Corrective education of children who have a deviation only from the phonetic side is carried out in the following areas: activation of the activity of the articulatory apparatus (by various methods depending on the state of the birth defect); formation of articulation of sounds; elimination of nasal tone of voice; differentiation of sounds in order to prevent violations of sound analysis; normalization of the prosodic side of speech; automation of acquired skills in free speech communication.
Correctional education of children with phonemic and phonemic underdevelopment includes the above areas, as well as systematic exercises to correct phonemic perception, form morphological generalizations, and overcome dysgraphia.
Correctional education of children with general underdevelopment of speech is aimed at the formation of a full-fledged phonetic side of speech, the development of phonemic representations, mastery of morphological and syntactic generalizations, and the development of coherent speech. All this can be done in a special school for children with severe speech disorders.
In domestic speech therapy, methodological techniques have been developed to eliminate rhinolalia (E. F. Pay, 1933; F. A. Pay, 1933; 3. G. Nelyubova, 1938; V. V. Kukol, 1941; A. G. Ippolitova, 1955, 1963; 3. A. Repina, 1970; I. I. Ermakova, 1984; G. V. Chirkina, 1987; Volosovets T. V. 1995).
The system developed by A. G. Ippolitova is of great importance. This system is highly effective in correcting sound pronunciation in children who do not have deviations in phonemic development. A. G. Ippolitova was one of the first to recommend classes in the preoperative period. Characteristic of her methodology is the combination of breathing and articulation exercises, the sequence of sound processing, due to articulatory interconnectedness.
The sequence of work on sounds is determined by the readiness of the articulatory base of the language. The presence of full-fledged sounds of one group is an arbitrary basis for the formation of the following. So-called "reference" sounds are used.
The preparation of the articulation base of sound is carried out with the help of special articulation gymnastics, which is combined with the development of the child's speech breathing. The peculiarity of the method of A. G. Ippolitova lies in the fact that when evoking a sound, the child's initial attention is directed only to the article.
1. Formation of speech breathing during the differentiation of inhalation and exhalation.
2. Formation of a long oral exhalation when the article implements vowel sounds (without turning on the voice) and fricative unvoiced consonants.
3. Differentiation of short and long oral and nasal expiration during the formation of sonorous sounds and affricates.
4. Formation of soft sounds.
L. I. Vansovskaya (1977) proposed to start eliminating nasalization not with a traditional sound a, a with front vowels and and uh, since it is they that allow you to focus the exhaled stream of air in the anterior part of the oral cavity and direct the tongue to the lower incisors. This enhances the clarity of kinesthesia in contact with the lower incisors; when pronouncing a sound, both the walls of the pharynx and the soft palate participate more actively.
The child is required to pronounce sounds in a low voice, with a slightly protruding jaw, with a half smile, with increased tension in the soft palate and pharyngeal muscles. After eliminating the nasalization of vowels, work is carried out on sonors (l, r), then fricative and stop consonants.
The improvement of methods for correcting speech defects in rhinolalia was influenced by the study by radiography. It made it possible to predict the possibility of restoring the function of the palate with speech therapy techniques (N.I. Serebrova, 1969).
Analysis of radiographs revealed the dependence of the effectiveness of speech therapy on the mobility of the soft palate and the posterior pharyngeal wall; from the distance between the back wall of the pharynx and the soft palate; from the width of the middle part of the pharynx.
Comparison of these data even before the start of speech therapy work makes it possible to resolve the issue of the degree of compensation for a speech defect by generally accepted means.
Methods of differentiated speech therapy work, depending on the anatomical and functional features of the articulatory apparatus, were developed by T. N. Vorontsova (1966).
With regard to adults, the technique of S. L. Taptapova (1963) was developed, which offers a kind of silence mode - the pronunciation of vowels to oneself. This removes grimaces and prepares pronunciation without nasalization. Vocal exercises are recommended.
I. I. Ermakova (1980) developed a step-by-step method for correcting sound pronunciation and voice. She established the age-related features of functional disorders of voice formation in children with congenital clefts and modified orthophonic exercises in relation to them. Special attention is paid to the postoperative period and techniques for developing soft palate mobility are recommended to prevent its shortening after surgical plasty.
Elimination of violations of the sound side of speech is based on careful speech therapy examination of children.
The presence and degree of palatopharyngeal insufficiency, cicatricial changes in the hard and soft palate, its length are established; the nature of contact with the posterior pharyngeal wall (passive, active, functional); dentoalveolar anomalies, peculiarities of motor skills of the articulatory apparatus; the presence of compensatory mimic movements.
The effectiveness of speech therapy work is closely related to the anatomical and functional state of the speech apparatus. Great importance is also attached to the psychophysical state of the child, his behavior and personality as a whole.
The system of corrective work on the development of phonetically correct speech includes the following sections: the development of soft palate movements, the elimination of nasal tint, the production of sounds and the development of phonemic perception.
Sound probe is used for massage with,(see Fig. 8, No. 2), which carefully moves back and forth along the hard palate. When stroking and rubbing the mucous membrane at the border of the hard and soft palate in the transverse direction, a reflex contraction of the muscles of the pharynx and soft palate occurs. Massage is also effective when pronouncing a sound. a- at this time, light pressure is applied to the soft palate. It is useful to produce acupressure and jerky massage with a finger.
The massage should last 1.5-2 minutes, that is, you need to make 40-60 quick rhythmic movements along the palate (2 times a day for 6-12 months, 2 hours before or after meals).
Essential in the postoperative period is the work to activate the soft palate. To do this, use the following exercises.
Gymnastics for the palate.
Swallowing water in small portions, which causes the highest elevation of the soft palate. With subsequent swallowing movements, the time for holding the soft palate in a raised position is lengthened. Children are invited to pour from a small glass or vial. You can drip a few drops of water onto your tongue from a pipette.
Yawning with open mouth; imitation of yawning.
Gargling with warm water in small portions.
Coughing, which causes a vigorous contraction of the muscles of the passavanna roller (at the back of the throat). The Passavan roller can increase up to 4-5 mm and largely compensates for palatopharyngeal insufficiency. When coughing, a complete seal occurs between the nasal and oral cavities. Active movements of the palate and posterior pharyngeal wall can be felt by children (the hand touches the muscles of the neck under the chin and "feels" the rise of the palate).
Voluntary coughing is performed two or three times or more on one exhalation. At this time, the contact of the palate with the back wall of the pharynx is maintained, and the air flow is directed through the oral cavity. At first, it is recommended to cough with your tongue hanging out. Then - coughing with arbitrary pauses, during which the child is required to maintain contact of the palate with the back of the pharynx. Gradually, the child learns to actively lift it and direct the air stream through the mouth.
A clear energetic exaggerated pronunciation of vowels (on a solid attack) is made in a high tone of voice. At the same time, the resonance in the oral cavity increases and the nasal shade decreases.
These exercises give positive results in the preoperative period and after surgery. Their systematic implementation for a long time in the pre-operative period prepares the child for operations and reduces the time for subsequent corrective work.
Work on breathing is necessary for the development of correct sound speech. Children with rhinolalia have a very short wasteful exit through the mouth and nasal passages. To develop a directed oral air stream, the following exercises are used: inhale and exhale through the nose; inhale through the nose, exhale through the mouth; inhale through the mouth, exhale through the nose; inhale and exhale through your mouth.
With the systematic implementation of these exercises, the child begins to feel the difference in the change in phonation and learns to correctly direct the exhaled air. This also contributes to the education of the correct kinesthetic sensations of the movement of the soft palate.
When exercising, it is important to constantly monitor the child, as it is difficult for him to feel the leakage of air through the nasal passages. Various control methods are used: a mirror, cotton wool, a strip of thin paper, etc. is attached to the nasal passages.
The upbringing of the correct air jet is facilitated by exercises with blowing on cotton wool, on a strip of paper, on paper toys, etc.
A more difficult and not always justified exercise is playing children's wind instruments. Such exercises must be alternated with lighter ones, as they cause rapid fatigue.
At the same time, a cycle of exercises is carried out, the main purpose of which is the normalization of speech motor skills. Their daily use eliminates the high rise of the root of the tongue, insufficient lip articulation and increases the mobility of the tip of the tongue. In this regard, the excessive participation of the root of the tongue and larynx in the pronunciation of sounds decreases.
Gymnastics for lips and cheeks.
Puffing out both cheeks at the same time.
Cheek puffing alternately.
Retraction of the cheeks into the oral cavity between the teeth.
Sucking movements - closed lips are pulled forward by the trunk, then returned to their normal position. The jaws are closed.
Grin: lips strongly stretch to the side, up, down, exposing both rows of teeth.
"Proboscis", followed by a grin with clenched jaws.
Grin with opening and closing of the mouth, followed by closing of the lips.
Grin with open mouth, followed by lips covering both rows of teeth (p, b, m).
Pulling out the lips with a wide funnel with open jaws.
Pulling lips with a narrow funnel (imitation of a whistle).
With the jaws wide open, the lips are retracted into the mouth, tightly pressing against the teeth.
Lifting tightly clenched lips up and down with tightly clenched jaws.
Raising the upper lip - the upper teeth are exposed.
Pulling down the lower lip - the lower teeth are exposed.
Imitation of rinsing teeth (air strongly presses on the lips).
Lip vibration.
Movement of the lips with the proboscis to the left and right.
Rotational movements of the lips with the proboscis.
Strong inflation of the cheeks (lips retain air in the oral cavity, intraoral pressure increases).
Holding a pencil or rubber tube with your lips.
Gymnastics for the tongue.
Sticking out the tongue with a shovel, sting.
Alternate protrusion of the tongue flattened and pointed.
Turning a strongly protruding tongue to the right or left.
Raising and lowering the back of the tongue - the tip of the tongue rests on the lower gum, and the root of the tongue then rises up, then falls down.
Suction of the back of the tongue to the palate, first with the jaws closed, and then with the jaws open.
The protruding wide tongue closes with the upper lip, and then is drawn into the mouth, touching the back of the upper teeth and the palate and bending upward at the soft palate.
Suction of the tongue to the upper alveoli with opening and closing of the mouth.
Pushing the tongue between the teeth so that the upper incisors "scrape" the back of the tongue.
Circular licking with the tip of the tongue.
Raising and lowering the widely protruding tongue to the upper and lower lips with the mouth open.
Alternately bending the tip of the tongue with a sting to the nose and chin, upper and lower lips, to the upper and lower teeth, to the hard palate and the bottom of the mouth.
The tip of the tongue touches the upper and lower incisors with a wide open mouth.
Hold the protruding tongue with a groove, a boat, a cup.
Hold the tongue in the shape of a cup inside the mouth.
Biting teeth on the lateral edges of the tongue.
Resting the lateral edges of the tongue against the lateral upper teeth, with a grin, raise and lower the tip of the tongue, touching the upper and lower gums.
With the same position of the tongue, repeatedly drum with the tip of the tongue on the upper alveoli (t-t-t-t).
Make movements one after another - tongue with a sting, a cup, up, etc.
Thus, the movements necessary for the correct pronunciation of sounds are brought up.
Vocal exercises are carried out on vowel sounds. Vowel sounds uh uh uh are put in the first place and then regularly (daily) are included in the exercises. Vowel sounds are first articulated without a voice (silently). This is especially useful for children who have compensatory additional facial movements (retraction at the wings of the nose). These children should daily engage in soundless articulation of vowels in front of a mirror, and then move on to loud pronunciation. The number of repetitions of vowels on one exhalation gradually increases.
For example:
The next stage is the abrupt, clear pronunciation of vowels of two and three sounds in different sequences. In addition to articulatory training, this develops the retention of a sequence of sounds and mastery of the syllabic structure of a word.
For example:
Then the children are required to pronounce vowels with small pauses, during which the high position of the soft palate should be maintained. Pauses gradually increase from one to three seconds.
For example: a-; a--; a - - - etc.
Prolonged continuous pronunciation of vowel sounds: a--e--a--y--and etc.
The education of the correct sound pronunciation is carried out by the usual corrective methods. Specific is the constant control of the direction of the air jet. In difficult cases, temporary clamping of the nasal passages can be used for a more intelligible and sonorous pronunciation of the sound. The order of the sounds is also specific. The first sound produced from consonants f- a dull fricative sound, which is easy to pronounce from exercises related to blowing an air stream through the mouth. The child is required to carry out a long correct exhalation, during which the upper teeth touch the lower lip, a sound is obtained f. Students practice making a sound in isolation (f-, f-), in reverse syllables (af, ef, if) then in direct syllables (fa, fu, afa, afu). To the articulation of sound P students are prepared with cheek puffing exercises that require a good palatopharyngeal closure. Next, the children should make an explosion of the bow of the lips for a sound P. If they fail, then the speech therapist opens the tightly compressed lips of the child, pushes the lower lip down. A sufficient explosion can only be obtained if there is no air leakage through the nasal passages, therefore, in the future, pronouncing a sound P can be used for training exercises to eliminate nasality.
When setting up sound t the attention of the child is mainly fixed on the correctness of the oral exhalation, during which the tip of the tongue is pressed against the upper teeth. All elements of the articulation of sounds must be prepared and automated in advance in articulation exercises and are automatically switched on if there is a sufficiently strong oral air jet.
Sound to presents a certain difficulty for children and is not always obtained by imitation, despite exercises in coughing. Therefore, a mechanical method of setting from sound can be used. t.
speech therapy classes in the preoperative period, they prevent the occurrence of serious pathological changes in the functioning of the speech organs. At the same time, the activity of the soft palate is being prepared; the position of the root of the tongue is normalized; the muscular activity of the lips is enhanced; directed oral exhalation is produced. This creates conditions for more effective results of the operation and subsequent correction.
Early speech therapy impact reduces degenerative changes in the muscles of the pharynx (I. I. Ermakova, 1984).
After the operation (in 15-20 days) many special exercises are repeated. Their main goal in this period is the development of elasticity and mobility of closure. In a significant number of cases, it becomes necessary to “stretch” the soft palate, since it can decrease in length in the postoperative period due to scarring.
To stretch fresh scars, a technique that simulates swallowing is used. At the same time, a massage is also carried out.
In the postoperative period, it is necessary to develop the mobility of the soft palate, eliminate the incorrect structure of the organs of articulation and prepare the pronunciation of all sounds without a nasal tone.
Children with rhinolalia attending a special kindergarten, under the guidance of a speech therapist, master the correct pronunciation of sounds. Classes are held both in a group and individually. In individual classes, special exercises are used to eliminate defects specific to this anomaly.
When drawing up an individual plan, a speech therapist should adhere to the following areas: normalization of the sound side of speech and elimination of lexical and grammatical underdevelopment.
A number of special sections are included:
I. Sounds to be staged, corrected, refined or differentiated. Attention is drawn to the violation of the actual articulation of sounds and the degree of nasalization during their pronunciation.
II. Rhythmic-syllabic structure. Difficulties in pronunciation of sounds in complex positions (such as SSG), as well as in polysyllabic words and at the end of a phrase, are singled out.
III. Phonemic perception and the state of auditory control over one's own speech.
During the first period of study in kindergarten in individual lessons, the pronunciation of vowel sounds is clarified a, uh, oh, uh, s and consonants p, p; f, f; in, in; t, t; setting and initial consolidation of sounds: k, to; x, x; s, s; g, g; l, l; b, b.
In the second period sounds are sounded: and; d, d; h, h; sh; R.
In the third period, the sound is worked out well, affricates and work continues on refining the articulation of previously passed sounds. At the same time, intensive work is underway to eliminate the nasal shade.
A large place is given to the differentiation of oral and nasal sounds: m - p; m - p; n - d; n - t; m - b; m - b.
In a school for children with severe speech disorders, specific defects are eliminated in individual speech therapy sessions.
In the process of corrective work on the normalization of the phonetic side of speech, it is necessary to control the effectiveness of speech therapy exercises.
The criteria proposed by L.I. Vansovskaya make it possible to more clearly dissect the complex speech disorders in rhinolalia and evaluate the corrective effect in two aspects - the elimination of nasalization and articulation defects.
The following speech grades have been established:
1. Normal and close to normal, i.e. sound pronunciation is formed and nasalization is eliminated.
2. Significant improvement in speech - sound pronunciation is formed, there is moderate nasalization.
3. Improving speech - articulation of not all sounds is formed, there is moderate nasalization.
4. Without improvement - articulation of sounds is not formed, hypernasalization persists.
The effectiveness of the correctional impact is greatly influenced by the active participation of parents in the education of normal speech in children with cleft.
Among some factors influencing the results of the correction (the age at which the operation was performed, its quality; the age at which speech therapy training began; the duration of training), the factor of cooperation with the child's family stands out. The speech therapist instructs parents on the methods of correction used and recommends a significant part of the well-developed exercises for systematic use at home.
CLOSED RINOLALIA
Closed rhinolalia It is formed with reduced physiological nasal resonance during the pronunciation of speech sounds. The strongest resonance in the nasal m, m, n, n. During normal pronunciation, the nasopharyngeal valve remains open and air enters directly into the nasal cavity. If there is no nasal resonance for nasal sounds, they sound like mouth sounds. b, b, d, d. In speech, the opposition of sounds on the basis of nasal-non-nasal disappears, which affects its intelligibility. The sound of vowels also changes due to the muffling of individual tones in the nasopharyngeal and nasal cavities. At the same time, vowel sounds acquire an unnatural connotation in speech.
The reason for the closed form is most often organic changes in the nasal space or functional disorders of the palatopharyngeal closure. Organic changes are caused by painful phenomena, as a result of which nasal breathing is difficult.
M. Zeeman distinguishes two kinds closed rhinolalia (rhinophony): front closed- with obstruction of the nasal cavities and back closed- with a decrease in the nasopharyngeal cavity.
Anterior closed rhinolalia observed in chronic hypertrophy of the nasal mucosa, mainly of the posterior inferior turbinates; with polyps in the nasal cavity; with curvature of the nasal septum and with tumors of the nasal cavity.
Posterior closed rhinolaliaat children may be the result of adenoid growths, rarely nasopharyngeal polyps, fibroids or other nasopharyngeal tumors.
Functional closed rhinolalia observed in children often, but not always correctly recognized. It occurs with good patency of the nasal cavity and undisturbed nasal breathing. However, the timbre of nasal and vowel sounds may be more disturbed in this case than with organic forms.
The soft palate during phonation and during the pronunciation of nasal sounds rises strongly and the access of sound waves to the nasopharynx is closed. This phenomenon is more often observed in neurotic disorders in children.
At organic closed rhinolalia First of all, the causes of obstruction of the nasal cavity must be eliminated. As soon as proper nasal breathing occurs, the defect disappears. If, after the elimination of obstruction (for example, after adenotomy), rhinolalia continues to manifest itself, they resort to the same exercises as with functional disorders.
The effectiveness of speech therapy work to eliminate rhinolalia depends on the state of the nasopharynx, the function of the uvula, and the age of the child. An important factor is the ability of the child to distinguish the nasal timbre of the voice from the normal one. At the initial stage of classes, breathing exercises are recommended, the purpose of which is to differentiate between nasal and oral inhalation and exhalation. This is achieved first by blowing exercises, and then by alternating short and long nasal exhalation. At the same time, the muscles of the soft palate and the posterior pharyngeal wall are activated. The next step is to work on the differentiation of oral and nasal exhalations. This prepares the possibility of staging and automating nasal sounds: labial occlusive m and anterior lingual stop to.
Children are taught to draw out exaggerated pronunciation so that a strong vibration is felt on the wings and the base of the nose. In the same way, vowels are exercised before nasal sounds. (am, om, mind, an). When pronouncing these sounds and syllables, the soft palate is passive, the speech therapist controls the movement of the lips (with m) or tongue (with k) due to nasal exhalation. After that, nasal sounds are fixed in words. They must be pronounced intensely and lingeringly, with a strong nasal resonance. To correct the defect, school-age children can insert a thin rubber tube into the nasal passage, its other end into the external auditory canal, so that the child “hears with his nose” and controls the vocal vibrations during the formation of nasal sounds. The final stage is work on the sonority of vowel sounds and on the opposition of sounds on the basis of nasality-non-nasality (n., b- m; d- n).
MIXED RINOLALIA
Some authors (M. Zeeman, A. Mitronovich-Modrzeevska) distinguish mixed rhinolalia - a speech condition characterized by reduced nasal resonance when pronouncing nasal sounds and the presence of a nasal timbre (nasalized voice). The reason is a combination of nasal obstruction and insufficiency of the palatopharyngeal contact of functional and organic origin.
The most typical are combinations of a shortened soft palate, its submucosal splitting and adenoid growths, which in such cases serve as an obstacle to air leakage through the nasal passages during the pronunciation of oral sounds.
The state of speech may worsen after adenotomy, as palatopharyngeal insufficiency occurs and signs of open rhinolalia appear. In this regard, a speech therapist should carefully examine the structure and function of the soft palate, determine which form of rhinolalia (open or closed) disrupts the timbre of speech more, discuss with the doctor the need to eliminate nasal obstruction and warn parents about the possibility of worsening the timbre of the voice. After the operation, correction techniques developed for open rhinolalia are used.
Conclusions and problems
Elimination of pathological nasalization of the voice in rhinolalia, despite the variety of techniques used, is a known difficulty. It is determined primarily by the severity of the defect and the nature of the surgical intervention, which does not always achieve a good anatomical and functional effect. Restoration of timbre is complicated by the fact that with congenital clefts of the hard and soft palate, the mechanism of voice formation suffers, since the innervation of the soft palate affects the function of the vocal folds. Corrective work requires an impact on the entire system of voice and speech production. Pathophysiological studies that reveal the features of breathing, phonation and articulation in this contingent expand the understanding of the structure of the defect and allow you to choose more reasonable and targeted methods of speech therapy. Particularly important are early preventive and complex corrective measures that can reduce the development of the defect and contribute to the speedy social rehabilitation of people with congenital anomalies of the palate.
Control questions and tasks
1. Describe the main forms of rhinolalia in children.
2. What is the effect of congenital cleft palate on the child's speech development?
3. What are the specifics of oral and written speech disorders in school-age children with rhinolalia?
4. Describe the techniques for correcting the sound side of speech in children with rhinolalia.
5. When visiting special preschool and school institutions, pay attention to children with rhinolalia. Compare them with children with dysarthria and alalia.
Literature
1. Ermakova I. I. Correction of speech in rhinolalia in children and adolescents. - M., 1984.
2. Ippolitova A. G. Open rhinolalia. - M., 1983.
3. Reader on speech therapy / Ed. - L. S. Volkova, V. I. Seliverstov. M., 1997. - Part I. - S. 120-162
4. Chirkina GV Children with disorders of the articulatory apparatus. - M., 1969.
CHAPTER 8. DYSARTRIA
Dysarthria - violation of the pronunciation side of speech, due to insufficient innervation of the speech apparatus.
The leading defect in dysarthria is a violation of the sound-producing and prosodic side of speech, associated with an organic lesion of the central and peripheral nervous systems.
Dysarthria - a Latin term, translated means a disorder of articulate speech - pronunciation (dis- violation of a sign or function, artron- articulation). When defining dysarthria, most authors do not proceed from the exact meaning of this term, but interpret it more broadly, referring to dysarthria disorders of articulation, voice formation, tempo, rhythm and intonation of speech.
Violations of sound pronunciation in dysarthria manifest themselves to varying degrees and depend on the nature and severity of the damage to the nervous system. In mild cases, there are separate distortions of sounds, "blurred speech", in more severe cases, distortions, substitutions and omissions of sounds are observed, the tempo, expressiveness, modulation suffer, in general, the pronunciation becomes slurred.
With severe lesions of the central nervous system, speech becomes impossible due to complete paralysis of the speech motor muscles. Such violations are called anartria(a- the absence of a given feature or function, artron- articulation).
Dysarthric speech disorders are observed in various organic lesions of the brain, which in adults have a more pronounced focal character. In children, the frequency of dysarthria is primarily associated with the frequency of perinatal pathology (damage to the nervous system of the fetus and newborn). Most often, dysarthria is observed in cerebral palsy, according to various authors, from 65 to 85% (M. B. Eidinova and E. N. Pravdina-Vinarskaya, 1959; E. M. Mastyukova, 1969, 1971). There is a relationship between the severity and nature of the lesion of the motor sphere, the frequency and severity of dysarthria. In the most severe forms of cerebral palsy, when there is damage to the upper and lower extremities and the child practically remains immobilized (double hemiplegia), dysarthria (anarthria) are observed in almost all children. The relationship between the severity of damage to the upper limbs and damage to the speech muscles was noted (E. M. Mastyukova, 1971, 1977).
Less pronounced forms of dysarthria can be observed in children without obvious movement disorders, who have undergone mild asphyxia or birth trauma, or who have a history of other mild adverse effects during fetal development or during childbirth. In these cases, mild (erased) forms of dysarthria are combined with other signs of minimal cerebral dysfunction (L. T. Zhurba and E. M. Mastyukova, 1980).
Often, dysarthria is also observed in the clinic of complicated oligophrenia, but data on its frequency are extremely contradictory.
The clinical picture of dysarthria was first described more than a hundred years ago in adults as part of the pseudobulbar syndrome (Lepine, 1977; A. Oppenheim, 1885; G. Pezitz, 1902, etc.).
Later, in 1911, N. Gutzmann defined dysarthria as a violation of articulation and identified two of its forms: central and peripheral.
The initial study of this problem was carried out mainly by neuropathologists in the framework of focal brain lesions in adult patients. A great influence on the modern understanding of dysarthria was exerted by the work of M. S. Margulis (1926), who for the first time clearly distinguished dysarthria from motor aphasia and divided it into boulevard and cerebral forms. The author proposed a classification of cerebral forms of dysarthria based on the localization of the brain lesion, which was later reflected in the neurological literature, and then in speech therapy textbooks (OV Pravdina, 1969).
An important stage in the development of the problem of dysarthria is the study of local diagnostic manifestations of dysarthria disorders (works by L. B. Litvak, 1959 and E. N. Vinarskaya, 1973). E. N. Vinarskaya was first carried out complex neurolinguistic study of dysarthria with focal lesions of the brain in adult patients.
Currently, the problem of childhood dysarthria is being intensively developed in clinical, neurolinguistic, psychological and pedagogical directions. It is described in most detail in children with cerebral palsy (M. B. Eidinova, E. N. Pravdina-Vinarskaya, 1959; K. A. Semenova, 1968; E. M. Mastyukova, 1969, 1971, 1979, 1983; I. I. Panchenko, 1979; L. A. Danilova, 1975, etc.). In foreign literature, it is represented by the works of G. Bohme, 1966; M. Climent, T. E. Twitchell, 1959; R. D. Neilson, N. O. Dwer, 1984.
The pathogenesis of dysarthria is determined by an organic lesion of the central and peripheral nervous system under the influence of various unfavorable external (exogenous) factors affecting the prenatal period of development, at the time of childbirth and after birth. Among the causes, important are asphyxia and birth trauma, damage to the nervous system during hemolytic disease, infectious diseases of the nervous system, craniocerebral injuries, less often - cerebrovascular accidents, brain tumors, malformations of the nervous system, for example, congenital aplasia of the nuclei of the cranial nerves. (Mobius syndrome), as well as hereditary diseases of the nervous and neuromuscular systems.
Clinical and physiological aspects of dysarthria are determined by the location and severity of brain damage. The anatomical and functional relationship in the location and development of motor and speech zones and pathways determines the frequent combination of dysarthria with motor disorders of various nature and severity.
Violations of sound pronunciation in dysarthria occur as a result of damage to various brain structures necessary for controlling driving mechanism speech. These structures include:
Peripheral motor nerves to the muscles of the speech apparatus (tongue, lips, cheeks, palate, lower jaw, pharynx, larynx, diaphragm, chest);
The nuclei of these peripheral motor nerves located in the brainstem;
Nuclei located in the trunk and in the subcortical regions of the brain and carrying out elementary emotional unconditioned reflex speech reactions such as crying, laughter, screaming, individual emotionally expressive exclamations, etc.
The defeat of these structures gives a picture of peripheral paralysis (paresis): nerve impulses do not reach the speech muscles, metabolic processes in them are disturbed, the muscles become lethargic, flabby, their atrophy and atony are observed, as a result of a break in the spinal reflex arc, the reflexes from these muscles disappear, sets in. areflexia.
The motor mechanism of speech is also provided by the following higher brain structures:
Subcortical-cerebellar nuclei and pathways that regulate muscle tone and the sequence of muscle contractions of the speech muscles, synchrony (coordination) in the work of the articulatory, respiratory and vocal apparatus, as well as the emotional expressiveness of speech. When these structures are affected, individual manifestations of central paralysis (paresis) are observed with impaired muscle tone, increased individual unconditioned reflexes, as well as with a pronounced violation of the prosodic characteristics of speech - its tempo, smoothness, loudness, emotional expressiveness and individual timbre;
Conducting systems that ensure the conduction of impulses from the cerebral cortex to the structures of the underlying functional levels of the motor apparatus of speech (to the nuclei of the cranial nerves located in the brain stem). The defeat of these structures causes central paresis (paralysis) of the speech muscles with an increase in muscle tone in the muscles of the speech apparatus, an increase in unconditioned reflexes and the appearance of reflexes of oral automatism with a more selective nature of articulatory disorders;
Cortical parts of the brain, providing both a more differentiated innervation of the speech muscles, and the formation of speech praxis. With the defeat of these structures, various central motor speech disorders occur.
Pathological changes in dysarthria are described by many authors (R. Thurell, 1929; V. Slonimskaya, 1935; L. N. Shendrovich, 1938; A. Oppenheim, 1885, etc.).
A feature of dysarthria in children is often its mixed nature with a combination of various clinical syndromes. This is due to the fact that when a harmful factor affects the developing brain, damage is often more widespread, and the fact that damage to some brain structures necessary to control the motor mechanism of speech can delay maturation and disrupt the functioning of others. This factor determines the frequent combination of dysarthria in children with other speech disorders (delayed speech development, general underdevelopment of speech, motor alalia, stuttering). In children, the defeat of individual links of the speech functional system during the period of intensive development can lead to complex disintegration of the entire speech development as a whole. In this process, the defeat of not only the actual motor link is of certain importance. speech system, but also violations of the kinesthetic perception of articulatory postures and movements.
The role of speech kinesthesia in the development of speech and thinking was first shown by I. M. Sechenov and further developed in the studies of I. P. Pavlov, A. A. Ukhtomsky, V. M. Bekhterev, M. M. Koltsova, A. N. Sokolov and other authors. N. I. Zhinkin (1958) noted the great role of kinesthetic sensations in the development of speech: “The control of the speech organs will never improve if they themselves do not report to the control center what they do when an erroneous sound that is not accepted by the ear is reproduced ... Thus, kinesthesia is nothing but feedback, by which the central control is aware of what has been carried out of those orders that are sent for execution ... The absence of feedback would stop any possibility of accumulating experience for controlling movement speech organs. Man could not learn speech. Strengthening feedback (kinesthesia) speeds up and facilitates the learning of speech.
The kinesthetic sense accompanies the work of all speech muscles. Thus, various differentiated muscle sensations arise in the oral cavity, depending on the degree of muscle tension during the movement of the tongue, lips, and lower jaw. The directions of these movements and various articulation patterns are felt when pronouncing certain sounds.
With dysarthria, the clarity of kinesthetic sensations is often impaired and the child does not perceive the state of tension, or, conversely, the relaxation of the muscles of the speech apparatus, violent involuntary movements, or incorrect articulation patterns. Reverse kinesthetic afferentation is the most important link in an integral speech functional system that ensures postnatal maturation of cortical speech zones. Therefore, a violation of reverse kinesthetic afferentation in children with dysarthria can delay and disrupt the formation of cortical brain structures: the premotor-frontal and parietal-temporal areas of the cortex - and slow down the process of integration in the work of various functional systems directly related to the speech function. Such an example may be the insufficient development of the relationship between auditory and kinesthetic perception in children with dysarthria.
A similar lack of integration can be noted in the work of the motor-kinesthetic, auditory and visual systems.
CLINICAL AND PSYCHOLOGICAL CHARACTERISTICS OF CHILDREN WITH DYSARTRIA
Children with dysarthria in their clinical and psychological characteristics represent an extremely heterogeneous group. At the same time, there is no relationship between the severity of the defect and the severity of psychopathological abnormalities. Dysarthria, including its most severe forms, can be observed in children with intact intelligence, and mild "erased" manifestations can be both in children with intact intelligence and in children with oligophrenia.
Children with dysarthria according to clinical and psychological characteristics can be conditionally divided into several groups depending on their general psychophysical development:
Dysarthria in children with normal psychophysical development;
Dysarthria in children with cerebral palsy (the clinical and psychological characteristics of these children are described within the framework of cerebral palsy by many authors: E. M. Mastyukova, 1973, 1976; M. V. Ippolitova and E. M. Mastyukova, 1975; N. V. Simonova, 1967, etc.);
Dysarthria in children with oligophrenia (clinical and psychological characteristics correspond to children with oligophrenia: G. E. Sukhareva, 1965; M. S. Pevzner, 1966);
Dysarthria in children with hydrocephalus (clinical and psychological characteristics correspond to children with hydrocephalus: M. S. Pevzner, 1973; M. S. Pevzner, L. I. Rostyagailova, E. M. Mastyukova, 1983);
Dysarthria in delayed children mental development(M. S. Pevzner, 1972; K. S. Lebedinskaya, 1982; V. I. Lubovsky, 1972, etc.);
Dysarthria in children with minimal brain dysfunction. This form of dysarthria is most common among children of special preschool and school institutions. Along with the insufficiency of the sound-producing side of speech, they usually have mildly pronounced disturbances in attention, memory, intellectual activity, the emotional-volitional sphere, mild motor disorders and delayed formation of a number of higher cortical functions.
Movement disorders usually present with more later dates the formation of motor functions, especially such as the development of the ability to sit down independently, crawl with alternate simultaneous extension of the arm and the opposite leg and with a slight turn of the head and eyes towards the forward arm, walk, grab objects with the fingertips and manipulate them.
Emotional-volitional disorders are manifested in the form of increased emotional excitability and exhaustion of the nervous system. In the first year of life, such children are restless, cry a lot, require constant attention. They have sleep disturbances, appetite, predisposition to regurgitation and vomiting, diathesis, gastrointestinal disorders. They do not adapt well to changing weather conditions.
in preschool and school age they are motor restless, prone to irritability, mood swings, fussiness, often show rudeness, disobedience. Motor restlessness increases with fatigue, some are prone to reactions of the hysteroid type: they throw themselves on the floor and scream, achieving what they want.
Others are timid, inhibited in a new environment, avoid difficulties, and do not adapt well to a change in the situation.
Despite the fact that children do not have pronounced paralysis and paresis, their motor skills are characterized by general awkwardness, lack of coordination, they are awkward in self-service skills, they lag behind their peers in dexterity and accuracy of movements, they have a delay in developing hand readiness for writing, therefore, for a long time there is no interest in drawing and other types of manual activities, poor handwriting is noted at school age. Disorders of intellectual activity are expressed in the form of low mental performance, memory and attention disorders.
Many children are characterized by a slow formation of spatio-temporal representations, optical-spatial gnosis, phonemic analysis, and constructive praxis. The clinical and mental characteristics of these children are described in the literature (E. M. Mastyukova, 1977; L. O. Badalyan, L. T. Zhurba, E. M. Mastyukova, 1978; L. T. Zhurba, E. M. Mastyukova, 1980, 1985).
PSYCHOLINGUISTIC ASPECTS OF DYSARTRIA
Determining the structure of a defect in dysarthria at the current level of development of science is impossible without the involvement of psycholinguistics data on the process of speech generation. With dysarthria, the implementation of the motor program is disrupted due to the unformed operations of the external design of the utterance: voice, tempo-rhythmic, articulatory-phonetic and prosodic disorders. In recent years, the attention of many linguists has been drawn to prosodic means of utterance (arranging pauses, highlighting individual elements of the utterance with an accent, including the necessary intonation) in the aspect of studying the relationship between semantics and syntax. In dysarthria, prosodic disturbances can cause peculiar semantic disturbances and impede communication.
The difficulty of a detailed statement in dysarthria can be due not only to purely motor difficulties, but also to violations of language operations at the level of processes associated with choice. the right word. Violations of speech kinesthesia can lead to insufficient reinforcement of words, and at the moment of speech utterance, the maximum probability of popping up exactly the right word is violated. The child experiences severe difficulties in finding the right word. This is manifested in the difficulties of introducing a lexical unit into the system of syntagmatic connections and paradigmatic relations.
In dysarthria, due to general disorders of brain activity, specific difficulties may arise in isolating significant and inhibiting side connections, which leads to insufficient formation of a general utterance scheme, which are aggravated by insufficient selection of the necessary lexical units.
With dysarthria, combined with a more local lesion (or dysfunction) of the parietal-occipital regions of the left hemisphere, there is an insufficient formation of simultaneous spatial syntheses, which makes it difficult to form complex logical-grammatical relationships. This is manifested in the difficulties in the formation of the utterance and its decoding.
CLASSIFICATION OF DYSARTRIA
It is based on the principle of localization, syndromological approach, the degree of intelligibility of speech for others. The most common classification in Russian speech therapy was created taking into account the neurological approach based on the level of localization of the lesion of the motor apparatus of speech (O. V. Pravdiva et al.).
There are the following forms of dysarthria: bulbar, pseudobulbar, extrapyramidal (or subcortical), cerebellar, cortical.
The most complex and controversial in this classification is cortical dysarthria. Its existence is not recognized by all authors. In adult patients, in some cases, cortical dysarthria is sometimes mixed with the manifestation of motor aphasia. The controversial issue of cortical dysarthria is largely associated with terminological inaccuracies and the lack of one point of view on the mechanisms motor alalia and aphasia.
According to the point of view of E. N. Vinarskaya (1973), the concept of cortical dysarthria is collective. The author admits the existence of its various forms, due to both spastic paresis of the articulatory muscles and apraxia. The latter forms are referred to as apraxic dysarthria.
Based on the syndromological approach, the following forms of dysarthria are distinguished in relation to children with cerebral palsy: spastic-paretic, spastic-rigid, spastic-hyperkinetic, spastic-atactic, atactico-hyperkinetic (I. I. Panchenko, 1979).
This approach is partly due to the more common brain damage in children with cerebral palsy and, in connection with this, the prevalence of complicated forms of it.
Syndromic assessment of the nature of articulatory motility disorders is a significant difficulty for neurological diagnosis, especially when these disorders appear without clear movement disorders. Since this classification is based on a subtle differentiation of various neurological syndromes, it cannot be carried out by a speech therapist. In addition, a child, in particular a child with cerebral palsy, is characterized by a change in neurological syndromes under the influence of therapy and evolutionary dynamics of development, and therefore the classification of dysarthria according to the syndromological principle also presents certain difficulties.
However, in some cases, with a close relationship between the work of a speech therapist and a neuropathologist, it may be appropriate to combine both approaches to identifying various forms of dysarthria. For example: a complicated form of pseudobulbar dysarthria; spastic-hyperkinetic or spastic-atactic syndrome, etc.
The classification of dysarthria according to the degree of intelligibility of speech for others was proposed by a French neurologist. G. Tardier (1968) in relation to children with cerebral palsy. The author distinguishes four degrees of severity of speech disorders in such children.
The first, easiest degree, when sound pronunciation disorders are detected only by a specialist in the process of examining a child.
The second - violations of pronunciation are noticeable to everyone, but speech is understandable to others.
The third is that speech is understandable only to those close to the child and partially to those around him.
Fourth, the most difficult - the lack of speech or speech is almost incomprehensible even to the relatives of the child (anartria).
Under Anarthria refers to the complete or partial inability to pronounce sound as a result of paralysis of the speech motor muscles. According to the severity of the manifestations of anartria, it can be different: severe - complete absence of speech and voice; moderate - the presence of only voice reactions; light - the presence of sound-syllabic activity (I. I. Panchenko, 1979).
Symptoms. The main signs (symptoms) of dysarthria are defects in sound pronunciation and voice, combined with speech disorders, especially articulation, motor skills and speech breathing. With dysarthria, unlike dyslalia, the pronunciation of both consonants and vowels can be disturbed. Vowel disorders are classified according to rows and rises, consonant disorders - according to their four main features: the presence and absence of vibration of the vocal folds, the method and place of articulation, the presence or absence of an additional rise of the back of the tongue to the hard palate.
Depending on the type of disturbance, all defects in sound pronunciation in dysarthria are divided into: a) anthropophonic (sound distortion) and b) phonological (lack of sound, replacement, undifferentiated pronunciation, mixing). With phonological defects, there is an insufficiency of oppositions of sounds according to their acoustic and articulatory characteristics. Therefore, the most common violations of written speech.
For all forms of dysarthria, articulatory motility disorders are characteristic, which manifest themselves in a number of ways. Violations of muscle tone, the nature of which depends primarily on the localization of brain damage. The following forms are distinguished in the articulatory muscles: spasticity of the articulatory muscles - a constant increase in tone in the muscles of the tongue, lips, in the facial and cervical muscles. An increase in muscle tone may be more localized and extend only to individual muscles of the tongue.
With a pronounced increase in muscle tone, the tongue is tense, pulled back, its back is curved, raised up, the tip of the tongue is not expressed. The tense back of the tongue, raised to the hard palate, helps soften consonant sounds. Therefore, a feature of articulation with spasticity of the muscles of the tongue is palatalization, which can contribute to phonemic underdevelopment. So, pronouncing the same words ardor and dust, they say and moth, the child may find it difficult to differentiate their meanings.
An increase in muscle tone in the circular muscle of the mouth leads to spastic tension of the lips, tight closure of the mouth. Active movements are limited. The impossibility or limitation of the forward movement of the tongue may be due to spasticity of the geniolingual, maxillohyoid, and digastric muscles, as well as the muscles attached to the hyoid bone.
All muscles of the tongue are innervated by the hypoglossal nerves, with the exception of the lingual-palatine muscles, which are innervated by the glossopharyngeal nerves.
An increase in muscle tone in the muscles of the face and neck further limits voluntary movements in the articulatory apparatus.
The next type of muscle tone disorder is hypotension. With hypotension, the tongue is thin, flattened in the oral cavity, the lips are flaccid, there is no possibility of their complete closure. Because of this, the mouth is usually half open, pronounced hypersalivation.
A feature of articulation in hypotension is nasalization, when the hypotension of the muscles of the soft palate prevents sufficient movement of the palatine curtain up and pressing it against the back wall of the pharynx. The jet of air comes out through the nose, and the jet of air coming out through the mouth is extremely weak. The pronunciation of labial-labial stop noisy consonants is disturbed p, p, b, b. Palatalization is difficult, and therefore the pronunciation of deaf stop consonants is disturbed, in addition, when forming deaf stop consonants, more energetic work of the lips is necessary, which is also absent in hypotension. It is easier to pronounce labial-labial occlusive nasal sonatas m, m, a also labio-dental fricative noisy consonants, the articulation of which requires loose closure of the lower lip with the upper teeth and the formation of a flat gap, f, f, v, v.
The pronunciation of the anterior lingual stop noisy consonants is also disturbed t, t, d, d; distorted articulation of anterior lingual fricative consonants w, w.
Often there are various types of sigmatism, especially often interdental and lateral.
Violations of muscle tone in the articulatory muscles with dysarthria can also manifest themselves in the form of dystonia (changing the nature of muscle tone): at rest, there is a low muscle tone in the articulatory apparatus, while trying to speak, the tone increases sharply. characteristic feature of these violations is their dynamism, inconstancy of distortions, substitutions and omissions of sounds.
Disturbance of articulatory motility in dysarthria is the result of limited mobility of the articulatory muscles, which is aggravated by impaired muscle tone, the presence of involuntary movements (hyperkinesis, tremor) and discoordination disorders.
With insufficient mobility of the articulatory muscles, sound pronunciation is disturbed. With damage to the muscles of the lips, the pronunciation of both vowels and consonants suffers. The pronunciation of labialized sounds is especially disturbed (oh, y), when they are pronounced, active movements of the lips are required: rounding, stretching. Pronunciation of labial-labial occlusive sounds is disturbed p, p, b, b, m, m. The child finds it difficult to stretch the lips forward, round them, stretch the corners of the mouth to the sides, raise the upper lip and lower the lower one and perform a number of other movements. Restriction of lip mobility often disrupts articulation as a whole, as these movements change the size and shape of the vestibule of the mouth, thereby affecting the resonance of the entire oral cavity.
There may be limited mobility of the muscles of the tongue, insufficiency of lifting the tip of the tongue up in the oral cavity. Usually this is due to a violation of the innervation of the stylolingual and some other muscles. In these cases, the pronunciation of most sounds suffers.
Restriction of the downward movement of the tongue is associated with a violation of the innervation of the clavicular-hyoid, thyroid-hyoid, maxillo-hyoid, genio-lingual and digastric muscles. This can disrupt the pronunciation of hissing and whistling sounds, as well as front vowels (i, e) and some other sounds.
Restriction of the backward movement of the tongue may depend on disorders of the innervation of the hyoid-pharyngeal, scapular-hyoid, awl-hyoid, digastric (posterior abdomen) and some other muscles. This disrupts the articulation of posterior lingual sounds. (g, k, x), as well as some vowels, especially middle and low rise (e, o a).
With paresis of the muscles of the tongue, violations of their muscle tone, it is often impossible to change the configuration of the tongue, its lengthening, shortening, extension, pulling back.
Violations of sound pronunciation are aggravated by the limited mobility of the muscles of the soft palate (stretching and raising it: palatopharyngeal and palatoglossal muscles). With paresis of these muscles, the rise of the palatine curtain at the time of speech is difficult, air leaks through the nose, the voice acquires a nasal tone, the timbre of speech is distorted, and the noise signs of speech sounds are not sufficiently pronounced. The innervation of the muscles of the soft palate is carried out by branches of the trigeminal, facial and vagus nerves.
Paresis of the muscles of the facial muscles, often observed in dysarthria, also affects the sound pronunciation. Paresis of the temporal muscles, masticatory muscles limit the movements of the lower jaw, as a result of which the modulation of the voice and its timbre are disturbed. These disorders become especially pronounced if there is an incorrect position of the tongue in the oral cavity, insufficient mobility of the palatine curtain, impaired muscle tone of the floor of the mouth, tongue, lips, soft palate, and posterior pharyngeal wall.
Discoordination disorders are a characteristic sign of articulatory motility disorders in dysarthria. They manifest themselves in violation of the accuracy and proportionality of articulatory movements. The performance of fine differentiated movements is especially impaired. So, in the absence of pronounced paresis in the articulatory muscles, voluntary movements are performed inaccurately and disproportionately, often with hypermetry (excessive motor amplitude). For example, a child may move the tongue up, touching it almost to the tip of the nose, and at the same time cannot place the tongue above the upper lip in the place exactly indicated by the speech therapist. These disorders are usually combined with difficulties in alternating movements, for example, a proboscis - a grin, etc., as well as with difficulties in maintaining certain articulatory positions due to the appearance of violent movements - tremors (fine trembling of the tip of the tongue).
With discoordination disorders, the sound pronunciation is no longer at the level of the pronunciation of isolated sounds, but when pronouncing automated sounds in syllables, words and sentences. This is due to the delay in the inclusion of some articulatory movements necessary to pronounce individual sounds and syllables. Speech becomes slow and scanned.
An essential link in the structure of articulatory motility disorders in dysarthria is the pathology of reciprocal innervation.
Its role in the implementation of voluntary movements was first experimentally shown by Sherington (1923, 1935) on animals. It was found that in voluntary movement, along with the excitation of nerve centers, leading to muscle contraction, an important role is played by inhibition, which occurs as a result of induction and reduces the excitability of the centers that control a group of antagonist muscles - muscles that perform the opposite function.
In many muscles of the tongue, along with the fibers that perform the main movement, there are antagonistic groups, the joint work of both ensures the accuracy and differentiation of movements necessary for normal sound pronunciation. So, in order to protrude the tongue from the oral cavity and especially to raise the tip of the tongue up, the lower bundles of the geniolingual muscle should be reduced, but its fibers, pulling the tongue back and down, should be relaxed. If this selective innervation does not occur, then the performance of this movement and the sound pronunciation of a number of front-lingual sounds are disturbed.
When moving the tongue backwards and downwards, the lower bundles of this muscle should be relaxed. The middle bundles of the geniolingual muscle are antagonists of the fibers of the superior longitudinal muscle, which arches the back of the tongue upward.
In the downward movement of the tongue, the hyoidoglossus muscle is the antagonist of the stylolingual muscle, but in the backward movement of the tongue, both muscles work synchronously, as agonists. Lateral movements of the tongue in one direction occur only when the paired muscles of the other side are relaxed. For symmetrical movements of the tongue along the midline in all directions (forward, backward, up, down), the muscles of the right and left sides must work as agonists, otherwise the tongue will deviate to the side.
Changing the configuration of the tongue, for example, its narrowing, requires the contraction of the fibers of the transverse muscles of the tongue while relaxing the fibers of the vertical muscles and the bundles of the hyoid-lingual and stylo-lingual muscles involved in the thickening and expansion of the tongue.
The presence of violent movements and oral synkinesis in the articulatory muscles is a common symptom of dysarthria. They distort sound pronunciation, making speech obscure, and in severe cases, almost impossible; usually aggravated by excitement, emotional stress Therefore, violations of sound pronunciation are different depending on the situation of speech communication. At the same time, twitching of the tongue, lips, sometimes in combination with facial grimaces, slight trembling (tremor) of the tongue, in severe cases, involuntary opening of the mouth, throwing the tongue forward, and a forced smile are noted. Violent movements are observed both at rest and in static articulatory positions, for example, when holding the tongue along the midline, intensifying with voluntary movements or attempts to them. In this they differ from synkinesis - involuntary accompanying movements that occur only with voluntary movements, for example, when the tongue moves up, the muscles that raise the lower jaw often contract, and sometimes the entire cervical muscles tense up and the child performs this movement simultaneously by extending the head. Synkinesis can be observed not only in the speech muscles, but also in the skeletal, especially in those parts of it that are anatomically and functionally most closely related to the speech function. When moving the tongue in children with dysarthria, there are often accompanying movements of the fingers of the right hand (especially often the thumb).
A characteristic feature of dysarthria is a violation of proprioceptive afferent impulses from the muscles of the articulatory apparatus. Children weakly feel the position of the tongue, lips, the direction of their movements, they find it difficult to imitate and maintain the articulatory pattern, which delays the development of articulatory praxis.
There is a wide variety corrective methods based on various psychological concepts, the views of their authors on the nature of the human psyche.
The method of classical psychoanalysis proceeds from the fact that all mental illnesses are caused by conflicts that have occurred with the individual as early as childhood. The essence of such conflicts is in the internal struggle between "possible and impossible", between conscious and unconscious needs and motives of human behavior. Information about such conflicts is stored in the subconscious of an adult and in certain situations imperceptibly controls the individual. The goal of psychoanalysis is the opening and conscious (mental) processing of such conflicts, the establishment of an equilibrium ʼʼʼʼʼ between the consciousness and the unconscious of the personality psyche.
The technique of psychoanalysis requires that the patient be in the supine position, and the psychotherapist - in a place inaccessible to the patient's view (for example, behind the headboard). This allows the patient to feel a little more relaxed, which is very important for the successful conduct of psychoanalysis sessions. At the same time, the patient must involuntarily, without long pauses and stops, say what comes to his mind, without fear of absurd things. The role of the psychologist consists in a discreet interpretation of individual destructive scenes from distant childhood reported by the patient. The goal is to reconstruct the history of his personality. In other words, the patient is transported back in time to childhood, repeats the feelings that he then experienced, and gets the opportunity to process them ʼʼcorrectlyʼʼ. There is a liberation of the subconscious from the centers of constant mental pressure on everyday behavior.
The method of confrontational (behavioral) psychotherapy provides for the organization of training meetings of the patient with those destructive situations that usually cause him mental imbalance. This is the principle that in an everyday situation is called ʼʼknock out with a wedgeʼʼ. If, for example, a person experiences constant fear when crossing a bridge over a river, then the psychologist helpfully provides him with the opportunity to experience this feeling until it loses its sharpness. Such sessions can both be realized in real conditions and be of an imaginary nature.
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At the same time, the psychologist at first should always be with the patient. The technology of the method provides for taking into account the personality of the patient when prescribing a training program.
The method of hypnotic influences involves the creation of a state of shallow trance in the patient, i.e., a state of great concentration and keeping his attention on some object. As a result, consciousness changes orientation from the perception of the external world to the perception of the internal. Such an altered state of consciousness is caused by the appearance of a focus of excitation in the cerebral cortex. The resulting dominant subjugates all neighboring areas of the cortex, gradually turning off the senses. A person ʼʼgoes into himselfʼʼ through the field of narrowing attention.
The further role of the hypnotist is to help the patient, as it were, to see his problems from the outside, but in a new, safe light. Contrary to the existing worldly opinion, a state of trance does not mean a loss of control over oneself. Trance makes available deeper layers of consciousness without losing control of oneself.
If a person applies the technique of fixing attention to himself, then this process is called meditation.
Leading hypnologists of the world (V. Kandyba, G. Estabruk) claim that such a deep trance is possible, when a person can be programmed for any act. Such a ʼʼman-zombieʼʼ can, at the right time, in an appropriate situation, on a certain signal, do what he is programmed to do. In a normal situation, he does not betray his ʼʼcodedʼʼ in any way, he does not stand out among other people, his work colleagues. The action of the ʼʼcodeʼʼ lasts for years and should only be removed by the person who coded it.
It is known that interrogation under hypnosis in investigative work allows obtaining 70-80% of additional information. It should be borne in mind that there is also criminal hypnosis aimed at suggesting to a person any deceptive version.
Auto training method. Here the patient himself influences the state of his own nervous system through the effects of self-hypnosis. Humanity owes the appearance of this method of mental unloading not only to its author, the psychotherapist I. Schultz. A collective patent can be issued to the better half of humanity - women. Patients of I. Schulz, having learned his techniques, possessing increased natural autosuggestibility, began to successfully engage in self-hypnosis. This prompted him to think about developing a special training system. Indeed, if it is proved that a suggested illness is possible, then why is a suggested recovery impossible?!
The power of self-hypnosis is enormous. Here is the story of the famous psychologist V. Levy. A criminal sentenced to death by electric chair was announced that he would be executed in a less painful way - by opening his veins. They showed a video explaining how it happens. They blindfolded the offender and ran the blunt side of the scalpel over the arm in the area of the vein, and warm water was poured on the bare arm in a thin stream. Death occurred almost after the same time as with a natural opening of a vein.
The following factors are used as instruments of influence on one's own psyche: muscle tone, breathing, sensual images and the word. It is known that all these factors are closely related to the work of the brain. A conscious (volitional) change in the tone of the skeletal muscles (in the direction of relaxation) affects the level of mental activity and the current state of the nervous system. Muscle relaxation is carried out synchronously with a change in the rhythm of breathing. The formation of a sensory image of a positive nature (through auditory, visual or other types of representations) contributes to the emergence and dominance of positive mental states, the mobilization of internal energy. A similar effect is exerted by a mentally spoken or voiced word in the form of commands and statements relating to oneself.
The method teaches you to manage your thoughts, state, mood, to see in environment more good, build good relationships with colleagues and much more.
The group training method is a wide variety of methods of influencing an individual, but they all use the principle of the training effect of the group factor. The method is based on the social component of the personality, subordinate to the sphere of public interests, values, rules and norms of behavior. The more an individual is included in social life, the more influence these factors exert on him. A feature of the method is that the search for solutions in situations of group choice is entrusted to the participants themselves without any pressure or prompts from the psychologist. The method is implemented in such forms as group discussions, role-playing games, group exercises, solving specific situations, etc.
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At the same time, video recording of the process of solving group problems is practiced.
The participants of the training acquire communication skills, the ability to deeply understand other people, increase the efficiency of their regulatory mechanisms of behavior, etc.
Method of neurolinguistic programming (NLP). First of all, about the name itself. The word ʼʼneu-roʼʼ indicates that neurological processes of perception are involved in the technique of the method (through hearing, sight, smell, etc.). The word ʼʼlinguisticsʼʼ indicates that the method is based on the use of the most important element of the psyche - language. The word ʼʼprogrammingʼʼ indicates a special way of organizing the work of both hemispheres of the brain, the ordering of thought and sensory processes. If we are talking about the methods of psychology, it is worth emphasizing that one of the authors of the method (R. Bandler) is a psychologist and mathematician by education, the second (D. Grinder) is a linguist.
NLP is a way of elusive penetration into the interlocutor's subconscious and effective influence on him through unconscious processes. NLP technology is based on four basic practical principles: - on the presence of dominant channels for receiving information in an individual; - on the effect of reflex movement of the eyes; - on the procedure of ʼʼcalibrationʼʼ of the interlocutor's reactions; - at the reception of manipulative imitation of the interlocutor.
The dominant channel for receiving information feeds the individual with basic information coming from the outside world. According to this criterion of information ʼʼmodalityʼʼ people are divided into: - visualists who have a connection with external environment realized mainly through visual images; - audiolists, whose relations with the environment are realized mainly through speech; - kinesthetics, in which information interaction with the environment is carried out mainly through muscle sensations, smell, taste.
In everyday life, they can be recognized by their characteristic keywords, demeanor and eye movements. If, in communicating with the interlocutor, one adheres to the terms of his dominant information channel (ʼʼmodalityʼʼ), then his subconscious mind will provide invaluable assistance in establishing mutual understanding. Conversely, speaking in a language of different modalities raises invisible but significant barriers to trusting communication and agreement.
The effect of the reflex movement of the eyes is based on the discovery of an involuntary movement of a person's gaze under the influence of information of various contents. It turns out that these movements are not random, but quite natural. In other words, eye movements also have their priority directions (sectors). For example: - if information (image) is extracted from a person's past experience, then the pupils of the eyes go ʼʼto workʼʼ to the sector of memory and representation; - if a person fantasizes, forms a new image (or simply lies), then the gaze rushes to the sector of constructing the image.
The effect of the reflex movement of the eyes helps to determine the current hidden intentions of the interlocutor, his feelings and train of thought, the system for working with information, and thus imperceptibly influence in the right direction.
The procedure for "calibrating" the interlocutor's reactions is based on the constancy of a person's behavioral reactions and their subconscious nature. The idea is consonant with the calibration of measuring instruments in engineering. Before you measure something, you need to put on the reference scale ʼʼzeroʼʼ position (let's say this is the middle of the scale). The deviation of the arrow to the left and right will correspond to a change in the measured process in one direction or the other. So here.
Through a series of "innocent" questions to the interlocutor, included in the context of the conversation, his typical reactions are revealed (for example, barely noticeable nods of the head, head tilts forward or backward, protrusion of the lips when answering). After that, questions are asked regarding the main purpose of the conversation. And if the interlocutor's answers are accompanied by a violation of the identified stereotypical reactions, then there is every reason to doubt the sincerity of his words and take steps in the right direction to influence him. Both pleasant and unpleasant thoughts of the interlocutor are subjected to calibration.
Reception of manipulative imitation of the interlocutor. Have you ever watched how they neutralize a crazed herd of horses, rushing furiously and trampling everything that comes in their way? A brave horseman leads his run and returns the herd to its normal obedient state. But first, he is forced to do what a distraught horse mass does - to rush ahead, that is, to adapt to its behavior. We note, by the way, that the subsequent behavior of the herd, copying the behavior of the rider, is not based on logic and thinking. The horse is not known to have these abilities. Everything happens at the level of ʼʼhorseʼʼ reflexes and instincts. This is the idea and psychological adjustment to the partner.
Most of all, we try to influence the interlocutor, invading his consciousness through logic, common sense, facts. But after all, at the same time, his position of criticality is “growing up” and strengthening. After all, we make him think, weigh everything on the impassive scales of consciousness. This does not always contribute to the effect of influence on the interlocutor. More productive impact on the subconscious level. These goals are served by a mechanism of adjustment to the interlocutor, which recommends copying, ʼʼmirroringʼʼ, imitating his postures, gestures, key words, speech rate, intonation, eye blinking frequency, behavioral reactions, etc.
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By this, a feeling of complete mutual understanding is achieved precisely at the subconscious level. Take a look at how two young guys behave at the bar with glasses in their hands. Οʜᴎ - the very repetition of each other! As soon as one of them folds his arms on his chest in a conversation, an adequate response from the interlocutor will not be long in coming.
It is very important that ʼʼmirroringʼʼ does not look like the usual ʼʼmonkeyingʼʼ. Imitation techniques should be subtly built into the structure of the partner's behavior and correspond to the current situation. The spirit is important here, not the letter.
29. Sigmund Freud and classical psychoanalysis The structure of personality according to Freud
30 Sigmund Freud and classical psychoanalysis. Working with the unconscious
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Unconscious or unconscious- a set of mental processes in respect of which there is no subjective control. The unconscious is everything that does not become an object of awareness for the individual. In psychology, the unconscious is usually opposed to the conscious, but within the framework of psychoanalysis, the unconscious (Id) and the conscious are perceived as concepts of a different level: much of what belongs to the other two structures of the psyche (I and Super-I) is also absent in consciousness.
Several basic classes of manifestations of the unconscious[edit | edit wiki text]
1. Unconscious motives, the true meaning of which is not realized due to their social unacceptability or contradiction with other motives.
2. Behavioral automatisms and stereotypes that operate in a familiar situation, the awareness of which is unnecessary due to their maturity.
3. Subthreshold perception, ĸᴏᴛᴏᴩᴏᴇ is not realized due to the large amount of information.
4. Superconscious processes: intuition, creative insight, inspiration.
Many actions, according to Freud, in the implementation of which a person is not aware of, are of an unconscious nature.
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Our secret desires and fantasies are forced into the unconscious, which contradict public morality and generally accepted norms of behavior, and also disturb us too much to be conscious. He considered how this or that motivation manifests itself in dreams, neurotic symptoms and creativity. It is known that the main regulator of human behavior is the subject's drives and desires. As an attending physician, he was faced with the fact that these unconscious experiences and motives can seriously burden life and even become the cause of neuropsychiatric diseases. This led him to seek means of ridding his analysands of conflicts between what their consciousness says and hidden, blind, unconscious urges. Thus was born the Freudian method of healing the soul, called psychoanalysis. 31. Carl Jung and analytical psychology. Jung's personality structure
Carl Gustav Jung, within the framework of the scientific discipline he created - analytical psychology - introduced the term ʼʼcollective unconsciousʼʼ, and significantly changed its meaning compared to psychoanalysis.
According to Jung, there is not only the unconscious of the subject, but also the family, tribal, national, racial and collective unconscious. The collective unconscious carries information from the mental world of the whole society, while the individual unconscious carries information from the mental world of a particular person. Unlike psychoanalysis, Jungianism considers the unconscious as a collection of static patterns, patterns of behavior that are innate and only need to be actualized. The unconscious is also divided into latent, temporarily unconscious, and suppressed processes and states of the psyche, forced out of the boundaries of consciousness.
In Jung's personality structure distinguishes Consciousness, Individual unconscious and Collective unconscious. There are two layers in the structure of consciousness: "I for others" (Persona) and "actually I" (Ego).
The concept of a person- the most superficial layer-mask in the structure of consciousness (archetype of conformity). It includes social roles through which a person presents himself to other people and society. This is our public face. Here, great importance is attached to the analysis of various kinds of symbols of covering oneself (clothing), occupation (tools, briefcase) or social status (car, house, diploma). All of these symbols can appear in dreams. For example, a person with a "weak" persona may dream of himself without clothes and even without skin. Social roles can both suppress individuality and contribute to its development.
At the same time, the main role in the conscious life of a person is played not by the Person, but by the deeper layers of consciousness - the Ego. Being one of the basic archetypes of personality, Ego creates a sense of conscious connectedness and continuity in the flow of thoughts, feelings and actions. Although the Ego arises from the unconscious, but has only a conscious content, ĸᴏᴛᴏᴩᴏᴇ was formed from personal experience.
In the personality structure of C. Jung individual unconscious is made up of experiences that were once conscious, and then forgotten and forced out of consciousness. It includes "Shadow", "Anima and Animus", as well as "Self".
Shadow- this is what a person considers low and immoral in himself, in his personality. Just as the ego is the center of consciousness, so the shadow is the center of the individual unconscious. Jung understands the shadow, unlike Freud, not as a scattered material of consciousness repressed into the unconscious, but as a kind of whole - the negative I. The shadow is often experienced in dreams as a dark, primitive, hostile and repulsive figure. Jung warns that you need to "look into yourself" more often, because. it is dangerous not to recognize your shadow.
Anima(in men) and Animus (in women) are unwanted ideas about oneself as a man or woman repressed from consciousness. Τᴀᴋᴎᴍ ᴏϬᴩᴀᴈᴏᴍ, Anima is the feminine in men, and Animus is the masculine in women. Jung believes that these images are collective unconscious images (archetypes) of a woman or a man as such and influence the choice of spouses, appear in dreams and fantasies. The mother for the boy and the father for the girl have a significant influence on the development of the anima and animus.
The central archetype of the individual unconscious is "Self"(Self). The self is the inner guiding factor of the integral personality, a kind of "ideal personality". Jung is convinced that consciousness and the unconscious do not oppose, but complement each other. Their dynamic balance, the reconciliation of polarities is a whole personality, united by selfhood.
32. Carl Jung and analytical psychology. The concept of the personal and collective unconscious
collective unconscious- one of the forms of the unconscious, common to society as a whole and is a product of inherited brain structures. The main difference between the collective unconscious and the individual is that it is common to different people, does not depend on individual experience and the history of the development of the individual, is a kind of common denominator for different people. The collective unconscious, in contrast to the individual (personal) form of the unconscious, is based on the experience of not a particular person, but society as a whole. Jung designated it as a deeper layer than the individual unconscious - behind the word there are not only direct meanings, but also more hidden layers, meanings that are understandable at the unconscious level.
The collective unconscious consists of archetypes (universal prototypes) and ideas.
Jung expanded and deepened Freud's concept of the unconscious. Instead of being just a container for repressed personal memories or forgotten experiences, the unconscious, according to Jung, consists of two components, or levels. The first level he named personal unconscious, essentially identical to Freud's concept of the unconscious. At this level of the unconscious lie memories of everything that is experienced, felt, thought out by the individual or recognized by him, but which is no longer held in active awareness due to defensive repression or simple forgetfulness.
At the same time, using his theory of archetypes to explain the similarities in mental activity and in representations throughout all epochs and in any arbitrarily different cultures, Jung discovered the second level of the unconscious, which he designated as collective unconscious. This level of the unconscious contained patterns of mental perception common to all mankind - archetypes. Due to the fact that the collective unconscious is the realm of archetypal experience, Jung considers the level of the collective unconscious to be deeper and more significant than the personal unconscious; as a level containing a fundamentally different mental source of energy, integrity and internal transformation. The archetypes he derived from astrological and religious symbols, ancient myths and fairy tales, as well as finding the relationship between these images and the psyche, had a significant impact on the development of psychoanalysis and revealed a new aspect of understanding the personality. The archetype is translated from Greek as a prototype. From the point of view of psychoanalysis, this concept means the original mental structure, which is part of the collective unconscious. This structure defines the human experience and usually manifests itself in dreams. The types of these structures can be found in the symbolism of myths and fairy tales. - In this article we will consider archetypes according to Jung: there are 7 of them in total, however, theoretically there should be much more of them. Before starting the description, it is worth noting that K. Jung considered the collective unconscious to be the "habitat" of archetypes, which is commonly understood as a deep layer in the personality structure that stores memories and feelings common to all people. Jung's Archetypes: Anima, Animus and Persona Anima and Animus. Here, as K. Jung suggested, the androgynous nature of people is expressed. The anima is part of the feminine in the man. Of course, this is an unconscious part of his personality. Animus - on the contrary, is the male part in the unconscious of a woman. Carl Jung explained this by the fact that hormones of both sexes are present in women and men, albeit in different quantities. Interestingly, the psychoanalyst believed that the harmonious development of both sides of the personality was right: a woman should show both feminine and masculine qualities, like a man, if they do not want to have one-sided growth. A person. From Latin, this word is translated as ʼʼmaskʼʼ, which to a large extent sheds light on the peculiarity of this archetype. Person - ϶ᴛᴏ our roles, manifestations of ourselves in relationships with other people. People with this pronounced archetype tend to hide their true nature from others by trying on various roles when they are in society, which as a result leads to superficiality and an inability to experience real and strong emotions. In moderation, the use of ʼʼʼʼʼ helps people interact.
Shadow - repressed desires and intentions, as well as with animal instincts, sexual and aggressive impulses. Carl Jung believed that if one is able to transform this energy in the right direction, then a person will have the opportunity to freely express his creative potential.
Self and Sage Self. the most important of all allocated to them. This is the central figure in the personality of a person, with the help of which all other archetypes are organized. In Jung's theory, the development of integrity, and before that, finding the self is the main goal of human life. Sage. Here, Carl Jung singled out a part of the personality that strives for knowledge. This archetype is presented in the image of a sage, an old man, a prophet who can shed the light of truth on exciting questions. Usually this archetype ʼʼturns onʼʼ in the unconscious when a person is faced with a choice, and the more such life moments he is given to experience, the more developed this part of the unconscious is, and the easier it is for consciousness to contact it through sleep or other borderline states.
God meant the highest stage of mental activity, when a person is able to see and understand the natural processes of his inner peace and the outside that surrounds it. It is in this connection that the archetype is preceded by the ʼʼSageʼʼ, which pushes a person to understand the key moments of life, however, when the ʼʼʼʼʼ archetype ʼʼʼʼʼ is switched on, a holistic relationship is realized, based on certain laws between its internal content and the external environment.- 33. Transactional Analysis by Eric Berne. Life path and scenario
Transactional analysis is based on the concept of Eric Berne that a person is programmed with “early decisions” regarding life position and lives his life according to a “script” written with the active participation of his relatives (primarily parents), and makes decisions in the present. time based on stereotypes that were once essential to its survival but are now largely useless.
The main goal of the therapeutic process in the tradition transactional analysis is the reconstruction of personality on the basis of a revision of life positions. A great role is given to a person's ability to realize unproductive stereotypes of his behavior, which prevent the adoption of decisions that are adequate to the present moment, as well as the ability to form new system values and decisions based on their own needs and capabilities.
At the root of the practice of transactional analysis lies the contract. It includes the goals set by the client for himself, and the ways in which these goals will be achieved; the contract also includes the counseling therapist's proposals and a list of requirements for the client to fulfill. The client decides which of his beliefs, emotions and behaviors he needs to change in order to achieve the intended goals. After reviewing early decisions, the client begins to think, behave and feel differently, seeking to acquire autonomy.
The structure of personality in the concept of transactional analysis is characterized by the presence of three ego-states: Parent, Child and Adult. Ego-states are not the roles that a person performs, but some phenomenological realities, behavioral stereotypes that are provoked by the current situation.
Transaction in the framework of transactional analysis is usually called the exchange of influences between the ego states of two people. Impacts can be thought of as units of recognition, similar to social reinforcement. Οʜᴎ find expression in touch or in verbal manifestations.
At the root of transactions lies the life script. It is the general and personal plan that organizes a person's life. The scenario was developed as a survival strategy.
Correctional methods in psychology - the concept and types. Classification and features of the category "Correctional methods in psychology" 2017, 2018.
Correction in teaching those children with rhinolalia who have only phonetic disorders is carried out as follows.1. Activation of the articulation apparatus. In this case, various techniques are used, due to the state of the peripheral articulatory apparatus and congenital pathology.
2. Formation of articulatory sounds.
3. Differentiation of sounds to prevent further violation of sound analysis.
4. Reducing the nasal sound of the voice.
5. Elimination of violations of the prosodic side of speech.
6. Bringing the acquired skills to automatism in free speech.
All of the above is taken into account when working with children with impaired phonetic phonemic development, and systematic classes are held to normalize phonemic perception, create morphological generalizations and eliminate dysgraphia.
Speech therapy assistance to children with general speech underdevelopment consists in the development of full-fledged phonetics, phonemic representations in patients, the formation of morphological and syntactic associations and generalizations, and coherent colloquial speech.
These techniques are used in specialized schools for children with severe speech defects.
Domestic speech therapists have developed a number of techniques to eliminate rhinolalia.
These are the methods of A. G. Ippolitova, Z. A. Repin, I. I. Ermakov, G. V. Chirkin, T. V. Volosovets.
The system of A. G. Ippolitova. Its use is highly effective when working with children who do not have deviations in phonemic development. When using this system, for the first time it was proposed to conduct classes before the surgical correction of the defect. The main thing in this technique is a combination of breathing and speech exercises, a sequence of practicing sounds that are articulatory interconnected. The stages in the development of sounds are determined by the degree of readiness of the articulatory base of the language. If there are full-fledged one-group sounds, then this is considered an arbitrary basis for working on the following. The so-called "reference" sounds are used. The preparation of the articulation base is carried out with the help of a specially developed articulation gymnastics. It accompanies the development of speech breathing. The originality of this method lies in the fact that during the formation of sound, the initial concentration of the child concentrates only on the articules. The speech therapy system of A. G. Ippolitova consists of several main sections.
1. Formation of speech breathing during the differentiation of inhalation and exhalation.
2. Formation of a long oral exhalation when the article implements vowel sounds (without turning on the voice) and fricative unvoiced consonants.
3. Differentiation of short and long nasal expiration during the formation of sonorous sounds and affricates.
4. Formation of soft sounds.
According to the method of L. I. Vansovskaya, the elimination of nasal sound does not begin with the vowel [a], as usual, but with the front vowels [i], [e], since with the help of these sounds the exhaled air flow can be focused in the anterior part of the oral cavity and direct the movement of the tongue to the lower incisors. When the tongue comes in contact with the lower incisors, kinesthetic clarity is enhanced, the movement of the pharyngeal walls and the soft palate is activated when pronouncing the sound [and]. The child should pronounce the required sounds quietly, while the jaw protrudes slightly forward, a half-smile and increased work of the muscles of the pharynx and soft palate are necessary. After the vowels lose their nasal sound, work is carried out on sonorant consonants [p], [l], after that - on fricative and stop consonants.
X-ray examination is of great importance in the selection and improvement of corrective techniques. With its help, it is possible to predict the success of speech therapy activities and the restoration of the functions of the palate. With the help of radiographs, the dependence of the effect of speech therapy on the mobility of the soft palate and the posterior pharyngeal wall was revealed; from the distance between the posterior pharynx and the soft palate; from the width of the middle part of the pharyngeal cavity.
For adult patients, you can use the technique of S. L. Taptapova. At the same time, it is recommended to pronounce vowel sounds in silence mode (pronunciation to yourself). This eliminates excessive facial expressions and helps to start pronunciation without a nasal connotation. Vocal exercises are also used in this technique.
Methodology I. I. Ermakova. It consists in the consistent correction of the pronunciation of sounds and voice. Ermakova revealed age-related features of functional voice formation disorders in children with congenital clefts. Orthophonic exercises have been improved for them. Much attention is paid to the postoperative stage. At the same time, techniques have been developed to increase the mobility of the soft palate, which can be shortened after surgical treatment.
To eliminate sound speech disorders, a thorough speech therapy examination of the child is required.
During the examination, the following defects and deformities are revealed: palatopharyngeal insufficiency, its severity; dimensions (length) of the soft palate, scars on the hard and soft palate; the nature of contact with the posterior pharyngeal wall (passive, active, functional); anomalies of teeth, jaws, alveolar processes; specificity of the activity of the articulatory apparatus; the presence of additional compensatory facial expressions.
The effectiveness of speech therapy assistance is closely related to the anatomical and functional features of the speech apparatus. In addition, the correct assessment of the psychophysical, psychoemotional status of the child, his personal characteristics is very important.
The speech correction system for children with rhinolalia contains several sections:
1) work on the mobility of the soft palate;
2) elimination of nasality;
3) staging sounds and working on correct phonemic perception.
The content of the first section varies depending on whether surgical correction was performed or not. If surgical treatment was performed, then a number of therapeutic measures are needed to soften and dissolve the postoperative scar so that the elasticity of the palate is not lost. For this purpose, a special type of massage is used - a sound probe with. With careful touches, it is moved in the anteroposterior direction and back along the hard palate. They also use the technique of stroking and rubbing the area between the soft and hard palate in the transverse direction. This technique causes a reflex contraction of the muscles of the pharynx and soft palate. The next technique is massage at the sound a in the form of light pressure on the soft palate.
Finger impact with point and jerky movements is also effective. The duration of the massage procedure is 1.5–2 minutes. During this time, 40-60 quick movements across the palate should be made. Massage is carried out twice a day before meals (1.5–2 hours) or after with the same interval. The duration of the massage course is from 6 to 12 months. Highly important point in the postoperative period are measures to activate the soft palate. For this purpose, the following sets of exercises are used.
Gymnastics for the palate
1. Swallowing small amounts of water. In this case, the soft palate occupies the highest position. The pharynx, following one after the other, keeps the palate high for some time. For younger children, use a pipette and drip water onto the tongue. Older children are encouraged to pour on the tongue from a bottle or from a small cup.
2. Yawning with an open mouth, imitation of yawning.
3. Easy cough. At the same time, the muscles of the Passavan roller are intensively reduced. It can have a size of 4-5 mm and in this state compensate for palatopharyngeal insufficiency. When coughing, the nasal and oral cavities are completely closed. The child can feel these movements if he puts his hand and fingers to the chin area.
On one exhalation, it is recommended to do 2-3 or more arbitrary coughs.
The closure of the palate and the posterior pharyngeal wall at this time is preserved, while the air stream leaves the oral cavity. In the initial stages, coughing is best done with the tongue hanging out.
Then - coughing with stops, in which the child should try to keep the closure of the palate and the back of the throat. Over time, the child acquires the ability to actively raise the sky and exhale through the mouth.
This increases the resonance in the mouth and reduces the nasality of the sound.
All of the above methods of correction bring positive results both before and after surgical treatment.
Long, systematic exercises prepare the child for surgery and reduce the duration and complexity of the period of postoperative correction.
Breath work
It is necessary for the formation of the correct sound speech. Children with rhinolalia have a very short airflow outlet that is distributed through the nasal and oral cavities. The following methods are used to form a functional air outlet:
1) inhale and exhale through the nose;
2) inhale and exhale through the mouth;
3) inhale through the mouth;
4) exhale through the nose;
5) inhale and exhale through the mouth.
If the exercises are performed correctly, regularly, for a long time, the child feels a change in phonation and tries to correctly direct the exhaled air flow. These exercises also form normal kinesthetic sensations of soft palate movements. When performing these exercises, it is necessary to help the child control himself, since it is rather difficult to feel the release of part of the air through the nose. To help in this, various methods are used - putting a mirror to the nose or a piece of cotton wool, thin paper. Sometimes a set of corrective exercises includes playing children's wind instruments. These are very difficult and tiring exercises for the child, not always appropriate, causing fatigue faster than other techniques.
At the same time, another set of exercises is performed in order to normalize the motor skills of speech. Its everyday use helps to reduce the high rise of the root of the tongue, the lack of participation of the lips in articulation and increases the amplitude of movements of the tip of the tongue, as a result, the pathological participation of the root of the tongue and larynx in sound pronunciation decreases.
Gymnastics for lips and cheeks:
1) inflating the cheeks from both sides at the same time;
2) puffing out the cheeks alternately; retraction of the cheeks between the teeth into the oral cavity; performing sucking movements - stretching closed lips with a "proboscis" forward with a return to its original position. When performing this exercise, it is necessary to close the jaws;
3) grinning - the maximum stretching of the lips in all directions with the exposure of the teeth;
4) "proboscis", then grinning teeth with closed jaws;
5) grinning with opening and closing of the oral cavity, then closing of the lips;
6) grinning in the position of the open mouth, then lowering the lips on the teeth of the lower and upper row;
7) the formation of a "funnel" (imitating a whistle);
8) retraction of the lips into the oral cavity with tight pressing to the teeth;
9) raising the lips with their tight squeezing up and down with closed jaws;
10) lifting of the upper lip with exposure of the upper row of teeth;
11) retraction of the lower lip, while exposing the lower teeth;
12) imitation of rinsing teeth (air pressure on the lips), trembling of the lips;
13) movements of the "proboscis" to the right and left, rotation;
14) maximum inflation of the cheeks (trying to keep the air in the mouth cavity with the lips, thereby increasing the pressure in the oral cavity);
15) holding a pencil between the lips.
Gymnastics for the tongue:
1) protrusion of the tongue in the form of a shovel, sting, tongue in a flattened or pointed form;
2) turns of the most advanced tongue to the right and left sides;
3) movements up and down the root of the tongue. In this case, the tip of the tongue rests on the lower gum, and the root of the tongue moves;
4) suction of the upper surface of the tongue to the palate - with closed and then open jaws;
5) the protruding flattened tongue connects with the upper lip, and then is drawn into the oral cavity, while touching the upper dentition and palate and touching the tip at the top of the soft palate, bending at the same time;
6) suction of the tongue to the upper alveolar processes when opening and closing the mouth;
7) advancement of the tongue between the teeth with a feeling that the incisors from above are scratching the back of the tongue;
8) the tip of the tongue licks the lips in a circular motion;
9) the tongue is maximally advanced, the mouth is open, while the tongue rises and falls between the upper and lower lip;
10) tongue in the form of a sting, mouth open, movements of the tip of the tongue up to the nose, down to the chin, to the upper and lower lip, upper and lower teeth, towards the hard palate and the bottom of the oral cavity;
11) the mouth is wide open, the tip of the tongue touches the upper and lower incisors;
12) the tongue is extended, alternately takes and holds the shape of a groove, a boat, a cup;
13) holding the tongue in the mouth in the form of a cup;
14) biting the sides of the tongue with the teeth;
15) side surfaces the tongue is pressed against the upper lateral teeth, when bared, the tip of the tongue touches the upper and lower gums;
16) tongue in the previous position, the tip of the tongue repeatedly taps on the base of the upper teeth (as when pronouncing the sound t);
17) repetition of the exercise - tongue in the form of a sting, a cup, a boat, raising it alternately up, lowering it down, then moving it to the right and left.
Voice exercises
They are carried out when pronouncing vowel sounds. The beginning of the exercises is with the setting of vowels [a], [o], [y], [e]. These vowels are then included in the gymnastics complex and repeated daily. The production of vowels begins in silent mode. This is done in order to eliminate additional auxiliary facial expressions (movements of the wings of the nose), which are present in many children.
Exercises are carried out in front of a mirror, first silently, and then in a loud voice with a gradual increase in the number of vowels with one exhalation: [u] - [uu] - [uuu]; [a] - [aa] - [aaa]; [and] - [ii] - [iii], etc.
The next step is to pronounce the vowels in different sequences. In this case, the sounds are pronounced short and clear. In addition to forming the correct articulation, this exercise helps to fill in the combination and sequence of sounds. In the future, the child should make small pauses between vowels, during which the high standing of the soft palate should be maintained. Pauses should be gradually lengthened from 1 to 3 s.
You also need to include in the complex a long pronunciation of vowels one after another without pauses [a] - [i] - [y] - [e], etc.) in a different sequence.
When practicing the correct pronunciation of sounds, an important and specific point is the constant monitoring of the direction of the air flow. In cases of difficulty, you can temporarily close the nasal passages so that the articulation of sounds is more sonorous and clear. Specific for this correctional complex of gymnastics is the order of setting consonants. The sound [f] is put first - deaf, fricative. Its setting is facilitated after exercises for the exit of the air stream through the oral cavity. The sound is first pronounced in isolation, then as part of syllables, and the vowel is placed both before [f] and after ([af] - [fa] - [afa], etc.). Exercises with puffing out the cheeks make it easier to set the sound n, since when performing these exercises, a palatopharyngeal closure is formed. Next, the child must perform an explosion of the bow of the lips to pronounce the sound p. If this movement is difficult, the speech therapist helps the child. Help lies in the fact that you need to move the lower lip down, while the child's lips need to be opened. A sufficient explosion occurs when the air stream exits through the mouth, bypassing the nasal cavity. The production and pronunciation of sound is used as one of the exercises that eliminate the nasal tone of the voice.
Setting the sound [t] requires proper exhalation through the mouth. In this case, the tip of the tongue is pressed against the upper teeth. The previously performed articulatory gymnastics makes sound articulation prepared and automated, and all stages of articulation are activated with sufficient oral airflow.
The articulation of the k sound is often difficult and is not always successfully pronounced in imitation. Coughing exercises do not help in all cases. Therefore, the production of sound k can be done mechanically.
Speech therapy lessons at the preoperative stage help to avoid serious pathological disorders in the functioning of the speech organs.
In addition, they activate the soft palate, promote the physiological position of the root of the tongue, enhance the work of the muscles of the lips, and form the direction of oral exhalation.
These positive results have an impact on the success of surgical treatment and the subsequent correction period.
2-3 weeks after the operation, the repetition of part of the exercises is resumed in order to achieve elasticity and mobility of the closure.
Postoperative scars on the soft palate can reduce (contract) the length of the soft palate. Swallowing exercises are used to stretch the fresh scar. At the same time, a massage course is scheduled.
The purpose of postoperative exercises is to increase the mobility of the soft palate, to prepare for the pronunciation of sounds without nasality.
Criteria of L. I. Vansovskaya. With their help, it is possible to clearly separate the combined speech disorders in children with rhinolalia and evaluate the ongoing correction in two main areas - the elimination of nasality and articulation disorders.
Speech is evaluated on the following grounds.
1. Normal and close to normal, i.e. there is a clear and physiological sound pronunciation and nasality is eliminated.
2. Significant improvement in speech - sound pronunciation is formed, there are moderately pronounced signs of nasality.
3. Improving speech - there is a well-formed articulation of some of the sounds with a moderate nasal sound.
4. Without improvement - there is no articulation of sounds, there is hypernasalization.
The results of correction are influenced by the following factors: the age at which surgical treatment was performed, the quality of the operation, the start of speech therapy, the duration of training, and the help of family members. It is recommended that some of the most correctly performed exercises be repeated at home.
Closed rhinolalia. This defect is formed with a decrease in physiological nasal resonance during sound pronunciation. Sounds [m], [n] have the strongest resonance. Normally, when they are pronounced, the nasopharyngeal valve is open and the air stream enters directly into the nasal cavity. In the absence of nasal resonance for these sounds, they sound like oral [b], [e].
The causes of this form of rhinolalia are, in most cases, organic changes in the nasal cavity or disorders of the palatopharyngeal closure of a functional property.
According to M. Zeeman, there are two types of closed rhinolalia (rhinophony) - the anterior closed, which occurs as a result of obstruction of the nasal cavities, and the posterior closed, which is formed when the oral cavity decreases.
The result of corrective work to eliminate rhinolalia is due to a number of factors: the state of the nasopharyngeal cavities, the function of the tongue (uvula), and the age of the child.
Early prevention and complex corrective action can be considered as especially important measures to solve this serious problem, which can reduce the development of pathology and accelerate the social rehabilitation of patients with congenital anomalies of the palate.
What is psychocorrection?
Who is involved in the PC, to whom and what is it aimed at?
The main methods used in psycho-correctional practice with children and adolescents.
Some methods of PC work with adults.
The term " correction literally means correction. Under the concept " psychocorrection", according to A.A. Osipova, in our country, most often means a system of measures aimed at correcting the shortcomings of psychology or human behavior with the help of special means7 psychological impact. Psychological correction is subject to shortcomings that do not have an organic basis and do not represent such stable qualities that are formed quite early and practically do not change in the future.
According to R.S. Nemova, the difference between the concepts of "psychotherapy" and "psychocorrection" is as follows:
psychotherapy- this is a system of medical and psychological means used by a doctor to treat various personality disorders;
psychocorrection is a set of psychological techniques used by a practicing psychologist to correct deficiencies in the psychology or behavior of a mentally healthy person.
According to Yu.E.Aleshina, the difference between the terms " psychocorrection" and " psychotherapy” arose not in connection with the peculiarities of the work, but with the ingrained opinion that people with a special medical education can engage in psychotherapy. In addition, the term " psychocorrection"in many countries of the world, except for Russia, is absent, but there is the concept of" psychotherapy”, since the principles of work carried out by professional psychologists and psychotherapists in world practice are very similar.
In connection with the above, at present the question of the separation of the two areas of psychological assistance - psycho-correction and psychotherapy, is debatable. Indeed, both in psychocorrection and in psychotherapy, similar requirements are imposed on the personality of a specialist who provides assistance; to the level of his professional training, qualifications and professional skills; the same procedures and methods are used; help is provided as a result of a specific interaction between the client and the specialist.
Thus, a specialist who meets certain requirements can deal with psychocorrection and psychotherapy:
Psychologist, psychotherapist with fundamental training in the field of psychology and special training in the field of specific methods of psycho-correctional and psychotherapeutic influence.
When implementing the psycho-corrective process, a psychologist can work independently with a person who is conditionally healthy physically and mentally, who has had problems of a psychological or behavioral nature in his life and, due to the prevailing circumstances, cannot solve the problem on his own. When a person who is suffering from different kind somatic or mental diseases, abnormalities of mental and behavioral processes, psychological assistance is provided by a pathopsychologist, defectologist, neuropsychologist, neuropsychiatrist, psychiatrist - depending on the age, complaints and requests. Psychocorrective measures in this case will be aimed at expanding the healthy part of the personality.
There are many methods of psycho-correctional influences. The choice of form, method, method of work for a specialist is based on a combination of many factors:
- age (stages of childhood and adolescence, adults, the elderly);
- individual and specific features of personality (intellect and its safety, level of education, personality type);
- the presence or absence of somatic and / or mental care;
- material and economic aspect;
- social and family resources;
- religious affiliation;
- demand oriented, etc.
These are far from all the factors that a specialist takes into account, but the above leads to an understanding of client-centeredness, the choice of correction methods will depend on the accuracy of building a typology of symptoms and syndromes of the disorder.
The main methods and techniques used in psycho-correctional practice in children and adolescents can conditionally be combined into 5 main groups:
- play therapy method,
- art therapy methods,
- behavioral therapy methods
- methods of social therapy (G.V. Burmenskaya, E.I. Zakharova, O.A. Karabanova, etc.).
- replacement ontogeny method
In psychoremedial practice, when working with adults, there are 3 main areas:
- psychodynamic direction- corrective influence in the classical psychoanalysis of Z. Freud.
- humanistic direction- individual psycho-correction by A. Adler; client-centered approach of K. Rogers; existential direction, gestalt approach by F. Perls.
- cognitively- behavioral direction - classical operant conditioning; (RET) rational-emotive approach; A.Beck's cognitive approach; dialectical behavioral approach (DBT) M.M. Linehan.
I propose to consider in more detail the 5 main groups of PCs in working with children:
1. Play therapy as a method of correction
Play and toys for a child are a natural environment for development, education, training and, of course, psycho-correction. What is difficult for a child to express in words, he expresses it through his own game. The game for the child is one of the forms of self-therapy, thanks to which various conflicts and troubles can be reacted (Webb, 1991, Oaklender V., 1997).
The game has been used in correctional practice since the early 1920s by psychoanalytic therapists - Anna Freud (1921), Melanie Kline (1922), Hermine Gut-Helmut (1926). Psychoanalysts have found that children cannot describe their anxiety in words, as adults do with success. Unlike adults, children, as a rule, are not interested in exploring their own past, discussing the early stages of development; one of the main methods of orthodox psychoanalysis does not “work” for children - the method of free word associations. M. Kline believed that almost any child's play action has a certain symbolic meaning, expresses conflicts and repressed desires of the child. This symbolic meaning must be interpreted by the therapist and brought to the child's mind.
The second major direction in development play psychotherapy arose in the 1930s. with the advent of the work of David Levy, which developed the ideas of "reaction therapy" - a structured play therapy for working with children who have experienced a traumatic event. Levy based his approach on the belief that play provides children with opportunities to respond to trauma. The course of play therapy according to Levy is built in three stages:
Stage 1 - establishing contact: the child's free play, his acquaintance with the playroom and the psychotherapist;
Stage 2 - the introduction into the child's game of any situation resembling a traumatic event (with the help of specially selected toys). In the process of acting out a psychotraumatic situation, the child controls the game and thereby moves from the passive role of the victim to an active, active role;
Stage 3 - continuation of the child's free play. D. Levy recommends the directive principle, according to which the initiative in game situations belongs to the psychotherapist. Careful technical and methodical preparation of game therapy sessions is important. A role-playing game plan is drawn up in advance, taking into account the age and characteristics of the psycho-emotional state of its participants, as well as the ultimate goal of psychotherapy.
G.L. Landreth identified the following areas of play therapy:
- parental therapy (B. Guerni, L. Guerni), which is a structured program in which parents are taught the skills necessary to conduct play therapy sessions at home;
- play therapy with adults;
- methods of play therapy in family therapy (involvement in the game of all members of the game contributes to their active interaction and has a therapeutic effect);
- group play therapy, which is a psychological and social progress in which children, naturally interacting with each other, acquire knowledge both about other children and about themselves;
- play therapy in a hospital setting.
A third major development in play therapy emerged with the research of Jesse Taft and Frederick Allen in the 1930s. It is a relationship play therapy that focuses on the healing power of the emotional relationship between therapist and patient. Developing these principles, Virginia Axline (1947) developed a system of non-directive play therapy for children. V. Exline considered the game as a means of maximum self-expression of the child, allowing him to fully reveal his emotions with the non-interference of adults in the process of his play activity. By studying the emotional and behavioral reactions of a child in various game situations, a psychologist or psychotherapist tries to understand his personality traits. At the same time, the host introduces certain restrictions if the gaming activity goes beyond the permissible limits.
Currently, many foreign psychiatrists, psychologists and psychotherapists use a combined approach, combining the principles of psychodynamic, non-directive and "reaction therapy" in the process of play therapy, often in combination with drug treatment.
2. Art therapy methods- the term "art therapy" in literal translation: art therapy was introduced by Adrian Hill. This is a specialized form of psychotherapy based on art, primarily visual and creative activities. The main goal of art therapy is to harmonize the development of the individual through the development of the ability of self-expression and self-knowledge.
Considering art therapy as a set of psycho-correctional techniques that have differences and features, determined both by the genre belonging to a certain type of art, and by the direction, technology of psycho-correctional application, the following types of art therapy can be conditionally distinguished:
Music therapy (through the perception of music, vocal therapy - through singing);
Kinesitherapy (dance therapy, corrective rhythm, psycho-gymnastics - as a therapeutic effect of movements);
Bibliotherapy (correctional influence by reading),
Fairy tale therapy, writing stories;
Imagotherapy (influence through the image, theatricalization): puppet therapy, figurative-role dramatization, psychodrama;
Isotherapy (drawing therapy) - corrective impact by means of fine arts: drawing, modeling, arts and crafts, etc.
3. Methods of behavioral correction one of the leading directions of modern psychotherapy and psychocorrection, which are based on the theory of learning, as well as on the principles of classical and operant conditioning. It is based on the idea that the symptoms of some mental disorders owe their appearance to malformed skills. Behavioral psychocorrection aims to eliminate unwanted forms of behavior and develop new behavioral skills that are useful for the client/patient.
Methods of behavioral correction
- Simulation learning - when using this method, the client (child, adult) is invited to observe and imitate the desired patterns of behavior. For this, not only a real person can be used, but the hero of the book or an image created by the client's imagination can also be used. One form of pattern learning is self-modelling: move like..look like..speak like..constantly tracking by type, find 10 differences and correct them.
- Role training, a method used to teach certain types of behavior (for example, training in communication skills), is a type of role play. The effect of role training is based on a combination of soft confrontation techniques, systematic desensitization (which helps reduce anxiety) and reinforcement of successful behavior in the form of positive feedback from a psychologist / psychotherapist. In this method, the psychologist and the client / patient act out a problem situation in a safe space, trying different role positions. This technique can be used both individually and in a group. Most often, the patient/client plays himself, but sometimes it is done by a psychologist or one of the group members, which allows the patient to see himself and his problem from the outside, and also to understand what is in this problem situation you can act differently.
- Biofeedback is a method of behavioral correction that uses equipment that accurately monitors quantitative information about the physiological state of the patient (pulse, heart rate, blood pressure, etc.) in a subjective stressful situation, such as flying on an airplane, an exam situation. As the patient manages to achieve a state of muscle relaxation, this is recorded by feedback sensors and the patient / client receives positive visual, auditory or tactile reinforcement (for example, pleasant music or an image on a computer screen, or vice versa, with bedwetting, a wake-up call is triggered patient).
- Systematic desensitization - used with both adults and children to overcome the state of increased anxiety and phobic reactions, is widely used in practice. Indications for use: fear of flying on an airplane, dogs, snakes, children's day and night fears, traveling in transport, fear of water, social phobias - fear of reciting a learned verse or coping with a test. In cases of multiple phobias, desensitization is carried out in turn, starting with the most significant subjective experience.
There are certain stages of systematic desensitization: Stage 1 - training the client / patient in the technique of deep muscle relaxation. Stage 2 - constructing a hierarchy of stimuli that cause anxiety and fear. Stage 3 - actually desensitization itself - alternate presentation of the hierarchy of stimuli verbally or in vivo, to work out the combination of a stressful stimulus and the ability to relax.
Methods of behavioral correction in educational practice
In order to teach a child with developmental disabilities new skills, it is necessary to correctly shape his behavior. The functional analysis of behavior is suitable for this, a discipline based on the scientific views of B. F. Skinner, and in particular on the concept of operant conditioning, where desired behavior is reinforced and undesired behavior is punished.
Applied behavior analysis is used in the education system both to improve performance - academic achievement, discipline, attendance for all children, and to include children with disabilities and problems with socialization (for example, with ASD) in general education classes.
With this approach, all skills that are difficult for children, including speech, contact, creative play, the ability to listen, look into the eyes, and so on, are divided into separate small blocks - actions. Then each action is learned separately with the child, and subsequently the actions are combined into a single chain, forming one complex action. For example, in the process of learning actions for a child with autism spectrum disorders, a specialist gives a task, if he cannot cope with it alone, then he gives a hint, and then rewards the child for the correct answers, while ignoring the wrong ones, positively reinforcing the desired action.
4. Methods of social therapy
The method of social therapy is a method of psychological influence based on the use of social acceptance and recognition, social approval and positive assessment of the child by a significant social environment, both adults and peers. What can be done only in conditions of active interaction with the group.
The need for social recognition is becoming one of the leading
The needs of the child already from the middle of preschool age and the older, the brighter this need manifests itself. The systematic dissatisfaction of this need becomes a source of the formation of a stable personal inferiority complex, entails deviations in the development of the self-awareness of the individual, affecting the formation of the self-concept and self-esteem, interpersonal relationships and communication; contributes to the formation of deprivation of claims to social recognition.
The method of social therapy allows solving problems of prevention and
Correction of deviations in the personal development of the child, due to
Deprivation of the need for social recognition and provides:
1) satisfaction of the individual's need for social recognition;
2) formation of adequate ways of social interaction
In children with a low level of communicative competence.
5. Method of replacement ontogenesis.
The ideology of the replacement ontogenesis method is based on the theory of A.R. Luria about the three functional blocks of the brain and the teachings of L.S. Tsvetkova on the neuropsychological rehabilitation of mental processes.
The fundamental principle in the MLO is the principle of correlating the current status of the child after a neuropsychological examination, correlating with the main stages of the normative formation of the brain organization of the HMF and the subsequent launch of those areas of his ontogenesis that, for one reason or another, have not been effectively mastered.
The impact on the sensorimotor level, taking into account the general patterns of ontogenesis, causes the activation of all higher mental functions (HMF) in the development. Since it is the base for further development VPF, at the beginning of the correctional process, preference is given to motor methods that activate, restore and build interactions between various levels and aspects of mental activity. The actualization and consolidation of any bodily skills implies the demand from the outside for such mental functions as, for example: emotions, perception, memory, self-regulation processes, etc. Consequently, a basic prerequisite is being created for the full participation of these processes in the acquisition of reading, writing, and mathematical knowledge.
Neuropsychological correction is a three-level system.
Each of the levels of correction has its own specific “target” of influence and is aimed at all three blocks of the brain.” (A.V. Semenovich)
1st level- “the level of stabilization and activation of the energy potential of the body”. Methods of the 1st level are aimed primarily at the functional activation of the subcortical formations of the brain.
2nd level- “the level of operational provision of sensorimotor interaction with the outside world”. Methods of the 2nd level are aimed at stabilizing interhemispheric interactions and specialization of the left and right hemispheres.
3rd level- "the level of arbitrary self-regulation and the meaning-forming function of mental processes." Methods of the 3rd level are aimed at the formation of the optimal functional status of the anterior (prefrontal) parts of the brain.
The correctional process gradually includes exercises of the 1st, 2nd and 3rd levels, however, the specific weight and time of application of certain methods vary depending on the initial status of the child. Accordingly, the use of methods of different levels requires a well-thought-out strategy and tactics based on the results of neuro psychological diagnostics.
Neuropsychological correction is intended for children from early childhood to school and adolescence. It is especially indicated for such types of dysontogenesis as early childhood autism, mental retardation, mental retardation of various types, general developmental disorders, alalia, dysarthria, dysgraphia, dyslexia, ADHD, cerebral palsy. In particular, neurocorrection helps children who experience learning difficulties due to psychological reasons(neurotic disorders, psychosomatic disorders, personality traits), with general physical underdevelopment, with school maladjustment and stress disorders.
Indications for starting psychocorrectional work can be:
- emotional development difficulties
- actual stress,
- depression,
- decrease in emotional tone,
- lability, impulsiveness of emotional reactions,
- emotional deprivation, experiences of emotional rejection, feeling of loneliness, the presence of conflicts in interpersonal relationships;
- dissatisfaction in the family situation, jealousy,
- increased anxiety, fears, phobic reactions,
- negative "I-concept", low, disharmonious, distorted self-esteem, low degree of self-acceptance
Thus, psychological correction has a large arsenal of means and methods, the use of which must be consistent with age and individual characteristics, the nature of the existing deviations, disorders and personality anomalies.
If necessary, accompanying the patient in a team of specialists - pathopsychologist, defectologist, neuropsychologist, psychoneurologist, psychiatrist.
To begin with, it is worth defining the concept of psychology. Literally, it is the science of the soul. Psychology as an independent discipline established itself only in the last century, after receiving an experimental basis and a natural scientific physiological basis.
What role does psychology play in modern life?
This science can be encountered not only as a scientific discipline, but also in fashion publications, radio and television programs in the form psychological tests, recommendations for couples, businessmen, etc.
Within the framework of modern society, the psychology of life has several meanings. This is:
- The practical role is to help solve real problems regarding production activities life difficulties, right choice profession, adaptation in the team, family relationships; training in the right approach to managers, colleagues, subordinates, relatives.
- The developing role is the application of the acquired psychological knowledge to oneself through self-observation, professional psychological tools (for example, tests).
- The general cultural role is the mastery of the cultures of different peoples through the acquisition of psychological knowledge (works of outstanding domestic and foreign scientists).
- The theoretical role is the study of fundamental problems.
Social psychology in modern society
Over the past few years, society has moved from a state of euphoria, anticipation associated with favorable hopes for scientific and technological progress (STP), to a state of so-called frustration (a real vision of the negative consequences of the impact of STP).
The first consequence is the divergence of humanitarian and technical knowledge. This is especially noticeable in the activities of technical specialists. They were prepared only for the systematic development of technology and production. The intellect of such a specialist, as well as his skills, abilities, worldview and psychology, were concentrated only on solving technical problems. Technicism manifests itself in the process of absolutization of any modern professional activity, relevant knowledge and required approaches. The consequence of this is the displacement of individual needs by universal ones. A particular manifestation of the above process is the tragic development of the ecological and military situation in the modern world.
Among the various sciences centered on a person, sociological and humanitarian ones, in particular, social psychology, are of particular importance. It will facilitate the process of neutralization in the aforementioned technical approaches regarding worldview issues. Social knowledge will help to see the depth and complexity of real human relationships.
The professional activity of, for example, an engineer (transformative, research, cognitive, etc.) is not only direct contact with the analyzed object (equipment, technology, design), but also live human communication (in addition to setting goals, making decisions, there is also coordination group ideas and goals, the ability to resolve intra-collective conflicts). All this is a manifestation of a special interpersonal communication that requires the engineer to have special socio-psychological knowledge and culture, which he must master in the course of training.
The psychology of life (as a science of the soul) should help modern society, along with the development of technology and technology, to evolve in the socio-psychological and humanitarian aspects.
Fundamentals of human psychology
An individual is a certain person with exceptional features inherent in him (a representative of the human race).
Everyone knows the expression: "A person is born, but a person becomes." So, a newborn child is already an individual, but not yet a person. If around it will be created favorable conditions, he will grow it. But there is another outcome: children raised outside of society (not knowing the language and generally accepted social norms) often do not fall under the category of personality. Also, individuals leading a vegetative lifestyle are not defined as individuals; incapable of interaction (due to genetic defects or various kinds of injuries). Non-personalities also include serial killers, maniacs and other psycho- and sociopaths.
Personality is a lifetime formation (systemic) that reflects the social essence of a real type of person as an active world transformer and a meaningful subject of cognition.
Individuality is a personality in all its originality (a combination of personal and individual properties that distinguishes one person from another). It can manifest itself in the specifics of either feelings, or mind, or will, or all at the same time.
What is vocational psychology?
This is a new branch that studies the patterns of personality formation within the framework of the phenomenology of professionalization, the specifics of professional self-determination, as well as the psychological costs of this process.
Practically in the life of any person, professional activity is given an important place. With the birth of their child, parents are already beginning to think about his future, carefully observing the inclinations and interests.
School graduates, as a rule, face the problem of choosing their future profession. Unfortunately, quite often educational institutions are chosen randomly. After admission, for most young people, the above problem is not permanently resolved. Many are disappointed in their choice already in the 1st year of study, some at the beginning of their careers, and still others after several years of working in their profile. Professional psychology is a branch that studies patterns in the formation of intentions, choosing a profession, mastering it.
Its object is the interaction of the profession with the individual. The center of the research is professional development of personality, professional self-determination.
Specific methods of analysis of occupational psychology are based on the formation of:
Interpretation of the concept of "psychological correction"
This is a directed manipulation of certain psychological structures, carried out in order to ensure the comprehensive development of the individual, as well as his full functioning.
This term became widespread in the 70s (at a time when psychologists began to diligently engage in psychotherapy, usually group). At that time, they constantly discussed the topic of the possibility of psychologists to carry out therapeutic (psychotherapeutic) activities, for which, in fact, they were prepared in the best possible way due to the initial psychological education. This has been consistently proven in practice. However, psychotherapy is predominantly a healing practice. Only persons with higher medical education can engage in it. In this regard, an unspoken distinction was introduced: the doctor conducts psychotherapy, and the psychologist conducts psychological correction. Nevertheless, the questions in which psychotherapy and correction (psychological) are correlated are still open at the present time.
It is customary to distinguish two points of view regarding this point:
1. Complete identity of the above concepts. But here it is not taken into account that correction (psychological) as a directed manipulation is implemented not only in medical practice (in three main areas of application: psychotherapy, rehabilitation and psychoprophylaxis), but also in other areas, for example, in pedagogy. Even in everyday communication, its echoes can be traced.
2. is called upon to deal with the tasks of psychoprophylaxis (at all stages), and especially when conducting secondary and subsequent prevention. But this rigid restriction on the scope of the procedure under consideration seems, so to speak, artificial: with regard to neuroses, it is not possible to clearly distinguish between such concepts as psychological correction, treatment, prevention, psychotherapy, because neurosis is a disease that occurs in dynamics (it is not always possible to track the stage of pre-illness from the disease itself, and the process of treatment for the most part consists of secondary prevention).
Also today, within the framework of the system of rehabilitation treatment of diseases, an integrated approach is increasingly being used, which takes into account the presence of social, biological and psychological factors in the etiopathogenesis, each of which requires therapeutic or corrective manipulations that correspond to its nature. In a situation where the psychological factor in a certain disease is regarded as etiological, then its professional correction for the most part coincides with one of the components of such a healing process as psychotherapy.
It is most often impossible to establish a general scheme regarding the correlation of the above concepts outside of nosology. The role of the psychological factor in the framework of the etiopathogenesis of a certain disease determines the orientation of methods for solving psychotherapeutic problems, which makes it possible to identify methods psychological correction with psychotherapy.
correction with psychological intervention
The result is an obvious resemblance. Correction (psychological), as well as psychological intervention, is regarded as a targeted psychological impact that is realized in various areas of human practice and is carried out with the help of psychological means.
Both perform the same function. In foreign literature, the concept of "psychological intervention" is more common, and in domestic literature - "psychological correction".
Methods of psychological correction
They are diverse, conditionally they can be classified based on their specifics of the main approaches:
1. Behavioral (deviations are interpreted as the principles of behaviorism: both psychotherapy and psychological correction are associated with the need to create optimal behavioral skills in the patient; different types mental disorders determined by maladaptive behavior).
Here, methods are used that can conditionally be classified into three groups:
- counterconditioning (breaking the negative, strengthened connection between the reactions and the stimulus and (or) replacing it with a new one (in practice, such psychological techniques are used as a combination of a pleasant effect with an unpleasant situation for the patient, or vice versa);
- operant methods (application of a system of rewards for desirable, in the opinion of the therapist, actions);
- methods based on the views of sociobehaviorists (presentation by the doctor of the model of the most acceptable behavior).
2. Activity (correction through the organization of a special learning process, the result of which is the management and control of external and internal activity).
3. Cognitivist (the basis is theories that characterize the personality as an organization of certain cognitive structures; the use of "personal constructors" that allow one to put forward appropriate hypotheses about the world).
4. Psychoanalytic (assistance to the patient in identifying the unconscious causes of serious experiences, painful manifestations through their study).
5. Existential-humanistic (based on the philosophy of existentialism).
6. Gestalt therapy (restoration of the continuity of human consciousness).
7. Psychodrama (modeling in theatrical form by group members of a situation proposed by one of the patients and based on real events from his life or stories from his dreams).
8. Body-oriented (based on the system of "vegetotherapy" by W. Reich: "opening of muscle shells", which subsequently helps a person to release energy, and therefore alleviate his mental suffering).
9. Psychosynthesis (an important role is given to subpersonalities - isolated personalities within each person, with whom the patient gets acquainted during therapy and learns to separate them from his real "I").
10. Transpersonal (helping the patient meet his own unconscious and live the corresponding experience through the use of the "holotropic breathing" method).
Methods of psychodiagnostics
They look like this:
- Blank (offering the subject a series of questions and judgments).
- Questioning methods of psychological diagnostics (asking oral questions to the subject).
- Drawing (using the drawings created by the subject or interpreting the finished images).
- Design (application of the above methods).
- Objective-manipulative methods of psychological diagnostics (representation in the form of various kinds of real objects of tasks solved by the subject).
The goals of psychocorrection of the child
Within the framework of domestic psychology, they are established by understanding the patterns of the child's psychological evolution as an actively developing activity process, which is implemented in cooperation with an adult.
The goals of psychological correction are formed on the basis of:
- optimization of the social situation of the observed development;
- formation of age-psychological new formations;
- development of various activities of the observed child.
There are rules that should be followed when specifying the goals of the correction in question, namely:
- They must be formulated in a positive way.
- The goals of psychological correction should be realistic enough.
- They necessarily include forecasts of the current and future development of the child's personality for the systematic refinement of the correctional program.
- It must be remembered that the psychological correction of children gives significant results only after a long period of time (during therapy, towards its completion, six months after it).
In the professional activity of a correctional and developmental orientation, a teacher-psychologist of a special institution uses subgroup, group and individual forms of work. Psychological correction and development of the child in one form or another is determined depending on its characteristics (severity of affective problems, age, rate of perception of the material, etc.).
Psychocorrection program for the behavior of adolescents with mental retardation
The education of socially appropriate behavior is the most important goal of correctional pedagogy. The program of psychological correction of the behavior of children with mental retardation has rather complex tasks due to the fact that there is a moment of weakened, deficient development, primarily of the psychophysiological base of the mechanisms of behavior (affective-volitional sphere of the personality).
The reason for the disharmony of mental homeostasis is acute cerebral insufficiency, inhibition of the development of the nervous system. In this regard, behavior correction is the most important direction in the process of working with adolescents with mental retardation. It should be focused on reducing aggression in children and on the formation of socially appropriate approved behavior in them.
She is engaged in specialized institutions, for example, the center for psychological correction "Speech Center of the Institute of the Family." The most important principle of his work is taking into account the severity and form of the child's mental development.