woman,
(the child imitates sculpting a snowball with both hands)
The birds were fed crumbs,
(the child “crumbs the bread” with all his fingers)
We rode down the hill
(the child moves the index finger of his right hand along the palm of his left)
And they were also lying in the snow.
(the child places his palms on the table or knees on one side or the other)
Everyone came home covered in snow,
We ate soup and went to bed.
Body games
Games with hands
For example, a specialist extends his hand to a child and says: “Let’s say hello.” But the child’s hand goes to the side or back. Therefore, we begin our work with this movement. The instructions help the child focus on the movement and his sensations and become aware of them. “Your hand wants to play. Let's play with her. The hand has gone up, it is tense, hard, strong, so hold it there and strengthen this movement. I will count to 3 (5). On the count of three (five), you will make a very strong effort to hold it in this position and intensify the movement. Now relax her and let her rest. Now it’s soft, relaxed, heavy.” Counting is necessary when performing the exercise, as it marks the beginning and completion of the tension process, and the transition to the next stage - relaxation. The specialist touches the hand, but does not perform the exercise for the child. This gesture can mean “I’m with you” and helps the child concentrate on the processes that occur in this hand. Hyperkinesis is an involuntary movement associated with increased muscle tone, that is, tension. The tension cannot continue constantly, and even if it intensifies. Therefore, after finishing the exercise (on the count of 3, 5), the hand relaxes. The child receives the first experience of voluntary tension and subsequent relaxation, which he is aware of. The exercise is repeated 2 more times. To better relax your hand, gently shake it. To do this, we gently hold the child’s elbow with our left hand, and with our right hand, holding the fingers, lightly shake it. You need to raise your arm (leg) no more than 7-10 cm from the surface on which the child is lying. But the most important thing at all stages of working with the body is the active participation of the child himself, his involvement in the process, his awareness of what is happening with his arm, leg, body, etc. This is very important. Next, we go clockwise. Let's move on to the left hand. “What does this hand want?” We start with the movement that the child suggests. We repeat all the procedures: tension exercise and shaking for the left hand.
The following exercise is aimed at strengthening the child’s differentiation of sensations of tension and relaxation.
Breathing exercises
We describe this stage of work in detail in the “Program” (See “Literature”, 6). After working with the body using psychophysical exercises, you can move on to motor exercises. These can be yoga exercises and psychodynamic meditations (see ibid.). We present a few more exercises that we came up with in the process of working with children with severe motor pathology.
Games with sticks and matches
Builders
The squirrels and bunnies decided to build houses for themselves. You need to build from these logs (15 matches or counting sticks). It is necessary to move the logs into place so that they do not slide on the ground.
Fulfilling the conditions of this game you need to transfer: -
a) using any fingers of both hands;
b) using the thumbs of the left hand;
c) only two fingers – thumb and little finger;
d) only the index and middle fingers;
e) only with the middle and ring fingers;
f) only the ring and little fingers;
g) with the two little fingers of both hands, lay out two straight lines of 4 sticks (matches) - a fence;
h) use the ring and little fingers to build a triangle (roofs of houses);
i) use your middle and little fingers to build a quadrangle (walls);
j) build a well with the index and nameless.
This exercise can be given at home. Let the whole family play.
Second version of the game with matches
In front of each participant in the game, 5 matches are placed one after another on the table. The player must pick up the fingers of two hands: one match with two thumbs, the other with the index fingers, the 3rd, 4th, 5th with the middle, ring and little fingers, without letting go of a single match. Raise consistently.
Game Build a house, hammer in nails
Hands clenched into fists, thumbs up - this is a hammer. Throughout the entire verse (or song), the hammer hammers in the nails - we build a house (movement from above with the thumb - first straight, then bent. Bent is more difficult.)
Lacing
Take a large card on which holes are made along the edges and also in the center in a certain sequence. The edges of the holes are painted in different colors. Using a long thick thread, the child performs the following tasks:
a) pass the thread through all the holes along the edge of the card;
b) stretch the thread into every second hole;
c) pass the thread only through the holes circled in red (alternating red and blue, etc.);
d) stitch over the edge;
e) make lacing in the center of the card, like in boots.
Methods of working with stencils and patterns
When working with a stencil with geometric shapes, the child places it on a sheet of album and traces familiar shapes with a simple pencil. Then the child removes the stencil from the sheet and divides each resulting geometric figure into parallel segments (strokes). Here, first of all, the following strokes are worked out: parallel segments from top to bottom, bottom to top, left to right. The distance between the segments should be approximately the width of the lowercase letter. Initially, to make the direction of the segment clear, children shorten the arrow on one of them.
In subsequent lessons, children build different objects from geometric shapes, shade them and create semantic compositions. You can accompany these compositions with a story. For example, they built an electric locomotive or an airplane and went on a trip. You can use Picture Games. Letter elements can then be incorporated into the shading. Hatching during this period is done with a felt-tip pen. Children can also shade their own contour drawings on various topics: space, traffic rules, etc.
The above exercises contribute to the development of not only the muscles of the hand and their coordination, but also the eye, as well as the formation of internal speech, figurative and logical thinking.
OUR RESULTS
Ribbon weaving
prettification
Weaving a rug
Weaving roses from ribbon
The first domestic works devoted to the psychological rehabilitation of preschool children with cerebral palsy were written in the 60s by M.V. Ippolitova (1967) and L.A. Danilova (1969). Based on foreign and their own experience, these scientists substantiated the need for the formation of a state system of special preschool education and psychological rehabilitation of children with cerebral palsy in our country.
Psychological rehabilitation for cerebral palsy involves carrying out a system of special measures aimed at restoring (development, formation) mental functions, processes, properties, abilities that allow the child to learn and perform various social roles, adapt in society, that is, aimed at restoring (development) psychological mechanisms social integration (E.S. Kalizhnyuk, 1987).
The psychological rehabilitation system consists of the following components: psychodiagnostics, psychocorrection, psychological support and psychological career guidance. The expediency of psychological rehabilitation, its priority directions, and optimal methodological techniques are determined, first of all, by which areas of mental activity were impaired and which mental functions should be restored and developed in the first place. This requires a psychodiagnostic examination. Psychodiagnostics allows us to determine the characteristics of the current mental state and potential mental development (zone of proximal development) of a child with cerebral palsy.
In the process of psychological diagnosis of children and adolescents with cerebral palsy, it is necessary to observe a number of basic principles (R.Ya. Abromovich-Lichtman, 1965);
- 1. An activity principle aimed at conducting a psychological examination in the context of activities available to a child with cerebral palsy: subject-related practical, playful, educational.
- 2. The principle of qualitative analysis of the obtained psychological examination data.
This is a principle built on the concept of L.S. Vygotsky (1960) about the determining role of learning in the process of child development is extremely important in the psychological diagnosis of developmental disorders. For a psychologist, not only the final result of completing a test task is important, but also the child’s way of working, his ability to transfer learned skills to a new task, the child’s attitude towards the task, and his own assessment of his results.
- 3. The principle of a personal approach in the diagnostic process, the psychologist analyzes not an individual symptom, but the child’s personality as a whole.
- 4. The principle of a comparative approach when studying impaired development, the psychologist must correctly navigate the characteristics of the mental development of a healthy child.
- 5. The principle of an integrated approach to diagnosing a child’s mental development includes taking into account many factors underlying developmental disorders of a child with cerebral palsy: clinical, pedagogical, psychological, social.
According to the results of psychodiagnostics there should be:
- -- disorders of mental activity and their mechanisms were identified to determine the prospects for rehabilitation;
- -- the most preserved mental functions have been identified in order to “activate” compensatory mechanisms, which is extremely important, especially when the impaired function cannot be restored;
- -- an assessment was made of those characteristics of mental activity that will contribute to the successful social integration of a child at different stages of age development.
The object of psychological rehabilitation is not only the child with cerebral palsy himself, but also his immediate environment, first of all, parents and family, therefore psychodiagnostics of the family is necessary to assess the system of relationships in which the child develops and his personality is formed. Psychological examination of the family is especially important in the early stages of ontogenesis of a child with cerebral palsy, since conducting psychological rehabilitation with children under 3-5 years of age without the active participation of their parents is organizationally difficult. Children suffering from cerebral palsy may experience a variety of mental development disorders. Nevertheless, it is possible to identify typical phenomenological features of the development of children suffering from cerebral palsy (T.N. Osipenko, E.E. Statsevich, L.A. Nochevka et al. 1993, pp. 25-40). They are expressed:
- - in violations of psychomotor functions, when both gross and fine motor skills are affected;
- - in violations of speech functions, when both expressive and impressive speech suffer;
- - in violations of sensory-perceptual functions, when spatial orientation is significantly difficult;
- - in violations of the function of memory and attention, which are most clearly manifested in relation to voluntary (active) memory and active attention;
- - in various dysfunctions of verbal and nonverbal thinking, when the most noticeable defect is observed in relation to the processes of generalization and abstraction, inductive, conceptual and spatial thinking, practical mathematical thinking;
As a rule, children suffering from cerebral palsy exhibit characteristic dynamics in the manifestation of mental development disorders. Thus, already in the early stages of ontogenesis (the first weeks, months of life), they may exhibit psychomotor, sensory-perceptual and speech disorders, disturbances in attention functions in the form of inadequate motor activity, discoordination of motor acts, and the absence of behavioral and emotional reactions to sensory and speech stimuli. and so on. (K.A. Semenova, 1999).
Based on this, A.V. Semenovich (2002) offers an in-depth psychodiagnostic examination of a child suffering from cerebral palsy, which should provide:
- - assessment of psychomotor development (especially at relatively early stages of child development);
- - comprehensive assessment of intellectual development (from assessment of the state of individual intellectual functions to an integral assessment of the level of mental development and structure of intelligence);
- - assessment of the emotional and motivational sphere;
- - assessment of the character and characteristics of the individual as a whole;
- - assessment of behavior and psychological mechanisms of its regulation.
In accordance with the above, a selection of methods, methodological techniques, and tests is made through which these psychodiagnostic problems can be solved. 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 biological age, but also to the level of his sensory, motor and intellectual development. Examination process A.A. Kataeva, E.A. Strebelev (1994) recommend conducting it in the form of play activities accessible to the child. Particular attention should be paid to the child’s motor abilities. Taking into account the physical capabilities of a patient with cerebral palsy 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. Didactic material used during the examination must be placed in his field of vision. It is recommended to carry out the examination in a playpen, on a carpet, or in a special chair. K.A. Semenova (1999) recommends that in case of pronounced muscle tension, the child is given 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 rings, belts, etc.), the child is fixed in this position. If involuntary unnecessary movements—hyperkinesis—that interfere with grasping the toy are severe, before starting the examination it is recommended to carry out special exercises to help reduce them. 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 movement disorders. The low activity of a child with cerebral palsy largely prevents him from actively exploring the world around him. The position of many children with cerebral palsy is forced; they lie in one position for a long time and cannot change it, turn on the other side or on their stomach. When placed in a prone position, they cannot raise and hold their head; in a sitting position, they often cannot use their arms, as they use them to maintain balance, etc. All this contributes to a significant limitation of the field of vision and interferes with the development of hand-eye coordination.
The main difficulties of a psychologist when working with patients suffering from cerebral palsy are that many widespread, verified and valid techniques cannot be used in whole or in part due to gross impairments of speech and motor functions (especially fine motor skills). Thus, with pronounced hyperkinesis and right-sided hemiparesis, the psychologist cannot fully use the Wechsler test, which is widely used to determine intellectual function. Patients, due to their motor impairments, are unable to perform subtests 7, 9, 11 and 12. Moreover, this does not allow us to judge their ability for Visual representation, constructive thinking, attention, hand-eye coordination, extrapolation. Even if the patient’s condition allows for a psychological experiment to be carried out, as a rule, a revision of the time limits provided for by the methodology is necessary. The same reasons can prevent the use of drawing tests and many others. The diversity in quality and severity of speech disorders observed in patients with cerebral palsy can significantly complicate the use of verbal techniques.
A psychologist working in a specialized institution for children with cerebral palsy must have and be able to master a large number of methods and interchangeable techniques and, before examining a patient, carefully select the most suitable ones for his examination, taking into account motor and speech disorders. So, the choice of methodological arsenal largely depends on the “capabilities” of the examined child with cerebral palsy, on his ability to perform certain test tasks. Thus, up to 3-4 years of age, a psychological examination of a child is based on fixed observation methods in natural or experimentally simulated situations.
Test psychological examination of children is effective from 4-5 years old.
In this case, test tasks are given orally and conducted individually. From 12 to 14 years old it is possible to use questionnaires. Considering the increased exhaustion of this group of children, you need to be careful about the “dosing” of test loads.
As a rule, up to 5-7 years, the duration of a single examination should not exceed 20-30 minutes. Impaired intellectual development in cerebral palsy brings its own specifics to the organization of a psychological examination, the advisability of changing the standard examination procedure or modifying instructions.
To assess intelligence and intellectual functions in cerebral palsy, the following can be used:
- -- Wechsler test;
- -- graphic tests;
- -- classification tests;
- -- method of excluding items;
- -- Amthauer intelligence test;
- -- school maturity tests.
To diagnose disorders of psychomotor functions (involuntary movements, decrease or increase in motor activity in general), methods of observing behavior, the nature of motor reactions, as well as graphic tests, a tremor test, a tapping test (from 5 years), and a reaction time test ( from 5 years), a method for assessing neuropsychic development (4-6 years), a method for determining the coefficient of psychomotor development (up to 4 years).
When diagnosing disturbances of perception and attention, in addition to observation methods, pathopsychological tests are used: proofreading test (from 5 years), the “Missing Details” test (from 5 years). A common method for studying attention is the Schulte table, and for studying performance and fatigue, the Kraepelin and Landolt methods.
When diagnosing mental functions in cerebral palsy, special attention must be paid to young children (up to 3-4 years). Their diagnosis is based mainly on the fixed observation method described in the Early Learning Manual (Portridge, USA), which assesses various levels of mental development: motor functions, speech, self-care skills, cognitive abilities, socialization.
The comprehensive rehabilitation treatment of cerebral palsy includes: medications, various types of massage, physical therapy, orthopedic care and more (E.G. Sologubov, K.A. Semenova, 1999).
The complex nature of correctional-psychological-pedagogical work requires constant consideration of the mutual influence of motor, speech and mental disorders in the dynamics of the child’s ongoing development. As a result, joint stimulation of the development of all aspects of the psyche, speech and motor skills, as well as the prevention and correction of their disorders, is necessary. The main tasks and principles of correctional work with children were developed by L.S. Vygotsky (1960) and were first used in defectology in relation to various types of developmental anomalies.
An early onset of ontogenetically consistent effects based on intact functions is necessary. In recent years, early diagnosis of cerebral palsy has been widely introduced into practice. Despite the fact that already in the first months of life it is possible to identify pathology of pre-speech development and disorders of orientation-cognitive activity, correctional and, in particular, speech therapy work with children often begins after 3-4 years. In this case, the work is most often aimed at correcting already existing speech and mental defects, and not at preventing them. Early detection of pathology of mental and speech development and timely correctional and pedagogical intervention in infancy and early childhood can reduce, and in some cases eliminate, psychospeech disorders in children with cerebral palsy at an older age. The need for early correctional work in cerebral palsy stems from the characteristics of the child’s brain - its plasticity and universal ability to compensate for impaired functions, as well as from the fact that the most optimal period for maturation of the functional speech system is the first three years of a child’s life. Correctional work is based not on age, but on what stage of psycho-speech development the child is at (A.R. Luria, 1948).
Correctional psychological work is organized within the framework of leading activities. Disorders of mental and speech development in cerebral palsy are largely due to the absence or deficiency of children’s activities. Therefore, during correctional pedagogical activities, the leading type of activity for a given age is stimulated: in infancy - emotional communication with an adult; at an early age - objective activity; in preschool age - play activities.
In order to carefully study and identify the structure of mental disorders, dynamic observation of the child’s development over a long period of time is necessary. At the same time, the efficiency of diagnosis and correction increases significantly. This is especially important when working with children with severe and combined disabilities.
In cerebral palsy, it is important to develop a coordinated system of interanalyzer connections, relying on all analyzers with the obligatory inclusion of the motor-kinesthetic analyzer. It is advisable to rely simultaneously on several analyzers (visual and tactile, tactile and auditory). A flexible combination of various types and forms of correctional-psychological-pedagogical work (individual, subgroup and frontal) is necessary. In the process of psychological correction of developmental disorders in children with cerebral palsy, it is necessary to take into account the complex structure of the child’s developmental characteristics, the nature of the combination in the picture of his condition of such factors as the social situation of development, the severity of personality changes caused by the disease, the degree of physical helplessness (I.I. Mamauchuk, 2001).
The experience of effective work of psychologists proves that psychological correction can be considered in the broad and narrow sense of this concept. In a broad sense, psychological correction is a complex of medical, psychological and pedagogical influences aimed at eliminating children’s shortcomings in the development of mental functions and personal properties. In a narrow sense, psychological correction is considered as a method of psychological influence aimed at optimizing the development of mental processes and functions and harmonizing the development of personal properties.
B. D. Elkonin (1978), depending on the nature of the direction of correction, distinguishes its two forms; symptomatic, aimed at symptoms of developmental disorders, and correction, aimed at the source and causes of developmental disorders. Symptomatic correction, of course, is not without significant drawbacks, since symptoms of developmental disorders have different causes and, as a result, the psychological structure of disorders in the child’s development is different. With the help of special pedagogical methods, you can help your child master ordinal counting, number composition, etc. However, despite intensive classes, the child still has significant difficulties in mastering mathematics. This method of correction is insufficient if we do not know the true cause of counting disorders in children with cerebral palsy.
The basis for violations of counting operations in children with cerebral palsy is the underdevelopment of spatial concepts, which is caused by cerebral-organic insufficiency of the parieto-occipital regions of the brain. Therefore, psychological correction should be more focused not on the external manifestations of developmental deviations, but on the actual sources that give rise to these deviations. For the effectiveness of psychocorrection, classes on the development of visual-spatial functions of a child with cerebral palsy are necessary.
The effectiveness of psychological correction largely depends on the analysis of the psychological structure of the disorder and its causes.
The complexity and uniqueness of child developmental disorders require a careful methodological approach to its analysis and psycho-corrective interventions. The development of principles, as fundamental, starting ideas, is extremely important in the theory and practice of psychological correction (L.M. Shipitsina, 2001).
An important principle of psychological correction is the principle of complexity. According to this principle, psychological correction can be considered as a single complex of medical, psychological and pedagogical influences. The effectiveness of psychological correction largely depends on taking into account clinical and pedagogical factors in the development of the child. For example, communication training that a psychologist uses in a clinic to optimize the child’s communication process will not be effective if the psychologist does not take into account clinical factors and the social environment (medical staff, teachers, parents) in which the child is located.
The second principle of psychological correction is a personal approach. This is an approach to the child as a whole person, taking into account all his complexity and individual characteristics. In the process of psychological correction, we take into account not some separate function or isolated mental phenomenon in a person, but the personality as a whole. Unfortunately, this principle is not always taken into account in the process of group training and psychoregulatory training.
When using various methods of psycho-correctional influences, a psychologist should not operate with such concepts as a generalized norm (age, gender, nosological). In the process of psychological correction, we focus not on one particular parameter, but on the person as a whole.
The third principle is the activity approach. Personality is manifested and formed in the process of activity. Compliance with this principle is extremely important in the process of psychological correction of children and adolescents. Psychocorrectional work should be structured not as a simple training of the child’s skills and abilities, not as individual exercises to improve mental activity, but as a holistic, meaningful activity that organically fits into the child’s system of everyday life relationships. The psychocorrection process should be carried out taking into account the main, leading type of activity of the child. If this is a preschooler, then in the context of play activities, if a schoolchild, then in educational activities. However, taking into account the specifics and tasks of the psychocorrection process, one should focus not only on the leading type of activity of the child, but also on the type of activity that is personally significant for the child and adolescent. This is especially important when correcting emotional disorders in children. The effectiveness of the correction process largely depends on the use of productive activities of the child (for example, drawing, designing, etc.).
The fourth principle of psychological correction is the unity of diagnosis and correction. The tasks of correctional work can be correctly set only on the basis of a complete psychological diagnosis of not only the zone of actual, but also the zone of proximal development of the child. The scheme and selection of diagnostic and psychocorrection methods and techniques must correspond to the nosology of the child’s disease, the characteristics of his age characteristics, physical capabilities, and the specifics of leading activities characteristic of each age period. The processes of psychological diagnosis and correction are complementary processes that are not mutually exclusive. The process of psychological correction itself contains enormous diagnostic potential. For example, no psychological testing reveals an individual’s communicative abilities as much as during group psychocorrectional classes. Or the child’s psychogenic experiences are reflected with the greatest depth in the process of gaming psychocorrection. The process of psychological diagnostics contains correctional possibilities, especially when using a training experiment.
The fifth principle of psychological correction is hierarchical. It is based on the position of L.S. Vygotsky (1960) about the leading role of education in the mental development of a child. The implementation of this principle means the purposeful formation of psychological new formations, requires maximum activity of the child and is proactive in nature, since the correction is aimed not at the actual zone, but at the zone of proximal development of the child. For example, to correct mnestic functions in a child, it is necessary to develop mental operations: analysis, synthesis, generalization. Teaching a child to use mental operations in the process of memorizing material will increase the effectiveness of memorization to a greater extent than simple memory training.
The sixth principle is causal. The implementation of this principle in psychocorrectional work is aimed at eliminating the causes and sources of deviations in the mental development of the child. Depending on the root cause, a psychocorrection strategy is developed. If the cause of a child’s emotional distress is family conflicts or inadequate styles of family education of a sick child, then the psychocorrection process should be aimed at normalizing family relationships. If the cause of emotional disorders is residual organic failure of the central nervous system, then the main element of psychological correction should be the reduction of the child’s emotional discomfort using special methods of psychoregulatory training against the background of drug therapy.
The seventh principle of psychocorrection is temporary, that is, the early onset of ontogenetically consistent influence based on intact functions. Early detection of pathology of pre-speech and early speech development and timely corrective pedagogical intervention in infancy and early childhood can reduce, and in some cases eliminate, psycho-speech disorders in children with cerebral palsy at an older age. The need for early correctional work in cerebral palsy stems from the characteristics of the child’s brain - its plasticity and universal ability to compensate for impaired functions, as well as due to the fact that the most optimal period for maturation of the speech functional system is the first three years of a child’s life. Correctional work is based not on age, but on what stage of psycho-speech development the child is at.
The main directions of psychocorrection work for cerebral palsy in early and preschool age are:
- - development of emotional, verbal, objective-active and playful communication with others;
- -- stimulation of sensory functions (visual, auditory, kinesthetic perception and stereognosis), the formation of spatial and temporal representations, correction of their violations;
- - development of prerequisites for intellectual activity (attention, memory, imagination);
- -- development of visual-motor coordination and functional capabilities of the hand and fingers; preparation for mastering writing.
The eighth principle is the unity of correctional work with the child and his environment, primarily with parents. Due to the enormous role of the family and immediate environment in the process of developing a child’s personality, it is necessary to organize society in such a way that could stimulate this development as much as possible and smooth out the negative impact of the disease on the child’s mental state.
The experience of psychologists-educators in the system of medical correctional institutions shows that the main goal is the maximum development of the cognitive abilities of children with disorders of psychomotor development (I.A. Smirnova, 2003).
The psychologist-educator solves the following problems:
- - development of intact aspects of cognitive activity;
- - correction of deviations in mental development;
- - formation of compensatory ways of understanding the surrounding reality;
- - development of visual perception of colors: discrimination, naming colors, classification by color, row formation by color intensity;
- - development of visual and tactile perception of forms: discrimination, naming, classification, transformation of forms;
- - development of visual and tactile perception of quantities: discrimination, naming, classification, transformation, comparison by size, ordering by size;
- - development of visual and tactile perception of the texture of objects: discrimination, naming, classification;
- - development of visual and tactile perception of spatial relationships: understanding, naming, orientation, transformation;
- - development of auditory perception of non-speech sounds;
- - development of tempo-rhythmic sense: recognition and reproduction of tempo-rhythmic structures. Speech development involves:
- - development of the phonemic system: differentiation of sounds, phonemic analysis and synthesis, phonemic representations;
- - development of visually effective and visually figurative forms of thinking: establishing the identity of objects, comparing objects, modeling by size and shape, developing the ability to correlate parts and the whole, classifying objects according to one or two characteristics;
- - development of verbal-logical forms of thinking: defining concepts, classifying objects into categories, excluding objects, guessing riddles, understanding figurative meanings of words, determining the sequence of events.
To summarize the above, it should be noted that correctional psychological work is organized within the framework of leading activities. Disorders of mental and speech development in DCD are largely due to the absence or deficiency of children’s activities. Therefore, during correctional psychological measures, the leading type of activity for a given age is stimulated: in infancy, emotional communication with an adult; at an early age - objective activity; in preschool age - play activities.
Also, the experience of existing special institutions has shown that it is advisable to recruit groups that are clinically and psychologically heterogeneous both in relation to musculoskeletal pathology and in relation to intellectual development. This not only allows you to solve organizational problems, but really has a positive effect on the personal development of children. Medical, psychological and pedagogical influence on children should be implemented comprehensively through the efforts of a number of specialists. It is important to clearly define the system of interaction between specialists for the rational organization of work.
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, dexterity 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.