In the first and second chapters, we theoretically substantiated the importance of using comprehensive physical rehabilitation of children preschool age with cerebral palsy. Based on this, we conducted a study in which it was necessary to carry out a diagnosis that would reveal that the use of modern technologies in comprehensive physical rehabilitation affects the level of physical development and motor activity of preschool children with cerebral palsy.
The experimental study was conducted at the Moscow Rehabilitation Center for Physical Rehabilitation of Disabled Children, located at: Smolensk Region, Moscow, st.
The experiment involved 20 children aged 3-6 years, who were divided into two groups: control (traditional technologies were used) and experimental (modern technologies were used). The study was carried out using a motor abilities testing card (see Appendix 1), which showed the following results.
Results of the “Motor Capability Testing Card” methoddiagnosticlevel of development of motor abilities in children with cerebral palsy in the control group
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Form of cerebral palsy |
Lying on your stomach |
Lying on your back |
Sitting on the floor |
Sitting on a chair, feet on the floor |
Moving on the floor |
Walking, running, jumping |
Total score | |||
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Spastic diplegia | ||||||||||
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Double hemiplegia | ||||||||||
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Atonic-astatic | ||||||||||
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Atonic-astatic | ||||||||||
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Spastic diplegia | ||||||||||
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Double hemiplegia | ||||||||||
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Hyperkinetic form | ||||||||||
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Hyperkinetic form | ||||||||||
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Double hemiplegia | ||||||||||
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Spastic diplegia |
High level of motor abilities – 0 hours (0%)
Average level of motor abilities – 4 hours (40%)
Low level of motor abilities – 6 hours (60%)
Analysis of tabular and graphical data showed that the motor capabilities of children with cerebral palsy in the control group, despite the systematic approach to conservative treatment of preschool children with cerebral palsy, involves the integrated use of physical therapy, massage, mechanical therapy, functional biofeedback, positioning and occupational therapy in the rehabilitation of children, is at a low level, therefore, for preschool children with various forms of cerebral palsy and varying degrees of severity of motor disorders, a differentiated approach is necessary when organizing the rehabilitation process using modern technologies in the comprehensive physical rehabilitation of children with cerebral palsy in a rehabilitation treatment center.
The results of the “Motor Capability Testing Card” method, diagnosing the level of development of motor capabilities in children with cerebral palsy in the experimental group
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Form of cerebral palsy |
Lying on your stomach |
Lying on your back |
Sitting on the floor |
Sitting on a chair, feet on the floor |
Moving on the floor |
Walking, running, jumping |
Total score | |||
|
Spastic diplegia | ||||||||||
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Double hemiplegia | ||||||||||
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Spastic diplegia | ||||||||||
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Double hemiplegia | ||||||||||
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Hyperkinetic form | ||||||||||
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Spastic diplegia | ||||||||||
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Atonic-astatic | ||||||||||
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Hyperkinetic form | ||||||||||
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Atonic-astatic | ||||||||||
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Double hemiplegia |
High level of motor abilities – 2 hours (20%)
Average level of motor abilities – 5 hours (50%)
Low level of motor abilities – 3 hours (30%)
Analyzing the tabular and graphical data obtained after conducting a study in the experimental group using modern technologies, we can conclude that the proposed technologies for the rehabilitation of preschool children with cerebral palsy turned out to be effective, which is confirmed by the dynamics of the functional state of the musculoskeletal system and the manipulative function of the hands.
To compare the results of the level of development of physical capabilities in the control and experimental groups in order to check the influence of modern technologies in complex physical rehabilitation on the level of physical development and motor activity of preschool children with cerebral palsy, we used the Mann-Whitney U test.
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Points (exp. group) |
Points (counter group) | ||
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Amounts: 458 |
Total ranks: 129.5 + 80.5 = 210
The equality of the real and estimated amounts is maintained.
We see that in terms of the level of motor capabilities, the sample from the experimental group is closer to the “higher” one. It is this sample that accounts for the large ranking sum: 120.
Now we are ready to formulate a hypothesis: The group of children from the experimental group is superior to the group of children from the control group in terms of motor abilities.
We determine the empirical value U:
Using the table, we determine the critical values for n = 10.
Uamp< Uкр(р Ј 0,05)
Thus, the group of children from the experimental group is superior to the group of children from the control group in terms of the level of motor capabilities, which suggests that the use of modern technologies in complex physical rehabilitation affects the level of physical development and motor activity of preschool children with cerebral palsy, which confirms our hypothesis. We have also developed a program for organizing classes to develop motor activity and increase the level of physical development of preschool children with cerebral palsy
(1 year 6 months). Cerebral palsy in the form of spastic diplegia. Entered for treatment for the first time.
Anamnesis. Child from the second pregnancy, second birth. The pregnancy proceeded with symptoms of toxicosis in the first half of pregnancy there was an injury belly. The birth was premature, birth weight 1300 g. He was not breastfed and was fed artificially.
Voice activity and communication function. You can establish emotional contact with a child, but the child himself does not strive for this. Indifferent to his surroundings. Spontaneously utters indistinct sounds in between A And e. Vocal activity is low. The cry is inexpressive and has no communication function. It is impossible to determine his desires by the cry of a child.
Rice. 9. Lack of support function Fig. 10. Pathological reliance on
hands legs, weak head hold.
Rice. 11. Vicious hand position. Rice. 12. Vicious position of the hands
Fig. 13. Massive tongue without Fig. 14. Forked tongue.
pronounced tip, uneven
distribution of tone in the muscles of the tongue.
Rice. 15. The tongue is spastically tense, Fig. 16. Flaccid lips.
bent upward.
Sensory development and cognitive activity. The child fixes his gaze on the adult’s face and toys, follows moving objects; reacts to sounding toys and localizes the direction of sound. However, he does not use the available sensory capabilities in cognitive activity. Focuses attention on speech, responds adequately to the tone of voice, but does not distinguish between speech instructions and does not know his own name.
Motor function. Can't hold his head up, can't sit, can't lean on his legs. Tries to reach for toys, but his fists are tightly clenched, the first finger is adducted, and he cannot grasp the toy. The child holds the inserted toy, but cannot look at it or reach his mouth.
Articulatory apparatus, voice, breathing. The face is amicable, the nasolabial folds are smoothed. The lips are flaccid, the tongue is wide, without a formed tip, the root of the tongue is tense. Hyperkinesis of the tongue in the anteroposterior direction is noted. The mobility of the tongue and lips is sharply limited. Feeding the baby is difficult. Sucking movements with the tongue and lips are preserved. Food leaks from the mouth because it is not retained in the mouth. While eating he chokes. Can't drink from a cup. The voice is weak, breathing is stridorous.
Conclusion. Delay in the development of orientation-cognitive activity. Vocal activity at the level of undifferentiated sounds. There is no humming or babbling. The child's pre-speech development corresponds to level II.
III level- revelry. This level in children with cerebral palsy in the form of spastic diplegia is characterized by uneven development of sensory perception, visual-motor coordination, orientation-cognitive activity, emotional sphere and sound communication with others.
Characteristics of voice activity and communication functions. Emotional contact is easily established with children; they respond to the intonations of a person’s voice. They have a pronounced “revitalization complex” and a focus on communicating with adults. The cry of children at this stage is already a means of expressing states, desires and, therefore, a means of communicating with people. Children spontaneously and by imitation pronounce hum sounds: long-sounding vowels, labial and guttural consonants combined with vowels (boo, poo, ma, ha, ka). While walking, autoecholalia appears, that is, self-imitation while walking.
Characteristics of sensory development. Children develop differentiated visual and auditory reactions: they recognize their mother, distinguish familiar people from strangers, and their voices. Perception difficulties greatly limit the possibilities of children's cognitive activity.
Characteristics of indicative-cognitive activity. Children show interest in their surroundings, pay attention to bright toys, and can perform basic manipulations with them. Children are emotional, active, and recognize some verbal instructions in a specific situation.
Characteristics of motor development. Children at this level develop hand-eye coordination. They can grab a toy and perform primitive manipulations with it, but their movements are limited, tense, and extremely awkward (Fig. 17); toys often fall out of hands. Children are able to maintain an upright position in a special chair, but cannot sit independently (Fig. 18) or stand (Fig. 19, 20).
Characteristics of the articulatory apparatus, voice and breathing. Pseudobulbar symptoms become very noticeable, manifested in disturbances in voice, breathing, and feeding. Such pathological symptoms of the articulatory apparatus as spasticity (Fig. 21), pareticity (Fig. 22), dystonia, hyperkinesis of the tongue, and oral synkinesis are clearly manifested. The mobility of the tongue and lips is significantly limited.
For illustration Level III Pre-speech development of children with cerebral palsy is given as example No. 3.
|
Rice. 17. Pathological position Fig. 18. Pathological posture when
hands when grasping a toy. seat.
Rice. 19. Pathological support on the legs. Rice. 20. Pathological support on the legs.
(10 months). Cerebral palsy in the form of spastic diplegia. The child was admitted for the first time.
Anamnesis. A child from the second pregnancy, first birth (the first pregnancy ended in miscarriage). This pregnancy proceeded with symptoms of toxicosis. The birth was premature at the 33rd week, fast, with stimulation, the child’s birth weight was 1900. The child was born with asphyxia and was on mechanical breathing. He screamed 5 minutes after being revived. Attached to the breast at the age of 1 month. He sucked poorly, choking, and milk flowed out of his nose. From 4 months he fixates and traces objects, toys and faces of adults, from 5 months he holds his head, from 7 months he reaches for toys, he walks from 4 months. The cry is inexpressive; the mother cannot determine the child’s desire by his cry. Auditory concentration appeared with a significant delay - after 8 months.
Voice activity and communication function. It is possible to establish emotional contact with a child. The “revitalization complex” with vocal manifestations is pronounced. The child's voice is expressive and serves as a means of communication with adults. The child makes humming sounds: a-a, ba, ga, nya- spontaneous and reflected, but the sounds do not have melodiousness and duration of sound.
Sensory development and cognitive activity. Visual concentration and attention are satisfactory. He is interested in toys and examines them. Distinguishes the tone of voice, knows his name. But the acoustic setting for speech is unstable and does not distinguish between speech instructions.
Motor development. The child sits independently for a short time, reaches for toys, grabs them and performs basic manipulations with them (knocking, pulling into his mouth).. Does not lean on his legs. In a vertical position, the tone in the lower extremities increases sharply.
Articulation apparatus, voice, breathing. Facial asymmetry is observed. The tone of the lips and tongue is reduced, and therefore the mobility of the tongue and lips is limited. The mouth is slightly open, the corners of the lips are lowered, and it is impossible to close the lips tightly. Feeding is slow, but without choking. Voice and breathing without any peculiarities.
Conclusion. Development of orientation-cognitive activity with a slight lag from the age norm. Delayed pre-speech development. Vocal activity manifests itself in the form of humming, devoid of melodiousness and duration. In terms of pre-speech development, the child corresponds to level III.
Fig. 21. Spasity of the tongue. Rice. 22. Flaccidity of the labial muscles,
lack of closed mouth posture.
IVlevel- babble. Children show disproportions in the development of certain functions; Thus, the level of development of the emotional sphere is much ahead of the level of motor and speech development.
Characteristics of voice activity, communication functions. The means of communication with others are expressive movements of the head and eyes, facial expressions, modulated screaming, babbling, and simplified words. Babbling is characterized by a poverty of sounds and is a combination of labial consonants with unclear vowel sounds. Syllable babble, as a rule, is not noted. Spontaneous babbling is rarely observed; reflected, monosyllabic babbling occurs more often. Autoecholalia in babbling is extremely weakly expressed. The existing simple babble words are pronounced rarely, after prolonged stimulation. The need for verbal communication in children is weakly expressed, speech activity low. Children understand spoken speech well: both simple situational instructions and complex two- or three-step tasks.
Characteristics of sensory development. Impairments in visual perception associated with strabismus, limited visual fields, etc., lead to difficulties in fixing the gaze on an object. However, the high level of mental activity of children contributes to the fact that they adapt to the “shortcomings” of the visual analyzer (they look at a toy, turning their head to the side so that they can fix it with their gaze, etc.). Disturbances in auditory perception are manifested in a decrease in auditory attention to speech, in difficulties in localizing sound and speech. All these sensory disturbances delay the rate of mental development of children.
Characteristics of orientation-cognitive activity. Children are distinguished by high activity of cognitive activity and stability of attention. They are interested in emotional contact; their emotions are differentiated. Children show a keen interest in everything around them and use the toy for a long time. Some children begin to develop objective activity, but they lack fine manual movements. The level of development of impressive speech is significantly ahead of the level of development of expressive speech, and in some cases even approaches the age norm.
Characteristics of motor development. Children can sit in a special chair (Fig. 23), hold up their heads, take toys and manipulate them, but ataxia, hyperkinesis in the hands, dysmetria, and abnormal positions of the hands and fingers are often observed (Fig. 24). With the help of adults, children can stand and step around the support, but the position of their legs is vicious (Fig. 25). With support from both hands, children step, but often with their legs crossed. Some children can sit up independently (Fig. 26).
Characteristics of the articulatory apparatus. The pathological state of the articulatory apparatus is manifested in changes in the muscle tone of the lips (Fig. 27, 28), tongue, hyperkinesis of the tongue (Fig. 29, 30), which leads to limitation of their mobility, absence of voluntary articulatory movements and other changes. Almost all children have increased salivation and pseudobulbar phenomena, expressed to a greater or lesser extent. All children have weakness in biting and chewing.
To illustrate the IV level of pre-speech development of children with cerebral palsy, we give example No. 4.
(1 year 2 months). Cerebral palsy in the form of spastic diplegia with cerebellar syndrome. Entered for the first time. Anamnesis. The child is from the second pregnancy (the first pregnancy ended in miscarriage). This pregnancy proceeded with toxicosis in the first half. Delivery on time. Labor was weak; stimulation and a vacuum extractor were used. The child was born in asphyxia with a weight of 3400 g. He began to cry within a few minutes. The condition after birth was severe, he sucked weakly, choked, and quickly got tired. He began to follow with his eyes from 2 months, to smile from 3 months, and humming appeared from 4 months. He has been unable to hold his head up since he was 3 months old. The first babbling sounds appeared towards the end of the first year of life.
Voice activity and communication function. Baby babbles spontaneously ma, 6a, nya, dya, but babbling activity is low. The babbling did not show multiple repetitions of the same sounds, which is typical for the babbling of a healthy child. The voice is inexpressive and quiet. In moments of emotional stress, the child can change the intonation of his voice and express his desires and states. For example, at the end of speech therapy classes, he voices dissatisfaction with the interrupted play, and when he sees a toy that interests him, he asks in his voice to give it. The child’s emotions are adequate, but they need in constant stimulation.
Sensory development and cognitive activity. The child is lethargic and inactive. Visual and auditory attention is stable, but performance is reduced: fatigue sets in after 5-7 minutes of work. He has a good memory. The stock of knowledge and ideas about the environment corresponds to the age norm. Understands spoken language according to age.
Motor development. He doesn't hold his head upright and lowers it onto his chest. The child sits in a special chair with his upper body resting on the table. Visual-motor coordination is developed, but hand movements are slow, uncoordinated, and awkward. Simple object actions with toys are available to him. When trying to put the child on his feet, the tone in the lower extremities increases sharply and he rests on his legs with a cross.
Articulation apparatus, voice, breathing. The weakness of the facial, labial, chewing and lingual muscles is pronounced. The corners of the lips are lowered, the nasolabial folds are not pronounced. The mouth is open. The tongue, without a pronounced tip, is located at the bottom of the oral cavity in the midline, inactive, but at the request of an adult, the child can stick his tongue forward. In an upright position and during emotional experiences, oral synkinesis appears. Constant drooling. The voice is weak, quiet. While eating, he occasionally chokes. Breathing at rest without visible pathology. During babbling, weakness of inhalation and exhalation is noted.
Rice. 25. Unstable support, feet Fig. 26. Short-term retention
in a pathological position. sitting postures.
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Rice. 29. Hyperkinesis of the tongue in combination - Fig. 30. Hyperkinesis of the tongue with
research with oral synkinesis. trying to take a toy
Thus, the study of children with cerebral palsy made it possible to detect voice disorders in them, mainly its intonation features. As for humming, the time of its appearance often corresponds to the age norm, but the further development of humming in children with cerebral palsy occurs differently than in their healthy peers: reflected humming and self-imitation are weakly expressed, and there is no melodiousness of sounds. The cry of children for a long time is not a means of communication due to the underdevelopment of the intonation-expressive system of speech as a whole. Babbling in most children occurs late and is characterized by poor sound composition, lack of voice modulation, and lack of syllable rows. Sound activity is extremely low. Children prefer to communicate by shouting, facial expressions, and gestures. In most cases, babbling does not follow the sequence of stages characteristic of a healthy child. The first stage of babbling development in children with cerebral palsy is extremely weakly expressed. Further, they do not develop the mechanism of autoecholalia, i.e., self-imitation. And finally, physiological echolalia, syllabic babbling, which corresponds to the third stage of babbling development, appears late and in a distorted form. The motor development of children suffering from cerebral palsy is severely impaired; this hinders the process of developing their perception. The grasping and manipulative functions of the hands are also underdeveloped.
Sensory impairments, manifested in insufficiency of the visual, auditory and kinesthetic analyzers, delay the development of cognitive activity.
The vast majority of children have pathology of the articulatory apparatus; muscle tone is changed, the mobility of the tongue and lips is impaired, hyperkinesis of the tongue is observed, etc. As a result of this, the articulatory apparatus of children is not ready for sound pronunciation. The speech-motor and speech-auditory analyzers lag behind in their development.
The majority of children suffering from cerebral palsy have a low level of development of the emotional and motivational-need sphere, which is one of the reasons for the insufficiency of their cognitive activity.
The data from our study helped to clearly present the pre-speech development of a child with cerebral palsy and identify the reasons for his retardation. It should be noted that correctional pedagogical work should be built on the basis of the maximum development of the child’s intact functions.
CORRECTIVELY- PEDAGOGICAL JOB
WITH CHILDREN WITH CEREBRAL PARALYSIS
IN PRE-RECHEVOI PERIOD
The purpose of correctional pedagogical work is the consistent development of the functions of the pre-speech period, ensuring the timely formation of the child’s speech and personality.
Basic principles of the correctional pedagogical systembots.
1. Early start of correctional and pedagogical work with children suffering from cerebral palsy, i.e. from the first weeks and months of life, since disturbances in the development of certain functions of the pre-speech period lead to a secondary delay in the development of other functions and pedagogical neglect.
2. Gradual development of all impaired functions of the pre-speech period. When working, it is not so much the age of the child that is taken into account, but the level of pre-speech development at which he is. At the same time, correctional pedagogical 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 the child’s “zone of proximal development.”
3. The use of kinesthetic stimulation in the development of motor skills of the articulatory apparatus, sensory and speech functions. This is due to the fact that with cerebral palsy, a lack of sensations of movement, position of body parts and muscle efforts, i.e. kinesthesia, leads to motor, speech and intellectual disorders. One type of kinesthesia disorder is the insufficiency or absence of a trace pattern of movement, including the movement of articulatory muscles.
The basis for the developed system of correctional and pedagogical work was the principle of the active participation of reverse afference in the formation of compensatory mechanisms, developed. When developing a system of exercises aimed at correcting and developing articulatory motor skills, the position was taken into account that the absence of feedback (kinesthesia) would stop any possibility of gaining experience to control the movements of the speech organs, a person would not be able to learn speech, and strengthening feedback (kinesthesia ) speeds up and facilitates speech learning.
4. Principles of Soviet didactics. Correction and development of pre-speech functions of children with cerebral palsy require the creative use of didactic principles such as an individual approach, systematic and consistent presentation of material, activity, and clarity. These principles of learning are related to each other and are interdependent. In correctional pedagogical work, all of the listed didactic principles are widely used, but taking into account the specific characteristics of children suffering from cerebral palsy.
5. Organization of classes within the framework of the child’s leading activities.
6. Complex medical and pedagogical intervention, which includes both pedagogical and medical measures aimed at restoring impaired functions. Medical treatment involves medication and physiotherapeutic treatment, physical therapy, massage, etc. The organization of speech therapy work involves the active participation of both medical personnel and the child’s parents.
Correctional pedagogical work should be carried out daily in a specially equipped room, individually. During the day, the mother or medical staff, after preliminary instructions, conducts simple exercises to consolidate the skills acquired in speech therapy classes.
Considering that, starting from the first days of life, under the influence of pathological tonic reflexes ( characteristic symptom cerebral palsy), the child develops pathological positions of the arms, legs, body position and head (torticollis), it is necessary to select individual body positions for each child in which pathological tonic reflexes would not appear at all or would appear minimally. These positions of the torso, limbs, and head, called “reflex inhibitory positions,” must be given to the child before the speech therapy session and maintained during the session.
Choosing a pose for the “Reflex inhibiting positions” exercise.
Goal: to choose a position for the child in which pathological tonic reflexes would manifest themselves minimally or not at all.
1. Fetal position - in the supine position, the baby’s head should be raised and lowered onto the chest, arms and knees should be bent and brought to the stomach. In this position, smooth rocking is performed up to 6-10 times, aimed at achieving the maximum possible muscle relaxation (method proposed by B. and K. Bobath).
2. In the supine position, a cushion is placed under the child’s neck, allowing him to slightly raise his shoulders and tilt his head back; The legs are bent at the knees.
3. In the supine position, the child’s head is fixed on both sides with rollers, allowing it to be kept in the midline.
4. In the lateral position, the baby is placed in the “fetal position.”
5. In the prone position, a cushion is placed under the child’s chest, and the buttocks are secured with a belt with a weight.
Main directions correctional pedagogical work
are the following:
normalization of the condition and functioning of the articulation organs through differentiated and acupressure massage, articulatory gymnastics;
development of visual and auditory perception; ^
development of emotional reactions;
development of hand movements and actions with objects;
formation of preparatory stages of development of speech understanding;
development of the preparatory stages of the formation of active speech.
These directions vary depending on the age of the child, his level of development and his capabilities.
The main task of correctional pedagogical work with children in Ipre-speech level of development, is the stimulation of vocal reactions.
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;
normalization of the position of the hand and fingers, necessary for the formation of visual-motor coordination.
Classes with children are conducted individually, both before and after feeding. During classes, the child is on the changing pad in the “reflex inhibiting position” position. Lesson duration is 7-10 minutes. The mother should be present at the classes and learn the techniques of correctional pedagogical work in order to continue working with her child during the day.
onIIpre-speech level of development, is the stimulation of humming.
The main directions of correctional and pedagogical work:
normalization of muscle tone and motor skills of the articulatory apparatus;
increasing the volume and force of exhalation with subsequent vocalization, stimulation of humming;
development of stability of 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 conducted during this period are individual in nature and do not exceed 10-15 minutes in duration. They are carried out in a specially equipped bright and warm room, isolated from extraneous noise. During the lesson, the child is in an appropriate position for him, “reflex prohibitive positions.” The activity uses the baby's waking hours before or after feeding. During the day, the mother or medical staff should work with the child according to a plan drawn up by a speech therapist. (This requirement should also be taken into account when conducting classes with children of levels III and IV of pre-speech development.)
The main task of correctional pedagogical work with children in onIIIpre-speech level of development, is the stimulation of intonated vocal communication and babble.
The main directions of correctional and pedagogical work:
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 classes are conducted individually, daily. The duration of classes does not exceed 20 minutes. Classes take place in a speech therapy room equipped with special furniture and a set of necessary toys. Depending on his motor capabilities, during the lesson the child is on a changing pad, in a special chair or in an armchair, i.e. in a position adequate to the capabilities of the child.
The main task of correctional pedagogical work with children in onIVlevel of pre-speech development, is the development of communication with adults through the intonation sounds of babbling and babbling words.
The main directions of correctional and pedagogical 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;
developing an understanding of speech instructions in a specific situation;
Classes are held in a speech therapy room. Particular attention is paid to the correct position of the child during classes, in which pathological reflexes would minimally manifest themselves. For this purpose, special rocking chairs and chairs are used that allow the upper part of the child’s body to be held in an upright position and the head in the midline.
Often, during classes, a child sits in a rubber inflatable circle of the appropriate diameter, in which his position approaches that of an embryo.
One of the important factors for the success of speech therapy classes is the creation of a positive emotional attitude of the child towards the class and towards the speech therapist. Great value To develop the child's activity, he has a choice of toys that are appropriate for his age. Classes are conducted individually and last 25-30 minutes. Due to the fact that children at this level understand speech addressed to them, special attention focuses on involving the child himself in completing the task.
BREATHING EXERCISES
The purpose of breathing exercises carried out with children of the first level of pre-speech development is to increase the volume of inhaled and exhaled air with subsequent vocalization of exhalation. Considering that children with cerebral pathology have respiratory failure from the first days, they carry out breathing exercises. After lightly stroking the child’s body and limbs, the speech therapist takes his hands and, shaking them slightly, spreads his arms to the sides and up, while slightly lifting the chest - inhale, then, pressing his hands to the body, lightly presses on the chest - exhale. The exercise is carried out for 1 - 1.5 minutes, 2-3 times daily.
Breathing exercises with children of level II pre-speech development are also aimed at increasing the volume and force of exhalation with its subsequent vocalization.
During this period, passive breathing exercises are performed to train the depth and rhythm of breathing. The following breathing movements are performed with a child over 5 months old:
1. Having placed the child in the “reflex inhibiting position” position, with a slight shake, spread the arms to the sides and raise them up (Fig. 31), while inhaling, and when lowering the arms and pressing them to the chest, exhale (Fig. 32 ).
2. Simultaneously with turning the child’s head to one side, his hand is also moved to the corresponding side (inhale) (Fig. 33). Lightly shaking the hand and head, return them to their original position (exhale) (Fig. 34). These movements help develop rhythmic movement and breathing.
3. The child is placed on his back in the “reflex inhibiting position.” Gently shaking the child's legs, they are stretched and unbent, while inhaling occurs, and bending them at the knees and bringing them to the stomach enhances exhalation. If the child does not resist
Rice. 31. Breathing exercise: Fig. 32. Returning hands to their original position
Psychospeech development map - used in a group for children with cerebral palsy.
1. Last name, first name, patronymic _____________________________________________________
2. Date of birth___________________________________________________________
3. Home address______________________________________________________________
4. Entered d/s No. 27 from __________________________________________________________
5. Indications for staying in a compensatory group for children with musculoskeletal disorders________________________________
Doctors' conclusions:
1. Neurologist_______________________________________________________________
2. Orthopedist________________________________________________________________
3. Psychiatrist________________________________________________________________
4. ENT_________________________________________________________________________
5. Oculist________________________________________________________________
6. Orthodontist________________________________________________________________
Family information:
Full name, age, profession, place of work of the mother_____________________________________________
Full name, age, profession, place of work of the father_____________________________________________
_____________________________________________________________________________
Parents' assessment of the child's condition and possibilities for his development__________________
Anamnesis:
1. Adverse development factors_____________________________________________
_____________________________________________________________________________
2. Hereditary burden__________________________________________________________
_____________________________________________________________________________
3. Pathology of pregnancy and childbirth___________________________________________
_________________________________________________________________________________
4. Head contusions, injuries, illnesses___________________________________________
________________________________________________________________________________
5. At what age were the main diseases diagnosed____________________
_____________________________________________________________________________
_____________________________________________________________________________
6. At what age was a lag in psychological development noticed?
_____________________________________________________________________________
7. At what age was mental retardation noticed_________________
_____________________________________________________________________________
8. Features of feeding at an early age_________________________________
__________________________________________________________________________________
9. Early psychomotor development:
Holds head with_________________
sits with support_______________________ independently with_____________________
Stands with support_______________________ independently with_____________________
Walks with support_______________________ independently with_____________________
Reacts to light with___________________________ Reacts to sound with ___________________
Speech history:
Humming with ________________________ babbling with ________________________________
First words with _________________________________ phrases with ________________________________
Speech understanding_______________________________________________________________
Motor capabilities:
Features of walking___________________________________________________________
______________________________________________________________________________
Hand mobility:
Lifting_________________________________________________________________
Lateral spread_________________________________________________________________
Pulling forward______________________________________________________________
Grabbing Items:
Large ones - with a brush___________________________ small ones - with fingers_____________________
Alternating connection of all fingers of the hand with the thumb_____________________
Leading hand_________________________________________________________________
Performing facial movements:
Raising eyebrows: together______________ one by one _____________________________
Closing the eyes: together _______________ alternately___________________________
Smile________________ puffing out cheeks: together___________ alternately___________
Verbal memory:
Repetition of a series of words: house, forest, table, cat__________________________________________
Visual-verbal memory:
Laying out 4 subject pictures in a given sequence with naming when memorizing and playing_________________________________________________
In 5 seconds_________________________________________________________________
Retelling a familiar text______________________________________________________________
Characteristics of attention:
Concentration_________________________________________________________________
Switchability______________________________________________________________
Conclusion about the state of mental processes:
Visual perception_______________________________________________________________
Memory_______________________________________________________________________
Conclusion on the development of cognitive activity______________________________
_______________________________________________________________________________
Speech therapy examination:
Structure of the articulatory apparatus__________________________________________________________
Bite_______________________________________________________________________
Jaws______________________________________________________________________________
Lips_________________________________________________________________________
Teeth_________________________________________________________________________
Language_________________________________________________________________________
Hyoid frenulum_________________________________________________________________
Hard palate________________________________________________________________________________
Soft palate___________________________________________________________________
Mobility of articulation organs:
Keeping the mouth closed outside of eating and speaking__________________________________________
Features of eating:
Eats independently or requires adult assistance________________________________
Chews solid food or not _____________________________________________
Swallows calmly or tilts head back________________________________________________
Chews with mouth open or closed_____________________________________________
Is chewing accompanied by sucking movements of the lips___________________________
Lip mobility:
Grin_________________________ lips stretched forward__________________________
Tongue mobility:
Sticking out the spread tongue ________________________________________________
Lifting the tip of the tongue onto the upper lip__________________________________________
Lowering the tip of the tongue onto the lower lip_____________________________________________
Movement of the tip of the tongue to the right and left___________________________________________
Licking lips_______________________________________________________________
Mobility of the soft palate:
"A" with his mouth open_________________________________________________________________
Severity of neurological symptoms:
Paresis (spastic, flaccid)__________________________________________________________
Hyperkinesis_______________________________________________________________________________
Kinesthetic apraxia_______________________________________________________________
Synkenesis______________________________Salivation______________________________
Cognitive activity:
Auditory perception of non-speech sounds (discrimination of sounding toys) _______________
Stereognosis
Recognizing the texture of objects by touch: wood___________ metal_________________
Glass_______________ plastic__________________________
Recognizing the shape of objects by touch: coil_______________ spoon_______________
Pencil________________________ cup___________________________
Recognition by touch geometric shapes: ball_______________ cube_________________
Cylinder ___________________________ pyramid ________________
Distinguishing objects by touch by size: large______________________________
Medium_________________________ small_______________
Visual perception
Color perception
Color Identification Naming
Red ______________ __________
Blue ______________ __________
Yellow ______________ __________
Green ______________ ___________
Brown______________ ___________
Black ______________ ___________
White ______________ ___________
Pink ______________ ___________
Blue ______________ ___________
Shape perception
Circle _______________ ___________
Square _______________ ___________
Triangle _______________ ___________
Rhombus _______________ ___________
Rectangle _______________ ___________
Oval _______________ ___________
Perception of size
Big – small _______________ ___________
Long – short _______________ ___________
High – low _______________ ___________
Thick – thin _______________ ___________
Wide - narrow _______________ ___________
Spatial representations
Orientation in the sides of one’s own body (left, right)__________________________
Distinction between concepts:
Constructive praxis:
Direct sample copy:
Of 3 elements (for four-year-old children)__________________________________________
Of 5 elements (for five-year-old children)__________________________________________
Of 6 elements (for six-year-old children)_____________________________________________
Temporary representations
Day______________Evening__________Night______________Morning____________________
Winter______________Spring_____________Summer______________Autumn_________________
From the age of five
Yesterday___________Today_________________Tomorrow______________________________
From the age of six
Minute__________ Hour___________ Day___________ Day__________ Week________
Mathematical representations
One__________ Many________________ Equally______________
Direct counting up to 3_________________________________________________
From 5 years old
Straight count to five_______________________________________________
Comparison of quantities on a specific material____________________
From 6 years old
Comparison of numbers_______________________________________________
Quantitative composition of a number from units___________________________________________
Thinking
Elimination of the extra item “4 is extra” _______________________________________
Classification of items (vegetables - dishes) ________________________________________________
Understanding the figurative meanings of words (“golden hands”, “golden hair”)____________
_____________________________________________________________________________
Memory
Visual memory: laying out 4 subject pictures in a given sequence without naming when memorizing and reproducing_______________
In 5 seconds_________________________________________________________________
(from 4 years old) Showing Naming
Self-Service Actions
Washing __________________________________________________________________________
Dressing_______________________________________________________________________________
Cleans_______________________________________________________________________________
Sweeps__________________________________________________________________________
Erases_______________________________________________________________________________
Strokes_______________________________________________________________________________
Relative adjectives:
Walnut_____________________________________________________________________
Morning_____________________________________________________________________
Glass___________________________________________________________________
Urban____________________________________________________________________
Qualitative adjectives:
Sweet______________________________________________________________________
Kind______________________________________________________________________
Smooth_______________________________________________________________________
Funny______________________________________________________________________
Possessive adjectives:
Lisiy______________________________________________________________________________
Hare______________________________________________________________________________
Canine______________________________________________________________________
Bearish____________________________________________________________________
Pot_____________________________________________________________________
Pan____________________________________________________________________
Kettle_______________________________________________________________________
Cup________________________________________________________________________
Sugar bowl__________________________________________________________________________
Saucer_______________________________________________________________________
(from 5 years old)
Transport:
Bus______________________________________________________________________
Trolleybus________________________________________________________________________
Tram______________________________________________________________________
Train________________________________________________________________________
Airplane______________________________________________________________________
Ship______________________________________________________________________
Pets:
Cow_______________________________________________________________________
Dog_______________________________________________________________________
Correlating words with objects and actions:
(from 4 years old) Showing Naming
Vegetables: cucumber________________________________________________________________
Tomato______________________________________________________________
Cabbage_______________________________________________________________
Onion___________________________________________________________________
Beet________________________________________________________________
Radish_________________________________________________________________
Fruit: Apple______________________________________________________________
Pear_______________________________________________________________
Plum_______________________________________________________________
Lemon_______________________________________________________________
Orange____________________________________________________________
Clothes: Dress________________________________________________________________
Shirt_______________________________________________________________
Coat________________________________________________________________
Trousers________________________________________________________________
Blazer_______________________________________________________________
Shoes: Slippers_________________________________________________________________
Shoes_________________________________________________________________
Boots________________________________________________________________
Boots_______________________________________________________________
Felt boots_______________________________________________________________
Sandals______________________________________________________________
Furniture: Table_______________________________________________________________
Closet_________________________________________________________________
Sofa_________________________________________________________________
Armchair________________________________________________________________
Bed_______________________________________________________________
Movements of humans and animals:
Going_______________________________________________________________
Sits_______________________________________________________________
Runs_______________________________________________________________
Costs____________________________________________________________
Flies______________________________________________________________
Floating_________________________________________________________________
Breath
Type (abdominal, thoracic, mixed)_____________________________________________
Frequency (normal, accelerated)________________________________________________
Uniform (even, intermittent)________________________________________________
Strength______________________________Height__________________________________________
Timbre________________________________________________________________________
Synchronicity in the work of the departments of the speech-motor apparatus_________________________
Respiratory and vocal ______________________________________________________________
Voice-breathing and articulatory__________________________________________
General characteristics speeches
Impressive speech:
Understanding situational speech: show the table_____________________________________________
Come to the table_______________________________________________________________
Understanding contextual speech: What did you drive to the d/s?___________________________
What toys do you have at home?_________________________________________________
Expressive speech:
Availability______________________________________________________________________
Detail (individual words, phrases)___________________________________________
Intelligibility______________________________________________________________________________
Using gestures in communication________________________________________________
Prosody state
Rate of speech (normal, slow, accelerated)________________________________
Rhythm of speech (normal, arrhythmia) ________________________________________________
Intonation (presence different types)_______________________________________________
Pronunciation state
P B V F T D N Y K G X S S Z Z Z Z Z F H S H L R R R
isolated
in words
State of the phonemic system
The presence of gross distortions in the structure of words________________________________________________
_____________________________________________________________________________
Volume________________________________________________________________________
Isolating the last stop consonant from a word
Cat_________soup____________poppy__________compote_________________
Determining the number and sequence of sounds in monosyllabic words like
POPPY_____________________HOUSE____________________CAT___________
Differentiation of sounds in words - quasi-homonyms
Hard – soft_______________________________________________________________
Voiceless - voiced ______________________________________________________________
Sonorov ______________________________________________________________________________
R – L _____________________________________________________________________________
Dr. sounds (in accordance with replacements in oral speech)________________________________
_____________________________________________________________________________
The state of the lexical aspect of speech
General characteristics of the active dictionary__________________________________________
_____________________________________________________________________________
State grammatical structure
Presence of phrasal speech______________________________________________________________
Sentence Understanding Compilation
Boy playing
Boy throwing a ball
Boy ironing clothes with an iron
Prepositions
IN ______________ _______________
ON ______________ _______________
FOR ______________ _______________
UNDER ______________ _______________
ABOVE ______________ _______________
AGAINST ______________ _______________
BETWEEN ______________ _______________
CO ______________ _______________
WITH ______________ _______________
FROM – UNDER ______________ _______________
BECAUSE OF ______________ _______________
Changing nouns by case:
There is a bridge___________ the river flows_______________
There is no bridge_______________ near the river_______________
Over the bridge________________ along the river__________________
I see a bridge______________ I see a river________________
Under the bridge______________ across the river__________________
On the bridge________________ on the river___________________
Changing nouns by number:
house-home__________ mushroom-mushrooms____________
Agreement of adjectives with singular nouns in gender
Red ribbon______________ red ball______________ red dress___________
Agreement of past tense verbs with nouns in gender:
The boy fell ______________ the girl fell ________________
Word formation:
(from 4 years old) mushroom-fungus____________house-house_________cup-cup________________
(from 5 years old) formation of adjectives from nouns
made of iron – iron_______________ made of wood – wooden_______________________
(from 6 years old) formation of verbs using prefixes
Entered__________left_________approached__________left________crossed_________
Speech therapist's report ___________________________________________________________
_____________________________________________________________________________
General map for assessing the results of correctional education
1. Regularity of attending classes_______________________________________________
2. Characteristics of the child’s attitude towards classes, behavior in classes______________
___________________________________________________________________________________
3. Dynamics of speech development_______________________________________________________________
Impressive speech______________________________________________________________
General characteristics of expressive speech_____________________________________________
Speech therapy conclusion _____________________________________________________
4. Dynamics of development of cognitive processes
Stereognosis__________________________________________________________________________
Visual perception
Spatial representations________________________________________________
Temporary representations_______________________________________________________________
Mathematical representations_______________________________________________________________
Thinking____________________________________________________________________
Attention_____________________________________________________________________
Conclusion on the development of cognitive activity________________________________
_____________________________________________________________________________
Formation of prerequisites for school education______________________________
_____________________________________________________________________________
Teamwork skills_________________________________________________________
Perseverance in frontal exercises_________________________________________________
Map of the physical development of a pupil of MAOU No. 186 with NODA (cerebral palsy)
Child: Nesterova Ksenia, age ____2008__
Diagnosis: cerebral palsy, mixed tetroparesis, convergent strabismus, cerebral palsy
During the monitoring of physical development, it was revealed: insufficiency in the development of motor functions of the upper and lower extremities of the musculoskeletal system, low level of development of fine motor skills, low level of development of general motor skills. Movement disorders are characterized by disturbances in coordination, tempo of movements, and limitations in their volume and strength. The child has weakness of the entire muscular system, he is unable to for a long time hold your head up, sit without support, stand and move on all fours. The girl cannot maintain her balance on her own, stand or move along the handrail. The child shows a keen interest in activities. He hears and tries to follow the verbal commands given by the instructor, but due to the severity of his illness he does not perform the exercises on his own; the instructor’s passive development is required.
Conclusion: – based on the monitoring of physical development, an individual program for the adaptive physical development of the child was developed, which took into account the characteristics of the clinical form of cerebral palsy of the given pupil.
Objectives of the individual development program:
- Form control over the position of the head and its movement;
- Teach to straighten the upper body, form posture:
- train support functions of the hands (support on the forearms and hands);
- Develop torso rotations (turning from back to stomach and from stomach to back);
- Form the functions of sitting and sitting down independently;
- Develop balance;
- teach to get on all fours and crawl in this position;
- Learn to get on your knees, then on your feet;
- Develop the ability to maintain an upright posture and walk with and without support;
- Stimulate independent walking and correct its violations.
-Braking and overcoming incorrect postures and positions.
- Prevention of the formation of a secondary vicious motor stereotype.
The program for the individual physical development of a child with cerebral palsy was designed for the school year, after which its effectiveness is monitored for the purpose of further planning activities. Individual work was carried out 2-3 times a week, for 15-20 minutes, starting from September 2015 to May 2016. - diagnostics.
The work uses diagnostics - Semenova K.A. "Treatment of movement disorders in cerebral palsy"
Level zero: The child is unable to hold a position while sitting, standing, turning while lying down, crawling, or holding his head up. Active movements of the upper limbs are kept to a minimum. The influence of tonic reflexes remains.
Level 1: The child moves with assistance or with the support of a walker. Self service is minimal. Able to hold his head up and sit while maintaining a defective posture with additional support. Doesn't hold the position in a standing position. The influence or parts of tonic reflexes are retained.
Level 2: The child moves with the support of crutches or canes for short distances without support. There is a slight limitation of self-care due to pathological installations in the joints of the upper extremities. Able to sit while maintaining a defective posture. Can stand with additional support.
Level 3: Characterized by defective walking over short distances without additional support or over long distances. Motor function of the hands without significant impairment. Self-care is not impaired, but fine motor skills of the hand are difficult.
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Attached files
Psychospeech development map - used in a group for children with cerebral palsy. General information: 1. Last name, first name, patronymic _________________________________________________________ 2. Date of birth___________________________________________________________ 3. Home address__________________________________________________________ 4. Admitted to kindergarten No. 27 from __________________________________________________________ 5. Indications for staying in a compensatory group for children with musculoskeletal disorders________________________________ Doctors' conclusions: 1. Neurologist________________________________________________________________ 2. Orthopedist________________________________________________________________ 3. Psychiatrist________________________________________________________________ 4. ENT_________________________________________________________________ 5. Ophthalmologist________________________________________________________________ 6. Orthodontist________________________________________________________________ Information about the family: full name, age, profession, place of work of the mother_________________________________ ______________________________________________________________________________ Full name, age, profession, place of work of the father_________________________________ ______________________________________________________________________________ Parents' assessment of the child's condition and possibilities for his development________________________________ h: 1. Unfavorable development factors_____________________________________________ _________________________________________________________________________ 2. Hereditary burden___________________________________________ ___________________________________________________________________________ 3. Pathology of pregnancy and childbirth___________________________________________ ______________________________________________________________________________ 4. Head contusions, injuries, illnesses___________________________________________ _________________________________________________________________________ 5. At what age were the main diseases diagnosed____________________ ______________________________________________________________________________ _________________________________________________________________________ 6. At what age was a lag in psychological development noticed____________________ _______________ ______________________________________________________________ 7. At what age was mental retardation noticed_________________ _______________________________________________________________________________ 8. Peculiarities of feeding at an early age______________________________ ___________________________________________________________________________________ 9. Early psychomotor development: Holds head with____________________ sits with support_______________________ independently with_____________________ Stands with support_______________________ independently with_____________________ Walks with support_______________________ independently with_____________________ Reacts to light with________________________ reacts to sound with ___________________ Speech history: Walking with________________________ babbling with ___________________________ First words with ________________________ phrases with ________________________________ Speech understanding________________________________________________________________ Motor abilities: Features of walking___________________________________________________________ ________________________________________________________________________________ Mobility of the arms: Lifting_________________________________________________________________ Spreading to the sides___________________________________________________________ Pulling forward______________________________________________________________ Grasping objects: Large - with a brush________________________ small - with fingers_____________________ Alternating connection of all fingers of the hand with the thumb_____________________ Leading hand___________________________________________________________ Performing facial movements: Raising eyebrows : together______________ alternately_____________________________ Closing your eyes eyes: together _______________ alternately___________________________ Smile________________ puffing out cheeks: together____________ alternately___________ Verbal memory: Repetition of a series of words: house, forest, table, cat__________________________________________ After 5 seconds_________________________________________________________________ Visual-verbal memory: Laying out 4 subject pictures in a given sequence with naming during memorization and reproduction_________________________________________________ After 5 seconds_________________________________________________________________ Retelling familiar text______________________________________________________________ Characteristics of attention: Concentration___________________________________________________________ Switchability___________________________________________________________ Conclusion about the state of mental processes: Stereognosis__________________________________________________________________________ Visual perception__________________________________________________________ Spatial representations________________________________________________ Temporal representations________________________________________________________________ Mathematical representations_________________________________________________ Thinking_________________________________________________________________________ Memory________________________________________________________________________________ Attention______________________________________________________________________________ Conclusion on the development of cognitive activity______________________________ _______________________________________________________________________________ Speech therapy examination : Structure of the articulatory apparatus_________________________________________________ Bite_______________________________________________________________________ Jaws_______________________________________________________________________________ Lips________________________________________________________________________________ Teeth________________________________________________________________________________ Tongue________________________________________________________________________________ Sublingual frenulum___________________________________________________________ Hard palate_________________________________________________________________ Soft palate_________________________________________________________________________ Motility of organs articulations: Keeping the mouth closed outside of eating and speaking__________________________________________ Peculiarities of eating: Eats independently or requires the help of an adult________________________________ Chews solid food or not _____________________________________________ Swallows calmly or throws back the head _____________________________________________ Chews with the mouth open or closed _____________________________________________ Is chewing accompanied by sucking movements of the lips ___________________________ Lip mobility: Grin _________________________ stretching of the lips forward __________________________ Mobility of the tongue : Sticking out the spread tongue _____________________________________________ Raising the tip of the tongue onto the upper lip __________________________________________ Lowering the tip of the tongue onto the lower lip ________________________________________ Movements of the tip of the tongue to the right and left__
