RU2838809C1 - Method for rehabilitation of accompanying disorders of motor and vestibular functions in preschool and primary school children with hearing loss - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to surdology and otorhinolaryngology, namely to rehabilitation of children with hearing impairment, and can be used for adaptive physical training and rehabilitation of vestibular, motor and speech functions in children of preschool and primary school age with hearing impairment. Three blocks of trainings are conducted sequentially. First block includes 24 trainings that involve 7 tennis ball exercises of 1 to 5 minutes each. Second unit includes 32 sessions. 9 exercises with the coordination ladder, the tennis racket and the tennis ball are performed for 5 to 15 minutes each. Third unit includes 40 trainings. There are performed 8 exercises with a coordination ladder, cones, a tennis racket and a tennis ball for 5 to 20 minutes each.

EFFECT: method provides improved results of rehabilitation and higher quality of life.

1 cl, 2 ex

Description

The invention relates to surdology-otorhinolaryngology, namely to the rehabilitation of children with hearing impairments, and consists of using adaptive physical education with elements of tennis in the rehabilitation of vestibular, motor and speech functions in children of preschool and primary school age with hearing impairments.

Based on a meta-analysis of 11,872 studies, it was determined that children with hearing impairments have concomitant problems with postural control, balance, coordination, and motor skill development due to, among other things, the combined involvement of vestibular structures in the pathological process [1]. This deficit leads to a decrease in the child's ability to participate in the social life of peers, the development of psycho-intellectual, academic difficulties, and, ultimately, a decrease in the quality of life of children with hearing loss. It is known about the relationship between the development of gross and fine motor skills, balance, and coordination with the development of cognitive and speech functions, including in children with hearing impairments [2, 3, 4]. In addition, a recent study showed that schoolchildren with hearing impairments have lower rates of motor-visual integration, visual-spatial relationships, and visual sequential memory compared to their normally hearing peers. Combined with the need for greater involvement of the visual analyzer, this creates difficulties for children with hearing loss, including when mastering reading skills. It has been studied that deaf children use predominantly visual and somatosensory information to maintain postural control. The authors recommend developing visual perception in children with hearing impairments [5].

Moreover, even if balance, motor skills and quality of life are assessed, the development of these skills is usually not included in the individual rehabilitation and education plan for a child with impaired hearing, except in cases of obvious neurological or orthopedic diseases [6]. At the same time, a number of studies confirm the possibility of improving motor skills, especially balance, in children with hearing impairments against the background of regular and targeted physical exercise [6, 7]. In Russian deaf education, based on many years of research, a comprehensive system of education and training of children with hearing impairments has been developed, which also takes into account the presence of vestibular and motor disorders in a significant portion of children with hearing impairments [8]. The programs for teaching children in preschool and school educational correctional institutions include the direction of physical training aimed at the general physical development of children, the development of their motor coordination and balance (Model Adapted Basic Educational Program for Preschool Education of Deaf Children; Model Adapted Basic Educational Program for Primary General Education of Hard of Hearing and Late-Deafened Students; Model Adapted Basic Educational Program for Preschool Education of Children Who Have Undergone Cochlear Implantation). Special attention is paid to the diagnosis and correction of vestibular dysfunction in the verbotonal method of speech development of hard of hearing children, developed in the 50-60s of the 20th century [3]. The development of motor function in the system of correctional work on speech formation additionally includes directions for the development of fine and articulatory motor skills as a basis for the formation of the pronunciation side of speech. It is also taken into account that 30-40% of children with hearing impairments studying in correctional institutions have additional pathologies, including movement disorders, and training programs include appropriate areas of correctional work [9].

In recent years, inclusive education of children with hearing impairments has become increasingly widespread. Up to 50% of children with hearing impairments are educated in mainstream schools [10]. Adapted programs for educating such children in inclusive settings provide additional psychological and pedagogical assistance aimed at speech development, the child's inclusion in the life of a group/class, and for schoolchildren - mastering the school curriculum [11, 12]. These programs do not provide additional support in the area of physical development and motor skills. In large cities, some preschool children with hearing impairments visit teachers of the deaf and speech therapists in audiological and rehabilitation centers, private offices and do not receive corrective assistance related to motor development. At the same time, the development of physical education methods has led to the emergence of a new direction of adaptive physical education for people with disabilities, the improvement of therapeutic physical education methods [13]. Achievements in these areas create the possibility of developing comprehensive rehabilitation programs for children with hearing impairments that include the development of the motor sphere.

The technical problem is the need to supplement auditory-speech rehabilitation programs with systematic therapeutic and adaptive physical education classes.

A method for treating patients with vestibular dizziness is known [14], during which a course of treatment consisting of 12 active sessions, including physical exercises, is carried out daily, 1 session against the background of music. During the first 6 sessions, physical exercises are performed against the background of music at a largo tempo, and the following 6 at an andante tempo. The advantages of the method include a reduction in the time of treatment of patients with vestibular dizziness, as well as a simplification of the treatment process, due to the lack of need for equipment of the room and technical support. The disadvantages of the method include:

- the complexity of execution and the multi-component nature of individual exercises, which makes it difficult for preschool and primary school-age children with hearing impairments to explain them and perform them independently;

- a large number of exercises with no motivational component, which leads to rapid depletion of attention, loss of interest in performing exercises by preschool and primary school children;

- the method is aimed at treating predominantly vestibular vertigo and is not aimed at compensating for impairments of motor skills, motor-visual integration, visual-spatial relationships and visual sequential memory in children with hearing impairments;

- the need for musical accompaniment.

The method of harmonious physical and psychophysiological development of a person [15] was chosen as a prototype , which consists in the fact that physiological parameters are preliminarily determined (imbalance of muscle development, posture disorders, blood pressure, pulse, speed of sensorimotor reactions, visual-motor coupling of the left and right hands, interhemispheric asymmetry of the brain and asymmetry of physical development). Then, based on the identified parameters, a plan of lessons is drawn up, including alternating strikes with two rackets, held in each hand, at a ball into a flat vertical barrier.

The advantages of the prototype include:

- no need for complex, expensive equipment;

- the presence in the program of active complex-coordinated multivariate movements with both hands and movements around the site, associated with the active work of the oculomotor system, fine motor skills of the hands and cross-lateral movements, which leads to the involvement of the main muscle groups of the shoulder girdle, activation of the motor, sensory and associative zones, visual centers in both hemispheres of the brain, activation of interhemispheric interaction and the development of interhemispheric connections.

The disadvantages of the prototype include:

- lack of competitiveness, monotony and cyclical movements, which leads to rapid depletion of attention, loss of interest in performing exercises by preschool and primary school children;

- lack of exercises to develop postural control, balance, coordination of movements of the legs, arms, torso and head, narrow focus of the proposed exercises to develop motor skills;

- the absence in the curriculum of exercises adapted for children with hearing impairments, aimed, among other things, at developing auditory perception, auditory-visual coordination and oral speech.

The technical result consists in improving motor, visual and auditory-speech skills, balance, coordination, postural control in children with hearing impairments and, as a consequence, improving the results of rehabilitation and increasing the quality of life.

The technical result is achieved in that in the method for rehabilitation of concomitant disorders of motor and vestibular functions in preschool and primary school children with hearing loss, during which classes are carried out that include physical exercises, according to the invention, three blocks of classes are carried out sequentially, wherein the first block includes 24 classes, during which 7 exercises with a tennis ball are performed lasting from 1 to 5 minutes each, the second block includes 32 classes, during which 9 exercises with a coordination ladder, a tennis racket and a tennis ball are performed lasting from 5 to 15 minutes each, and the third block includes 40 classes, during which 8 exercises with a coordination ladder, cones, a tennis racket and a tennis ball are performed lasting from 5 to 20 minutes each.

One of the most suitable types of physical activity in the structure of complex rehabilitation of children with hearing impairments can be individual elements of the game of tennis. Tennis is a complex coordination sport that requires simultaneous work of various muscle groups and constant involvement of the visual and auditory analyzers. It has been shown that tennis classes lead, among other things, to the development of balance, coordination, postural control, motor-visual integration. In addition, acoustic differences when hitting the ball with a racket, the distance of the opponent and the coach when it is necessary to perceive their speech create additional opportunities for the development of auditory perception for children with hearing impairments, especially in complex acoustic conditions. Thus, in the process of playing tennis, a child with hearing impairment is exposed to polymodal stimulation, leading to an acceleration of the formation of connections between neurons. Additional benefits of tennis classes for children with hearing impairments are: the development of emotional intelligence, social interaction skills, and the emotional-volitional sphere. Tennis has been proven to be beneficial for children with visual impairments, as the need to visually control the ball trains accommodation, which helps improve visual acuity. As a game sport, tennis fosters discipline, self-control, behavioral and emotional control.

The technical result, including due to the fact that in the process of complex auditory-speech rehabilitation of children with hearing impairments, systematic classes in adaptive physical education with elements of tennis are conducted.

The claimed method is carried out as follows.

Classes are held twice a week on a tennis court with a stretched net. The program of classes includes three consecutive blocks.

The first block includes 24 lessons and is aimed at developing general coordination, balance, and "ball sense." Each lesson includes 7 exercises lasting from 1 to 5 minutes each. A tennis ball is used to perform the exercises.

First exercise: running with high hip lifts from the back line of the court to the net. Starting position: the child stands upright. When pushing off with the supporting leg, lifts the hip of the swinging leg high with a high hip lift frequency. The supporting leg is located high on the foot, without falling on the heel. When landing, the leg is placed on the front part of the foot. The body takes a vertical position, the center of gravity is transferred to the shoulders. The arms are bent at the elbows, they work in the same way as when running. The exercise is repeated 20 times in a row.

Second exercise: running with a shin sweep back from the back line of the court to the net. Starting position: the child stands upright. Then he runs elastically, alternately bends his legs at the knee joint, throws his shin back to the buttock. The body is slightly tilted forward, the arms work the same way as when running. The exercise is repeated 20 times in a row.

Third exercise: "star", jumping with simultaneous spreading and bringing arms and legs together. Starting position: the child stands straight, feet shoulder-width apart, arms freely hanging at the sides. Inhale and bend the knee joints. Exhale, push off the floor powerfully and jump up. Simultaneously with the jump, spread straight legs to the sides, and arms at an angle of 45° upward. Lowering to the floor, bring the limbs together in the starting position. Repeat the exercise 20 times in a row.

Exercise 4: Jumping with alternating arms and legs from the back line of the court to the net. Starting position: the child stands upright. When pushing off, the pushing leg is fully straightened, while the swinging leg, bent at the knee, is sharply brought forward. The leg is placed upon landing with an active raking motion on the entire foot. The arms work in opposite directions. The body is in a position with a slight forward tilt.

Fifth exercise: hitting the ball on the court and then catching it with one hand (right and left, alternately). Starting position: the child stands upright, holding a tennis ball in his right hand, palm down. Hits the ball on the court and catches it with his right hand, maintaining the position with the palm down. Then the exercise is repeated with the left hand. The exercise is repeated 10 times in a row for the right and left hand.

Exercise 6: Throwing the ball forward and upward with one hand and catching it after it bounces off the court. The exercise is performed in a circle of 4-5 people. Starting position: children stand in a circle, facing inside the circle with a diameter of 4-5 steps, gradually increasing the distance to 8-10 steps. One child throws the ball up, the one standing opposite catches the ball within the circle after it bounces off the court, without bringing the hand close to the body. Then he throws the ball to another child, the exercise is repeated 10 times in a row.

Exercise 7: Throwing a tennis ball with one hand (right and left alternately) forward and downwards and catching the ball with your partner, first with both hands, then with one, after it bounces off the court. Starting position: facing each other at a distance of 4-5 steps, gradually increasing the distance to 8-10 steps. Catch the ball in front of you, without bringing your hand close to your body. Repeat the exercise 10 times in a row.

The second block includes 32 lessons and is aimed at developing postural control, motor functions, balance, racket and ball control. Each lesson includes 9 exercises lasting from 5 to 15 minutes each. The exercises are performed using a coordination ladder, a tennis racket and a tennis ball.

First exercise: starting position - the child stands at the outermost cell of the coordination ladder facing the end of the ladder. Takes steps with the right and left foot inside each cell of the coordination ladder, then exits, placing the feet on the sides of the coordination ladder, moving forward in the longitudinal direction one cell to the end of the coordination ladder.

Second exercise: initial position - the child stands at the outermost cell of the coordination ladder facing the long part of the ladder. Performs steps with the right and left foot into the adjacent cells of the coordination ladder, then - exits it, placing the feet outside the coordination ladder, moving in the transverse direction first to the left, then to the right to the end of the coordination ladder.

Third exercise: starting position - the child holds the racket by the edge of the handle. He hits the ball with the racket downwards on the court first with the right hand, then with the left hand, standing still. The hits are performed at waist level. The exercise is repeated 10 times in a row for the right and left hands.

Fourth exercise: starting position - the child holds the racket by the edge of the handle. He hits the ball with the racket down on the court first with the right hand, then with the left hand, moving in steps from the back line of the court to the net. The hits are performed at waist level.

Fifth exercise: starting position - the child holds the racket by the edge of the handle with the right hand. He hits the ball upwards with the racket with the right hand, standing still. The hits are performed at waist level. The exercise is repeated 10 times in a row.

Exercise 6: Initial position - the child holds the racket by the edge of the handle with his right hand. He hits the ball up with the racket alternately with one side of the string surface of the racket, standing still. The hits are performed at waist level. The exercise is repeated 10 times in a row.

Exercise 7: Initial position - the child holds the racket by the edge of the handle with the right hand. The child hits the ball upwards with the racket with the right hand, moving in steps from the back line of the court to the net and back. The hits are performed at waist level.

Exercise 8: Initial position - the child holds the racket in front of him by the edge of the handle with his right hand, the plane of the racket is directed upwards. A ball is placed on the string surface, which the child rolls along the rim of the racket 3 times clockwise, 3 times counterclockwise.

Exercise Nine: Initial position - the child holds the racket in front of him by the edge of the handle with his right hand, the plane of the racket is directed downwards. A ball is placed on the string surface, which the child holds on the surface of the racket, moving in steps from the back line of the court to the net with his face and back - with his back.

The third block includes 40 lessons and is aimed at developing motor functions, social interaction, emotional-volitional sphere, auditory-speech skills, balance, ball hitting and serving skills. Each lesson includes 8 exercises lasting from 5 to 20 minutes each. To perform the exercises, a coordination ladder, cones, a tennis racket and a tennis ball are used.

First exercise: starting position - the child stands at the outermost cell of the coordination ladder facing the end of the ladder. Jumps on one leg (first on the right, then on the left) along the coordination ladder to the end in a "snake", the first jump is inside the cell, the second - to the right side, the third - inside the next cell, the fourth - to the left side, etc.

Second exercise: starting position - the child holds the racket by the edge of the handle. Performs a static imitation of the position of individual phases of the strikes in the following sequence: starting position, swing with a turn of the body, phase of direct impact on the ball, follow-through and end of the strike. The exercise is repeated 10 times in a row for the right and left hand.

Third exercise: starting position - the child holds the racket by the edge of the handle. Performs a dynamic imitation of a full racket strike without a ball to the right and left. The exercise is repeated 10 times in a row for the right and left hand.

Fourth exercise: starting position - the child holds the racket by the edge of the handle with the right hand. The instructor throws the ball to the child. The child, turning the body to the right (left side to the net), hits the ball over the net with the right hand, bouncing off the court and hitting the designated area (half-court, middle line - designated by a cone), standing still. The exercise is repeated 10 times in a row.

Fifth exercise: starting position - the child holds the racket by the handle with both hands. The instructor throws the ball to the child. The child, turning the body to the left (with the right side to the net), hits the ball over the net with a rebound from the court with both hands and hits the designated area (half-court, the middle line - designated by a cone), standing still. The exercise is repeated 10 times in a row.

Exercise 6: Initial position - the child holds the racket by the edge of the handle in the right hand. The instructor throws the ball to the child under the right hand. The child hits the ball with the right hand over the net and hits the area marked with a cone (half-court, the middle line - marked with a cone). The exercise is repeated 10 times in a row.

Exercise 7: Initial position - the child holds the racket by the edge of the handle in the right hand. The instructor throws the ball to the child under the left hand. The child hits the ball with the right hand over the net and hits it into the area marked by the cone (half-court, the middle line - marked by the cone). The exercise is repeated 10 times in a row.

Exercise 8: Initial position - the child holds the racket by the edge of the handle in the right hand. The instructor throws the ball to the child. The child runs towards the ball and hits the ball from the right side with a rebound from the court through the net and into the designated area (half-court, middle line - designated by a cone). The exercise is repeated 10 times in a row.

Exercise Nine: Initial position - the child holds the racket by the handle with both hands. The instructor throws the ball to the child. The child runs towards the ball and hits the ball from the left with a rebound from the court through the net and into the designated area (half-court, middle line - designated by a cone). The exercise is repeated 10 times in a row.

Exercise 10: Initial position: two children stand opposite each other on either side of the net in the half-court area, holding rackets by the edge of the handle. They sequentially hit the ball back and forth across the net with the racket, using right and left hits. The exercise is repeated 20 times in a row.

The claimed invention is explained by examples.

Example 1

Boy, 9 years old, diagnosis: bilateral chronic sensorineural hearing loss of the IV degree, condition after cochlear implantation on the right ear at the age of 2. Constantly uses a speech processor on the right ear, a digital super-power hearing aid on the left ear. Studies in the 2nd grade of a comprehensive school. Speech is presented as an expanded phrase with pronunciation disorders. According to the results of the vestibular examination, it was revealed that the child's postural stability indicator is below average, the quality level of the balance function is average.

The child underwent a rehabilitation course using adaptive physical education and elements of tennis.

Classes were held twice a week on a tennis court with a stretched net. The first block consisted of 24 classes, including 7 exercises with a tennis ball, each lasting 5 minutes. Then the second block consisted of 32 classes, including 9 exercises with a coordination ladder, a tennis racket, and a tennis ball, each lasting 15 minutes. Then the third block consisted of 40 classes, including 8 exercises with a coordination ladder, cones, a tennis racket, and a tennis ball, each lasting 20 minutes.

After the rehabilitation course, the vestibular examination showed an increase in the indicators of postural stability and the quality of the balance function to a level above average. According to the medical and speech therapy examination, the number of pronunciation disorders was significantly reduced.

Example 2

Girl, 12 years old, diagnosis: bilateral chronic sensorineural hearing loss of the 3rd degree. Has been using two digital powerful hearing aids binaurally since the age of 3. Concomitant diagnosis: attention deficit hyperactivity disorder. Studies in the 5th grade of a school for children with hearing impairments. According to the medical and speech therapy examination, general speech underdevelopment of the 3rd level was determined. According to the results of the vestibular examination, it was revealed that the child's postural stability indicator is below average, the level of the balance function quality is below average.

The child underwent a rehabilitation course using adaptive physical education and elements of tennis.

Classes were held twice a week on a tennis court with a stretched net. The first block consisted of 24 classes, including 7 exercises with a tennis ball, each lasting 1 minute. Then the second block consisted of 32 classes, including 9 exercises with a coordination ladder, a tennis racket, and a tennis ball, each lasting 5 minutes. Then the third block consisted of 40 classes, including 8 exercises with a coordination ladder, cones, a tennis racket, and a tennis ball, each lasting 5 minutes.

After the rehabilitation course, the vestibular examination showed an increase in the indicators of postural stability and the quality of the balance function to a level above average. According to the medical and speech therapy examination, general speech underdevelopment of level 4 was revealed (positive dynamics).

References

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2. Bogdanova T.G. Deaf psychology: Textbook for students of higher pedagogical educational institutions. - M.: Academy, 2002. - pp. 3-203.

3. Rulenkova L.I. How to teach a deaf child to listen and speak based on the verbotonal method. Moscow, Paradigma, 2010, 91 p.

4. Magadmi R.M., Kamel F.O. Beliefs and barriers associated with COVID-19 vaccination among the general population in Saudi Arabia. BMC Public Health. 2021 Jul 21; 21 (1): 1438. doi: 10.1186/s12889-021-11501-5. PMID: 34289817; PMCID: PMC8294288.

5. Thakur R., Jayakumar J., Pant S. Visual Perception and Attentional Skills in School-aged Children: A Cross-Sectional Study of Reading Proficiency in the Hearing Impaired. Indian J Community Med. 2023 Jul-Aug; 48 (4): 544-549. doi: 10.4103/ijcm.ijcm_204_22. Epub 2023 Jul 14. PMID: 37662132; PMCID: PMC10470561.

6. Rajendran V., Roy F.G. An overview of motor skill performance and balance in hearing impaired children. Ital J Pediatr. 2011 Jul 14; 37: 33. doi: 10.1186/1824-7288-37-33.

7. Mehrem E.S, Fergany LA, Mohamed SA, Fares HM, Kamel RM. Efficacy of fine motor and balance exercises on fine motor skills in children with sensorineural hearing loss. Restor Neurol Neurosci. 2022; 40 (1): 43-52. doi: 10.3233/RNN-211156.

8. Golovchits L.A. Correctional and pedagogical assistance to preschoolers with hearing impairments with complex developmental disorders / L.A. Golovchits // Defectology: scientific and methodological journal: published since 1969 / Ed. N.N. Malofeev, A.B. Menkov. - 2006. - No. 6 2006. - pp. 42-49.

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10. Tufatulin G.Sh., Koroleva I.V. Medical-psychological-pedagogical rehabilitation of children with hearing impairments at the regional level // Science and innovation in medicine. - 2021. - Vol. 6. - No. 2. - P. 30-36. doi: 10.35693/2500-1388-2021-6-2-30-36

11. Leonhard E.I. et al. I don’t want to be silent! Experience of teaching children with hearing impairments using the Leonhard method, 3rd ed. Moscow: Terevinf 2009.

12. Leonhard E.I. Violation of the laws of speech development in children and adolescents with hearing impairments in the process of (re)habilitation is the main factor in the emergence of "tertiary defects" (behavioral disorders) // Central mechanisms of speech: Collection of materials of the X All-Russian (with international participation) scientific and practical conference named after prof. N.N. Traugott. Under the general editorship of E.I. Galperina / St. Petersburg, 2022, p. 86.

13. Yakhnina, E.Z. Methods of musical and rhythmic classes with children with hearing impairments: a teaching aid for students of higher educational institutions / E.Z. Yakhnina. - Moscow: Vlados, 2003. - 272 p. - (Corrective pedagogy). - ISBN 5-691-01002-6.

14. Method for treating patients with vestibular dizziness: patent RU 2722881, Russian Federation, application RU 2019135665, filed 05.11.2019, published 04.06.2020.

15. Method for harmonious physical and psychophysiological development of a person: patent RU 2737997, Russian Federation, application RU 2018137931, filed 10/26/2018, published 12/07/2020.

Claims (29)

A method for the rehabilitation of concomitant disorders of motor and vestibular functions in preschool and primary school children with hearing loss, during which classes are held that include physical exercises, characterized in that classes are held twice a week on a tennis court with a stretched net, with three blocks of classes being held sequentially, with the first block including 24 classes, during which 7 exercises are performed with a tennis ball, each lasting from 1 to 5 minutes: - first exercise: running with high hip lifts from the back line of the court to the net, the exercise is repeated 20 times in a row; - the second exercise: running with a backward shin kick from the back line of the court to the net, the exercise is repeated 20 times in a row; - the third exercise is "star": from the starting position standing, feet shoulder-width apart, arms freely hanging at the sides, then inhale and bend the knee joints, exhale, push off the floor and jump up, simultaneously with the jump, spread straight legs to the sides, and arms at an angle of 45° upwards, then, lowering to the floor, bring the limbs together in the starting position, repeat the exercise 20 times in a row; - the fourth exercise: jumping with a change of arms and legs from the back line of the court to the net, with the starting position: the child stands straight, when pushing off, the pushing leg is fully straightened, while the swinging leg is bent at the knee joint and brought forward, the leg is placed upon landing with an active raking movement on the entire foot, the arms work in opposite directions, the body is in a position with a forward tilt; - fifth exercise: hitting the ball on the court and then catching it with one hand, the exercise is repeated 10 times in a row for the right and left hand; - the sixth exercise is performed in a circle of 4-5 people, the starting position: children stand in a circle, facing inside the circle with a diameter of 4-5 steps with a gradual increase in distance to 8-10 steps, while one child throws the ball up, the one standing opposite catches the ball within the circle after it bounces off the court, then throws the ball to another child, the exercise is repeated 10 times in a row; - the seventh exercise is performed from the starting position facing each other at a distance of 4-5 steps with a gradual increase in distance to 8-10 steps: throw a tennis ball with one hand alternately right and left forward and down, after bouncing off the court the partner catches the ball first with both hands, then with one, the exercise is repeated 10 times in a row; The second block includes 32 sessions, during which 9 exercises are performed with a coordination ladder, a tennis racket and a tennis ball, lasting from 5 to 15 minutes each: - first exercise: starting position - the child stands at the outermost cell of the coordination ladder facing the end of the ladder, takes steps with the right and left foot inside each cell of the coordination ladder, then exits, placing the feet on the sides of the coordination ladder, and moves forward in the longitudinal direction one cell to the end of the coordination ladder; - the second exercise: the starting position is the child standing at the outermost cell of the coordination ladder facing the long part of the ladder, steps with the right and left foot into the adjacent cells of the coordination ladder, then exits it, placing the feet outside the coordination ladder, moving in a transverse direction first to the left, then to the right to the end of the coordination ladder; - third exercise: starting position - the child holds the racket by the edge of the handle, hits the ball with the racket downwards on the court first with the right hand, then with the left hand, standing still, the hits are performed at waist level, the exercise is repeated 10 times in a row for the right and left hand; - the fourth exercise: the starting position is that the child holds the racket and hits the ball with the racket down on the court, first with the right hand, then with the left hand, moving in steps from the back line of the court to the net, hitting at waist level; - fifth exercise: starting position - the child holds the racket with his right hand and hits the ball upwards with the racket with his right hand, standing still, the hits are performed at waist level, the exercise is repeated 10 times in a row; - the sixth exercise: the starting position is that the child holds the racket by the handle with his right hand and hits the ball upwards with the racket, alternately with one side and then the other of the string surface of the racket, standing still, the hits are performed at waist level, the exercise is repeated 10 times in a row; - the seventh exercise: starting position - the child holds the racket with his right hand, hits the ball upwards with the racket with his right hand and moves with a step from the back line of the court to the net and back, hitting at waist level; - the eighth exercise: starting position - the child holds the racket in front of him with his right hand, the plane of the racket is directed upwards, a ball is placed on the string surface, which the child rolls along the rim of the racket 3 times clockwise, 3 times counterclockwise; - the ninth exercise: starting position - the child holds the racket in front of him with his right hand, the plane of the racket is directed downwards, a ball is placed on the string surface, which the child holds on the surface of the racket, moving in steps from the back line of the court to the net with his face and back - with his back; The third block includes 40 sessions, during which 10 exercises are performed with a coordination ladder, cones, a tennis racket and a tennis ball, lasting from 5 to 20 minutes each: - first exercise: starting position - the child stands at the outermost cell of the coordination ladder, jumps on one leg, first on the right, then on the left, along the coordination ladder to the end in a “snake” pattern, first jumping inside the cell, then to the side on the right, inside the next cell, to the side on the left; - the second exercise: the starting position - the child holds the racket and performs a static imitation of the position of individual phases of the strikes in the following sequence: the starting position, the swing with a turn of the body, the phase of the direct strike on the ball, the follow-through and the end of the strike, the exercise is repeated 10 times in a row for the right and left hand; - third exercise: starting position - the child holds the racket and performs a dynamic imitation of a full racket strike without a ball from the right and left, the exercise is repeated 10 times in a row for the right and left hand; - the fourth exercise: the starting position is the child holding the racket with his right hand, the instructor throws the ball to the child, the child turns his body to the right with his left side towards the net and hits the ball over the net with a rebound from the court with his right hand and hitting the middle line marked with a cone, standing still, the exercise is repeated 10 times in a row; - fifth exercise: starting position - the child holds the racket by the handle with both hands, the instructor throws the ball to the child, the child turns his body to the left with his right side to the net and hits the ball over the net with a rebound from the court with both hands and hitting the middle line, marked with a cone, standing still, the exercise is repeated 10 times in a row; - the sixth exercise: the starting position is the child holding the racket in his right hand, the instructor throws the ball to the child's right hand, the child hits the ball with his right hand over the net and hits the middle line marked with a cone, the exercise is repeated 10 times in a row; - the seventh exercise: the starting position is that the child holds the racket by the edge of the handle in his right hand, the instructor throws the ball to the child under his left hand, the child hits the ball with his right hand over the net and hits the middle line, marked with a cone, the exercise is repeated 10 times in a row; - the eighth exercise, starting position - the child holds the racket in his right hand, the instructor throws the ball to the child, the child runs towards the ball and hits the ball from the right with a rebound from the court through the net to the middle line, marked with a cone, the exercise is repeated 10 times in a row; - the ninth exercise: the starting position is the child holding the racket with both hands, the instructor throws the ball to the child, the child runs towards the ball and hits the ball from the left with a rebound from the court through the net and hitting the middle line, marked with a cone, the exercise is repeated 10 times in a row; - the tenth exercise starting position - two children stand opposite each other on both sides of the net, holding rackets, and sequentially hit the ball with a racket to each other over the net, using right and left strokes, the exercise is repeated 20 times in a row.