Correction and development program of individual lessons with children with cerebral palsy and mental retardation: “The palms of hope. Psychological help for children with cerebral palsy

Introduction……………………………………………………….3

Characteristics of the phenomenon of cerebral palsy………………………..4

Working with children with cerebral palsy………………………………….7

Conclusion………………………………………………..12

Literature………………………………………………...13

INTRODUCTION

Every family wants to have a healthy child. Perhaps there are no parents who would not want their children to be strong, smart and beautiful, so that in the future they would be able to take their rightful place in society.

But some children immediately after birth experience painful changes in muscle tone and a number of other symptoms, which then leave an indelible imprint on the entire life of the child, and subsequently the adult and the life of his parents.
The well-known Austrian physician and psychologist Sigismund Freud at the end of the nineties of the century before last united these phenomena under the name of cerebral palsy. The causes of this disease can also be an infection, antibodies, an incorrect Rh factor, hypoxia in newborns, or birth trauma.

Most children with cerebral palsy have speech disorders that greatly hinder their contact with parents and peers.

Pronounced movement disorders and speech disorders in children with cerebral palsy make it difficult for these children to communicate with others, negatively affect their entire development, contribute to the formation of negative character traits, the appearance of behavioral disorders, and the formation of an acute sense of inferiority.

But these children are full-fledged members of society and it is necessary to provide all conditions for the full-fledged personal development of children with disabilities.

aim This work is to study the features of working with children with cerebral palsy.

A great contribution to the study of this issue was made by: Badalyan L.O., Lebedev V.N., Kirichenko E.S. , Zeigarnik B.V., Petrova V.G.

CHARACTERISTICS OF THE PHENOMENON OF ICP.

As mentioned earlier, in the late nineties of the nineteenth century, the Austrian physician and psychologist Sigismund Freud singled out a group of diseases called "cerebral palsy". Although, in fact, we are not talking about paralysis, as such, but about impaired coordination of movements associated with damage to certain brain structures that occurs in the pre- and post-natal period of a child’s development and as a result of birth trauma. Often such lesions occur even in the embryo. Their culprits are infection, antibodies, wrong Rh factor or neonatal hypoxia.

Neurologists distinguish three main forms of cerebral palsy: spastic, which is characterized by a constant increased tone of individual muscle groups - most often flexors; hyperkinetic, or athetoid, when the tone in the flexors and extensors is constantly changing, which causes sharp involuntary movements of the trunk and limbs that prevent the child from walking and maintaining balance, and asthenic-astatic. With this form of the disease, the tone of all muscle groups is reduced, which also makes it difficult to maintain balance and move normally. There are cases when the asthenic-astatic form becomes athetoid.

Most children with cerebral palsy have speech disorders that greatly hinder their contact with parents and peers. Severe, so-called generalized, forms of cerebral palsy, when the arms and legs, speech, and sometimes the child's hearing are affected, lead him to a deep disability. Cerebral palsy is a non-progressive disease, but it can cause complications in the form of contractures and various deformities. In fact, cerebral palsy is not even a disease, but a condition in which the normal development of a child is extremely difficult.

Forms of cerebral palsy.

The hemillegic form is the most common type of cerebral palsy. It depends on the predominant damage to one hemisphere of the brain. Already from the first days of a child's life, it can be noted that one of his arms and legs do not take part in the constant movement of the limbs. Such children begin to sit up late and especially late and with difficulty to stand and walk. In the paretic limbs, violent movements of an athetotic nature are often noted. There are epileptic seizures of the general or Jacksonian type.

The diplegic form of cerebral palsy, which is called Little's disease, is expressed in spastic paralysis or spastic paresis of both legs. The child lags behind in physical development and if he starts to stand and walk, then with a big delay. As a result of an increase in muscle tone, a sharp tension in the adductor muscles of the thigh and contracture of the calf muscles, the gait of such patients is very peculiar, which sometimes makes it possible to make a diagnosis without a detailed study. Patients do not rely on the sole, but on the fingers, the knees touch each other and rub against each other when walking, the gait is spastic-paretic, and it seems that the patient is constantly striving forward and down. This defect in the legs may be accompanied by athetosis in the muscles of the face and in the distal parts of the arms. Various synkinesis can also be observed, which, combined with hyperkinesis, make it very difficult to perform voluntary movements. Intellectually, these patients can be quite safe.

The hyperkinetic form is characterized by the presence of violent movements such as athetosis, myoilonia, which are combined with a significant violation of muscle tone and psyche. Speech disorders are often noted.

Thus, motor disorders in children with cerebral palsy adversely affect the entire course of its mental development.

Psychophysical development of children with CP.

A feature of mental development in children with cerebral palsy is not only its slow pace, but also its uneven nature, disproportion in the formation of individual, mainly higher cortical functions, accelerated development of some, unformedness, lagging behind others.

Violations of spatial gnosis are manifested in the slow formation of concepts that determine the position of objects and parts of one's own body in space, the inability to recognize and reproduce geometric figures, to put together a whole from parts. While writing, errors in the graphic representation of letters, numbers, their specularity, asymmetry are revealed.

In close connection with violations of visual-spatial synthesis is the weakness of counting functions. These disorders are manifested in slow assimilation of the number and its bit structure, slow automation of mechanical counting, misrecognition or confusion of arithmetic signs and numbers when writing and reading.

Disorders of attention and memory are manifested in increased distractibility, inability to concentrate for a long time, narrowness of its volume, predominance of verbal memory over visual and tactile. At the same time, in individual conditions and in a learning experiment, children reveal a sufficient "zone" of their further intellectual development, show a kind of perseverance, perseverance, pedantry, which allows them to compensate to a certain extent for disturbed activity and more successfully assimilate new material.

Manifestations of mental infantilism, characteristic of almost all children suffering from cerebral palsy, are expressed in the presence of features of childishness, spontaneity, predominance of activity motivated by pleasure, a tendency to fantasize and daydreaming, which are unusual for this age. But in contrast to the classical manifestations of “harmonic infantilism”, children with cerebral palsy show insufficient activity, mobility, and brightness of emotionality. characteristic of children with cerebral palsy fearfulness, increased inhibition in unfamiliar conditions are recorded in them for a long time, which significantly affects the learning process.

In children, there is also often a delay in the formation of individual mental functions. The severity of motor impairment in a child does not correlate with the severity of deviations in his mental development.

Specially conducted studies have shown that cerebral palsy is a disease that has a non-progressive type of course.

WORK WITH CHILDREN WITH ICP

One of the most important aspects of working with children with cerebral palsy is the creation of conditions for the full-fledged personal development of children with limited mobility in the course of implementing measures for psychological and pedagogical rehabilitation and social adaptation, followed by their integration into modern society. Systematic monitoring of the development of students in the course of the educational process, dynamic, comprehensive, comprehensive and holistic study of the child is considered as the basis for the socio-psychological support of the educational process of children with cerebral palsy. Taking into account the results of the psychological and pedagogical study of the child, the educational route is adjusted, individual training programs are developed, and their implementation is analyzed. The model of socio-psychological support for children with cerebral palsy has its own specifics, which is determined by the psychological characteristics of children, the deformation of their personal development, and sometimes disharmonious relationships with parents.

Approximately half of children with cerebral palsy are mentally retarded. However, one should not rush to conclusions. Children with cerebral palsy move clumsily, either too slowly or too fast. Their faces are distorted due to weakness of the facial muscles or difficulty in swallowing, grimaces appear on them. Therefore, a child with normal mental development may appear mentally retarded.

Such a child needs special help with learning. After all, very often he understands much more than he can say or show.

Through intensive work in preschool age child who has reached school age, turns out to be quite normal mentally and practically trainable.

A child with higher mental abilities usually successfully adjusts to his condition. However, intelligence does not always play a major role. Some developed children are much more easily frustrated and discouraged by failure. Additional efforts are needed to find new and interesting ways to stimulate their development.

The main postulates of the life of a sick child should be:

self-confidence and the ability to like yourself;

the ability to communicate with other people;

self-care skills.

In many countries, cerebral palsy is the most common cause of physical handicaps. In our country, this disease ranks second after polio. Approximately one child in three hundred newborns is born with cerebral palsy or develops it shortly after birth. children with physical or mental illnesses have the right to receive qualified pedagogical assistance at home.

A well-designed and carefully designed home-schooling program should help a child with a developmental delay to progress much further than would be possible without outside help.

All classes with a sick child have a flexible structure, developed taking into account age characteristics and the degree of severity of the defect. Classes are built on the basis of the principle of integration by alternating exercises according to the degree of complexity. The structure of the classes is flexible, but at its core it includes cognitive material and elements of psychotherapy.

In the process of studying with a sick child, it must be remembered that the assimilation of educational material should simultaneously form communicative qualities, enrich emotional experience, activate thinking, design social interactions and motor acts, and form a personal orientation.

The psychological state of the child at a particular moment can cause a variation in the methods, techniques and structure of the lesson.

Effective methods of corrective impact on the emotional and cognitive sphere of children with developmental disabilities are:

game situations;

didactic games, which are associated with the search for specific and generic features of objects;

game trainings that contribute to the development of the ability to communicate with others;

psycho-gymnastics and relaxation, allowing you to relieve muscle spasms and clamps, especially in the face and hands.

The development of active thinking goes in two ways: from visual-active to visual-figurative and logical. These paths of development at a certain stage merge together, and this plays a special role in the cognitive activity of the child.

An important method of comprehending new facts and phenomena has become an appeal to a visual image: a pantomime image of the subject of conversation, artistic illustrations, a drawing, a symbolic sign - all that becomes a support for the development of the thinking of a sick child. All this ensures the union of reason and feeling.

It is advisable to introduce elements of developmental education into the methodology of home education V.V. Davydova - D.B. Elkonin and L.V. Zankov, in which a modification of the sound analytic-synthetic method can be applied. These methods are based on the concepts of words formulated earlier in the process of teaching the child, that is, the child must understand the lexical meaning of the word.

But the basis of all education should be that mental function that is most accessible and is the leading one at this stage of the physical and mental state of a sick child.

Classes with a sick child are recommended to be carried out in the form of a lesson. A lesson is a communication between a teacher and a student. The child is arranged in such a way that he develops in the process of this communication. This process is based on the emotional contact between an adult and a child, which gradually develops into cooperation, which is a necessary condition for the development of a child. Their cooperation lies in the fact that an adult seeks to convey his experience, and a child wants and can learn it.

Be patient and observant. Children do not study all the time, they need rest. Watch the child carefully, try to understand how he thinks, that he knows how to use skills.

When talking with your child, give him time to answer your questions, take turns talking, remember the importance of repetition.

Be consistent. Move from simple to complex, from one skill to another.

Diversify your classes, add new elements to your lesson daily.

Be expressive, emotional, change the intonation of your voice, but speak clearly, do not lisp.

Praise and encourage your child often.

Be practical, give more independence to the child in choosing methods of solution and answers - this contributes to the development of independence.

Keep your confidence. Remember that all children respond to love, care and attention.

Upbringing should be sparing for childhood - a time of inability, ignorance, mistakes, oversights, misconduct and misunderstanding.

Conclusion.

For children with such a serious disease as cerebral palsy, not only medical, but also pedagogical assistance is important. Their parents, together with specialists - teachers, doctors, need to draw up a single complex of influence on the child.

Together with medical measures, the necessary corrective work should be carried out aimed at the overall development of the child, preventing the occurrence of undesirable personality traits in him, such as stubbornness, irritability, tearfulness, uncertainty, timidity, etc. It is necessary to form the cognitive activity of the baby, to cultivate activity and a variety of interests, especially since many children with cerebral palsy have potentially intact prerequisites for the development of thinking, including its higher forms.

It is very important to cultivate strong self-care and hygiene skills, as well as other household skills. The child must know for sure that he has duties, the fulfillment of which is significant for other family members, and strives to cope with them. Constant observance of the regime, a calm, friendly atmosphere in the family contribute to strengthening nervous system child, his mental, physical and moral development.

A child with impaired functions of the musculoskeletal system, like any other, must be protected in every possible way from injuries. However, it cannot be permanently protected from difficulties. Growing up in greenhouse conditions, he will subsequently turn out to be helpless, unadapted to everyday life. It is very important to form in him the right attitude towards himself, towards his capabilities and abilities. To do this, it should be repeatedly emphasized that, along with shortcomings, he has great advantages, that he can achieve a lot in life if he makes an effort. It is necessary to educate in him a full-fledged member of society, no worse than the rest, and treat him accordingly.

Literature.

Badalyan, L.O. Neuropathology / L.O. Badalyan - M., 1987

Badalyan L.O. and other Children's cerebral palsy. - Kyiv, 1988.

Lapshin, V.A. Fundamentals of defectology / V.A. Lapshin, Puzanov B.P. – M. 1990

Lebedev V.N. Disorders of mental development in children with cerebral palsy. - M., 1991.

Information resources of the global Internet network:

a) http://www.deti-feniksa.ru/readarticle.php?article_id=10

b) http://nature.web.ru/db/search.html?words=%E4%F6%EF

in) http://en.wikipedia.org/wiki/CP

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The first domestic works devoted to the psychological rehabilitation of preschool children with cerebral palsy were written in the 60s by M.V. Ippolitova (1967) and L.A. Danilova (1969). Based on foreign and their own experience, these scientists substantiated the need to form a state system of special preschool education and psychological rehabilitation of children with cerebral palsy in our country.

Psychological rehabilitation in cerebral palsy implies a system of special measures aimed at restoring (development, formation) of mental functions, processes, properties, abilities that allow the child to learn and perform various social roles, adapt in society, that is, aimed at restoring (development) psychological mechanisms social integration (E.S. Kalizhnyuk, 1987).

The system of psychological rehabilitation consists of the following components: psychodiagnostics, psychocorrection, psychological support and psychological career guidance. The expediency of psychological rehabilitation, its priority areas, optimal methodological techniques are determined, first of all, by what areas of mental activity were disturbed and by what mental functions should be restored and developed in the first place. This requires a psychodiagnostic examination. Psychodiagnostics allows you to determine the features of the current mental state and the potential for mental development (zones of proximal development) of a child with cerebral palsy.

During psychological diagnostics children and adolescents with cerebral palsy must comply with a number of basic principles (R.Ya. Abromovich-Lichtman, 1965);

• 1. The activity principle aimed at conducting a psychological examination in the context of activities available to a child with cerebral palsy: subject-practical, playful, educational.
• 2. The principle of qualitative analysis of the obtained data of psychological examination.

This is a principle built on the concept of L.S. Vygotsky (1960) about the decisive role of education in the process of child development is extremely important in the psychological diagnosis of developmental disorders. For a psychologist, not only the final result of the test task is important, but also the way the child works, the ability to transfer the acquired skills to a new task, the child's attitude to the task, and his own assessment of his results.

• 3. The principle of a personal approach in the process of diagnosis, the psychologist analyzes not a single symptom, but the personality of the child as a whole.
• 4. The principle of a comparative approach in the study of impaired development, the psychologist must correctly orientate himself in the peculiarities of the mental development of a healthy child.
• 5. The principle of an integrated approach to diagnosing a child's mental development includes taking into account many factors that underlie the developmental disorders of a child with cerebral palsy: clinical, pedagogical, psychological, social.

According to the results of psychodiagnostics should be:

• -- Identified violations of mental activity, their mechanisms for determining the prospects for rehabilitation;
• - the most preserved mental functions were identified in order to “activate” compensatory mechanisms, which is extremely important, especially when the impaired function cannot be restored;
• - an assessment was made of those features of mental activity that will contribute to the successful social integration of the child on different stages age development.

The object of psychological rehabilitation is not only the child with cerebral palsy, but also his immediate environment, primarily parents, family, therefore, psychodiagnostics of the family is necessary to assess the system of relations in which the child develops, his personality is formed. Psychological examination of the family is especially important in the early stages of the ontogeny of a child with cerebral palsy, since it is organizationally difficult to conduct psychological rehabilitation with children under 3–5 years of age without the active participation of their parents. Children with cerebral palsy may experience a variety of developmental disorders. Nevertheless, typical phenomenological features of the development of children with cerebral palsy can be identified (T.N. Osipenko, E.E. Statsevich, L.A. Nochevka et al. 1993, p. 25-40). They are expressed:

• - in violations of psychomotor functions, when both large and fine motor skills suffer;
• - in violations of speech functions, when both expressive and impressive speech suffer;
• - in violations of sensory-perceptual functions, when spatial orientation is significantly hampered;
• - in violations of the function of memory and attention, which is most clearly manifested in relation to arbitrary (active) memory and active attention;
• - in various violations of the functions of verbal and non-verbal thinking, when the most noticeable defect is observed in relation to the processes of generalization and abstraction, inductive, conceptual and spatial thinking, practical mathematical thinking;

As a rule, in children suffering from cerebral palsy, there is a characteristic dynamics in the manifestation of mental developmental disorders. So, already in the early stages of ontogenesis (the first weeks, months of life), they may have psychomotor, sensory-perceptual and speech disorders, impaired attention functions in the form of inadequate motor activity, discoordination of motor acts, and the absence of behavioral and emotional reactions to sensory and speech stimuli. etc. (K.A. Semenova, 1999).

Based on this, A.V. Semenovich (2002) offers an in-depth psychodiagnostic examination of a child with cerebral palsy, which should provide:

• - assessment of psychomotor development (especially in the relatively early stages of a child's development);
• - a comprehensive assessment of intellectual development (from assessing the state of individual intellectual functions to an integral assessment of the level of mental development and the structure of intelligence);
• - assessment of the emotional and motivational sphere;
• - assessment of the nature and characteristics of the individual as a whole;
• - assessment of behavior and psychological mechanisms of its regulation.

In accordance with the foregoing, a choice of methods, methodological techniques, tests is made, through which these psychodiagnostic problems can be solved. The psychological examination of children with cerebral palsy is extremely difficult. This is due to severe motor pathology, as well as the presence of intellectual, speech and sensory disorders in most children. Therefore, the examination of children with cerebral palsy should be aimed at a qualitative analysis of the data obtained.

The tasks presented to the child should not only be adequate to his biological age, but also to the level of his sensory, motor and intellectual development. The examination process A.A. Kataeva, E.A. Strebeleva (1994) recommend that it be carried out in the form of play activities accessible to the child. Particular attention should be paid to the motor abilities of the child. Taking into account the physical capabilities of a patient with cerebral palsy is very important in a psychological examination. For example, with complete immobility, the child fits into a position that is convenient for him, in which maximum muscle relaxation is achieved. The didactic material used in the examination must be placed in his field of vision. The examination is recommended to be carried out in the arena, on the carpet, or in a special chair. K.A. Semenova (1999) recommends that with pronounced muscle tension, the child is given the so-called "embryonic position" (the child's head is bent to the chest, the legs are bent at the knee joints and brought to the stomach, the arms are bent at the elbow joints and crossed on the chest). Then several rocking movements are made along the longitudinal axis of the body. After that, muscle tone is significantly reduced, and the child is placed on his back. With the help of special devices (rollers, sandbags, rubber circles, belts, etc.), the child is fixed in this position. With the severity of involuntary extra movements - hyperkinesis, which interfere with the capture of the toy, it is recommended to conduct a test before the start of the examination. special exercises contributing to their reduction. For example, you can perform cross movements with simultaneous flexion of one leg and extension and bringing the opposite arm to this leg. Devices for fixing the posture are especially important when examining a child with hyperkinesis (special belts, cuffs, gauze rings, helmets, etc. are used).

In children with cerebral palsy, mental development disorders are closely related to movement disorders. The low activity of a child with cerebral palsy in many ways prevents him from actively learning about the world around him. The position of many children with cerebral palsy is forced, they lie in one position for a long time, cannot change it, turn on the other side or on the stomach. Placed in a position on their stomach, they cannot raise and hold their heads; in a sitting position, they often cannot use their hands, as they use them to maintain balance, etc. All this contributes to a significant limitation of the field of vision, hinders the development of hand-eye coordination.

The main difficulties of a psychologist when working with patients suffering from cerebral palsy are that many widely used, verified and valid methods cannot be used in whole or in part due to severe impairments of speech and motor functions (especially fine motor skills). So, with pronounced hyperkinesis, right-sided hemiparesis, the psychologist cannot fully use the Wechsler test, which is widely used to determine intellectual function. Patients due to their motor disorders are unable to perform 7, 9, 11 and 12 subtests. Moreover, this does not allow us to judge their ability to visual representation, constructive thinking, attention, hand-eye coordination, extrapolation. Even if the patient's condition allows for a psychological experiment, as a rule, it is necessary to revise the time limits provided for by the methodology. The same reasons may prevent the use of drawing tests and many others. The variety in quality and severity of speech disorders observed in patients with cerebral palsy can significantly complicate the use of verbal techniques.

A psychologist working in a specialized institution for children with cerebral palsy must have and be able to large quantity methods and interchangeable methods and before examining the patient, carefully select the most suitable for his examination, taking into account motor and speech disorders. So, the choice of a methodological arsenal largely depends on the "capabilities" of the child with cerebral palsy being examined, on his ability to perform certain test tasks. So, up to 3-4 years of age, the psychological examination of a child is based on the methods of fixed observation in natural or experimentally modeled situations.

Test psychological examination of children is effective from 4-5 years.

At the same time, test tasks are given orally and are conducted individually. Questionnaires can be used from 12-14 years old. Given the increased exhaustibility of this contingent of children, you need to be careful about the "dosing" of test loads.

As a rule, up to 5 - 7 years, the duration of a single examination should not exceed 20 - 30 minutes. Impairment of intellectual development in cerebral palsy introduces its own specifics into the organization of psychological examination, the expediency of changing the standard examination procedure or modifying instructions.

To assess intelligence and intellectual functions in cerebral palsy, the following can be used:

• -- Wexler test;
• -- graphic tests;
• -- classification tests;
• -- method of exclusion of items;
• -- Amthauer intelligence test;
• - tests of school maturity.

To diagnose disorders of psychomotor functions (involuntariness of movements, decrease or increase in motor activity in general), methods of observing behavior, the nature of motor reactions, as well as graphic tests, a tremor test, a tapping test (from 5 years old), a reaction time test ( from 5 years), a method for assessing neuropsychic development (4-6 years), a method for determining the coefficient of psychomotor development (up to 4 years).

When diagnosing disorders of perception and attention, in addition to observation methods, pathopsychological tests are used: a correction test (from 5 years old), the Missing Details test (from 5 years old). A common method for studying attention is the Schulte tables, and for the study of working capacity and fatigue, the methods of Kraepelin, Landolt.

When diagnosing mental functions in cerebral palsy, special attention should be paid to young children (up to 3-4 years). Their diagnosis is based mainly on the method of fixed observation described in the "Early Learning Guide" (Portrage, USA), which assesses various levels of mental development: motor functions, speech, self-care skills, cognitive abilities, socialization.

The complex rehabilitation treatment of cerebral palsy includes: medications, various types of massage, exercise therapy, orthopedic care and more (EG Sologubov, KA Semenova, 1999).

The complex nature of correctional-psychological-pedagogical work provides for constant consideration of the mutual influence of motor, speech and mental disorders in the dynamics of the child's ongoing development. As a result, it is necessary to jointly stimulate the development of all aspects of the psyche, speech and motor skills, as well as the prevention and correction of their violations. Main tasks and principles corrective work with children were developed by L.S. Vygotsky (1960) and were first used in defectology in relation to different options developmental anomalies.

An early onset of ontogenetically consistent action based on preserved functions is necessary. In recent years, early diagnosis of cerebral palsy has been widely introduced into practice. Despite the fact that already in the first months of life it is possible to identify the pathology of pre-speech development and disorders of orienting-cognitive activity, corrective and in particular speech therapy, work with children often begins after 3-4 years. In this case, the work is most often aimed at correcting already existing defects in speech and psyche, and not at preventing them. Early detection of the pathology of mental and speech development and timely correctional and pedagogical influence in infancy and early age can reduce, and in some cases eliminate psychoverbal disorders in children with cerebral palsy at an older age. The need for early corrective work in cerebral palsy stems from the characteristics of the child's brain - its plasticity and universal ability to compensate for impaired functions, as well as from the fact that the most optimal time for the maturation of a functional speech system is the first three years of a child's life. Correctional work is built not taking into account age, but taking into account at what stage of psychoverbal development the child is (A.R. Luria, 1948).

Correctional psychological work is organized within the framework of the leading activity. Disorders of mental and speech development in cerebral palsy are largely due to the absence or deficiency of children's activities. Therefore, during correctional and pedagogical activities, the leading type of activity for a given age is stimulated: in infancy - emotional communication with an adult; at an early age - objective activity; at preschool age - game activity.

In order to carefully study and reveal the structure of mental disorders, it is necessary to dynamically monitor the development of the child for a long time. At the same time, the efficiency of diagnostics and correction is significantly increased. This is especially important when working with children with severe and combined disorders.

With cerebral palsy, it is important to develop a coordinated system of inter-analyzer connections, rely on all analyzers with the mandatory inclusion of a motor-kinesthetic analyzer. It is advisable to rely on several analyzers simultaneously (visual and tactile, tactile and auditory). A flexible combination of various types and forms of correctional-psychological-pedagogical work (individual, subgroup and frontal) is necessary. In the process of psychological correction of developmental disorders in children with cerebral palsy, it is necessary to take into account the complex structure of the developmental features of the child, the nature of the combination in the picture of his condition of such factors as the social situation of development, the severity of personality changes caused by the disease, the degree of physical helplessness (I.I. Mamauchuk, 2001).

The experience of effective work of psychologists proves that psychological correction can be considered in the broad and narrow sense of this concept. In a broad sense psychological correction-- this is a complex of medical, psychological and pedagogical influences aimed at eliminating the shortcomings in the development of mental functions and personality traits in children. In a narrow sense, psychological correction is seen as a method psychological impact, aimed at optimizing the development of mental processes and functions and at harmonizing the development of personal properties.

B. D. Elkonin (1978), depending on the nature of the direction of the correction, distinguishes two of its forms; symptomatic, aimed at the symptoms of developmental deviations, and correction, aimed at the source and causes of developmental deviations. Symptomatic correction, of course, is not without significant shortcomings, since the symptoms of developmental deviations have different causes and, as a result, the psychological structure of developmental disorders in the child is different. With the help of special pedagogical methods, it is possible to help the child learn the ordinal count, the composition of the number, etc. However, despite intensive studies, the child still has significant difficulties in mastering mathematics. This method of correction is insufficient if we do not know the true cause that generates counting disorders in children with cerebral palsy.

The basis of violations of counting operations in children with cerebral palsy is the underdevelopment of spatial representations, which is due to cerebral-organic insufficiency of the parieto-occipital regions of the brain. Therefore, psychological correction should be more focused not on the external manifestations of deviations in development, but on the actual sources that give rise to these deviations. For the effectiveness of psychocorrection, classes are needed to develop the visual-spatial functions of a child with cerebral palsy.

The effectiveness of psychological correction largely depends on the analysis of the psychological structure of the disorder and its causes.

The complexity and originality of developmental disorders of the child require a careful methodological approach to its analysis and psycho-corrective influences. The development of principles as fundamental, starting ideas is extremely important in the theory and practice of psychological correction (L.M. Shipitsina, 2001).

An important principle of psychological correction is the principle of complexity. According to this principle, psychological correction can be considered as a single complex of medical, psychological and pedagogical influences. The effectiveness of psychological correction largely depends on the consideration of clinical and pedagogical factors in the development of the child. For example, communication training that a psychologist uses in a clinic to optimize the child's communication process will not be effective if the psychologist does not take into account clinical factors and the social environment (medical staff, teachers, parents) in which the child is located.

The second principle of psychological correction is a personal approach. This is an approach to the child as a whole person, taking into account all its complexity and individual characteristics. In the process of psychological correction, we take into account not some separate function or isolated mental phenomenon in a person, but the personality as a whole. Unfortunately, this principle is not always taken into account in the process of group trainings, psychoregulatory trainings.

When using various methods of psycho-correctional influences, a psychologist should not operate with such concepts as a generalized norm (age, gender, nosological). In the process of psychological correction, we focus not on any one parameter, but on the personality as a whole.

The third principle is the activity approach. Personality is manifested and formed in the process of activity. Compliance with this principle is extremely important in the process of psychological correction of children and adolescents. Psychocorrective work should be built not as a simple training of the child's skills and abilities, not as separate exercises to improve mental activity, but as a holistic meaningful activity that organically fits into the system of the child's daily life relationships. The psycho-corrective process should be carried out taking into account the main, leading type of activity of the child. If this is a preschooler, then in the context of play activities, if a schoolchild, then in educational activities. However, taking into account the specifics and tasks of the psycho-corrective process, one should focus not only on the leading type of activity of the child, but also on the type of activity that is personally significant for the child and adolescent. This is especially important when correcting emotional disorders in children. The effectiveness of the correctional process largely depends on the use of the child's productive activities (for example, drawing, designing, etc.).

The fourth principle of psychological correction is the unity of diagnosis and correction. The tasks of corrective work can be correctly set only on the basis of a complete psychological diagnosis of not only the zone of actual, but also the zone of proximal development of the child. The scheme and selection of diagnostic and psycho-corrective methods and techniques should correspond to the nosology of the child's disease, the characteristics of his age characteristics, physical capabilities, the specifics of the leading activity characteristic of each age period. The processes of psychological diagnostics and correction are complementary processes, not mutually exclusive. The very process of psychological correction has a huge diagnostic potential. For example, under no psychological testing so the communicative abilities of the individual are not revealed, as in the process of group psycho-correctional classes. Or psychogenic experiences of the child are reflected with the greatest depth in the process of game psycho-correction. The process of psychological diagnostics contains corrective possibilities, especially when using a learning experiment.

The fifth principle of psychological correction is hierarchical. It is based on the position of L.S. Vygotsky (1960) about the leading role of education in the mental development of the child. The implementation of this principle means the purposeful formation of psychological neoplasms, requires maximum activity of the child and is of a proactive nature, since the correction is not aimed at the actual zone, but the zone of proximal development of the child. For example, in order to correct mnestic functions in a child, it is necessary to develop mental operations: analysis, synthesis, generalization. Teaching a child to use mental operations in the process of memorizing material will increase the effectiveness of memorization to a greater extent than simple memory training.

The sixth principle is causal. The implementation of this principle in psycho-corrective work is aimed at eliminating the causes and sources of deviations in the mental development of the child. Depending on the root cause, a psychocorrection strategy is developed. If the cause of the emotional distress of the child is family conflicts, inadequate styles of family education of a sick child, then the psycho-correctional process should be aimed at normalizing family relations. If the cause of emotional disorders is residual organic insufficiency of the central nervous system, then the main link in psychological correction should be the reduction of the child's emotional discomfort by special methods of psychoregulatory training against the background of drug therapy.

The seventh principle of psycho-correction is temporary, that is, the early onset of an ontogenetically consistent impact based on preserved functions. Early detection of the pathology of pre-speech and early speech development and timely corrective pedagogical influence in infancy and early age can reduce, and in some cases eliminate psycho-speech disorders in children with cerebral palsy at an older age. The need for early corrective work in cerebral palsy arises from the characteristics of the child's brain - its plasticity and universal ability to compensate for impaired functions, and also due to the fact that the most optimal time for maturation of the speech functional system is the first three years of a child's life. Correctional work is built not taking into account age, but taking into account at what stage of psychoverbal development the child is.

The main directions of psycho-correctional work with cerebral palsy in early and preschool age are:

• -- development of emotional, speech, subject-effective and game communication with others;
• - stimulation of sensory functions (visual, auditory, kinesthetic perception and stereognosis), the formation of spatial and temporal representations, the correction of their violations;
• -- development of prerequisites for intellectual activity (attention, memory, imagination);
• -- development of visual-motor coordination and functionality of the hand and fingers; preparation for writing.

The eighth principle is the unity of corrective work with the child and his environment, primarily with the parents. Due to the huge role of the family, the immediate environment in the process of becoming a child's personality, such an organization of society is necessary that could stimulate this development as much as possible, smooth out the negative impact of the disease on the mental state of the child.

The experience of psychologists-teachers in the system of medical correctional institutions shows that the main goal is to maximize the development of the cognitive abilities of children with psychomotor development disorders (I.A. Smirnova, 2003).

The psychologist-teacher at the same time solves the following tasks:

• - development of safe aspects of cognitive activity;
• - correction of deviations in mental development;
• - formation of compensatory ways of cognition of the surrounding reality;
• - development of visual perception of colors: distinction, naming of colors, classification by color, row formation by color intensity;
• - development of visual and tactile perception of forms: distinction, naming, classification, transformation of forms;
• - development of visual and tactile perception of quantities: distinction, naming, classification, transformation, comparison in magnitude, row formation in magnitude;
• - development of visual and tactile perception of the texture of objects: distinction, naming, classification;
• - development of visual and tactile perception of spatial relationships: understanding, naming, orientation, transformation;
• - development of auditory perception of non-speech sounds;
• - development of tempo-rhythmic feeling: recognition and reproduction of tempo-rhythmic structures. The development of speech involves:
• - development of the phonemic system: differentiation of sounds, phonemic analysis and synthesis, phonemic representations;
• - development of visual-effective and visual-figurative forms of thinking: establishing the identity of objects, comparing objects, modeling in size and shape, developing the ability to correlate parts and the whole, classifying objects according to one or two features;
• - development of verbal-logical forms of thinking: defining concepts, classifying objects into categories, excluding objects, guessing riddles, understanding the figurative meanings of words, determining the sequence of events.

Summing up the above, it should be noted that correctional psychological work is organized within the framework of the leading activity. Disturbances in mental and speech development in DCD are largely due to the absence or deficiency of children's activities. Therefore, during corrective psychological measures, the leading type of activity for a given age is stimulated: in infancy, emotional communication with an adult; at an early age - objective activity; at preschool age - game activity.

Also, the experience of existing special institutions has shown that it is advisable to complete groups that are clinically and psychologically heterogeneous both in terms of musculoskeletal pathology and in terms of intellectual development. This not only allows you to solve organizational problems, but really positively affects the personal development of children. The medical-psychological-pedagogical impact on children should be implemented in a comprehensive manner through the efforts of a number of specialists. It is important to clearly define the system of interaction between specialists for the rational organization of work.

Annotation: The article reveals questions about correctional and speech therapy work with children with cerebral palsy.

In children, the formation of all motor functions is delayed and impaired. Motor disorders that limit subject-practical activity and impede the development of independent movement, self-service skills make a sick child from the first years of life almost completely dependent on the adults around him. This contributes to the formation of his passivity, lack of initiative, disrupts the development of his motivational and volitional sphere. Thus, movement disorders affect the entire course of the mental development of the child. In speech therapy work with children with cerebral palsy during the period of speech development, psychotherapy occupies an important place, the main goal of which is to eliminate painful mental manifestations and develop an adequate attitude towards oneself, one's own defect and the environment.

"Features of speech therapy work in children with cerebral palsy"

Cerebral palsy is a disease of the central nervous system with a leading lesion of the motor areas and motor pathways of the brain.

Signs of cerebral palsy in a child are detected from birth, therefore, already in the first weeks of life, the entire course of the mental development of the baby is disrupted, in particular, the process of forming his speech is slowed down and distorted. As a rule, in the future there is a severe speech disorder - dysarthria.

Despite the fact that violations of pre-speech development can be detected in the first months of life, speech therapy work sometimes begins only after reaching the age of three and is aimed at correcting an already established persistent speech disorder.

In addition, the slow and distorted speech development of children with cerebral palsy leads to a violation of the cognitive and emotional-volitional sphere of the child.

In this regard, the primary task of early correctional and developmental work with children with cerebral palsy, aimed at preventing secondary deviations in the development of the child, arises.

Tasks:

Studying and overcoming not only speech, but also other developmental disorders. The system of speech therapy work with children with cerebral palsy includes:

• development and correction of auditory perception,
• development and correction of visual perception,
• development and correction of speech-auditory and speech-motor analyzers.

Speech therapy work is built taking into account the age of the child, the severity of damage to the articulatory apparatus, the degree of delay in pre-speech and speech development, the age and intellectual characteristics of the child, the general somatic and neurological condition.

The effectiveness of working with children of a very early age largely depends on how the speech therapist will be able to properly organize not only special individual lessons, but also the upbringing and development of pre-speech and speech activity at all regime moments.

Early speech therapy work should be an integral part of the overall comprehensive work with children with cerebral palsy.

Goals:

correctional and pedagogical work in the pre-speech period with cerebral palsy is the consistent development of the functions of the pre-speech period, ensuring the timely formation of the speech and personality of the child.

The main directions of correctional and pedagogical work:

Normalization of the state and functioning of the organs of articulation through differentiated and acupressure massage, articulatory gymnastics;

Development of visual and auditory perception;

Development of emotional reactions;

Development of hand movements and actions with objects;

Formation of preparatory stages in the development of speech understanding.

There are IV levels of pre-speech development in cerebral palsy: the absence of voice activity, the presence of undifferentiated voice activity, cooing, babbling.

The main task of correctional and pedagogical work with children who are at the I pre-speech level of development- stimulation of vocal reactions. Work is carried out in the following areas:

exhalation vocalization;

Development of a "revitalization complex" with the inclusion of a voice component in it;

Development of visual fixation and tracking;

Development of auditory concentration;

Formation of hand-eye coordination.

In order to normalize muscle tone and motor skills of the articulatory apparatus, a massage is performed. To increase the volume of inhaled and exhaled air, followed by exhalation vocalization, breathing exercises are used for 1-1.5 minutes 2-3 times daily.

In order to form a “revitalization complex” and include a voice component in it, the adult leans towards the child, talks to him affectionately, melodiously, strokes him, and shows bright toys.

The appearance of a smile indicates the emergence of a child's need to communicate with an adult. Stimulation of vocal reactions begins with the vocalization of the child's exhalation.

Against the background of emotionally positive communication between a child and an adult, the vibration of his chest and larynx is carried out in order to evoke vocal reactions.

The ability to vocalize exhalation is reinforced by repeated repetition of this exercise throughout the day. For the development of visual fixation and tracking, the child is presented with optical objects that are adequate from the point of view of his perceptual capabilities. For the formation of auditory perception, a time is chosen when the child is in an emotionally negative state. The speech therapist leans towards the child, gently talking to him, trying to calm him down and attract his attention.

Work on the development of hand-eye coordination begins with the normalization of the position of the hand and fingers.

Working with children in at the II pre-speech level of development, is the stimulation of cooing. The main directions of correctional and pedagogical work:

Normalization of muscle tone and motility of the articulatory apparatus;

Increase in volume and exhalation followed by vocalization, stimulation of humming;

Development of gaze fixation stability, tracking smoothness;

Formation of the ability to localize sounds in space and perceive the differently intoned voice of an adult;

Development of the grasping function of the hands.

Classes last 10-15 minutes and are individual. In order to normalize muscle tone and motor skills of the articulatory apparatus, speech therapy massage is performed. Breathing exercises in the form of passive breathing exercises are aimed at increasing the volume and strength of exhalation with its subsequent vocalization in order to train the depth and rhythm of breathing.

The development of visual perception is aimed at increasing the mobility of the eyeballs, the smoothness of tracking a moving object, the stability of fixing the gaze when the position of the head and body changes, and the formation of smooth tracking with the eyes while the head position remains unchanged. These exercises are carried out using bright voiced toys.

Further development of auditory attention goes towards the formation of the ability to localize sounds in space and to perceive differences in the intonations of an adult's voice. To this end, they cause concentration on sounds that are adequate for this child(loud, quiet, high, low). Sound irritants are toys of different sound quality.

Preparation for the formation of an understanding of addressed speech begins with the development of perception of various intonations of the voice. The child, first of all, learns those intonations that are more often used by adults. It is necessary to ensure that the child not only perceives the intonations of the voice, but also adequately responds to them.

For the development of the grasping function of the hands, it is necessary to draw the child's attention to their own hands, to develop kinesthetic sensations in the hands.

The main task of working with children who are at the III pre-speech level of development- Stimulation of intoned vocal communication and babble. Work is carried out in the following areas:

Normalization of muscle tone and motility of the articulatory apparatus;

Development of the rhythm of breathing and movements of the child;

Stimulation of babbling;

Formation of a positive emotional attitude to classes;

Development of visual differentiations;

Stimulation of kinesthetic sensations and the development of finger touch based on them;

Development of an acoustic installation for sounds and voice;

Development of auditory differentiations;

Formation of preparatory stages of speech understanding.

Speech therapy massage is aimed at normalizing the muscle tone of the tongue and lips, attenuating hyperkinesis, and at developing oral muscle afferentation. Passive gymnastics contributes to an increase in the activity of the lips and tongue; the development of the mobility of the lips and tongue is also carried out through active gymnastics.

An important factor for the development of voluntary vocalization is the correctly set voluntary breathing of the child. For this purpose, more complex breathing exercises are carried out compared to the exercises of the previous levels, which are aimed at establishing the rhythm of movements and breathing.

In order to stimulate babble, they try to cause a "complex of revival." The child has a smile, he begins to fix his attention on the articulation of the speech therapist, who leans low towards him, talks to him, utters melodious sounds.

Stimulation of emotional reactions involves the formation in children of a positive emotional attitude to classes and the activation of vocal babble activity.

The decisive role is played by the emotional state of the child during classes: only a positive emotional background contributes to the actualization of cooing, babbling, etc.

The main goal of the development of visual perception is the development of visual differentiations. During the lesson, the child’s attention is attracted not only to toys, but also to the environment: the child must learn to recognize others, to be alert at the sight of the mother’s changed face.

The absence of kinesthetic sensations and the lack of formation of touch under visual control due to motor pathology prevent the child from developing the simplest manipulation of objects, and therefore it is necessary to pay attention to this side of hand-eye coordination. Work continues on developing the sensitivity of the fingertips.

The development of auditory perception is aimed at the formation of an acoustic attitude to a person's voice and sounds and auditory differentiation. To develop an acoustic attitude to sounds and voice, the child is offered various sound stimuli (sounds are different in height and sound strength).

To form auditory differentiations, the tone of the conversation is changed from affectionate to strict and vice versa, while trying to evoke adequate reactions in the child. Any intonationally colored sound of a child serves as a means of expressing his state, desire, attitude to the environment, feelings, which, in combination with expressive facial expressions, gestures, expressive eye movements, serves as a means of speechless contact with people around him and contributes to the formation of preparatory stages in the development of speech understanding.

The main task of correctional and pedagogical work with children who are IV level of pre-speech development, is the development of communication with an adult through the intonational sounds of babble and babble words. Areas of work:

Normalization of muscle tone and motility of the articulatory apparatus;

Increasing the strength and duration of exhalation;

Stimulation of physiological echolalia and babbling words;

Development of the manipulative function of the hands and differentiated movements of the fingers;

Formation of understanding of speech instructions in a specific situation.

Speech therapy massage is performed to normalize muscle tone and motor skills of the articulatory apparatus. Breathing exercises are aimed at increasing the strength and duration of exhalation. Along with passive exercises, active breathing exercises are carried out with the inclusion of an element of imitation. At the same time, the required position of the lips is passively held. Drawing the child's attention to the sound of his own voice, encouraging his activity, they try to cause the repetition of sounds, i.e. autoecholalia, which contributes to the development of speech-motor and speech-auditory analyzers, babble activity.

The development of the simplest manipulation with objects is hindered not only by the child's lack of kinesthetic sensations, but also by the lack of formation of touch under visual control due to motor pathology.

Much attention should be paid to the development of this side of hand-eye coordination. Work continues on developing the sensitivity of the fingertips.

Children who are at the IV level of the pre-speech level of development understand the speech addressed to them, therefore, special attention is paid to attracting the child himself to the task.

Speech therapy work during the period of speech development begins with learning to manipulate objects (toys), which stimulates the lexical side of speech. Before starting classes, children are given massage, articulation and breathing exercises, they activate attention, perception and pronunciation of available sounds, their combinations, simple words.

When performing various tasks, an adult first shows the child what to do. This contributes to the accumulation of speech impressions and the development of the ability to imitate the speech of others.

A child with cerebral palsy is encouraged to speak in ways that are interesting and easy for him.

Speech therapy classes begin with the creation of a certain sound base, for which they use massage, articulatory gymnastics. Further, the child's communication is stimulated with the help of sound reactions available to him, amorphous root words, sentence words. After that - classes on the development of onomatopoeia.

To stimulate speech development, classes on the formation of speech hearing, pitch, phonemic, auditory attention, perception of the pace and rhythm of speech are important.

To develop pitch hearing, children are taught to differentiate adult voice variations in pitch in accordance with the emotional coloring of speech. This is achieved with the help of expressive reading of fairy tales by roles, recognition of the voices of children and adults, etc.

Special games are aimed at developing auditory attention: “Whose voice?”, “Guess what sounds”, etc. The child should focus his eyes on sounding toys.

At preschool age, stimulation of speech development is aimed at expanding the vocabulary and developing the grammatical structure of speech. Every day, children should be introduced to new objects, their verbal designations.

Classes for the development of speech are phased in nature. They are based on learning to compose various types of sentences with a gradual complication of their syntactic structure.

It is recommended to conduct special games-classes, during which the child names objects, actions, images in pictures. You should make the most of the visibility and rely on the joint subject-practical and gaming activities of the speech therapist and the child.

Special training of children in methods of sensory examination of objects with the obligatory connection of a motor-kinesthetic analyzer (feeling objects with a paretic hand and recognizing them) is necessary. At the same time, words are introduced that indicate the quality of the subject (adjectives). For their development, a comparison of objects with opposite properties is used. The child is offered objects in which the distinguishable qualities are presented most clearly.

In older preschool age, they develop the ability to more accurately select words that characterize the features and properties of objects. To consolidate and activate the dictionary, they use the description of objects, guessing riddles, didactic games and everyday communication with the child.

A special direction of work on the word, as a unit of the language, ensures the development of the qualitative side of the vocabulary. The child acquires an understanding of the ambiguity of a word, synonyms and antonyms, the ability to correctly use words in context. This work, begun at preschool age, is most intense at school.

At school age, practical familiarization of children with the most simple ways the formation of the main lexical and grammatical categories of words, which helps to overcome persistent language difficulties. It is necessary to constantly develop the motivation of speech utterance through the cultivation of the desire for communication. Already at the initial stages of education, to stimulate the development of coherent speech, children are given primary information about the language, because. conscious comprehension accelerates the development of relevant skills and abilities.

As already noted, dysarthria is most often observed in cerebral palsy, in the majority - its pseudobulbar form.

Speech therapy classes for dysarthria are built taking into account the pathogenetic commonality of the structure of motor and speech defects. So, with pseudobulbar dysarthria in conditions of increased muscle tone in the speech muscles, classes begin with relaxation of the muscles of the articulatory apparatus, for which they use techniques aimed at relaxing the muscles of the neck, labial muscles, muscles of the tongue, relaxing facial massage.

Further work includes articulation, breathing exercises, voice development, articulatory praxis, work on sound pronunciation.

A variety of exercises when working on sound pronunciation with children with cerebral palsy depends on the form of dysarthria:

With pseudobulbar dysarthria, the focus is on relaxing the general and facial muscles, overcoming hypersalivation, synkinesis;

With cerebellar dysarthria, a strengthening massage of the articulatory muscles is combined with exercises to develop coordination of breathing, phonation and articulation. They train the ability to reproduce and maintain articulation patterns, the accuracy of articulation movements;

With extrapyramidal dysarthria, the child is taught to monitor the position of the mouth, tongue, general facial expressions, inhibit hyperkinesis, arbitrarily close and open the eyes without accompanying movements and general tension, reproduce, hold and feel various articulation modes and smoothly move from one to another;

In cortical afferent apraxic dysarthria, the focus is on the development of kinesthetic sensations, oral and manual praxis;

With cortical efferent dysarthria articulation gymnastics is aimed at developing subtle differentiated movements, especially moving the tip of the tongue up. The child's attention is focused on the feeling of the position of the tongue, then they are taught to lower the tongue to the bottom of the mouth. The main thing is the stimulation of anterior lingual sounds.

Corrective speech therapy work with alalia in cerebral palsy syndrome includes four stages:

- I stage- preparatory. They activate the mental processes that form the basis of speech activity, there is a consistent development of memory, attention, thinking, the need for speech communication, and they also form skills aimed at perception, comprehension, and understanding of speech messages.

- Stage II- the formation of speech skills in a situation of dialogic communication. Much attention is paid to the formation of speech in the process of subject-effective and play communication between a child and an adult. Semantic, lexical, syntactic, morphological, phonemic and phonetic speech operations are consistently developed.

- stage III- teaching the child to build sentences various types, then to a simple statement.

- Stage IV- development of coherent speech skills, the ability to plan a speech message, the selection of the necessary words and control over one's own statement.

With sensory alalia, they develop an understanding of addressed speech, communication skills and abilities. On the preparatory stage carry out work on the formation of visual, tactile perception, voluntary attention, memory, thinking.

Particular attention is paid to the development of auditory gnosis. With the help of sounding toys, stimulation of the perception of non-speech sounds is carried out. At the same time, the psychological prerequisites for speech perception are formed: speech-auditory attention, speech understanding in a particular situation.

At the second stage, the main attention is paid to the skills of understanding speech outside the specific situation. To do this, they train auditory memory, the ability to recognize words by their sound form, the ability to correlate words with objects and actions.

At the third stage, communicative skills are formed through the development of phonemic analysis and synthesis, phonemic and phonetic operations, semantic and lexico-grammatical aspects of speech.

Findings:

In children with cerebral palsy, various speech disorders are noted, on average, their frequency is 70-80%.

Features of the structure of speech disorders and the degree of their severity depends primarily on the location and severity of brain damage.

Violation of speech ontogenesis in children with cerebral palsy is also associated with the insufficiency of subject-practical activity of children and the limitation of their social contacts.

In children with cerebral palsy, there is a certain relationship between motor and speech disorders. This is manifested in the commonality of disorders of the skeletal and speech muscles. Speech disorders in children with cerebral palsy include:

1. phonetic-phonemic, which manifest themselves in various forms of dysarthria;
2. specific features of the assimilation of the lexical system of the language, due to the specifics of the disease itself. When forming the lexical system of the language in children with cerebral palsy, it is necessary to widely mediate all classes with practical tasks based on game techniques that activate the child's cognitive activity. At the same time, children are specially taught methods of sensory examination of objects;
3. violations of the grammatical structure of speech, which are inextricably linked with lexical and phonetic-phonemic disorders, their formation is carried out as a single inseparable process;
4. violations of the formation of coherent speech and understanding of the speech message, which have some specifics in different forms cerebral palsy. These disorders can be both of a specifically linguistic nature and of a non-specific nature due to the general mental characteristics of children with cerebral palsy;
5. all forms of dysgraphia and dyslexia. In the genesis of these disorders, a large role belongs to the immaturity of the visual-motor and optical-spatial systems. Their formation, as well as the development of articulation and acoustic skills, is important in the prevention and correction of dyslexia and dysgraphia in children with cerebral palsy.

An important problem in the study of speech disorders in cerebral palsy is the development of a neurolinguistic approach to their analysis, taking into account the forms of cerebral palsy, as well as improving the ways and methods of speech therapy, taking into account the main mechanisms of speech disorders in this disease.

No less important is the further development of ways and methods of early speech therapy, starting from the pre-preschool and preschool period.

Melnik G.V.
teacher speech therapist,
Chelyabinsk

Features of conducting classes with children with severe motor pathology in a sensory room using techniques of body-oriented psycho-correction.

Ponomareva G.A., psychologist

Children with severe forms of cerebral palsy are children with multiple disorders, including the leading ones - motor and sensory (sensory) disorders. This is a very difficult contingent. Indeed, how to properly organize work with a child if he does not walk and does not sit on his own, but only with the help of a parent, he has almost or no voluntary movements with either his arms or legs, and he does not speak, but can make separate sounds, and sometimes not even that? How to include him in society, how to help him learn something? How to fill his life with new content?

Our experience of working with children with severe motor pathology aged 5-7 years and older in the sensory room shows that correctional and developmental work can be quite productive if a lot of attention is paid to working with the body in the classroom, and body-oriented therapy techniques are used. The child in our classes is always the subject of the process and relationships, so children come to classes with pleasure, feel successful. Starting work in a group with the needs of the body of each individual child, we build relationships of cooperation and mutual respect in which children acquire the necessary social experience, as a result, their behavior and self-esteem change.

Psychophysical rehabilitation of children with cerebral palsy of preschool and school age has its own characteristics, since by this time the children have already formed pathological stereotypes of postures and movements. The pace of obtaining positive dynamics as a result of physical culture and health-improving work is sharply slowed down, which negatively affects further development their cognitive activity and limits the possibility of their social adaptation. The process of restructuring pathological postures and movements in children with cerebral palsy, as a rule, is long and difficult, since the old, fixed pathological “body scheme” is convenient and familiar to them, and any attempt to normalize the vicious position causes a feeling of discomfort and a new unusual action. Specialists working with the body (teachers of exercise therapy, specialists in adaptive physical education, psychologists who use body-oriented methods in their work, etc.) at the same time face the negative emotions of the child, his unwillingness to take an active and even passive part in the restructuring of the fixed pathological stereotype.

A specially organized environment in the sensory room, filled with a variety of stimuli, allows you to improve and develop not only the sensorimotor skills of a child with cerebral palsy, but also significantly stabilize the psycho-emotional state, create conditions for stimulating speech activity, form a more positive self-esteem, and significantly improve the quality of life.

A particularly important point is the ability to unite children in groups, to conduct group classes. During classes in a group, children's tendency to imitate is realized, and the elements of competition present in the classes push the child to master new motor skills that require significant active volitional efforts. These abilities are especially pronounced when building a lesson in the form of a game that stimulates physical activity, the most adequate for children of preschool and school age.

As you know, the developing brain has great compensatory capabilities. In its structural and functional maturation, among other factors, the leading role of the endogenous mechanism - motor afferentation - is confirmed. This, first of all, determines the need for constant use in the complex of rehabilitation measures for cerebral palsy psycho exercise, a technique of body-oriented psycho-correction, as a pathogenetically substantiated method of correctional-developing and health-improving work with an emphasis on the active participation of the child himself in the rehabilitation process.

Provided that a relationship based on empathy, cooperation between a specialist and a child is established, it becomes possible to develop it. conscious attitude to the rehabilitation process and interest in achieving positive results. Then the volitional efforts of the child can be directed to the correction of motor defects with the help of various means.

Movement disorders, hypodynamia and stiffness of children with cerebral palsy often create a false impression that they have a pronounced mental retardation. However, during observation and communication, intellectual preservation and differentiation of emotions are revealed, deep personal reactions are noted - touchiness, experiencing one's defect, and in the process of psycho-correctional work, positive dynamics in psycho-emotional development are noted.

Under the influence of psychophysical exercises in the muscles, tendons, joints, nerve impulses arise that go to the central nervous system and stimulate the development of the motor areas of the brain. In the process of working with the body, the postures and position of the limbs are normalized, muscle tone is reduced, violent movements are reduced or overcome. The child begins to correctly feel the position of various parts of the body and his movements, which is a powerful incentive for the development and improvement of motor functions and skills.

The use of body-oriented methods aims to influence the nature of sensory corrections. A special role is given to movement as a psycho-corrective factor. At the same time, psychophysical exercises are the nonspecific stimulus that affects the mental and physiological mechanisms involved in the development and manifestation of the disease. Therefore, work with the body helps to work through the traumatic psycho-emotional experience of the child. Let us refer to the words of L. Burbo (2001): "The body is the best friend and adviser." All necessary resources available to the child at any given time. However, certain methods are needed to awaken them and teach him consciously use them. The concept of a psychological “body scheme” was introduced by P. Schilder to describe a person’s system of ideas about the physical side of his own “I”, about his body - a kind of bodily-psychological “map”. Neurophysiologically, the corresponding primary or projection zones of the cerebral cortex are primarily associated with the body schema (the primary sensorimotor zone is the precentral gyrus of the frontal lobe, the primary somatosensory area is the postcentral gyrus of the parietal lobe), as well as secondary, associative zones that perform integrative functions (lower parietal gyrus - the zone of two-dimensional-spatial skin sensitivity and the lower parietal gyrus - the area of ​​\u200b\u200bthe primary brain circuit of the body). In the modern view, the body schema is created on the basis of the functional association of various parts of the brain responsible for both sensory-discriminatory processes (listed above) and cognitive-evaluative and motivational-emotional processes. (Cited by M. Sandomiersky, 2007).

According to M. Feldenkrautz, “every person moves, feels, thinks and speaks in his own way, that is, in a way corresponding to the self-portrait that he continues to paint throughout his life. In order to change his course of action, he must change the self-portrait he carries within himself. Often our ideas about ourselves, which are also expressed in our “body scheme”, are distorted or incomplete ...”. The essence of the Feldenkrautz method is the awakening in oneself of the ability to find one's own ways of moving, expanding one's set of movements with the help of an experimental enumeration of different options. In this way, bodily sensitivity is noticeably improved, and the “body schema” can be significantly refined and expanded. The nervous system and the musculoskeletal system are closely related to each other. Any activation of the nervous system is accompanied by a change in the state of the muscles, and the brain, in turn, constantly receives information about every change in the position of the body, joints, muscle tension, etc. Such an interconnection of systems allows, on the one hand, to recognize muscle tension internal state nervous system, and, on the other hand - through the muscles and joints - to influence the nervous system. Muscle tension there is an external, visible picture of the state of the nervous system. Every thought and every feeling finds its expression in movement. Strong emotions such as rage and fear cause noticeable changes in the muscles of the body.

External changes lead to internal changes. Next, we present the conclusions made by M. Feldenkrautz, and on the basis of which we build our work on body-oriented psychocorrection with children with severe motor pathology:

All muscular activity is movement;

The nervous system is primarily concerned with movements;

Movements reflect the state of the nervous system;

The quality of movement is most easily determined from the outside;

The movements bring great experience;

Sensations, feelings and thoughts are based on movements;

Movement is the basis of self-awareness.

Thus, Feldenkrautz considered movement to be the most effective means of achieving fundamental changes in human life in general.

Body language is a universal language for all people, including those with severe impairments in the motor sphere. It is likely that the involuntary, unconscious movements of a child with cerebral palsy are a consequence of the reaction of the brain, nervous system and body to the experience experienced during childbirth (89% of parents of children with cerebral palsy indicate birth trauma) or in infancy, psycho-emotional or physical injury. Working with unconscious, reflex (spasticity, hyperkinesis) movements and translating them into conscious, controlled ones helps to harmonize the interaction between the brain and the body. As Robert Masters puts it, “We don’t know how to connect together movement, sensation, thinking and feeling, and we don’t know how the interaction of mind and body determines what we are and what capabilities we really have.”

Involuntary movements (we mean hyperkinesis and spasticity) of a child with cerebral palsy suggest that he once needed these movements for something! "Every process tends to end," says Arnold Mindell. Movement is a process. Therefore, every movement strives for completion. To help the child work with these movements that are quite natural for him, to feel and complete the process that once began, but not completed, to translate unconscious movements into conscious, regulated, controlled - this is the task that we set in our classes in the sensory room when working with body.

The experience of our work with children with severe motor pathology shows that such work is always productive, it leads at the first stage to an improvement in the motor sphere of the child: a decrease in muscle spasticity, a decrease in hyperkinesis, with muscle rigidity - to an increase in muscle tone, the development of voluntariness in movements. Also, and, in our opinion, this is a very important factor, the child's attitude towards himself changes, his own abilities are assessed in a new way, the child begins to experiment and move differently than before. In the process of working with the body, other problems are also solved: behavior improves, motivation for activity and cooperation appears, and the emotional state improves significantly. The situation of success and the acquisition of new bodily experience helps to discover resources that were not previously used by the child himself.

Thus, body-oriented psychocorrection with children with severe motor pathology, in our opinion, is that important link in correctional and developmental work that allows you to optimize the entire process of correction and development of such children and make it more successful and productive.

Very important, in our opinion, in our classes is the mandatory presence of a parent. After all, it is necessary not only to teach the child to move and treat himself in a new way, but also to show the parent what the child can do, to teach him to perceive him in a new way. Parents learn how to properly interact with the child, learn how to work with the body and continue this work at home. It is always a pleasure to watch how the shyness of mothers and fathers passes, they rejoice in the achievements of their child, they begin to be proud of him.

Working with children with severe forms of cerebral palsy has a number of features. Most often, these children cannot speak, and the specialist cannot get an answer to any of his questions. But body language is more eloquent than any other language. If a specialist organizes the work correctly, proceeding from the needs of this particular child, then the child cooperates with pleasure: plays games with legs, arms, etc.

In any work with the body, the basis is the person's differentiation of sensations of tension and relaxation of the whole body, its parts or some muscle group. But how to explain to a child what tension and relaxation are, if his body is in constant tension and relaxes only during the period of night sleep, and he does not know how this happens, since he is not aware of this process? How to teach him to be aware of what is happening in his body, arm, leg? How to teach to control involuntary movements?

A differentiated approach to correctional and developmental work is, first of all, work with the potential that each individual child has, taking into account his characteristics and his capabilities. It is very important - to go from the child, his movements, his needs. Therefore, we begin our work with the body by studying the possibilities of the body of each individual child. First of all, for any specialist, the presence of voluntary movements is of interest. But in children with severe forms of cerebral palsy, voluntariness in movements is practically absent or very difficult. Work with the body in such cases begins with an involuntary movement - hyperkinesis or strong spasticity. Simply put, we work with what we have, turning the whole process of working with the body into a fun game.

Body games.

Hand games. For example, a specialist holds out his hand to a child with the words: "Let's say hello." But the child's hand goes to the side or back. Therefore, we begin work with this movement. The instruction helps the child to focus on the movement and his sensations, and to realize them. “Your hand wants to play. Let's play with her. The hand went up, it is tense, hard, strong, so keep it there and intensify this movement. I will count to 3 (5). On the count of three (five), you will make a very big effort to keep her in this position and increase the movement. Now relax and let her rest. Now it is soft, relaxed, heavy.” The account is necessary when performing the exercise, as it marks the beginning and end of the process of tension, and the transition to the next stage - relaxation. The specialist touches the hand, but does not perform the exercise for the child. This gesture can mean "I'm with you" and helps the child to concentrate on the processes that occur in this hand. Hyperkinesis is an involuntary movement associated with an increase in muscle tone, that is, tension. Tension cannot continue all the time, and even with its intensification. Therefore, after the end of the exercise (at the expense of 3, 5), the hand relaxes. The child receives the first experience of voluntary tension and subsequent relaxation, which he is aware of. The exercise is repeated 2 more times. For better relaxation of the hand, gently shake it. To do this, gently hold the child's elbow with the left hand, and with the right, holding the fingers, lightly shake it. You need to raise your arm (leg) no more than 7-10 cm from the surface on which the child lies. But the most important thing at all stages of working with the body is the active participation of the child himself, his involvement in the process, his awareness of what is happening with his arm, leg, body, etc. This is very important. Next, we go clockwise. Let's move on to the left hand. What does this hand want? We start with the movement that the child suggests. We repeat all the procedures: an exercise for tension and shaking for the left hand.

The next exercise is aimed at strengthening the child's differentiation of feelings of tension and relaxation.

"Handle-table". The child lies on the tatami. We help him stretch his right hand up and open his fingers (if the fingers do not open in the first lessons, we work with a fist). The specialist puts his hand on the palm (fist) of the child, while fixing the elbow. Slightly pressing the palm (cam), we artificially create tension in the hand. We count to 5. Then carefully shake off the hand, and leave it alone. We comment on what is happening: “At first the hand was hard, tense, and now it is soft, heavy, relaxed, it has worked, and now it is resting.” We do the exercise 3 times. We do the same with the left hand.

Foot games. We perform the first exercise, focusing on the needs of the body of a particular child. Everything is like with hands. Each movement is performed on 3-5 accounts, 3 times. After each tension exercise, gently shake off the legs. To do this, hold the child's leg under the kneecap with the right hand, and hold the toes with the right hand. Raise the leg 7-10 cm above the surface of the tatami and gently shake it.

The following exercise will help reinforce the child's experience of distinguishing between tension and relaxation.

"Strong legs". The specialist kneels at the feet of the child. If possible, we straighten and raise the child's legs, with one hand we hold the knees so that the legs do not bend, with the other we hold the foot and rest our stomach against the legs. According to the count, we begin to lean forward, using the child’s legs as a support, artificially creating tension. We hold the tension up to 5. Now, helping the child to relieve tension, we shake our legs (see above).

Head and neck games. We gently bring our hands under the child’s neck, so that his head lies in his hands folded in a boat, carefully pull his neck towards us. "Now I'll shake your head." The movements are slow, careful we do 3-5 times.

“Now let’s play with the head and neck. I turn your head to the right, and you hold it a little in this position. Gently turn the child's head to the right, carefully fix it with a hand on the cheek, closer to the ear, and count up to 3 (5). “Now the head is straight and I will shake it again.” The specialist gently shakes the child's head. “Now turn your head to the left. Hold her while I count to 3 (5)." Again, soft wiggles. We do head turns 3 times in each direction.

Similarly, we tilt the head forward and backward. The main thing is that the child maintains a given position until the end of the count. The specialist holds a little, helps to hold a little, sets the movement, but all this is at the first stages of work, when the child is just entering the process of working with the body.

Body games. We carefully take the child by the waist and, slightly lifting it up, shake it. Now the child is passive, he feels how his spine is being released from tension. We do the exercise 3-5 times.

An exercise "Stretching" helps to remove muscle clamps, harmonize the internal energy of the child.

"Vertical stretch". We start on the right side of the child's body. The specialist carefully holds the right hand at the wrist and the right leg at the ankle and, according to the count, begins to easily pull the arm up and the leg down. We count up to 3. At count 3, the movement stops. It is very important to simply indicate the movement, the child performs it himself. We do the exercise 3 times. Then the specialist moves to the left side of the child's body. The stretch is repeated 3 times on the left side.

"Diagonal stretch". It is performed in the same way as the "vertical stretch", only right hand stretches with the left leg, and the left arm with the right leg. It is also performed 3 times. Finish stretching by shaking your arms and legs. It is very good if a parent or other specialist is present at the lesson, then the arms and legs are shaken at the same time. One specialist shakes the hands, the other shakes the child's legs. If one specialist works, then we shake the child’s hands first, then the legs.

The results of working with the body can be felt and evaluated immediately: the tone of the muscles changes, they become less tense, more relaxed. But the most important thing is that such work is perceived by children very positively, children play with great pleasure, cooperate with a specialist, other children and parents.

Very often, in the process of working with the body of a child with cerebral palsy, vibrations, muscle tremors in the arms and legs occur. A. Lowen paid special attention to the induction of involuntary muscle contractions in the patient (muscle tremors, tremors, vibrations) in the process of therapy. Therefore, there is no need to be afraid of this. It is necessary to draw the child's attention to this process and let the process complete without trying to interrupt it: “Your leg is dancing. Feel this dance, let her finish it." So, according to Lowen, the movement of energy in the muscles is restored. And this indicates positive changes in the body of the child.

Such work with the body helps the child develop kinesthetic sensitivity, that is, the ability to perceive and analyze the movements of his own body, expand the range of motion, recognize and control the needs of the body. Work with the body leads to the development of motor abilities, improvement of coordination of movements, reduction of hyperkinesis and spasticity, improvement of breathing and psycho-emotional state of the child.

Breathing exercises. This stage of work is described in detail by us in the "Program" (See "Literature", 6). After working with the body using psychophysical exercises, you can move on to motor exercises. These can be yoga exercises and psychodynamic meditations (see ibid.). We give a few more exercises that we invented in the process of working with children with severe motor pathology.

Game movement exercises.

Target: development of motor skills, coordination of movements, obtaining new motor experience, formation of a positive attitude towards oneself in a situation of success.

Starting position: children sit on their heels with emphasis on their knees around the soft module. “Once upon a time there was a leopard. He was bold and agile and loved to hunt. But, at first, he sat in ambush so that no one would notice him and waited for the prey (the children are grouped: they lower their heads to their knees, facing the back of their hands, the posture is relaxed, free). And then, sneaking up and - jumping (children rise on their hands and, helping with their feet, fall on a soft module). In subsequent lessons, the instruction is short: “The leopard hid, hid (grouping). Now creeps up (several hand movements, similar to the movements of a cat that sharpens its claws). And jumps (jump on the soft module). We repeat 3 times.

Equipment: large soft module "Island".

"Jackknife"(from yoga)

Target: development of coordination of movements, stretching of the spine,

Content: Starting position: lying on the right side - the posture of the fetus. Then the “knife opened”: according to the instructions, the children simultaneously stretch their arms up and their legs down, keeping on their side. The exercise is performed slowly, to calm music. Now the "knife" is folded. Slowly, slightly relaxed, the children pull their arms to their chest, and their legs to their stomach. "Knife" formed. We perform the exercise 3 times on the right side. Then the children roll onto their left side and repeat the exercise 3 more times.

Children with severe motor pathology in the early stages of work need the help of parents or a specialist.

Equipment:

Target: harmonization of the energy potential of the body, development of coordination of movements, acquisition of new motor experience, work with fear of unusual movements.

Equipment: sports tatami for every child.

Sensory ball exercises.

Attempts to adapt the energy exercises of A. Lowen "Arch of Lowen" and "Arc of Lowen" for children with severe motor pathology led us to improvisation using a sensory ball.

Target: harmonization of the internal energy of the child, removal of muscle clamps, stretching of the spine.

Content: Place the child face down on the sensory ball. We bring our hands under the stomach and gently shake. This will help him relax his back. Then 3-5 soft, sliding hand movements along the spine from top to bottom, comment: "The back relaxes, the body seems to spread over the ball." Now, with soft, sliding movements, we lead along the arms from the shoulders to the fingertips: “The arms relaxed and hung”, also with the legs - we lead from the hip to the foot: “The legs relaxed and hung.” "The whole body is relaxed, as if spread over a ball." Then you can swing the ball back and forth. We turn the child over, now he lies on the ball face up. We repeat the procedure. We finish by swinging on the ball. After a few sessions, you can finish rolling on the ball when you hold the child’s legs, and he tries to reach the floor with his hands, if this brings him pleasure.

Equipment: big touch ball.

"Tower"

Target: development of concentration of attention, activation of motor potential, improvement of self-esteem and self-attitude, formation of motivation for activity.

Equipment: soft modules "Pebbles".

"Free yourself!"

Target: increasing the energy potential of the child, overcoming fears and phobias, the formation of positive self-esteem and self-attitude.

Equipment: soft modules "Trapeze" 6 pieces.

"Tunnel"

Target: increase in energy potential, improvement of psychophysical and emotional state and breathing, improvement of self-esteem and self-attitude, formation of motivation for activity.

Content: We put the Tumbleweed soft module horizontally in front of the child, give the instruction: “There is a tunnel in front of you, you need to climb through this tunnel, and I (mother) will wait on the other side.” We help the child, if necessary, climb inside and go to the other end of the pipe. At this point, emotional support and empathy are needed for the child.

Equipment: soft module-pipe "Tumbleweed".

Warning!

This is a very psychologically difficult exercise for children who were traumatized at birth and are afraid of confined spaces. Therefore, when performing it by a child, especially for the first time, the specialist must be extremely careful and monitor the emotions of the children. When a child shows anxiety, you need to help him quickly get out of the pipe, praise, say that it was not easy, but he did it. Overcoming your fear is not an easy task. As a rule, with the right support, already in the second lesson, the child copes with this task on his own to a greater extent.

"Rocket launch"

Target: increasing self-esteem, overcoming fears, phobias, the formation of motivation for activity.

Content: From the soft modules "Pebbles" we build a staircase. The highest module is the cosmodrome, from where the rocket (child) will be launched into space. Cosmos - soft module "Island", which is located behind the cosmodrome. In order to send a rocket into space - to drop a child onto a module, you need him to climb the stairs and get ready for launch. Of course, children cannot walk up the stairs on their own, they are helped by a specialist and parents. But they try very hard to walk with their legs, tune in to the flight, and on the count of 3 they fall on the soft module. This exercise causes a storm positive emotions, delight from the feeling of flight and landing that the child had not experienced before.

Equipment: soft module "Island", soft modules "Pebbles".

Each lesson ends with a 5-minute relaxation with the lights off using special equipment for the "Sensory Room": "Light fiber" lamp, tactile-light bubble column, "Mercury" projector. Nice slow music is on. Each child finds his own place to rest.

Literature.

1. Levchenko I.Yu., Prikhodko O.G., Guseynova A.A. Cerebral palsy: correctional work with preschoolers.-M .: "Book-lover", 2008.

2. Lowen A. and L. Collection of bioenergy experiments. Ed. "AST", M.: 2006.

3. Malkina-Pykh I.G. Body Therapy. Directory practical psychologist. - M.: Eksmo Publishing House, 2007.

4. Masters R. Body awareness. Psychophysical exercises. "Sofia": 2006.

5. Mindell A. The power of silence. How symptoms enrich life. - M.: Publishing house "AST", 2004.

6. Ponomareva G.A., "The program of correctional and developmental activities with children with cerebral palsy from 3 to 12 years old in a sensory room" Sat. DO of Moscow YuOUO "Education and upbringing of children with disabilities." (From the experience of the work of specialists of the Center for Curative Pedagogics and Differentiated Education), M: 2008.

7. Sandomiersky M. Psychosomatics and body psychotherapy. Practical guide. - M.: "Class", 2007.

8. Shubina E. Fundamentals of body therapy. Publisher: "Science and technology", 2007.

9. Ustinova E.V. Cerebral palsy: correctional work with preschoolers.-M .: "Book-lover", 2008.

Test work on the basics of pedagogy and psychology

Subject: Correctional work in children with cerebral palsy.

1. Medical correction.

2. Psychological correction cognitive processes.

3. Principles of psychocorrection of the child.

4. Psychological correction of emotional disorders.

5. Correction of speech disorders.

6. Special correctional institutions.

7. Psychological and pedagogical correction in a preschool institution.

The main goal of correctional work in cerebral palsy is to provide children with medical, psychological, pedagogical, speech therapy and social assistance; ensuring the most complete and early social adaptation, general and vocational training. It is very important to develop a positive attitude towards life, society, family, learning and work. The effectiveness of medical and pedagogical measures is determined by the timeliness, interconnectedness, continuity, succession in the work of various links. Medical and pedagogical work should be complex. An important condition for a complex impact is the coordination of the actions of specialists in various fields: a neuropathologist, a psychoneurologist, an exercise therapy doctor, a speech therapist, a defectologist, a psychologist, and an educator. Their common position is necessary during examination, treatment, psychological, pedagogical and speech therapy correction.

1. Medical correction.

Healing Fitness - component medical rehabilitation of patients, a method of complex functional therapy that uses physical exercises as a means of maintaining the patient's body in an active state, stimulating its internal reserves in the prevention and treatment of diseases caused by forced physical inactivity

The means of physical therapy - physical exercises, massage, hardening, passive gymnastics (manual therapy), labor processes, organization of the entire motor regimen of patients with cerebral palsy - have become integral components of the treatment process, rehabilitation treatment in all medical institutions and rehabilitation centers.

The positive effect that is observed when using funds physiotherapy exercises in patients with cerebral palsy, is the result of optimal training of the whole organism. The principles and mechanisms of the development of fitness are exactly the same both in normal and pathological conditions. To obtain a positive rehabilitation effect in children with cerebral palsy, long and hard work is required. Tasks of exercise therapy during the period of residual phenomena:

Reduction of hypertonicity of the adductor and flexor muscles, strengthening of weakened muscles;

Improvement of mobility in the joints, correction of perverse installations of the musculoskeletal system;

Improved coordination of movements and balance;

Stabilization right position body, strengthening the skill of independent standing, walking;

Expansion of the general motor activity of the child, training of age-related motor skills;

Training together with educators and parents of self-service, the assimilation of the main types of household activities, taking into account the mental development of the child.

To solve the tasks, the following groups of exercises are used:

Relaxation exercises, rhythmic passive shaking of limbs, swing movements, dynamic exercises;

Passive-active and active exercises from lightweight starting positions (sitting, lying), exercises on a large-diameter ball;

Exercises with objects to music, switching to new conditions of activity, development of expressiveness of movements; exercises in various types of walking: high, low, "slippery", "hard", with pushing; exercises for the head in i.p. sitting, standing;

Adoption of the correct posture at the support with visual control; exercises in various starting positions in front of a mirror;

Exercises for the development and training of basic age-related motor skills: crawling, climbing (on the bench), running, jumping (at first on a mini-trampoline), throwing; exercises in motion with frequent changes in starting position;

Game exercises “how I dress”, “how I comb my hair”, etc.

During the period of residual effects, the complex of means of physiotherapy exercises is expanding. The physical rehabilitation program includes massage, applied types of physical exercises, occupational therapy, hydrocolonotherapy, physiotherapy (heat therapy, electrophoresis, UHF), hippotherapy, orthopedics (walking in splints, orthopedic boots, Adele space suit). The volume of daily motor activity of children gradually increases as they grow and develop.

2. Psychological correction of cognitive processes.

The complex structure of an intellectual defect in children with cerebral palsy requires a differentiated approach to psychological correction. When drawing up a psycho-correction program, it is necessary to take into account the form, severity, specifics of mental dysfunction and the age of a patient with cerebral palsy.

The main tasks of psychological correction of sensory-perceptual processes:

Teaching children the assimilation of sensory standards and the formation of perceptual operations.

· Development of constancy, objectivity and generalization of perception.

· Development of speed of perception of objects.

For this purpose, a variety of activities are used with children to teach them an adequate perception of the shape and size of objects. Classes are held in stages, with increasing complexity of tasks.

The correction process itself should take place in parallel with teaching children productive activities: designing, drawing, modeling, and appliqué. Particular attention is paid to the formation of constructive activity. Constructive activity is a complex cognitive process, as a result of which the perception of the shape, size of objects and their spatial relationships is improved (Luria, 1948; Wenger, 1969).

An important direction of psycho-correction is the development of visual-effective and visual-figurative thinking. In this regard, psychological correction should solve the following tasks:

1. Teaching children a variety of object-practical manipulations with objects various shapes, sizes, colors.

2. Training in the use of auxiliary items (gun actions).

3. Formation of visual-figurative thinking in the process of constructive and visual activity.

Psychocorrective classes with children on the development of cognitive processes can be carried out both individually and in a group. In the classroom, the unity of requirements for the child on the part of the teacher, psychologist and other specialists should be observed, especially when correcting the ability to control one's actions. This is successfully achieved by observing the daily routine, clearly organizing the child's daily life, and excluding the possibility of not completing the actions begun by the child.

Directions and tasks of psychological correction of children with cerebral palsy in combination with mental retardation

Working with parents is very important in the psycho-correction of children with cerebral palsy.

3. Principles of psychocorrection of the child.

Principles as fundamental ideas of psychological correction are based on the following fundamental provisions of psychology:

Mental development and the formation of a child's personality are possible only in the process of communication with adults (Lisina, Lomov, etc.).

An important role in the mental development of the child is played by the formation of the leading type of activity (in preschool childhood - play, in primary school childhood - educational activity) (D.B. Elkonin and others).

The development of an abnormal child occurs according to the same laws as the development of a normal child. In the presence of certain, strictly thought-out conditions, all children have the ability to develop (L.S. Vygotsky, M. Montessori).

An important principle of psychological correction of abnormal development is the principle of the complexity of psychological correction, which can be considered as a single complex of clinical, psychological and pedagogical influences. The effectiveness of psychological correction largely depends on the consideration of clinical and pedagogical factors in the development of the child.

The second principle of psychological correction is the principle of unity of diagnostics and correction. Before deciding whether a child needs psychological correction, it is necessary to identify the features of his mental development, the level of formation of certain psychological neoplasms, the correspondence of the level of development of skills, knowledge, skills, personal and interpersonal relationships to age periods. The tasks of corrective work can be correctly set only on the basis of a complete psychological diagnosis of both the zone of the actual and the immediate development of the child. L.S. Vygotsky emphasized that “... in developmental diagnostics, the task of the researcher is not only to identify known symptoms and enumerate or systematize them, and not only to group phenomena according to external, similar features, but solely to use mental processing of these external data to penetrate into the inner essence of the processes of development”.