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Lecture 1. The value of discipline.

Lecture 1. The value of discipline.

Objective: The relevance of the study course. Course objectives: develop a certain level of education, cognitive interests, intellectual and creative abilities in the process of studying the discipline, allowing to solve problems in the field of professional and social activities.


1. Subject and tasks " Clinical features of children with disabilities."

2. The general pattern of growth and development of children with disabilities.


Children with disabilities - children with various deviations of mental or physical plane, who are responsible for violations of the overall development, not allowing children to enjoy a full life. Synonymous with this concept may make the following definitions of these children, "children with problems", "children with special needs", "atypical children", "children with learning difficulties", "abnormal children", "exceptional children".

Subject "Clinical features of children with disabilities" defines the concepts about normal psychological and physical development of the child, the various etiopathogenic mechanisms in the development of abnormalities. Much attention is paid to the hereditary diseases, early childhood diseases, various diseases of the nervous system. The course aims to help students in creating a framework for learning and majors in learning the basics of clinical developmental disabilities.The study of theoretical and practical knowledge of preschool children in the future will contribute to the implementation of work on strengthening health and physical maturation.

The purpose of the discipline - development of a certain level of education, cognitive interests, intellectual and creative abilities in the process of studying the discipline, allowing to solve problems in the field of professional and social activities.

Objectives of discipline:

-provide students with an enrollment of children belonging to the category of "children with disabilities";

-familiarize with the ontogenesis of children in health and children with disabilities;

-to teach students methods of examination of children with disabilities;

- introduce theoretically and in practice, with clinical symptoms of various diseases;

-form the theoretical basis for the further perception of essential medical and biological and clinical knowledge.

At the end of the course the student must know:

-peculiarities of development of children at different ages;

-methods of examination of children with disabilities;

-clinical signs of disease, leading to abnormalities in development;

-etiology and pathogenesis of abnormalities in the psychomotor development.

-peculiarities of development of children at different ages;

-methods of examination of children with disabilities;

-clinical signs of disease, leading to abnormalities in development;

-etiology and pathogenesis of abnormalities in the psychomotor development.

be able to:

- apply knowledge of anatomy, physiology and hygiene in the study of the professional modules and professional activities;

- evaluate the environmental factor in terms of their impact on the functioning and development of the human body as a child;

- carried out under the supervision of health professional interventions for the prevention of diseases of children;

- ensure compliance with hygiene requirements in the office, in the organization of preschool education;

- to take into account features of the physical working capacity and patterns of change different time intervals (academic year, quarter, month, week, day, employment) for the design and implementation of educational and educational process. - carry out a psychological examination of children in order to determine the progress of mental development, compliance with the age requirements;

- differential diagnosis to determine the type of developmental disorders;

- formulate a psychological detention;

- own methods of counseling parents and teachers on the issue of training, development, life and professional self-determination of children and adolescents;

- psycho prophylactic own methods of work aimed at preventing secondary deviations in the intellectual and personal development of children and adolescents, as well as to create a favorable psychological climate in educational institutions, the family;

- psychological support of the process of education of children with disabilities;

- use of modern psychological and pedagogical technologies;

- psychological support of the learning process of children with disabilities;

- use of modern scientific and reasonable and the most appropriate techniques and psycho-methods of work;

- implementation of a student-centered approach to education and development of children.


- according to international and national laws to protect the rights of children with and their families;

- understanding the importance of their future profession, professional motivation to do, to be able to take a look at the empathy of persons with disabilities.

- collection, analysis and information systematize in professional activities;

- design information activities about the problems of education;

- organizational and methodological:

- The structure, content and significance of the innovation processes, teaching techniques and educational processes in the field of special and general education;

- The main prospects and directions of development of pedagogical sciences and special education;

- Characteristics and value of professional activity;

- Theory and practice of special education in historical perspective;

- Analysis of the trends and status of vocational education;

- Objectives, principles, object of education;

- Characteristics and composition of the pre-school education process;

- Analysis of the scientific basis of pre-school education.



The relevance of the course.

Course objectives

Interconnection with other disciplines

Basic concepts of the discipline



Lecture 10. Psychomotor development of the child in ontogenesis: the physical and mental development of children of primary school age (7 to 11 years); senior school (puberty) period (from 11 to 20 years), the onset of puberty


Objective: familiarization with the psychomotor development of the child in ontogenesis


1. The physical and mental development of children of primary school age (7 to 11 years);

2. Psychomotor development of the child in ontogenesis: senior school (puberty) period (from 11 to 20 years), the onset of puberty

Starting primary school age is determined by the child's entry point in the school. In recent years, in connection with the transition to training from 6 years and the introduction of a four-year primary school age lower boundary of the phase shifted, and many children are students, not since the age of 7, as before, but with 6 years. Accordingly, the boundaries of primary school age, coinciding with the period of primary school, established at the present time from 6-7 to 9-10 years.

During this period, there is a further physical and psycho-physiological development of the child, providing the possibility of systematic training in the school. First of all, improving brain function and the nervous system. According to physiologists, to 7 years in the cerebral cortex it is already largely mature. However, the most important, specifically human parts of the brain responsible for the programming, regulation and control of complex shapes psihicheskoydeyatelnosti in children of this age have not yet completed their formation (the development of the frontal parts of the brain ends only to 12 years), thereby regulating and inhibitory effect of the cortex on subcortical structures is insufficient. Imperfection regulatory cortex function is manifested in peculiar to children of this age peculiarities of behavior, organization and emotional sphere: junior high school students are easily distracted, incapable of prolonged concentration, excitable, emotional.

Home schooling is practically coincides with the period of the second physiological crisis attributable to the age of 7 years (in the body of the child is a sharp shift in the endocrine, accompanied by the rapid growth of the body, increasing the internal organs, the autonomic rearrangement). This means that a fundamental change in the system of social relations and the activities of the child coincides with the period of restructuring of all systems and functions of the body, which requires great effort and mobilization of its reserves.

However, despite the celebrated at this time certain complications that accompany the restructuring of the physiological (fatigue, neuro-psychological vulnerability of the child), physiological crisis is not so much a burden, how much, on the contrary, contributes to a child's successful adaptation to the new conditions.

Junior school age is a period of intensive development and qualitative transformation of cognitive processes: they begin to acquire mediated character and become conscious and arbitrary. The child gradually takes possession of his mental processes, learning to manage the perception, attention, memory.

According to LS Vygotsky, with the beginning of school thinking extends to the center of the conscious activity of the child, it becomes the dominant feature. In the course of systematic training aimed at mastering scientific knowledge, is the development of verbal and logical, conceptual thinking, leading to the restructuring and all other cognitive processes' memory at this age becomes a thinking, thinking and perception. "1 Assimilation in the educational activity the foundations of theoretical consciousness and thinking leads to the emergence and development of new high-quality education, as a reflection, analysis, internal plan of action.

During this period, the ability to qualitatively change any regulation of behavior. What is happening in this age, "the loss of childish" (Vygotsky) represents a new level of development of motivation-tionally-need sphere that allows the child to act indirectly, guided by conscious goals, elaborated social norms, rules of conduct and manners.

For primary school age starts to develop a new type of relationship with other people. Unconditional adult authority being lost, increasing the value of a child beginning to acquire peers, the role of children's community.

Thus, the central tumors of primary school age are:

- A qualitatively new level of development of voluntary regulation of behavior and activity;

- Reflection, analysis, internal plan of action;

- The development of new cognitive relation to reality;

- Focus on the peer group.

Profound changes in the psychological make-junior student show wide possibilities of development of the child at this age stage. During this period, to a qualitatively new level realized the potential development of the child as an active subject, learn about the world and himself, acquiring their own experience of acting in this world.

Junior school age is the sensitive to:

- The formation of motives for learning, sustainable development of cognitive needs and interests;

- The development of productive techniques and skills training activities, the ability to learn;

- Disclosure of individual characteristics and abilities;

- The development of skills of self-control, self-organization and self-regulation;

- The formation of an adequate self-esteem, development of criticality in relation to themselves and others;

- Assimilation of social norms, moral development;

- The development of communication skills with peers, build strong friendly contacts.

The most important tumors occur in all areas of mental development: converted intelligence, personality, social relations. The leading role of training activities in the process does not exclude the fact that the younger the student is actively engaged in other activities (game elements work, sports, art, etc.), In which improved and reinforced the new achievements of the child.

Younger school age - a period of positive change and transformation. It is therefore important level of achievement, the implementation of each child at this age stage. If at this age the child does not feel the joy of learning, acquires the ability to learn, not learn to make friends, not to acquire confidence in themselves, their abilities and opportunities to do so in the future (beyond sensitive periods) will be much more difficult and will require immeasurably higher mental and physical costs.

However, looking ahead, we can say that most of these positive developments (primarily those koto-rye with particular care cultivated by adults in children of this age: their organization, self-interested attitude to learning, etc.) In appearance may be lost a baby in the peak of the global restructuring of adolescence. But without them, she would wear this restructuring qualitatively different, since it would not have the necessary bases. The more positive acquisitions will be in primary school children, the easier it is to cope with the upcoming challenges of adolescence.

Younger school age child is called the vertex [9. S. 251]. The modern periodization of mental development covers the period from 6-7 to 9-11 years.


At this age, there is an image and a lifestyle change, new requirements, new social role of the student, a completely new type of activity - training activity. In school, he acquires not only knowledge and skills, but also a certain social status. Changing the perception of its place in the system of relations. I am interested in the value of the child, his whole way of life.

The child is on the border of the new age period.

From a physiological point of view - this time the physical growth when children are quickly drawn up, there is disharmony in physical development, it is ahead of the psychological development of the child, which affects the temporary weakening of the nervous system. Manifested by increased fatigue, anxiety, increased need for movement.

The social situation in the early school years:

1. The training activity is the dominant activity.

2. completes the transition from visual-figurative to verbal and logical thinking.

3. Clearly visible the social meaning of the doctrine (the ratio of the small school to marks).

4. Motivation of achievement becomes dominant.

5. There is a change in the reference group.

6. There is a change in the daily routine.

7. Strengthen new internal position.

8. Changes the system child relationships with other people.

Leading activity

The leading activity in primary school age - learning activity. Its characteristics: efficiency, commitment, arbitrariness.

Basics of educational activity was laid in the early years of education. Educational activities should be, on the one hand, to build age-appropriate opportunities for children, and on the other - must ensure that they are necessary for the further development of the amount of knowledge.

The components of educational activity (in El'konin):

1. Motivation.

2. The training task.

3. The training operation.

4. Monitoring and evaluation.

Motives of the doctrine:

• educational (aimed at the acquisition of knowledge, ways of learning, methods of independent work, the acquisition of additional knowledge, self-improvement programs);

• social (responsibility, understanding the social significance of the doctrine, the desire to take a stand in relation to others, get their approval);

• uzkolichnye - get a good mark, deserve praise (for Sapogova EE).

Schooling is not only a special social significance of the child's activities, but also mediating the relationship with older samples and estimates, by following the rules, common to all, the acquisition of scientific concepts.

As a result of learning activities occur mental neoplasms: the arbitrariness mental processes, reflection (personal, intellectual), an internal plan of action (planning in mind, the ability to analyze).


Increases vocabulary to 7 thousand. Words. Exhibits own active position to the language. When nauchenii easily masters the sound analysis of words. The child listens to the sound of the word. The need for a dialogue of younger schoolboys determines the development of speech. Contextual speech - an indicator of the level of development of the child.

In writing distinguish correct spelling (the correct spelling of words), grammar (sentence structure, the formation of morphological forms) and punctuation (the alignment of punctuation marks).


Thinking in the early school years becomes the dominant feature completes the incipient in the preschool transition from visual-figurative to verbal and logical thinking.

By the end of primary school age are shown individual differences in thinking (theorists, thinkers, artists).

The scientific concepts (bases of theoretical thinking) are formed during training.


Memory is developing in two directions - the arbitrariness and meaningfulness.

The training activities are developing all kinds of memory: long-term, short-term and operational.

The development of memory associated with the need to memorize the course material. Actively formed voluntary memorization.


Children are able to concentrate, but they still dominated by involuntary attention.

The arbitrariness of cognitive processes occur at the peak of volitional effort (especially organizing themselves under the influence of requirements). Attention is activated but not yet stable. Hold focus is possible thanks to the efforts of a strong-willed and highly motivated.


Perception is also characterized by involuntary, although elements of arbitrary perceptions occur as early as the preschool years.

Perceptions differ poor differentiation (confused objects, their properties).

In the primary school age is increasing focus on the sensory standards of form, color, time.


Imagination in its development has two stages: in the first - to recreate the (reproductive), the second - productive. In the first class of the imagination based on specific subjects, but with age in the first place speaks a word, giving space fantasy.

7-8 years - sensitive period for the assimilation of moral norms (the child is psychologically ready to understand the meaning of the rules and regulations in their daily execution).


Intensively developing self-awareness. Becoming a junior student self-esteem depends on the performance and features of dialogue of the teacher with the class. Of great importance is the style of family education received in the family values. In standouts and some well-achieving children develops high self-esteem. We are extremely weak and underachieving students systematic failures and reduce the level of low self-confidence in their capabilities. Do they have a compensatory motivation. Children begin to be approved in another area - in sports, in music.

Value orientations are becoming the norm in the name of life. It is important that the child received another type of treatment for him - by name. This provides the child's self-esteem, self-confidence.

The need for self-affirmation. Of great importance is the authority of adults. Considerable importance is the place occupied by the child in the family.

The general development of motor skills in primary school age is flowing in the direction of the permanent acquisition coordination opportunities that were created at the child as a result of the final anatomical maturation of the motor sphere. In the younger child, little by little come into operation kartikalnye higher levels is progressively being established and precise power movement (there is accuracy in throwing, climbing, athletics, dance movements). However, the wealth of the motor age is only when the free movements. It is necessary to force the child to make precise movements, he immediately begins to sweat and strive to escape to the games where free movement. The inability of the accuracy depends on the underdevelopment of cortical brain mechanisms and a lack of development of the movement of the formulas.

Thus, in this age dominated by expressive, fine motor skills and everyday. Apparent motor does not fatigue the child is related to the fact that it does not produce productive working activities requiring precision and overcome the resistance, and hence the high energy costs. In common usage, and even more so when the expressive and visual movements, almost unrelated to the resistance movement is, of course, that start, run and end respectively physiological and mechanical properties of the skeletal system in an appropriate pace and rhythm, with smooth, soft transitions from a reduction of certain muscle groups to their relaxation and back. From graceful movements of children. In particular, the pace, the rhythm is already well developed at this age, but the power of movements is quite small.

Total motor development of younger schoolboys sent to the gradual mastery of those coordinating the opportunities that were created at the child as a result of final maturation anatomical motoriuma. The researchers note that "together with the improvement of locomotor system slightly reduced the wealth of movements, but small precise movements are adjusted subsequently the gradual development of the cortical components."

However, there may occur among children of primary school age are very different relative degree of development of the individual levels of coordination. There are children differ much grace and harmony of movements, whose hands, at the same time extremely helpless and do not know how to cope with the most primitive tasks by writing. Others have exceptional precision small movements (when writing letters rounded, smooth, do not get out of the line), however, these children may be baggy, clumsy, stumble on a level floor, dropping chairs.

The existence of such individual differences and quality for a long time and is well known as the fact that, in direct correlation with the proportion of the cash of the individual sides and motor skills is the ability of learning new motor skills of a different quality. One child is very easy and well learns fine and accurate work, but very tight mastering the exercises of rhythmic gymnastics, for example. Another easy dance moves are very difficult, for example, playing the piano. Of course, the selected motor and constitutional profiles correlate with each other. It is therefore appropriate to raise the question about the choice of adjustment methods and those and others that contribute to their further development and training.

Development of motor skills and abilities is not a passive "giving of" influences coming from outside and active psychomotor activity forming and exterior design and the very essence of motor exercises. Formation of motor skills is a whole chain of the successive phases of different meaning and qualitatively different mechanisms.

Among the many developing motor functions in primary school age occupy a special place function movement of the fingers.

The motor function of the fingers have a tremendous impact on the development of all the higher nervous activity of the child.

Actions with child objects have a great influence on the development of brain function.

"All the infinite variety of external manifestations of brain activity is reduced finally to only one phenomenon - muscular movement", - wrote IM Section. Strengthening the motor component of the effector link gaming, food and other basic reflex reactions strengthens. The construction of each movement is determined by the nature of the signal that caused it, and performed as a process of coordination of the elements of the movement. N.A.Bronshteyn and AV Zaporozhets believe that coordination of any motor act - from the most elementary to the complex such as writing and articulation - defined by the image or view the expected result action. The concept of action, N.A.Bronshteyn says, is "the leading invariant", which determines the course of the restructuring program of the motor act.

In the scientific literature, psychology, physiology, pedagogy to distinguish between two basic types of movements: voluntary and involuntary. Of course, both types are peculiar to children of primary school age.

Involuntary, simpler, fully reproduce the innate motor responses. Arbitrary, complex movements, once formed as a learned, they are a lot of life experience acquired on the skills, abilities. The complex motor acts elements of voluntary and involuntary movements are intertwined very closely and very difficult to differentiate them. In the case of multiple repetition of these components are transformed into "secondary arrangements" (ie, the study of dance movement, playing a musical instrument) and are beginning to be implemented without the active participation of the cerebral cortex.

In psychology, studies point to three main features of arbitrary action: 1) they are free from external stimuli; 2) are aimed at achieving some - any purpose; 3) anticipate the future (since the goal is to be achieved in the future). That is why psychologists have come to the conclusion that voluntary movements are not determined by external influences and driving force behind their development is the human decision making.

"Involuntary can be arbitrary, but this is achieved by means of the second signal system", - said Pavlov. LS Vygotsky wrote that the higher forms of regulation of human movements are born in the social communication of people. Individual development of voluntary movement begins with the fact that the child learns to subordinate his motion verbally formulated by adult standards.

Getting acquainted with the surrounding world, the child learns to distinguish between a plurality of objects and phenomena, their spatial, temporal and causal relationships. The information received by it from analizatorskih systems, including from the motor is subjected to sorting, analyzing, association, feeling different modalities merge into images of objects. This process is called IMSechenov objective thinking. The development of objective thinking in children aged 6-7 years is largely due to the development of its propulsion motor. The works of Sechenov draws attention to the fact that each reflex movement contains: eye movement control muscle movement in the arms and legs, etc. Hence, the process of allocating the corresponding reflexes in the brain and their subsequent integration into a complete image of the object implies participation of the motor analyzer.

This age is characterized by increased growth, reorganization of the endocrine system. There is a rapid puberty, and before it begins in girls, and then - in boys. This period is often marked functional disturbances caused by the rapid growth of the whole body, individual organs, as well as the instability of the autonomic nervous and endocrine systems.

In this age of fully formed character. This period is considered to be a difficult period of psychological development.

Each child is peculiar to its own path of development, depending on the individual characteristics of the organism, the external environment and other factors.

The main features are its child growth and development.

Physical development of children - is a complex of morphological and functional characteristics of the organism. To control the physical development necessary to evaluate changes in body size, physique, muscle strength and other factors.

In accordance with the periods marked unevenness childhood growth of certain parameters. After birth, there is a constant decline in the growth of individual indicators.

In an age dominated by the processes of growth, and the other - the processes of development of various organs. Adolescence or senior school during child development, age - from 12 to 17-18 years. It coincides with puberty. For quite a short period of time at the young men and women reproductive system matures, its morphological and functional state reaches that of the adults to 17-18 years.

In adolescence there is an intense sexual differentiation, due to the activities of the endocrine glands. Increased activity of the pituitary-gonadal and adrenal-pituitary relationships governing the development and formation of the sexual sphere. On the organization of the brain activity affects not only the maturation of its own structures, but also endocrine changes.

This period is characterized by a rapid increase in body size, a sharp change in the endocrine glands function. Prior to the onset of puberty gonadotropin in the blood of girls and boys low. Period of 1 year before the first signs of puberty are regarded as sexual infantilism stage. However, a slight and gradual increase in the secretion of pituitary hormones, and sex glands - the indirect evidence of maturation diencephalic structures.

The concentration of testosterone in the blood of boys aged 7-13 years is low, but increases significantly, since 15 years, with the stabilization of the hormone concentration to 20 years. In parallel with the pubertal development of the larynx occurs votes mutation - an important sign, indicating the degree of maturity of youth. In the ovaries of mature germ cells, the synthesis of many hormones (estrogen, androgen, progesterone).

Already in the 10-12 years against the background of a low content of estrogen on certain days celebrate its increase by 2-3 times. The closer menarche, the more often watch such a short-term increase in the excretion of estrogen. The average age of menarche - 12-13 years. In 16-17 years, most of the girls have a right ovarian menstrual-cycle.

Increasing the length of the body it is especially pronounced at puberty, so in 12-14 years old girls often outperform boys in physical development. During the "sprout jump", aged about 12 years, girls grow by about 8 cm per year. In boys, a "jump" happens later - about 14 years, when they grow by an average of 10 cm per year.

Significantly increase muscle strength and performance. Increasing motor and neuro-psychic activity, the intensive growth of the mass and length of the body require hard work of the endocrine glands, nervous system, and the high intensity of metabolic processes, which necessitates the introduction of additional nutrients. Accelerated physical and sexual maturity does not always go in parallel with the development of intellectual, physical maturation is faster and ends earlier.

Particular attention should be drawn to the heart with a variety of morphological variants of its development, the lability of heart rate, imperfection neurovegetative control. During this period, often meet the functional disorders of the cardiovascular and autonomic nervous systems ("youthful heart," "Youth hypertension" dyscirculatory disorder).

Widely distributed as eating disorders (obesity, degeneration) and gastrointestinal diseases (gastritis, duodenitis, peptic ulcer disease). With the onset of puberty reveal defects of the genital apparatus (dysmenorrhea, amenorrhea, etc.), May worsen infectious and allergic diseases, and tuberculosis.

Due to hormonal changes may be deviations in the functioning of the endocrine system (hypothyroidism or hyperthyroidism, etc.). Imbalance of hormonal influences, a temporary reduction of immune properties of the skin, enhancing the function of the sebaceous glands as in boys and girls is often accompanied by pustular diseases of the skin, especially on the face. This is a difficult period of psychological development, the desire for self-affirmation, often with a dramatic revision of the whole system of life values, attitude towards themselves, their parents and peers.

To determine the biological age using signs reflecting the process of biological maturation.

In adolescence, often choose a profession, it's time for self-determination and personal development, time of the adoption of gender and development of a sense of sexual satisfaction. Thinking becomes more independent, active and creative. Appears capacity for self-sacrifice, loyalty, trust.

It must be emphasized that each child is an individual characteristic of the biological pace of development, with its biological age can be to a certain extent different from his age peers.



1. The physical and mental development of children of primary school age (7 to 11 years);

2. In what is the specificity of mental development in the early school years?

3. What are the potential development opportunities in these times?



Lecture 15. Clinical examination methods: survey; examination of the child; anthropometry; palpation. Clinical and genealogical research method. Laboratory testing methods. Instrumental methods of research.


Objective: to give information about the clinical examination methods


1. Clinical examination methods: survey; examination of the child; anthropometry; palpation.

2. Clinical and genealogical research method.

3. Laboratory testing methods.

4. Instrumental methods of research.


Diagnostics - a key step in the treatment of any disease. From fidelity and accuracy of the diagnosis depends on further treatment strategy. All the diagnostic methods of examination can be divided into two categories:

• Clinical methods - are held directly by your doctor.

• Additional (or paraclinical) - carried out by a physician using specific diagnostic methods.

patient diagnosis is established on the basis of clinical and paraclinical studies.

Clinical methods of examination include history taking, examination of the patient, palpation, percussion and auscultation.


History - is information about the history of the patient's disease, which is obtained by questioning the patient and / or his loved ones. In certain situations the doctor may need medical history and / or history of the patient's life.

History of the disease - a collection of information about the beginning and course of the disease. When collecting medical history doctor discovers the nature of the patient's complaints and their change over time. A short history usually indicates the presence of an acute illness and anamnesis lasting usually indicates chronic pathologic process.

Life history - is to collect data on the physical, mental and social status of the patient throughout his life. History taking in patients with mental disorders provides for subjective (from the patient) and objective information, which can be obtained from the patient's friends.


There are general and special inspection. General inspection carried out in all cases, regardless of the patient's complaints. Special inspection is carried out by specialists (eg, gynecologist, urologist, ophthalmologist) using the special tools.

On examination, the patient's condition is assessed overall, his body position, posture, facial expression, skin color, height, weight, gait. We examine the head, face, neck, trunk, limbs, genitals, assessed the state of the adipose tissue, bones, muscular system and lymph nodes.


Palpation - tactile method of study patients. With palpation is possible to determine the place of the location of their consistency, the nature of mobility, flexibility, local temperature. Also, in some cases, palpation reveals abnormal formation in the various cavities of the body.

Palpation is superficial and deep. The latter is carried out only after the superficial palpation.

In carrying out systematic surveys conducted palpation of the skin, muscles, bones, chest, abdomen and lymph nodes. In the study of the internal organs can be used special palpation techniques: transrectal palpation of the pelvic organs, kidneys bimanual palpation, vaginal palpation of the uterus and others.


Percussion - survey method based on the rapping parts of the body and further interpretation of the sound produced during the examination. Percussion is often used in cases of suspected presence of compacted fabrics, definitions Hollow, flexibility and lightness of tissues and organs.


Auscultation - the method of clinical diagnosis, which is based on listening and further interpretation of the sounds that are produced by the various bodies. There are direct and indirect auscultation. Direct auscultation involves attachment doctor ear to the patient's body surface. Indirect auscultation - is the use of special tools that enhance the sound.

Normal operation of the internal organs is characterized by certain sounds, and the development of pathological process is changing the nature of sounds that allows the physician to suspect the presence of diseases.

The data from all clinical diagnostic methods allow the doctor to identify the proper benchmark in the way of diagnosis. If necessary, the doctor refers the patient to carry out further special examination methods.

Clinico-genealogical method

One of the prerequisites the correct and timely diagnosis, prevention and treatment of hereditary diseases, as well as the determination of genetic risk and clinical prognosis for the patient's relatives is the use of clinical-genealogical method.

For the first time this method has been introduced in medicine F. Galton in the last century. In our country, the most complete and widely pedigrees analysis method applied in clinical practice excellent clinician, geneticist and neurologist, Professor SN Davidenkov.

Clinico-genealogical method is based on an analysis of the nature of transmission of various symptoms and diseases in a single family with an indication of kinship between members of the pedigree. Clinico-genealogical method helps to make a correct diagnosis and therefore to choose adequate treatment and time to carry out targeted preventive measures. Therefore, going to the doctor-genetics, the couple should be well prepared. It is necessary to ascertain the state of health or the cause of death of the nearest and distant relatives from both the wife and by the husband. It is desirable to know not only the maiden names of women pedigree, but also age, and even better - the date, place of birth and residence of their ancestors.

For families the parents of the patient, or just the consulted person in a geographically isolated area in closely spaced areas suggesting a common ancestor, which may contribute to the accumulation of more of the same genes, helps to identify the presence of the family of consanguineous marriages. Marriages between close relatives increases the risk and are of great importance when considering diseases with hereditary predisposition. In addition, the doctor-genetics should be told about the ethnic origin of the family, for persons of different ethnic groups (eg, Jews, Uzbeks, Finns and others.) Have increased susceptibility to certain hereditary diseases. Correctly and accurately collected data gives the doctor information and often serve as the basis for the diagnosis of hereditary diseases.

It is known saying: "How many families, so many secrets." Practical experience proves that often families are hiding the facts of diseases, providing false information about fatherhood and so on. N. Pedigree is based on a sense of trust relationship to the doctor, cross-comparison of data surveys and inspections relatives. Therefore, you should not be surprised if the doctor-geneticist (after mandatory consultation with Consult) invite for an interview and clinical examination of his relatives, assigning them additional clinical and instrumental examination, ask to provide for the study of photographs of family members, if necessary - medical documents confirming or absence of a disease. It should be understood that this is done only in the interests of the consulting! After all, only in the case of reliably collected pedigree specialist can determine the type of inheritance of the disease and thereby confirm the diagnosis, identify those in need of medical and genetic counseling, to determine the clinical prognosis for the patient and his relatives, and to develop a plan of treatment, rehabilitation and prevention, taking into account individual and family characteristics of the disease.

Each family is pedigree, which are used for certain symbols. Graphical representation of the pedigree is accompanied by "legend" (information), which highlighted the details of each family member and symbols used in the scheme. After anamnesis and graphic pedigree conducted clinical and genealogical analysis, which allows to determine the hereditary nature of the disease, the type of his inheritance, the outlook for posterity, to find out who the members of the pedigree of the most threatened in terms of the appearance of the same pathology. Appoint additional diagnostic measures necessary to complete consultations determined prognosis of the disease and its possible complications, selected the optimal therapeutic measures.

The use of clinical-genealogical method involves along with the collection of family history thorough clinical, laboratory and instrumental examination as possible of all family members.

Clinico-genealogical (genealogical) method is based on data obtained from the proband and his family members during the initial appointment with a doctor. This method is an integral part of the initial reception.

Genealogical method refers to the oldest methods of medicine, but still is and will remain one of the most sought after.

This method is relatively simple and available. Its essence is to collect physician genealogical data necessary for the subsequent compilation and analysis of the proband's family pedigree.

The collection of such data is aimed at identifying and studying the symptoms of hereditary and congenital disease that appeared in the proband and his patients and healthy relatives.

The procedure for collection of genealogical data and the nature of the questions asked of the proband and his close relatives are given below. During data collection, it is desirable to use family photo albums, medical records and other documentation.

In drawing up the pedigree doctor uses standard techniques and symbols.

The individual, which begins with genealogical research, - a proband. Brothers and sisters of the proband - a proband siblings (family, cousins, second cousins).

Each person included in the family lineage, gets its symbol (square stands a man, a circle - a woman), and cipher, consisting of two digits (Roman denotes the generation number in the pedigree Arabic - an individual number in the pedigree, the numbering of the members of one generation is performed sequentially from left to right ).

There are other symbols (symbols): abortion, heterozygous carriers of the mutant gene, mono- and dizygotic twins, miscarriage (spontaneous abortion), one dead, the deceased individual, etc. Under the family lineage placed her legend decryption conventionally accepted designation. Schematic representation of a family tree begins with the proband (marked by arrow), which is usually located in the latter (under study) family generation. Family pedigree should cover at least two to three generations of relatives. Limitations in the number of analyzed generations there, and the more they investigated, the more reliable are the conclusions.


Next collected and designated data on children of the proband (if an adult) and his sibs (including a sequence of pregnancies and their outcomes).

Then, gather information about relatives on the mother's side, first of all proband mother, her siblings and their children, and then all of my grandmother on the mother, her siblings and their children and grandchildren. If possible, gather information about the great-grandmother of the proband. In the same sequence gather information about relatives on the father.

The next step - an analysis of the causes of an existing disease (trait). There are crucial: the value of the sample on which is made up pedigree (2-3 generations of relatives), the completeness of the registration carriers feature and other indicators. It must be remembered phenocopies disease.

The current value of clinical-genealogical method can not be overestimated. The collected genealogical data doctor can determine the proband hereditary or non-hereditary nature of the disease (individual symptom), version of his inheritance (traditional monogenic or polygenic or non-traditional options), set in the case of monogenic variant localization of the abnormal gene on autosome or allosome (ie mapped gene ), and to determine its frequency distribution in a population.

Clinico-genealogical method was successfully applied to the analysis of coupling of the disease gene from his marker (marker locus). This analysis is widely used in the diagnosis of heterozygous states, prenatal diagnosis, early diagnosis of the disease in the preclinical phase, diagnosis and erased forms with late manifestation of the disease. For example, with the help of gene linkage analysis AIV diagnosed hemophilia, Duchenne muscular dystrophy, Becker, myotonic dystrophy, hypoplasia syndrome Nail patella and the lack of many other diseases.

After collecting genealogical data doctor starts an objective examination of the proband and his family members.

Laboratory methods are widely used in clinical practice. We study the excretions and secretions, feces, blood, exudates and transudates. They are held in the following areas:

1) study of the general properties of the material, including physical (quantity, color, appearance, odor, nalichie impurities, relative density, and so on. D.) And the chemical study to determine prisutstviya of certain substances (substances normally contained in body fluids and substances which poyavlyayutsya only in diseases);

2) microscopic examination;

3) bacteriological and virological studies;

4) Serological diagnosis;

5) histology and cytology punctate bodies;

6) immunological studies.

Actions of nursing staff in the preparation of patients for clinical and diagnostic laboratory tests.

Instrumental study of the nervous system provide the most objective information about the presence of pathological changes, and are widely used in pediatric neurology.

Craniography (x-ray of the skull). It is used to detect defects in the bones of the skull, a change in its internal relief of pathological calcifications in the brain (toxoplasmosis, hydatid disease, and others.) "Congenital malformations. X-ray is usually performed in two projections (face and profile).

In the specialized neurological and neurosurgical departments are often used contrasting methods of brain and spinal cord radiography pneumoencephalography (PEG), ventrikulo-, myeloma and angiography.

Transillumination (transillumination). It is used in the diagnosis of hydrocephalus, sub- and epidural hematomas.

To conduct the study needed a light bulb of 100 watts, mounted in a special tube, easy-to-raying the bones of the skull. The study was conducted in a darkened room. With the penetration of the concentrated beam of light through the thin bone of the skull of the newborn baby or the first year of life in places where there is a pathological CSF glow (Fig. 28). Normally, around the glow tube in the form of the corolla in the frontal and parietal bones of the skull does not exceed 1.5-2 cm in the occipital bone, 1 cm. With the development of hydrocephalus glow can be spread around the skull. When sub- and epidural hemorrhages glow in no bruising.

Echoencephalography. Based on the ability of intracranial structures having different acoustic impedance, partly reflects the direction of the ultrasound. Response ultrasonic vibrations are converted into electrical impulses that are registered on echoencephalography screen in the form of the curve. Using this method allows you to neurological, neurosurgical clinic to detect three-dimensional processes in the brain (tumor, bleeding, abscesses, hydrocephalic-hypertensive manifestations and others.). Signals comprising echo encephalogram normally include an initial complex, the median echo (M - echo) and the final complex. The most constant is the echo of the middle brain structures (III ventricle, the pineal gland, and others.), Usually located in the same place on the screen in the study encephalograph right and left.

Electroencephalography. This registration of bioelectrical activity of the brain using a multichannel encephalograph, amplifying and recording biotoki brain. A study carried out in a specialized neurological department in the presence of shielded from the interference of light and a sound-proof chamber.

To record encephalograms on the child's head, respectively, of the projection of the skull lobes applied electrodes which are lubricated with a special paste, which has a high electrical conductivity. The electrodes are usually fastened flexible helmet. During the study, the child should be in a calm relaxed state, because even the occasional muscle movements cause additional biotoki.

Electroencephalogram (EEG) is a graphical representation of wave rhythms. In a healthy person at rest and wakefulness a-waves are detected at a frequency of 8-12 cycles per second and an amplitude of 40-70 mV and (3-waves with a frequency of 16-30 cycles per second and an amplitude of 10-30 mV.

Rheoencephalography. This registration of changes electrical resistance of the brain by passing through AC high frequency and low power. The electrical resistance and the electrical conductivity of tissue depends on their blood supply, so the method rheoencephalography aims to study cerebral hemodynamics. When the expansion of the brain blood vessels and blood filling a significant electrical resistance decreases, and the narrowing of vessels - increases. Register of electrical resistance oscillations allows you to get an idea of ​​the state of vascular tone, the size of their blood supply, the state of the walls of cerebral blood vessels.

Normal rheogram is a regular wave like pulsovym. They distinguish the ascending portion and the descending part of the top. Normally, the apex slightly rounded. Rising part is seen as a-time (with 0,08-0,11) and characterizes the degree of elongation of the vascular wall. Downward part is defined as (3-time (0.5-0.8 s) and characterizes the elasticity of the vascular wall. The magnitude of the amplitude of the wave rheographic judge the severity of blood supply to the brain vessels. Rheoencephalography in combination with other methods helps identify conditions caused by cerebrovascular .

Electromyography. This registration of bioelectrical activity of muscles using a cathode-ray oscilloscope or stub. Used to detect movement disorders and topical diagnosis of focal lesions of the nervous system.

To avert the potential from the measured bioelectrical muscle, cutaneous electrodes apply a diameter of 0.5-1 cm. Metal plate electrodes with gauze pads soaked with saline, fixed on the skin bandages or rubber bands. The distance between them should be 1.5-2 cm. The registration is carried out at arbitrary contraction of muscles and tonic tension. EMG is a curve which takes into account the wave height, frequency, duration and waveform.

Investigation of cerebrospinal fluid is often necessary for the diagnosis of meningitis, encephalitis, tumors, head injuries and other diseases. Spinal fluid obtained by lumbar puncture. In the specialized neurological and neurosurgical institutions sometimes resort to suboccipital and ventricular puncture.

Lumbar puncture is usually performed in the treatment room or operating room, better on an empty stomach.


Lecture 16. The study of mental activity status


Objective: to give information about the clinical examination methods


The study of mental retardation

Current status of the study oligophrenics

The study of mentally retarded children do not end examination in medical and educational commission. It continues in the institution where the child directs the Commission.

The objectives of this study are different. Sometimes it is necessary to clarify the status of the child. This happens when a very complicated case in the differential-diagnostic attitude and one-time inspection in the Commission was insufficient. In conclusion, medical and pedagogical commission writes: "To send to a special school to provisionally re-examination in a year." These cases are rare, but they have a special responsibility on the teachers of the special school and require careful examination of the child. It must be from the first day at school to clarify the class, the group, in accordance with the general development of the child level, the extent of its knowledge and skills. A deep and comprehensive study is needed to improve the efficiency of the educational process. Knowing the individual characteristics of each child, the teacher has the opportunity to choose the appropriate methods, ways and means of corrective action.

Systematic and focused study allows us to trace the dynamics of the development of children in a timely manner to find new areas of work with them, prognozirovatih state, make recommendations in the choice of profession, to maximize their social rehabilitation.

In conducting the study should be guided by the same principles as in the examination of children in medical and pedagogical commissions: an integrated, comprehensive and holistic dynamic study of children taking into account their specific features.

The stages of studying mentally retarded children

The beginning of work with children preceded familiarize teachers with their personal affairs (medical and pedagogical documentation). Survey protocols in the commission provide the first information about the child, which allows teachers to correctly determine the child's place in the team, interested in his studies, to establish contact with him. It is important to take into account the state of hearing, sight, to immediately put his respective party. Materials characteristics reveal personality traits that should be considered already at the first contact with the child. If possible, it is necessary to speak in advance with the parents of the child.

The next stage of the study puts special diagnostic purpose. In the context of supporting the schools, this work is carried out in the first two weeks of the school year. The program of studies includes "revealing lessons", which with the help of special assignments specified state of the mental processes of the child, compliance with this class. These experimental tasks are organically part of the learning process. Targeted studies of children, conductive under the special program, helps to identify certain aspects of the child's personality, which have not been seen by members of the commission at a short survey.

After the first two "diagnostic" weeks beginning stage of the "current" study, which lasts the entire period of the child's stay in the institution.

A very important issue is the design of the study materials the children. In the gardens, schools, children's homes for mentally retarded decided to keep a diary of observation.

On the first pages of the diary written general information about the child's home address and parents' workplaces, data from the history of the development, diagnosis, garden figures, school, family (after the test conditions the teacher home education). All this information should always be on hand at teachers. Thereafter, the recording material begins the current study children.

A mandatory requirement for keeping a diary is a regular records and analysis of observations. It is recorded, not all, but only the fact that increasingly characterizes the studied phenomenon, reflecting the progress in development of the child, or, conversely, indicates a deterioration of his condition. Entries must be precise and objective, fixed by the fact, rather than a generalized teacher's opinion of him. We can not postpone the recording.

The blog made not only personal observations of the teacher, but also observing other teachers, technical staff, parents, children, and so on. N. In this case, be sure to note, from whose words made entry

Very useful fix Entries (in those cases when it is necessary), and methods of teaching impact pupil reaction to that effect.

Over the past decade, there have been new developments in the understanding of the essence of mental retardation, and to use the methods of its detection. This is primarily due to the success of science dealing with the problem. Clinical studies of the etiology and anatomical and physiological mechanisms of mental retardation, the latest hardware diagnostics, uphold the principles of determinism in medicine and psychology have contributed to the development of the most efficient ways and methods of selection of mentally retarded children in special institutions. Approve the personal approach when examining children with developmental disabilities. Now experts seek comprehensive, holistic, and more in-depth study of children, as well as early diagnosis of mental retardation. All big role to teaching, social environment.

Materials XXIII International Conference, held in Geneva in 1960, show a variety of organizational forms of acquisition of special schools for children who are lagging behind in mental development.

In most states, issues of selection involved not individuals (only teachers, or only doctors, or only psychologists), and the group of experts that make up the so-called commissions, teams, medical and psycho-social centers and other bodies, bearing different names in different countries. The data for some countries.

In the United States (2d) selection of mentally retarded children is conducted by admission committees, which include doctors, school psychologists, speech pathologists, teachers, school nurses, specialists in hearing and speech, representatives of the school administration.

Admissions Office along with a test of intelligence research conducts a psychological examination, which includes the study of speech development of the child, as well as the study of its emotional sphere and personal qualities. To this end, various questionnaires and projective techniques. Neurological examination to investigate the cause of existing difficulties and the child is determined by the method of treatment. The Commission summarizes the materials research and produces uniform way teaching remedial classes to the child. The main indicators of mental retardation consider the value of the intellectual coefficient (IQ) and social factor (SQ). Under SQ is the degree of sociability of the child, the ability to navigate. In the study of the IQ, t. E. The capacity for teaching, investigated the level of mastery in reading, numeracy, artistic development. For this purpose, various commonly used "batteries" tests. At the heart of most of the tests are tests Binet - Simon various upgrades. The most common scale Stanford - Binet and Wechsler scale for children.

It should be noted that more and more demands are put multifaceted study of children with developmental disabilities and repeated surveys.

In England (2d), there is the following order of selection. All children from the age of 5, are sent to regular schools. If within 1.5-2 years, they did not learn the program, the detailed characteristics of the teacher sent a neuropsychiatrist and a psychologist investigated. An indicator of underachievement believe that the child has not learned to count to 7 years. Psychologists examine the child with the help of tests.

If children 6 years revealed clear signs of mental retardation, they are immediately sent to special schools. Thus, the mentally retarded, learning begins from 6-7 years.

In England, as in the United States, extended the concept of mental retardation itself. It includes children educationally neglected, underdeveloped, with delayed mental and physical development, and so on. D.

The main indicator of mental retardation is a value of 10. In this case, if the child lags behind their peers by 20%, then it is considered possible training in a special school or in special classes at public schools. If it falls short by more than 50%, then it is recognized and learning disabilities are placed in special boarding schools under the jurisdiction of the social security authorities.

Many progressive oligophrenopedagogs psychologists and England oppose the test survey in determining the type of school believing that they check not only mental ability, as the general development associated with child rearing conditions, with the social environment and culture that surround it.

It should be noted that the study of UK children are not only through the school, but in some cases, through special diagnostic centers. These centers are working on the delimitation of morons, imbeciles children from 6-8 years of age. The center may be 1-2 group (15-30 children), which are engaged from 6 months to 2 years. With a group engaged in the teacher and the assistant that allows deeply individualized work on the children.

The children spend in group 6 hours (except classes have lunch and walk). During their stay in diagnostic centers, children learn the elements of reading and writing, as well as accurately identifies which of them can be trained at a special school, and who can not.

In recent years, there is a tendency to early detection of mental retardation in children and timely transfer them to special schools.

In France (2d) selection of mentally retarded children in special schools is carried out medical and pedagogical commission, which organizes all the work foremen school inspector. The committee also includes the director of the special school, teacher, doctor, psychologist. For the survey used Binet Tests - Simon Zaz- LP, Porteous. At the same time we have the tendency to study the qualitative uniqueness of children.

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