RU2746661C1 - Method for rehabilitation of children with speech and mental disorders - Google Patents

Abstract

FIELD: medicine; pediatrics; neurology.SUBSTANCE: invention relates to medicine, namely to pediatrics and neurology, and concerns the rehabilitation of children with speech and mental disorders. For this purpose, complex treatment is carried out, including nootropic therapy, classes with a developmental pediatrician, psychocorrective classes, and game and physical exercises according to the established program. Classes are held in a specially equipped hall of sensory integration and in a sensory room. Course duration is 14 days.EFFECT: method provides an effective rehabilitation of children with speech and mental disorders due to the stimulation of various sensor system and formation of adaptive responses to different types of sensations.1 cl, 3 ex, 9 dwg

Description

The invention relates to medicine, namely to medical rehabilitation, and can be used for the rehabilitation of children with speech and mental disorders.

The field of sensory integration in medicine began to develop in the 60s of the XX century in connection with the identification of a large number of cases of mental disorders affecting the learning of the development of children. Anne Jean Ayres, MD, occupational therapist and renowned expert in child development, developed a theory of sensory integration, revealing the causes of sensory impairments, their impact on the daily life of children with such impairments and their parents, and ways and means of assistance. Sensory integration therapy carefully selects physical interactions and activities to provide sensory experiences that stimulate sensory integration. Thus, learning ability and behavior are corrected, and ultimately the very quality of life (see Ayres E. Jean. Child and sensory integration. Understanding the hidden problems of development. Terevinf, 2009).

Sensory integration is the ability of a person to organize the sensations experienced by the body for movement, learning and normal behavior (see Sadovskaya Yu.E., Blokhin B.M., Troitskaya N.B., Pronicheva Yu.B. Disorders of sensory processing in children // General Medicine. 2010, pp. 24-28). Sensory integration is an unconscious process that takes place in the brain, it organizes the information received through the senses, gives meaning to the sensations we experience, filtering information and choosing what to focus on, allows us to act meaningfully and react to the situation in which we are are, forms the basis for theoretical learning and social behavior (see Ayres E. Jean. Child and sensory integration. Understanding the hidden problems of development. Terevinf, 2009).

The goal of sensory integration is to provide as many appropriate sensory stimuli as possible to create conditions for the normal functioning of the central nervous system.

As you know, there are 8 sensory systems: vestibular, visual, auditory, olfactory, gustatory, tactile, proprioceptive, interoceptive. The interaction of these eight systems makes it possible to register, conduct and process sensory stimuli.

Within the framework of Jean Ayres' sensory integration (see Ayres E. Jean. Child and sensory integration. Understanding hidden developmental problems. Terevinf, 2009. S. 58-66), three main sensory systems are considered: vestibular, proprioceptive and tactile. By acting on these basic systems, we can modulate and change the rest of the sensory systems.

The main tasks of sensory integration are:

1. Enrichment of sensory experience (obtaining various sensations) through the impact on the senses.

2. Overcoming sensory perception problems (discomfort caused by a specific stimulus).

3. Development of visual, auditory, tactile, kinesthetic perception.

4. Development of gross and fine motor skills in children.

5. Development of concentration of attention.

6. Formation of the necessary skills (adherence to verbal instructions, independent performance of a series of tasks, hand-eye coordination).

Thus, impaired sensory processing is a complex cerebral disorder in which a child misinterprets everyday sensory information, which can lead to problems with coordination of movements, speech, behavior, and learning.

In clinical practice, the term sensory integration dysfunction is adopted, within which sensory modulation disorders and sensory-related movement disorders are distinguished, and patients can have one or two types of dysfunction at the same time.

At present, on the basis of the scientific working group and the US National Institutes of Health, the issue of including sensory integration dysfunction as a separate diagnostic category in the new version of the DSM-V classification is being considered.

The prevalence of sensory dysfunctions in the child population is quite high and amounts to about 5%. Sensory dysfunctions tend to be protracted, requiring examination and hospitalization and are accompanied by the risk of aggravating the physical illness. The presence of sensory dysfunctions leads to a deterioration in the development of the child and the quality of life of the patient himself and his family (see Sadovskaya Yu.E., Blokhin B.M., Troitskaya N.B., Pronicheva Yu.B. Disorders of sensory processing in children. case. 2010).

Sensory dysfunctions can be caused by:

1. Perinatal pathology.

2. Hereditary factor.

3. Impact of unfavorable environmental factors (chemical, toxic effects, etc.).

4. Sensory deprivation

5. Diseases of the nervous system.

6. Other somatic diseases.

Perinatal pathology includes pathological conditions that arise during pregnancy from 22 weeks, including 7 days after its end. The perinatal period is extremely important for the development of a person in the future, since by the end of pregnancy the intrauterine formation of the fetus ends, during childbirth the fetus is exposed to many factors, and during the first 7 days it adapts to extrauterine life. The perinatal period is both the most important for human development and the most vulnerable. The influence of unfavorable factors, such as bad habits, somatic diseases of the mother, exposure to medicinal, toxic substances, traumatic injuries and much more, all this contributes to the formation of various pathologies, including sensory deficits.

A significant role of hereditary predisposition in the formation of sensory dysfunction cannot be ruled out. Exposure to unfavorable environmental factors can trigger sensory deficits in children with a hereditary predisposition.

The body of children can be very sensitive to the influence of many environmental factors, especially environmental pollution by industrial and agricultural waste and vehicles. Anthropogenic pollution of the environment poses a particular danger to the health of children due to the physiological characteristics of the child's body. This can be expressed in a delay in the development of not only the immune, but also the interferron systems, the immaturity of the antioxidant system, high permeability of the blood-brain barrier, and insufficient local immunity. Contamination can even have a negative effect on reproductive function and cause embryotoxic and mutagenic effects.

In children who have little contact with the outside world and people, sensory, motor and intellectual functions develop insufficiently and not fully adequately. Sensory deprivation disorganizes the brain, even in healthy adults. Children who do not have the opportunity to explore the world, get sensations and interact with the new, will not develop the perception necessary for the development of skills.

Neurological diseases are one of the main causes of dysfunction of sensory systems. The pathology of certain areas of the brain leads to so-called internal sensory deprivation. The sensory stimulus is formed, but due to inadequate work of the brain, it cannot be properly processed, which in turn leads to difficulties in mastering new information.

Also, one should not forget about the role of endocrine, metabolic and other disorders of internal organs in the formation of sensory deficit. Indeed, only with adequate functioning of all vital organs and systems is it possible to receive, conduct and process sensory stimuli.

At the moment, the causes of impaired sensory integration are not fully understood, therefore, rehabilitation based on sensory integration can be applied to children with speech and mental disorders.

The main basis of rehabilitation, based on sensory integration, is play activity, and the organization and choice of types of activity are determined by the interests and preferences of the child. In this rehabilitation, a careful choice of activities and the strength of influence on one or another sensory system of the child is important, the methods and techniques of therapy should in no way harm the child.

The child's response to sensory impulses is a reliable measure of the success of sensory integration-based rehabilitation. The sensory aspects of activity are the basis for development and learning. Good perception and integration of sensations is the key to correctly dealing with difficulties and mastering the skills necessary for the child. An effective response to difficulties in mastering new skills is essential for the development of sensory integration of the nervous system.

1. Mastering complex skills and types of behavior depends on a combination of answers to simpler problems.

2. The main postulate of therapy is to follow the child in his development. You should not force, coerce the child into actions unknown to him, this can provoke aggression, negativism, protest behavior, which in turn slow down the rehabilitation process.

3. The choice of tasks assigned to the child provides for the basic level of knowledge and skills of the child, as well as his preferences.

4. The effectiveness of therapy is determined by the effective and adequate work of the child with tasks previously inaccessible to him.

5. Starting work with the child at levels preceding the desired, at which the child feels confident and balanced, is the basis for achieving a positive end result.

6. In therapy, it is important to purposefully stimulate individual systems of perception of sensations in such a way that others have as little work as possible.

7. Organization of sensory perception of effective responses leads to an improvement not only in motor, sensory, psychoemotional disorders, but also in the correction of behavioral reactions.

8. Motivation plays an essential role in the child's performance, both simple tasks and more complex ones. The more motivated the child is, the more likely he is to withstand the difficulties and, as a result, will be more effective.

9. In therapy, it is necessary to take into account the interconnection and mutual influence of all sensory systems.

10. An important aspect of the work is to involve parents in therapy.

The following inventions are known from known patent sources.

1. "Method of sensory correction in autism syndrome" (see patent for invention RU No. 2666271 C1, publ. 09/06/2018, bull. No. 25), in which sensory correction is carried out by activating muscles through exercise. In this case, physical exercises are jumping on a trampoline. Before jumping on a trampoline, a sports warm-up is carried out. When exercising and jumping, the instructor is located close to the patient's back and the instructor's movements are synchronized with the patient's body movements in a single rhythm. Jumps are performed up, forward, backward, as well as with turns alternately to the left and to the right for 2-5 minutes, while the instructor simultaneously counts or reads poetry. Exercises are carried out 1-3 times a week. The correction course is 15 sessions. The method provides effective comprehensive rehabilitation of patients with autism syndrome, due to the development of cognitive, emotional-volitional and musculoskeletal spheres in this category of patients. However, the disadvantage of this method is the lack of complexity of measures and continuity of specialists, which significantly reduces the functionality of the method.

2. "Method of preventive and rehabilitation correction of the functional state and increasing the adaptive capabilities of the body" (see patent for invention RU No. 2557695 C2, publ. 07/27/2015, bull. No. 21). The invention relates to restorative medicine and can be used for non-drug correction, prevention and rehabilitation of the functional state and improving the adaptation of patients of different age groups, with various kinds of neuropsychiatric symptoms. Three consecutive stages are carried out: setting (UE), adaptive (AE) and the stage of tactile interaction (TE) between the patient and the dolphin. UE includes familiarizing the patient with the peculiarities of the structure and behavior of dolphins, teaching the techniques of performing the commands necessary for communicating with the dolphin, tactile communication with the dolphin. AE includes acquaintance and direct tactile contact with a live dolphin on the platform of the pool, out of the water. TE includes exercises aimed at developing the patient's communication skills, fine motor skills, coordination of movements, control of motor activity, emotional state and attention, using elements of art therapy, musical exercises with the dolphin, active games with the dolphin with objects. TE is carried out in a pool with mineral water NaCl1.8-2.0 ppm with a temperature of 25 to 28 degrees, the duration of the full course of correction is from 10 to 14 sessions, each from 30 to 40 minutes. Duration of UE is not less than 3 sessions of 30 minutes each, AE - from 1 to 3 sessions of 30-35 minutes each, TE - from 7 to 9 sessions of 35-40 minutes each. The method provides an increase in stress resistance, adaptive potential of a patient with any degree of functional training, an integral increase in communication skills and focus on active purposeful activity, optimization of the duration of the rehabilitation course depending on the psychoemotional state and abilities of the patient. However, the disadvantage of this method is the complexity of the technical support, as well as the lack of complexity of measures and the continuity of specialists of different profiles.

3. "Method for the treatment of delayed psycho-speech development in neuropsychiatric diseases" (see patent for invention RU No. 2305537 C2, publ. 09/10/2007, bull. No. 25). The invention relates to medicine, namely, to neurology. Measurement of biologically active points (BAP) of classical meridians by the Nakatani method with a predominant assessment of the state of the meridians C, VB, IG, TR, GI, RP, V, F. Identify elements of delayed psychoverbal development and background neuropsychiatric disease. The therapeutic effect is carried out through the governing BAPs of the classical meridians. The cranial zones additionally include the projection of the Wernicke, Brocca and initiative zones onto the patient's scalp. The therapeutic effect on the selected cranial zones is carried out through the extramedial BAPs located in the center of the corresponding projection of the region or zone of the brain. In case of hyperfunction of the C meridian, indicating residual phenomena of perinatal hypoxia of the cerebral cortex, the therapeutic effect is carried out in the mode of mediated sedation. In case of hyper- or hypofunction of the VB meridian, indicating a violation of the blood supply to the cerebral cortex as a result of dystonia of its vessels, the therapeutic effect is carried out in the mode, respectively, of an indirect sedative or indirect and direct tonic effect. With hypofunction of the IG, TR, GI meridians, indicating a decrease in the activity of the endorphin system in connection with a stressful situation, the therapeutic effect is carried out in the mode of an indirect and direct tonic effect. In case of hyper- or hypofunction of the RP and / or V meridians, indicating a violation of CSF dynamics, the therapeutic effect is carried out in the mode of mediated sedation in the case of their hyperfunction and indirect and direct tonic effect in the case of their hypofunction. In case of hyperfunction of the F meridian, indicating dysfunction of the subcortical structures, the therapeutic effect is carried out in the mode of mediated sedation. The sedative therapeutic effect on the control and non-meridian BAP is carried out with a direct current of negative polarity, and the tonic effect is performed by alternately applying impulses of positive and negative polarity. The direct tonic effect on the hypofunctional meridian is carried out by influencing the companion point, the tonic point and the sympathetic point of this meridian. An indirect sedative or tonic effect on the meridian, which is in a state of hyper- or hypofunction, respectively, is carried out by acting on accessory points, lo-points, tonic points, sympathetic points and connection points selected from the meridians P, MC, C, IG, TR, GI, RP, F, R, V, VB, E, VG, VC according to the classical rules of acupuncture, taking into account the state of these meridians, determined by the Nakatani method. The projection of Wernicke's zone on the patient's scalp is affected in case of disorders of understanding and attention to directed speech. The projection of Brocca's zone is affected in case of pronunciation disorders of words and phrases. The projection of the initiative zone is influenced by a decrease in speech activity and hysterical manifestations. Additionally, they carry out a symptomatic effect on corporal and auricular BAPs. With a sedative and tonic effect on the control and non-meridian BAPs, the short-circuit current is 40-120 μA. The duration of impulses of positive and negative polarity with a tonic effect is 2-6 seconds. The area of the contact surface of the electrode is chosen equal to 0.2-12.0 mm. The exposure time for each BAP is 45-90 seconds. The therapeutic effect is carried out daily, with the duration of one session 40-60 minutes and the total number of sessions 13-18 per course of treatment. The method increases the effectiveness of treatment by identifying elements of delayed psychoverbal development and a differentiated approach to treatment. However, the disadvantage of this method is the lack of complexity of measures and continuity of specialists, which significantly reduces the functionality of the method.

The objective of the present invention is to stimulate sensory systems, especially the motor, vestibular systems, muscles, joints and skin for the spontaneous formation of adaptive responses to various types of sensations in order to increase the effectiveness of complex rehabilitation measures in children with speech and mental disorders.

The technical result is the development of a highly effective method for the rehabilitation of children with speech and mental disorders, based on sensory integration in combination with additional methods of physical rehabilitation.

The technical result is achieved by the fact that on the day of admission of the patient to the department of medical rehabilitation with the previously established nootropic therapy is prescribed for him: glycine for children over 3 years old, 1 tablet 3 times a day; then, regardless of age, they carry out daily classes with a speech therapist-defectologist in the hall of sensory integration in the morning during the entire rehabilitation period: children 3-4 years old for 30 minutes, 5-7 years old for 40 minutes; from the second day of the child's stay in the department, regardless of age, conduct daily psycho-correctional classes in the sensory room in the morning in a fourteen-day course: children 3-4 years old for 30 minutes, 5-7 years old for 40 blowjobs, also from the second half of the first day of stay children in the department carry out game exercises for 14 days: children 3-4 years old for 30 minutes, 5-7 years old for 40 minutes, and also conduct a course of physiotherapy exercises: children 3-4 years old for 30 minutes, 5-7 years old for 40 minutes in the sensory integration room in the morning, lasting 14 days.

The novelty of the method of rehabilitation of children with speech and mental disorders lies in the complex work of various specialists in a certain sequence in the hall and room of sensory integration, based on sensory integration in combination with additional methods of physical rehabilitation, which stimulates sensory systems, spontaneous formation of adaptive responses to various types of sensations ...

We give figures for a better understanding of the meaning of the proposed method.

FIG. 1 shows a lesson with an exercise therapy instructor in a hall for sensory integration. Using a soft barrel for a rocking technique to stimulate the vestibular system.

FIG. 2 shows the equipment of the hall for sensory integration.

FIG. 3 shows a lesson with an exercise therapy instructor in a hall for sensory integration. An exercise to stimulate the vestibular system is presented: amplitude exercises in a hammock with twisting, twisting, unwinding, swinging up and down, and at the end - light swinging back and forth and to the side.

FIG. 4 shows an exercise on a swing with light swaying.

FIG. 5 shows a dry pool filled with balls, which improves the general psychological state of children, develops proprioceptive and tactile sensitivity. While in a dry pool, a child listens to a psycho-corrective fairy tale.

FIG. 6 depicts: a decorative lamp that changes the color scheme with the effect of "multicolor", with the use of calm music, contributing to the development of visual and auditory sensations, stimulating the development of visual-motor and semantic memory, the development of creative abilities.

FIG. 7 shows an interactive table for drawing with sand, which provides stimulation and development of fine motor skills, tactile, visual-spatial sensations.

FIG. 8 shows a session with a speech therapist in a hall for sensory integration. An exercise for the development of the visual system is presented - the creation of forms.

FIG. 9 shows a lesson with a psychologist in a sensory room. Use of "Seguin boards" in the process of psychocorrectional classes.

Within the framework of the claimed method, a program for the rehabilitation of children with speech and mental disorders is proposed and tested, based on an individual approach to each child, taking into account the identified pathology and the severity of sensory deficit. The rehabilitation program is implemented in a sensory room and a room for sensory integration and includes the following stages:

⋅ Initial examination by a neurologist and psychiatrist, including the collection of complaints, the study of anamnestic, objective and paraclinical data, in order to determine the severity of the existing impaired functions, make a diagnosis and determine the amount of care provided and types of additional examination methods;

⋅ Development of an individual plan and volume of planned rehabilitation measures by a multidisciplinary team (speech therapist, psychologist, exercise therapy doctor, teacher);

⋅ Conducting individual lessons with the child;

⋅ Tracking the dynamics of the child's condition to determine the level of the child's development and the necessary technical support;

When organizing the work of the sensory room and the hall for sensory integration, it is necessary to take into account the contraindications for visiting:

• History of epilepsy;

• Expressed asthenic manifestations;

• Syndrome of hyperreactivity or motor disinhibition;

• Severe movement disorders;

• Infectious diseases;

• Acute and exacerbation of chronic somatic diseases.

The sensory room of the medical rehabilitation department should be equipped with the following equipment:

- Interactive devices and a projector that stimulate the brain and creative activity of children, which in turn contributes to the development of gnostic functions, increasing the efficiency of visual, auditory and tactile perception;

- An interactive table for drawing with sand, supplemented with various figurative figures, provides stimulation and development of fine motor skills, tactile, visual-spatial sensations, allows you to get a lot of positive, pleasant emotions;

- Decorative lamps that change the color scheme with the effect of "multicolor", with the use of calm music, promoting the development of visual and auditory sensations, stimulating the development of visual-motor and semantic memory, the development of creative abilities; in addition, the soft light that highlights the areas of the room has a beneficial effect on the psychoemotional state of the child;

- Sensory equipment, such as "Night sky", "Colored rain", "Fresh flowers", developing tactile and proprioceptive sensitivity, vestibular apparatus, and also allowing to restore the emotional balance of the child;

- The use in the process of psychocorrectional measures soft-seat bean bags, a dry pool filled with balls, improve the general psychological state of children, develop proprioceptive and tactile sensitivity;

- Educational aids: "Seguin's Boards", analogues of the developmental method "Mailbox", "Nikitin's tabs", various inserts, constructors and puzzles designed for children of preschool and primary school age, contribute to the development and maintenance of cognitive activity, visual-figurative thinking, the development of voluntary attention, contribute to an increase in the efficiency of visual, tactile perception.

The use of elements of art therapy, didactic and plot-role games, dramatization games helps in the work of a psychologist in the implementation of psychocorrectional work with children who have communication difficulties, anxious children, and children suffering from various types of phobias. The use of these methods and techniques helps to resolve children's and adolescent problems, relieve stress, reduce the child's increased excitability, and has a beneficial effect on the development of large and fine motor skills of the child.

The main techniques used in the sensory room are:

1. Removal of emotional stress using light and color therapy.

Vision belongs to the most responsible role in the process of cognition of the external world. Through the eyes, we receive up to 90% of the information. In addition, light and color therapy is the best way to relieve nervous and muscle tension. These techniques can help those children who suffer from various anxiety disorders, and are also used to influence mood and general well-being.

The effect of flowers on the body is known (Shevchenko M.A.Psychological color and drawing test for adults and children, Liters 2015):

red - activates, stimulates;

orange - restores, warms, stimulates;

yellow - strengthens, tones;

green - compensates for energy losses, relieves tension, soothes;

blue - soothes, restrains, cools emotions.

purple - inspires, calms, relieves stress.

The use of various lighting effects in the sensory room while working with children and their parents helps to achieve the most rapid effect when working with the emotions and feelings of patients.

Also, the following breathing techniques and exercises are used by the psychologist in the sensory room;

1) "Calming" breath.

Psychologist's instructions:

⋅ Take a deep breath through your nose.

⋅ As you exhale, gently squeeze the muscles in your throat to create a snoring sound.

⋅ The exhalation, like the inhalation, is carried out with the mouth closed.

⋅ Having mastered this exhalation, accompany the inhalation with exactly the same sound.

⋅ Breathe in this way for a few minutes.

2) "Relaxing" breathing.

Psychologist's instructions:

⋅ Bring your right hand to your nose.

⋅ During breathing, you will have to alternately close the left nostril and then the right nostril with the fingers of this hand.

⋅ Take a slow breath of moderate depth, then close the right nostril with your thumb.

⋅ Exhale slowly through the left nostril.

⋅ Inhale through the same nostril and close it with your middle and ring fingers.

⋅ Exhale through the right nostril, inhale through the right nostril, then close the right nasal passage again and inhale-exhale through the left.

⋅ Continue these alternate breaths for five to ten minutes.

⋅ After a few cycles you will notice positive results.

3) "Push" breathing.

Psychologist's instructions:

1. Open your mouth very wide.

2. Stick out your tongue as much as possible and say with force three times: "Haaahha!". This sound must come from the depths of the throat.

3. Along with the sound, push out of yourself bitterness, anger, sadness, negative thoughts. Get rid of depression and frustration.

4) "Fire" breath

Psychologist's instructions:

⋅ Imagine yourself as a mighty fire-breathing dragon.

⋅ You are full of heat and energy from the sun.

⋅ Keeping these images in mind.

⋅ Take several short and powerful breaths, pushing air through your nostrils without opening your mouth.

⋅ Start slowly, but gradually build up your speed.

⋅ You can breathe out in this way up to twenty-five times.

⋅ During this breathing, you can calmly inhale through the nose, practically not paying attention to the inhales.

5) "Binding" breath

Psychologist's instructions:

⋅ Lying on your back, place your palms on your stomach.

⋅ Inhale slowly and deeply.

⋅ Feel your belly expand as you inhale.

⋅ Now exhale slowly and fully.

⋅ Feel the belly “contract” as the air escapes.

⋅ Repeat this five more times.

⋅ Do the exercise slowly.

The “Fairytale therapy in the sensory room” technique allows, with the help of a psycho-corrective fairy tale, to help solve a specific psychological problem in a child, such as: hyperactivity, disobedience, aggression, anxiety, shyness, lies, jealousy of the younger child, night fears, parental divorce, theft. The essence of the technique: a psychologist reads a psycho-corrective fairy tale, that is, one that gently affects the child and helps to replace an ineffective style of behavior with a more productive one. After the tale, questions for discussion with the child. While listening to a fairy tale, the child is in a sensory room, the light and sound effects of which help to immerse himself as much as possible in the atmosphere of fantasy and imaginary reality.

The sensory integration room should be equipped with all the necessary equipment, taking into account the variety of sensory stimuli required for a sensory experience by the child (see Fig. 2). Given the multifunctionality of the hall, work in it can be carried out by specialists of various profiles, including: exercise therapy instructor, speech therapist, teacher.

Requirements for equipping the hall for sensory integration

1. Sufficient and safe space

2. Availability of flooring

3. Organization of the hall, taking into account the need for the absence of external noise during classes

4. Ensuring the organization of cleaning and quartzing in the hall

5. Availability of the necessary sensory equipment

6. Availability of equipment and devices for organizing children's games

Room hardware for sensory integration

1. When vestibular dysfunction is used:

• Trampoline

• Hippo simulator

• Large therapy balls

• Hammock

• Swing

• Balancing boards

• Centrifuge

• Slide

• Soft tunnels, barrels

2. In case of violation of tactile perception, use:

• Heavy blankets

• Large pillows

• Massage mats and paths

• Massage brushes, rollers

• Materials of different texture and density

• Dry pool with balls

• Various bulk materials (sand, pebbles, cereals)

• Tactile boards

• Balls of various textures and sizes

3. In case of violation of proprioceptive perception:

• Elastic rope

• Spring expander

• Various types of special weights (scarves, vests)

• Use of beads, rings, buttons, paper

• Working with plasticine

• Beading

The instructors of physiotherapy exercises of the medical rehabilitation department, who have undergone special training, based on the conclusions of a clinical psychologist, select the exercises required in each case (see Table 1).

1. Activities for the development of tactile sensation

⋅ Exercise "Three-Rub" - rub different textures on the skin. It is suggested to use liquid soap, oatmeal soap, shaving cream, scrubs, sponges, thick washcloths, plastic brushes.

⋅ Exercise "Sandwich" - the child lies face down on "bread" (mat, couch or pillow) and with a sponge, vegetable brush, brush or washcloth his hands, feet and body are "smeared", imagining that it is mustard, mayonnaise, ketchup or sauce. It is passed over the body with stroking movements from top to bottom and cover the child from neck to fingertips with another “piece of bread” (mat, mattress or pillow). The bread is then pressed gently to "squeeze out the excess mustard" so that the child feels a deep, soothing pressure.

2. Activities for the development of the vestibular system

⋅ Classes on a swing with light swaying and juggling of objects, gripping, carrying and performing various tasks with color, texture, size and action.

⋅ Complexes of exercises on a balancing board with and without auxiliary objects (analysis of objects by size, color, texture, holding them, throws and transfers).

⋅ Amplitude exercises in a hammock with twisting, twisting, unwinding, swinging up and down, and at the end - light swinging back and forth and to the side.

⋅ Somersault.

⋅ Rocking - A gentle linear motion soothes. Swinging strongly and high on the hanging swing stimulates sensory sensations.

⋅ Rotation on a swivel chair.

⋅ Glide - many ways to slide down gently: sitting, lying, front, back, sideways, no arms, legs apart, etc.

⋅ Balance on a large ball - the child can lie on the ball on his stomach, back, sit on it and jump. Some balls have handles for jumping up and down (hip-hop).

3. Classes for the development of the proprioceptive system

⋅ Pull-Push Exercise - Hard muscle work energizes the child's muscles.

⋅ Hang and move on hand bars - this exercise helps to develop upper body arm strength.

⋅ Exercise "Ant Trail" - put a large bag of rice or beans on the back of the child and let him walk with a heavy "shell" on his back.

⋅ Exercise "Bear hugs" - everyone needs twelve hugs a day.

4. Bilateral coordination

⋅ Catch the ball - the child catches the beach ball at close range, which can be gradually increased.

⋅ To hit the ball - with a baseball bat, a mop stick, a rolling pin, a cardboard tube, a ruler, holding them in both hands, the child hits the ball.

⋅ Keep your feet still.

⋅ "Hanging ball" - a ball of foam rubber on a string is suspended in a wide doorway. The child chooses different objects for the role of the bat.

⋅ "Balloon" - the child throws and catches the balloon with both hands. He can support the ball in the air, toss with two hands, or punch it with his fist.

⋅ "Dance of ribbons" - holding a stick with ribbons tied over his head, the child turns the ribbons from side to side.

All of these tasks provide the child with impaired sensory integration with the necessary sensory experience, which in turn generates adaptive responses that increase the efficiency of the brain.

The work of a speech therapist includes the following types of activities and exercises.

To develop tactile sensation

• Exercise "Black box" (a box for feeling objects in it) - the child inserts his hand into the hole and tells which toy he is touching.

• Exercise "Can you describe this?" - the child is given objects with different textures, temperatures and weights, and he talks about the object that he touches.

• Oral motor exercises - lick and apply stickers, blow whistles and pipes, blow bubbles, drink through a straw or from sports bottles.

Bilateral coordination for the correct development of balance and coordination:

• Exercise "Body rhythm" - while reciting or singing, pat or tap on various parts of the child's body, he repeats the movements.

For the development of the visual system

• Shape Creation - Your child draws and creates shapes, letters and numbers from a variety of materials, such as plasticine, shaving cream, sand, clay, pizza dough, and draws with his finger and folds from strings or small pieces.

The work of a teacher includes conducting the following types of classes and exercises

• Exercise "Sprinkle" - the child pours sand, beans, pours water from one container to another.

• Game "Labyrinth" and game "Point to point" - the child leads the labyrinth on paper with his finger, toy car, colored pencil, marker, chalk, connecting the dots to get some kind of pattern or drawing.

• Cut - cut stripes, teeth or fringes.

• Exercise "Rubbish on the floor" - a child, using a broom and a scoop, sweeps pieces of newspaper from the floor.

• Stringing and lacing - the child stringing buttons, pasta, corn sticks, spools, lumps of paper with laces or long string.

• Household tools - Use tweezers to pick up cornflakes.

• Playing with water - the sink is filled with soapy water and shatterproof bottles, and balls, sponges, rubber toys, toys - water pumps. The task is to pour water back and forth and measure the volume.

• Drawing with water - the child is offered a bucket of water and a brush to "paint" the floor, objects and his own body.

• Drawing with your fingers. For a different tactile sensation, you can mix the paint with sand or put in some shaving foam.

• Playing with sand, you can add small toys to the sandbox that the child will bury, open, rearrange. Instead of sand, you can use dry beans, rice, pasta, and cereals.

The method of rehabilitation of children with speech and mental disorders is carried out as follows.

On the day of admission of the patient to the medical rehabilitation department with a previously established diagnosis, a neurologist consults, determines the neurological status (see Badalyan L.O. Pediatric neurology. 2010, pp. 71-214) and prescribes nootropic therapy: glycine for children over 3 years old - according to 1 tablet 3 times a day.

A neurologist is consulted daily during the entire period of the child's rehabilitation.

Further, after consulting a neurologist, the patient is consulted by a psychiatrist to determine the mental status (see Eidemiller EG Child psychiatry. 2005. S. 218-286).

After examination by a neurologist and a psychiatrist on the day of admission, the patient undergoes examination by a speech therapist-defectologist with the appointment, regardless of age, of daily classes in the hall of sensory integration in the morning during the rehabilitation period from the second day, children 3-4 years old for 30 minutes, 5-7 years for 40 minutes; the speech therapist conducts the following activities: for the development of tactile sensation - exercise "Black box" (a box for feeling objects in it) - the child inserts his hand into the hole and tells what toy he is touching; exercise "Can you describe this?" - the child is given objects with different textures, temperatures and weights, and he talks about the object that he touches; oral motor exercises - lick and stick stickers, blow whistles and pipes, blow bubbles, drink through a straw or from sports bottles; bilateral coordination - exercise "Rhythm of the body" - when reciting or singing, pat or tap on various parts of the child's body, he repeats the movements; activities for the development of the visual system - creating shapes - the child draws and creates shapes, letters and numbers from various materials, such as plasticine, shaving cream, sand, clay, pizza dough, draws with his finger and folds from strings or small parts.

Further, after the conclusion of the speech therapist - defectologist, the child is consulted by a psychologist using diagnostic tests and techniques, and then, from the second day (second half) of the child's stay in the department, regardless of age, the psychologist conducts daily psychocorrectional sessions in the sensory room for a ten-day course, for children 3 -4 years for 30 minutes, 5-7 years for 40 minutes, which contribute to the all-round development of the child, including the sensory sphere. The break between classes with a speech therapist and a psychologist is 30 minutes. The psychologist uses the following techniques and equipment in his arsenal: relieving emotional stress using color and light therapy; breathing techniques and exercises - "Calming" breathing, "Relaxing" breathing, "Push" breathing, "Fire" breathing, "Binding" breathing; method "Fairytale therapy in a sensory room"; developmental manuals: "Seguin's boards", analogues of the developmental technique "Mailbox", "Nikitin's tabs", various inserts, constructors and puzzles; the use of elements of art therapy, didactic and role-playing games, dramatization games.

Also, on the day of admission, the psychologist writes out a program of game exercises for children, which is conducted by a teacher who starts its execution from the first day (second half) of the child's stay in the department after a day's rest: children 3-4 years old for 30 minutes, 5-7 years old 40 minutes - 14 days. The teacher uses the following exercises: Exercise "Pour" - the child pours sand, beans, pours water from one container to another; the game "Labyrinth" and the game "Point to point" - the child leads the labyrinth on paper with a finger, a toy car, a colored pencil, a marker, chalk, connecting the dots to get some kind of pattern or drawing; cutting - cut stripes, teeth or fringes; exercise "Rubbish on the floor" - a child, using a broom and a scoop, sweeps scraps of newspapers from the floor; stringing and lacing - the child stringing buttons, pasta, corn sticks, spools, lumps of paper on laces or a long thread; household tools - using tweezers, the child picks up cornflakes; playing with water - the sink is filled with soapy water and shatterproof bottles, and balls, sponges, rubber toys, toys - water pumps. The task is to pour water back and forth and measure the volume; drawing with water - the child is offered a bucket of water and a brush to "paint" the floor, objects and his own body; drawing with your fingers - for a different tactile sensation, you can mix paint with sand or put a little shaving foam; playing with sand, you can add small toys to the sandbox that the child will bury, open, rearrange.

Further, after all the above examinations, on the day of admission, the physical therapy doctor prescribes a course of daily individual lessons for children: 3-4 years old for 30 minutes, 5-7 years old for 40 minutes in the hall of sensory integration in the morning, lasting 14 days, after 30 minutes after classes with a psychologist.

Exercise therapy doctor uses the following classes: classes for the development of tactile sensation - exercise "Three-rub" - rub various textures on the skin; exercise "Sandwich" - the child lies face down on the "bread" (mat, couch or pillow) and with a sponge, vegetable brush, brush or washcloth his hands, feet and body are "smeared", imagining that it is mustard, mayonnaise, ketchup or sauce. Classes for the development of the vestibular system: classes on a swing with light swaying and juggling of objects, gripping, transferring and performing various tasks with color, texture, size and action; sets of exercises on a balancing board with and without auxiliary objects; amplitude exercises in a hammock with twisting, twisting, unwinding, swinging up and down, and at the end - light swinging back and forth and to the side; somersault; rocking; rotation on a swivel chair; slip; balance on a large ball. Classes for the development of the proprioceptive system: "Push-pull" exercise - hard muscle work; hang and move along the hand bars; exercise "Ant trail" - put a large bag of rice or beans on the back of the child and let him walk with a heavy "shell" on his back. Bilateral coordination: catch the ball - the child catches the beach ball at close range, which can be gradually increased; hitting the ball - with a baseball bat, a mop stick, rolling pin, cardboard tube, ruler, holding them in both hands, the child hits the ball, the legs must be kept motionless; "Hanging ball" - a ball of foam rubber on a string is suspended in a wide doorway, the child chooses different objects to play the role of a bat; "Balloon" - the child throws and catches the balloon with both hands; "Dance of ribbons" - holding a stick with ribbons tied over his head, the child turns the ribbons from side to side.

Thus, during hospitalization in the department of medical rehabilitation using sensory integration methods, the child has an improvement in speech and cognitive functions, stabilization of the emotional sphere, and normalization of behavioral reactions.

When a patient is withdrawn from the rehabilitation program (discharge from the department), specialists give detailed recommendations with an invitation to the next course, the frequency of courses is 1-3 times a year.

The practical implementation of the proposed method is illustrated by examples from clinical practice.

Example 1.

Patient A., 3 years old, was admitted to the department of medical rehabilitation of GBU RO "CSTO" on 08.07.19 with complaints of a disorder of speech and mental development (lack of phrasal speech, unclear pronunciation, limited vocabulary), difficulties in understanding tasks, motor disinhibition , restlessness, mood swings.

Anamnesis: sick from an early age; the perinatal history is burdened (pregnancy - the fourth, proceeding with the threat of collapse in the second trimester, preeclampsia of the second half of pregnancy, childbirth - the second, at 40 weeks, cesarean section according to the mother's indications, weight - 3600 g, cried out immediately); the child is monitored by a psychiatrist at the place of residence, a neurologist in the CSTO.

He was admitted to the Department of Medical Rehabilitation of the State Budgetary Institution of Regional Development of the CSTO with the first diagnosis: "Organic lesion of the central nervous system, alalia, general speech underdevelopment of the 1st level, mixed specific disorder of mental development, hyperdynamic syndrome, syndrome of emotional-volitional instability."

The child arrived for rehabilitation with the results of the examination:

EEG shows slight diffuse changes of an irritative-dysrhythmic nature. Epic activity is not traced.

On MRI of the brain + MRA - on a series of tomograms, images of sub-, supratentorial structures of the brain in sagittal, frontal and axial projections were obtained. No pathologically altered MP signal was found in the brain substance, trunk, cerebellum. Differentiation of gray and white matter is not reduced. The ventricles of the brain are not dilated, the lateral ventricles are symmetrical, not dilated. There is no displacement of the median structures. In the area of MMU on both sides of the pathological masses is not determined. The base tanks are not widened. The chiasmally sellar region is unremarkable; the pituitary gland has a typical MP signal. The craniovertebral junction was unremarkable; the cerebellar tonsils were located at the BZO level. The sinuses are airy. When performing MP angiography, the left and right internal carotid and its siphon of the usual direction and diameter, without signs of displacement or external compression, the MP signal inside the lumen of the vessels is homogeneous. The circle of Willis is closed, the intracranial part of the vertebral arteries is asymmetric (D <S), the MP signal is uniform, and no filling defects were found. Aneurysms and AVMs of cerebral vessels were not identified. Conclusion: MP signs of pathological changes in the substance of the brain were not revealed. A variant of the structure of the circle of Willis.

07/08/19 - examination by a neurologist and a psychiatrist

07/08/19, consultation of a psychologist: according to the results of an experimental psychological study: with an existing disorder of psychological development, the child has pronounced changes in the sensory-perceptual, cognitive, emotional-volitional and behavioral spheres. Decrease in the rate of formation of prerequisites for verbal and logical thinking, immaturity of visual-figurative thinking. Decreased plasticity of thought processes. Uneven decrease in long-term auditory-speech memory. Decreased concentration of voluntary attention. Pronounced violations of speech development. Change in the emotional - volitional sphere: pronounced emotional lability. Immaturity of the sphere of self-control. Hyperkinetic forms of behavior.

07/08/19 - examination by a speech therapist-defectologist revealed alalia, general speech underdevelopment of the I level

The consultations of these specialists in the department of medical rehabilitation confirmed the established diagnosis: "Organic lesion of the central nervous system, alalia, general speech underdevelopment of the I level, mixed specific disorder of mental development, hyperdynamic syndrome, syndrome of emotional-volitional instability."

The rehabilitation course included: drug therapy prescribed by a psychiatrist and a neurologist: glycine - 1/2 tablet × 3 times a day - 14 days, starting from 07/08/19, followed by the continuation of therapy on an outpatient basis after discharge.

Also, classes with a speech therapist-defectologist in a hall for sensory integration - a course of 14 individual lessons, lasting 30 minutes, the beginning of classes from 07/09/19, including:

To develop tactile sensation:

• exercise "Black box" (a box for feeling objects in it) - the child inserts his hand into the hole and tells which toy he is touching;

• exercise "Can you describe this?" - the child is given objects with different textures, temperatures and weights, and he talks about the object that he touches;

• oral motor exercises - lick and stick stickers, blow whistles and pipes, blow bubbles, drink through a straw or from sports bottles;

Bilateral coordination

• exercise "Rhythm of the body" - while reciting or singing, pat or tap on various parts of the child's body, he repeats the movements;

Classes for the development of the visual system

• creating shapes - the child draws and creates shapes, letters and numbers from various materials, such as plasticine, shaving cream, sand, clay, pizza dough, draws with his finger and folds from strings or small parts.

The psychologist, after assessing the psychological status of the child, conducts a course of 14 sessions in a sensory room, lasting 30 minutes.

The lesson included:

• removal of emotional stress using color and light therapy; breathing techniques and exercises - "Calming" breathing, "Relaxing" breathing, "Push" breathing, "Fire" breathing, "Binding" breathing;

• methodology "Fairy tale therapy in a sensory room";

• developmental manuals: "Seguin's boards", analogues of the developmental technique "Mailbox", "Nikitin's tabs", various inserts, constructors and puzzles;

• use of elements of art therapy,

• didactic and role-playing games, dramatization games.

Then, after a 30-minute break, the exercise therapy instructor prescribes a 14-day course of exercises in a hall for sensory integration, lasting 30 minutes in the morning.

The set of classes included:

Activities for tactile sensation:

• exercise "Three-rub" - rub different textures on the skin;

• exercise "Sandwich"

Activities for the development of the vestibular system:

• classes on a swing with light swaying and juggling of objects, gripping, carrying and performing various tasks with color, texture, size and action (see Fig. 4);

• sets of exercises on a balancing board with and without auxiliary objects;

• amplitude exercises in a hammock with twisting, twisting, untwisting, swinging up and down, and finally, light swinging back and forth and to the side (see Fig. 3);

• somersault;

• rocking (see Fig. 1);

• rotation on a swivel chair;

• sliding;

• balance on a large ball.

Classes for the development of the proprioceptive system:

• push-pull exercise - hard muscle work;

• hang and move along the hand bars;

• Exercise "Ant Trail" - put a large bag of rice or beans on the back of the child and allow him to walk with a heavy "shell" on his back.

Bilateral coordination

• catch the ball - the child catches the beach ball at close range, which can be gradually increased;

• hitting the ball - with a baseball bat, a mop stick, rolling pin, cardboard tube, ruler, holding them in both hands, the child hits the ball, the legs must be kept motionless;

• "hanging ball" - a ball of foam rubber on a string is suspended in a wide doorway, the child chooses different objects to play the role of a bat;

• "balloon" - the child throws and catches the balloon with both hands;

• "dance of ribbons" - holding a stick with ribbons tied over his head, the child turns the ribbons from side to side.

In the second half of the day, after a day's rest, the teacher, taking into account the recommendations of a psychologist in a hall for sensory integration, conducted the following classes:

• exercise "Pour-ka" - the child pours sand, beans, pours water from one container to another;

• the game "Labyrinth" and the game "Point to point" - the child leads the labyrinth on paper with his finger, toy car, colored pencil, marker, chalk, connecting the dots to get some kind of pattern or drawing; cutting - cut stripes, teeth or fringes;

• exercise "Rubbish on the floor" - a child, using a broom and a scoop, sweeps the scraps of newspapers off the floor;

• stringing and lacing - the child stringing buttons, pasta, corn sticks, spools, lumps of paper on laces or a long thread;

• household tools - using tweezers, the child picks up the cornflakes;

• playing with water - the sink is filled with soapy water and shatterproof bottles, and balls, sponges, rubber toys, toys - water pumps. The task is to pour water back and forth and measure the volume;

• drawing with water - the child is offered a bucket of water and a brush to “paint” the floor, objects and his own body;

• drawing with your fingers - for a different tactile sensation, you can mix paint with sand or put a little shaving foam; playing with sand, you can add small toys to the sandbox that the child will bury, open, rearrange.

The duration of the lesson was 30 minutes, over a period of 14 days.

From 10.07.19 - daily examinations by a psychiatrist and a neurologist, psychocorrection carried out by a psychologist, with a child and a mother.

Against the background of the ongoing complex of rehabilitation measures on the 5-7th day, the child shows positive dynamics in the form of improved speech and cognitive functions, stabilization of the emotional sphere, and normalization of behavioral reactions. This made it possible to reduce the rehabilitation period to 14 days.

When the patient is withdrawn from the rehabilitation program and is discharged from the department, the specialists issued detailed recommendations with an invitation to the next course.

The second course of rehabilitation according to the proposed method was carried out from 10/28/19 to 11/11/19.

The rehabilitation period is 14 days.

The third course of rehabilitation according to the proposed method was carried out from 13.02.20 to 27.02.2019.

The rehabilitation period was 14 days.

Thus, the child underwent 3 rehabilitation courses according to the proposed scheme, and against the background of a complex of rehabilitation measures, the child's speech and cognitive functions improved, the emotional sphere stabilized, and behavioral reactions normalized.

Example 2.

Patient D., 5 years old, was admitted to the Department of Medical Rehabilitation of the State Budgetary Institution of the Russian Regional Children's Clinical Hospital on 06.12.19 with complaints of a disorder of speech and mental development (blurred speech, vocabulary is limited, commands are performed with additional stimulation), motor disinhibition, restlessness, excitability, mood swings, irritability, self-will, stubbornness, lack of self-service skills.

Anamnesis: sick from an early age; perinatal history is burdened (pregnancy - the second, proceeding, with the threat of failure in the first trimester. Childbirth - first, natural, 39 weeks, rapid, stimulated, weight - 3600 g, cried out at once); the child is monitored by a psychiatrist at the place of residence, a neurologist in the CSTO.

He was admitted to the department of medical rehabilitation of the State Budgetary Institution of Regional Development of the CSTO with the first diagnosis: "Organic lesion of the central nervous system, retrocerebellar cyst, occipital cyst, hypoplasia of the posterior communicating artery on both sides, dysarthria, general speech underdevelopment of the II level, mixed specific mental disorder , hyperdynamic syndrome, syndrome of emotional volitional instability "

The child arrived for rehabilitation with the results of the examination:

EEG shows slight diffuse changes of an irritative-dysrhythmic character

On MRI of the brain + MRA - on a series of tomograms, images of sub-, supratentorial structures of the brain in sagittal, frontal and axial projections were obtained. No pathologically altered MP signal was found in the brain substance, trunk, cerebellum. Differentiation of gray and white matter is not reduced. The ventricles of the brain are not dilated, the lateral ventricles are symmetrical, not dilated. Subarachnoid convexital spaces are not enlarged. A cyst with dimensions of 20.5 × 9.0 mm is determined retrocerebellar. There is no displacement of the median structures. In the area of MMU on both sides of the pathological masses is not determined. The base tanks are not widened. The chiasmally sellar region is unremarkable; the pituitary gland has a typical MP signal. The craniovertebral junction was unremarkable; the cerebellar tonsils were located at the BZO level. When performing MP angiography, the left and right internal carotid and its siphon of the usual direction and diameter, without signs of displacement or external compression, the MP signal inside the lumen of the vessels is homogeneous. The circle of Willis is closed, the intracranial spine of the vertebral arteries is asymmetric (on the right - 2.0 mm, on the left - 4.0 mm), on the right is crimped, the MP signal is uniform, no filling defects were found. Aneurysms and AVMs of cerebral vessels were not identified. In the projection of the sinus drainage, the cyst measures 8.0 × 8.2 mm. Conclusion: MP signs of a retrocerebellar cyst, cysts in the area of sinus drainage, pathological changes in the substance of the brain were not revealed. Hypoplasia, tortuosity of the intracranial part of the right vertebral artery.

06.12.19 - examination by a neurologist and a psychiatrist.

06.12.19, consultation of a psychologist: with an existing disorder of psychological development, the child has changes in the cognitive, emotional-volitional and behavioral spheres. Changes in the cognitive sphere: decreased plasticity of thought processes; underdevelopment of verbal - logical thinking. Decrease in the concentration of voluntary attention with an unevenly pronounced decrease in mnestic functions. Pronounced violations of speech development, impressive, expressive and communicative components of speech. Changes in the emotional - volitional sphere: emotional lability, increased psychomotor excitability. Decreased ability to mental stress. Low randomness of activity. Immaturity of the sphere of self-control and self-regulation. Features in the behavioral sphere: unevenly expressed lack of emotional contact. Rigidity of psycho-emotional attitudes

06.12.19 - examination of a speech therapist - defectologist, which revealed dysarthria, general speech underdevelopment of the II level

The consultations of these specialists in the department of medical rehabilitation confirmed the established diagnosis: “Organic lesion of the central nervous system, retrocerebellar cyst, cyst of the occipital lobe, hypoplasia of the posterior communicating artery on both sides, dysarthria, general speech underdevelopment of the II level, mixed specific disorder of mental development, hyperdynamic syndrome, syndrome of emotional volitional instability ”.

The rehabilitation course included: drug therapy prescribed by a psychiatrist and a neurologist: glycine 1 tablet × 3 times a day - 14 days, starting from 07.12.19, followed by the continuation of therapy on an outpatient basis after discharge.

Classes with a speech therapist-defectologist in a hall for sensory integration - a course of 14 individual lessons, lasting 40 minutes, classes begin on 07.12.19, including:

To develop tactile sensation -

• exercise "Black box" (a box for feeling objects in it) - the child inserts his hand into the hole and tells which toy he is touching;

• exercise "Can you describe this?" - the child is given objects with different textures, temperatures and weights, and he talks about the object that he touches;

• oral motor exercises - lick and stick stickers, blow whistles and pipes, blow bubbles, drink through a straw or from sports bottles;

Bilateral coordination

• exercise "Rhythm of the body" - while reciting or singing, pat or tap on various parts of the child's body, he repeats the movements;

Classes for the development of the visual system

• creating shapes - the child draws and creates shapes, letters and numbers from various materials, such as plasticine, shaving cream, sand, clay, pizza dough, draws with his finger and folds from strings or small parts.

The psychologist, after assessing the psychological status of the child, conducts a course of 14 sessions in a sensory room, lasting 30 minutes.

The lesson included:

• removal of emotional stress using color and light therapy (see Fig. 6); breathing techniques and exercises - "Calming" breathing, "Relaxing" breathing, "Push" breathing, "Fire" breathing, "Binding" breathing;

• technique "Fairytale therapy in a sensory room" (see Fig. 5);

• developmental manuals: "Seguin's boards", analogues of the developmental technique "Mailbox", "Nikitin's tabs", various inserts, constructors and puzzles;

• use of elements of art therapy (see Fig. 7)

• didactic and role-playing games, dramatization games.

Then, after a 30-minute break, the exercise therapy instructor prescribes a 10-day course of exercises in a hall for sensory integration, lasting 30 minutes in the morning.

The set of activities included: Activities for tactile sensation:

• exercise "Three-rub" - rub different textures on the skin;

• exercise "Sandwich".

Activities for the development of the vestibular system:

• classes on a swing with light swaying and juggling of objects, gripping, carrying and performing various tasks with color, texture, size and action;

• sets of exercises on a balancing board with and without auxiliary objects;

• amplitude exercises in a hammock with twisting, twisting, untwisting, swinging up and down, and at the end - light swinging back and forth and to the side;

• somersault;

• rocking;

• rotation on a swivel chair;

• sliding;

• balance on a large ball.

Classes for the development of the proprioceptive system:

• push-pull exercise - hard muscle work;

• hang and move along the hand bars;

• exercise "Ant trail" - put a large bag of rice or beans on the back of the child and let him walk with a heavy "shell" on his back.

Bilateral coordination

• catch the ball - the child catches the beach ball at close range, which can be gradually increased;

• hitting the ball - with a baseball bat, a mop stick, rolling pin, cardboard tube, ruler, holding them in both hands, the child hits the ball, the legs must be kept motionless;

• "hanging ball" - a ball of foam rubber on a string is suspended in a wide doorway, the child chooses different objects to play the role of a bat;

• "balloon" - the child throws and catches the balloon with both hands;

• "dance of ribbons" - holding a stick with ribbons tied over his head, the child turns the ribbons from side to side.

In the second half of the day, after a day's rest, the teacher, taking into account the recommendations of a psychologist in a hall for sensory integration, conducted the following classes:

• exercise "Pour-ka" - the child pours sand, beans, pours water from one container to another;

• the game "Labyrinth" and the game "Point to point" - the child leads the labyrinth on paper with his finger, toy car, colored pencil, marker, chalk, connecting the dots to get some kind of pattern or drawing; cutting - cut stripes, teeth or fringes;

• exercise "Rubbish on the floor" - a child, using a broom and a scoop, sweeps the scraps of newspapers off the floor;

• stringing and lacing - the child stringing buttons, pasta, corn sticks, spools, lumps of paper on laces or a long thread;

• household tools - using tweezers, the child picks up the cornflakes;

• playing with water - the sink is filled with soapy water and shatterproof bottles, and balls, sponges, rubber toys, toys - water pumps. The task is to pour water back and forth and measure the volume;

• drawing with water - the child is offered a bucket of water and a brush to “paint” the floor, objects and his own body;

• drawing with your fingers - for a different tactile sensation, you can mix paint with sand or put a little shaving foam; playing with sand, you can add small toys to the sandbox that the child will bury, open, rearrange.

The duration of the lesson was 40 minutes, over a period of 14 days.

From 07.12.2020 - they conduct daily examinations by a psychiatrist and a neurologist, psychocorrection carried out by a psychologist, with a child and a mother.

Against the background of the ongoing complex of rehabilitation measures on the 5-7th day, the child shows positive dynamics in the form of improved speech and cognitive functions, stabilization of the emotional sphere, and normalization of behavioral reactions. This made it possible to reduce the rehabilitation period to 14 days.

When the patient is withdrawn from the rehabilitation program and is discharged from the department, the specialists issued detailed recommendations with an invitation to the next course.

The second course on this method of rehabilitation was carried out to the patient from 03/23/2020 to 04/06/2020. Against the background of the ongoing complex of rehabilitation measures, the child's cognitive and speech functions improved, the emotional sphere stabilized, and behavioral reactions normalized. The rehabilitation period was 14 days.

Example 3.

Patient K., 7 years old, was admitted to the department of medical rehabilitation of the GBU RO "CSTO" on 09/01/2020 with complaints of impaired speech and mental development (difficulty in constructing sentences, impaired pronunciation, writing errors), irritability, restlessness, rapid distraction , motor disinhibition.

Anamnesis: sick from an early age; perinatal history burdened (pregnancy - the first, proceeding with the threat of failure twice (first, second trimester). Childbirth - the first, at 38 weeks, the umbilical cord entwined around the neck. Weight - 3200 g. Cried at once); the child is monitored by a neurologist in the CSTO.

He was admitted to the department of medical rehabilitation of the State Budgetary Institution of Regional Development of the CSTO with the first diagnosis: "Organic lesion of the central nervous system, dysarthria, general speech underdevelopment of the III level, mixed specific disorder of mental development, hyperdynamic syndrome, syndrome of emotional - volitional instability"

The child arrived for rehabilitation with the results of the examination:

EEG shows slight diffuse irritative changes. Light local changes are registered in the form of a few pointed alpha, theta waves in the parieto-occipital region

On MRI of the brain + MRA - on a series of tomograms, images of sub-, supratentorial structures of the brain in sagittal, frontal and axial projections were obtained. No pathologically altered MP signal was found in the brain substance, trunk, cerebellum. Differentiation of gray and white matter is not reduced. The ventricles of the brain are not dilated, the lateral ventricles are symmetrical, not dilated. Subarachnoid convexital spaces are not enlarged. There is no displacement of the median structures. In the area of MMU on both sides of the pathological masses is not determined. The base tanks are not widened. The chiasmally sellar region is unremarkable; the pituitary gland has a typical MP signal. The craniovertebral junction was unremarkable; the cerebellar tonsils were located at the BZO level. Slight parietal hypertrophy of the maxillary mucosa, the main sinuses. Increased MP signal from the cells of the mastoid processes of the temporal bones. Adenoids. When performing MP angiography, the left and right internal carotid and its siphon of the usual direction and diameter, without signs of displacement or external compression, the MP signal inside the lumen of the vessels is homogeneous. The circle of Willis is closed, the intracranial part of the vertebral arteries is not changed, the MP signal is uniform, and no filling defects were found. Aneurysms and AVMs of cerebral vessels were not identified. Conclusion: MP signs of pathological changes in the substance of the brain were not revealed. A variant of the structure of the circle of Willis.

01/09/2020 - examination by a neurologist and a psychiatrist

01/09/2020 consultation of a psychologist: with an existing disorder of psychological development, the child has changes in the sensory-perceptual, cognitive and emotionally-volitional spheres. Signs of uneven sensory integration disorder, mainly of proprioceptive and auditory modality. Immaturity of verbal and logical thinking, uneven decrease in intellectual productivity (social intelligence). Decrease in concentration of voluntary attention, with an uneven decrease in mnestic functions. Speech disorders in the form of general speech underdevelopment, level 3. Dysarthria. Changes in the emotional - volitional sphere: emotional lability, hyperthymic variant. Increased psychomotor irritability. Decreased ability to mental stress. Increased fatigue, satiety with psychoemotional or intellectual stress. Immaturity of the sphere of self-control and self-regulation.

01/09/2020 - examination of a speech therapist - defectologist, which revealed dysarthria, general speech underdevelopment of the III level

The consultations of these specialists in the department of medical rehabilitation confirmed the established diagnosis: "Organic lesion of the central nervous system, dysarthria, general speech underdevelopment of the III level, mixed specific disorder of mental development, hyperdynamic syndrome, syndrome of emotional and volitional instability"

The rehabilitation course included: drug therapy prescribed by a psychiatrist and a neurologist (sonapax - 10-20 mg / day in 2-3 doses per day, glycine - 1 tablet 3 times a day) - 14 days, starting from 01/09/2020. with the subsequent continuation of therapy on an outpatient basis after discharge;

Classes with a speech therapist-defectologist in a hall for sensory integration - a course of 14 individual lessons, lasting 40 minutes, the beginning of classes from 01/10/2020, including:

To develop tactile sensation -

• exercise "Black box" (a box for feeling objects in it) - the child inserts his hand into the hole and tells which toy he is touching;

• exercise "Can you describe this?" - the child is given objects with different textures, temperatures and weights, and he talks about the object that he touches;

• oral motor exercises - lick and stick stickers, blow whistles and pipes, blow bubbles, drink through a straw or from sports bottles;

Bilateral coordination

• exercise "Rhythm of the body" - while reciting or singing, pat or tap on various parts of the child's body, he repeats the movements;

Classes for the development of the visual system

• creation of shapes - the child draws and creates shapes, letters and numbers from various materials, such as plasticine, shaving cream, sand, clay, pizza dough, draws with his finger and folds from strings or small parts (see Fig. 8)

The psychologist, after assessing the psychological status of the child, conducts a course of 14 sessions in a sensory room, lasting 30 minutes.

The lesson included:

• removal of emotional stress using color and light therapy; breathing techniques and exercises - "Calming" breathing, "Relaxing" breathing, "Push" breathing, "Fire" breathing, "Binding" breathing;

• methodology "Fairy tale therapy in a sensory room";

• developmental manuals: "Seguin's boards" (see Fig. 9), analogues of the developmental technique "Mailbox", "Nikitin's tabs", various inserts, constructors and puzzles;

• use of elements of art therapy,

• didactic and role-playing games, dramatization games.

Then, after a 30-minute break, the exercise therapy instructor prescribes a 10-day course of exercises in a hall for sensory integration, lasting 30 minutes in the morning.

The set of classes included:

Activities for tactile sensation:

• exercise "Three-rub" - rub different textures on the skin;

• exercise "Sandwich".

Activities for the development of the vestibular system:

• classes on a swing with light swaying and juggling of objects, gripping, carrying and performing various tasks with color, texture, size and action;

• sets of exercises on a balancing board with and without auxiliary objects;

• amplitude exercises in a hammock with twisting, twisting, untwisting, swinging up and down, and at the end - light swinging back and forth and to the side;

• somersault;

• rocking;

• rotation on a swivel chair;

• sliding;

• balance on a large ball.

Classes for the development of the proprioceptive system:

• push-pull exercise - hard muscle work;

• hang and move along the hand bars;

• exercise "Ant trail" - put a large bag of rice or beans on the back of the child and let him walk with a heavy "shell" on his back.

Bilateral coordination

• catch the ball - the child catches the beach ball at close range, which can be gradually increased;

• hitting the ball - with a baseball bat, a mop stick, rolling pin, cardboard tube, ruler, holding them in both hands, the child hits the ball, the legs must be kept motionless;

• "hanging ball" - a ball of foam rubber on a string is suspended in a wide doorway, the child chooses different objects to play the role of a bat;

• "balloon" - the child throws and catches the balloon with both hands;

• "dance of ribbons" - holding a stick with ribbons tied over his head, the child turns the ribbons from side to side.

In the second half of the day, after a day's rest, the teacher, taking into account the recommendations of a psychologist in a hall for sensory integration, conducted the following classes:

• exercise "Pour-ka" - the child pours sand, beans, pours water from one container to another;

• the game "Labyrinth" and the game "Point to point" - the child leads the labyrinth on paper with his finger, toy car, colored pencil, marker, chalk, connecting the dots to get some kind of pattern or drawing; cutting - cut stripes, teeth or fringes;

• exercise "Rubbish on the floor" - a child, using a broom and a scoop, sweeps the scraps of newspapers off the floor;

• stringing and lacing - the child stringing buttons, pasta, corn sticks, spools, lumps of paper on laces or a long thread;

• household tools - using tweezers, the child picks up the cornflakes;

• playing with water - the sink is filled with soapy water and shatterproof bottles, and balls, sponges, rubber toys, toys - water pumps. The task is to pour water back and forth and measure the volume;

• drawing with water - the child is offered a bucket of water and a brush to “paint” the floor, objects and his own body;

• drawing with your fingers - for a different tactile sensation, you can mix paint with sand or put a little shaving foam; playing with sand, you can add small toys to the sandbox that the child will bury, open, rearrange.

The duration of the lesson was 30 minutes, over a period of 14 days.

From 01/09/2020 - they conduct daily examinations by a psychiatrist and a neurologist, psychocorrection carried out by a psychologist, with a child and a mother.

Against the background of the ongoing complex of rehabilitation measures on the 5-7th day, the child shows positive dynamics in the form of improved speech and cognitive functions, stabilization of the emotional sphere, and normalization of behavioral reactions. This made it possible to reduce the rehabilitation period to 14 days.

When the patient is withdrawn from the rehabilitation program and is discharged from the department, the specialists issued detailed recommendations with an invitation to the next course.

The child underwent 1 course of rehabilitation. When the patient is withdrawn from the rehabilitation program and is discharged from the department, the specialists issued detailed recommendations with an invitation to a second course of rehabilitation, if necessary.

In this way, 60 patients were rehabilitated.

The technical and economic efficiency of the application of the method lies in the fact that its application makes it possible to improve the cognitive, psychoemotional and behavioral spheres, the spontaneous formation of adaptive responses to various types of sensations by stimulating the sensory systems.

Claims (1)

A method for the rehabilitation of children with speech and mental disorders, which consists in the fact that on the day of admission of the patient to the medical rehabilitation department with a previously established diagnosis, he is prescribed nootropic therapy: glycine for children over 3 years old, 1 tablet 3 times a day; then, regardless of age, they carry out daily classes with a speech therapist-defectologist in the hall of sensory integration in the morning during the entire rehabilitation period: children 3-4 years old for 30 minutes, 5-7 years old for 40 minutes; from the second day of the child's stay in the department, regardless of age, they conduct daily psychocorrectional classes in the sensory room in the morning in a 14-day course: children 3-4 years old for 30 minutes, 5-7 years old for 40 minutes, also from the second half of the first day of the child's stay in the department, they conduct game exercises for 14 days: children 3-4 years old for 30 minutes, 5-7 years old for 40 minutes, and also conduct a course of physiotherapy exercises: children 3-4 years old for 30 minutes, 5-7 years 40 minutes in the hall of sensory integration in the morning, lasting 14 days.

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