The advances in psychology, neurophysiology and medicine (neurology, neurosurgery) at the beginning of the 20th century paved the way for the formation of a new discipline - neuropsychology. This branch of psychological science began to take shape in the 20-40s of the XX century in different countries and especially intensively in our country.
The first neuropsychological studies were carried out back in the 1920s by L. S. Vygotsky, however, the main merit of the creation of neuropsychology as an independent branch of psychological knowledge belongs to A.R. Luria.
Vygotsky's work in the field of neuropsychology was a continuation of his general psychological research. Based on the study of various forms of mental activity, he was able to formulate the main provisions:
* about the development of higher mental functions;
* about the semantic and systemic structure of consciousness (L. S. Vygotsky, 1956,1960).
The early works of LS Vygotsky on neuropsychology were devoted to systemic disorders of mental processes resulting from the defeat of individual parts of the cerebral cortex, and their characteristics in children and adults. Vygotsky conducted his first neuropsychological studies together with A.R. Luria.
The research of LS Vygotsky (1934, 1956, and others) laid the foundation for the development of neuropsychological ways of compensating for the disorders of mental functions that arise with local brain lesions. On the basis of these works, he formulated the principles of localization of the higher mental functions of a person. L.S.Vygotsky was the first to express the idea that the human brain has a new principle of organizing functions, which he designated as the principle of "extracortical" organization of mental processes(with the help of tools, signs and, above all, language). In his opinion, the forms of social behavior that have arisen in the process of historical life lead to the formation of new "Inter-functional relations", which make possible the development of higher forms of mental activity without significant morphological changes in the brain itself. Later this idea of new "functional organs" was developed by A. N. Leont'ev (1972).
The position of LS Vygotsky that "the human brain has a new localization principle in comparison with the animal, thanks to which it became a human brain, an organ of human consciousness" (L. S. Vygotsky, 1982. T. 1. - P. 174), completing his well-known theses "Psychology and the doctrine of the localization of mental functions" (published in 1934) is undoubtedly one of the most fundamental provisions of Russian neuropsychology.
Vygotsky's ideas about the systemic structure and systemic cerebral organization of higher forms of mental activity are only part of the important contribution that he made to neuropsychology. No less important is his concept of the changing significance of the brain zones in the process of intravital development of mental functions.
Observations on the processes of the child's mental development led Vygotsky to the conclusion on the sequential (chronological) formation of the higher mental functions of a person and the sequential lifetime change in their cerebral organization(due to changes in "interfunctional" relations) as the main laws of mental development. He formulated the provision on the different influence of the focus of brain damage on the higher mental functions in childhood and in an adult.
The idea of an unequal effect in the defeat of the same areas of the cortex at different stages of mental development is one of the most important ideas of modern neuropsychology, which has been truly appreciated only recently in connection with the development of research in the field of neuropsychology of childhood.
Both during the Great Patriotic War and in the subsequent time, the formation and development of neuropsychology were closely related to the success neurology and neurosurgery, which made it possible to improve its methodological and conceptual apparatus and to test the correctness of hypotheses in the treatment of patients with local brain lesions.
Research in the field of pathopsychology, conducted in a number of psychiatric clinics in the Soviet Union. These include the work of the psychiatrist R. Ya. Golant (1950), devoted to the description of mnestic disorders with local brain lesions, in particular with damage to the diencephalic region.
The Kiev psychiatrist A. L. Abashev-Konstantinovsky (1959) did a lot to develop the problem of general cerebral and local symptoms that arise with local brain lesions. He described the characteristic changes in consciousness that occur with massive lesions of the frontal lobes of the brain, and highlighted the conditions on which their appearance depends.
B.V. Zeigarnik and her colleagues made an important contribution to Russian neuropsychology. Thanks to these works:
* thought disorders were studied in patients with local and general organic brain lesions;
* the main types of pathology of thought processes are described in the form of various violations of the very structure of thinking in some cases and violations of the dynamics of mental acts (defects
motivation, purposefulness of thinking, etc.) - in others.
Of unconditional interest from the standpoint of neuropsychology are works Georgian School of Psychologists, who studied the features of a fixed installation in general and local brain lesions (D. N. Uznadze, 1958).
Important experimental psychological studies were carried out on the basis of neurological clinics. These primarily include the work of B.G. Anan'ev and his collaborators (1960 and others), devoted to the problem of the interaction of the cerebral hemispheres and which made a significant contribution to the construction of modern neuropsychological concepts of the cerebral organization of mental processes.
Of great value for the development of neuropsychology are neurophysiological studies, which have been and are being carried out in a number of laboratories in the country. These include the studies of G.V. Gershuni and his collaborators (1967), devoted to the auditory system and revealed, in particular, two modes of its operation: the analysis of long sounds and the analysis of short sounds, which made it possible to approach the symptoms of damage to the temporal lobes of the cerebral cortex in a new way. in humans, as well as many other studies of sensory processes.
A great contribution to modern neuropsychology was made by the research of such major Russian physiologists as N.A. Bernstein, P.K.Anokhin, E.N.Sokolov, N.P. Bekhtereva, O.S. Adrianov, etc.
The concept of N.A. Bernstein (1947 and others) on the level organization of movements served as the basis for the formation of neuropsychological ideas about the cerebral mechanisms of movements and their disorders in local brain lesions.
The concept of PK Anokhin (1968, 1971) about functional systems and their role in explaining the expedient behavior of animals was used by A.R. Luria to construct a theory of systemic dynamic localization of higher mental functions of a person.
The works of E.N.Sokolov (1958 and others), devoted to the study of the orienting reflex, were also assimilated by neuropsychology (together with other achievements of physiology in this area) to build a general scheme of the brain as a substrate of mental processes (in the concept of three brain blocks, to explain modal-nonspecific disorders of higher mental functions, etc.).
Of great value for neuropsychology are the studies of N.P. Bekhtereva (1971, 1980), V.M.Smirnov (1976, etc.) and other authors, in which, for the first time in our country, using the method of implanted electrodes, the important role of deep brain structures in implementation of complex mental processes - both cognitive and emotional. These studies have opened up new broad prospects for the study of the cerebral mechanisms of mental processes.
Thus, Russian neuropsychology was formed at the junction of several scientific disciplines, each of which made its own contribution to its conceptual apparatus.
The complex nature of the knowledge that neuropsychology relies on and that is used to build its theoretical models is determined by the complex, multifaceted nature of its central problem - “the brain as a substrate of mental processes”. This problem is interdisciplinary, and progress towards its solution is possible only with the help of the common efforts of many sciences, including neuropsychology. To develop the proper neuropsychological aspect of this problem (i.e., to study the cerebral organization of higher mental functions, primarily on the basis of local brain lesions), neuropsychology must be armed with the entire amount of modern knowledge about the brain and mental processes, gleaned from both psychology and from other related sciences.
Modern neuropsychology develops mainly in two ways. The first one is Russian neuropsychology, created by the works of L. S. Vygotsky, A. R. Luria and continued by their students and followers in Russia and abroad (in the former Soviet republics, as well as in Poland, Czechoslovakia, France, Hungary, Denmark, Finland, England, USA, etc. .).
The second is traditional western neuropsychology, the most prominent representatives of which are such neuropsychologists as R. Reitan, D. Benson, H. Ekaen, O. Zangwill and others.
Methodological framework Russian neuropsychology are the general provisions of dialectical materialism as a general philosophical system of explanatory principles, which include the following postulates:
About the materialistic (natural science) understanding of all
mental phenomena;
· About the socio-historical conditioning of the human psyche;
· About the fundamental importance of social factors for the formation of mental functions;
· About the mediated nature of mental processes and the leading role of speech in their organization;
About the dependence of mental processes on the methods of their formation, etc.
As you know, A.R. Luria, along with other domestic psychologists (L. S. Vygotsky, A. N. Leontiev, S. L. Rubinstein, A. V. Zaporozhets, P. Ya. Galperin, etc.) foundations of domestic psychological science and on this basis he created a neuropsychological theory of the cerebral organization of higher mental functions of a person. The successes of Russian neuropsychology are explained primarily by its reliance on general psychological concepts scientifically developed from the standpoint of materialistic philosophy.
Comparing the development paths of Russian and American neuropsychology, A.R. Luria noted that American neuropsychology, having achieved great success in the development of quantitative methods for studying the consequences of brain damage, actually does not have a general conceptual scheme of the brain, a general neuropsychological theory that explains the principles of the functioning of the brain as a whole.
The theoretical concepts of Russian neuropsychology determine the general methodological strategy of research. In accordance with the concept of the systemic structure of higher mental functions, according to which each of them is a complex functional system, consisting of many links, violations of the same function proceed differently depending on which link (factor) is affected. That's why the central task of neuropsychological research is to determine the qualitative specificity of the disorder, and not only to establish the fact of a disorder of a particular function.
It should be noted that at present, both theoretical positions and methods of domestic neuropsychology are gaining more and more popularity among Western researchers. The methods developed by A.R. Luria are subject to standardization, are widely used, and are discussed at special conferences.
The rich scientific heritage left by A.R. Luria determined the development of Russian neuropsychology for a long time and significantly influenced the development of neuropsychology abroad.
At present, Russian neuropsychology is an intensively developing branch of psychological science, in which several independent directions, united by common theoretical concepts and a common final task, states in the study of cerebral mechanisms of mental processes.
Main directions:
1.clinical neuropsychology, the main task of which is to study neuropsychological syndromes arising from the defeat of one or another part of the brain, and to compare them with the general clinical picture of the disease.
2. experimental neuropsychology, whose tasks include the experimental (clinical and instrumental) study of various forms of mental disorders in local brain lesions and other diseases of the central nervous system.
A.R. Luria and his collaborators experimentally developed the problems of the neuropsychology of gnostic processes (visual, auditory perception), the neuropsychology of intellectual activity.
3. psychophysiological the direction was created in experimental neuropsychology on the initiative of A.R. Luria. In his opinion, this direction of research is a natural continuation of experimental neuropsychology by methods of psychophysiology.
4.rehabilitation direction, dedicated to the restoration of higher mental functions, impaired due to local brain damage. This direction, based on general neuropsychological ideas about the activity of the brain, develops the principles and methods of restorative education for patients who have suffered from local brain diseases. This work began during the Great Patriotic War.
During these years, it was nominated the central position of the concept of neuropsychological rehabilitation: restoration of complex mental functions can be achieved only by restructuring the disturbed functional systems, as a result of which the compensated mental function begins to be realized with the help of a new "set" of psychological means, which also presupposes its new brain organization.
5.neuropsychology of childhood(70s of the XX century on the initiative of A.R. Luria) The need for its creation was dictated by the specifics of mental disorders in children with local cerebral lesions. There was a need for a special study of "children's" neuropsychological symptoms and syndromes, description and generalization of facts. This required special work to "adapt" the methods of neuropsychological research to childhood and to improve them.
The study of the features of the cerebral mechanisms of higher mental functions in children with local cerebral lesions makes it possible to reveal the patterns of chronogenic localization of these functions, which Vygotsky wrote about in his time (1934), and also to analyze the different influence of the lesion focus on them depending on age ( "Up" - for not yet formed functions and "down" - for already established ones).
One might think that over time will be created and neuropsychology of old age(gerontoneuropsychology). So far, there are only a few publications on this topic.
6. neuropsychology of individual differences(or differential neuropsychology) - the study of the cerebral organization of mental processes and states in healthy individuals on the basis of theoretical and methodological achievements of Russian neuropsychology. The relevance of neuropsychological analysis of mental functions in healthy people is dictated by both theoretical and practical considerations. The most important theoretical problem that arises in this area of neuropsychology is the need to answer the question of whether it is possible in principle to spread the general neuropsychological concepts of the cerebral organization of the psyche, which developed in the study of the consequences of local brain lesions, to the study of the cerebral mechanisms of the psyche of healthy individuals.
Currently in the neuropsychology of individual differences has developed two lines of research.
The first is study of the features of the formation of mental functions in ontogenesis from the standpoint of neuropsychology,
The second is study of the individual characteristics of the psyche of adults in the context of the problem of interhemispheric asymmetry and
inter-hemispheric interaction, analysis of the lateral organization of the brain as a neuropsychological basis for the typology of individual psychological differences
7. neuropsychology of borderline states of the central nervous system, which include neurotic conditions, brain diseases associated with exposure to low doses of radiation ("Chernobyl disease"), etc. Research in this area has shown the existence of special neuropsychological syndromes inherent in this contingent of patients, and great possibilities of using neuropsychological methods to assess the dynamics of their states, in particular for the analysis of changes in higher mental functions under the influence of psychopharmacological drugs ("Chernobyl trace", 1992; E. Yu. Kosterina et al. 1996,1997; E. D. Khamskaya, 1997, etc.).
Neuropsychology is a young science. Despite a very long history of studying the brain as a substrate of mental processes, which dates back to the pre-scientific ideas of ancient authors about the brain as a receptacle of the soul, and the huge factual material about various symptoms of brain damage accumulated by clinicians around the world, neuropsychology as a system of scientific knowledge developed only in 40-50s of the XX century. The decisive role in this process belongs to the Russian neuropsychological school. Her successes and high international prestige are primarily associated with the name of one of the most prominent psychologists of the 20th century - Alexander Romanovich Luria.
Neuropsychology- a specific area of knowledge, where the subject is the study of the cerebral organization of mental processes, emotional states and personality on the material of pathology, first of all, on the material of local lesions of the g / m.
Neuropsychology, as a branch of psychological science, began to take shape in the 20-40s of the twentieth century in different countries. The successes of psychology, neurophysiology and medicine (neurology, neurosurgery) at the beginning of the 20th century paved the way for its formation.
The first neuropsychological studies were carried out in the 1920s by L.S. Vygotsky; however, the main merit of creating N. as an independent branch of psychological knowledge belongs to A.R. Luria.
Based on the works of Vygotsky (1934, 1956), they were the principles of localization of the highest psycho are formulated. f-tions of a person... He first expressed the idea that the human brain has a new principle of organization of functions, which he designated as the principle of "extracortical" organization is crazy. processes(with the help of tools, signs and language).
Observation of the processes of the psycho. development of reb. led Vygotsky to the conclusion about the sequential (chronological) formation of the highest psycho. f-tions of a person and a consistent lifetime change in their cerebral organization as a basic pattern of psycho. development. He formulated the provision on the different influence of the focus of brain damage on the highest psychotic. f-tion in childhood and in an adult.
The central task of neuropsychol. research is to determine the qualitative specifics of the disorder, and not only the statement of the fact of a disorder of a particular function.
The main tasks of neuropsychology .
The study of changes in mental processes with local brain lesions, which allows you to see with which brain substrate a particular type of mental activity is associated.
Neuropsychological analysis makes it possible to identify those common structures that exist in completely different mental processes.
Early diagnosis of focal brain lesions.
There are two method groups used in neuropsychology. The first should include the methods by which the basic theoretical knowledge was obtained, and the second - the methods that are used by neuropsychologists in practice.
In the first group, the comparative anatomical research method, the method of irritation and the method of destruction are distinguished.
In the practice of neuropsychologists, the method of syndromic analysis proposed by A. R, Luria, or, in other words, the "battery of Luriev's methods", is used. A.R. Luria selected a series of tests, combined into a battery, which makes it possible to assess the state of all the main HMFs (according to their parameters). These techniques are addressed to all brain structures that provide these parameters, which makes it possible to determine the area of brain damage.
These methods, being the main tool of clinical neuropsychological diagnostics, are aimed at studying various cognitive processes and personal characteristics of the patient - speech, thinking, writing and counting, memory.
Currently, several areas of neuropsychology have appeared, differing in their tasks.
Clinical neuropsychology is engaged in the study of patients with local brain lesions. The main task is to study neuropsychological syndromes in local brain lesions. Research in this area is of great practical importance for diagnosis, preparation of a psychological opinion on the possibility of treatment, recovery and prognosis of the further fate of patients. The main method is the method of clinical neuropsychological research.
Experimental neuropsychology (neuropsychology of cognitive processes). The main task: experimental study of various forms of disorders of mental processes with local brain lesions. Thanks to the works of A.R. Luria and his students, memory and speech have been most studied. In experimental N., on the initiative of Luria, psychophysiological direction - This is a direction whose task is to study the physiological mechanisms of disorders of higher mental functions.
Rehabilitation neuropsychology . The main task: restoration of HMF in local brain lesions. The most developed are the principles and methods of speech restoration.
Environmental neuropsychology assesses the influence of various unfavorable environmental factors on the state of mental functions and on the emotional-personal sphere from the standpoint of neuropsychology.
Developmental neuropsychology . The task is to identify patterns of brain development.
In recent years, neuropsychology of childhood ... This is a new area of neuropsychology that studies the specifics of mental disorders in local brain lesions in children. Research in this area makes it possible to identify the patterns of localization of higher mental functions, as well as to analyze the effect of localization of the lesion focus on mental function depending on age.
Finally, lately, more and more begins to establish itself neuropsychology of individual differences (or differential her psychology ), which studies the cerebral organization of mental processes and states in healthy individuals on the basis of theoretical and methodological achievements of Russian neuropsychology.
The practical tasks facing differential neuropsychology are primarily associated with psychodiagnostics, with the use of neuropsychological knowledge for the purpose of professional selection, career guidance, etc.
Neuropsychology was formed due to the needs of practice, first of all - the need to diagnose local brain lesions and restore impaired mental functions.
In the conceptual apparatus of neuropsychology, one can distinguish two concept class . The first one isconcepts common to neuropsychology andgeneral psychology; the second isproper neuropsychological softwareness, due to the specifics of its subject, object and research methods.
The first class of concepts includes such as:
action;
operation;
higher mental function;
mental activity;
psychological system;
mental process;
speech mediation;
meaning;
personal meaning;
psychological tool;
interiorization and many others.
Second class of conceptsmake upproper neuropsychologicalconcepts, which reflected the application of general psychological theory to neuropsychology. The basis of this theory is the provision on the systemic structure of higher mental functions and their systemic cerebral organization.
In neuropsychology, as in general psychology, under higher psi chemical functions are understood as complex forms of conscious mental activity, carried out on the basis of appropriate motives, regulated by the corresponding goals and programs and obeying all the laws of mental activity.
Higher mental functions have three main characteristics:
* they are formed during their lifetime under the influence of social factors (awareness);
* they are mediated in their psychological structure (mainly with the help of the speech system) - mediation;
* they are arbitrary in the way they are implemented (arbitrariness)
Higher mental functions as systems have great plasticity, the interchangeability of their components.
The regularity of the formation of higher mental functionsis thatinitially they exist as a form of interactionrelations between people (i.e., as an interpsychological process) and onlylater - as a completely internal (intrapsychological) process.
A functional system in neuropsychology is understood as a morthe physiological basis of higher mental functions (i.e., the totalityness of various brain structures and the physiologicaltheir processes), which ensures their implementation.
These provisions are central tothe theory of systemic dynamic localization of higher mental functions.
The second class of concepts - actually neuropsychological - includes the following.
Neuropsychological symptom- impairment of mental function resulting from local damage to the brain (or due to other pathological reasons leading to local changes in the brain).
Primary neuropsychological symptoms- disorders of mental functions directly related to the defeat (loss) of a certain neuropsychological factor.
Secondary neuropsychological symptoms- disorders of mental functions arising as a systemic consequence of primary neuropsychological symptoms according to the laws of their systemic relationships.
Neuropsychological syndrome- a natural combination of neuropsychological symptoms due to the defeat (loss) of a certain factor (or several factors).
Neuropsychological factor- a structural and functional unit of the brain, characterized by a certain principle of physiological activity (modus operandi), the violation of which leads to the appearance of a neuropsychological syndrome.
Syndromic analysis- analysis of neuropsychological syndromes in order to find a common basis (factor) explaining the origin of various neuropsychological symptoms; the study of the qualitative specifics of violations of various mental functions associated with the defeat (loss) of a certain factor; qualitative qualification of neuropsychological symptoms (synonym - factor analysis).
Neuropsychological diagnostics- study of patients with local brain lesions using clinical neuropsychological methods in order to establish the site of brain damage (topical diagnosis).
Functional system- a morphophysiological concept borrowed from the concept of functional systems by PK Anokhin (1968, 1971, etc.) to explain the cerebral mechanisms of higher mental functions; a set of afferent and efferent, links, combined into a system to achieve the final result. Higher mental functions of different content (gnostic, mnestic, intellectual, etc.) are provided by qualitatively different functional systems.
Brain mechanisms of higher mental function(morphophysiological basis of mental function) - a set of morphological structures (zones, areas) in the cerebral cortex and in subcortical formations and the physiological processes occurring in them, which are part of a single functional system and are necessary for the implementation of this mental activity.
10. Localization of the higher mental function(cerebral organization of higher mental function) is the central concept of the theory of systemic dynamic localization of higher mental functions, explaining the connection between the brain and the psyche as the ratio of various links (aspects) of mental function with different neuropsychological factors (i.e., the principles inherent in the work of one or another brain structure - cortical or subcortical).
11. Polyfunctionality of brain structures- the ability of brain structures (and, first of all, the associative zones of the cerebral hemispheres) to rebuild their functions under the influence of new afferent influences, as a result of which an intrasystem and intersystem restructuring of the affected functional systems occurs.
Function rate- the concept on which neuropsychological diagnostics of disorders of higher mental functions is based; indicators of function implementation (in psychological units of productivity, volume, speed, etc.), which characterize the average values in a given population. There are variants of "normal function" associated with premorbid (gender, age, type of interhemispheric organization of the brain, etc.).
Interhemispheric asymmetry of the brain- inequality, a qualitative difference in the "contribution" made by the left and right hemispheres of the brain to each mental function; differences in the cerebral organization of higher mental functions in the left and right hemispheres of the brain.
Functional specificity of the cerebral hemispheres- the specificity of information processing and cerebral organization of functions inherent in the left and right hemispheres of the brain and determined by integral hemispheric patterns.
Interhemispheric interaction- a special mechanism for combining the left and right hemispheres of the brain into a single integrative, integrally working system, which is formed under the influence of both genetic and environmental factors.
The listed concepts are included in basic understanding tial apparatus of the theory of systemic dynamic localization of higher mental functions of a person .
The main provisions of theosystemic dynamic localization of higher psychosiCal functions:
each mental function is a complex functional system and is provided by the brain as a whole. At the same time, various brain structures make their own specific contribution to the implementation of this function;
various elements of the functional system can be located in areas of the brain that are quite distant from each other and, if necessary, replace each other;
When a certain part of the brain is damaged, a "primary" defect occurs - a violation of a certain physiological principle of work inherent in a given brain structure;
As a result of the defeat of a common link included in different functional systems, "secondary" defects may arise.
Currently, the theory of systemic dynamic localization of higher mental functions is the main theory explaining the relationship between the psyche and the brain.
In neuropsychology, based on the analysis of clinical data, general structural and functionalnal model of the brain as a substrate of mental activitysti, according to which the whole brain can be subdivided into three main structural and functional blocks :
I- an energy block, or a block for regulating the level of brain activity,
II- a unit for receiving, processing and storing exteroceptive (i.e., outgoing) information;
III- block of programming, regulation and control over the course of mental activity.
Each higher mental function (or a complex form of conscious mental activity) is carried out with the participation of all three brain blocks that contribute to its implementation.
Energetic block includes nonspecific structures of different levels:
reticular formation of the brainstem;
nonspecific structures of the midbrain, its diencephalic divisions;
the limbic system;
* mediobasal parts of the cortex of the frontal and temporal lobes of the brain.
Non-specific structuresfirst block according to the principle of their action, they are divided into the following types:
* ascending (conducting excitation from the periphery to the center);
* descending (conducting excitation from the center to the periphery).
Cortical structures of the first block(cingulate cortex, medial cortexand the basal, or orbital, sections of the frontal lobes of the brain)belongin their structure lie mainly in the crust of the ancient type, withconsisting of five layers.
Functional valuethe first block in providing mental functions consists, firstly, in the regulation of activation processes, in maintaining the general tone of the central nervous system, which is necessary for any mental activity (activating function). Secondly, in the transmission of the regulatory influence of the cerebral cortex on the underlying stem formations (modulating function). Due to the descending fibers of the reticular formation, the higher parts of the cortex control the work of the underlying apparatuses, modulating their work and providing complex forms of conscious activity.
The first block of the brain is involved in the implementation ofbattle of mental activity, especially in the processes of attention, memory, regulation of emotional states and consciousness in general.
The second block is a block for receiving, processing and storage exterocepbeer(T.e.coming from the external environment)information - located in the outer sections of the neocortex (neocortex) and occupies its posterior sections, including the apparatus of the occipital, temporal and parietal cortex. The structural and anatomical feature of this brain block is the six-layer structure of the cortex. It includes primary zones (providing reception and analysis of information coming from the outside), secondary zones (performing the functions of synthesizing information from one analyzer) and tertiary zones, the main task of which is a complex synthesis of information.
A distinctive feature of the apparatus of the second block is modal specificity and narrow specialization. The first means that the nerve cells of the primary zones respond to excitation of only one modality (one type), for example, only visual or only auditory. The second assumes that these neurons respond only to a separate sign of a stimulus of the same type (for example, only to the width of the line or the angle of inclination, etc.). Due to this, the devices of the second functional block of the brain perform the functions of receiving and analyzing information coming from external receptors and synthesizing this information.
All major analyzer systems are organized according to a common nprinciple: they consist ofperipheral (receptor) and centof the regional departments.
Peripheral divisionsanalyzers analyze and discriminate stimuli according to their physical qualities (intensity, frequency, duration, etc.).
Central departmentsanalyzers include several levels, the last of which is the cerebral cortex.
The processes of analysis and processing of information reach the maximum complexity and granularity in the cerebral cortex. Analyzer systems are characterized by a hierarchical structure principle, while the neural organization of their levels is different.
The cortex of the posterior cerebral hemispheres has a number of common features that allow it to be combined into a single brain block. It distinguishes "nuclear zones" of analyzers and "periphery" (in the terminology of IP Pavlov), or primary, secondary and tertiary fields (in the terminology of A. V. Campbell). The primary and secondary fields are referred to the nuclear zones of the analyzers, and the tertiary fields are referred to the periphery.
The third block is a block of programming, regulation and control complex forms of activity is associated with the organization of purposeful, conscious mental activity, which includes in its structure a goal, a motive, a program of actions to achieve the goal, the choice of means, control over the implementation of actions, correction of the result obtained. The third block of the brain serves to provide these tasks.
The devices of the third functional block of the brain are located anterior to the central frontal gyrus and include includesmotor, premotor and pre-frontal departmentsbarkfrontal lobes of the brain... The frontal lobes are characterized by great structural complexity and many bilateral connections with cortical and subcortical structures. The third brain block includes the convexital frontal cortex with its cortical and subcortical connections.
The anatomical structure of the third block of the brain determines its leading role in programming the intentions and goals of mental activity, in its regulation and control over the results of individual actions, as well as all behavior in general.
Various stages of voluntary, mediated speech, conscious mental activity are carried out with the obligatory participation of all three brain blocks:
it begins with the phase of motives, intentions, intentions (1 block);
then these motives, intentions, intentions turn into a certain program (or "image of the result") of reality, including ideas about the ways of its implementation (block 3);
* after which it continues as a phase of the implementation of this program with the help of certain operations (block 2);
* mental activity ends with the phase of comparing the results obtained with the original "image of the result". In the event of a discrepancy between these data, mental activity continues until the desired result is obtained.
The defeat of one of the three blocks (or its department) is reflected in any mental activity, as it leads to a violation of the corresponding stage (phase, stage) of its implementation.
These guidelines have been developed by the All-Russian Center for Pediatric Neurology. They provide a somewhat abbreviated (in comparison with the generally accepted methodology of A.R. Luria) scheme of neuropsychological research, aimed at examining children, mainly of preschool and primary school age.
The scheme includes basic trials and tests that revealed violations of the functions of praxis, gnosis, speech, memory and thinking; in a special formalized table, possible variants of deviations in filling out samples by a child, as well as their neuropsychological interpretation and connection with dysfunction of certain brain structures are presented.
The high diagnostic efficiency of the proposed adaptive scheme of neuropsychological research was confirmed by in-depth dispensary examination of children in kindergartens and a general orphanage. Functional deviations, determined by neuropsychological research, make it possible to choose a method of directed correctional and restorative learning.
PREPARATION FOR RESEARCH. CONVERSATION.
The research is carried out in a separate room, at the table. The child is seated opposite the researcher. There should be no strangers in the room, bright posters and toys that would distract the child's attention from work. For the study, special pictures should be prepared to determine visual perception, a set of objects for the study of tactile perception, as well as blank sheets of paper, a pen, a pencil.
Preparation for a neuropsychological examination begins with a preliminary conversation, during which the researcher must win over the child and inspire his confidence. During the conversation, the personality of the child, the adequacy of his behavior, criticality, attitude towards family members, friends, kindergarten teachers, teachers at school are assessed.
Then the child is presented with a series of tasks to identify obvious or latent signs of left-handedness, motor or sensory dominance: the definition of the "leading" hand in everyday life, the "leading" leg, the "leading" eyes, ear.
As a result, a kind of left-handedness coefficient is determined - in the form of a fraction, in the numerator of which the number of samples that revealed left-handedness is put down, and in the denominator the total number of tests carried out.
Usually at least 11 tests are carried out:
1 - 4 the "leading" hand in everyday life (when writing, when using a spoon, toothbrush, comb);
5 - crossing the fingers of both hands (with right-handedness, the right thumb is on top);
6 - the cross of arms on the chest (with right-handedness, the right hand is on top);
7 - applause (with right-handedness, the right hand is above and more active);
8 - "leading" hand when playing with the ball;
9 - side preference when bouncing on one leg;
10 - preference for one eye when using a "telescope" rolled from a sheet of paper;
11 - ear preference when listening to the ticking of the clock.
NEIROPSYCHOLOGICAL EXAMINATION.
Objective research is carried out strictly according to the attached scheme (Appendix 1), all observations in the process of conducting samples are recorded in the protocol. If it is impossible to conduct a study (with depletion of the child's attention, poor health, etc.), it is necessary to indicate the numbers of the missed samples in the protocol. The submission of tasks is carried out according to the list of tests presented in the table, which gives a list of the studied mental functions, the numbers of the samples related to each of them, as well as brief instructions for their use. The researcher must make sure that the task is understood by the child and, in case of incorrect execution, repeat the instructions.
Appendix 1 includes the study of 67 samples, which are assigned to 14 groups in accordance with the investigated function. The kinesthetic basis of movements is investigated using tests for reproducing various positions of the fingers of the hand and includes performing a task according to a visual sample (samples 1-6), according to a tactile sample (samples 7-9), as well as reproducing a pose from one hand to another (samples 11 - fourteen). The study of spatial praxis is carried out using tests from 15 to 21, in which the child reproduces a certain position of the hand in relation to various parts of the body, and dynamic praxis (tests 22-27) includes tests for changing three positions of the hand, drawing a given pattern with the right hand; a test for reciprocal coordination of movements is of independent importance.
Auditory-motor coordination is investigated using tests 28-36 and includes the assessment of rhythms, their reproduction according to an auditory pattern or oral instruction.
Stereognosis is investigated using samples 37-38, and visual gnosis - 39-42. The study of the sensory, motor, nominative function of speech is devoted to 43-47 tests. With the help of tests 48-51, auditory-speech memory is investigated, and when carrying out tests 56-57, visual memory. Separately, tests are carried out corresponding to the study of drawing (52-54), reading (58), writing (59-64), counting (65). At the end of the study, the child is offered the simplest tasks (66-67). It should be noted that samples 35-36 and 58 to 67 are intended for school-age children, although testing them in 5-6-year-old children can be useful in determining their development and readiness for school.
NEIROPSYCHOLOGICAL ANALYSIS OF DISORDERS. TOPIC ANALYSIS.
The analysis of the results of neuropsychological research presents certain difficulties. To simplify the researcher's task, a special formalized scheme has been developed (Appendix 2), in which, based on the experience of neuropsychological examination of children, the most significant violations of the samples are given, as well as their psychophysiological interpretation and possible localization of functional insufficiency in the cerebral cortex. Given the focus of a series of tests on the study of a specific function, the revealed violations are of a cumulative nature, summarizing the results of studies not of a single sample, but of a separate function.
o So, violations of kinesthetic praxis (samples 1 - 14) can have 6 variants with 1.1. up to 1.6. (in the numbering of violations, a code was adopted in which the first digit corresponds to the number of functions, the second to the violation, and the third to the test with the right or left hand). Depending on the nature of the dysfunction, the psychophysiological assessment varies: for example, disturbances in kinesthetic praxis can be caused by disturbances in the kinesthetic basis of movements, unilateral spatial agnosia, disturbances in interhemispheric interaction, and inertia of movements. According to the psychological assessment, the localization of cerebral dysfunction can differ significantly, revealing the interest of the right or left hemisphere, interhemispheric commissures, frontal, temporal, parietal and occipital lobes, or a combination of the lesions.
Thus, the interpretation of the results of a non-psychological study is based not only on the statement, but also on the qualification of the symptoms of neuropsychological processes. It determines the need to highlight the main defect underlying this disorder, which leads to the appearance of a complex of symptoms, made up of outwardly heterogeneous, but in fact, internally related manifestations. Already the results of the study of the first function (kinesthetic praxis) make it possible to designate a certain "territory" of dysfunction in the brain, as well as
When making a topical diagnosis, the researcher can use Appendix 3, which summarizes the digital codes of violations of all investigated functions, distributed depending on the localization of the lesions in the left or right hemisphere of the brain.
The researcher should emphasize the disorders that he identified in the process of individual studies, thus, determine the topical diagnosis. At the same time, it should be borne in mind that the local neuropsychological syndromes listed in Appendix 3 are a key benchmark for assessing the identified disorders, but in specific cases they can vary depending on a number of factors.
CONCLUSION. The proposed scheme of an adapted neuropsychological study can increase diagnostic capabilities, however, the results of these studies should not be absolute and evaluated without taking into account the general characteristics of the health status of a preschooler and a younger student.
The deviations revealed by neuropsychological examination significantly enrich the idea of minimal cerebral dysfunction (MMD), taking into account the predominant localization and psychophysiological characteristics of the functional deficit, which makes it possible to determine the main directions of corrective measures in each case.
With a deeper local psychological syndrome, functional deficit can be caused by various organic brain lesions (developmental anomalies, consequences of perinatal CNS damage, hereditary-degenerative, inflammatory or tumor processes, etc.). In these cases, the child needs additional examination.
If the child copes poorly with the above tasks, the structure of cognitive impairments should be clarified. This is extremely important because, depending on the degree of violations and their qualitative originality, methods of individual psychological and pedagogical correction are selected and the issue of forecasting the development of the child is decided. It is necessary to use the methods of neuro-psychological diagnostics in the case of a sharp unevenness of indicators of the success of the functioning of the cognitive sphere. If a child with a normally developed intellect cannot master the skills of reading, writing, counting (dyslexia, dysgraphia, dyscalculia); if a child with normal vision and intellect is not able to produce visual synthesis (simultaneous agnosia), which manifests itself in the impossibility to cover the whole image, to understand the connections and relationships between the details of the drawing, to grasp its meaning and meaning; if a 4–7-year-old child, understanding well the speech addressed to him, cannot speak (with an outwardly normal structure of the speech apparatus) and is explained by gestures or inarticulate sounds (motor alalia) - all this indicates partial disorders of higher mental functions. Various types of mental developmental disorders in the vast majority of cases are associated with organic brain damage in the early stages of ontogenesis and secondary underdevelopment of brain structures that form in the postnatal period.
Difficulties in teaching children are often caused not only by partial disorders of specific mental functions (perception, praxis, speech, memory), which ensure the mastery of elementary school skills, but also by general nonspecific disorders of brain activity, reflecting the discoordination of cortical-subcortical functional relationships. These can be disorders of general neurodynamics (which manifests itself in increased exhaustion, impaired tempo and mobility of mental processes, impaired performance according to the asthenic type) or impaired arbitrariness and purposefulness of cognitive activity (absence or instability of cognitive motives, instability of voluntary attention and control, difficulties in planning a given mental operations).
Here we present an abbreviated version of the neuropsychological method of I.F. Markovskaya (Practical work on pathopsychology, 1987, pp. 136-156), designed to study mental development disorders in children from 7 years of age. The possibility of reducing the methodology is due to the fact that the school psychologist usually does not face the need to diagnose the gross pathology of the mental development of children, since up to 7 years old these children are already under the supervision of psychiatrists, defectologists, speech therapists. In this regard, we do not provide the tasks intended for such children and the parameters of their assessment. Developed by I.F. Markov's five-point rating scale combines the characteristics of neurodynamic and regulatory disorders, as well as the child's susceptibility to the help of a psychologist, the content and effectiveness of auxiliary measures:
5 points - the task is being performed correctly. This means that there are no neurodynamic disorders.
4 points - the task is performed correctly, but slowly; in case of difficulties, the child himself finds ways to overcome them (for example, traces the image with his finger, accompanies the action with pronunciation, etc.). This indicates mild neurodynamic disorders.
3 points - the task is performed correctly at the beginning, but in case of exhaustion, nonspecific errors occur, easy disautomation of a motor stereotype or other skill, which means instability of control when implementing a still-intact program of a given operation. The optimal measure of the psychologist's help is to organize the child's attention and emotional reinforcement. This indicates a moderate degree of neurodynamic disorders.
2 points - the presence of regulatory disorders: loss of the action program, simplification or distortion of its content side, slipping to the program of the previous task, specific errors (perseveration, persistent echo fractions). Essential help from a psychologist is required in the form of a phased formation of actions (dividing the program into its constituent elements, working out the program in speech terms, including verbal commands in the process of practical implementation of the learned program), which leads to unstable error correction and the child often refuses to complete the task, seeing his constant failure. This indicates gross neurodynamic disorders.
1 point - the task is not available, the help of a psychologist is ineffective. This indicates the extreme degree of gross disturbances in neurodynamics, primary disturbances in the structure of a given operation (in the absence of a connection with the phenomena of exhaustion of general neurodynamics).
The fulfillment of certain tasks for 1 and 2 points indicates the presence of specific partial violations of the corresponding zones of higher cortical functions. The same scores allow us to assume pronounced violations of programming processes, but the final conclusion about this "is possible only at the end of a complete system analysis of the results of neuropsychological research. Usually the latter is carried out (depending on the child's performance) in 1-3 sessions lasting about 1 hour. We we propose to apply tasks from I.F.Markovskaya's methodology in our modification in the course of pathopsychological examination.The fact is that many tasks in both types of studies coincide, however, the interpretation of the results in the framework of neuropsychological diagnostics is more informative. characteristics of the child's actions corresponding to 4, 3 and 2 points.
Research on visual gnosis. If the child does not understand the meaning of the plot pictures, cannot complete the tasks of the method of "establishing the sequence of events depicted in the figures", but at the same time shows good results in tasks for generalization, abstraction, analogy, then it is legitimate to assume not mental underdevelopment, but a violation of visual gnosis. To test this assumption, the child is offered tasks for the study of visual perception (see 2.3), adding 5 more pictures, where the images are “noisy” with specks (Atlas ... 1980, p. 7).
Evaluation of results: 4 points - correctly recognizes objects, but when examining "noisy" and superimposed images, he himself resorts to auxiliary methods: draws outlines with his finger, comments on assumptions with words; 3 points - independently recognizes only contour images, uses auxiliary techniques only after the advice of a psychologist, but even then sometimes he is mistaken; 2 points - despite the help of a psychologist, he makes mistakes all the time while completing tasks (only recognition of contour images is available).
Study of movements and actions. To clarify the question of the presence of violations of the sensorimotor development of the child, the following methods are used.
1. Enumeration of fingers - alternate touches of the thumb to the II, III, IV and V fingers (5 series of movements), which should be performed simultaneously with both hands, first at a slow pace (2-3 series of movements in 5 seconds), and then at the fastest possible (5-7 series of movements in 5 seconds). In case of difficulties, the psychologist provides assistance in the form of the inclusion of the game component and speech commands.
Evaluation of the results 4 points - execution correctly, but in a slightly slower pace; 3 points - deautomation of depletion processes; 2 points - the phenomenon of persistence on exhaustion.
2. Reciprocal coordination of movements (Ozeretsky's test) is checked during simultaneous and alternate clenching and unclenching of the hands. First, the psychologist shows how to make movements with your hands. If the child cannot repeat the movements, the re-display is accompanied by the instruction: “Put both hands on the table - like this. Squeeze one into a fist, and let the other lie still for now. Now put your hands like this. Keep moving with me. " If the child still does not cope with the task, additional help is introduced - a game situation with the inclusion of speech commands is proposed ("Command: one, two, one, two, etc.").
Evaluation of results: 4 points - movements are coordinated, smooth, but slow; 3 points - disautomation and impaired coordination on exhaustion; 2 points - persistent impairment of coordination, isolation or alliance of movements. Ozeretsky's test "palm-rib-fist" 1 represents a complicated version of the previous task. The subject is asked to alternately hit the table with the palm, the edge of the palm and the fist at an increasing pace. The types of assistance and the evaluation of the results are carried out in the same way as in the previous assignment.
3. Graphic samples. The child is offered, without lifting the pencil from the paper, to reproduce graphic rows from one or two alternating links:
First, the child is offered to work according to a visual model, and in case of difficulties, they help by including verbal instructions, for example: "Draw and tell yourself: tower-roof, tower-roof, etc.".
Evaluation of results: 4 points - deceleration, separation of the pencil from the paper; 3 points - if the topological scheme is preserved, pronounced exhaustion, impaired smoothness, exaggeration or understatement of the pattern; 2 points - the loss of the topological scheme at the end of the graphical row.
4. Constructive praxis is investigated already in the course of pathopsychological examination by folding cut pictures (not evaluated in points) and "Cubes of Koos". In case of difficulty in folding the cubes, two types of assistance are used: 1) insignificant organizing
("Look carefully, where are the white corners?" 2) massive planning assistance: dividing the pattern into 2 symmetrical parts, imposing a "grid" dividing the pattern into 4 squares.
Evaluation of results: 4 points - correct execution, but slowed down, by trial and error; 3 points - with the correct choice of cubes, difficulties in their arrangement, however, to correct mistakes, it is enough to provide insignificant organizing assistance; 2 points - the principle of action is learned after massive planning assistance.
Additionally, the following tasks are applied:
a) drawing without relying on a sample of "house", "Christmas tree", "little man", "chamomile" - not evaluated in points;
b) folding of spatially organized structures from sticks in two versions: simple copying, that is, when the experimenter folds the sample, sitting next to the child; copying with "re-encryption", "inversion" at 180s, when the experimenter folds the sample, sitting opposite. In case of difficulty, the task is performed after preliminary training.
Evaluation of the results: 4 points - simple correct copying, with “flipping” - long search; 3 points - copying is simple correctly, with “flipping” - “mirror image” is often encountered; 2 points - specularity or other gross violations are noted in all tasks with "overturning".
5. Auditory coordination. The child is asked to listen to the percussion of the rhythmic group (the psychologist's hands are hidden by a screen or a sheet of paper) and repeat it. Instructions: "Knock like this." Rhythmic groups give simple (......, .........) and complex ones with accents. The interval between groups is 1–1.5 seconds. In case of difficulties, they provide assistance in the form of emotional stimulation (they give a game option: "You are a drummer. Come on, knock like me") and additional help in the form of verbal commands ("Hit and say: one, two - knock, knock, fat, etc. ").
Evaluation of results: 4 points - correct execution, but delayed; 3 points - disautomation on exhaustion while maintaining the rhythmic scheme, however, help significantly improves the result; 2 points - the appearance of perseverations on exhaustion, help is ineffective.
Analysis of the performance of the above graphic tests and rhythmic sequences allows us to judge the presence of violations of the regulation of voluntary actions (planning and control). Indicators of impaired voluntary regulation: inert and uncontrolled repetition of one or two links of the graphic series: inability to switch from the previous rhythmic pattern, erratic knocking.
As a special task to identify violations of the regulation of actions, the child is offered the following instruction: "If I show you a finger, then you are a fist to me, and if I show a fist, then you are a finger to me." First, the psychologist presents the signals one by one, then he changes the order of presentation. This allows you to see if the child is able to overcome the stereotype and subordinate his actions to the instructions.
Evaluation of results: 4 points - correct execution, but delayed; 3 points - after the first 4-5 series, with exhaustion, echopraxia appears, or echopraxia predominates in the first series of movements, and then a series of correct answers, the child notices and corrects mistakes on his own; 2 points - persistent echopraxia, the child does not always notice mistakes.
The study of speech functions begins as early as pathopsychological examination. If, when drawing up a story based on a plot picture, the child has difficulties, the evaluation of the results is carried out as follows:
4 points - limited vocabulary, rare agrammatisms; 3 points - poverty of vocabulary, in speech more often there are agrammatisms, unstable literal paraphrasies, amnesia of words; 2 points - extreme poverty of vocabulary, persistent agrammatisms, literal paraphrasies, amnesia of words with verbal substitutions.
Assessing passive speech, they present tasks for understanding logical and grammatical constructions: inflectional (“Show the pencil with the key”, “Show the key with a pencil”); comparative ("Olya is taller than Katya, but lower than Lena. How to put them in height, who will be behind whom?"); prepositional ("Draw a cross under a circle", "Draw a circle under a cross", "Listen and tell me what I did first, and what then - I had breakfast after I read the newspaper"); complex you- | motions with alternating active and passive constructions ("Kolya hit Petya. Who's the fighter?", "The boy runs after the dog. Who runs first?" etc.).
Evaluation of the results: 4 points - minor difficulties in complex tasks, overcome with independent repetition of instructions; 3 points - pronounced difficulties, even after speaking the instructions; 2 points - mistakes in all difficult tasks; in the lighter ones - unstable difficulties that are overcome when the psychologist repeats the instructions.
Expressive speech (kinesthetic and kinetic foundations of the speech act) is studied using the following tasks.
1. Oral praxis. praxis of the lips (pull out the lips with a tube, show the teeth), tongue (stick out, remove, shift), cheeks (puff out, pull in), facial muscles (raise eyebrows, then frown), conditional oral movements (whistle, click tongue, etc.) ), switching from one oral position to another.
2. Repeated speech: repetition of individual sounds (a, o, u, y, b, d, k, x, s, l); disjunctive pairs (b – n, k – s, m – r), opposition pairs (b-p, p-b, d-t, t-d); correlated pairs (g – k, k – g, rl, l – r), words (house, cinema, colonel, cooperative, shipwreck).
Evaluation of the results: 4 points - correct execution, but in slow motion; 3 points - difficulty in pronouncing a complex syllable structure (without distorting it), when switching from one oral position to another slight tension of the muscles of the tongue, lips, face and neck; 2 points - distortion of words with a complex syllable structure, when switching from one oral position to another, pronounced muscle tension, hyperkinesis, synkinesia.
Phonemic hearing is checked additionally in case of difficulties in performing the above similar tasks. The child is offered to repeat after the psychologist a series of three sounds or simple syllables: a-o-y, u-a-i, b-r-k, b-p-b, d-t-d, bi-ba-bo, ba -bi-bo, etc.
Evaluation of the results: 4 points - single errors in serial presentation of acoustically and articularly similar phonemes; 3 points - many mistakes in the same tasks; 2 points - difficulty in distinguishing between pairs of oppositional and correlated phonemes.
Based on the results obtained, an individual "profile" of the child's neuropsychological characteristics can be drawn up: intensity (severity) and extensiveness (prevalence) of mental disorders; determination of the leading factor that impedes the completion of assignments, and hence the assimilation of school skills. For example, if a child scores 4–3 on all tasks, then the leading factor is impairment of neurodynamics (ie, exhaustion, decreased performance, impaired pace and mobility of nervous processes); if the child performs most of the tasks at 4–5, and only for some (even one) has 2, then this indicates the presence of partial disorders of cortical functions; if for all tasks the child receives no more than 3 points, then this indicates serious violations of the higher forms of regulation (programming of integral actions and control over their implementation).
Control questions
1. How is the conversation method applied to work with children?
2. How to carry out pathopsychological examination if the child is silent? When does this happen?
3. What methods do you know for studying attention and performance9
4. What methods are used in the study of memory?
5. What is the difference between impaired thinking and decreased intelligence? By what methods can these violations be determined?
6. For what purpose is neuropsychological examination used?
7. Why, when studying the psyche of children, they can be assisted in completing assignments9 What is the “zone of proximal development”?
Atlas for the experimental study of deviations in human mental activity / Edited by I.A. Polischuk, A.E. Vidrenko. Kiev, 1980.
Bleikher V. M. Clinical pathopsychology. Tashkent, 1976.
Bleikher V.M., Kruk I. V. Pathopsychological diagnostics. Kiev, 1986.
Diagnostic and correctional work of a school psychologist // Sat. scientific tr. / Ed. I.V. Dubrovina. M., 1987.
Diagnostics of mental development / B. Banashtan et al. Prague, 1978.
Korolenko Ts.P., Frolov G.V. Imagination is normal and pathological. Novosibirsk, 1975.
The best psychological tests for professional selection and vocational guidance / Ed. A.F. Kudryashova. Petrozavodsk, 1992.
Workshop on pathopsychology / Ed. B.V. Zeigarnik, V.R. Nikolaeva, V.V. Lebedinsky. M., 1987.
Working book of a school psychologist / Ed. I. In Dubrovina. M., 1991.
Stadnenko N.M. u dp Diagnostics of deviations in the mental development of students: A guide for the teacher. Kiev, 1991.
Kherson BG Method of pictograms in psychodiagnostics of mental diseases. Kiev, 1988.
Experimental psychological study of children during pre-school clinical examination / Ed. S.Ya. Rubinstein. M., 1982.
Traditional neuropsychological examination includes:
- collection of anamnestic data;
- assessment of motor and sensory lateral preferences;
- study of motor (kinesthetic, kinetic, spatial, tactile and somatognostic functions) ;
- visual gnosis;
- auditory gnosis and spatial representations;
- drawing;
- copying a picture, letters, numbers;
- visual and auditory-speech memory;
- speech functions;
- letter;
- reading;
- intellectual processes;
- emotional and personal processes.
The true picture of dysontogenesis of the cerebral organization of mental processes is revealed in many children only with the obligatory introduction of sensitized conditions into the examination. These are:
- "deaf instruction",
- dynamic loads in the form of an increase in the time and pace of performing experimental tests,
- exclusion of visual and speech self-control (closed eyes, bitten tongue),
- application of monomanual (separately with right and left hands) performing graphic tests is relevant and on the traces of memory
- The psychologist must state the presence or absence of such phenomena in the child as:
- hypo- or hypertonicity, muscle clamps, synkinesis, tics, obsessive movements, pretentious postures and rigid bodily attitudes;
- usefulness of oculomotor functions (convergence and amplitude of eye movement) ;
- plastic (or, conversely, rigidity) during the performance of any action and during the transition from one task to another, exhaustion, fatigue;
- fluctuations in attention and emotional background, affective excesses;
- the presence of pronounced autonomic reactions, allergies, enuresis;
- breathing failures up to its obvious delays or noisy "pre-breathing";
- somatic dysrhythmias, sleep disorders, dysembryogenetic stigmas, etc.
- The psychologist needs to note:
- how inclined the child is to simplify the program given from the outside;
- whether it easily switches from one program to another or inertly reproduces the previous program.
- Does he listen to the instruction to the end, or does he impulsively set to work, without trying to understand what is required of him?
- How often is it distracted by side associations and slipped into regressive forms of response?
- Is he capable of independently systematically performing the required, or is the task available to him only after leading questions and detailed prompts from the experimenter.
- Can he give himself or others a clearly formulated task, check the course and the result of its implementation;
- Can you slow down your emotional reactions inadequate to the given situation?
- Review of age dynamics in accordance with age standards, which can be relied on during the survey.
- In the study of motor functions, it was found that various types of kinesthetic praxis are fully available to children as early as 4-5 years old, and kinetic only at 7 (moreover, the test for reciprocal hand coordination is fully automated only by the age of 8).
- Tactile functions reach their maturity by 4-5 years, while somatognostic - by 6.
- Various types of objective visual gnosis do not cause difficulties by the age of 4-5; the sometimes arising confusion is associated not with the primary deficit of visual perception, but with the slow selection of words. This circumstance can also be found in other samples, so it is extremely important to separate these two reasons. Up to 6-7 years old, children demonstrate difficulties in the perception and interpretation of plot (especially serial) pictures.
- In the sphere of spatial representations, structural-topological and coordinate factors mature earlier than anyone else (6-7 years), while metric representations and the strategy of optical-constructive activity - by 8 and 9 years, respectively.
- The volume of both visual and auditory-speech memory (i.e. retention of all six reference words or figures after three presentations) sufficient in children as early as 5 years old;
- By the age of 6, the storage strength factor of the required number of elements reaches maturity, regardless of its modality. However, the selectivity of mnestic activity reaches its optimal status only by the age of 7-8. In the course of visual memorization, the child, while well holding the required number of reference figures, distorts their original image, expanding it, not observing proportions, not drawing any details (that is, demonstrating a lot of paragraphs and reversions), confusing the given order.
- The same applies to auditory-speech memory:
up to 7 years, even a four-time presentation does not always lead to a full retention of the order of verbal elements, there is a lot of paraphasia, that is, replacement of standards with words that are close in sound or meaning. The most recent of the basic factors of speech activity ripen in a child:
- phonemic hearing (7 years),
- quasi-spatial verbal syntheses;
- programming of independent speech utterance (8-9 years old).
From an ontogenetic perspective, it is directly related to the concept of a zone of proximal development:
"0" - exhibited in cases where the child, without additional explanations, performs the proposed experimental program;
"1" - if a number of small errors are noted, which are corrected by the child himself practically without the participation of the experimenter; in fact, "1" is the lower normative limit;
"2" - the child is able to complete the task after several attempts, expanded prompts and leading questions;
"3" - the task is not available even after a detailed multiple explanation from the experimenter.
- increasing the speed and duration of the task;
- exclusion of visual (closed eyes) and speech (fixed language) self-control.
ANAMNESTIC DATA AND CLINICAL INTERVIEW
Protocol
Date of examination _________________FULL NAME. child ______________________________________________________________________
Day, month, year of birth __________________________________________________________
The presence of a factor of actual and / or family left-handedness (right-handed, left-handed, ambidextrous, left-handed in the family) ________________________________________________________________
Parental complaints (legal representatives) __________________________________________
Attitude (reactions) child to their problems ________________________________________
The presence of obsessive bad habits _________________________________________________
Family composition (family members) __________________________________________________________
Parents' place of work (education, professional status):
Mother ______________________________________________________________________________
Father ______________________________________________________________________________
Social environment (the child is brought up at home, by his mother, grandmother, d / s, nursery, orphanage, etc.)
Family history:
chronic diseases (respiratory, cardiovascular, gastrointestinal, allergic, endocrine, oncological, neuropsychic, etc.) , alcoholism, occupational hazards, intoxication, drug addiction, tendency to depressive reactions:
Mother (maternal line) ____________________________________________________________
Father (paternal line) ______________________________________________________________
The course of pregnancy:
what is the age of the mother (at the beginning of this pregnancy) _____, father's age _________
Previous pregnancies have ended :
honey. abortion, early miscarriage, late, child death, childbirth / indicate how many years ago)
Pregnancy course: toxicosis (weak or pronounced), anemia, nephropathy, infectious diseases, Rh-conflict, edema, high blood pressure, bleeding, threat of miscarriage (indicate the term), Acute respiratory infections, flu, honey. treatment (outpatient, inpatient)
1st half of pregnancy ____________________________________________________________
2nd half of pregnancy ____________________________________________________________
Childbirth: what is the count ___, for how long (on time, premature, late); independent, caused, operational (planned, forced).
Labor activity began: with the discharge of water, with contractions
Childbirth:
stimulation, dropper, mechanical extrusion of the fetus, forceps, vacuum, caesarean section, anesthesia
Duration of labor (impetuous, fast, lingering, prolonged, normal)
The duration of the anhydrous period is _____________. Apgar scale __________________________
The child was born:
in head, gluteal, leg diligence
Weight ________, child's height __________.
The child screamed (immediately, after sucking off the mucus, after patting, resuscitation was carried out)
Scream character: (loud, weak, squealed) ____________________________________________
Color of the skin (pink, cyanotic, cyanotic, white)
There were: entanglement of the umbilical cord around the neck, short umbilical cord, nodular umbilical cord, cephalohematoma, fracture of the clavicle, green amniotic fluid, etc.
Diagnosis at birth:
birth trauma, birth asphyxia (degree), prenatal encephalopathy, hypertensive-hydrocephalic syndrome, malnutrition (degree) etc.
The first feeding: for a day, he took the breast actively, sluggishly
Discharged from the hospital on __________ days, later because of the mother, child, transferred to the premature department, hospital
Hospital treatment:______________________________________________________________
Conclusion after hospital (lay with his mother, separately)
Feeding up to a year: breastfeeding, up to a month, artificial from ______ months, mixed with ______ months.
Child development up to a year:
the child is characterized by motor restlessness, regurgitation (often, rarely), sleep and wakefulness disturbances, etc.
It was noted: hyper- or hypotonia, flinching, tremor of the arms, chin, "pulled his head back", etc.
Motor functions:
He holds his head since _____ months, sits since _______ months, crawls since ___ months, walks since ____ months, walks independently since ______ months.
Speech development:
humming from a month, babbling from _____ months, words from ______ months, a phrase from ________ months.
Up to a year had been ill:
colds, infectious diseases, allergic reactions, etc.__________________________
Treatment: outpatient, inpatient with the mother or separately
Special treatment: massage, sedation, medicine, etc.
Were there any difficulties in mastering the following skills:
potty use, independent walking, independent eating, dressing / undressing, autonomous falling asleep, etc.
Reasons for difficulties:
hospitalization, relocation, divorce, birth of a second child, death of loved ones, etc. at the age of ___________________________________________________________________________________
Was there enuresis, encopresis, specific food preferences, movement disorders, sleep disorders, etc. at the age of ________
Past illnesses during life ____________________________________________
Head trauma, concussion, treatment (inpatient, outpatient) at the age of ________ Operations at the age of _______
Was observed in _______________________ with a diagnosis of _____________,
Deregistered in _________________________ Included to date
Attends kindergartens since _________ years.
Currently attending _________________________________________________________
Visit to a special d / s ________________________________________________________
During adaptation, there were: increased excitability, protest reactions (active, passive), began to get sick often, others ._____________________________________________________
Play activities: liked / did not like to play with toys.
Favorite toys, games: _____________________________________________________________
I was ready for school: I knew / did not know the letters, read syllables, read well.
Counting: up to 3, 5, 10, more, performed / did not perform arithmetic operations.
Drawn: could / could not, bad, good, loved / disliked.
Wanted / did not want to go to school
Training program: 1-4,1-3 ordinary schools
Education in a correctional, auxiliary, speech, etc. school
Adapting to school _________________________________________________________________
Interest in learning: yes / no
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