Individual training for children with cerebral palsy. Treatment and rehabilitation of a child diagnosed with cerebral palsy
GBU DPO VORONEZH REGION
"INSTITUTE FOR EDUCATIONAL DEVELOPMENT"
Department of Educational Technologies, Correctional and Inclusive Education
TEST PROJECT
student of advanced training courses
teachers of educational organizations teaching children with disabilities and disabled children
“Federal State Educational Standards requirements for the training and education of disabled children and students with disabilities, taking into account the characteristics of their mental and personal development”
12.12 – 19.12.2016
« Features of teaching children with cerebral palsy in the distance education system »
Completed by: Savrasova M.I.. chemistry teacher , KOU VO "Center for Curative Pedagogy and Differentiated Education" (Voronezh)
Checked by: Candidate of Pedagogical Sciences, Associate Professor of the Department of Physical Education and Physical Fitness
Nedelina S.V.
VORONEZH, 2016
Last name First name Patronymic: Savrasova Marina Ivanovna
Position, name of educational organization (chemistry teacher KOU VO "Center for Curative Pedagogy and Differentiated Education" (Voronezh)
General teaching experience: 33 years, in the position: Geography teacher 6 years.
Contact phone (personal, mobile): 89065852387
e-mail (personal) [email protected]
| 1. Characteristics of the developmental features of children diagnosed with cerebral palsy (CP) | |
| 2. Design of the educational process taking into account the characteristics of children diagnosed with cerebral palsy (CP) | |
| 3. Criteria and indicators for achieving planned results | |
| 4. List of used literature |
1. Characteristics of the developmental features of children diagnosed with cerebral palsy (CP)
The Concept of the Federal Target Program for the Development of Education for 2011–2015 states the principle of equal access of children to a full-fledged quality education, regardless of health status.
“The right to education is one of the most important individual rights. Being an integral element of the system of human rights and the life of society as a whole, it creates the opportunity to access the results of the development of civilization, introduces a person to the level of culture achieved by society, fosters respect for universal human values, forms a national culture, and promotes social progress" 1
The relevance of the study is beyond doubt. The increase in the incidence of cerebral palsy, one of the most disabling neuropsychiatric diseases. Children with dysfunction of the musculoskeletal system have been the object of close attention of special educators, psychologists, speech therapists, and clinicians for several decades.
Cerebral palsy (CP) is a severe multifactorial disease of the nervous system caused by harmful effects on the brain during various periods of the child’s intrauterine development, during childbirth and in the first weeks of life. The time of exposure to harmful factors determines the picture of the disease to a greater extent than the nature of the influencing factors. The disease is accompanied not only by gross motor disturbances themselves, but also by a distortion of the program of normal development of movements.
Movement disorders characteristic of cerebral palsy: muscle hypertonicity, development of contractures, impaired coordination of movements, muscle atrophy, etc. With cerebral palsy, stable vicious postures and movements are formed, posture changes, contractures and deformations of the musculoskeletal system (MSA) and other disorders occur. There is a disorder in the activity of the analyzer, which complicates the normal adaptation of patients to the environment. Increased emotional excitability, mental inertia, etc. are typical. 2
Features of teaching children with cerebral palsy
The main manifestations of cerebral palsy are slowness and immaturity of motor skills and abilities. In some children, motor impairments are complicated by violent movements (hyperkinesis) of the head, arms, shoulders, facial grimaces, etc., which are especially intensified by excitement, fear, unexpected approach to the child, as well as when trying to perform certain purposeful actions. Tremors are often observed in children - trembling of the fingers and tongue. It is most pronounced during purposeful movements (for example, when writing). A decrease in the number of contacts with others leads to the formation of a number of negative character traits: moral, volitional. Such children do not know how to overcome difficulties and subordinate their actions to certain requirements and rules. They find it difficult to organize their activities, regulate them and their behavior. Features of the development of cognitive and personal spheres should be taken into account when organizing the educational process.
Impaired mental performance usually manifests itself in two ways.
1. Persistent, uniform decrease in performance, asthenic manifestations. These children have low perceptual activity educational material, weakened attention. Children quickly experience mental exhaustion, to which the child can react with outbursts of irritation, active avoidance of contact, or complete refusal.
2. Uneven (flickering) nature of mental performance. In such children, the condition sometimes changes several times during one lesson. A short period of cognitive activity is replaced by sudden fatigue, attention is unstable. Impaired mental performance is the main obstacle to productive learning. Attention is characterized by instability, increased distractibility, and insufficient concentration on the object. To prevent problems with attention and performance, it is necessary
Dosing of intellectual load (the volume of educational material should be reduced by a third of the usual volume);
Reducing lesson time;
The number of lessons should be reduced or divided into periods with a long rest between them;
Planning a change in activities to prevent fatigue;
During lessons, it is necessary to plan motor warm-ups and special relaxation exercises;
Use special methods and techniques for presenting material in lessons, taking into account the nature of the disorder or disease.
The quality of children's knowledge and ideas about the world around them is significantly reduced. Therefore, when presenting educational material, the teacher must introduce additional explanations and make extensive use of clarity and vary it when explaining. 3
Memory deficiencies lead to slow accumulation of knowledge and skills in academic disciplines. In this regard, when planning and conducting lessons, it is advisable to rely on the linear-concentric principle of teaching, which involves building the study of new things on the past experience of children; at each stage of learning the same areas of activity are studied, but at a higher level. Multiple repetitions of material are introduced. The personal characteristics of children must be taken into account when selecting tasks. The level of difficulty of the task should correspond to the child’s capabilities, and the assessment should stimulate and motivate to continue the activity.
Since the needs and attitudes of an individual largely depend on his scale of values, the teacher’s task is to bring to the first place in this scale those values that would contribute to the orientation of the child’s personality towards achieving real, accessible goals for him (for example, studying, acquiring a profession, doing what he loves). and a useful activity, the solution of some creative problem, etc.) and the formation of an adequate level of aspiration. To increase the effectiveness of ongoing pedagogical correction activities, it is necessary to attract the parents of students to your side, explain to them the goals and objectives of this work and develop general tactics of behavior in
regarding their children. 4
The special socio-legal status of disabled children necessitates securing guarantees for receiving education, including in the context of integrated education. To implement these priorities, it is necessary to take into account international experience, reflected in a number of regulatory documents, in particular the conventions: “On the Rights of the Child”, “On the Rights of Persons with Disabilities”, “On Human Rights”, “On the Rights of Mentally Retarded Persons”, which prohibit discrimination against children, guaranteeing access for people with disabilities to services in the field of education and vocational training , medical care, restoration of health with the aim of fully involving the child in social life, developing his cultural and spiritual potential. 5
Modern education unthinkable without innovative processes. In a general sense, “innovation” (Latin “innovation”) – innovation, change, renewal, is associated with the activity of creating, mastering, using and disseminating something new. At the same time, the prevailing position is that: “Innovation is not just the creation and dissemination of innovations, it is changes that are significant in nature and are accompanied by changes in the way of activity and style of thinking.”
The specifics of innovation are manifested in the following:
Innovation always contains a new solution to a current problem;
The use of innovation leads to a qualitative change in the level of development of the student’s personality;
The introduction of innovations causes qualitative changes in other components of the school system.
Currently, there are many ways of innovative learning, for example, modular learning, electronic-interactive learning, problem-based learning, distance learning, research methodical training, project method, etc.
So, the goal innovation activity is a qualitative change in the student’s personality compared to traditional system. Developing the ability to motivate actions, independently navigate the information received, the formation of creative unconventional thinking, the development of children through the maximum disclosure of their natural abilities, using the latest achievements of science and practice, are the main goals of innovative activity.
2. Design of the educational process taking into account the characteristics of children diagnosed with cerebral palsy (CP).
The priority area of work is the provision of distance educational services to children with severe disabilities who cannot attend general education institutions and are deprived of the opportunity to receive a quality education.
The work is carried out online using sets of special equipment supplied as part of the program for distance learning for disabled children studying under individual programs at home. Specialized equipment is designed for children with various pathologies, including children with diseases of the musculoskeletal system. Distance learning is a way of organizing the learning process based on the use of modern IT technologies. This form makes it possible to implement distance learning, providing the learner with a significant part of the educational material and most of interaction with the teacher is carried out using technical, software and administrative tools of the global Internet. The work uses various information resources (training and monitoring systems, video and audio recordings). Together with traditional textbooks and methodological manuals electronic libraries are used. Distance learning significantly expands the opportunities for children with disabilities health, who for certain reasons cannot attend school. Such training allows the child to learn at his own pace, based on individual capabilities and personal characteristics. Communication with the teacher is carried out using the Skype program, which creates opportunities for real-time communication; the student has the opportunity to ask the teacher a question, express his opinion, judgment, and answer questions for the lesson.
Among disorders of the musculoskeletal system, the main place is occupied by cerebral palsy (CP). Equipping the workplace with technical means makes it possible to partially or fully compensate for the limitations associated with dysfunction of the musculoskeletal system: computer control devices, special keyboards, alternative information input devices, joysticks, trackballs, head mice. Teaching children with cerebral palsy has its own characteristics that must be taken into account when organizing and conducting lessons. The range of intellectual impairments in cerebral palsy is extremely large: from a normal level of mental development to severe degrees of mental retardation. Experts note that the structure of cognitive impairment in cerebral palsy has a number of specific features: uneven nature of violations of individual mental functions; increased fatigue, exhaustion of mental processes; reduced stock of knowledge and ideas about the world around us; Difficulties in switching to other activities, lack of concentration, slowness of perception, decreased mechanical memory and other features are noted. Delayed mental development in cerebral palsy is most often characterized by favorable dynamics in the further mental development of children. 6 Working with such children is difficult, but interesting; they are spontaneous, impressionable, and responsive. They need constant attention, support, and praise. On initial stage interaction with the student, the teacher needs to establish a trusting relationship, interest in the subject, make, technically, the educational process understandable, accessible, and interesting. They easily use the help of an adult when learning; they have sufficient, but somewhat slow, assimilation of new material. At the initial stage, it is also important to establish contact with the student’s parents, find out the level of development of the child’s academic skills, the degree of computer skills of family members (so that, if necessary, parents can provide support and assistance). The teacher needs to know the characteristics of the student in order to effectively structure the educational process and avoid stressful situations. In my work, in addition to general didactic principles, I am guided by the following principles: the principle of independence, the principle of motivation, the principle of connecting theory with practice, the principle of efficiency. All this provides the opportunity to individualize the approach to the student, control the student and maintain feedback with him, ensure self-control of educational activities, demonstrate visual educational information, simulate various processes and phenomena, increase interest in the learning process. The main thing, in my opinion, is to make the learning process entertaining, interesting, and accessible. Create conditions for the student that will allow them to assimilate the information as much as possible, receive benefits and practical results. During lessons, I use an Internet connection based on high-speed access technologies, which allows a student with disabilities to be in constant remote contact with the teacher. In the process of work, a number of network resources are used, and first of all, the material from the distance education server of the KOU “Center for Curative Pedagogy and Differentiated Education,” which, in addition to technical support, provides a repository of software, methodological materials and media resources for academic disciplines of the school course. In practice, I use an algorithm for preparing for a lesson, developed taking into account knowledge of distance learning technology, correctional pedagogy and subject methodology: Algorithm of actions when preparing for a distance lesson 1. Information block (a) individual characteristics of the student; b) information on the topic of the lesson): a) Taking into account the individual characteristics of the student: - existing disabilities (cerebral palsy); - academic performance; - pace of work in the lesson; - general preparedness of the student in the subject; - attitude to different forms of work (prefers working with illustrative material and discussing questions on the topic of the lesson, etc.); - communication skills; - emotionality; - ability to use technical teaching aids. b) topic of the lesson, place of the lesson in the thematic section, purpose of the lesson; - selection of materials (audio-video) for the lesson; - what the student should understand, remember, know and be able to do after the lesson; - determine the amount of material available to the student, record Interesting Facts on the topic of the lesson; - methods and techniques of teaching this lesson; - inclusion of a health-saving component in the structure of the lesson (warm-up, reflective technique, prevention of visual fatigue); - decor technological map lesson. 2. Practice (selection of methods, techniques for the lesson) 3. Reflection (analysis of the lesson) 4. Additional material for the lesson. Techniques for working in the classroom: using tables, mini-memos, brief instructions, repeatedly returning to the material covered, using entertaining tasks. The study of the most complex sections and topics is preceded by systematic repetition, which creates conditions for generalizing previously covered material and consolidating newly learned material. With this model of educational organization, all subjects of the educational process are involved in the process of cognition, they have the opportunity to understand and reflect on what they know and think. Interactive activities in the classroom involve the organization and development of dialogue communication, which leads to interaction, mutual understanding, and the joint solution of common but significant tasks for each participant. Interactivity eliminates the dominance of one opinion over others. During dialogue learning, the student learns to think critically, solve complex problems based on an analysis of circumstances and relevant information, weigh alternative opinions, make thoughtful decisions, participate in discussions, and communicate with other people. For this purpose, the lessons offer research projects, role-playing games, working with documents and various sources of information, creative works, drawings, etc.
It seems appropriate to note once again that it is important for a teacher to study the developmental features of their students with disabilities. This knowledge will allow you to qualitatively organize the educational process, select adequate methods and techniques of pedagogical influence and achieve maximum learning results.
3. Criteria and indicators of planned results.
Observing a student allows you to track his individual cognitive activity, independence, productivity, the dynamics of the student’s development, the stability of the main manifestations of personal characteristics in the educational process, identify strengths and weaknesses and at the same time allows him to be assessed not only by indicators of educational activity, but also by personal manifestations, which is especially important when solving educational problems.
All this makes it possible to individualize the educational process; a student’s “cognitive profile” is gradually formed, that is, a unique type of thinking that must be adequate to the subject content scientific knowledge. Identification of such a “cognitive profile” is the basis for drawing up a student’s development trajectory; the same data will be the basis for summing up the learning outcomes for the course. An important role is given to students’ self-esteem based on the results of the lesson. It is possible to use self-assessment sheets, which are offered at the beginning of studying a new topic. There are many examples of such sheets. For example:
I did my job well in class;
I could have done a much better job;
I didn't do well in class.
The list of questions I use most often is:
1. What I liked most about the lesson was
2. I didn’t like the lesson...
3. I remember something from the lesson
4. I wanted to know more about:
In addition, self-assessment sheets can be used to reinforce knowledge gained in the lesson and stimulate motivation to further search for information. At the same time, the answers help to understand the correctness of the lesson structure, to see opportunities for: creating a situation of success for the student, maximizing the disclosure of his individual abilities, developing cognitive interests and creating readiness for independent learning. Analysis of the answers helps to form an attitude towards creative activity, development of motivation for further creative growth, formation of positive moral qualities of the individual. The acquisition of reflection skills contributes to the formation of the ability to analyze one’s own interests, inclinations, needs and correlate them with available opportunities.
Mastering the basics of self-assessment allows the student to judge what he knows and can do well, what he still needs to understand, and what remains to be learned. The self-assessment procedure should include: development of standards for assessing student activity; motivating the student to analyze the process and results of their own actions; creating a situation in which students compare their results with existing assessment standards. Possible option for self-assessment: before performing the self-assessment, practical work The teacher discusses with the students the criteria for successfully completing it. Having completed the work, the student gives himself points (not necessarily on a five-point grading scale) in accordance with jointly accepted criteria for each task. After this, the teacher checks the work and gives his points.
Summing up the work is perhaps no less important than doing the work itself. The student must note what has changed in his consciousness and understanding, what he has learned and how he can use this knowledge and skills in real life. In other words, at the final stage of work there is a transfer of skills and abilities, crystallization of knowledge, development of incentives for independent study and principles of self-esteem.
The following are not subject to assessment: the pace of the student’s work, the personal qualities of schoolchildren, the uniqueness of their mental processes (features of memory, attention, perception, pace of activity, etc.).
Individual educational achievements of students are subject to assessment (comparing the child’s today’s achievements with his own yesterday’s achievements). Every successful step and attempt (even unsuccessful) to independently find the answer to a question is assessed positively. It is necessary to encourage any manifestation of initiative, the desire to speak out, to answer a question. Encourage without fear of overpraising. Teach children to exercise self-control: compare their work with a model, find errors, establish their causes, and make corrections themselves. 7
List of used literature
1. Vagina M.V.2008 / News of the Russian State Pedagogical University named after. A.I. Herzen “Self-esteem of students with cerebral palsy”
2. Irina Gennadievna Vechkanova2015 / Kazan pedagogical journal “Game technologies in the psychological and pedagogical rehabilitation of children with cerebral palsy in the socio-cultural sphere”
3. Dmitrieva E. N., Levitskaya T. E. 2005 / Siberian psychological journal “Peculiarities of perception of one’s own age in children and adolescents suffering from cerebral palsy”
4. Zakharova Anastasia Vladimirovna Historical and social-educational thought. 2013. No. 2 (18) “Socio-legal aspects of accompanying children with disabilities in the conditions of integrated schooling”
5. Zinchenko S. S. Distance learning for children with musculoskeletal disorders // Young scientist. - 2015. - No. 2.
6. Kiamova N. I., Khasanova A. R. 2007 / Philology and culture “Peculiarities of physical development and functional state of cardio-vascular system children and adolescents with cerebral palsy"
7. Levchenko I. Yu. Psychological characteristics of adolescents and high school students with cerebral palsy. M., Alpha. 2000.
8. Levchenko I. Yu., Prikhodko O. G. Technologies for teaching and raising children with musculoskeletal disorders, M., Academy. 2001.
9. Nikitina M.N. Cerebral palsy. - M.: Education, 2007.
10. Yakimanskaya I.S. Educational psychology: Basic problems. M., 2008.
Shinkareva E.Yu. The right to education of a child with disabilities in Russian Federation and abroad: monograph. Arkhangelsk, 2009.
Nikitina M.N. Cerebral palsy. - M.: Education, 2007.
Kiamova N. I., Khasanova A. R. 2007 / Philology and culture “Features of physical development and functional state of the cardiovascular system of children and adolescents with cerebral palsy”
Levchenko I. Yu., Prikhodko O. G. Technologies for teaching and raising children with musculoskeletal disorders, M., Academy. 2001
Zakharova Anastasia Vladimirovna Historical and social-educational thought. 2013. No. 2 (18) “Socio-legal aspects of accompanying children with disabilities in the conditions of integrated schooling”
Levchenko I. Yu., Prikhodko O. G. Technologies for teaching and raising children with musculoskeletal disorders, M., Academy. 2001.
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3.3. System of education and training of children with musculoskeletal disorders
general characteristics disorders of the musculoskeletal system. Cerebral palsy
Disorders of the musculoskeletal system can be either congenital or acquired. Congenital and acquired diseases and damage to the musculoskeletal system are observed in 5–7% of children. Developmental deviations in children with pathologies of the musculoskeletal system are characterized by significant polymorphism and dissociation in the severity of various disorders. Motor dysfunctions occur as a result of various diseases.
Nervous system diseases: cerebral palsy (CP), polio ( infection with predominant damage to the anterior horns of the spinal cord, leading to paralysis).
Congenital pathology of the musculoskeletal system: congenital hip dislocation, torticollis, clubfoot and other foot deformities, spinal abnormalities (scoliosis), underdevelopment and defects of the limbs, developmental abnormalities of the fingers, arthrogryposis (congenital deformity).
Acquired diseases and injuries of the musculoskeletal system: traumatic injuries of the spinal cord, brain and limbs, polyarthritis (simultaneous or sequential inflammation of many joints), skeletal diseases (tuberculosis, bone tumors, osteomyelitis), systemic skeletal diseases: chondrodystrophy (congenital disease of the osteochondral system with disproportionate growth of body parts and disorders ossification), rickets (a disease most often found in infants, caused by vitamin deficiency and characterized by metabolic disorders).
The leading one in the clinical picture of these diseases is a motor defect: delayed formation, underdevelopment, impairment or loss of motor functions.
Cerebral palsy (CP) – this is a polyetiological disease of the brain that occurs as a result of exposure to harmful exogenous or endogenous factors in the intrauterine (prenatal) period, at the time of birth (intranatal) or in the first year of life (in the early postnatal period). The most common cases of cerebral palsy are associated with brain damage in the prenatal period and at the time of birth. When the brain is damaged in the early stages of ontogenesis, its “young” parts – the cerebral hemispheres, which regulate voluntary movements, speech and other cortical functions – are most severely affected.
With cerebral palsy motor, cognitive, and speech functions suffer.
Motor disorders in cerebral palsy have a complex structure and include the following components
Muscle tone disorders. At hypotension(low muscle tone) the muscles of the limbs and trunk are flabby, sluggish, weak, the range of passive movements is much greater than normal. Decreased muscle tone is largely due to insufficient function of the cerebellum and vestibular apparatus.
Dystonia – changing character of muscle tone. At rest, the muscles are relaxed; when attempting to move, the tone increases sharply, as a result of which it may turn out to be impossible.
Often with cerebral palsy there is an increase in muscle tone (spasticity). In this case, the muscles are tense. With a sharp increase in muscle tone, flexion and adduction contractures (limitation of the range of passive movements in the joints), as well as various deformities of the limbs, are often observed.
At rigidity the muscles are tense and in a state of tetanus (maximum increase in muscle tone). The smoothness and coherence of muscle interaction is disrupted.
In complicated forms of cerebral palsy, a combination of various types of muscle tone disorders may be observed.
Restriction or impossibility of voluntary movements(paresis and paralysis). Central paralysis - complete lack of voluntary movements caused by damage to the motor areas of the cerebral cortex and the motor pathways (pyramidal) pathways of the brain. Central paresis – limited range of motion is usually combined with decreased muscle strength. The child has difficulty or cannot raise his arms up, stretch them forward, to the sides, bend or straighten his leg.
Presence of violent movements. Hyperkinesis – involuntary, violent movements caused by variable muscle tone, with the presence of unnatural postures and unfinished movements. Violent movements can be expressed in the muscles of the articulatory apparatus, neck, head, and various parts of the limbs. Tremor – trembling of limbs.
Impaired balance and coordination of movements (ataxia) manifest as instability when sitting, standing and walking. In severe cases, the child cannot sit or stand without support. Coordination disorders manifest themselves in inaccuracy and disproportion of movement (primarily of the hands), which causes difficulties in mastering objective actions.
Impaired sense of movement (kinesthesia). Children with cerebral palsy often have a weakened sense of posture; Some people have a distorted perception of the direction of movement, which inhibits the development of large and fine coordinated movements.
Insufficient development of chain installation rectifying, stato-kinetic reflexes, which ensure the formation of the vertical position of the child’s body and voluntary motor skills.
Synkinesis – These are involuntary friendly movements that accompany the performance of active movements.
Presence of pathological tonic reflexes(labyrinthine tonic reflex, symmetrical cervical tonic reflex, asymmetrical cervical tonic reflex). Pathologically enhanced postural reflexes reflect the severity of the disease; they disrupt the consistent development of motor functions and are one of the reasons for the formation of pathological postures, movements, contractures and deformities of the limbs.
Children with cerebral palsy may experience a combination of these reflexes, which significantly aggravates the structure of their defect.
Mental development disorders in cerebral palsy
The problem of mental development disorders and their correction in cerebral palsy is considered in the works of L.A. Danilova, E.S. Kalizhnyuk, G.V. Kuznetsova, I.Yu. Levchenko, E.M. Mastyukova, O.G. Prikhodko, K.A. Semenova.
Deviations in cognitive activity are characterized uneven, disharmonious nature of intellectual deficiency, severity of psychoorganic manifestations, lack of information and ideas about the environment.
The uneven, disharmonious nature of intellectual non-impairments is characterized by insufficiency some intellectual functions, delayed development of others and preservation of others, which is associated with early organic brain damage.
Lack of formation of higher cortical functions – an important link in cognitive impairment in cerebral palsy. Most often, individual cortical functions are affected, i.e., their impairment is partial. Most often, there is a lack of spatial and temporal representations, difficulties in differentiating the right and left sides of the body, optical-spatial disorders, deficiencies in stereognosis (the child cannot recognize objects by touch, is not oriented in the diagram of his own body, cannot differentiate spatial relationships), all types praxis (execution of purposeful automated movements), deficiencies in the processes of comparison and generalization, insufficient development of phonemic hearing.
Psychoorganic syndrome manifests itself in slowness and exhaustion of mental processes, difficulty switching to other types of activity, lack of concentration, slowness of perception, and a decrease in the volume of mechanical memory.
Poverty of ideas about the world around us is caused by forced isolation, limited communication contacts, difficulties in understanding the world around us due to the manifestation of movement disorders, and sensory dysfunction. Pathology of vision and hearing (which is noted approximately in
25% of cases), muscle-joint sensation negatively affects perception and complicates intellectual activity.
Many children have low cognitive activity.
By state of intelligence Children with cerebral palsy constitute a heterogeneous group. In some cases, intelligence may be close to normal, in others there is mental retardation, most often there is a delay in mental development of cerebral-organic origin. In this case, the shortcomings of mental activity and the lack of formation of mental operations come to the fore. If adequate corrective work is started in a timely manner, these children demonstrate positive dynamics.
Disorders of the emotional-volitional sphere can manifest themselves in the form of emotional excitability, irritability, motor disinhibition or, on the contrary, inhibition, shyness, timidity. There is a combination of increased emotional excitability with tearfulness, irritability, capriciousness, a reaction of protest, and sometimes a euphoric mood background is observed - a complacent, overly joyful mood not justified by reality.
Personal development also has its own characteristics. Most often, personal immaturity is noted: naivety of judgment, poor orientation in everyday and practical issues.
Children with intact intelligence are often unsure of themselves, not sufficiently independent, and have increased suggestibility.
In children with mental retardation, the underdevelopment of all mental functions is total. The insufficiency of higher forms of cognitive activity - perception, memory, thinking, as well as gnostic functions - comes to the fore; these disorders are persistent and irreversible.
In the structure of the defect in children with cerebral palsy, a significant place is occupied by speech disorders, the frequency of which is up to 80%.
Features of speech disorders and the degree of their severity depend primarily on the location and severity of brain damage.
In children with cerebral palsy, the main forms of speech disorders are dysarthria and alalia. In the early stages, there is a delay in speech development, and later the underdevelopment of speech is systemic in nature.
Dysarthria is a consequence of organic damage to the central nervous system, in which the motor mechanism of speech is disrupted. The leading defects in dysarthria are disturbances in the sound-pronunciation aspect of speech and prosody (melodic-intonation and tempo-rhythmic aspects of speech), as well as disturbances in articulatory motor skills, speech breathing and voice.
Alalia is the absence or systemic underdevelopment of speech due to organic damage to the speech areas of the cerebral cortex. There are motor and sensory alalia. Motor alalia characterized by underdevelopment of motor speech.
At sensory alalia understanding of addressed speech is impaired with intact hearing and cognitive activity.
Violations oral speech and deficiencies in cognitive activity lead to impairments writing.
Classification of cerebral palsy
SPASTIC DIPLEGIA
Spastic diplegia – the most common form of cerebral palsy.
It affects more than 50% of patients with cerebral palsy. The main symptom of spastic diplegia is increased muscle tone (spasticity) in the limbs with limited strength and range of motion in combination with persistent tonic reflexes. The severity of speech, mental and movement disorders varies widely, this is due to the time and strength of exposure to harmful factors.
Prognostic-spastic diplegia – This is a favorable form of the disease in terms of overcoming mental and speech disorders and less favorable in terms of the development of motor functions.
DOUBLE HEMIPLEGIA
This is the most severe form of cerebral palsy, in which there is total damage to the brain, primarily to its cerebral hemispheres. Movement disorders are expressed equally in the arms and legs, or the arms are more affected than the legs. Voluntary motor skills are absent or severely limited. Children do not sit, do not stand, do not walk. The functions of the hands practically do not develop.
Almost all children have severe speech impairments such as anarthria and severe dysarthria.
The prognosis for motor development is unfavorable. Standing and walking are impossible. Some children have difficulty mastering the skill of sitting, but even in this case, severe deviations in mental development hinder their social adaptation.
In most cases, children are unteachable. Severe motor impairments of the hands and reduced motivation exclude self-care and even simple work activities. This indicates the child is completely or almost completely disabled.
HEMIPARETIC FORM OF CP
This form is characterized by unilateral damage to the same-named (left or right) limbs. The arm is usually more affected than the leg. There is damage predominantly to one hemisphere, its cortical sections and the nearest subcortical nuclei. Violation of the cortical functions of one of the hemispheres manifests itself in the form of hemiparesis.
Children with hemiparesis acquire age-related motor skills later than healthy children. Over time, a persistent pathological alignment of the limbs and torso is formed: shoulder adduction, flexion and pronation of the forearm, flexion and deviation of the hand, adduction of the thumb, scoliosis of the spine. Speech pathology is observed in 30–40% of children, most often of the type of dysarthria or motor alalia. The degree of intellectual impairment varies from mild to severe intellectual disability. The prognosis for motor development is favorable in most cases. The ability to self-care depends on the degree of damage to the hand.
As a rule, children with hemiparesis are learning.
HYPERKINETIC FORM of cerebral palsy
The hyperkinetic form of cerebral palsy is associated with damage to the subcortical parts of the brain. Movement disorders manifest themselves in the form of involuntary violent movements - hyperkinesis.
In the hyperkinetic form, voluntary motor skills develop with great difficulty. Children cannot learn to sit, stand or walk independently for a long time. The gait is usually not smooth, jerky, and asymmetrical. Balance when walking is easily disturbed, but standing still is more difficult for patients than walking. Voluntary movements are inexpressive, sweeping, discoordinated; automation of motor skills, especially writing skills, is difficult.
Speech disorders are observed in 90-100% of patients, most often in the form of hyperkinetic dysarthria. In 20–30% of cases, hearing loss is detected, mainly for high tones, and in 10–15% – convulsions. Mental development is less impaired than in other forms of cerebral palsy, i.e., intellect in most cases develops quite satisfactorily. 50% of children have mental retardation.
The prognosis for the development of motor functions depends on the severity of damage to the nervous system, on the nature and intensity of hyperkinesis.
ATONIC-ASTATIC FORM of cerebral palsy
Associated with damage to the cerebellum and frontal parts of the brain. From the motor sphere, the following pathology is observed: low muscle tone, imbalance of the body at rest and when walking, disturbance of the sense of balance and coordination of movements, tremor, hypermetry (disproportion, excessive movements).
60–80% of children have speech disorders in the form of delayed speech development, dysarthria; motor alalia may occur.
Intelligence varies from mental retardation to disability of varying degrees of severity. When the frontal parts of the brain are damaged, children are less emotional, indifferent to others, have little initiative, and can be very aggressive.
Corrective work with children up to school age with cerebral palsy
The main goal of correctional work for cerebral palsy is to provide children with medical, psychological, pedagogical, speech therapy and social assistance; ensuring the most complete and early social adaptation, and in the future - general and vocational training. Development is very important positive attitude to life, society, family, learning and work. The effectiveness of therapeutic and pedagogical measures is determined by timeliness, interconnectedness, continuity, continuity in the work of various units. Therapeutic and pedagogical work must be comprehensive. An important condition for complex influence is the coordination of the actions of specialists in various fields: neurologist, psychoneurologist, exercise therapy doctor, speech therapist, defectologist, psychologist, educator.
Comprehensive rehabilitation treatment for cerebral palsy includes: medications, various types of massage, physical therapy (physical therapy), orthopedic care, and physiotherapeutic procedures.
Correctional pedagogical work with children suffering from cerebral palsy is based on the following principles:
a systematic approach to correctional pedagogical work, which provides for constant consideration of the mutual influence of motor, speech and mental disorders.
early onset of complex effects based on preserved functions.
organization of work within the framework of leading activities, taking into account the patterns of ontogenetic development.
monitoring the dynamics of psycho-speech development.
a combination of various types and forms of correctional pedagogical work.
close interaction with the child’s family.
The optimal option involves an early start, in the first year of life, of comprehensive medical, psychological and pedagogical correction. Such assistance can be provided to the child in a hospital setting. It is important to train parents in corrective measures. The main tasks of correctional pedagogical work in the pre-speech period are (according to O.G. Prikhodko):
– development of emotional communication with an adult (stimulation of the “revival complex”, the desire to prolong emotional contact with an adult, inclusion of communication in the practical cooperation of a child with an adult);
– correction of feeding (sucking, swallowing, chewing);
– development of sensory processes (visual concentration and smooth tracking; auditory concentration, sound localization in space, perception of an adult’s differently intonated voice; motor-kinesthetic sensations and finger touch);
– formation of hand movements and actions with objects;
– formation of the preparatory stages of speech understanding.
The main directions of correctional and pedagogical work in early age are:
– formation of objective activity (use of objects according to their functional purpose), the ability to voluntarily engage in activity. Formation of visually effective thinking, voluntary, sustained attention, switching in activities;
– formation of verbal and objective-effective communication with others (development of understanding of addressed speech, one’s own speech activity; formation of all forms of non-speech communication - facial expressions, gesture and intonation);
– development of elementary ideas about the environment;
– stimulation of sensory activity (visual, auditory kinesthetic perception);
– formation of the functional capabilities of the hands and fingers;
– development of hand-eye coordination (through the formation of passive and active actions);
From the age of 3, children with cerebral palsy who are capable of movement and possess neatness skills can enter a special kindergarten or group. Group capacity is 8 people. Correctional pedagogical work in kindergartens of this profile is based on program and methodological materials developed by E.F. Arkhipova, L.A. Danilova, G.V. Kuznetsova, I.Yu. Levchenko, O.G. Prikhodko, N.V. Simonova, I.V. Smirnova, The main directions of correctional and pedagogical work in preschool age are:
– development of gaming activities;
- development verbal communication with others;
– expanding the stock of knowledge and ideas about the environment;
– development of sensory functions;
– formation of spatial and temporal representations, correction of their violations. Development of kinesthetic perception and stereognosis;
– development of attention, memory, thinking (visual-figurative and abstract-logical elements);
– formation of mathematical concepts;
– development of manual skills and preparation of the hand for mastering writing;
– development of self-care and hygiene skills. A significant place in correctional and pedagogical work for cerebral palsy is given to speech therapy correction. Its main goal is the development of verbal means of communication, improving the pronunciation side of speech and its intelligibility.
O.G. Prikhodko points to the following tasks speech therapy work:
– normalization of muscle tone and motor skills of the articulatory apparatus;
– normalization of tempo-rhythmic and intonation speech;
– formation of articulatory praxis at the stage of production, automation and differentiation of speech sounds;
– development of the functions of the hands and fingers;
– development of the lexical and grammatical aspects of speech, formation of skills in constructing a detailed statement.
Education of children with cerebral palsy in special (correctional) schools of the VI type
Graduates of special groups with mild motor impairments can study in a general education school. Children with severe movement disorders are sent to study in type VI schools.
The purpose of correctional education and training is comprehensive development of the child in accordance with his capabilities.
60–70% of children with cerebral palsy study in specialized boarding schools.
Type VI correctional institutions carry out the educational process in accordance with the levels of general education programs at three levels of education: primary general education (4–5 years), basic general education (6 years), secondary education (2 years). The total duration of study is 12 years. Class size is 10 people.
As a rule, children aged 7 years are admitted to first grade. Preparatory classes are opened for children who did not attend kindergarten. Tasks of working with children in the preparatory class: identification of the state of intelligence, level of training of the child and his potential, preparation for further education at school according to an adapted program (mass or special).
Objectives of the specialized educational process in school for children with cerebral palsy are: a combination of training and education with treatment and rehabilitation measures, labor training, vocational guidance.
Consistent development of cognitive activity and correction of its disorders;
Purposeful formation of higher mental functions;
Nurturing sustainable forms of behavior and activity necessary for social and everyday adaptation.
One of the forms of organizing pedagogical assistance is home-based education of children with severe musculoskeletal disorders. On the one hand, home education includes this category of children in the educational space, on the other hand, it has a number of disadvantages: abbreviated general educational program, irregularity of home lessons, isolation of the student from the society of peers, lack of opportunity for career guidance.
In boarding schools labor education carried out both in the process of everyday life and in special occupational therapy classes, there are labor workshops: sewing, carpentry, metalworking. Children are taught office work, typing, photography, gardening and other specialties.
Career guidance carried out throughout the educational process. The purpose of career guidance: preparation for a future profession in accordance with the psychophysiological capabilities of children with cerebral palsy and the interests of the pupils. With intact intelligence, graduates can master the professions of programmer, economist, accountant, librarian, translator, etc.
For getting vocational education the opportunity is provided for preferential admission to vocational schools, technical schools, and higher educational institutions.
There is a network of specialized vocational schools of the Ministry of Health and social development RF.
When employing disabled people, the recommendations of the medical labor expert commission (VTEK) are strictly followed; work ability examination.
Questions and tasks
1. Describe the clinical forms of cerebral palsy.
2. Explain the nature of movement disorders in cerebral palsy.
3. What are the psychological characteristics of children with cerebral palsy?
4. What is the organization and content of correctional pedagogical work with children with cerebral palsy in special kindergartens?
5. Reveal the features of the pedagogical process in special schools for children with cerebral palsy.
Corrective education and upbringing of children with cerebral palsy in a secondary school
IN last years Children with movement disorders began to enter mass educational institutions. Most often these are children with scoliosis, congenital dislocations of the hips, club feet and cerebral palsy. The main manifestations of motor disorders in them are unsteady walking, a slow pace of walking, and the inability to independently go up and down the stairs. Such children find it difficult to dress, undress, tie a bow, fasten a button, etc. without outside help. These difficulties are most pronounced in children with cerebral palsy. Their right or left hand may be affected and they cannot perform actions with the affected hand; impaired coordination of movement is noted: they walk on their legs widely spaced, their gait is extremely unstable, and when frightened or excited they may fall. Self-care skills in these children are most often not fully developed, practical activities are extremely limited, and they are not ready to master drawing and writing skills.
Children with cerebral palsy often have incorrect pronunciation of certain sounds. Such children are deprived of the opportunity to move freely and manipulate objects, their communication is limited, and therefore, by the beginning of school, they cannot acquire the stock of knowledge and ideas about the world around them that their normally developing peers have. Information about the environment is often formal, fragmentary, isolated from each other. Most children slowly develop operations such as comparison, identifying essential and non-essential features, establishing a cause-and-effect relationship between objects and phenomena of the surrounding world, which results in a poor stock of knowledge and ideas, inaccuracy of existing concepts, and limited active and passive vocabulary. Lack of knowledge and ideas about the world around us is often a consequence of the fact that the child simply has not encountered many life events and phenomena, since his access to public places is limited (for example, shops, sports grounds, various entertainment events, etc.).
It must be remembered that children with cerebral palsy, due to their pathology, not only do not have developed motor skills,but there are also no correct ideas about movement. Consequently, they need not only to develop this or that motor skill, but also to develop a correct understanding of it through the sensation of movement.
To successfully organize the educational process of children with cerebral palsy, the teacher needs to know the characteristics of their psychophysical development, as well as the typical difficulties that arise when mastering educational material and due to the nature of the disease. It is important for the teacher to understand why this or that learning difficulty arose, at what stage it arose, and how this will affect the mastery of the program material.
Before starting educational work with an abnormal student, the teacher needs to have a detailed conversation with the parents about the child’s hobbies, interests, inclinations, favorite activities, games; find out what motor skills he has developed and during what activities he activates them. In addition, the teacher must find out what positive character traits the child has so that he can rely on them in the process of teaching and educational activities; It is also necessary to identify negative character traits that will require special attention from the teacher. Establishing close contact and cooperation between teachers and parents is a prerequisite for the successful adaptation of a child with cerebral palsy to a public school. It should be noted that in parallel with education in a public school, a child with cerebral palsy continues to receive the necessary special complex of treatment and rehabilitation measures at the clinic, and undergoes courses of treatment in specialized hospitals.
Before a child with motor impairments comes to class, it is necessary to carry out some work with healthy peers. The teacher should talk about the hobbies and positive qualities of the sick child, and also explain to the students that they should not focus attention on his defect, much less tease and offend him. On the contrary, he should be given all possible help.
The main manifestations of cerebral palsy are slowness and immaturity of motor skills and abilities necessary e educational and labor activity. Therefore, we will consider the difficulties that children may experience in mastering the skills of writing, self-care and work.
Difficulties in mastering writing by students with cerebral palsy are associated primarily with the immaturity or impairment of the grasping function of the hand. The act of writing itself, which requires smooth movement of the hand, is impaired due to muscle weakness, disorders of muscle tone in the hand, violent movements, and the inability to consistently contract and relax the muscles of the hand. These children usually hold the pen incorrectly when writing; writing is done through movements of the hand, sometimes the entire arm. Children write very slowly, illegibly, the letters are different in size, the lines are not observed. In such children, there are two main types of incorrect writing: in the first case, the student begins to write with sufficient strength and normal sized letters, but then their size changes, the lines go down, the writing becomes illegible; in another case, on the contrary, the student begins to write in small letters and without pressure, and then the size of the letters and the pressure increase. Uneven writing is especially pronounced in students with hyperkinesis, since violent movements interfere with the work of the fingers at the time of writing.
It should be taken into account that the act of writing in children with cerebral palsy is formed extremely slowly. Even with the act of writing already formed, large volumes of written work and an increase in writing speed lead to an increase in the defect in motor skills of the hands and fingers to a greater or lesser extent.
Similar defects are also discovered in the process of developing labor and everyday skills. During labor lessons, children find it difficult to work with plasticine without special correction: they cannot roll it out, divide it into parts, or give a certain shape to a figure. The lack of formation of the function of differentiation of grasping and holding an object, violent movements, the inability to balance muscle efforts with the motor task interferes with the performance of labor operations with natural material and paper.
In physical education lessons, the characteristics of motor disorders in students with cerebral palsy should also be taken into account. Performing exercises in these lessons is difficult due to the fact that students cannot correctly reproduce the starting positions, maintain stability in the required position, coordinate the movements of the torso, arms and legs, and perform exercises with the required amplitude. There may also be difficulties when performing exercises with various objects: it is difficult to grasp and hold objects, the accuracy of passing and throwing is impaired, etc. Impairment of the motor sphere makes it difficult or impossible to run, jump, climb, etc. In children with cerebral palsy, When performing exercises, breathing may be impaired, which further complicates the task.
For some children, difficulties in learning may be caused by undeveloped visual-motor coordination, i.e., uncoordinated work of the hand and eye. Visual-motor coordination is especially important at the initial stage of learning to read, when the child barely follows the finger with his eye, which determines the sequence of letters, syllables, and words. Students with cerebral palsy are often unable to maintain a line of work in a notebook or when reading because they slip from one line to another. As a result, they do not understand the meaning of what they read and cannot check what they wrote. Lack of development of hand-eye coordination can also manifest itself when mastering self-care skills and other labor and study skills(for example, in tact labor lessons, it is difficult for children to correctly arrange the material, attach a pattern, perform cutting, etc.).
Children with cerebral palsy sometimes have insufficiently developed spatial analysis and synthesis; , which is especially evident when mastering construction, self-service skills, reading, writing, and physical education lessons. Such children find it difficult to differentiate between the left and right sides and to put parts together into a whole. They do not follow the rulers in notebooks, distinguish between the right and left sides, can start writing or drawing anywhere in the notebook or album, and read from the middle of the page. When the lack of development of spatial analysis and synthesis is combined with a lack of visual-motor coordination, the severity of the above difficulties increases significantly.
The lack of formation of spatial representations is reflected at the initial stage of studying mathematics. For example, when learning the composition of a number, children cannot arrange or represent it in the form of separate groups of objects. But the process of mastering material in geometry and trigonometry is especially difficult for them.
Insufficient development of spatial imagination and memory in some students can cause difficulties in mastering program material in geography (location of parts of the world, direction of river flow, etc.), this is most clearly manifested when working with contour maps.
Thus, motor disorders largely determine the specifics of educational activities of students with cerebral palsy. The lack of development of motor skills is the result not only of impaired motor skills, but also of insufficient development of more complex functions that are based on movement (visual-motor coordination, spatial analysis and synthesis).
The characteristics of teaching and raising children with cerebral palsy are also determined by various speech disorders. Characteristic manifestations of speech disorders in such children are various disorders of the sound-pronunciation aspect of speech. The speech of these children is often slurred and incomprehensible to others, since in some cases they do not pronounce some sounds at all, pronounce them distortedly, or replace them with others. The severity of disturbances in the sound pronunciation aspect of speech can be increased due to respiratory disorders. Various voice disorders are often observed; it often has a nasal tone and is monotonous.
Some children experience a variety of violent movements in the speech apparatus, which are especially pronounced during oral responses (this can be grimaces, an unnatural smile, etc.) and can cause certain difficulties in determining the degree of mastery of the material and assessing students' knowledge. Such children try to express their thoughts briefly and concisely in their oral answers; they usually answer with speech cliches and only to the teacher’s question. Sometimes children find it difficult to answer questions right away. asked question, they need some time to prepare for an answer, since this requires a certain adjustment of the speech apparatus (preparation of breathing, overcoming violent movements); they may refuse to answer at all.
Sound pronunciation disorders are often combined with difficulties in distinguishing speech sounds by ear. Children mix sounds that are similar in sound (for example, whistling and hissing, hard and soft, voiced and voiceless) and therefore make mistakes when writing similar sounds by ear.
The lexical and grammatical aspect of the speech of children with cerebral palsy develops in a unique way; their vocabulary is limited, and the lack of understanding of the meaning of many words and concepts encountered during the passage of program material is especially noticeable. Children have a limited understanding of polysemy and discrimination of semantic shades of individual expressions depending on the context. This leads tothat in oral speech children mainly use short, stereotypical phrases, and sometimes prefer to communicate in separate words. In most cases, speech underdevelopment only reflects the specifics of the disease, but is not a primary defect.
In the written speech of such children, confusion, replacement and omission of sounds that are distorted during pronunciation are often found. It should be noted that difficulties in writing may not correspond to the state of the child’s oral speech. For some children, gross violations of the sound pronunciation side of speech do not affect their writing in any way, while for others, on the contrary, even a slight violation of sound pronunciation can cause difficulties in writing. The greatest difficulty for teachers is presented by children who have errors in written speech associated with a lack of differentiation of sounds that are similar in sound (M, V. Ippolitova, E. D. Chernobrovkina, E. A. Zabara).
The originality of the formation of the lexico-grammatical aspect of speech is often reflected in writing. Most often this manifests itself in errors that are associated with a violation of the morphological structure of the word. Such children tend to incorrectly use prefixes and suffixes to form related words. In written work, students often use words that they do not understand well enough, and therefore they allow omissions, rearrangements, and repetitions of words. This also leads to the fact that children confuse prefixes and prepositions when writing: they tear the prefix from the word, but the preposition can be written together. The teacher often has to deal with the impoverishment and some stereotypedness of the written speech of such students. In case of such violations, the teacher must show the child to a speech therapist so that he can determine the cause of these violations and give the teacher specific recommendations on how to overcome them.
Next, we consider it necessary to consider the characteristics of the mental activity of students with cerebral palsy. There are children who are slow to get involved in work. In such cases, an individual approach is required on the part of the teacher, who must repeat the task, focusing on difficult places, and in a calm voice encourage the child to complete it. If a child has difficulty switching from one type of work to another, then he should be given time before performing a new task. Such children are characterized by low and unstable performance and increased attention exhaustion.
Features of the educational activity of students with cerebral palsy may be caused by insufficient development of control actions, as a result of which students do not “see” their mistakes and do not know how to check their work.
Let's consider the features of the organization academic work children with cerebral palsy. First, the teacher must seat the student with cerebral palsy in such a way that he can stand and move freely from behind the desk. The space on the desk should be sufficient for free manipulation of textbooks, school supplies, etc. After observing the student, the teacher must determine in what position it is easier for him to complete written work, how it is more convenient to answer (sitting, standing).
The teacher must identify the most optimal dosage for completing written and tests for such a student. He must individually select the volume and methods of completing tasks in each specific case. Taking into account the motor characteristics of students with cerebral palsy and their rapid fatigue, it is necessary to vary the forms of performing and changing tasks. To do this, you can use individual cards, lined albums, chalk and a magnetic board, computer, etc.
The slow pace of writing in students with cerebral palsy determines the need to provide more time to complete written work, and in some cases the child may give part of the answer orally. Thus, when conducting written work and assessing students’ knowledge, the teacher must carefully consider the conditions for presenting educational material, the volume and method of implementation.
If there are spatial impairments and undeveloped hand-eye coordination, the teacher must specifically indicate (with a pen or pencil the line and place from which to start writing or drawing, mark the required distance between lines, works or parts of the task. Special attention should pay attention to writing numbers in a columnwhen performing arithmetic operations, since incorrect spelling can lead to an erroneous result. It is recommended to color the cells with different colored pencils (for example, for hundreds - red, tens - green, for ones - blue). It is advisable to use individual cards with slots for numbers that stand in the place of units, tens, hundreds. When teaching children to read, it is recommended to use special bookmarks with slots that allow you to record a word, phrase or sentence and
preventing your gaze from wandering off the line. In drawing lessons, before starting work, the teacher should first stipulate the location of the object on the sheet, name its main parts, as well as the sequence of their depiction.
If a child with cerebral palsy has difficulty starting a speech when responding verbally, the teacher should give him time to prepare. In this case, it is advisable to first address the question to the whole class, listen to the answer of the healthy student, warning in advance that the student with cerebral palsy will answer next.
When assessing an oral response and reading, the teacher must take into account the speech characteristics of the sick child and not reduce his mark for insufficient intonation expressiveness, slow pace, or lack of fluency of speech.
When assessing written work, you should not deduct a mark for incorrectly written lines (jamming, oblique placement of letters, non-compliance and omission of a line, non-compliance with margins); loss of elements of letters or their incompleteness, unnecessary additions to letters, unequal slope, etc.; violation of the size of letters and their ratio in height and width; mixing letters of similar style; intermittency of writing or repetition of individual elements due to violent movements.
When assessing knowledge, it is very difficult to take into account errors associated with phonetic-phonemic and general underdevelopment of speech. It is often difficult for a teacher to determine which errors are specific to such students and which are due to ignorance of spelling rules. In such cases, the teacher afterexecution control dictation Together with the speech therapist, he analyzes the nature of errors and outlines ways to overcome them.
When conducting presentations and essays, the teacher should pay attention to the development in students with cerebral palsy of the ability to coherently, consistently and competently present the content of the text, correctly construct sentences and grammatical structures. For presentation, you need to take texts that, in terms of content, volume, vocabulary and syntactic structures, are accessible to students with cerebral palsy.
The knowledge of students with this pathology in various subjects should be assessed using the following criteria:
Completeness and depth of knowledge;
Efficiency and flexibility of knowledge;
The degree of generalization and systematicity of knowledge. Students must also possess the skills of rational educational work, the ability to briefly present the main content of the topic, connect new material with previously completed, which contributes to the correction of impaired functions.
KOU OO "Oryol secondary school for students with disabilities"
Article on the topic:“Features of teaching children with cerebral palsy”
Prepared by: Fedotova A.Z.
Among the entire population of children with disabilities, a significant part is occupied by children suffering from various forms of cerebral palsy - from 2 to 6 patients per 1000 children. Approximately half of children suffering from cerebral palsy are mentally retarded. Children with dysfunction of the musculoskeletal system have been the object of close attention of special teachers for several decades. Children who have physical or mental illness, have the right to receive qualified pedagogical assistance at home.
A well-constructed and carefully designed home education program should help a developmentally delayed child progress much further than would be possible without outside help.
I conduct all my sessions with a sick child taking into account age characteristics and the severity of the defect. Classes are based on the principle of integration by alternating exercises according to the degree of difficulty. The structure of the classes is flexible, but at its core it includes educational material and elements of psychotherapy. Assimilation of educational material simultaneously forms communicative qualities, enriches emotional experience, activates thinking, and forms personal orientation. Psychological condition the child at a particular moment is the reason for varying the methods, techniques and structure of the lesson.
Effective methods of corrective influence on the emotional and cognitive sphere of children with developmental disabilities are:
Game situations;
Didactic games which are associated with the search for specific and generic characteristics of objects;
Game trainings that promote the development of the ability to communicate with others;
Psycho-gymnastics and relaxation to relieve muscle spasms and tension, especially in the face and hands.
I constantly monitor the child’s posture and the correct position of the limbs. If unwanted pathological motor reactions occur, I help overcome them through passive-active interventions. I start each meeting with passive gymnastics, which promotes the development of kinesthetic and visual sensations of movement patterns, inhibits friendly reactions, prevents the development of contractures and deformities, and stimulates the development of isolated movements. I repeat passive movements many times, fixing the child’s attention on their implementation.
As soon as the child learns to perform at least some of the movements, I move on to passive-active gymnastics.
Passive exercises for hands and fingers:
I make stroking, kneading movements on each finger from tip to base.
I pat and rub the tips of my fingers, as well as the areas between the bases of my fingers.
I stroke and pat the back surface of my hands and arms (from fingers to elbow).
I pat the child’s hand on my hand, on a soft and hard surface.
I rotate the child’s fingers, each one separately.
I make circular turns with a child's brush.
I abduct and adduct the hand to the right and left.
I straighten the fingers of the hand one by one, and then bend the fingers (the thumb is on top).
I do massage using various massagers.
I contrast the thumb with the rest (finger rings). I use exercises: squeezing soft toys with the thumb and forefinger, spreading scissors, shaking hands, playing with dolls that are put on the fingers.
I contrast (connect) the palms and fingers of both hands.
I also form the function of grasping, unclenching the hand, and transferring an object from one hand to another. To stimulate isolated movements of the index finger, I use the following exercises: finger pressing on plasticine balls, drawing with finger paints.
In all lessons I use stimuli of various modalities - visual, auditory, tactile, and I use this stimulation for a long time. I combine stimuli of different modalities (music, color, smells), which has a different effect on the mental and emotional state of the child - tonic, stimulating, restorative, strengthening, relaxing, calming. Thus, various problems are solved:
Formation of gaze fixation, concentration, smooth tracking and hand-eye coordination.
Formation of ideas about color, shape and size (use multi-colored cups, pads, balls, plates, boxes, etc.).
Development of tactile sensitivity (placing objects in the child’s palms).
Lessons are held in game form. Features of the development of thinking in children with mental retardation make it necessary to use a variety of visual materials. In literacy lessons, I use techniques that eliminate the need for writing - I use cut-out alphabet, object pictures, lotto, magnetic board, puzzles, and mnemonic tables.
Children do not study continuously; they need rest. I carefully observe the child, trying to understand how he thinks, what he knows, how he uses skills. I try to be consistent. I move from simple to complex, from one skill to another. Every day I introduce new elements into my lesson. I try to praise and encourage the child more often.
A sick child lives in a closed space of love, understanding and silence, and any knock, cry, or even just a cough makes the child flinch and shrink internally. And therefore, the dialogue between student and teacher should be carried out more with the help of the eyes, and if the voice, then very quiet, reaching to a whisper.
The schedule of visits by the teacher to the child is agreed upon with the parents, and all factors and features of the daily routine are taken into account. Most often this is the second half of the day, since morning procedures, therapeutic massage, and preparation for classes take up the entire first half of the day.
Only by creating favorable conditions for upbringing and learning can positive dynamics in the development of a child with cerebral palsy be achieved.
Bibliography
1. Cerebral palsy Reader/compilers L.M. Shipitsyn and I.I. Mamaichuk. - St. Petersburg, “Didactics Plus”, 2003.
2. Magazine " Primary School» N 38, 2003
3. Fundamentals of special psychology, ed. L.V. Kuznetsova 3rd ed. M.: “Academy”, 2006
4. Special psychology ed. IN AND. Lubovsky - 2nd ed. Rev. - M.: 4.
5. Shipitsyna L.M., Mamaichuk I.I. Psychology of children with musculoskeletal disorders. M.:
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1 Consultations on the topic: “Features of teaching children with cerebral palsy in the distance education system” Compiled by: Tatyana Vladimirovna Timofeeva, biology teacher of the Central Educational Education Center of the KGBOU "AKPL"
2 Features of teaching children with cerebral palsy in the distance education system The principle of pedagogical optimism is associated with a high level of scientific and practical knowledge about the potential capabilities of persons with special educational needs; modern pedagogical opportunities for habilitation and rehabilitation of children and adults with developmental disabilities; the right of every person, regardless of his characteristics and organizational capabilities of life, to be included in the educational process. Children with special educational needs tend to learn more slowly, but can learn and achieve well. The principle is based on Vygotsky’s idea of the zone of proximal development (ZPD) and rejects the “ceiling” theory. Modern special pedagogy claims that there are no uneducable children. A person with special educational needs, in accordance with this principle, is a well-developing and socially valuable person if society wants this or if it can provide the conditions for this. Like all other people, a person with disabilities in his development is aimed at mastering social experience, socialization, and inclusion in the life of society. However, the path that he must go through for this differs significantly from that generally accepted in pedagogy: physical and mental
3 deficiencies change and aggravate the development process, and each disorder in its own way changes the development of a growing person. The most important tasks, therefore, are to prevent the occurrence of secondary developmental deviations, their correction and compensation by means of education. This means the fullest possible satisfaction of the specific educational needs that arose in connection with the violation and, therefore, with the limitation. It should be remembered that disability is not a purely quantitative factor (i.e. a person simply hears or sees worse, is limited in movement, etc.). This is an integral, systemic change in the personality as a whole, this is a “different” child, a “different” person, not like everyone else, who needs completely different educational conditions than usual in order to overcome the limitation and solve the educational task that faces in front of any person. Congenital and acquired diseases and damage to the musculoskeletal system are observed in 5-7% of children. Disorders of the musculoskeletal system can be either congenital or acquired. In children with musculoskeletal disorders, the leading one is a motor defect (underdevelopment, impairment or loss of motor functions). The bulk of them are children with cerebral palsy (89%). Cerebral palsy (CP) is a group of movement disorders that occur when the motor systems of the brain are damaged and manifests itself in the lack or absence of control by the central nervous system over the functioning of muscles. These children have movement disorders combined with mental and speech disorders, so most of them need not only medical and social assistance, but also psychological, pedagogical and speech therapy correction. Other categories of children with musculoskeletal disorders, as a rule, do not have
4 disorders of cognitive activity and do not require special training and education. But all children need special living conditions, learning and subsequent work. There are two directions in their social adaptation. The first is intended to adapt to the child environment. For this purpose, there are special technical means of transportation (strollers, crutches, canes, bicycles), household items (plates, spoons, special switches for electrical appliances), ramps, and ramps on sidewalks. The second way to adapt a child with a motor defect is to adapt him to the usual conditions of the social environment. Peculiarities of teaching children with cerebral palsy The main manifestations of cerebral palsy are slowness and immaturity of motor skills. In some children, motor impairments are complicated by violent movements (hyperkinesis) of the head, arms, shoulders, facial grimaces, etc., which are especially intensified by excitement, fear, unexpected approach to the child, as well as when trying to perform certain purposeful actions. Children often experience tremors and trembling of the fingers and tongue. It is most pronounced during purposeful movements (for example, when writing). A decrease in the number of contacts with others leads to the formation of a number of negative character traits: moral, volitional. Such children do not know how to overcome difficulties and subordinate their actions to certain requirements and rules. They find it difficult to organize their activities, regulate them and their behavior. Features of the development of cognitive and personal spheres should be taken into account when organizing the educational process. Impaired mental performance usually manifests itself in two ways. 1. Persistent, uniform decrease in performance, asthenic
5 manifestations. Such children have low activity in perceiving educational material and weakened attention. Children quickly experience mental exhaustion, to which the child can react with outbursts of irritation, active avoidance of contact, or complete refusal. 2. Uneven (flickering) nature of mental performance. In such children, the condition sometimes changes several times during one lesson. A short period of cognitive activity is replaced by sudden fatigue, attention is unstable. Impaired mental performance is the main obstacle to productive learning. Attention is characterized by instability, increased distractibility, and insufficient concentration on the object. To prevent disturbances of attention and performance, it is necessary to dose the intellectual load (the volume of educational material should be reduced by a third of the usual volume); reducing lesson time; the number of lessons should be reduced or divided into periods with a long rest between them; planning changes in activities to prevent fatigue; during lessons it is necessary to plan motor warm-ups and special relaxation exercises; use special methods and techniques for presenting material in lessons, taking into account the nature of the disorder or disease. The quality of children's knowledge and ideas about the world around them is significantly reduced. Therefore, when presenting educational material, the teacher must introduce additional explanations and make extensive use of clarity and vary it when explaining. Memory deficiencies lead to a slow accumulation of knowledge and skills in academic disciplines. In this regard, when planning and conducting lessons, it is advisable to rely on the linear-concentric principle of teaching, which involves building the learning of new things on the past experience of children; at each stage of learning the same areas of activity are studied, but at a higher level. Multiple repetitions of material are introduced. The personal characteristics of children must be taken into account when selecting tasks. The level of difficulty of the task should correspond to the child’s capabilities, and the assessment should stimulate and motivate
6 for continuation of activities. Since the needs and attitudes of an individual largely depend on his scale of values, the teacher’s task is to bring to the first place in this scale those values that would contribute to the orientation of the child’s personality towards achieving real, accessible goals for him (for example, studying, acquiring a profession, doing what he loves). and a useful activity, the solution of some creative problem, etc.) and the formation of an adequate level of aspiration. To increase the effectiveness of ongoing pedagogical correction activities, it is necessary to attract the parents of students to your side, explain to them the goals and objectives of this work and develop general tactics of behavior in relation to their children. Distance learning has a number of qualities that make it very effective when working with disabled and sick children. Mainly, efficiency is achieved through the individualization of learning: each child studies according to a schedule convenient for him and at a pace convenient for him; everyone can study as much as they personally need to master a particular discipline. In addition to lecture (theoretical) material, distance learning courses use interactive elements: assignments, tests, forums, chats (instant messaging capabilities), etc. These elements ensure dialogue not only between the teacher and the child, but also communication between the children participating in the course. The presence of interactive elements in the course stimulates independent work children, thereby providing the opportunity for their creative expression within the framework of the curriculum. Distance education is easily integrated into educational courses that are simplest in terms of the level of pedagogical approaches used. In remote mode, you can send educational materials. It is also not difficult to control the level of mastery of educational material through a system of tests and control questions for students. The use of computer technology improves students' self-control skills. Thanks to the presence of feedback, training programs allow schoolchildren to independently analyze and correct mistakes made, adjusting their activities. At the same time, students are not afraid to answer questions, since the computer allows you to record the result without marking and reacts correctly to incorrect answers, allowing each student to solve a mathematical problem, relying on the necessary help, i.e. a situation of training success is created. The advantages of DL are obvious: individualization, flexibility and adaptability of learning. It should be noted that new technical and
7 technological means of network communications can provide fundamentally new methodological opportunities for distance learning of children with special needs within the framework of general education. Firstly, it provides the opportunity to build an individual progression trajectory for each child due to the ability to select the level and type of presentation of the material depending on the characteristics (limitations) and individual development, organize independent progress on course topics for a successful child and the opportunity to return to neglected material for a child who is lagging behind. Possible irregularity in attending classes in a mass or specialized school due to restrictions on movement is replaced by training at a time convenient and suitable for the child. The flexibility of the structure of the educational process allows us to take into account the needs and capabilities of each child, his interests and individual pace of progress through the material being studied. It is also important that creating conditions for distance learning will enable students to begin implementing professional activity even before leaving school, master the primary skills necessary for professions that require proficiency in information technology. It is clear that distance learning provides great opportunities for children with special needs. Thanks to sufficiently developed technical capabilities modern computers, and software, which allows, for example, to enter information by voice, different categories of disabled children can be involved in distance learning, and not only those with musculoskeletal problems. Moreover, there are specialized technical means of adaptation that allow children with various disabilities to fully interact with the computer. Assistive technologies for students with motor impairments Motor impairments are manifested in the impossibility or limitation of the volume and strength of movements (gross and fine motor skills), difficulties in controlling and coordinating voluntary movements, weakness and rapid fatigue during movement, and insufficient hand-eye coordination of the arms and legs. Assistive technologies can in many cases compensate for the functional limitations described above. Simple assistive technologies Many functional limitations of people with movement disorders can be compensated for by the use of “simple” technologies. For example, changing the type of handle makes many educational and recreational devices more accessible: cameras with a modified shutter release, scissors with a modified handle, rackets and oars with additional grips for holding them. Thanks to a special cuff that is attached to the wrist and allows
8 hold the string, a person with limited strength and range of motion can fly a kite. In addition, some teaching aids can act as aids (for example, wooden alphabet, calculators with enlarged input buttons, etc.). Among the simple ones technical means, used to optimize the writing process, use larger pens and special pads for them, allowing you to hold and manipulate the pen with minimal effort, as well as weighted (with additional weight) pens that reduce the manifestations of tremor when writing. In addition, special magnets and buttons are used to attach the notebook to the student’s desk. Assistive technologies that make writing easier The personal computer has long been recognized as an effective learning tool for people with mobility impairments, providing users with, among other things, the ability to write and communicate with others. The main problems faced by students with motor impairments are related to the use of a keyboard and mouse to carry out the typing process. Possible methods overcoming difficulties is the use of various information input devices (via keyboards) for students with motor impairments. For mild and moderate motor impairments (when there is a need to avoid accidental impact on the keyboard, pressing several buttons at the same time, as well as the need to control a combination of buttons on the keyboard) are used plastic or metal linings. They sit on top of the standard keyboard and make the buttons easier to access. In case of severe movement disorders, alternative keyboards are used: - enlarged: reducing the number of buttons and increasing their size facilitates selection and accuracy of movements), - reduced: small in size and closely spaced keyboard buttons are used in cases where the user cannot carry out large volumes movement and is prone to fatigue. - touch: the device has a special surface that is sensitive to pressure and touch, which is divided into programmable areas. Overlays may vary. - virtual: the keyboard is reproduced on the monitor screen and can be controlled using a mouse or viewing technology. - Using voice command: The user's voice is recognized and converted into computer commands. This technology provides the ability to manage functions operating system, as well as text input using voice. Various devices are also used to facilitate
9 manipulations for students with movement disorders. Used literature: 1. Levchenko I. Yu. Psychological characteristics of adolescents and senior schoolchildren with cerebral palsy. M., Alpha Levchenko I. Yu., Prikhodko O. G. Technologies for teaching and raising children with musculoskeletal disorders, M., Academy Features of the psychophysical development of students in schools for children with musculoskeletal disorders / ed. T.V. Vlasova. M., Features of mental and speech development of students with cerebral palsy / ed. M. V. Ippolitova. M., Andreev A. A. Introduction to distance learning: Educational manual. M.: VU, Distance learning: Tutorial
Features of teaching children with cerebral palsy in the distance education system The principle of pedagogical optimism is associated with a high level of scientific and practical knowledge about the potential capabilities of persons with special needs
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