RU2405523C1 - Method of central nervous system stimulation in children with mental retardation - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention belongs to medicine, notably to neurology, neuropsychology and defectology. First goes complex of physical exercises, including homolateral and heterolateral movement and torsion exercises. Exercises are performed in succession which involves higher and higher ranges of nervous system; first go homolateral movements of limbs, then heterolateral ones - at the beginning without crossing of body's median line, then crossing it, farther are performed torsion exercises. Performing movements and exercises children hold in hands flags of different colours, marking left and right sides of body. Instructor is standing with his face to children and holds flags mirrored to children. Homolateral movements are performed in groups of 3-4 children. Heterolateral exercises are started in lying flat on the back position, then in sitting and standing positions. In children with coordinatory disturbance heterolateral and torsion exercises are performed with back support during 3-4 initial lessons. ^ EFFECT: method broadens the range of central nervous system stimulations means in children with mental retardation. ^ 2 tbl, 2 ex

Description

The invention relates to medicine and pedagogy, in particular to neurology, neuropsychology and defectology.

Perinatal pathology of the central nervous system (CNS) in children entails a delay in mental and motor development, often leading to intellectual failure of varying degrees. Such children lag behind their peers in the pace of formation of motor skills and mental functions.

A characteristic feature of the development of the motor sphere of children with intellectual disability is a weak differentiation of movements due to impaired sensory sphere, in particular the process of perception. In such children, there is a violation of orientation, coordination, the presence of stereotyped movements, inadequate motor behavior, which indicates violations in the formation of higher cortical centers responsible for motor control and higher nervous functions. In the central nervous system, cross-links and associative zones are not formed or are formed with a long delay. As a result of this, there is no cross laterality of movements in children; the formation of a body pattern is disturbed. The late formation of associative zones underlies intellectual deficiency, disorders in the psychomotor sphere.

These lesions are diagnosed in the first year of a child’s life in the form of delays or distortions of motor development, in the future, without rehabilitation and corrective measures, they are exacerbated. In most cases, the subcortical structures of the brain are relatively preserved and the information coming from the preserved primary zones of the analyzers is distorted at the level of associative zones in the process of polymodal synthesis and analysis of monomodal afferent information, which leads to incorrect formation of sensory stereotypes and, as a result, a violation of mental and motor functions.

Therefore, to stimulate the development of a child with impaired intellectual development, it is important to stimulate the formation of associative zones in the cerebral cortex and create conditions for multimodal afferent synthesis.

Known used in the field of primary and special school education is a way to improve learning ability. It uses a set of exercises aimed at improving interhemispheric connections [BRAIN GYM, Educational Kinesiology Foundation, No. 2003128 United States Patent and Trademark Office].

The disadvantages of the method: the complex includes 10 exercises and elements of auto-training. Physical exercises are difficult in coordination plan, some are accompanied by the implementation of complex logical and creative tasks. In addition, the given complex haphazardly uses exercises without taking into account the phylogenetic and ontogenetic organization of the brain with its gradual complication, there are no techniques for combining oculomotor reactions with functional loads on both hemispheres, moreover, the exercises in it are given without a detailed description, in the form of a general recommendation, and may not always be understandable. Preschoolers with mental retardation cannot perform such tasks.

In corrective pedagogy, a group of exercises for the development of interhemispheric interaction is known [Ekzhanova EA, Frolikova OA Effective correction for first graders in games and exercises. - 2007. - St. Petersburg: Karo. - 271 p.]. The proposed exercises are based on cross movements with the intersection of the midline of the body in a sitting and standing position.

Disadvantages: the proposed group of exercises is aimed at enhancing the thought process in children of preschool and school age, without taking into account the specific characteristics of children with mental retardation. The proposed exercises are too complicated for preschoolers with mental retardation. When describing the exercises, the order of their development and the mode of use for correcting existing shortcomings in the mental sphere are not proposed. Most of the proposed exercises are not physiological (imitating standard motor acts), which causes considerable difficulty in their implementation even in younger students without pathology, for preschoolers with intellectual disability, it is simply impossible to perform them.

Closest to the proposed is a special training method - “gymnastics for the brain”, designed to integrate and improve brain functions [Kudryavtseva G.Yu., Kuznetsova O. V. Gymnastics for the brain: educational and methodological recommendations, Novokuznetsk, 2002. - 18 p.]. The method involves performing 5 types of tasks.

1. Heterolateral movements. Four physical exercises, which are based on cross movements, in one - movements with the intersection of the midline of the body: “Pistol”, “Lizard”, “Football”, “Skier”.

2. Acceptance of self-massage "buttons", including the brain.

3. Twisting exercise by rotating the shoulder girdle in one direction, and the pelvic girdle in the other direction.

4. The simultaneous load on the right and left hemispheres using standard tasks accepted in neuropsychology.

5. Simultaneous movements of the eyes and limbs. Autotraining - creating and remembering the image of jointly functioning hemispheres.

The disadvantages of the method:

1. The method does not contain a phased methodology for learning exercises, which is important for children with mental retardation.

2. The method is designed for preschoolers who can distinguish between the right and left sides of the body. Preschoolers with mental retardation do not know how.

3. The method includes self-massage, a simultaneous load on both hemispheres, which preschoolers with mental retardation cannot do.

4. The method provides for a complex simultaneous load on the muscles of the limbs and oculomotors, which children with mental retardation are not able to perform.

The objective of the invention: neuropsychological rehabilitation of children with mental retardation by stimulating the central nervous system using a set of special exercises, performed in a certain sequence, aimed at sequential activation of phylogenetically older, lower parts of the brain, then younger ones, stimulation of polymodal afferent synthesis, formation and activation of interhemispheric connections.

The task is achieved by a method of stimulating the development of a child with a mental retardation, including the implementation of a set of exercises consisting of homolateral, heterolateral movements, twisting exercises.

Exercises are performed in a sequence involving ever higher levels of the nervous system, starting with homolateral movements of the limbs, then making heterolateral movements - first without crossing the midline of the body, then intersecting the midline of the body, then perform twisting exercises.

When performing movements and exercises, children hold flags of different colors in their hands to indicate the right and left sides of the body, the instructor is facing the children, holding the flags in mirror image in relation to them.

Homolateral movements are carried out in subgroups of 3-4 children.

Heterolateral exercises begin to be performed in a supine position, then sitting, then in a standing position, these exercises are learned individually, and then children are connected into subgroups.

If the child does not coordinate their movements, heterolateral exercises and twisting exercises in the first 3-4 classes, children perform using the support behind.

The novelty of the invention.

- Exercises are performed in a sequence involving lower, then higher, levels of the nervous system, starting with homolateral movements of the limbs, then making heterolateral movements - at first without crossing the midline of the body, then with intersection of the midline of the body, then perform exercises on twisting. The sequence of exercises allows you to gradually involve various sections of the brain stem, midbrain, subcortex and cortex of the cerebral hemispheres, improve interhemispheric connections.

- Homolateral exercises activate the lower parts of the brain, which are most preserved in children with this pathology. The activity of individual hemispheres is activated.

- Heterolateral movements are formed at the level of the midbrain and above. To perform these movements, the coordinated work of both hemispheres is necessary.

- Exercises with twisting, eye movements are possible only with the synthesis of information coming through various afferent channels: proprioceptive, vestibular, visual. This is how polymodal afferent synthesis is formed.

- When performing exercises, children hold flags of different colors in their hands to indicate the right and left sides of the body, the instructor is facing the children, holding flags in mirror image in relation to them, classes are carried out in subgroups of 3-4 children. Children with this pathology at this age are often confused in distinguishing between the right and left sides. Learning using the flags is easier, since the show makes the exercises as accessible as possible for understanding and reproduction.

- Heterolateral exercises begin to be performed in a supine position, then sitting, then in a standing position, while performing exercises while sitting and standing, children hold colorful flags, these exercises are learned individually, and then connect the children into subgroups. With this sequence of exercises, the didactic principle from simple to complex is implemented, which allows you to learn the exercises, despite the violations in the mental retardation.

- The method involves a complex simultaneous load on the muscles of the limbs and oculomotors in the process of performing heterolateral movements after learning them. At the same time, interhemispheric interactions and polymodal afferent synthesis are activated.

- If the child’s coordination of movements is disturbed, the children perform heterolateral exercises and twisting exercises in the first 3-4 sessions using the support behind the back, compensating for the lack of formation of vestibulotonic reactions and multimodal afferent synthesis, which consists in processing afferents from the vestibular apparatus, proprioceptors of the neck, lumbar, upper and lower limbs. As these reactions form, the support is reduced and removed.

The set of essential features allows you to get a new technical result:

1. Through a system of physical exercises that activate first the lower, then the higher parts of the brain, the higher parts of the brain are affected and the higher mental processes improve. The formation of cross-links and associative zones is accelerated.

2. Using a holistic approach to the activity of the nervous system allows you to use the reserve capabilities of the preserved areas of the brain.

3. When performing a set of exercises, interhemispheric connections are activated, which allows you to use the large compensatory capabilities of the brain.

4. When performing exercises in a standing position, unstable position (twisting exercise “hooks”), by tracking eyes with a movement of the hands, a multimodal afferent synthesis is formed.

5. The required physiological level of the whole complex is achieved, which facilitates the assimilation of children by the exercises included in its composition.

6. Individual work with children allows you to take into account ontogenetic features, subgroup - forms a sense of camaraderie and improves the emotional state. Communication skills develop on the one hand and self-control skills on the other hand are acquired. Work in groups develops discipline in children, teaches them not to be distracted, and prepares them to enter school and classes in the classroom.

The method is as follows.

Classes are carried out after active recreation of children, in the morning before bedtime. For children with mental retardation, the implementation of a set of exercises presents significant difficulties. Therefore, immediately after classes that require maximum intellectual stress, the children are reluctant and with a large number of errors fulfill their tasks.

The duration of the lesson is 10 minutes, because with a longer time the children begin to get tired, they lose interest, their attention weakens, they begin to make a large number of mistakes, which leads to improper exercise and a decrease in efficiency. Based on the individual characteristics of the child, his general physical condition, the depth of the intellectual defect and related defects, the occupation can be divided into several stages, giving the child a break in between and distracted from this type of activity.

To facilitate the learning of the proposed exercises, children are offered colorful flags that allow them to differentiate the right and left sides. As experience shows, mirroring the colors of flags in the instructor’s hands gives the best results, since preschoolers with a mental retardation are characterized by performing the exercises after the instructor exactly in the mirror image, if he faces them.

At the stage of learning homoloteral movements, work in a group of 4-6 people, the duration of one exercise is 60 s, with the introduction of heterolateral movements into the complex, the execution time of each exercise is reduced to 30 s and increases within two weeks to the initial 60 sec.

Homolateral (one-sided) steps to activate the lower parts of the brain stem and individual hemispheres.

The child’s time of mastering two exercises on homolateral movements depends on individual characteristics, on the condition of daily exercises, on average, it takes 2 weeks. We consider the moment of mastering the proposed exercises by the child a lesson when the child performs the exercise after the instructor, but without his additional verbal help:

- steps in place while raising the same hand;

- Lead to the side of the same arm and leg at the same time. The angle of the leg depends on the individual characteristics of the child and does not matter much. Some children with impaired coordination may be encouraged to perform this exercise without taking their legs off the floor, taking them to the side, sliding their feet on the floor.

1. Homolateral movements.

1.1. Starting position (IP): the children stand in a row, the flags in different colors in their hands (for example: blue in the right hand, red in the left), legs together, arms lowered along the body, the instructor facing them, flags in the hands in mirror image (for example: red in the right hand, blue in the left). On the count of times a hand with a red flag is raised and a step is made in place with the same foot, on the count of two - IP, on the count of three - a hand is raised with a blue flag and a step is made in place of the same foot, on the count of four return to SP.

1.2. IP, as in 1.1. The hand with the red flag and the foot of the same name is taken away at the count of times, the IP is counted at two, the hand with the blue flag and the foot of the same name are taken away at the count of three, and the SP is counted at four. After mastering the exercises, the children are asked to look at the flag, taken to the side, during the execution of the movement.

The study of heterolateral movements begins individually from the PI while lying down, while mastering the movements of the children, they are transferred to the PI while sitting and then standing, after which they switch to group classes. If the child's coordination of movements is impaired when performing exercises in the IP, standing, you can use the support in the form of a wall or couch at his back, not restricting his movement.

At the beginning of training, the instructor must show the child the sequence of movements in the supine position, clearly saying what he is doing now, and then repeat this with the child. In the future, the teacher pronounces each movement, controlling the implementation of the exercise, sitting next to the child, so that at any time there is an opportunity to correct the child in his movement. The next step in learning heterolateral exercises is to transfer the child from a lying position to a sitting position. The moment of a change in body position for each child is determined individually. The main criterion that determines the transfer from a lying position to a sitting position is the child’s ability to maintain body balance while lifting the opposite arm and leg. When sitting, the instructor is in front of the children, at the same level as they are. To facilitate the implementation of exercises, colored flags were used in the hands of children and in a mirror image by the instructor. Based on a large number of errors when performing this category of exercises, we did not limit the time frame, but considered the exercise completed after 10 correct repetitions. When all the children individually mastered the performance of these exercises in a sitting position, they switched to group classes. After the children mastered the rules for performing exercises while sitting, they transferred them to standing positions. The criterion for determining the change in body position was the ability of children to maintain balance when performing movement.

To facilitate the implementation of exercises in the room there should be no extraneous sound background, except for a clearly counted rhythm.

When performing cross-movement exercises, children are much more difficult to maintain balance than when performing homolateral movements. To facilitate the implementation of the exercises, children were provided with support behind their backs (wall, couch or any other elevation that does not constrain movements, providing reliable support and reaching children to the waist).

2. Heterolateral movements.

2.1. "Pistol".

2.1.1. When performing lying - FE - lying on your back, legs are straight, arms are extended along the body, in the hands are multi-colored flags (see 1.1). The instructor is located to the right or left of the child so that there is an opportunity to adjust his movements. On the count of times - a hand with a blue flag (the right hand in children) and the opposite leg (left) rises, on the count of two - PI, on the count of three - a hand with a red flag (left hand in children) and the opposite leg (right) are raised at the count of four - IP.

2.1.2. When performing sitting PI of children - sitting on a chair, legs are bent at the knees at an angle of 90 °, hands are lowered along the body. Instructor in the same position facing the ranks. In the hands of children and the instructor flags (see 1.1). On the count of times - a hand with a blue flag (the right hand in children) and the opposite leg (left) rises, on the count of two - the starting position, on the count of three - a hand with a red flag (left hand in the children) and the opposite leg (right) , at the count of four accepted IP. They monitor the correct execution of the instructor's instructions by the children and clearly measure the rhythm.

2.1.3. When standing up - IP (see 1.1). Implementation in 2.1.2.

2.2. "Lizard".

2.2.1. IP, as in 2.1.1. At the count of times, the right hand (with a blue flag in children) is tilted to the side and upward at an angle of up to 45 °, the opposite leg is at an angle of 45 °, at the expense of two - FE, and at the expense of three the left hand (with a red flag at children) to the side and upward at an angle of up to 45 ° and the opposite leg at an angle of 45 °. When performing the exercise, make sure that at the moment of movement the arm and leg remain straight.

2.2.2. IP, as in 2.1.2. At the count of times, the right hand (with a blue flag in children) is pulled to the side and upward at an angle of up to 45 ° and the opposite leg is forward and, as far as the physical abilities of the children allow, to the side, to the count of two - PI, to the count of three left hand (with the red flag in children) is moved to the side and up at an angle of up to 45 ° and the opposite leg forward and to the side.

2.2.3. IP, as in 2.1.3. At the count of times, the right hand (with a blue flag in children) is tilted to the side and up at an angle of up to 45 ° and the opposite leg is at an angle of up to 45 °, at the count of two - PI, three at the count of the left hand (with a red flag in children) to the side and upward at an angle of up to 45 ° and the opposite leg at an angle of up to 45 °. When performing the exercise, make sure that at the moment of movement the arm and leg remain straight.

Heterolateral forced movements with the intersection of the midline, the rotation of the shoulder girdle in one direction, and the pelvic - in the other. This group of exercises is completed after the children have mastered all of the above exercises. Assimilation of exercises is considered to be performed according to the model, using colored flags, without corrections by the instructor. The duration of each exercise is 60 s. At the initial stage of learning the last two exercises, the execution time was not recorded, and either 10 correct repetitions or the apparent fatigue of the child served as a signal of completion. When performing the “Football Player” exercise, the instructor was in front of the children, as in paragraph 2. When performing the "Lock" exercise, the instructor is in line with the children.

3. Heterolateral movements with the intersection of the midline of the body.

3.1. "Footballer".

3.1.1. IP, as in 2.1.1. At the expense of a swipe, the right hand (with a blue flag in children) intersects the midline of the body and the front surface of the right shoulder joint. At this time, the left leg crosses the midline of the body and the front surface of the right thigh. At the expense of two, the child takes an IP. At the count of three, the exercise is repeated with opposite limbs. At the count of four - IP.

3.1.2. When performing the exercise in a sitting position, children sit on chairs with straight legs extended forward and arms lowered along the body, flags are in their hands (p.1.1). The instructor is in front of the formation facing the children. Performing the exercise as in 3.1.1.

3.1.3. IP as in 1.1. Execution as in 3.1.1.

3.2. "Skier".

Due to the peculiarities of performing the “Skier” exercise, learning it with the children begins immediately from the IP while standing. IP, as in 1.1. At the count of times, the left hand (red flag in children) is pulled forward, and the right (blue flag in children) is pulled back, at the same time a step forward is made with the right foot and body weight is transferred to it, the left leg is straightened, the foot touches the floor. At the expense of two - IP. At the count of three, the right hand (the blue flag in children) is stretched forward, and the left (red flag in children) is pulled back, at the same time a step forward is made with the left foot and body weight is transferred to it, the right leg is straightened, the foot touches the floor. At the count of four - IP.

Twisting Exercise

4. "Hooks."

IP - legs together, arms lowered along the body. In the first 3-4 lessons, children are offered support behind their back when doing this exercise. The instructor is in a common rank. At the expense of times - straight arms rise to chest level, with thumbs down, the right leg is placed in front of the left. On the count of two - the right hand is transferred over the left and the fingers are locked into the lock. At the count of three - the arms are bent at the elbow joints and pressed to the chest. In this position, the children remain no more than 30 seconds, after which they return to the IP.

After mastering the set of exercises, its implementation takes an average of 10 minutes.

Example 1

Dima K. Diagnosis: perinatal encephalopathy. Organic brain damage. The age at the beginning of classes is 5 years 8 months, at the end - 5 years 10 months.

At the time of the start of classes, the child had motor awkwardness, increased distractibility, and hyperactivity, so he had to work with him individually, otherwise he was distracted by other children and stopped listening to the teacher. At correctional and developmental classes, a teacher-defectologist Dima showed increased fatigue, as a result of which his concentration and volume of attention decreased, signs of hyperactivity appeared, which significantly reduced the effect of classes.

After mastering the exercises (a month after the start of classes), the child could already perform exercises in a subgroup, significantly less distracting from tasks for other children. The time to focus on the exercise is increased. Due to motor awkwardness, part of the exercises was performed while sitting, part - with support behind the back.

After a month of daily fulfillment of the set of exercises in the child, a decrease in the distraction of attention was noted both in the gymnastics classes and in the correctional developmental classes of the defectologist. An increase in the concentration time and a decrease in distractivity favorably affected the child's development of the material offered in the classroom. Dima K. began to take less time and fewer repetitions when memorizing new material.

We studied simple and complex visual-motor coordination at the time of the beginning of the study of the complex of exercises, after a month of classes - immediately after mastering the whole complex of exercises and after a month of full-fledged classes. According to the results of the examination, it was shown that the time between the presentation of the stimulus and the reaction to it slightly decreased after the first month of classes (Table 1). After completing the entire set of exercises for 30 days, when assessing simple hand-eye coordination, the reaction time decreased by 1.5 times, and with complex hand-eye coordination, the exposure decreased by 1.3 times when responding to stimuli for the right hand and these indicators approached the indicators of the left hand, which Dima is leading. The child decreased the number of errors when performing tests for simple hand-eye coordination and the number of passes with complex hand-eye coordination in the sum for both hands.

This means that the proposed set of exercises turned out to be effective both for activating neurophysiological processes (hand-eye coordination, complex afferent synthesis, operations of visual and motor analysis and synthesis, lateralization), and basic mental functions (perception, attention, memory), which suggests improvement of higher mental functions (arbitrariness, thinking, memory).

Table 1 The results of the study of simple and complex hand-eye coordination in Dima K. The studied indicators Before you begin After mastering the exercises After 30 days of classes Simple hand-eye coordination Exposure (ms) 671 650 443 The ratio of the number of errors to the number of presented signals 5/15 2/15 1/15 Complex hand-eye coordination Exposure (ms) Right hand 2544 2100 1946 Left hand 1843 1846 1824 The ratio of the number of passes to the total number of presented signals for the right and left hands 6/15 3/15 2/15

Example 2

Anya K. Diagnosis: perinatal encephalopathy. Organic brain damage. Delay in psychomotor development. The age at the beginning of classes is 6 years 2 months, at the end - 6 years 4 months.

At the beginning of the study of the complex of exercises, the child was distinguished by increased distractibility, asthenic phenomena were observed, which significantly reduced working capacity during classes. The child was characterized by lack of initiative in all types of activities, ranging from play to training. Learning the complex of exercises was immediately performed in a subgroup, which had a very good effect on the emotional state and diligence of Ani K. in mastering the movements. At the correctional and developmental classes at the teacher-defectologist Anya very quickly got tired during exercises requiring intellectual stress, which led to a decrease in attention, a decrease in working capacity up to the rejection of further cooperation. Similar phenomena were observed when learning exercises for heterolateral movements, which required a high concentration of attention on the part of the child.

By the time the child mastered the whole range of exercises and gymnastics began to require less focus on the movements performed, Anya began to engage willingly, the manifestations of the asthenic state became much less. Anya herself took the initiative in preparing for classes, prepared in advance for them.

When performing the exercises in full during the month, the teachers in the group and the teacher-defectologist in their classes noted a decrease in intellectual fatigue, which was manifested in a longer retention time in one lesson, an increase in the amount of memory, and faster memorization of the material studied. In the behavior of Ani, manifestations of initiative were noted when performing one or another task.

The child was examined simple and complex hand-eye coordination before the start of classes, a month after the start of classes, when the exercises were learned, and after a month of full classes. After two months of exercise, the motor reaction time to a visual stimulus decreased 5-fold in a test studying simple hand-eye coordination (Table 2). There was a decrease in the number of erroneous clicks on the button when performing tasks for simple and complex hand-eye coordination, and a decrease in the number of omissions of the presented signals. Thus, we can conclude that the complex of exercises had a beneficial effect on neurophysiological processes.

table 2 The results of the study of simple and complex hand-eye coordination in Ani K. The studied indicators Before you begin After mastering the exercises After 30 days of classes Simple hand-eye coordination Exposure (ms) 671 671 130 The ratio of the number of errors to the number of presented signals 5/15 2/15 3/15 Complex hand-eye coordination Exposure (ms) Right hand 1402 1405 1350 Left hand 1382 1400 1400 The ratio of the number of passes to the total number of presented signals for the right and left hands 2/15 3/15 1/15

Thus, a method for stimulating the central nervous system of a child with a mental retardation is proposed, which consists in stimulating the central nervous system by using a set of special exercises that are performed in a certain sequence aimed at sequential activation of the phylogenetically older, lower parts of the brain, then the younger ones, stimulation of polymodal afferent synthesis, the formation and activation of interhemispheric connections.

Due to the consistent involvement of higher regulatory levels, the complex has a beneficial effect on the state of the nerve centers in individual hemispheres, activates interhemispheric connections and improves the quality and speed of the brain, which favorably affects the development of basic mental functions (perception, attention, memory), so and higher mental functions (randomness, memory, thinking).

Claims (1)

A method of stimulating the development of a child with a mental retardation, including performing a set of exercises consisting of homolateral, heterolateral movements, twisting exercises, characterized in that the exercises are performed in a sequence involving ever higher levels of the nervous system, starting with homolateral movements of the limbs, then make heterolateral movements - first, without crossing the midline of the body, then with the intersection of the midline of the body, then perform exercises n twisting, when performing movements and exercises, children hold flags of different colors in their hands to indicate the right and left sides of the body, the instructor is facing the children, holding the flags in mirror image in relation to them, homolateral movements are carried out in subgroups of 3-4 children, heterolateral exercises begin to be performed in a supine position, then sitting, then in a standing position, these exercises are learned individually, and then they connect the children into subgroups, if the child’s coordination of heterolateral movements is disturbed In the first 3-4 lessons, children perform the exercise and twisting exercises using the support behind their backs.