The effectiveness of rehabilitation children
The effectiveness of rehabilitation of children with borderline neuropsychic disorders in preschool establishment
Recent data indicate about the growing deterioration in the health of
preschoolers and high prevalence of borderline neuropsychic disorders in children.
According to the results of the all-Russia prophylactic medical examination of children and adolescents 2002, about 8% (16 thousand) kids, and the Yaroslavl region have abnormalities in the mental health requiring psychological and pedagogical correction. Significant deviations that require monitoring by a psychiatrist diagnosed in 1% of children.
Numerous studies have shown thatin case of any deviations harmony of ontogenesis of the child, it is particularly important the timeliness, comprehensiveness and systematicity of correctional therapy.
The presence of “sensitive periods” of development of organs and systems, high plasticity of functional systems of an organism of the child provides a real opportunity for effective care and habilitation. At the same time, the limited time of exposure determines the necessity of intensification of correction and creating the optimum daily system of interaction between health professionals, teachers, psychologists, family and child.
These patterns were taken into account when creating programs of complex rehabilitation of children with borderline neuropsychic disorders (borderline mental disorders) that is embedded in the practice of the kindergarten of compensating type of Yaroslavl in 2000.
In the process of developing the program for the study of ontogeny, priority risk factors, psychosomatic, physical, and adaptive status 44 preschool children 5-7 years of age with borderline mental disorders. The information obtained was used to create the database and to develop optimal approaches to rehabilitation of children with psychosomatic health problems.
The results suggested that the defining influence on the mental health status of biomedical risk factors, primarily on the early stages of ontogenesis (the trouble obstetric and gynecological history was observed in 83.3 per cent of children; complications intrapartum period – 45.8% of the children). In addition, the priority of risk factors related to the variance in mental health, includes:
the severity and time of occurrence of neuropsychiatric abnormalities (predominantly at 1 year of life (91,7%);
the presence of deviations in physical development of children, both at birth (29,1%), and in postnatal period of life (54,2%);
anomalies and malformations (41,7%);
the presence of traumatic brain injury in history (25% children).
It should be noted that the results of factor analysis, the vast majority of these postnatal risk factors had a high degree of dependence on risk factors originating in the perinatal period of development of the child.
In the first 6 months of postnatal development in the great majority of children (95,8%) had been diagnosed with clinical manifestations of perinatal lesions of the nervous system (18.2% of children from birth; and 27.3% at 1 month, 50% of cases at the age of 1-3 months; 4.5% – from 3 to 6 months). In most cases, exhibited syndromal diagnosis: syndrome of hyperosmolality (50% children), muscle dystonia syndrome (33,3%), early organic lesions of the Central nervous system (8,3%), convulsive disorder in the post-vaccination period (4.2 percent).
Noteworthy is the fact that, despite concerns expressed by the anomalies perinatal history, the presence of clinical manifestations of perinatal lesions of the Central nervous system, in the great majority of the children (62.5% of cases), the lag in psychological development and other neuropsychiatric disorders were diagnosed only at the age of 4 years. At this age, the question arose about the advisability of transferring the child to a specialized preschool.
Thus, during the first 3-4 years of life – a period of intensive development of the child’s body, and most importantly – active morphogenesis of the nervous system, children did not receive the required correction, while it has been proved that early comprehensive rehabilitation, an exciting period of “sensitive Windows”, is the key to maximum effectiveness of interventions. That is why, in our opinion, one of the priority directions of preventive work in the children’s outpatient care institutions should be the improvement of the system of prophylactic medical examination of children with perinatal lesions of the Central nervous system, providing for prolonged observation during the early stages of development (up to 3 years of age), and in critical periods of life.
When assessing the psychosomatic status revealed that most of the children (62.5% of cases) had concomitant rejection of psycho-neurological development. 66.7% of preschool children had mixed specific disorders of psychological development, 54,2% – speech disorders, 29.2% of the syndrome of minimal brain dysfunctions, 25% of children with enuresis, 20.8% of the sleep disturbance.