Neuropsychological examination of schoolchildren, young children, adolescents and adults is the task of neuropsychology. Under this term is hidden medical science, a subsection of neurology, psychological science, neurosurgery. Science explores the topical arrangement of brain systems, correlates them with the received scientific information on the higher functions of the psyche. Scientific advances are applicable in practice and are used to study people of different sex and age. Such skills are especially important in the work of speech pathologists.
Why and why
Neuropsychological diagnostics, examination of writing and reading are carried out to determine the specific mechanisms inherent in a particular child. Having examined the condition, it is possible to determine what provoked the failure of development, for what reason the child experiences difficulties with adaptation in society. Timely and responsibly diagnostics makes it possible to determine which parts of the cerebral hemispheresamazed at how widespread the violations are. In addition to the topical diagnosis, the examination makes it possible to analyze the extent to which mental functions are preserved. The doctor compiles a complete picture of malfunctions in the functioning of the psyche, which becomes the foundation for working out a corrective program. Restoration work will be entrusted to a group of specialists, parents will be necessarily involved.
Pre-conducted neuropsychological examination of younger students involves the use of tests, samples designed to assess mental functionality. Based on the results, one can conclude about the features of a person’s memory, his ability to think and speak. Gnosis and praxis are also analyzed. The tables developed for these trials provide a detailed description of the various incorrect responses. From them you can learn how brain dysfunction and disorders are connected, how this can be influenced through games, exercises.
Features
Often, a neuropsychological examination of preschool children is organized in the form of a stereognosis. To do this, the object is given an object for palpation, while the person's eyes are closed. The task of the child is to identify what has been received. Visual gnosis involves the recognition of images, including incomplete ones, covered with hatching, as well as the selection of a specific figure from the general background.
Kinesthetic assessment of mobility, during which the specialist pays attention to the position of the fingers, is a method of neuropsychological examination. Praxis in space- an approach in which a person must reproduce the posture of the hand relative to another body. Praxis in dynamics is an alternative study, during which the object must change the position of the brush, draw predetermined drawings.
Another method of neuropsychological examination is auditory-motor coordination. The task of the object is to reproduce the given rhythm. The doctor may prescribe a study of the ability to speak, during which a person must name objects in the displayed images, repeat words, phrases. Hearing-speech memory is studied by tests on the repetition of given words in a certain order and retelling of insignificant volumes of prose. To assess the development of intelligence, it is necessary to do a test for counting, writing text, reading. A lot of information can be extracted from the drawings of the object under study.
Special case: epilepsy
Eminent scientists, psychologists and neurosurgeons have been actively working and are working on the topic of neuropsychological examination. Glozman, in particular, proposed a popular theory of interpretation of the results. Currently, it is used in application to a variety of cases, including the study of the results of samples of patients with epilepsy. It is known that the pathological condition is associated not only with characteristic seizures, but also with certain cognitive dysfunctions. Their presence is not required, but possible. To determine the presence of such disorders, to assess their severity, the patient is sent for research, based on which a decision is made.about the optimal therapeutic, rehabilitation program.
According to Akhutina, a neuropsychological examination aims to assess how mental functions have changed due to illness. As a rule, analyze the patient's attention, his ability to remember, speech skills, visual and spatial. Be sure to pay attention to the higher mental functionality. During the study, the doctor assesses how the patient is able to think logically, how he approaches problem solving. Such studies are based on computer, paper, pencil methods. Some last only a short time, others stretch for hours - it depends on the nuances of the issue. Sometimes questionnaires allow assessing the mental state, determining the quality level of a person's everyday life. The doctor reveals how abilities affect the life of the patient.
Functional Impairment: Sources and Root Causes
By analyzing the album of neuropsychological examination, several types of cognitive failures can be identified. Their causes are presumably usually related. Epilepsy develops against the background of structural brain damage, in which the functions of certain parts of the organ are weakened. Temporary disturbances are possible due to epileptic activity. This largely depends on the specifics of seizures, their duration, frequency, time intervals between seizures. Possible cognitive impairment due to the use of medications, including specialized antiepileptic and other drugs to combat seizures. Shortly after completionthe drug program, the functionality of the brain usually returns to normal.
If surgery is planned against the background of epilepsy, neuropsychological examination methods become an important preparatory step. Its exclusion is strictly prohibited. The object of research is the ability of a person to speak and remember, his attentiveness, processing of data coming through the organs of vision, mental higher functionality. The study reveals how the lack of cognitive functionality and brain structural disorders are related. At the same time, already known information about the epileptic focus is taken into account.
Verification specifics: what and how?
If a neuropsychological diagnosis is planned, the preoperative examination is directed primarily to assess speech skills. The doctor must determine which cerebral hemisphere is more responsible for this function. Formulate dangerous factors, on the basis of which they plan a surgical event. Most often, functional MRI is used for this. During the procedure, brain activity is recorded during the period when the subject is working on speech tasks. It is allowed to conduct a Wada test, in which the hemispheres are turned off in turn. By analyzing the results, one can understand which hemisphere in a particular case is most important for speech functionality.
Preoperative neuropsychological examination of children with epilepsy also includes an assessment of the risks associated with the plannedevent. The doctor must determine how the violations can correct a person's life in the future, how they will affect his ability to work.
The system proposed in Freiburg for conducting a neuropsychological examination of children, and the methods used to assess the condition of patients with epilepsy, using MRI tools, help to assess the integrity of the cerebral hemispheres and the ability of individual parts to cope with the functions provided by nature. Following the results obtained, it is possible to foresee what measures will be needed in the future to recover from the operation. In order to fix the results of surgery for a long time, in the future it will be necessary to carry out control measures at least twice. As a rule, the first is organized a quarter of a year after the operation, the second - a year later.
Everything is under control
The neuropsychological examination of children against the background of epilepsy allows us to clarify how effective the prescribed medications are, how this or that medication affects brain functionality. Focusing on the results obtained, you can choose a good dosage, fix all the qualities of the composition that are manifested in a particular case. In the future, if it is decided to increase the dose, the results of the samples are compared with those obtained earlier. With a decrease in cognitive abilities against the background of a therapeutic course, the volumes of drugs taken are reduced or completely abandoned.
At present, the initial neuropsychological examination is usually organized using high-precision computerized technology, which allowsduring the day to monitor changes. Mobile monitoring is the most effective method of fixing the correction of the patient's brain performance, as well as his psycho-emotional status. This takes into account how much habitual conditions, everyday routine tasks affect the patient.
All-Russian approach and general recommendations
In our country, the rules and nuances of conducting a neuropsychological examination were proposed by a specialized center dealing with neurological problems of minors. In relation to the original theory of Luria, the rules developed later have a more abbreviated form. The main idea of the applied scheme is to study the condition of the child. The All-Russian Center for Child Neurology, which presented the guideline so widely used today, specializes in working with patients of preschool and primary school age.
The scheme used in our country includes tests, tests designed to simplify the assessment of mental abilities, the ability to remember and speak, gnosis, and practice. A special table has been developed that includes all possible deviations and interpretations, the rules for their interpretation. Using such a table, a neurologist can easily identify the functional problems of which particular brain structure are present in a particular patient.
Practice has shown a high level of effectiveness of such a neuropsychological examination as the main diagnostic method. In-depth dispensary events were held with the participation ofkindergarteners, orphanage students from general institutions. Deviations revealed in this way help to choose the best ways to educate and correct the child's behavior.
Nuances of the event: preparatory stage
Neuropsychological examination begins with a conversation with the child. To do this, you need to organize a separate room. Furniture must include a table and chairs. The child sits opposite the interlocutor. The presence of toys, strangers, bright objects that can attract the attention of the baby should be excluded. Beforehand, it is necessary to prepare images that allow assessing the ability of the subject to visually perceive information. For a tactile test, you need to prepare suitable items. In addition, you will need sheets of paper, pencils and pens. The preliminary conversation is aimed at calling the disposition towards the researcher: the child must trust the adult. When talking, the task of the responsible person is to assess the personality of the child, the nuances of his behavior, the ability to think critically. An adult must determine how the younger one treats friends, relatives, teachers and caregivers.
After a preliminary acquaintance, they begin to complete tasks that help determine the child's tendency to be left-handed. It is necessary to analyze the behavior not only for explicit, but also for latent signs. The researcher must identify motor, sensory dominance, determine which arm, leg, ear, eye of the child are leading. The result of the study should be the coefficient of left-handedness, calculated as the ratio of the number of samples that confirmed left-handednessto the total number of organized studies. Typically 11 or more are made.
Main Stage
For the survey, you must first prepare a scheme. The researcher is obliged to follow it in all details, without deviations. The results of the samples are entered into a specialized official protocol. If the characteristics of the child's condition do not allow work to be done, it should be noted which tests were not performed. Tasks are presented following a pre-prepared list. In the attached table, the researcher can see which functions a particular test is aimed at. The task of the person conducting the examination is to make sure that the subject understands and understands the task. If the child has taken the instruction incorrectly, it is necessary to repeat it until understanding is achieved.
By analyzing the information received, it is possible to identify what difficulties the child is facing. To make data evaluation easier, formalized schemes are used that take into account typical and pronounced violations. The application shows what anatomical, physiological features can explain the result. Each series of tests is designed to study a specific brain function, and the violations determined by the results of the study will be cumulative. In fact, the results are not about violations during the test, but about function failures.
A careful assessment is the key to an accurate result
Interpretation of resultsexamination includes both a statement of symptoms and its qualification. Based on the information obtained, it can be concluded which defect provoked a symptomatic heterogeneous complex of interconnected manifestations. As a rule, the basic limitation of the "territory" of violations is seen from the kinesthetic praxis, while other tests are aimed at clarifying the state.
Formulation of a topical diagnosis is made using a special application approved at the federal level, which includes encoding a variety of functional disorders, taking into account the localization of the lesion. The task of the personnel conducting the study is to highlight the detected violations, to describe the topical diagnosis. The local syndromes listed in the official supplement are considered to be the basis for assessing disorders, but this information is general. In a separate case, individual deviations due to specific factors are possible.
Summing up
Using the generally accepted research scheme, you can make a diagnosis quickly, accurately and as correctly as possible. At the same time, the results of a formalized survey cannot be considered an absolute truth. When interpreting them, it is important to take into account the nuances of the he alth status of a particular object.
The deviations determined by the described methodology help to form an accurate representation of the minimum brain dysfunction. At the same time, the child's psyche, his physiology and localization of disorders are taken into account, which means that they can choose the optimal course of correction applicable to this case.
With a local deep symptomatic complex, deficiency can be associated with organic brain disorders. This indicates the need for additional research and diagnostic measures. During these, you can detect a tumor, inflammation or tissue degeneration, abnormal development of the organ.
