Institute of Special Education and Comprehensive Rehabilitation. Prikhodko Oksana Georgievna Doctor of Pedagogical Sciences, Professor, Head of the Department of Speech Therapy, Director of the Institute of Special Education and Integrated
O.G.PRIKHODKO
EARLY HELP FOR CHILDREN WITH MOTOR PATHOLOGY.
Toolkit
Prikhodko O.G. Toolkit. St. Petersburg: Publishing house "KARO", 2006.The methodological manual contains data on the developmental features and complex correction of developmental disorders in children with motor pathology in the first years of life. The book analyzes the process of formation of motor functions, describes the stages of cognitive, pre-speech and speech development of a child in ontogenesis. The clinical manifestations of delayed motor and psycho-speech development were systematized, allowing the author to bring up for discussion various options for deviant development; Methods for correcting disorders of cognitive and speech development in young children are presented.
The manual is addressed to defectologists, speech therapists, psychologists and all specialists working in the rehabilitation system for young children, as well as parents.
© Prikhodko O.G., 2005
INTRODUCTION
1. COMPARATIVE CHARACTERISTICS OF MOTOR, COGNITIVE AND SPEECH DEVELOPMENT OF A CHILD IN THE FIRST YEARS OF LIFE WITH NORMAL AND DISTURBED PSYCHOPHYSICAL DEVELOPMENT.
1.1. CHILDREN'S DEVELOPMENT IN THE FIRST YEAR OF LIFE
1.2. development of children with motor pathology at an early age (from one to three years).
2. PSYCHOLOGICAL AND PEDAGOGICAL STUDY OF EARLY CHILDREN WITH MOTOR PATHOLOGY.
3. correctional and developmental pedagogical work with children with motor impairments in the first years of life.
CONCLUSION
INTRODUCTION
In recent decades, in correctional pedagogy there has been growing interest in the problem of early comprehensive assistance to children with developmental disabilities (E.F. Arkhipova, E.R. Baenskaya, I.A. Vyrodova, O.E. Gromova, N.N. Malofeev, Yu A. Razenkova, E. A. Strebeleva, N. D. Shmatko, etc.). Infancy and early age (from birth to 3 years) in a child’s life is the most responsible (sensitive) for the development of motor functions, cognitive activity and speech.
In recent years, there has been an increase in the number of children born with signs of perinatal damage to the central nervous system. Perinatal lesions of the central nervous system combine various pathological conditions caused by exposure of the fetus to harmful factors in the prenatal period, during childbirth and in the early stages after birth. The leading place in perinatal pathology of the central nervous system is occupied by asphyxia and intracranial birth trauma, which most often affect the nervous system of an abnormally developing fetus. According to various authors, PEP occurs in up to 83.3% of cases.
Early brain damage almost always later manifests itself as impaired development to one degree or another. PEP is a risk factor for the development of motor pathology in a child. Despite the equal probability of damage to all parts of the nervous system, when pathogenic factors act on the developing brain, it is the motor analyzer that suffers first and most severely. Due to the fact that the immature brain suffers, further rates of its maturation slow down. The order of inclusion of brain structures as they mature into functional systems is disrupted.
In children with perinatal cerebral pathology, gradually, as the brain matures, signs of damage or disturbances in the development of various parts of the motor analyzer, as well as mental, pre-speech and speech development, are revealed. With age, in the absence of adequate therapeutic and pedagogical assistance, a more complex pathology gradually develops, developmental disorders are consolidated, which often leads to the outcome of the disease in cerebral palsy (CP).
The bulk of children with motor pathology are children with cerebral palsy (89%). However, in the first year of life the diagnosis "cerebral palsy" It is given only to those children who have severe movement disorders: impaired muscle tone, limitation of their mobility, pathological tonic reflexes, involuntary violent movements (hyperkinesis and tremor), impaired coordination of movements, etc. The remaining children with cerebral pathology are diagnosed “perinatal encephalopathy; cerebral palsy syndrome (or movement disorder syndrome)."
In children with movement disorder syndromes and cerebral palsy, mastery of all motor functions is delayed and to one degree or another impaired: the function of holding the head, the skills of independent sitting, standing, walking, and manipulative activities are formed with difficulty and delay. Motor disorders, in turn, have an adverse effect on the formation of mental and speech functions. That is why it is so important to identify disorders in the child’s motor sphere as early as possible. The severity of movement disorders varies over a wide range, with severe movement disorders at one extreme and minimal ones at the other. Speech and mental disorders, as well as motor disorders, vary widely, and a whole range of different combinations can be observed. For example, with severe movement disorders, mental and speech disorders may be minimal, but with mild movement disorders, severe mental and speech disorders are often encountered.
Long-term studies have shown that in the case of early detection in the first months of life and the organization of adequate corrective work, significant success can be achieved in overcoming perinatal pathology. Research by K.A. Semenova, L.O. Badalyan, E.M. Mastyukova shows that, subject to early diagnosis - no later than 4-6 months of age of the child - and the early start of adequate systematic medical and pedagogical influence, practical recovery and normalization of various functions can be achieved in 60-70% of cases by 2-3 years of age. In the case of late detection of children with perinatal pathology and the lack of adequate correctional work, the occurrence of severe motor, mental and speech disorders is more likely.
Currently, there are effective methods for the clinical diagnosis of PEP in the first year of life. If psychomotor development disorders are identified that indicate brain damage, it is necessary to organize work to overcome them. The leading role in this case is played by a neurologist. He prescribes rehabilitation treatment and gives recommendations on the regimen. But an important role also belongs to the exercise therapy instructor, speech pathologist, speech therapist and, of course, parents.
1. COMPARATIVE CHARACTERISTICS OF MOTOR, COGNITIVE AND SPEECH DEVELOPMENT OF A CHILD IN THE FIRST YEARS OF LIFE WITH NORMAL AND DISTURBED PSYCHOPHYSICAL DEVELOPMENT.
1.1. CHILDREN'S DEVELOPMENT IN THE FIRST YEAR OF LIFE
The development of a child in the first year can be divided into 5 main stages:
I - neonatal period; II - 1-3 months; III - 3-6 months; IV - 6-9 months; V - 9-12 months. At each age stage, specific functions are formed that serve as indicators of age-related development and determine its sequential course. To identify disorders of psychomotor development in the first year of life, first of all, it is necessary to know the main stages of development of a healthy child.
I. Newborn period.
Motor development.
A newborn baby is characterized by a flexing posture. The arms are bent at all joints, brought to the chest, the hands are clenched into fists, the thumb is brought to the palm. The legs are slightly bent at all joints. Spontaneous motor activity manifests itself in the form of chaotic uncoordinated movements. In a child, it is normally possible to evoke reflexes of congenital automatism: protective, grasping, Moro, support, automatic walking, crawling, Galanta. By the 3rd week, the baby, in a prone position, makes an attempt to raise his head. By the end of the first month of life, the child develops a labyrinthine righting reflex to the head (in the position on the stomach or on the back, the child raises and holds his head).
At motor development disorder During the neonatal period, children may experience various types of muscle tone disorders. Muscle hypertonicity (increased muscle tone) is expressed in general stiffness: during all manipulations the child maintains a flexed posture. The arms are bent and brought towards the body. With muscular hypotonia, on the contrary, the child lies with the limbs extended in all joints. Muscular hypotonia in newborns is more common and can be a symptom of many neurological diseases. The range of passive movements has been significantly increased. Spontaneous motor activity is reduced. Unconditioned reflexes are often suppressed. By the end of the first month of life, the child does not develop a labyrinthine righting reflex to the head.
Cognitive development.
During the newborn period, with normal development, visual and auditory orienting reactions are formed: at the age of 10 days, the child holds a moving object in his field of vision (step tracking), at the age of 20 days, a stationary object (adult’s face). A crying child becomes silent and listens when there is a strong sound stimulus. At the age of 1 month, visual concentration and smooth tracking of a moving object are noted; prolonged auditory concentration (listens to the sound of a toy, the voice of an adult). In response to the affectionate treatment of an adult, the child develops a positive emotional reaction in the form of “oral attention” and a smile.
in children with motor pathology it manifests itself in the fact that even by the end of the newborn period they often do not have visual and auditory concentration, “oral attention”, or tracking a moving object. Optical and auditory stimuli cause defensive reactions in the form of flinching, blinking of eyelids, and crying. The indicative reactions that some children have are of a weakly expressed cognitive nature. The period of wakefulness is short, and negative reactions arise against its background. Children often scream a lot for no reason or, conversely, are sleepy. Children's emotional communication with others is weak (they do not smile).
Pre-speech development.
The first period of pre-speech development is unconditional reflex, when unconditioned food and protective reflexes are of leading importance for the life of the body. Vocal reactions are sounds pronounced by a newborn and inseparable from his vital physiological functions. In addition to screaming, vocal reactions of a newborn include coughing, sneezing, sucking sounds, and yawning. The cry is normally loud, clear, medium or low in tone, with a short inhalation and a long exhalation ( wa-a-a-), lasting at least 1-2 seconds, without intonation expressiveness. At times the child makes individual guttural sounds, between A And uh.
Children exhibit the following unconditioned food and defensive reflexes, which, with normal development, appear from birth, and then gradually weaken and fade away:
Palmar-mouth-cephalic reflex (Babkina). It is caused by pressure on the palm in the area of the eminence of the thumb, while the mouth opens and the head bends. It weakens by the end of the 1st month of life and disappears by the 3rd month.
Lip reflex. When patting one of the corners of the half-open mouth, an involuntary movement of the lips occurs, closing the mouth - preparing for sucking. After 6 weeks the reflex gradually fades away.
Proboscis reflex. Irritation in the area of the middle of the upper lip causes a reflexive movement of the lips forward, they extend into a “proboscis” (reflex of preparation for sucking). Fades away after 6 weeks.
Search reflex. Irritation of the cheek in the area of the corner of the mouth causes movement of the lips towards the irritant (reflex of preparation for sucking). Fades away after 6 weeks.
Sucking reflex. With tactile irritation of the lips, the front surface of the tongue and the hard palate, sucking movements occur. Gentle movement of the stimulus (pacifier or finger) accelerates and intensifies the activity of sucking movements. The reflex disappears between the ages of 4 months and 1 year.
Swallowing reflex. Caused by tactile stimulation of the root of the tongue, palate, and posterior wall of the pharynx. Swallowing usually follows sucking activity. But during the newborn period, swallowing precedes the sucking reflex. Changes in swallowing and sucking patterns begin at 12 weeks.
Mouth opening reflex. It is caused by visual stimulation - when seeing a breast or a bottle of milk, a reflexive opening of the mouth occurs (conditioned sucking reflex). It appears at 4 months and begins to fade away at 6 months.
The chewing reflex appears from 7 months and is caused by tactile stimulation of the gums or teeth.
manifests itself in the fact that various pathological conditions can lead to difficulty or impossibility of carrying out even primitive vocal reactions. Violations of the tone of the articulatory and respiratory muscles make the child's cry weak, short, and high-pitched. When screaming, there may be no predominance of the second phase ( wow instead of wow). Sometimes the sound side of the scream also changes. It can be shrill, sharp, or very quiet, in the form of individual sobs or cries, which the child usually makes while inhaling. The cry can be so quiet that only by facial reactions (a grimace on the face) can one guess that the child is crying. In severe cases, there may be no cry at all (aphonia). Sometimes there is whimpering, which is unusual for healthy newborns. A child with weakness of the respiratory muscles has a weakened or absent cough impulse, and he sneezes poorly.
The vocal responses of a newborn with motor disorders may be poor or absent altogether due to depression of the central nervous system. In this case, the child does not even pronounce individual guttural sounds.
In the first weeks and months of life, in children with motor pathology, the reflexes of oral automatism are most often weakened, suppressed or not manifested at all, which makes feeding difficult for children and prevents the development of vocal reactions.
II period (1-3 months.)
Motor development.
The flexion posture is still preserved, but is less pronounced. There is an increase in the range of movements in the limbs, the hands are especially activated. The child can bring them to his mouth. By the end of the period, he can hold a toy placed in his hand for a short time; makes active turns of the head to the sides, especially to a sound stimulus. In the third month, lying on his back, the baby tries to raise his head.
By the third month, in a prone position, raising his head, the child rests on his forearms, his arms are semi-extended at the elbow joints. At the beginning of the period, unconditioned reflexes are clearly expressed, but towards the end they begin to fade away.
In case of motor development disorder the tone of the flexor muscles remains elevated or even increases. The range of active movements may be reduced, especially the activation of the arms is absent; the hands remain clenched into fists. Pathological signs are a persistent decrease in muscle tone and dystonia (changing muscle tone). A flexion position is maintained on the stomach (arms are placed under the chest, legs are bent at the hips and knees, the pelvis is raised). With muscle hypotonia, the posture remains prostrate, legs straightened. There is practically no support on the hands.
With hypertonicity, the asymmetric cervical tonic reflex (ASTR) is activated, which causes asymmetry in muscle tone and posture. ASHT manifests itself in the fact that when the head is turned to the side, the limbs in the direction of which the head is turned are extended; the child assumes the “fencer’s pose.” Straightening reactions are absent or insufficiently developed. In the position on the stomach, the child does not raise his head well and does not hold it, does not move his arms forward, and does not lean on his forearms. That's why he doesn't like to lie on his stomach.
There is an activation of reflexes of congenital automatism, instead of their gradual extinction.
Cognitive development.
With normal development in the second period, in response to positive emotional communication with an adult, the child exhibits a “revival complex” - a combination of a smile and the initial sounds of humming with general facial animation and motor activity. The child has prolonged visual concentration and tracking of an object (in all directions). A search reaction occurs: searching turns of the head during a prolonged sound. The child begins to distinguish the intonations of an adult’s voice (reacts differently to a gentle and angry voice).
By the end of the second period, normally, most unconditioned reflexes weaken significantly, which is expressed in their inconstancy, rapid exhaustion with repeated stimulation, and fragmentation. Children begin to move their hand towards an object.
Cognitive development disorder during this period it manifests itself in the following. In children with motor pathology, negative emotional reactions most often predominate; their expressiveness and differentiation are not observed. A smile is absent or difficult to produce after repeated stimulation and a long latent period. The “revival complex” is usually not formed. There is no eye-to-eye reaction with an adult.
Visual and auditory orienting reactions are incomplete or absent. The child does not fixate his gaze on an object well, the tracking reaction is fragmentary, and quickly depletes. Sometimes there is increased sensitivity to any auditory stimulus, which is expressed in defensive reactions in the form of flinching and blinking.
The range of active movements in the hands is reduced. There is no movement of the hand towards the object.
Pre-speech development.
The second period of pre-speech development is characterized by a new, qualitative enrichment - the appearance of intonational expressiveness in a cry, initial humming and laughter.
In the 3rd month, screaming as an expression of negative emotions takes on a different character depending on what caused it. The nature of the cry can determine the condition of the child. The child in different ways, with certain intonations in the cry, signals to others about the feeling of hunger, pain, discomfort due to wet diapers. In the intonation of the scream, against the background of displeasure, notes of demand slip through (in the face - facial expressions of anger, “protesting” movements of the arms and legs).
Gradually, the frequency of the scream decreases, and instead of it an initial hum (hooking) appears against the background of a positive emotional state (repeatedly pronounces various vowels and laryngeal consonants). At the same time, the first laughter and joyful squeals appear.
Pre-speech development disorder in children with motor pathology, it manifests itself in the fact that the cry remains monotonous, short-lived, quiet, poorly modulated, often with a nasal tint. The intonation expressiveness of the cry does not develop: there are no differentiated intonations expressing shades of joy, dissatisfaction, and demand. Screaming is not a means of expressing the child’s state and his desires, that is, it cannot serve as a means of communication with others. Even by the end of the stage, the initial hum is absent.
There is often a delay in extinction and even an increase in reflexes of oral automatism. For example, if at stage I the sucking reflex was weakened, then at stage II the sucking movements may be intensified and the child is not able to slow them down in pauses between feedings, i.e. sucking remains a purely reflex act and does not include elements of voluntary regulation.
In children with motor pathology in the first months of life, a relationship is revealed between the development of motor and vocal activity. When motor disorders are severe, the development of voluntary vocal reactions is delayed, screaming does not acquire intonational expressiveness and has extremely limited significance in the development of communication between a child and an adult.
With. 1
young children
| I. SOCIAL DEVELOPMENT | |
| CONTACT(emotional, gesture-facial, speech) : | |
| - Does not make contact | |
| - Contact is formal (purely external) | |
| - It does not come into contact immediately, with great difficulty. Shows no interest in him | |
| - Selective contact | |
| - Easily and quickly establishes contact, shows interest in him, willingly obeys | |
| ^ EMOTIONAL SPHERE: | |
| - passive, lethargic, inert | |
| - increased emotional excitability, irritability | |
| - mood swings | |
| - active, cheerful, active | |
| ^ COMMUNICATION MEANS: | |
| 1) Nonverbal means: | |
| - Communication is poorly expressed and is realized through undifferentiated body movements combined with an expressionless smile and shouting | |
| - Communication through body movements, head movements, smiles, vocal reactions | |
| - Communication through differentiated vocal and facial reactions, expressive gaze, natural and special gestures | |
| 2) Speech means (various statements): | |
| ^ SELF-CARE SKILLS (when eating, dressing and undressing, personal hygiene skills) : | |
| - Complete lack of skills | |
| - Partial mastery of skills | |
| - Mastery of skills with a little help from an adult | |
| - Independent mastery of skills | |
| ^ II. MOTOR DEVELOPMENT | |
| GENERAL MOTOR SKILLS: | |
| Development of basic motor skills: | |
| - Head hold | |
| - Independent sitting | |
| - Maintaining a vertical standing position (at support / independently) | |
| - Walking with support | |
| - Independent walking | |
| ^ FUNCTIONAL CAPABILITIES OF HANDS AND FINGERS: | |
| - Direction of the hand towards the object | |
| - Grasping an object, holding it in the hand | |
| - Voluntary release of an object | |
| - Simple manipulations with objects | |
| - Free manipulation of objects | |
| - Differentiated movements of the fingers | |
| - Leading hand selection (right/left) | |
| ^ ARTICULATIVE MOTOR SKILLS: | |
| - Neurological syndrome in the muscles and motor skills of the articulatory apparatus (spastic paresis, hyperkinesis, ataxia) | |
| Facial muscles: | |
| - Hypomimia | |
| - Facial muscle tone: spasticity / hypotonia / dystonia / N | |
| - Smoothness of nasolabial folds | |
| - Oral synkinesis | |
| - Facial asymmetry | |
| - Facial hyperkinesis | |
| Lips: N, thick/thin; presence of a cleft | |
| - Labial muscle tone: spasticity / hypotonia / dystonia / N | |
| - Mobility: lips are inactive/mobile | |
| Teeth : large, small, rare, frequent, dentition, N | |
| - Bite: anterior open, lateral open, prognathia, progenia, correct | |
| Solid sky: Gothic, low, flattened, presence of a cleft, N | |
| Soft sky: long/short, mobile/sedentary, uvulus deviation | |
| Movement of the lower jaw: - opening/closing of the mouth Ability to keep your mouth closed | |
| Language: thick, small, narrow, forked, unpronounced tip, shortened hyoid ligament | |
| - Tone of the lingual muscles: spasticity / hypotonia / dystonia / N | |
| - Hyperkinesis of the tongue | |
| - Tremor of the tongue | |
| - Deviation (deviation) of the tongue to the side | |
| ^ Volume of articulatory movements of the tongue: | |
| - Strictly limited / Incomplete / Reduced amplitude of articulatory movements / In full volume | |
| - Ability to maintain articulatory posture | |
| - Switchability | |
| - Voluntary protrusion of the tongue | |
| - Tongue lift | |
| - Lateral leads (right/left) | |
| - Clicking | |
| - Licking lips (circular movements of the tongue) | |
| Pharyngeal and palatal reflexes: - increased/lowered/normal | |
| Presence of pathological reflexes of oral automatism (labial, proboscis, search, palmar-oral-cephalic, etc.) | |
| Autonomic disorders: | |
| - Hypersalivation: - constant/increasing under certain conditions | |
| Chewing: - lack of chewing solid food / difficulty chewing / N | |
| Swallowing: - not violated; chokes, choke when swallowing | |
| ^ III. COGNITIVE DEVELOPMENT: | |
| LEVEL OF DEVELOPMENT OF COGNITIVE ACTIVITY AND MOTIVATION | |
| - absence or extremely low cognitive activity and motivation for activity | |
| - decreased cognitive activity and motivation for various activities | |
| - lack of cognitive activity and motivation for activity | |
| - pronounced cognitive activity and motivation | |
| ATTENTION: | |
| - Low concentration and instability of attention (the child has difficulty concentrating, has difficulty maintaining attention on an object) | |
| - Attention is unstable, superficial. Depletes quickly | |
| - Attention is not stable enough | |
| - Duration of concentration and switching of attention is satisfactory | |
| ^ LEVEL OF ACTIVITY DEVELOPMENT: | |
| 1) Showing interest in toys, selectivity, persistence of play interest (whether he plays with one toy for a long time or moves from one to another): | |
| - Shows no interest in toys (Doesn’t act in any way with toys. Doesn’t join in joint play with an adult. Doesn’t organize independent play). | |
| - Shows a superficial, not very persistent interest in toys, objects | |
| - Shows persistent selective interest in toys. | |
| 2) Adequacy of the use of toys: | |
| - Performs inappropriate actions with objects (ridiculous, not dictated by the logic of the game or the quality of the subject of the action). | |
| - Uses toys adequately (uses the item in accordance with its purpose). | |
| 3) The nature of actions with toy objects: | |
| a) Non-specific manipulations (he acts the same way with all objects, stereotypically - taps, shifts, pulls into the mouth, sucks, throws). | |
| b) Specific manipulations - takes into account only the physical properties of objects. | |
| c) Object actions - uses objects in accordance with their functional purpose. | |
| d) Procedural actions (from 1.5 years). | |
| e) Playing with plot elements (from 2 years old). | |
| ^ STOCK OF KNOWLEDGE ABOUT THE ENVIRONMENT: - Absent or extremely low | |
| - Strictly limited | |
| - Slightly reduced | |
| - Age appropriate | |
| ^ SENSORY DEVELOPMENT: | |
| VISUAL CONDITION: myopia, farsightedness, strabismus, optic nerve atrophy, nystagmus, N | |
| ^ VISUAL PERCEPTION: | |
| - Visual concentration (keeping a stationary object in the field of vision: an adult’s face, a toy). | |
| - Tracking a moving optical object: fragmented/smooth. | |
| - Recognizing the mother, distinguishing between loved ones and strangers. | |
| - Examination of people, toys, surrounding objects in the field of view; arbitrary switching of gaze from one object to another. | |
| - Visual examination of distant objects | |
| - Recognition, discrimination of familiar objects, toys in single-subject pictures, where the image is as close as possible to the original. | |
| - Differentiation of toys and single-subject pictures (comparing objects, toys with their images) - from 1.5 years. | |
| - Examination and recognition of objects, toys in subject and plot pictures - from 1.5 years. | |
| - Correlation (comparison) of objects by color, shape, size (from 1.5 years). | |
| - Discrimination (selection by word) of objects by color, shape, size (from 2 years). | |
| - Knowledge and naming of the color, shape, size of objects (from 2-2.5 years). | |
| ^ HEARING CONDITION: hearing loss/N | |
| AUDITORY PERCEPTION: | |
| - Auditory concentration. | |
| - Orienting-search reaction (searching turns of the head) to sound stimuli, voice and speech of an adult. | |
| - Localization of sound in space (turning the head towards an invisible sound source and finding it). | |
| - Differentiation of timbre coloring and intonation of the mother’s voice (or another “close” person) and “strangers” people. | |
| - Recognizing your name (differentiating your own and someone else’s name). | |
| - Distinguishing between strict and affectionate intonation of an adult’s voice. | |
| - Auditory attention to adult speech. | |
| ^ PERCEPTION OF SPATIAL RELATIONS: | |
| - Knowing and showing parts of the body and face. | |
| - Orientation in the sides of your own body. | |
| - A holistic image of the object. | |
| - Differentiation of spatial concepts (right-left, above-below, further-closer, front-behind, in the center). | |
| - Constructive praxis. | |
| ^ IV.SPEECH DEVELOPMENT | |
| PRE-VERBAL DEVELOPMENT: - Proceeded with a pronounced delay |
|
| - Flowed with a delay |
|
| - Normal (by age) |
|
| Time of appearance and features of vocal reactions: |
|
| - Scream |
|
| - Booming |
|
| - Babbling |
|
| ^ UNDERSTANDING SPEECH: |
|
| - Does not understand spoken speech |
|
| - Understanding of addressed speech is limited (situational). Follows simple verbal instructions |
|
| - Understanding of addressed speech at the everyday level. Follows complex verbal instructions |
|
| - In full |
|
| ^ CHARACTERISTICS OF YOUR OWN SPEECH (expressive speech) |
|
| 1st level of speech development: |
|
| - Complete absence of audio and verbal means of communication |
|
| - Pronounces individual sounds, sound complexes |
|
| - Pronounces several babbling and common words and onomatopoeias |
|
| Uses non-verbal means of communication (expressive facial expressions, gestures, intonation). |
|
| 2nd level of speech development: |
|
| - Uses a simple phrase |
|
| - Agrammatic, undeveloped (simplified), structurally broken phrase. The active vocabulary consists of nouns; verbs and adjectives are less common. Prepositions are rarely used. The syllabic structure of words is broken |
|
| 3rd level of speech development: Uses an extended phrase. Insufficient development of the lexical and grammatical structure of speech (errors in case endings, confusion of tense and aspectual forms of verbs, errors in agreement and control). The syllabic structure of the words is not broken. The syntactic constructions of phrases are poor. Phonetic-phonemic disorders |
|
| 4th level of speech development: Lexico-grammatical and phonetic-phonemic insufficiency |
|
| N: Uses an extended phrase. Coherent speech formed |
|
| SPEECH FEATURES: - Shows a tendency towards echolalia. |
|
| - Presence of speech stamps. |
|
| ^ LEXICAL AND GRAMMARICAL STRUCTURE OF SPEECH: |
|
| VOCABULARY: - sharply limited / poor / within the limits of everyday life / sufficient |
|
| GRAMMAR STRUCTURE: - Not formed |
|
| - Not formed enough |
|
| - Formed (N) |
|
| ^ Syllabic structure of words: Violated/not violated (N) |
|
| PHONETIC STRUCTURE OF SPEECH: |
|
| ^ Anthropophonic (phonetic) defects in sound pronunciation - distortions |
|
| - Vowel averaging; Lack of pronunciation of sibilants/sibilants/sonorants/labiolabials/labiodentals/mid-palatal/velar/hard consonants/voiced consonants |
|
| - Pronounces all sounds correctly in isolation, but with increasing speech load - general blurred speech |
|
| - The phonetic structure of speech is sufficiently formed (N) |
|
| ^ Phonological defects (impaired differentiation of sounds): - Substitutions |
|
| - Mixtures |
|
| ^ Phonemic processes : Broken/Safe |
|
| - Recognizes non-speech sounds |
|
| - Distinguishes the pitch and timbre of the voice (onomatopoeia) |
|
| - Distinguishes between paronymous words (close in sound composition) |
|
| - Distinguishes and repeats close syllables: ma-na, ba-pa, da-ta |
|
| Speech intelligibility: |
|
| - Speech is slurred, blurred, and difficult to understand for others |
|
| - Speech intelligibility is somewhat reduced, speech is unclear |
|
| - Speech intelligibility is not impaired (N) |
|
| BREATH: Loose/difficult/shallow/uneven, irregular |
|
| - Differentiation of nasal and oral exhalation |
|
| VOICE: |
|
| - Insufficient voice strength: - Quiet, weak, exhausted |
|
| - Voice timbre disorders: muffled/choked/hoarse/nasalized/tense/shaky |
|
| - Strong, sonorous (N) |
|
| Synchronicity of breathing, voice production and articulation: broken/safe |
|
| ^ Prosodic organization of sound flow: Melodic-intonation side of speech:
N |
|
| - Violation of intonation of speech |
|
| - Lack of voice modulations (unmodulated voice) |
|
| - Weak expression of voice modulations (voice is monotonous, little modulated) |
|
| Speech rate: normal/tachylalia/bradylalia/hesitation/stuttering |
|
| Rhythm of speech: normal/stretched/scanned |
|
CONCLUSION:
So, in children with motor pathology, complex combined developmental disorders are noted already in the first year of life. Therefore, early detection of psychophysical development disorders is necessary, as well as the organization of targeted correctional work with children.
^ 3. correctional and developmental pedagogical work with children with motor pathology in the first years of life.
The basic principles that determine the system and sequence of correctional and developmental interventions for children with movement disorders are the following:
The complex nature of correctional and developmental work requires constant consideration of the mutual influence of motor, mental and speech disorders in the dynamics of the child’s ongoing development. As a result, joint stimulation of the development of all motor, cognitive, pre-speech and speech functions is necessary, as well as the prevention and correction of their disorders.
Early start of ontogenetically consistent step-by-step correctional and developmental intervention based on preserved functions. Correctional work is based not on age, but on the individual level of development of the child.
Correctional pedagogical work is based on close unity with therapeutic measures aimed at developing motor functions. The combination of speech therapy work with rehabilitation treatment (medicines, massage, exercise therapy, physiotherapy, orthopedic care) is an important condition for the complex impact of specialists from the medical and pedagogical unit. It is necessary to coordinate the actions of the speech therapist-defectologist, neurologist, doctor and exercise therapy instructor and their common position during examination, diagnosis and medical and pedagogical correction. In order to select the most effective and adequate correction methods, it is important to take into account the relationship of motor, mental and speech disorders in cerebral palsy, the commonality of damage to articulatory and general motor skills (for example, it is necessary to suppress pathological reflex activity in both speech and skeletal muscles). In this case, it is necessary to simultaneously develop and correct disorders of articulatory motor skills and functional capabilities of the hands and fingers.
Corrective work is organized within the framework of leading activities. At the same time, the leading type of activity for a given age is stimulated: in infancy - emotional communication between the child and an adult, at an early age - objective activity.
Development of a coordinated system of interanalyzer connections, reliance on all analyzers with the obligatory inclusion of the motor-kinesthetic analyzer. It is advisable to use several analyzers simultaneously (visual, tactile, auditory).
Dynamic observation of the psychophysical development of a child over a long period of time. 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.
Flexible combination of various types and forms of correctional work.
Close interaction with parents and the entire environment of the child, which is the key to the effectiveness of correctional and developmental interventions. It is necessary to organize the environment (everyday life, upbringing) in a way that could maximally stimulate the child’s development and smooth out the negative impact of the disease on his mental state.
Correctional and developmental work is carried out in the process of targeted general development of the child, as well as correction of developmental disorders.
^ The main directions of correctional and developmental pedagogical work in infancy (in the pre-speech period) are the following:
Development of emotional communication with an adult (stimulation of the “revival complex”, the desire to prolong emotional contact with an adult, inclusion of communication in the practical cooperation of a child with an adult).
Development of sensory processes (visual concentration and smooth tracking; auditory concentration, sound localization in space, perception of an adult’s differently intonated voice; motor-kinesthetic sensations and finger touch).
Formation of the preparatory stages of speech understanding.
Stimulation of vocal reactions, sound, and later speech activity (undifferentiated vocal activity, humming, babbling, babbling words and onomatopoeia, common words, simple phrases, etc.).
Formation of hand movements and actions with objects (normalization of the position of the hand and fingers necessary for the formation of visual-motor coordination; development of grasping and manipulative function - nonspecific and specific manipulations; differentiated movements of the fingers).
Normalization of muscle tone and motility of the articulatory apparatus (reducing the degree of manifestation of motor defects of the speech apparatus - spastic paresis, hyperkinesis, ataxia, tonic control disorders such as rigidity). Development of mobility of articulation organs.
Correction of feeding (sucking, swallowing, chewing). Stimulation of oral automatism reflexes (in the first 3 months of life), suppression of oral automatisms (after 3 months).
Development of breathing and voice (vocalization of exhalation, increasing the volume, duration and force of exhalation, developing the rhythm of the child’s breathing and movements).
^ The main directions of correctional and pedagogical work with young children
are the following:
I. Development of cognitive activity.
Development of various forms of communication between a child and an adult (stimulation of the desire to prolong emotional, gestural and facial contact with an adult, inclusion of a child in practical cooperation with an adult).
Formation of cognitive activity, motivation for activity, interest in the world around us.
Development of knowledge about the environment and understanding of spoken speech (at an accessible level).
Stimulation of sensory activity (visual, auditory, kinesthetic perception).
Formation of subject activity (use of objects for their functional purpose, ability to voluntarily engage in activity).
Development of voluntary, sustained attention.
It is necessary to activate any vocal, sound reactions and speech expressions available to the child. The methodology involves the creation of pedagogical conditions that ensure the gradual development and improvement of the lexical side of speech, as well as the acquisition of grammatical categories. To increase the efficiency of work, games are used, game situations are created where the lexical and grammatical material being practiced is included in the speech practice of children, in all types of their activities. To communicate with others, children with severe delays in speech development develop gestural, facial, vocal, and sound-pronunciation reactions, train and consolidate the skills of voluntary pronunciation of syllables, syllabic complexes, and lightweight words.
III. Stimulation of motor development and correction of its disorders (speech motor disorders, disorders of the functionality of the hands and fingers and general motor skills).
When implementing this direction, the following tasks are solved.
Reducing the degree of manifestation of motor defects of the articulatory apparatus (spastic paresis, hyperkinesis, ataxia), and in milder cases – normalization of muscle tone and motility of the articulatory apparatus. Various methods are used for this:
Differentiated speech therapy massage of the facial, labial and lingual muscles, depending on the nature of the disorder in muscle tone and motility of the articulatory apparatus (relaxing - for muscle spasticity, stimulating - for hypotension). Massage of the lingual muscles is given particular importance not only for normalizing muscle tone and motility of the articulatory apparatus, but also in order to reduce hypersalivation, develop kinesthetic sensations, and strengthen the pharyngeal reflex. Tongue massage can be carried out in various ways - with special toothbrushes, a wooden spatula, or manually.
Passive articulatory gymnastics with elements of active gymnastics, carried out with the aim of including new muscle groups in the articulation process or increasing the mobility of previously included ones.
The method of artificial local contrastothermia is a combination of artificial local hypothermia (cryomassage) and hyperthermia (thermal massage). This method is used to reduce spasticity of the muscles of the articulatory apparatus and hyperkinesis of the lingual and facial muscles. The contrastothermal effect is exerted not only on the articulatory muscles, but also on the hands.
Development of breathing, voice, voice modulations and correction of their disorders. To solve this problem, breathing and voice exercises are used. The purpose of breathing exercises is to increase the volume, depth and strength of inhaled and exhaled air, as well as normalize the breathing rhythm. Breathing exercises are carried out first in a passive form, and then gradually become active (by imitating the actions of an adult). Voice exercises to develop strength, timbre, voice pitch, and voice modulations are used in the third year of life.
Development of the functional capabilities of the hands and fingers and hand-eye coordination. In the course of correctional work, the stages of development of motor skills of the hands and fingers in ontogenesis are taken into account: the development of the support function on open hands, the implementation of voluntary grasp of objects with the hand, releasing the object, the inclusion of a finger grip, the opposition of fingers, gradually increasing complexity of manipulations, differentiated isolated movements of the fingers. In this case, the following are used: manual and brush massage of the fingers and hands, shaking of the hands (according to the Phelps method), passive and active exercises.
Stimulation of general motor activity.
Depending on the structure of violations, correctional pedagogical work should be structured in a differentiated manner.
For each child, it is necessary to draw up an individual comprehensive program, including a long-term work plan and specific correctional tasks for the near future. All classes should be of a combined nature, consisting of several parts, each of which is devoted to solving a specific problem and provides for a new type of activity. At the same time, it is necessary to solve developmental and correctional problems. Gradually, the content of the classes expands and becomes more complex.
^ I. Development of cognitive activity.
1. Formation of various forms of communication and interaction with adults.
In the course of work, developing various forms of communication between a child and an adult, it is necessary to stimulate the desire to establish and prolong emotional, gestural and facial contact, as well as to include the child in practical cooperation with an adult. An important task in this case is the formation of ways of assimilating social experience.
At the first stages of correctional and developmental work, an important section is stimulation of emotional communication, the formation of a “revival complex”. To develop the need for communication, the first emotional and communicative reactions, an adult, smiling, bends over the child, tries to “catch” his gaze, if necessary, uses tactile contact (stroking him), giving his voice a melodious, affectionate tone, and sings songs. We addressed the child affectionately by name, trying to keep the child’s gaze on our face.
Gradually, the child develops a positive attitude towards the toy. To do this, with a gentle conversation, they attract the child’s attention to the adult’s face, evoke a response smile, and then transfer his gaze to the toy. Gradually, when seeing the face of an adult or a toy, the child will experience a smile, laughter, a “revival complex,” and various vocal reactions.
Next, work is carried out to establish the child’s emotional contacts with close adults, as well as to differentiate between “close” and “stranger” adults. When meeting a child, they are taught to say hello (extend a hand to acquaintances), when saying goodbye - to wave a hand (“bye”, “goodbye”), to express a request (“give”) when showing a bright, interesting toy, to express gratitude with a gesture (nod of the head) or a word ("Thank you"). In order to establish and prolong emotional and gestural-facial contact, various games can be played: “Gore - gore”, “Peek-a-boo”, “Wind-up toy”.
Subsequently, the child develops a concept of himself (his “I”). It is necessary to teach the child in response to the question “Where is our girl Masha?” point to yourself and, if possible, say your name. If the child does not act in any way, you can affectionately say, “Here is our Mashenka!” How beautiful you are!”, stroke her head, while the child’s hand should point to itself (you can do it passively).
In the third year of life, much attention is paid to the child’s perception of his peer and interaction with him: saying hello, extending a hand, taking or giving toys, saying goodbye.
2. Stimulation of sensory activity (visual, auditory, tactile-kinesthetic perception).
Sensory education is aimed at developing all types of child perception (visual, auditory, tactile-kinesthetic), on the basis of which full-fledged ideas about the external properties of objects, their shape, size, color, position in space are formed. It involves the development in the child of indicative-exploratory reactions and further orientation towards the properties and qualities of objects. Sensory education also develops the child’s thinking, since the manipulation of sensory information coming through the senses is carried out in the form of mental processes.
^ A. Development of visual perception.
The development of visual perception begins with the formation of visual concentration and tracking of an optical object. First, the adult stimulates the development of visual fixation on the adult’s face, and then on a toy (preferably with a soft silhouette, but with intense color, size 7 x 10 cm). Subsequently, training begins in coordinated movements of the head and eyes, which arise when the eyes smoothly follow an object. As the optical object moves (the adult's face, then the toy), it is necessary to passively turn the child's head in the direction of the object's movement. When the child's interest wanes, a sound component is connected to the toy.
Further development of visual perception is aimed at developing smooth tracking of a moving object (in the horizontal, vertical plane), stability of gaze fixation when changing the position of the head and torso. It is necessary to play special games with the child, bringing your face closer to the child and moving it away, talking affectionately to him. Bright voiced toys are also used. In this case, the child is in various positions (lying, sitting, vertically - in the arms of an adult).
At later stages, the development of visual differentiation is necessary. For classes, toys are selected that are different in color, size, shape, and sound. The child’s attention is drawn not only to toys, but also to surrounding objects and people. For this, various games are played (“Hide and Seek”, “Peek-a-boo”, when the speech therapist or mother throws a scarf over their head or hides behind a closet, the back of a chair, or a screen).
From the age of one and a half years, correctional pedagogical work is carried out to develop orientation towards the size, shape and color of objects in the following stages: 1) comparison of size, color or shape (“give me this, not that”). 2) Selection by word of size, color or shape (“give me red”, “give me big”, “give me round”). 3) Naming a feature - size, color, shape - by the child (for children who speak speech).
^ B. Development of auditory perception.
The development of auditory perception begins with the formation of auditory concentration (on voice and sound). To do this, use the period when the child is in an emotionally negative state - during a period of mild crying or general movements. The adult leans towards the child, talks to him tenderly, shakes the rattle, trying to attract the child’s attention and calm him down. Sound stimuli range from soft sounds (the sound of a rattle, light tapping of one toy against another) to louder sounds (the sound of a squeaking toy).
Further development of auditory perception occurs with the formation of the ability to localize sound in space. As sound stimuli, the child is offered toys of different sounds (loud-quiet, high-low, squeaking, ringing), as well as the adult’s differently intonated voice. By offering the child a voiced toy, then talking to him, he is taught to listen to the sound of the toy and the voice of an adult, and then look for them with his eyes. In this case, the child first sees the toy and the adult’s face, which gradually appear out of his field of vision. If a child with a motor pathology cannot independently turn his head to the source of the sound, the speech therapist does this passively.
Next, children are taught to differentiate the timbre color and intonation of the voice of the mother (or another close person) and “strangers”, using visual reinforcement. At the same time, other differentiated reactions are being formed: recognizing one’s name, distinguishing between strict and affectionate intonation of an adult’s voice and an adequate reaction to them, differentiating the nature of a melody (cheerful and sad, quiet and loud). Children are given special exercises to develop the differentiation of the sounds of toys: pipes, drums, rattles (choice of two). Particularly important is the development of auditory attention to adult speech.
^ B. Development of tactile-kinesthetic perception.
Correction of tactile-kinesthetic perception disorders begins with massage and passive gymnastics (to improve proprioceptive sensations). The development of tactile-kinesthetic sensations occurs in the 3rd year of life in parallel with the formation of knowledge about the properties of objects: soft-hard, heavy-light (weight), cold-warm (temperature). The concept of softness-hardness is given on different materials: a soft cap, soft plasticine, hard sugar, a hard apple. The concept of weight is given by the material: a heavy hammer, a heavy chair, a light ball, a light cube. The concept of thermal sensations is compared: cold and warm water, cold and warm day, cold ice, warm radiator, as well as during artificial local contrastothermy. For example, you can let your child touch cotton wool (“Do you feel the cotton wool is soft?”), and then a piece of wood (“Wood is hard”).
^ D. Formation of initial spatial representations.
The formation of spatial concepts is an important section of the sensory education of children with motor pathology, starting from 1.5-2 years. The formation of spatial ideas begins with the development of ideas about the diagram of one’s body and the location and movement of the body in space. To form ideas about the body diagram, a mirror is used in which the child sees his reflection. The child is brought to the mirror and told: “Look, here is your nose, mouth, etc.”, “Touch your nose, forehead, eyes, etc.” Then the action is transferred to the adult: “Look, here are my hands, etc.”
At the next stage, these exercises are performed on a doll, on a picture of a person, etc. When studying the schema of the face and body, much attention is paid to consolidating ideas about the right and left sides of the body and face as the child himself and other people. Orientation along the main spatial directions is formed in exercises with a ball, a flag, and moving in space. During such exercises, the concepts of “ahead”, “behind”, “right”, “left”, “far”, “close”, “closer”, “further” are learned and reinforced.
To develop optical-spatial perception, the child is taught to compose cut pictures from 2 (then from 3) parts, compose plot pictures from cubes with parts of the image, construct geometric shapes and object images from sticks.
3. Formation of cognitive activity and motivation for activity.
The development of cognitive activity and motivation for various types of activities goes through the entire process of correctional and pedagogical work with children, as well as in everyday life, at various moments. Cognitive interest, activity and persistence in mastering skills, purposefulness of activity, and the desire to achieve results are stimulated. For their development, various games and play situations using bright toys are used.
4. Development of knowledge about the environment and understanding of spoken speech (at an accessible level).
Preparing a child to develop an understanding of spoken speech begins with developing the perception of various intonations of an adult’s voice. It is necessary to obtain from the child not only the perception of various voice intonations (affectionate, gentle, joyful; angry, rude), but also an adequate reaction to them (smile, laughter or resentment, crying). The primary understanding of addressed speech occurs when the sound of a word spoken by an adult coincides with the presentation of the object it denotes. The child is asked to remember the names of bright toys that cause fairly strong indicative reactions. For memorization, two-syllable babbling words or onomatopoeia are used: Lala, kitty (meow), bi-bi, aw-aw. When learning to remember the names of toys or other surrounding objects, it is necessary that they are always in a certain place, in the child’s field of vision. Simultaneously with the presentation of the toy, at the moment the gaze is fixed on it, its name is pronounced. An adult pronounces words slowly, melodiously, with different intonations. At the same time, he passively performs various manipulations with the toy with the child’s hands (palpating, stroking movements). When teaching a child to search for a named toy, the adult gradually gets him to find the toy or object with his gaze ( Where is Lala? Here's lala! Here, take it!). If necessary, you need to passively turn the child's head towards the named toy. After the child has memorized the name of one toy, they move on to forming his understanding of the name of another toy, distant from the first one in space.
When developing understanding of spoken speech, the following skills are practiced:
remembering the names of toys, surrounding objects and faces, and finding them according to an adult’s word;
remembering the names of simple movements ( goodbye, okay, magpie-crow, give, here, take, give me a pen) and performing these movements according to verbal instructions;
adequate inclusion of a child in play with an adult ( hide and seek, peek-a-boo, gore, oh, I'm afraid);
performing various manipulations and actions with objects and toys according to the word.
formation of ideas about the functional purpose of objects, adequate actions with them.
correlation of toys and objects of the surrounding reality with their images in the pictures.
familiarizing children with the various properties and qualities of objects.
5. Formation of manipulative and objective actions.
It is necessary to take into account the stage-by-stage formation of manipulative, objective and game actions in ontogenesis: grasping, nonspecific and specific manipulations, objective actions, procedural actions, objective play with plot elements.
When developing specific manipulations, the child is taught to squeeze and unclench squeaking rubber toys, wave ringing rattles, swing hanging toys, roll balls or balls. When forming objective actions, pyramids, insert cubes, nesting dolls, dolls, a comb, a spoon, a pipe, a hammer, and a drum are used. Children are taught to remove and put on rings from the rod of a pyramid, open and close the lid of a box or pan, and knock with a hammer; beat the drum; blow a pipe, roll and throw a ball, open and close parts of a folding doll, etc. In the process of carrying out routine moments, children become familiar with the functional purpose of objects such as a spoon, cup, plate, etc.
When forming procedural and object-play actions, a set of toys is used - a doll, clothes for it, toy dishes (cup, plate, spoon, pan, lid), furniture (bed with bedding, chair, table), comb; cars, a set of building materials (cubes, roofs, bars), a ball, a cat, a dog, a bear. The adult performs procedural and object-play actions with various toys, trying to emotionally involve the child in the activity. Giving the child a doll, he offers to feed it, comb its hair, undress it, put it to bed, rock it, and dress it for a walk. To create a playful situation, they resort to expressive gestures: putting a finger to the lips when the doll was “sleeping”; they threaten her if she “ate badly.” From a set of building materials (cubes, bars, roofs) you can build a tower, house, road, gate, inviting the child to take part in the construction, rolling a bear doll in a car.
An important section of pedagogical work is stimulation of vocal responses, sound and speech activity of the child. In the course of correctional and developmental work, it is necessary to take into account the stages of pre-speech and early speech development: undifferentiated vocal activity, humming, babbling, babbling words and onomatopoeia, common words, etc. It is necessary to stimulate in children any available vocal, sound reactions, and subsequently words.
Each lesson to stimulate humming, and later babbling activity, begins with involving the child in emotional contact. In this case, you can perform the following exercises:
With a smile, now leaning towards the child's face, now moving away from him, the adult clearly pronounces certain sounds of humming and babbling. The same sound complex (“gu”, “bo”, “ma”, etc.) is repeated several times at certain intervals, with different intonations, encouraging the child to make a reflected utterance.
Exercises aimed at pronouncing the syllables “ma”, “ba”, “pa”, etc. To do this, during moments of vocal activity, passive vibration of the lower lip is activated. Rhythmic closing and opening of the lips creates the possibility of pronouncing labial sounds: “p”, “b”, “m”.
A combination of voluntary vocalization and passive lip vibration. Certain lip patterns are created for the exaggerated pronunciation of vowel sounds: “a”, “o”, “u”, “i”.
Next, the pronunciation of babbling words is stimulated, which are pronounced by the child in imitation and correlate with a specific person, object or action. You need to try to ensure that the utterance of babbling words is not formal, but conscious. It is necessary to select words that are accessible to the child based on their sound-syllable composition (“mom”, “dad”, “baba”, “uncle”, “Tata”, “Vava”). The pronunciation of various onomatopoeias (“bi-bi”, “ha-ga”, “ko-ko”, “kva-kva”, “mu-mu”), which correlate with toys, objects, and animals, is also stimulated.
Then the pronunciation of commonly used as well as lightweight words develops. In addition to words denoting objects, the child is offered words denoting action: “give”, “on”, “bang”, “go”. Gradually, the stock of spoken words should expand. At the same time, there is constant stimulation of verbal communication at an accessible level.
The next stage of speech therapy work is the formation of the pronunciation of a simple phrase. During classes, children, as they master them, are presented with new words that become more complex in their sound-syllable composition. The child’s passive and active vocabulary should consist of the names of objects that the child often sees and actions that he himself has performed or that his loved ones perform. For children to imitate, two-word sentences with the following structure are offered:
address + command expressed by a verb in the imperative mood (“Baba, go.” “Mom, give.”);
command + names of objects (“On, ball.” “Give, av-av.”);
question + names of objects (“Where is bi-bi? Here is bi-bi.”).
The main goal of further work is to stimulate the development of phrasal speech. It occurs in the process of objective activity with a large number of toys and various household items. Three-word constructions like “address + command + names of objects” are practiced (“Nata, beep.” “Katya, give me the ball.”). Individual everyday phrases are learned (“I want to go for a walk”, “pour some water”, “can I go?”, “let’s go home”, “my ball”, “give me more!”, etc.)
In the process of work, we actively use various rhymes, songs, nursery rhymes that accompany the actions of a child and an adult not only in classes, but also during routine moments, which helps create a positive emotional mood, develop a sense of rhythm and strengthen the connection between an object, an action and a word, denoting them. For example:
The cat washes itself with its paw:
I washed my nose, I washed my mouth,
I washed my ear and dried it.
To simultaneously stimulate speech and motor activity, we use games with poetry, accompanied by simultaneous performance of movements (first passive, then passive-active and finally active). All games are selected taking into account the level of motor development of the child. For example:
We raise our hands up
We lower our hands down,
We clenched our fists tightly,
They knocked their fists,
They stomped their feet: stomp, stomp, stomp,
They clapped their hands: clap-clap-clap.
To communicate with others, children with delayed pre-speech and speech development need to form gestural, facial, vocal, sound pronunciation reactions, develop and consolidate the skills of voluntary pronunciation of syllables, syllabic complexes, and lightweight words.
^ III. Development of motor skills and correction of its disorders.
1. Development of the functional capabilities of the hands and fingers.
During therapeutic and pedagogical work, it is necessary to take into account the stages of development of motor skills of the hand and fingers: support on an open hand, voluntary grasping of objects with the hand, inclusion of a finger grip, opposition of fingers, gradually more complex manipulations and object actions, differentiated movements of the fingers.
Before developing the functional capabilities of the hands and fingers, it is necessary to achieve normalization of the muscle tone of the upper extremities. Muscle relaxation is facilitated by shaking the hand according to the Phelps method (grasping the child’s forearm in the middle third, light rocking and shaking movements are performed). Next, massage and passive exercises of the hands and fingers are carried out:
stroking, spiral, kneading movements along the fingers from the tip to their base;
patting, tingling, rubbing the fingertips, as well as the areas between the bases of the fingers;
stroking and patting the back of the hand and arm (from fingers to elbow);
patting the child’s hand on the teacher’s hand, on a soft and hard surface;
rotation of fingers (each separately);
circular turns of the brush;
abduction-adduction of the hand (right-left);
movement of supination (turning the hand with the palm up) - pronation (palm down). Supination of the hand and forearm makes it easier to open the palm and abduct the thumb (game “Show your palms”, movements of turning a key, switch);
alternately extending the fingers of the hand, and then bending the fingers (the thumb is on top);
opposing the thumb to the rest (finger rings);
brush massage (of the fingertips and the outer surface of the hand from the fingertips to the wrist joint, which causes the fist to straighten and the fingers to fan out); Pile brushes of varying hardness are used. Brush massage is used to form palpating movements and stimulate proprioceptive sensations of the hands and fingers. If the child’s hand still remains clenched into a fist, the speech therapist grabs it and squeezes it with all his fingers in order to cause the child’s fist to clench even more. At the same time, his hand is shaken. Then the speech therapist quickly unclenches his hand, releases the child’s fist, after which the child’s fist reflexively relaxes and the fingers open (repeat 2-3 times).
The development of the supporting function of the arms is facilitated by the child slowly rolling forward on a large ball while lying on his stomach. In this case, it is easier for a child to place his fingers on the convex side of the ball than on a horizontal surface; abduction of the thumb is also easier.
The grasping function begins to be trained from the neonatal period. First, toys are placed in the child’s hand and helped to bring them to his mouth. Objects placed in a child's hand must be different in shape, size, weight, texture, and temperature. This helps to recognize them by touch. They should be easy to grip and hold. Then the child is encouraged to reach for his face and bright objects hanging in the crib or on the adult’s chest. The child feels them first passively (with the help of an adult’s hands), and then actively. In different positions (lying on the stomach, on the back, sitting, standing on all fours, on the knees, on the legs), they train to reach and grasp objects located at different distances in front, on the sides of the child and at different heights. It is necessary to ensure that the child grasps the object not with the little finger and ring finger, but with the participation of the thumb, index and middle fingers.
It is important to teach the child not only to grasp an object, but also to release it (letting go). Unclenching the hand is made easier by shaking it towards the little finger, turning the hand palm up, as well as running the hand along a rough surface, sand. Further development of the functional capabilities of the hands and fingers involves the formation of the manipulative function of the hands and differentiated movements of the fingers. The child is encouraged to take (grab) toys from different positions - below, above, on the side of him. An adult helps to examine it, touch it, stroke it, move it from hand to hand, and take it into the mouth. Following this (from one year of age), simple objective actions are developed, if necessary, performed passively or passively-actively. The following actions can be suggested:
voluntary release of a toy from the hand (into an adult’s hand or into a bucket, box);
taking out and moving toys from one place to another;
opening and closing the box;
removing and putting on pyramid rings;
rolling a ball, a car;
building a tower from cubes;
grasping large objects with the whole hand (one and two hands);
picking up small objects with two and three fingers.
2. Correction of speech motor (dysarthric) disorders.
When carrying out correctional speech therapy work on normalization of muscle tone and motility of the articulatory apparatus with children with motor impairments it is advisable to use the following speech therapy methods:
differentiated speech therapy massage (relaxing or stimulating),
acupressure,
passive and active articulatory gymnastics,
artificial local contrastothermia (combination of hypo- and hyperthermia).
Differentiated speech therapy massage
Speech therapy work should begin with weakening the manifestations of innervation disorders of the speech apparatus. By expanding the possibilities of movements of the speech muscles, one can count on their better spontaneous inclusion in the articulatory process. It is necessary to use means and techniques of differentiated speech therapy massage (relaxing or stimulating) taking into account the nature of the violation of muscle tone and motor skills of the articulatory apparatus in a given child. Depending on the state of muscle tone, a relaxing massage is performed (for muscle spasticity - for the purpose of relaxation) and a stimulating massage (for hypotension - for the purpose of activating muscle tone). The essence of massage is the application of mechanical irritations in the form of light stroking, rubbing, kneading, vibration and effleurage. Techniques such as vibration, deep kneading, and pinching are used only for muscle hypotonia.A speech therapist, if possible, can teach the child’s mother basic massage techniques and passive articulatory gymnastics.
Relaxing massage of articulatory muscles.
Used in case of increased muscle tone of the speech muscles (in the facial, labial, lingual muscles). During a relaxing massage, the choice of position for working with a child is very important. The child is given positions in which pathological tonic reflexes would manifest themselves minimally or not at all (“reflex-inhibiting positions”). The tone of the muscles of the face, neck, and tongue decreases somewhat.
“Fetal position” - in a supine position, the child’s head is raised and lowered onto the chest, arms and knees are bent and brought to the stomach. In this position, smooth rocking is performed up to 6-10 times, aimed at achieving maximum muscle relaxation (Bobat method).
In the supine position, a cushion is placed under the child’s neck, allowing him to slightly raise his shoulders and tilt his head back; The legs are bent at the knees.
In the supine position, the head is fixed on both sides with bolsters that allow it to be held in the midline.
^ Relaxation of the neck muscles (passive head movements).
Before starting a relaxing massage of the articulatory muscles, especially in the case of increased muscle tone of the upper shoulder girdle and neck, it is necessary to achieve relaxation of these muscles. The speech therapist makes passive movements of the child's head.
The position of the child is on the back, the head hangs slightly back: a) with one hand the speech therapist supports the child’s neck from behind, with the other he makes circular movements of the head, first clockwise, then counterclockwise. b) with slow, smooth movements, the speech therapist turns the child’s head in one direction and the other, rocks it forward (3-5 times). Relaxation of the neck muscles causes some relaxation of the root of the tongue.
Relaxation of the oral muscles is achieved by lightly stroking and patting the muscles of the face, lips, neck, and tongue. Movements are carried out with both hands in the direction from the periphery to the center. Movements should be light, sliding, slightly pressing, but not stretching the skin. Each movement is repeated 5-8 times.
Relaxation of facial muscles:
stroking from the middle of the forehead to the temples;
from eyebrows to scalp;
from the forehead line around the eyes;
stroking the eyebrows from the bridge of the nose to the sides to the edge of the hair, continuing the eyebrow line;
from the forehead line down through the entire face along the cheeks, chin and neck;
from the lower edge of the auricle (from the earlobes) along the cheeks to the wings of the nose;
light pinching movements along the edge of the lower jaw;
Pressure massage of the face from the hair roots down.
Relaxation of the labial muscles:
stroking the upper lip from the corners of the mouth to the center;
stroking the lower lip from the corners of the mouth to the center;
stroking the upper lip (movement from top to bottom);
stroking the lower lip (movement from bottom to top);
stroking the nasolabial folds from the wings of the nose to the corners of the lips;
acupressure of the lips (light rotational movements clockwise);
lightly tapping your lips with your fingers.
Stimulating massage of articulatory muscles.
Stimulating massage is carried out in case of muscle hypotension (in order to strengthen muscle tone). Massage movements are carried out from the center to the periphery. Strengthening the facial muscles is carried out by stroking, rubbing, kneading, pinching, vibration. After 4-5 light movements, their strength increases, they become pressing, but not painful. The movements are repeated 8-10 times.
Strengthening facial muscles:
stroking the forehead from the middle to the temples;
stroking the forehead from the eyebrows to the hair;
stroking eyebrows;
stroking along the eyelids from the inner to the outer corners of the eyes and to the sides;
stroking the cheeks from the nose to the ears and from the chin to the ears;
squeezing the chin with rhythmic movements;
kneading the zygomatic and buccal muscles (spiral movements along the zygomatic and buccal muscles);
rubbing the cheek muscle (index finger in the mouth, the rest outside);
pinching cheeks.
Strengthening the labial muscles:
stroking from the middle of the upper lip to the corners;
from the middle of the lower lip to the corners;
stroking the nasolabial folds from the corners of the lips to the wings of the nose;
tingling lips;
tingling lips.
^ Massage of the lingual muscles.
If the tongue is spastic, a relaxing massage is performed; if the tongue is hypotoned, a strengthening massage is performed. Spasticity of the lingual muscles is observed much more often than hypotonia of the tongue. With hypotension, massage techniques are more active and intense than with spasticity.
The goals of tongue massage are: a) normalization of muscle tone; b) inclusion of new muscle groups in speech activity and increase in the intensity of previously included muscles; c) increasing the volume and amplitude of articulatory movements; d) reduction of salivation; e) strengthening the pharyngeal reflex; f) afferentation into the speech zones of the cerebral cortex (to stimulate speech development).
Tongue massage can be done in various ways:
massage with toothbrushes (various in material, shape, bristle hardness, size). During massage, both bristles and a brush stick are used;
manual massage (in a fingertip or through a gauze pad);
massage with a wooden or metal spatula;
probe massage.
While massaging the tongue, the child's mouth is slightly open. The speech therapist first massages in the oral cavity, then outside it.
^ Tongue massage techniques (direction of massage movements):
stroking the tongue in different directions: - from the root of the tongue to the tip (impact on the longitudinal muscles); from the center of the tongue to the lateral edges (transverse muscles); circular, spiral movements;
patting the tongue (starting from the tip, moving gradually to the root and back. (Rhythmic pressure affects the vertical muscles);
light vibrating movements transmitted to the tongue through a probe (spatula);
tingling of the tongue (with a needle probe);
massage of the upper rise of the tongue, stretching the frenulum (movement from bottom to top under the tongue);
“rubbing” the tongue with a gauze cloth or a clean handkerchief (in case of increased sensitivity of the child to gauze);
spreading the tongue with a small enema-syringe (folded twice, most of the enema is in the mouth; the tip is outside).
Articulation gymnastics with infants and young children is carried out in a passive, then in a passive-active form.
Passive articulatory gymnastics.
Passive articulatory gymnastics is carried out after the massage. The speech therapist performs passive movements of the articulation organs in order to include new muscle groups in the articulation process, which were previously inactive, or to increase the activity of previously included muscles. This creates conditions for the formation of voluntary movements of the speech muscles. The direction, volume and trajectory of passive movements are the same as active ones. They differ from active movements in that the time of turning on and off from the movement, fixation is determined by the speech therapist. The speech therapist draws up a diagram of articulatory movement, if possible explaining it to the child, requiring visual control from him. Passive exercises are performed in series of 3-5 movements. The child is asked to become aware of the 3 stages of each movement: entry, fixation, exit. It is necessary to gradually cultivate the ability to visually control and evaluate every movement, feel and remember it.
Passive tongue gymnastics:
moving the tongue forward from the oral cavity;
tongue retraction;
lowering the tongue down (towards the lower lip);
lifting the tongue up (towards the upper lip);
lateral abductions of the tongue (left and right);
pressing the tip of the tongue to the bottom of the mouth;
raising the tip of the tongue to the hard palate;
light, smooth swaying movements of the tongue to the sides.
Passive lip gymnastics:
gathering the upper lip (place the index fingers of both hands at the corners of the lips and move towards the midline);
gathering the lower lip (with the same technique);
gathering the lips into a tube (“proboscis”), moving towards the midline;
stretching the lips into a “smile”, fixing them with fingers in the corners of the mouth;
raising the upper lip;
lowering of the lower lip;
closing the lips to develop the kinesthetic sensation of a closed mouth;
creating different lip patterns necessary for pronouncing vowel sounds ( a, o, y, and, s, e).
pushing out a gauze napkin tucked behind the cheek with the tongue (alternately left and right);
holding various objects (cork, gauze) with the lips.
Artificial local contrastothermy.
The method of artificial local contrast therapy (ILC) is used to reduce spasticity of the muscles of the articulatory apparatus, hyperkinesis of the lingual and facial muscles, as well as for articulatory apraxia. This method consists of the contrasting effects of low-temperature (cryomassage) and high-temperature agents (thermal massage). Low-temperature agents are ice chips or very cold water, and high-temperature agents are hot water or herbal infusion.
Hypothermia (cryomassage) and hyperthermia (thermal massage) can be used alternately or selectively. There are various options for their use:
Hypothermia only (cryomassage).
Only hyperthermia (thermal massage).
Hypothermia, then hyperthermia.
Alternating use of cryo- and heat applications.
Artificial local hypothermia is carried out as follows: crushed ice in gauze is applied alternately to the muscles of the articulatory apparatus (orbicularis oris muscle, zygomaticus major muscle, chin in the area of the submandibular fossa, lingual muscles). In case of IPH on the muscles of the tongue, the speech therapist holds the tongue with a gauze napkin (be sure to act on the root, back, tip, and lateral edges of the tongue).
The duration of exposure to ice application during one session is from 2 to 7 minutes in total (we increase the exposure time gradually). Simultaneous application of ice to one of the interested cryotherapy zones for 5 to 20 seconds. The course of treatment is 15-20 sessions performed daily.
Hyperthermia (thermal massage of articulatory muscles) is carried out in a similar way. In this case, you can use a thermal electric massager.
To activate the central sections of the speech motor analyzer and speech afferentation, contrastothermal effects can be exerted not only on the articulatory muscles, but also on the muscles of the upper extremities (especially the right hand).
From the first weeks and months of life, children with motor pathology are given ontogenetically consistent stimulation of reflex development. In children in the first months of life, this is stimulation of sucking, swallowing, and the development of reflexive emotional and communicative reactions.
^ Normalization of the feeding process is vital for the child. The activity of the act of sucking depends on the timely manifestation and severity of oral automatism reflexes. If they are absent or insufficiently expressed, techniques are used to stimulate unconditioned reflex activity. Oral reflexes are stimulated immediately before feeding the baby. Each reflex is evoked no more than 2-3 times, since the activity of the reflex drops sharply with further stimulation. To regulate the feeding process, it is important to strictly observe the constancy of the position and place of feeding, which strengthen unconditioned food reflexes (searching for the breast, opening the mouth, sucking movements). During feeding, the mother finds a position so that her hands are free. The child is in a position of slight flexion, in which the most complete muscle relaxation occurs.
Immediately before feeding (preferably in the “reflex-inhibiting position”) the innate unconditioned reflexes are stimulated - labial, searching, proboscis, sucking. To stimulate them, a cotton swab dipped in warm milk, a nipple, pacifier or finger are passed several times over reflexogenic zones - in the area of the nasolabial folds, at the corners of the mouth, along the middle part of the upper lip, along the front surface of the tongue.
When inducing a search reflex, touch the cheek in the area of the corners of the mouth; Having not received a response in the form of turning the head and moving the lips towards the stimulus, they passively gently turn the head and move the lips in the direction corresponding to the stimulus. When inducing the proboscis reflex, they irritate the middle of the upper lip with a finger and help passively pull the lips forward, collecting them into a “proboscis”. If the swallowing reflex is impaired, the root of the tongue and the back wall of the pharynx are stimulated by irritating them with drops of warm milk or sweet water. Inducing a sucking reflex, the baby's lips gather around the nipple with a bottle or the mother's nipple, rhythmically compress the baby's lips and at the same time squeeze out a small portion of milk. If sucking is possible, but lip closure is impaired (if the orbicularis oris muscle is damaged), the lower jaw sagging, and milk is leaking from the corners of the lips, at the time of sucking it is necessary to lightly hold the lips around the nipple or pacifier and support the lower lip and jaw from below.
Stimulation of oral automatism reflexes contributes not only to the normalization of the feeding process, but also to the formation of positive emotional relationships between mother and child, the development of initial visual and auditory concentration, and prepares the appearance of the first vocal reactions.
A feature of speech therapy work after 3-4 months is the lack of stimulation of early congenital unconditioned reflexes; on the contrary, the reflexes of oral automatism begin to actively slow down and be suppressed. To do this, the child is placed in a “reflex-inhibiting position”; the speech therapist gently touches the child’s lips with a cotton swab, pacifier or finger with one hand, and with the other hand prevents the reflex movement of the lips. In order not to stimulate the reflexes of oral automatism, in some cases it is advisable to massage the articulatory muscles after feeding the child.
Development of breathing and correction of its disorders (breathing exercises).
An important section of speech therapy work is the development of breathing and the correction of its disorders. This work begins from the first months of a sick child’s life, which affects his general somatic condition and also stimulates vocal reactions.
Correction of breathing disorders begins with general breathing exercises, the purpose of which is to increase the volume, strength and depth of inhaled and exhaled air and normalize the breathing rhythm. The speech therapist conducts passive breathing exercises with the child. While doing breathing exercises, you can turn on (or hum) a quiet, smooth melody, or calmly and affectionately tell something to your child. Gymnastics is carried out in various positions of the child: lying on his back, sitting, standing. Breathing exercises must be carried out in a supine position - in “reflex-inhibiting positions”. It is advisable to use the following breathing exercises:
In the supine position, by lightly stroking the body and, above all, the upper shoulder girdle, shaking the child’s limbs, some relaxation of the skeletal muscles is achieved. Having grabbed the child’s hands and lightly shaking them, the speech therapist spreads his arms to the sides, raises them up (inhale), then lowers them forward, pressing his hands to the body and lightly pressing on the chest (exhale).
In the supine position, in the rhythm of breathing, carefully shaking the child’s legs, they are stretched, unbent (inhalation occurs), and bending them at the knees and bringing them to the stomach strengthens and lengthens the exhalation. To activate the diaphragm, this exercise can be performed with the child’s hands under the head.
Simultaneously with turning the child’s head to the side, the speech therapist moves his hand to the appropriate side (inhale). Lightly shaking the hand, return the hand and head to their original position (exhale). This exercise helps develop rhythmic movement and breathing.
The child lies on his stomach, his arms under the chest rest on a hard surface, his head is lowered. The speech therapist raises his head and shoulders while leaning on his hands (inhale), then lowers them (exhale). It is necessary to strive to actively involve the child in the exercise through play ( Here's our baby! Peek-a-boo, our baby hid).
With the child lying or sitting, the speech therapist puts his hands on the child’s pectoral muscles and listens to the rhythm of breathing. At the moment of exhalation, it presses on the chest, as if preventing inhalation (for several seconds). This exercise promotes deeper and faster inhalation and longer exhalation.
CONCLUSION
Traditional in the treatment of motor pathology, including cerebral palsy, is the correction of the formed motor stereotype. At the same time, such important socially significant functions as cognitive activity and speech often remain outside the scope of correctional work. Unfortunately, a study of the experience of various institutions shows that pedagogical work on the development of cognitive and speech functions and the correction of their disorders begins too late (only after 3-5 years), when the sensitive period of development of the psyche and speech is missed. Not only parents, but also some specialists involved in the rehabilitation treatment of children with motor pathology do not understand the importance of carrying out simultaneous correctional and developmental work on all impaired functions.
Our long-term dynamic observations show that children with mild developmental disabilities in the first year of life, in the absence of the necessary adequate therapeutic, correctional, developmental and pedagogical measures, subsequently experience certain difficulties in learning. On the other hand, comprehensive, systematic and adequate classes with children with significant developmental disabilities allow one to achieve noticeable results. Moreover, the earlier classes start, the more effective they are.
It should be noted that not only doctors, teachers, massage therapists, but also, first of all, the family should be involved in the correctional and developmental process of raising children with developmental disabilities. Unfortunately, many parents expect positive results without making any efforts to restore impaired functions. But only parents can patiently and painstakingly carry out hard daily work, developing one or another delayed function in their child.
^ BIBLIOGRAPHY
Arkhipova E.F. Corrective work with children with cerebral palsy. Pre-speech period: A book for speech therapist. – M.: Education, 1989. – 79 p.
Badalyan L.O., Zhurba L.T., Timonina O.V. Cerebral palsy. – Kyiv: Health, 1988. – 328 p.
Education and training of young children / Ed. L.N. Pavlova. – M., 1986.
Education and development of young children / Ed. G.M. Lyamina. – M., 1981.
Zhukova N.S., Mastyukova E.M. If your child is developmentally delayed. – M.: Medicine, 1993. – 112 p.
Zhurba L.T., Mastyukova E.M. Disorders of psychomotor development of children in the first year of life M, 1981.-270 p.
Correctional and speech therapy work with children suffering from cerebral palsy in the first year of life: Methodological recommendations / Comp. K.A. Semenova, E.F. Arkhipova. – M., 1982. – 28 p.
Mastyukova E.M. Diagnosis of pre-speech development disorders in children with cerebral palsy and ways of speech therapy and pedagogical measures in this period. – M., 1973. – 24 p.
Mastyukova E.M. Physical education of children with cerebral palsy. - M. “Enlightenment”, 1991.-157 p.
Pantyukhina G.V., Pechora K.L., Frucht E.L. Diagnosis of neuropsychic development of children in the first three years of life. – M., 1979.
Pilyugina E.G. Baby's sensory abilities. – M.: Education, 1996. – 112 p.
Razenkova Yu.A. Games with infants. – M.: School Press, 2000. – 160 p.
Serganova T.I. How to overcome cerebral palsy: with the mind of a specialist, with the heart of a mother. – St. Petersburg: TAS Publishing House, 1995. – 192 p.
If a child does not speak or speaks poorly, this affects his further development. Speech therapist Oksana Prikhodko, with her unique technique, teaches children to speak better with the help of... differentiated speech therapy massage. Many children, falling into the caring hands of Oksana Georgievna, begin not only to speak, but also to explore the world. The speech therapist, whom hundreds of parents remember with gratitude, shared the secrets of her method with MK readers and told how to diagnose abnormalities in a baby in the first year of life.
One of the speech therapist’s most difficult patients is Anya Rumyantseva. Now Anya is 25 years old, and she is the champion of Moscow and Russia in swimming among disabled teenagers and a bronze medalist at the Paralympic Games. And once upon a time the girl was brought to Oksana Prikhodko’s mother, a defectologist. Anya’s medical record said: “incurable.” A diagnosis that means that the child will not progress in his psycho-speech development. No one could have dreamed that with such a stigma a girl would be able to adapt to life normally. However, thanks to constant classes and massage, at the age of seven Anya walked and spoke for the first time. The fact that she was once seriously ill is reminded only by minor imperfections in her gait and speech.
Will my child be normal?
More than once Oksana Georgievna had to hear this question from mothers, asked with a mixture of fear and hope. The speech therapist always answers them honestly.
It is impossible to reassure and deceive a parent, Prikhodko believes, but one should not instill fear either. Otherwise, the mother may not be able to stand it and abandon the child, but the progress of the baby’s development depends primarily on herself. But in what form the truth should be presented depends on the mother herself. One, in Oksana Georgievna’s opinion, needs to be intimidated: they say, if she doesn’t take care of the child, then there will be no positive result, and for the other, it’s enough to outline the treatment and just help along the way.
- When I was young, I asked myself the question: why should children live who are completely unresponsive to the outside world, see poorly, hear poorly, cannot speak and have no hope? - Oksana Georgievna shared with MK. - But then I put myself in the place of this mother... I saw women who began to glow with happiness because their seriously ill child simply looked at them...
Nowadays many children are born with pathologies. And if severe genetic pathology can be detected in the womb, then less obvious disorders can not be tracked during pregnancy. And when the baby is born, problems with his health grow like a snowball. There are many reasons for deviations: poor maternal health, smoking, alcoholism, ecology, genetic predisposition, chronic diseases and much more.
If pathologies were diagnosed from the first months, then they are easier to eliminate. Prikhodko can remember many such cases when children with disabilities were cured.
“If a child does not sit at 6 months, you need to see a doctor and get advice! It happens that pathology sleeps in a child like a bud, and if a shock appears in the form of fever or convulsions, then it can open up in full,” explains Oksana Georgievna to MK.
Minibus specialist
Prikhodko worked for 16 years at Children's Psychoneurological Hospital No. 18 as a speech pathologist and speech pathologist. And now he not only gives lectures to students, but also receives patients. Although Oksana Georgievna is not only a practicing defectologist - she is the head of the Department of Speech Therapy, Dean of the Faculty of Special Pedagogy, Doctor of Pedagogical Sciences, Professor of the Moscow City Pedagogical University. Her daughter says that her mother advises children everywhere - on the subway, on the train, and on the minibus.
“I immediately see such children: their mouths are slightly open, their lips are slightly limp. Mom sometimes doesn’t even know that her child is sick,” Prikhodko said. - Parents react to such revelations differently. Some admit that their suspicions are confirmed, while others refuse to agree. But the child needs to be treated, and the sooner, the more effective it will be.
Just recently, a mother and daughter sat in the same minibus with Oksana Georgievna - right there the defectologist made a diagnosis and prescribed a corrective course: “I received great satisfaction from the fact that I helped! This family came from another city, was looking for a specialist to cure their daughter, and found him in a minibus.”
Problems from childhood
According to official data, 86% of children are born with neuropathological abnormalities. Nature did not give health to some, others received birth injuries.
Twins Lenya and Volodya Nakonechny became victims of medical error. Their mother, when she was still carrying children under her heart, was accidentally injected with a labor stimulant, and the boys were born at seven months. Doctors assessed the children’s condition, and Volodya was placed in a special incubator, where optimal conditions for the child’s development are maintained. Lenya felt better, so he was placed in a regular crib. But at night the boy had respiratory and cardiac arrest, prolonged convulsions, and his condition sharply worsened. After which Lenya acquired persistent developmental disabilities. Soon the children ended up with Oksana Prikhodko.
The speech therapist worked with the children for many years using her own methods, regularly gave massages and worked on the development of cognitive and speech activity. At first, both babies underwent the same procedures, but Vova’s progress was much faster than his brother’s. The boy began to speak and subsequently successfully studied at a comprehensive school, and then graduated from college. The young man has a slight cosmetic defect from his previous diagnosis of cerebral palsy - he has a limp. But for Leni, fate turned out differently: the young man remained severely disabled for the rest of his life.
Simple movements for big results
In the last decade, in speech therapy, many specialists have been providing massage to their patients, but very few have been doing it from the first months of a child’s life. Most suggest parents wait 3-5 years to see how the pathology manifests itself. But Oksana Georgievna strongly does not recommend waiting. You can improve your speech intelligibility with simple exercises. It would seem, how can you understand from a baby that he will have problems with speech? But Oksana Prikhodko claims that already at an early age there is a motor pathology in the muscles and motor skills of the articulatory apparatus.
- There is no need to say that all children are individual and each has their own time to speak. This is not so, notes Prikhodko. - The child can speak individual small words, but meaningfully. Say “mom” and look exactly at her.
With the help of massage, in severe cases, the degree of manifestation can be reduced, and in mild cases, it can be completely eliminated. You need to massage your tongue, lips and even your hands.
Oksana Georgievna plays children's songs in the background and begins the massage session. If the child is afraid, then first she massages his mother so that the baby understands that it is not scary. If everything is clear with the hands and lips - they are gently massaged in a circular motion, lightly patted and pinched, then for the tongue you need to use special devices. But you can also use a regular toothbrush. You need to massage from root to tip, stroking and patting. Parents can do this themselves, after first consulting a neurologist. After all, even for such seemingly simple actions there are contraindications: high fever, convulsions, hysterics in the baby. And when the specialist has shown exactly what needs to be done, you can massage the child yourself.
Lazy nature
Oksana Prikhodko says that success in the development of problem children consists of three criteria: natural abilities, specialist help and mother’s care. If any of these three components is missing, then some kind of pathology will definitely emerge. However, according to the defectologist, mother’s love should not go beyond the bounds of reason. Before her eyes, many mothers, having spoiled their child and not taught him to take care of himself, made his life worse: “You can’t do everything for the child!” The speech therapist believes that the primary task of the mother of a disabled child is to teach him how to care for himself. Motivation is a great thing: if he wants to eat, he will try and eventually learn to hold a spoon.
But there are some parents who hope that all defects will go away with time. Oksana Georgievna said that once a girl with mental retardation was brought to her. The defectologist outlined a program for the child’s recovery for the mother and told her to come back in three months. The mother showed up a year and a half later, when the child was already three and a half, and admitted that she had not studied according to the recommended method. The girl left with a diagnosis of “mental retardation”...
Just don't tell your husband!
According to the speech therapist, diagnoses affect dads differently. Oksana Georgievna had such a case when a married couple came from Orel to show their daughter. The doctor diagnosed mental retardation and, before announcing this, asked dad, under a plausible pretext, to leave the room. When the mother heard the diagnosis, she burst into tears and begged: “Just don’t tell our dad - he’ll leave us!” Prikhodko left the truth to her mother’s discretion: “Here I’m on her side - fathers very often abandon families with sick children.”
“I try not to judge anyone,” Oksana Georgievna says philosophically. - I have a friend who placed her sick child in an orphanage. She works as a flight attendant and has no one to leave her child with. She did not give up on her baby, she comes to him at every opportunity, but she cannot take him home: there is no one to leave him with, there are no relatives.
Young old woman
Now many people are making plans: I’ll study, work a little, and then, after 30, I’ll find a husband and have a child. Oksana Georgievna believes that it is better to give birth before the age of 30 and not later - after all, then the chances of giving birth to a defective child increase many times over. Before planning a pregnancy, the doctor advises to be examined and treated for any detected diseases. Because during pregnancy they will sharply worsen, and treatment can cause undesirable consequences in the child.
From the first days of his life, you need to constantly monitor your baby and, if something goes wrong, immediately sound the alarm and contact a specialist.
- Mom and dad believe that the main thing is that the child is beautifully dressed, he has an expensive stroller and large plush toys, but this is not so! The child needs the care of his parents and constant communication with them, summarized Oksana Prikhodko.
Severe speech disorders (SSD) are persistent specific deviations in the formation of components of the speech system (lexical and grammatical structure of speech, phonemic processes, sound pronunciation, prosodic organization of the sound flow), observed in children with intact hearing and normal intelligence. Severe speech disorders include alalia (motor and sensory), severe dysarthria, rhinolalia and stuttering, childhood aphasia, etc. 6
In children with SSD: Strict limitation of active vocabulary, persistent agrammatisms, immaturity of coherent speech skills, severe impairment of general speech intelligibility; difficulties in the formation of not only oral, but also written speech. The need for communication is reduced, forms of communication (dialogue and monologue speech) are not formed. Optical-spatial gnosis is at a lower level of development. Spatial impairments cause pronounced and persistent disorders of written speech (dyslexia, dysgraphia), and counting disorders (acalculia). The level of voluntary attention, auditory memory, and memorization productivity are reduced. The possibilities of semantic and logical memorization are relatively preserved. Specific features of verbal thinking, which, in their psycho-speech mechanism, are primarily associated with the underdevelopment of all components of speech, and not with a violation of (non-verbal) thinking itself. 7
The psychological and pedagogical classification includes two groups of speech disorders: 1) impairment of means of communication: phonetic-phonemic underdevelopment (FFN) and general speech underdevelopment (GSD); 2) violation in the use of means of communication (stuttering and a combination of stuttering with general underdevelopment of speech). Reading and writing disorders are considered in the structure of ONR and FFN as their systemic, delayed consequences, caused by the immaturity of phonemic and morphological generalizations. 8
Clinical and pedagogical classification of speech disorders. Disorders of oral and written speech are distinguished. I. Impairments of oral speech are divided into two types: Violations of the phonation (external) design of the utterance (dysphonia / aphonia /, bradilalia, tachylalia, stuttering, dyslalia, rhinolalia, dysarthria), Violations of the structural-semantic (internal) design of the utterance (alalia, aphasia) . II. Written language disorders are divided into two types: dyslexia and dysgraphia. 9
For most children with SLD, it is almost impossible to receive a full-fledged education without timely special speech therapy assistance, as well as the necessary medical, psychological and pedagogical support. Traditionally, children with severe speech impairments were provided with comprehensive psychological and pedagogical assistance in the special education system (in special correctional preschool and school educational institutions of the V type). In special (correctional) institutions, systematic speech therapy assistance is provided, the curriculum is modified, special didactic aids and textbooks are used, developed in accordance with the capabilities and educational needs of children with SLD. 10
The educational activity of children with SLD is characterized by a slower pace of perception of educational information, reduced performance, and difficulties in establishing associative connections between the visual, auditory and speech motor analyzers; difficulties in organizing voluntary activities, low levels of self-control and motivation, possible weakening of memory, deviations in spatial orientation and constructive activity, disorders of fine motor skills, visual-motor and auditory-motor coordination. The imperfection of oral speech prevents the full assimilation of program material in the Russian language, which creates unfavorable conditions for the formation of written speech. The situation of failure in mastering the native language, which is so significant for the social environment, leads to a sharp decrease in motivation to overcome not only speech underdevelopment, but also the entire learning process as a whole. The lack of development of speech, language and communication skills in students with speech and language development disorders causes problems in their learning, negatively affects the formation of self-esteem and behavior of children, and leads to school maladjustment. eleven
Special educational needs of children with SLI: The need for training in various forms of communication (verbal and non-verbal), especially in children with a low level of speech development (motor alalia); in the formation of social competence. Development of all components of speech, speech and language competence. Difficulties in mastering lexical and grammatical categories create the need for the development of understanding of complex prepositional-case constructions, the purposeful formation of a language program for oral utterance, skills of lexical content and grammatical construction, coherent dialogical and monologue speech; children with SLI need special training in the basics of language analysis and synthesis, phonemic processes and sound pronunciation, prosody. Formation of reading and writing skills. Development of spatial orientation skills. Students with special needs require a special individually differentiated approach to the development of educational skills. 12
Special educational conditions for the training, education and development of children with speech disorders: early identification of children with speech pathology and organization of speech therapy assistance at the stage of detecting signs of deviant psycho-speech development; systematic correctional and speech therapy assistance in accordance with identified disorders in early or preschool age; receiving mandatory systematic speech therapy assistance in a mass or special type institution; interaction and coordination of pedagogical, psychological and medical means of influence with close cooperation of a teacher-speech therapist, teacher-defectologist, educational psychologist, teachers and doctors of various specialties; availability of necessary medical services to help overcome and smooth out the primary defect; 13
Possibility of modification and adaptation of the curriculum when studying philological and linguistic courses, variability: interchangeability/reduction/increase in academic and socially significant components of training, individual thematic sections, teaching hours; the use of individually oriented specific techniques and methods of speech therapy correction for various forms of speech pathology; choosing an individual pace of learning, with a possible change in the timing of advancement in the educational space; special organization of diagnostic, testing and control-evaluation tools: reducing the volume of control tasks, targeted step-by-step tasks, with more detailed instructions; objective assessment of the results of students mastering PLO; gentle, health-saving, comfortable mode of training and workload; 14
Psychological and pedagogical support of the family with the aim of its active involvement in correctional and developmental work with the child; the presence of an adapted educational program for children with severe speech impairments, which will determine the content and organization of the educational process at each level of general education; inclusion in the educational process in educational institutions of special subjects of a correctional linguistic course (part of specially designed programs that are aimed at overcoming the deficiencies of oral and written speech of students with severe speech impairments; flexible variation of two components - academic and life competence in the learning process by expansion/reduction of the content of individual thematic sections, changes in the number of training hours and the use of appropriate methods and technologies; 15
Implementation of an individual differentiated approach to teaching a child with SSD (taking into account the structure of speech impairment, the child’s speech and communication capabilities, his individual pace of learning and advancement in the educational space, etc.); the need for a concentric approach to the study of educational material, for repeated repetition of the studied material; organization for students with severe speech impairments in general education organizations, patronage of special assistance and support services (PMPC, PMPK, advisory centers, PMS centers, speech therapy centers); creation of a barrier-free environment, including physical and psychological components. Organization of educational work using the resources of the additional education system; constant monitoring of the effectiveness of the academic component of education and the development of students’ life competence. 16
A speech therapist is a specialist who deals with the identification and correction of speech development and communication disorders in children with disabilities. The goal of a speech therapist teacher is to create conditions that facilitate the identification and overcoming of speech development disorders, as well as the further development of oral and written speech, and the improvement of communication among students with disabilities for the successful mastery of the academic component of the educational program. The content of the professional activity of a speech therapist teacher includes diagnostic, correctional and developmental, organizational and methodological, advisory, educational and preventive work. 17
A speech therapist teacher must have fundamental scientific, theoretical and methodological knowledge in the field of speech therapy. It is necessary to take into account new educational trends in the practice of correctional institutions for children with speech disorders. The issue of methodological preparation is acute. 18
The development of modern theoretical and practical speech therapy is impossible without the integration of knowledge from various scientific fields: fundamental (medicine, psychology, pedagogy) and highly specialized (neuropsychology, linguistics, cognitive psychology, psycholinguistics). This is reflected in various approaches to the diagnosis of speech disorders and, as a consequence, the structure and content of speech therapy documentation. 19
Protocol for examining children's speech Individual speech cards Examination journal Long-term and daily plans for speech therapy work Class schedule. Based on these documents, conclusions are drawn about the level of qualifications of the speech therapist. Objective: maximum standardization and unification of speech therapy documentation. 20
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Each manifestation of speech pathology needs a clear and precise formulation. Serious contradictions exist in the assessment and recording of various forms of speech pathology in the form of a speech therapy report. Different ideas about their essence and relationships. Task: standardization and uniformity of the speech therapy report. 24
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Options for speech therapy conclusion Motor alalia (I level of speech development). Phonetic-phonemic underdevelopment of speech in erased dysarthria. General underdevelopment of speech (II level of speech development) with dysarthria. General underdevelopment of speech (III level of speech development) with rhinolalia. Systemic underdevelopment of speech (II level of speech development) in a child with mental retardation. Systemic underdevelopment of speech (I level of speech development) with mental retardation. 26
Disciplines taught
“Early diagnosis of disorders of cognitive, speech and motor development”, “Correctional and developmental work with infants and young children”, “Speech therapy (impaired pronunciation of speech - dysarthria)”, “Differentiated speech therapy massage in the correction of dysarthric speech disorders”, “Speech therapy work with children with motor disorders”, “Comprehensive rehabilitation of children with cerebral motor pathology (cerebral palsy)”.
He holds the title of Honorary Worker of Higher Professional Education of the Russian Federation; Veteran of labour. He has a medal in memory of the 850th anniversary of Moscow and the Order of “Professional of Russia”. Laureate of Moscow Grants in the field of humanities in 2001, 2004, 2005, 2010.
Certificates of honor from the Ministry of Education and Science of Russia and the Department of Education of Moscow, diploma from the Ministry of Education of the Russian Federation.
About MeGraduated from the Moscow State Pedagogical Institute in 1986. IN AND. Lenin, specializing in oligophrenopedagogy.
Full member of the Academy of Medical and Technical Sciences, expert of the State Duma of the Russian Federation on the problems of early assistance and prevention of childhood disabilities, expert of the coordination council of the Moscow mayor's office for the disabled, public expert on the development of preschool educational services for children with disabilities of the Moscow Department of Education, member of the National association of experts on cerebral palsy and related diseases, Association of preschool educational institutions, educational and methodological association in the field of special (defectological) education.
He is a leading specialist in such areas as the system of early assistance for children with developmental disabilities and comprehensive rehabilitation (medical-social and psychological-pedagogical) of children with cerebral palsy; the specifics of social, cognitive, speech and motor development in children of early and preschool age with developmental disabilities ; overcoming speech motor disorders in children with cerebral palsy, development of components of the motor sphere (articulation, fine manual and gross motor skills) in early and preschool children with speech disorders; correction of dysarthria in children with neurological symptoms.
Oksana Georgievna is the author of the unique practical methodology “Differentiated speech therapy massage”, as well as a number of fundamental scientific and educational works on the problems of complex rehabilitation and specialties. education of children with disabilities.
Based on the obtained theoretical, methodological and practical results, she developed and introduced into the educational process a number of original academic disciplines, in which, as part of her scientific and pedagogical activities, she gives original lecture courses.
Since 2011 under the leadership of O.G. Prikhodko and with her direct participation in the Moscow State Pedagogical University, a bachelor’s training program in the profile “Preschool Defectology” was opened, as well as a master’s training program in “Early comprehensive assistance to children with developmental disabilities.”
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