Experience of supporting a child with epilepsy

Peculiarities of mental processes and personality, typical for patients with epilepsy were properly described in the medical and psychological literature [Isaev D.N., 2001 Kononova M.P., 2000; Ljapidevsky S.S., 2000; etc.]; displays of asthenia and the reduced efficiency , slowness and inhibition of all reactions, a pedantry, rigidity, reduction of attention’s switching, pathological strengthening of an interference in memory, strengthening of mechanisms of a retro and proactive inhibition, the phenomena of amnesic aphasia. Typical processes of thinking are: jamming on details, reduction of a level of generalization, weakness of abstraction. In emotional and will spheres the increased sensitivity, easy vulnerability, and the steady, intense, viscous affect the increased irritability, obstinacy and roughness is marked.

According to L.S.Vygotsky position, at the pathological processes in a child’s brain the mental functions suffer first of all and natural mental functions suffer to a lesser degree. A direction of infringement is “from bottom to top upwards”. However, in a case of epilepsy the other direction of infringement takes place too — “from the top downward” This means that the greater (or equal) infringement of basic (natural) mental functions in relation to the supreme mental functions. Thus, there is an infringement of both elementary (natural) mental functions, and the supreme mental processes.

Therefore there is a necessity of development of programs on psychological correction (treatment) both for development (restoration) of natural mental processes, and for development of the supreme mental functions.

The description of a case

Vera P. The age at the moment of initial medical examination (March, 2005) — 7 years 5 months. The left-handed. The diagnosis at the moment of discharge from a maternity hospital was perinatal encephalopathy, a convulsive syndrome. Convulsive attacks were marked from 4 day of life. In the age of 7 months on EEG the center of pathological activity in parietal area was registered. She took various anticonvulsant medicines to the moment of initial medical examination the child during some months were without medicine therapy. The frequency of epileptic attacks reached 2—4 per day. Convulsive attacks were accompanied with salivation and vomiting. There were also difficulties with falling asleep.

As a method of diagnostics of psychological development of the child the method of neuropsychological diagnostics, based on the theory of system dynamic localization of the supreme mental functions that was developed by A.R. Lurija was chosen. The variant of techniques adapted to children’s age (by Semenovich A.V., 2002) was used. For development of the correctional program the initial neuropsychological diagnostics directed on definition of the current level of mental processes’ development (a zone of actual development according to L.S.Vygotsky) was carried out. On the basis of neuropsychological diagnostics’ results it became possible to speak about the rough functional deficiency mainly of the left hemisphere that was shown in:

• reduction of function of programming and control of the behaviour;
• the phenomenon of speech adynamia ;
• infringement of the phonetic and phonemic analysis and synthesis, of (acoustic) hearing-speech memory (both mechanical, and intelligent);
• infringement of the visual - spatial analysis and synthesis, a visual memory.

Among safe parts of mental sphere, which could become a basis for correctional and developmental lessons, as the basic were allocated the following:

• visual memory-recognition;
• visual -spatial gestalt-perception (gestalt-recognition) and the analysis;
• kinesthetic analysis; — preservation of cognitive interest in the form of game.

The basic attention was given to correct victims who had suffered most from disease of processes — (1) functions of regulation, programming and the control of activity and (2) visual and spatial spheres. But at performance of tasks all systems of analyzers were involved to provide formation of new functional systems on the basis of which the damaged mental processes would be built (Tsvetkova L.S. 2001).

Individual correctional work was carried out with use of developing materials of M.Montessori. The materials developed by Montessori and his pedagogical system allows to develop separate properties of a child on a separate material (the size, color, form etc.) to generate new interfunctional connections (visual — impellent, visual — tactile etc.). The didactic material provides five types of mistakes control: mechanical, psychological (with the help of sense organs), by means of control points, control set, and the teacher (psychologist). In this case it appeared especially significant as the greatest difficulties at the child were marked in a part of the control.

For development of the visual — spatial analysis and the control the silhouette and painted over images were used, the cubes of Nikitina, “a geometrical locker“ and M.Montessori’s cylinders, various meccano, graphic dictations, finishing of images, colouring of graphic ornaments, dealing with origami, writing on whistle, recognizing of subjects by means of the touching, etc. Lessons also were devoted to development of space of child’s own body and space of a class where were the lessons took place. (Semenovich A.V., 2002; Tsyganok A.A., Gordon E.B., 1999].

To memorize non-verbalizing pictures, groups of subject pictures, associated rows of figures and words were used for develop visual and (acoustic) hearing-speech memory. Rough letters and figures, and writing with fingers on whistle were directed on consolidation of graphic images of letters and figures.

At the development of memory the basic attention was given to development of intelligent memory. With this purpose, and also for development of speech and function of the control and programming, we used the retelling the read story. If the child had troubles to do it we developed activity (took out it outside), using for these purposes intermediaries — counters, cards, — the amount of them corresponded to number of semantic parts in the story, to number of sentences or to the amount of words in the sentence.

To develop of a keen motility of a hand we used designing of beads from details of the different size, drawing on whistle , work with plasticine, scissors etc.

With the purpose of removal of an emotional pressure we used techniques of a muscular relaxation and optimization of a muscular tone. At the same time the exercises directed on development of brain’s inter-hemispheres interaction were used (Semenovich A.V., 2002). Individual correction-developing lessons were carried out since April till May 2005 and since September 2005 till April, 2006 two times per one week. Duration of lessons made from 40 minutes till 1 hour. During each lesson the tasks directed on activization of all mental processes were used.

Repeated neuropsychological investigation was carried out in May, 2006. The comparative analysis of the data of initial and repeated neuropsychological data allowed to reveal the following dynamics in the psychological status of the child:

• Improvement of attention (average time of search of 20 numbers at Schulte tables has decreased from 245 up to 166 seconds.);
• Smoothing of symptoms of kinesthetic dyspraxia
• Increasing of stability (acoustic) hearing-speech memory to interfering influences (the deferred reproduction was improved from 3 up to 5 words);
• Improvement of spatial thinking;
• Development of left hemisphere (gestalt) strategy of the visual - spatial analysis and synthesis;
• Increasing of integrity in strategy of copying of figure;
• Improvement of verbal — logic thinking (in a technique “the Fourth is superfluous“ the amount of truly fulfilled tasks has increased from 0 up to 7);
• Reduction of emotional uninhibition (расторможенности) and explosiveness;
• Steady paragnosia at perception(recognition) of dimmed pictures;
• Low volume and firmness of a visual memory;
• Preservation of metric and topological mistakes at copying figure;
• Steady troubles with putting into shape of the ideas in speech.

These results testify that the most steady to correctional-pedagogical influence were those mental processes, which psychophyisiological maintenance was connected most closely to injured parts of a brain cortex. In the examined case such parts were of parietal-occipital zones of a cortex of the left hemisphere and frontal departments of a brain. With the first ones the successive visual — spatial analysis is and memory is connected, with the second — the regulation, programming and the control of behavior, voluntary attention and speech activity.

From the data mentioned above it is visible, that at the case of given child the functions connected to frontal structures yield to the greater correction in comparison with the functions connected to parietal-occipital structures of a brain cortex.

Simultaneously noticed improvement of spatial and verbal — logic thinking we categorize as due to improvement of functions of frontal departments (regulation, programming and the control), and improvements of functioning of zone of a cortex of the left hemisphere responsible for quasispatial analysis and synthesis.

Thus, the treatment (psycho-correctional) program has resulted in positive changes in the mental status of the child. The most resistant to correctional influence appeared the mental processes which psychophysiological maintenance was most closely connected to damaged parts of a brain These data confirm L.S. Vygotsky theory.

It is necessary to note, that the changes described above became possible only on a background of medicamentous therapy with anticonvulsive medicines that have resulted in practically full disappearance of epileptic attacks.