The main directions of work of a psychologist with this category of persons. Psychological assistance to children with cerebral palsy, its direction and objectives

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 to form state system 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 a single 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 disorders 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 mental development and structures 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 qualitative analysis received data.

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. 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, preventing 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, it is necessary Special attention give 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 last years Early diagnosis of cerebral palsy has been widely introduced into practice. Despite the fact that already in the first months of life pathology can be detected before 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 child’s development. 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 mental state of the child.

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.

Introduction

cerebral palsy child psychological

First clinical description cerebral palsy was made by W. Little in 1853. For almost 100 years, cerebral palsy was called Little's disease. The term “cerebral palsy” belongs to S. Freud. He also belongs to the first classification of cerebral palsy. In 1893, he proposed combining all forms of spastic paralysis of intrauterine origin with similar clinical signs into the group of cerebral palsy. And already in 1958, at the meeting of the VIII revision of the WHO in Oxford, this term was approved and the following definition was given: “cerebral palsy is a non-progressive disease of the brain that affects its parts that control movements and body position, the disease is acquired in the early stages of brain development "

With cerebral palsy, a wide variety of motor disorders are observed. Muscle structures are affected to the maximum extent, and first of all, violations of coordination of movements are detected. Disorders of motor activity are formed due to damage to brain structures. Moreover, the volume and localization of brain lesions determine the nature, form and severity of manifestations of muscle disorders.

Cerebral palsy is a clinical term that unites a group of chronic, non-progressive symptom complexes of motor disorders secondary to lesions and/or abnormalities of the brain that occur during the perinatal period. False progression is noted as the child grows. Approximately 30-50% of people with cerebral palsy have intellectual impairment.

Children with cerebral palsy are characterized by specific deviations in mental development. The mechanism of these disorders is complex and is determined both by time and by the degree and location of brain damage. A significant number of works by domestic specialists (E.S. Kalizhnyuk, L.A. Danilova, E.M. Mastyukova, I.Yu. Levchenko, E.I. Kirichenko, etc.) are devoted to the problem of mental disorders in children suffering from cerebral palsy. .

Features of personality formation and the emotional-volitional sphere in children diagnosed with cerebral palsy can be determined by two factors:

biological characteristics associated with the nature of the disease;

social conditions - the impact of family and teachers on the child.

Raising a child with cerebral palsy in a family often occurs under excessive care. Parents often worry and worry about their child. They often feel guilty, disappointed, and even depressed because they are unable to change the situation. But such care often harms the child and does not allow him to feel the need for movement, activity and communication with others. Also, as a result of overprotection, the child’s self-esteem decreases, isolation and self-doubt appear. The purpose of the course work is to consider the organization of work with parents of children with cerebral palsy.

To achieve this goal, the following tasks have been identified:

define the concept and main forms of cerebral palsy;

consider psychological characteristics and deviations in children diagnosed with cerebral palsy;

study the concept and features of working with children with cerebral palsy;

The course work consists of an introduction, main part, conclusion, list of used sources and literature.

1. Theoretical foundations of cerebral palsy

.1 Concept and main forms of cerebral palsy

Cerebral palsy (CP) is a concept that unites a group of movement disorders that arise as a result of damage to various brain structures in the perinatal period. Cerebral palsy may include mono-, hemi-, para-, tetra - paralysis and paresis, pathological changes in muscle tone, hyperkinesis, speech disorders, unsteadiness of gait, motor coordination disorders, frequent falls, and retardation of the child in motor and mental development.

The main cause of cerebral palsy is hypoxia (oxygen starvation) of the child in the womb or immediately after birth. Hypoxia, in turn, can be caused by pregnancy pathology (toxicosis, infections, impaired placental circulation). Less commonly, birth injuries are the cause of cerebral palsy. They are usually caused different types obstetric pathology. They may be weakness of labor, a narrow maternal pelvis or its irregular structure, rapid or protracted labor, a long anhydrous interval before childbirth, and incorrect presentation of the fetus. After childbirth, the most common cause of the disease is hemolytic jaundice of newborns. It usually occurs due to incompatibility of the blood groups or Rh factors of the child and mother or due to liver failure in the newborn.

I.N. Ivanitskaya believes that the term “cerebral palsy” combines a number of syndromes that arose in connection with brain damage and are manifested, first of all, by the inability to maintain a posture and perform voluntary movements.

For example, D. Werner defines “cerebral palsy” as a disease that causes impaired motor activity and unnatural body position.

L.M. Shipitsyn and I.I. Mamaichuk, the term “cerebral palsy” refers to disorders of posture and motor functions acquired in the first years of life, non-progressive, partly amenable to functional correction and explained by insufficient development or damage to the brain.

ON THE. Ermolenko, I.A. Skvortsov, A.F. Neretina believes that the term “cerebral palsy” combines syndromes that arise as a result of brain damage in the early stages of ontogenesis and are manifested by the inability to maintain a normal posture and perform voluntary movements.

L.O. Badalyan noted that damage to the nervous system in cerebral palsy is not a “breakdown” of a ready-made mechanism, but a delay or distortion of development.

Motor disorders in cerebral palsy are caused by the fact that increased muscle tone, combined with pathological tonic reflexes (tonic labyrinthine and cervical reflexes), interferes with the normal development of age-related motor skills. Tonic reflexes are normal reflexes in children under 2-3 months of age. However, with cerebral palsy, their reverse development is delayed, and they significantly complicate the child’s motor development. The severity of tonic reflexes depends on the severity of brain damage. In severe cases they are pronounced and easy to detect. With milder lesions, children learn to inhibit the reflex. Tonic reflexes also affect the muscle tone of the articulatory apparatus.

Currently, there is no single universally accepted classification of cerebral palsy. During the study of this formidable disease, numerous classifications were proposed - more than 20.

The classification is based on the clinical manifestations of movement disorders. Bye. Semenova distinguishes the following forms: spastic diplegia (the term is erroneous, because it implies lower paraparesis, and in classical neurology diplegia means double hemiplegia), hyperkinetic or dyskinetic, hemiparetic, bilateral hemiplegia, atonic-astatic and ataxic. G G Shanko recommends distinguishing the severity of movement disorders according to the ability to move independently: - move independently; - with outside help; - do not move.

There are three stages in the development of the disease: the early stage (up to 4 months), the initial chronic-residual stage (up to 3-4 years) and the late final residual stage.

In domestic neurology, the classification proposed in 1952 by A. Ford and initially modified by D.S. Footer has been adopted. (1958), and then Semyonova K.A. (1964). According to this classification, there are five forms of cerebral palsy:

Double hemiplegia - motor disorders are represented by tetraparesis.

Spastic diplegia, in terms of the prevalence of motor disorders, is, like double hemiplegia, tetraparesis, but the muscle tone is changed not according to the type of rigidity, but according to the type of spasticity. The arms are affected to a much lesser extent than the legs, sometimes only minimally.

Hyperkinetic form of cerebral palsy.

In the atonic-astatic form of cerebral palsy, unlike other forms of this disease, paresis is minimal.

The hemiparetic form of cerebral palsy originates either in difficult childbirth (i.e. intrapartum), complicated by cerebrovascular accident and asphyxia, or during the newborn period as a result of traumatic brain injury, neuroinfection or intoxication.

Cerebral palsy is especially common in very low birth weight infants and premature infants.

New treatments that increase the birth rate of low birth weight babies and premature babies do show the overall number of children with cerebral palsy. New technologies have not changed the rate of development of cerebral palsy in children who were born at a normal term and at normal weight.

1.2 Psychological characteristics and deviations in children diagnosed with cerebral palsy

Children with cerebral palsy have a rather unique psychological development. The degree of deviation from the norm depends on many factors, but first of all, the characteristics of mental development are determined by the location and degree of damage to the patient’s brain. True, his social status, the attitude of the people around him.

The psychological characteristics of children with cerebral palsy are presented in more detail in the works of I.Yu. Levchenko, O.G. Prikhodko, I.I. Mamaichuk. The authors unanimously note that in cerebral palsy there is a complex structure of the defect, classified according to the classification of V.V. Lebedinsky to the variant of deficient development.

The psychological characteristic of deficient development is the varying degree of correctable specificity of the formation of all spheres of the personality, caused in this case by severe motor disorders combined with psychological signs of damage (sometimes associated with underdevelopment) of the central nervous system, as well as possible pathology of the analyzers.

The chronological maturation of the mental activity of children with cerebral palsy is sharply delayed and against this background various forms of mental disorders, and primarily cognitive activity, are revealed. There is no clear relationship between the severity of motor and mental disorders: for example, severe motor disorders can be combined with mild mental retardation, and residual effects of cerebral palsy can be combined with severe underdevelopment of mental functions. Children with cerebral palsy are characterized by a peculiar mental development anomaly caused by early organic brain damage and various motor, speech and sensory defects. An important role in the genesis of mental disorders is played by restrictions on activity, social contacts, as well as conditions of upbringing and environment.

Among the types of abnormal development of children with cerebral palsy, developmental delays of the type of mental infantilism are most common. Manifestations of mental infantilism, characteristic of almost all children suffering from cerebral palsy, are expressed in the presence of childish features unusual for this age, spontaneity, the predominance of activities based on pleasure, a tendency to fantasize and daydreaming.

The basis of mental infantilism is the disharmony of maturation of the intellectual and emotional-volitional spheres with the immaturity of the latter. With infantilism, mental development is characterized by uneven maturation of individual mental functions. Simple mental infantilism is distinguished. It also includes harmonious infantilism. In this form, mental immaturity manifests itself in all areas of the child’s activity, but mainly in the emotional-volitional one. There are also complicated forms, such as organic infantilism.

Many children are highly impressionable. This can be partly explained by the compensation effect: physical activity the child is limited, and against the background of this, the senses, on the contrary, receive high development. Thanks to this, they are sensitive to the behavior of others and are able to detect even minor changes in their mood. However, this impressionability is often painful; Completely neutral situations and innocent statements can cause a negative reaction in them.

The complex structure of intellectual defects in children with cerebral palsy requires a differentiated approach to psychological correction.

There are different opinions about the prevalence of speech dysfunction in cerebral palsy. In almost 70% of cases, when children are diagnosed with cerebral palsy, speech pathology is diagnosed, and the level of speech disorder depends on the form of paralysis.

Emotional-volitional and behavioral disorders in children with cerebral palsy manifest themselves in increased excitability and excessive sensitivity to all external stimuli. Typically, these children are restless, prone to outbursts of irritability, and stubbornness. Their larger group, on the contrary, is characterized by lethargy, passivity, lack of initiative, indecision, and lethargy. Many children are characterized by increased impressionability, they react painfully to the tone of voice and neutral questions and proposals, and note the slightest change in the mood of loved ones. Children with cerebral palsy often have sleep disorders: they sleep restlessly, with terrible dreams. Increased fatigue is typical for almost all children with cerebral palsy. It is important that the child begins to recognize himself as he is, so that he gradually develops the right attitude towards the disease and his capabilities. The leading role in this belongs to parents and educators. Pathocharacterological formation of personality is observed in the majority of children with cerebral palsy. Negative character traits are formed and reinforced in children with cerebral palsy to a large extent as a result of overprotective upbringing.

It is difficult to give a psychological and pedagogical description of children with cerebral palsy, because the primary importance in the psychological portrait of a child is not age, but motor abilities and intelligence. Therefore, only the most general age patterns can be identified.

The pronounced disproportionality and uneven, disturbed pace of development, as well as qualitative originality in the formation of the psyche of I.Yu. Levchenko, I.I. Mamaichuk, I.A. Smirnova and other researchers call the main features of the cognitive activity and personality of a child with cerebral palsy.

When drawing up a psychocorrection program, it is necessary to take into account the form, severity and specificity of mental dysfunction. The range of intellectual impairments in cerebral palsy is extremely large - from normal level mental development to severe degrees of mental retardation.

2. General characteristics of working with parents of children with cerebral palsy

.1 Concept and features of working with children with cerebral palsy

The effectiveness of psychological and pedagogical influence depends on an integrated approach and the joint activities of a team of specialists and teachers. Each stage of work is discussed with the teaching staff not only at the PMPK, but also at teacher councils and individual consultations for employees. In groups, notebooks are kept for communication between all specialists and teachers, in which recommendations are given from each specialist, both individually and for all children in the group (educational fairy tale games, relaxation music before bed, calm music for background accompaniment of routine moments, games, physical education exercises, texts of songs and melodies in music classes, etc.).

It often happens that in the presence of a certain defect, the child’s other mental and physical abilities are sufficiently preserved. It is important here to try to activate them in order to compensate for the defect itself. This way, you can develop the child’s creativity and potential. By helping him learn to communicate with people, developing wit and charm, and constantly expanding his range of interests, parents will help their child successfully compensate for his physical disabilities.

As a rule, psychologists use a variety of methods, equipment, and techniques. Some of them are famous. For example, finger theater - working with finger puppets - is a technique aimed at developing fine motor skills and correcting the child’s emotional sphere. It is also possible to use special developmental equipment “Psychomotor”.

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.

The main goals of correctional work for cerebral palsy are: providing children with medical, psychological, pedagogical, speech therapy and social assistance, ensuring the most complete and early social adaptation, general and vocational training. It is very important to develop a positive attitude towards life, society, family, learning and work. The effectiveness of therapeutic and pedagogical measures is determined by timeliness, interconnectedness, continuity, continuity in work various specialists. Therapeutic and pedagogical work must be comprehensive. Important condition complex impact - coordination of actions of specialists in various fields: neurologist, psychoneurologist, exercise therapy doctor, speech therapist, defectologist, psychologist, educator. Their common position is necessary during examination, treatment, psychological, pedagogical and speech therapy correction.

One of the important directions in correctional work with children is the formation of spatial concepts, ideas about spatial relationships. To develop optical-spatial perception, it is necessary to teach the child to compose plot pictures, for example, from cubes with parts of an image or cut cards with illustrations; building geometric shapes and images using various objects, such as sticks. To normalize optical-spatial gnosis, it is necessary to develop both optical-spatial orientation skills in flat design and volumetric design. It should be noted that if visual functions are impaired, the material used by the child (visual aids, pictures) must be sufficiently contrasting with the background on which they are depicted. During classes there must be mandatory verbal accompaniment of all motor skills. It is important that the child develops a sense of posture and develops a movement pattern.

There are several basic principles of correctional pedagogical work with children suffering from cerebral palsy.

The complex nature of correctional pedagogical work. This means constantly taking into account the mutual influence of motor, speech and mental disorders in the dynamics of the child’s ongoing development. As a result, joint stimulation (development) of all aspects of the psyche, speech and motor skills is necessary, as well as the prevention and correction of their disorders.

Early onset of ontogenetically consistent effects based on intact functions. 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 pedagogical, 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 pre-speech and early speech development and timely correctional and 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 and speech therapy work for 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.

Organization of work 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 main type of activity for a given age is stimulated. In infancy (up to 1 year), the leading type of activity is emotional communication with an adult; at an early age (from) one year to 3 years) - objective activity; in preschool age (from 3 to 7 years) - play activities; at school age - educational activities.

Observation of a child in the dynamics of ongoing psycho-speech development.

Close interaction with parents and the entire environment of the child.

The difficulties of restorative treatment of children with cerebral palsy are caused not so much by the severity of the motor defect, but mainly by the peculiar features of their mental and emotional-volitional development. Therefore, timely provision of psychological and pedagogical assistance is one of the most important links in the system of their rehabilitation.

Currently, the issues of psychological assistance to children with cerebral palsy are not sufficiently covered. Practical use various psychotechnical techniques aimed at patients with cerebral palsy are often used by psychologists and teachers without taking into account the form of the disease, the level of development of intellectual processes and the characteristics of the emotional-volitional sphere. The lack of clearly developed differentiated methods of psychocorrection for children with cerebral palsy and inadequate selection of psychotechnical means can negatively affect the quality of mental development of the sick child, and also create significant difficulties in the work of teachers and parents.

Selected methods of psychological assistance, taking into account the individual psychological characteristics of patients, have a positive impact on the dynamics of their mental and personal development.

Parents with a child with cerebral palsy know how many accompanying psychological problems this serious illness brings with it. Therefore, it is clear that the character of the child bearing her imprint is very complex, and his mental abilities are often reduced. But this is not the child’s fault, but his misfortune.

All work with parents who have a special child is based on cooperation and trust; carried out in stages.

At the 1st stage, even before children enter the preschool educational institution, psychologists provide patronage to families. The family study program is effective: family structure and psychological climate, social status of mother and father in the family, basic principles of family relationships, style and background of family life, educational climate of the family, cultural level of parents, difficulties.

At stage 2, we help the family develop the correct attitude towards the reaction of others to the external characteristics of the child, we involve parents in the process of integrating children into society.

E.A Strebeleva and Yu.Yu. Belyakov distinguishes the following forms of work that a defectologist uses when working with children: preschool age with developmental disorders and their parents: advisory and recommendation; lecture and educational; practical classes for parents; organization " round tables", parent conferences, children's matinees and holidays; individual lessons with parents and their child; under group classes.

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.

Parents are the main participants in psychological and pedagogical assistance for cerebral palsy, especially if the child does not attend an educational institution for one reason or another.

For creating favorable conditions education in a family, it is necessary to know the characteristics of the child’s development, his capabilities and development prospects, organize targeted correctional classes, form an adequate assessment, and develop the volitional qualities necessary in life.

For this, it is important to actively include the child in the daily life of the family, in feasible work activities, the desire to ensure that the child not only takes care of himself (eats, dresses independently, is neat), but also has certain responsibilities, the fulfillment of which is significant for others (cover the table, clear the dishes).

Let us dwell on some principles of organizing effective interaction between parents and a special child.

Child activity and independence.

The parent is obliged to help the child, but to help, and not to do for him. The most difficult thing is to look at his unsuccessful attempts, his fatigue, and sometimes despair. To withstand this tension, this state of conscious helplessness is a task and a great feat of parental love. We must realize that faith in the possibility and strength of a child will give him strength and courage.

Constant hard training every day.

Any development, both physical and mental, occurs sequentially; it does not tolerate leaps and breaks. Therefore, the child must go through each step of his ascent himself. Only then will he really learn to control himself. The task of parents is to develop and support this activity, to consistently set increasingly complex goals for the child. Every concession to laziness is a betrayal of your child.

Conscious helplessness of the parent.

If a parent catches himself thinking that he can no longer look at the child’s unsuccessful attempts and are ready to do something for him, the parent does not feel sorry for him, but for himself! If a parent did something for a child, he took away his chance to learn something new.

Unconditional acceptance of the child and his defect by parents.

1) Use the verticalizer for no more than 3 hours.

) Allow the child to move independently (in a stroller, with supports).

) Develop grasping actions, the ability to hold an object in one or two hands, etc.).

) Based on what the child can do.

) Develop self-care skills: eating, washing, dressing, etc.

) Develop orientation in your own body (arms, legs, face, stomach, etc.).

) Develop orientation in time (season, month, date, day of the week, parts of the day).

) Discuss with your child how the day went, what you liked, what you paid attention to.

In addition to those mentioned, other recommendations for parents whose child has cerebral palsy can be identified as follows:

It is important to focus on the child himself, and not on his illness. If you show concern about every issue and limit the child’s independence, then the baby will certainly be overly restless and anxious. This rule is universal for all children - both sick and healthy.

Fatigue from worrying about a disabled child sometimes leaves a corresponding imprint on the appearance of his parents. They look unhappy. But every child needs happy parents who are able to give love and warmth, and not their sick nerves. Only an optimistic outlook on life can help in the fight against this insidious disease.

The correct attitude towards a child can be expressed by the formula: “If you are not like others, this does not mean that you are worse.”

Often, the pursuit of new specialists and treatment methods makes us lose sight of the personality of the baby himself. But an attempt to look at the disease “from the inside”, i.e. through the eyes of a sick child, and is the best opportunity to help him overcome mental and physical suffering. You should not lose sight of the child’s own attitude towards the illness. Recent studies have shown that awareness of the defect in children with cerebral palsy manifests itself by the age of 7-8 years and is associated with their worries about the unkind attitude of others and lack of communication. At this time, psychological support for the child from the family is especially important.

It is necessary to seek the help of specialists as often as possible. For example, a child’s feelings about his appearance can be well corrected by working with a child psychologist.

It is important to adjust the daily routine in order to avoid sleep disturbances, which gives complete rest to the sick body. It is necessary to create a calm environment for the child, avoid overly active and noisy games before bedtime, and limit TV viewing.

In order for a child to form a correct perception of himself and those around him, it is important to give up excessive guardianship towards him. Parents should perceive their child not as a hopeless disabled person, but as a person, albeit in some ways unlike others, but quite capable of overcoming his illness and leading an active lifestyle.

It is especially important to set a firm start time for classes. Thanks to this, a habit is developed, at the appointed time a psychological readiness and predisposition to mental work appears, and even interest in playing or walking is lost.

It is important to find the correct body position so that the tremors are minimal. According to the recommendations of an orthopedist and psychologist, if the child is studying at home.

Necessary permanent place for classes where all the necessary items are at hand. This is how the habit of internal mobilization is developed from the moment classes begin and until the ability to manage one’s behavior has been developed, the workplace should only be a place for studying (no games, no pictures, no toys, no extraneous books, no colored pencils and markers , if they are not needed for the current job). If it is not possible to allocate a permanent place, then at a certain hour a place must certainly be allocated and freed up for classes.

An important rule is to start working immediately, preferably with a subject that is more difficult for the child. The longer you delay starting work on a complex task, the more effort you will need to force yourself to start it. For a person who systematically begins work without delay, the period of “getting involved” in work is short, things go faster and more efficiently, and study becomes a source of not only hard work, but also a source of satisfaction. You should not force your child to rewrite homework multiple times or use the draft only for calculations and drawings.

It is necessary to have breaks from work. The unity of the school and home education regime and the prevention of overload are important.

The work should proceed at a good pace - from 1 hour in elementary school to 4 - 5 hours for high school students.

It is impossible for a schoolchild not to have other responsibilities besides studying: a person who has to do a lot of things during the day gets used to valuing time and planning work.

Accustoming a child to the correct regime must be combined with parental self-discipline, respect for the child, goodwill, and reasonable demands.

Biological factors associated with physical disabilities in cerebral palsy have a direct impact on the development of the child's personality. Children with cerebral palsy's awareness of their physical disability negatively affects personal development. The consequence of this is that children with musculoskeletal disorders are more likely to have inadequate self-esteem and an increased level of personal anxiety than their healthy peers. Thus, the task of parents and specialists is to create conditions for adequate development and personality formation of disabled children.

The formation of adequate self-esteem is a characteristic feature of a child’s personality. The level of development of self-awareness and the adequacy of self-esteem serve as a good criterion for assessing psychological age a person and his psychological characteristics, including any deviations and problems.

With optimal, adequate self-esteem, the child correctly correlates his capabilities and abilities, is quite critical of himself, strives to realistically look at his failures and successes, tries to set achievable goals that can be achieved in practice.

Thus, the personality development features of a child with cerebral palsy largely depend not only on the specifics of the disease, but primarily on the attitude of parents and relatives towards the child. Therefore, you should not assume that the cause of all the failures and difficulties of upbringing is the child’s illness. Believe me, you have enough opportunities in your hands to make your baby a full-fledged personality and just a happy person.

Conclusion

Cerebral palsy (English: child cerebral palsy) is a polyetiological disease that most often begins in utero and continues to develop in the first years of life. The term “cerebral palsy” was proposed by S. Freud (1893) to combine all forms of spastic paralysis of prenatal origin with similar clinical signs. With cerebral palsy, a complex picture of neurological and mental disorders is observed, not only a slow pace of mental development, but also an uneven, disproportionate nature of the formation of individual mental functions.

Cerebral palsy is a group of pathological syndromes that arise as a result of intrauterine, birth or postpartum brain damage and manifest themselves in the form of motor, speech and mental disorders.

Motor disorders are observed in 100% of children, speech disorders in 75% and mental disorders in 50% of children.

Motor disorders manifest themselves in the form of paresis, paralysis, and violent movements. Particularly significant and complex are disorders of tone regulation, which can occur such as spasticity, rigidity, hypotension, and dystonia. Tone regulation disorders are closely related to the delay of pathological tonic reflexes and the immaturity of chain righting reflexes. Based on these disorders, secondary changes are formed in the muscles, bones and joints (contractures and deformities).

Speech disorders are characterized by lexical, grammatical and phonetic-phonemic disorders.

Mental disorders manifest themselves in the form of mental retardation or mental retardation of all degrees of severity. In addition, there are often changes in vision, hearing, vegetative-vascular disorders, convulsive manifestations, etc.

Not many people know that only by understanding the child, by looking at the disease from the inside through the eyes of a little patient, can one really find a way out. After all, the developmental features of children with cerebral palsy are a rather general concept, and each child develops the disease independently, on an individual basis. So the approach should be chosen for each child separately.

The mental development of a child with cerebral palsy is characterized by a violation of the formation of cognitive activity, emotional-volitional sphere and personality. Specialists working with these children and parents face the important task of preventing and correcting these disorders. The specific tasks of this work for each child can be determined only after a comprehensive examination.

Features of the formation of personality and the emotional-volitional sphere in children diagnosed with cerebral palsy can be determined by two factors: biological characteristics associated with the nature of the disease; social conditions - the impact of family and teachers on the child.

In other words, the development and formation of a child’s personality, on the one hand, is significantly influenced by his exceptional position associated with the restriction of movement and speech; on the other hand, the family’s attitude towards the child’s illness and the atmosphere surrounding him. Therefore, you should always remember that personal characteristics children suffering from cerebral palsy is the result of the close interaction of these two factors. It should be noted that parents, if desired, can mitigate the social impact factor.

List of sources and literature used

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Badalyan L.O. Cerebral palsy [Test] / L.O. Badalyan, L.T. Zhurba, O.V. Timonina, - M.: New World, 2012. - 139 p.

Vlasova T.A. About children with developmental disabilities [Text] / T.A. Vlasova, M.S. Pevzner. - M.: Mir, 2010. - 103 p.

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Danilova L.A. Methodology for correcting speech and mental development in children with cerebral palsy [Text] / L.A. Danilova - M.: Knowledge, 2012, 540 p.

Dyachkova A.I. Fundamentals of training and education of abnormal children [Text] / A.I. Dyachkova - M.: Education, 2010. - 235 p.

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Levchenko I.Yu. Technologies for teaching and raising children with musculoskeletal disorders [Text] / I.Yu. Levchenko, O.G. Prikhodko M.: Publishing center "Academy", 2011. - 192 p.

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Larisa Basyrova
Guidelines for working with children with cerebral palsy

Preparatory group (6 - 7 years)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

18. Use onomatopoeia games that promote correct speech pronunciation.

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

Bibliography

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

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

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

Publications on the topic:

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

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

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

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

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

Methodological recommendation for teachers

The current global trend is the desire for social adaptation of persons with special needs of psychophysical development. It provides for the formation of a new culture and educational norms, primarily respect for physically and intellectually disabled people, ensuring sufficient conditions for their integration into society. This trend primarily concerns persons with complex disorders of psychophysical development,

Children with “special needs” are a rather complex, unique contingent. They are distinguished by a number of features, the main one of which is that teachers and psychologists wait a long time for the results of their training and upbringing, children do not give “feedback” like their peers who develop normally due to organic brain damage and, as a result, have cognitive impairment activities. In order to find out and “feel the result”, it is necessary to use various methods and techniques of an educational and educational nature in your work. At the same time with traditional methods psychological and pedagogical impact on the child, it is advisable to use the kinesiological correction method aimed at relieving individual symptoms, improving the development of mental processes, fine and gross motor skills, reducing fatigue, activating cognitive processes, etc. The integrated use of exercises such as:

1) finger gymnastics;

2)exercises aimed at developing interhemispheric interaction;

Such children are in dire need of individual assistance. This is the only way they can feel comfortable and build their self-awareness and self-esteem, and therefore their independence from adults. The problem of early correction is of great importance. The child’s body has great plasticity, so it is at this age that there is the most real possibility of effective correction. A child's cognitive, emotional, motor and speech development are inextricably linked. Violation of one of these areas can lead to a delay in the formation of another.

Children with cerebral palsy have difficulties in spatial analysis and synthesis, disruption of the body diagram, and verbal reflection of spatial relationships. For them, movements are not only difficult to perform, but also very weakly perceptible, which causes difficulty in simple and more complex forms of perception. Weakness of tactile perception and kinesthetics significantly complicate the subsequent acquisition of writing skills.

Children with cerebral palsy experience great difficulties in understanding the world around them (clenched fists, limited movement), which makes it difficult for them to form object-spatial concepts. It is necessary to create a special therapeutic space: a subject-based developmental environment in which the child can feel confident and will show independence and autonomy. After all, illness is not always the determining factor in the lag in sensory activity of these children. Acquired frequent negative experiences make the child passive. A passive attitude towards learning new things dominates and the child refuses attempts to learn. Exercises that cause difficulties are usually ignored, although there is some interest. It is important to recognize the child’s interest and not miss it, to help with the exercise, perhaps simplifying it somewhat.

Each exercise has a dual purpose: actual movement of the child and work for the future. When performing exercises, the child receives a wide variety of sensory sensations, accumulates them and eliminates sensory deficits; exercises that develop visual perception are composed of fragments of different sizes (length, height, width), shapes and colors. Tactile exercises ensure the development of the perception of texture, shape, weight, temperature. The structure of each lesson has constructive principles of working material: from left to right, from simple to complex, etc.

The gradual complication of the material, for example, in design and use (vertical and horizontal versions of the material) allows you to organize repetition on the same thing, but with a new form;

Consistently abstracting material from simple initial functions.

Emotional contact of the child with the teacher and parents (visual, auditory and tactile contacts) atmosphere of cooperation;

Changing activities during the lesson;

Reliance on positive results, cognitive interest of the child;

Consolidating skills at home on other materials, at home;

Helping parents (consulting) in corrective work with children at home.

Program effectiveness, expected results:

The program helps to increase the level of development of cognitive processes and general intellectual abilities of the student, the development of communication skills and abilities, cooperation skills, and improvement of general and fine motor skills.

In the process of classes, a positive emotional mood is created in the child, an atmosphere of trust, goodwill, and a positive attitude towards others is formed.

The goal of the program is to promote the development of the child, create conditions for the realization of her internal potential, help in overcoming and compensating for deviations that impede her development.

Program objective:

Speech development and communication skills;

Development of fine motor skills;

Development of mental processes and spatial concepts;

Expansion of vocabulary;

Development of all types of perception (visual, auditory, tactile and kinesthetic (motor)

Formation of sensory standards of color, shape, size, time, space, as well as muscle-joint sense;

Formation of complete ideas about the world around us;

Development of higher mental functions (attention, thinking, memory) and correction of their disorders;

Target group: children with special needs, namely with cerebral palsy.

Age of participants: 6-8 years

Program duration: academic year.

Lesson duration: 20-25 minutes.

Frequency of classes: 1 time per week.

Number of classes: 34

Class room: the child’s workplace at home where classes take place

Form of implementation: individual.

Methods and techniques: verbal, visual, practical, game methods and techniques; finger gymnastics.

Lesson structure:

1. Greeting.

2. Games to develop hand motor skills.

3. Games for the development of cognitive processes, the cognitive sphere.

4. Reflection.

5. Class diary

6. Traditional farewell.

Introduction

Chapter 1. Theoretical study of children with cerebral palsy

2 Speech disorders in preschool children with cerebral palsy

Chapter 2. Psychological assistance to children with cerebral palsy

Conclusion

List of used literature

INTRODUCTION

Cerebral palsy (CP) is a serious disease of the central nervous system, which manifests itself in the form of various motor, mental and speech disorders. In this case, the motor structures of the brain that regulate voluntary movements, speech and other cortical functions are especially severely affected. Among all forms of cerebral palsy, the most common is spastic diplegia, which is observed in more than 50% of children suffering from cerebral palsy

The psychological and pedagogical study of children with cerebral palsy presents significant difficulties due to the variety of manifestations of disorders of the motor, mental and speech development of these children. But earlier psychological diagnosis and the beginning of psychological correctional work, especially in the first 3 years of life of these children, contributes to the maximum use of the compensatory capabilities of the child’s body: brain plasticity, sensitivity to stimulation of mental and speech development, and the ability to compensate for impaired functions.

Thus, in early preschool and primary school age, special attention should be paid to the peculiarities of the formation of communication in children with cerebral palsy, since, according to many psychologists, the mental development of children of this age occurs precisely in communication and the greatest influence is exerted by the child’s communication with his mother.

The greatest contribution to the study of this problem was made by the works of such researchers as E.S. Kalizhnyuk, I.Yu. Levchenko, I.I. Mamaichuk, E.M. Mastyukova, N.V. Simonova and others.

Many domestic and foreign studies have also been devoted to the study of speech disorders in children with cerebral palsy, which occupy a significant place among other pathological manifestations in cerebral palsy: E.F. Arkhipova, L.A. Danilova, M.V. Ippolitova, etc.

CHAPTER 1 THEORETICAL STUDY OF CHILDREN WITH cerebral palsy

1 Cerebral palsy: characteristics of the defect, its causes and forms

In children with musculoskeletal disorders, the leading one is a motor defect. The bulk of them are children with cerebral palsy (CP). These children have movement disorders combined with mental and speech disorders, so most of them need not only medical and social assistance, but also psychological, pedagogical and speech therapy correction.

Cerebral palsy occurs as a result of underdevelopment or damage to the brain in early ontogenesis. In this case, the parts of the brain responsible for voluntary movements, speech and other cortical functions are most severely affected. Thus, with cerebral palsy, the most important functions for a person suffer: movement, psyche and speech. The leading ones in the clinical picture of cerebral palsy are motor disorders, which are often combined with secondary defects (mental and speech disorders, dysfunctions of other analytical systems (vision, hearing, deep sensitivity), convulsive seizures). The cause of cerebral palsy can be various adverse factors affecting

· in the intrauterine (prenatal) period (infectious diseases suffered during pregnancy, viral infections, rubella, toxiplasmosis; cardiovascular and endocrine disorders in the mother; toxicosis of pregnancy; physical injuries, bruises of the fetus; Rh factor incompatibility; mental trauma; physical factors - overheating or hypothermia, vibration, irradiation, including ultraviolet in high doses; some medications; environmental problems);

· at the time of birth, intrapartum period (birth injuries, asphyxia, clinical death);

· or in the first year of life, in the early postnatal period (transfer of neuroinfections - meningitis, encephalitis, severe head contusions).

The greatest importance in the occurrence of this disease is attributed to brain damage in the prenatal period and at the time of birth.

In children with cerebral palsy, the formation of all motor functions is impaired and delayed: holding the head, sitting, standing, walking, and manipulative skills. Impaired motor function is a primary disorder, which, in the absence of timely correctional work, leads to secondary mental and speech disorders.

The variety of motor disorders in children with cerebral palsy is due to a number of factors related to the specifics of the disease.

Violation of muscle tone (such as spasticity, rigidity, hypotension, dystonia). Any motor act is accompanied by muscle tone. Often with cerebral palsy, there is an increase in muscle tone - spasticity when the muscles are tense (characteristic is an increase in muscle tone when trying to make a particular movement, especially when the body is in an upright position). In such children, the legs are adducted, the knees are bent, the support is on the fingers, the arms are brought to the body, the elbows are bent, the fingers are bent into fists. With a sharp increase in muscle tone, flexion and adduction contractures (limitation of the range of passive movements in the joints), as well as various deformities of the limbs, are often observed. With rigidity, the muscles are tense and in a state of maximum increased muscle tone. With hypoponia (low muscle tone), the muscles of the limbs and torso are flabby, sluggish, and weak. Dystonia is a changing pattern of muscle tone. Muscle tone in this case is characterized by inconstancy and variability. At rest, the muscles are relaxed; when attempting to move, the tone increases sharply, as a result of which it may turn out to be impossible. In complicated forms of cerebral palsy, a combination of various options muscle tone disorders. The nature of this combination may change with age.

Restriction or impossibility of voluntary movements (paresis and paralysis). Depending on the severity of brain damage, a complete or partial absence of certain movements may be observed. The complete absence of voluntary movements caused by damage to the motor zones of the cerebral cortex and conductive motor pathways is called central paralysis (the child has difficulty or cannot raise his arms up, stretch them forward, to the sides, bend or straighten his legs, walking is difficult), and the limitation of the range of movements - central paresis (the most subtle and differentiated movements suffer first, for example, isolated movements of the fingers).

H. The presence of violent movements is characteristic of many forms of cerebral palsy. They can manifest themselves in the form of hyperkinesis (involuntary violent movements caused by variable muscle tone, with the presence of unnatural postures) and tremor (trembling of the fingers and tongue).

Impaired balance and coordination of movements (ataxia). Trunk ataxia manifests itself as unsteadiness when sitting, standing, and walking. In severe cases, the child cannot sit or stand without support. Unsteadiness of gait is noted: children walk on widely spaced legs, staggering, leaning to the side. Coordination problems (the child cannot accurately grasp an object and place it in a given place; when performing these movements, he misses, he has a tremor).

Impaired sensation of movement (kinesthesia). The development of motor functions is closely related to the sensation of movement. The sensation of movements is carried out with the help of special sensitive cells, which provide information about the position of the limbs and torso in space, the degree of muscle contraction (for example, in children with cerebral palsy, the sense of posture is weakened or the perception of the direction of movement is distorted - movement of the fingers in a straight line is felt as movement along the circle or to the side).

Insufficient development of chain righting reflexes (statokinetic reflexes). Statokinetic reflexes ensure the formation of a vertical position of the child’s body and voluntary motor skills; if they are underdeveloped, it is difficult for the child to hold his head and torso in the desired position. As a result, he experiences difficulties in mastering self-care skills, work and educational activities.

Synkinesias are involuntary cooperative movements that accompany the performance of active movements (for example, when trying to grab an object with one hand, the other hand bends; the child cannot straighten the bent fingers, and when straightening the entire hand, the fingers unbend).

The presence of pathological tonic reflexes. With normal development, tonic reflexes do not appear sharply in the first months of life. Gradually (by the 3rd month of life) they fade away, creating the basis for the emergence of a higher level in the child’s unconditional reflex activity, the so-called attitudinal reflexes. In cerebral palsy, there is a delay in the extinction of tonic reflexes. Pathologically enhanced tonic reflexes are one of the reasons for the formation of pathological postures, movements, and deformations. The development of motor skills most often stops at the stage where tonic reflexes have a decisive influence. The child can be 2 years old, 5 years old, 10 years old or more, and his motor development will be at the level of a 5-8 month old healthy baby.

Motor disorders in children with cerebral palsy can have varying degrees of severity. In severe cases, the child does not master walking skills and manipulative activities. He cannot take care of himself. With moderate motor impairment, children master walking, but walk unsteadily, often with the help of special devices (crutches, walking sticks, etc.). Their self-service skills are not fully developed, as well as manipulative activities. With mild motor impairment, children walk independently, confidently both indoors and outside. They can travel independently on public transport. They fully serve themselves, and their manipulative activities are quite developed. However, children may experience abnormal pathological postures and positions, gait disturbances, and movements that are insufficiently dexterous and slow. Reduced muscle strength.

The structure of the defect in cerebral palsy includes specific deviations in mental development. The mechanism of mental development disorders depends on the time of occurrence, as well as the degree and location of brain damage. Mental disorders against the background of early intrauterine damage are characterized by gross underdevelopment of intelligence. With lesions that developed in the second half of pregnancy and during childbirth, mental disorders are more mosaic and uneven in nature. There is no clear relationship between the severity of motor and mental disorders: for example, severe motor disorders can be combined with mild mental retardation, and residual effects of cerebral palsy can be combined with severe underdevelopment of mental functions. Children with cerebral palsy are characterized by a peculiar mental development anomaly caused by early organic brain damage and various motor, speech and sensory defects.

The structure of the intellectual defect in cerebral palsy is characterized by a number of specific features.

An unevenly reduced supply of information about the environment (due to forced isolation; difficulty in objective-practical activities due to a movement disorder; sensory dysfunction). There is a violation of the coordinated activity of various analytical systems (pathology of vision, hearing, muscle-joint sense), which affects perception as a whole, limits the amount of information, and complicates intellectual activity.

The mosaic nature of the development of the psyche, i.e., a violation of some intellectual functions, a delay in the development of others and the preservation of others. Some children develop predominantly visual forms of thinking, while others, on the contrary, especially suffer from visual-effective thinking with better development of verbal-logical thinking.

H. The severity of psychoorganic manifestations - slowness, exhaustion of mental processes, difficulties in switching to other types of activity, lack of concentration, decrease in the volume of mechanical memory.

In terms of intelligence, children with cerebral palsy represent an extremely heterogeneous group: some have normal or close to normal intelligence, others have mental retardation, and the rest have mental retardation. Children without deviations in mental development are rare. The main disorder of cognitive activity is mental retardation (of cerebral-organic origin).

Such children are characterized by disorders of the emotional-volitional sphere; in some children they manifest themselves in the form of increased emotional excitability, irritability, motor disinhibition, in others - in the form of inhibition, shyness, and timidity. The tendency to mood swings is often combined with inertia of emotional reactions.

Speech disorders occupy a significant place in the structure of the defect in children with cerebral palsy. Of great importance in the mechanism of speech disorders in cerebral palsy is the motor pathology itself, which affects the muscle tone of the speech apparatus. Speech disorders are based not only on damage to brain structures, but also on the later formation or underdevelopment of the parts of the cerebral cortex responsible for speech. Delays in speech development are associated with a limitation in the amount of knowledge and ideas about the environment, and a lack of subject-specific practical activity.

2 Speech disorders in preschool children with cerebral palsy

In the structure of the defect in children with cerebral palsy, a significant place is occupied by speech disorder, with a frequency of about 70 percent of all children with this disease.

The forms of speech disorders are varied, which is associated with the involvement of various brain structures in the pathological process. It is advisable to distinguish the following forms of violations:

) Secondary delay in speech development;

) Violations of the grammatical structure of speech;

) Violations of the formation of coherent speech;

) All forms of dysgraphia and dyslexia;

) Phonetic-phonemic underdevelopment of speech, which manifests itself within various forms of dysarthria;

) In more severe cases, speech underdevelopment such as alalia develops;

) General underdevelopment of speech.

With secondary delay in speech development in children with cerebral palsy, there is a disturbance in the rate of speech development due to severe motor impairment and severe impairment of activity.

General underdevelopment of speech is a persistent disorder of speech development due to severe damage to articulatory motor skills in combination with sensory defects.

Vinarskaya E.N. the main forms of dysarthric speech disorders in children with cerebral palsy were identified. Thus, based on a clinical and phonetic analysis of pronunciation speech disorders, eight main constantly occurring forms of dysarthric speech disorder are identified:

) spastic-paretic (leading syndrome - spastic paresis);

) spastic-rigid (leading syndromes are spastic paresis and tonic control disorders such as rigidity);

) hyperkinetic (leading syndrome - hyperkinesis: choreic, athetoid, myoclonus);

) ataxic (leading syndrome is ataxia);

) spastic-atactic (leading syndrome - spastic paresis and ataxia);

) spastic-hyperkinetic (leading syndrome - spastic paresis and hyperkinesis);

) spastic-atactic-hyperkinetic (leading syndrome - spastic paresis, ataxia, hyperkinesis);

) atactico-hyperkinetic (leading syndrome - ataxia, hyperkinesis)

Let us consider in more detail the differentiated clinical symptoms for each form of dysarthria.

Pseudobulbar dysarthria as a neurological concept (damage to the central conduction of the cranial nerves) is only one of the components of this complex speech disorder. In addition to pure motor pseudobulbar disorders, children also exhibit rigidity, hyperkinesis, ataxia, and apraxia.

With the development of pseudobulbar dysarthria, the child’s speech is blurred and unclear; the voice is quiet, nasal, as a rule; salivation occurs. Chewing is impaired (children under 3-5 years of age often eat only pureed or semi-liquid food).

There are signs of underdevelopment not only of intelligence and thinking, but also of other mental functions (perception, memory, attention, speech, motor skills, emotions, will, etc.) Secondly, there is a predominant underdevelopment of the most differentiated, ontogenetic young functions - thinking and speech with relative preservation of evolutionarily more ancient elementary functions and instincts. Speech is not developed, limited to sounds, individual words, there is no understanding of speech addressed to them.

Spastic paresis, the name of which defines the first form of dysarthria (spastic-paretic), is most common in the speech motor system in cerebral palsy. This syndrome occurs in almost all forms of dysarthric disorders. Spastic paresis is associated with loss or weakening of the innervations of various cranial nerves, and damage to the central neurons of the V, VII, IX, X, XI, XII pairs of cranial nerves can be general or selective, which in turn forms varying degrees participation of speech muscles in the speech act. In this case, it is important to carry out the examination simultaneously, taking into account the degree of manifestations of spastic paresis.

Spastic paresis manifests itself in different ways: some patients cannot maintain the desired articulatory position in time, others cannot perform it, and others cannot quickly switch from one position to another. In a number of patients, paresis leads to an increase in the latent period when engaging in movement, and to salivation to varying degrees.

The nature of the pronunciation aspect of speech: the voice is of insufficient strength and sonority, all parameters of vocal capabilities are depleted, the amplitude of voice modulations necessary for lively intonation is reduced, the rate of speech is slow, speech exhalation is depleted, inhalation is shallow.

The amplitude of articulatory movements with spastic paresis is always reduced, there is no complete reciprocity in the activity of the longitudinal, vertical, transverse muscles of the tongue, labialization is insufficient (protrusion of the lips forward with the sounds: o, u, i, s, w, zh, h, c).

The hyperkinetic form of dysarthria is named after the leading hyperkinetic syndrome.

Pronunciation side of speech: the voice is tense, intermittent, vibrating, changing in pitch and strength, modulation capabilities are possible within limited limits. With athetoid hyperkinesis, it is somewhat more difficult to pronounce affricative and fricative sounds.

Very often, a child’s potential voice production capabilities are much higher than he uses them in his speech. Intelligibility depends on the control of respiratory movements, on the ability to ensure the strength of the voice in speech. Well-voiced speech is perceived by the listener as understandable. Even in the presence of many defects in the phonetic structure, cortical disorders are usually not observed; only writing and reading techniques suffer.

The spastic-rigid form of dysarthria is characterized by the manifestation of spastic paresis of speech muscles and a violation of the tonic control of speech activity as an extrapyramidal disorder.

With this form of dysarthria, there is no long-term background of rest in the speech muscles, since the threshold of sensitivity to various kinds of stimuli is increased. A tense smile can be replaced by an instant spasm of the upper and lower quadratus lip muscles, a tensely raised tip of the tongue is replaced by a wide spread across the lower lip. This position is replaced by the tongue moving outwards, narrow and tense.

During articulatory activity, the amplitude of articulatory movements in this form of dysarthria gradually decreases, reaching zero, the child is forced to stop, a breathing spasm appears, after a slight inhalation and a pause, the child again continues to speak until a new spasm, and so on every 4-5 syllables. Very often with this syndrome there is undifferentiation of labial and lingual movements.

Pronunciation side of speech: the voice is dull, tense, the amplitude of voice modulations is reduced to zero, the strength of the voice is weakened, the flight of vowels is extremely small, the tempo is fast, the speech is sharply abrupt, in rare cases the tempo can be slow with gradual attenuation of the voice. The nature of sound pronunciation suffers to a greater extent in phonetic coloring, but more often the phonemic properties of sounds are still preserved. In the case of apraxic disorders, certain groups of sounds may be lost (as always, the most difficult ones are fricatives, affricates, and sanors). A specific type of sound pronunciation in this syndrome will be a weakness in the differentiation of labial, dental, soft and hard. Speech intelligibility is significantly reduced due to lack of sound clarity.

Thus, psycho-emotional disorders and personality traits in cerebral palsy, which are formed as a result of a complex of factors, play an important role in disrupting the cognitive activity of sick children and require a special approach to the correction of these disorders. An analysis of the literature and data from pedagogical practice shows that the content, methods and techniques of teaching and upbringing, developed for normally developing children in the first years of life, cannot be fully used in correctional and developmental work with young children with developmental disorders, including with cerebral palsy, due to the significant specificity of their development. Features of the development of the personality and emotional-volitional sphere of a child with cerebral palsy largely depend not only on the specifics of the disease, but primarily on the attitude of the parents, mother, and other loved ones towards the child

CHAPTER 2. PSYCHOLOGICAL ASSISTANCE FOR CHILDREN WITH CEREBRAL PALSY

1 Speech therapy work with children with cerebral palsy

Planning of speech therapy work is based on an understanding of speech disorders, which are a complex complex of dysontogenesis, and includes a number of sections not only of a correctional and speech therapy orientation, but also of a psychological and pedagogical orientation.

Basic principles of diagnosis: a comprehensive study of the child with the participation of various specialists - doctors, psychologists, teachers; systematic and qualitative analysis of identified disorders in the development of speech activity, recording age characteristics the child and the conditions of his development, identifying not only actual, but also potential opportunities for the speech development of the subject.

In education correct speech important has normalization of speech breathing, because in patients with cerebral palsy, it is usually superficial, sharp, restless, short, and the words are often pronounced by the child while inhaling. It is necessary to pay attention in speech exercises to ensure that the child pronounces words in a phrase together, i.e. not each word separately, but all together as one big word, because It is usually difficult to start speaking, and therefore the fewer scattered words he utters, the less difficulty he will have.

To teach to highlight vowels in a word (reliance on vowel sounds) acquires great importance for those children who experience speech spasms on consonant sounds. Pronouncing some vowel sounds in length makes speech easier and relieves speech cramps.

At the same time, the speech therapist, if necessary, works to correct pronunciation deficiencies, expand vocabulary, improve grammatical structure, and develop the ability to correctly and consistently express one’s thoughts and desires.

The other side of speech therapy work is no less important - the education of a harmoniously developed personality. The main task is to eliminate speech therapy in children. Speech therapy work begins with a psychological and pedagogical study of the child. It determines the choice of means and techniques before and during this work, allows you to evaluate its effectiveness and make recommendations after completion.

Speech therapy classes are the main form of speech therapy work, because most fully express the direct correctional and educational impact on the child (direct speech therapy impact). All other forms of work of a speech therapist constitute a system of indirect speech therapy influence, because in essence, they contribute to, complement or consolidate the results of direct speech therapy.

Speech therapy classes are conducted both with a group of children and individually. But for training verbal communication and developing the correct behavior skills of a child in a team, the predominant form is group classes.

Individual lessons are conducted in the form of additional exercises to correct incorrect pronunciation, psychotherapeutic conversations, etc. Speech therapy classes should, first of all, reflect the main objectives of the correctional and educational impact on the child’s speech and personality.

An important requirement for speech therapy classes is to take into account the basic didactic principles: to be regular, systematic and consistent; carried out depending on the individual characteristics of each child; rely on the consciousness and activity of children; be equipped with the necessary aids, visual and technical teaching aids; promote the strength of the developed skills of correct speech and behavior.

2 Basic methods of developmental correction for children with cerebral palsy

paralysis defect psychological speech therapy

Bot technique

The French Botha outlined their system of work in the book: “Therapeutic education of children with movement disorders of cerebral origin.” The goal of Bot's work is to ensure maximum achievements for each child.

Pedagogical work consists of several sections:

) Education of motor functions.

) Skill development.

) Speech education.

) Social adjustment.

The authors attach no less importance to the development of personal qualities. Much attention is paid to preparation for school. Includes not only preparation for writing, but also the development of speech, auditory perception, rhythm, visual attention and memory.

In case of significant motor difficulties, it is suggested to consider the possibility and advisability of using a typewriter

Conductive technique by A. Peto.

Andras Peto was the organizer and first director of a rehabilitation center in Budapest. He created a system of conductive (guided) learning.

The purpose of the work is to prepare for independent life.

Therapeutic, psychological, pedagogical and social influences are combined. All work is performed by specialists - conductors or conductors, who are trained at the same institute. During training they work as assistant conductors.

General principles of conductive pedagogy:

It is necessary to adapt a child with pathology to real life conditions.

This adjustment is achieved through skill training.

It is necessary to achieve maximum mastery of preserved functions.

Consolidation of formed actions in practical situations.

It is necessary to carry out work to prevent and eliminate the inferiority complex.

The child should see around him not only sick, but also healthy children.

The learning process must ensure continuous development.

One of the main provisions of the method is that the child must master a new ability every day. This significantly improves motivation. Much attention is paid to teaching grip, emphasis, and maintaining a pose.

Training must be conducted in groups. In free games with peers, learned abilities develop.

The Peto technique is applicable to children with cerebral palsy with a fairly high level of consciousness. When selecting children for classes, preference is given to children with intact or partially intact intelligence, who have competent, persistent, active parents. Children's age is over 3 - X years.

Method of psychomotor kinesitherapy by M. Prokus.

Marcel Prokus's method is designed to work with children aged 4 - 7 years. The main principle of the technique is the alignment of psychomotor development by influencing the main areas of development: motor, sensorimotor, intellectual, emotions and speech.

The motor area is corrected according to the following parameters: normalization of muscle tone, development of visual-motor, visual-auditory, visual-motor-tactile coordination, improvement of the ability to maintain balance, elimination of unnecessary accompanying movements.

The classes include 4 stages:

Stage. Introductory part. A relaxing massage is provided with a conversation to understand the body diagram, as well as rhythmic exercises accompanied by music.

Stage. Development of general motor skills.

Stage. Development of fine motor skills.

Stage. Generalizing.

Combined exercises are used to strengthen muscles, develop the body diagram, develop spatial orientation, develop time orientation, and develop a tempo-rhythmic sense.

Methodology by E. Mazanek.

Eva Mazanek's technique is presented as psychological and pedagogical rehabilitation, serving as one of the sections of an integrated approach, including therapeutic work, speech therapy, feeding training, and physical therapy.

The work is based on the following principles:

Mandatory emotional contact.

Providing the child with a sense of security.

Active participation of the child in work. This is ensured by explaining to the child what his difficulties and shortcomings are.

The work is carried out in play activities.

Dosage of tasks according to the child’s capabilities.

Repetition and consolidation of material.

The Mazanek technique is designed for children from birth.

CONCLUSION

Cerebral palsy is a disease based on a motor disorder that leads to mental and speech disorders. The sooner correctional work begins, the better for the child. The main goal of correctional work for cerebral palsy is to provide children with medical, psychological, pedagogical, speech therapy and social assistance; ensuring the most complete and early social adaptation, general and vocational training.

It is very important to develop a positive attitude towards life, society, family, learning and work. The effectiveness of therapeutic and pedagogical measures is determined by timeliness, interconnectedness, continuity, continuity in the work of various units. Therapeutic and pedagogical work must be comprehensive. An important condition for complex influence is the coordination of the actions of specialists in various fields: neurologist, psychoneurologist, exercise therapy doctor, speech therapist, defectologist, psychologist, educator. Their common position is necessary during examination, treatment, psychological, pedagogical and speech therapy correction.

LIST OF REFERENCES USED

1. Arkhipova E.F. Corrective work with children with cerebral palsy. M., 1989.

Badalyan L.O., Zhurba L.T., Timonina O.V. Cerebral palsy. M., 1989.

Danilova L.A. Methods for correcting speech and mental development in children with cerebral palsy. M., 1997.

Levchenko I.Yu., Prikhodko O.G. Technologies for teaching and raising children with musculoskeletal disorders: Textbook. aid for students avg. ped. textbook establishments. -- M.: Publishing Center "Academy", 2001.

Mamaichuk I.I. Psychological assistance to children with developmental problems. - St. Petersburg: Rech, 2001.

Mastyukova E.M., Ippolitova M.V. Speech disorders in children with cerebral palsy. M., 1995.

Nazarova N.M. Special pedagogy. / Edited by Nazarova N.M. - M.: Publishing house ACADEMA, 2000.8. Shipitsina L.M., Mamaichuk L.M. Cerebral palsy. St. Petersburg, 2001.

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