Neuropsychological methods for studying memory. Neuropsychological examination in traumatic brain injury

The successes of psychology, neurophysiology and medicine (neurology, neurosurgery) of the early 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 20th century in different countries and especially intensively in our country.

The first neuropsychological studies were carried out back in the 20s by L. S. Vygotsky, but the main achievement of creating neuropsychology as an independent branch of psychological knowledge belongs to A. R. Luria.

The works of L. S. Vygotsky in the field of neuropsychology were a continuation of his general psychological research. Based on the study of various forms of mental activity, he was able to formulate the following basic principles:

* about the development of higher mental functions;

* about the semantic and systemic structure of consciousness (L. S. Vygotsky, 1956,1960).

L. S. Vygotsky’s early works on neuropsychology were devoted to systemic disorders of mental processes that arise as a result of damage to individual areas of the cerebral cortex, and their characteristics in children and adults. L. S. Vygotsky conducted his first neuropsychological studies together with A. R. Luria.

The studies of L. S. Vygotsky (1934, 1956, etc.) laid the foundation for the development of neuropsychological ways to compensate for mental dysfunctions that occur with local brain lesions. Based on these works, he formulated the principles of localization of higher mental functions of a person. L. S. Vygotsky first expressed 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, forms of social behavior that arose in the process of historical life lead to the formation of new ones in the human cerebral cortex. "cross-functional relationships" 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. Leontiev (1972).

L. S. Vygotsky’s statement that “the human brain has a new localization principle compared to animals, thanks to which it became the human brain, the organ of human consciousness” (L. S. Vygotsky, 1982. T. 1. - P. 174), concluding his well-known theses “Psychology and the doctrine of the localization of mental functions” (published in 1934), undoubtedly refers to one of the most fundamental provisions of Russian neuropsychology.

L. S. Vygotsky’s ideas about the systemic structure and systemic brain organization of higher forms of mental activity constitute only part of the important contribution that he made to neuropsychology. No less important is his concept of the changing significance of brain zones in the process of lifetime development of mental functions.

Observations of the processes of mental development of a child led L. S. Vygotsky to the conclusion about the consistent (chronological) formation of higher mental functions of a person and consistent lifetime changes in their brain organization(due to changes in “interfunctional” relationships) as the main pattern of mental development. He formulated position on the different influence of the focus of brain damage on higher mental functions in childhood and in adults.

The idea of ​​a different effect when the same cortical areas are damaged 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 subsequently, the formation and development of neuropsychology were closely related to the successes neurology and neurosurgery, which made it possible to improve its methodological and conceptual apparatus and test the correctness of hypotheses in the treatment of patients with local brain lesions.

Research in the field also made a certain contribution to the creation of domestic neuropsychology. pathopsychology, carried out in a number of psychiatric clinics in the Soviet Union. These include the works of psychiatrist R. Ya. Golant (1950), devoted to the description of mnestic disorders in local brain lesions, in particular with damage to the diencephalic region.

Kiev psychiatrist A.L. Abashev-Konstantinovsky (1959) did a lot to develop the problem of general cerebral and local symptoms that arise from local brain lesions. He described characteristic changes in consciousness that occur during massive lesions of the frontal lobes of the brain, and identified the conditions on which their appearance depends.

An important contribution to Russian neuropsychology was made by B.V. Zeigarnik and his collaborators. Thanks to these works:

* thinking 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 thought acts (defects
motivation, purposeful thinking, etc.) - in others.

Of unconditional interest from the standpoint of neuropsychology are the 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 also carried out in neurological clinics. These primarily include the works of B. G. Ananyev and his colleagues (1960 and others), devoted to the problem of interaction of the cerebral hemispheres and who made a significant contribution to the construction of modern neuropsychological ideas about the cerebral organization of mental processes.

Of great value for the development of neuropsychology are neurophysiological research, which were and are being carried out in a number of laboratories in the country. These include studies by G.V. Gershuni and his colleagues (1967), devoted to the auditory system and revealing, in particular, two modes of its operation: analysis of long and analysis of short sounds, which made it possible to take a new approach to the symptoms of damage to the temporal cortex of the brain in humans, as well as many other studies of sensory processes.

A great contribution to modern neuropsychology has been made by the research of such prominent domestic physiologists as N.A. Bernstein, P.K. Anokhin, E.N. Sokolov, N.P. Bekhtereva, O.S. Adrianov and others.

The concept of N.A. Bernstein (1947 and others) about the level organization of movements served as the basis for the formation of neuropsychological ideas about the brain mechanisms of movements and their disorders in local brain lesions.

The concept of P.K. Anokhin (1968,1971) about functional systems and their role in explaining the expedient behavior of animals was used by A.R. Luria to build a theory of systemic dynamic localization of higher mental functions in humans.

The works of E. N. Sokolov (1958 and others) devoted to the study of the orientation reflex were also assimilated by neuropsychology (together with other achievements of physiology in this area) to construct a general scheme of the brain as a substrate of mental processes (in the concept of three brain blocks, to explain modality-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 the implementation of complex mental processes - both cognitive and emotional. These studies have opened up broad new perspectives for studying the brain mechanisms of mental processes.

Thus, Russian neuropsychology was formed at the intersection of several scientific disciplines, each of which contributed to its conceptual apparatus.

The complex nature of the knowledge on which neuropsychology relies and which 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 joint efforts of many sciences, including neuropsychology. To develop the actual neuropsychological aspect of this problem (i.e., to study the brain organization of higher mental functions, primarily on the basis of local brain lesions), neuropsychology must be armed with the entire sum of modern knowledge about the brain and mental processes, drawn both from psychology and from other related sciences.

Modern neuropsychology develops mainly in two ways. The first one is domestic 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, the USA, etc. .).

The second one is traditional Western neuropsychology, the most prominent representatives of which are such neuropsychologists as R. Reitan, D. Benson, X. Ekaen, O. Zangwill and others.

Methodological foundations domestic 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 indirect 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 is known, A. R. Luria, along with other domestic psychologists (L. S. Vygotsky, A. N. Leontiev, S. L. Rubinstein, A. V. Zaporozhets, P. Ya. Galperin, etc.) directly developed theoretical foundations of Russian psychological science and on this basis created a neuropsychological theory of the brain organization of higher mental functions of a person. The successes of domestic neuropsychology are explained primarily by its reliance on general psychological concepts scientifically developed from the standpoint of materialist philosophy.

Comparing the development paths of domestic and American neuropsychology, A. R. Luria noted that American neuropsychology, having achieved great success in developing quantitative methods for studying the consequences of brain lesions, actually does not have a general conceptual scheme of brain function, a general neuropsychological theory that explains the principles of functioning of the brain as a whole.

Theoretical concepts of Russian neuropsychology also determine the general methodological strategy of research. In accordance with the idea 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 just to state the fact of a disorder of a particular function.

It should be noted that at present, both theoretical principles and methods of domestic neuropsychology are becoming increasingly popular 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 domestic neuropsychology for a long time and significantly influenced the development of neuropsychology abroad.

Currently, domestic neuropsychology is an intensively developing branch of psychological science, in which several independent directions, United by common theoretical concepts and a common final goal, states in the study of brain mechanisms of mental processes.

Main directions:

1. clinical neuropsychology, the main task of which is to study neuropsychological syndromes that arise when a particular part of the brain is damaged and compare them with the general clinical picture of the disease.

2. experimental neuropsychology, whose tasks include experimental (clinical and instrumental) study of various forms of mental processes disorders in local brain lesions and other diseases of the central nervous system.

A. R. Luria and his colleagues also experimentally developed problems of the neuropsychology of gnostic processes (visual, auditory perception), and 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 using the methods of psychophysiology.

4.rehabilitation direction, dedicated to the restoration of higher mental functions impaired due to local brain lesions. This direction, based on general neuropsychological ideas about brain activity, develops principles and methods of rehabilitation training for patients who have suffered local brain diseases. This work began during the Great Patriotic War.

During these years it was put forward 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 carried out using 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 dysfunction in children with local brain 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” neuropsychological research methods to childhood and improve them.

The study of the characteristics of the brain mechanisms of higher mental functions in children with local brain lesions makes it possible to identify patterns of chronogenic localization of these functions, which L. S. Vygotsky (1934) once wrote about, and also to analyze the different influence of the lesion on them depending on age ( “up” - to functions that have not yet been formed and “down” - to already established ones).

One might think that over time it will be created and neuropsychology of old age(gerontoneuropsychology). So far there are only isolated publications on this topic.

6. neuropsychology of individual differences(or differential neuropsychology) - study of the brain organization of mental processes and states in healthy individuals based on theoretical and methodological achievements of domestic neuropsychology. The relevance of neuropsychological analysis of mental functions in healthy people is dictated by both theoretical and practical considerations. The most important theoretical task that arises in this area of ​​neuropsychology is the need to answer the question whether it is in principle possible to extend the general neuropsychological ideas about the cerebral organization of the psyche, 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, the neuropsychology of individual differences has developed two directions of research.

The first is studying the features of the formation of mental functions in ontogenesis from the perspective of neuropsychology,

The second is study of individual characteristics of the psyche of adults in the context of the problem of interhemispheric asymmetry and

interhemispheric 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 group of patients, and the great possibilities of using neuropsychological methods to assess the dynamics of their conditions, 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 the 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 the seat of the soul, and the enormous factual material about various symptoms of brain damage accumulated by clinicians around the world, neuropsychology as a system of scientific knowledge emerged only in 40-50s of the XX century. The decisive role in this process belongs to the domestic neuropsychological school. Its successes and high international authority are associated primarily with the name of one of the most outstanding psychologists of the 20th century - Alexander Romanovich Luria.

1. What does neuropsychology study?

Neuropsychology- is a branch of psychology that studies the brain basis of mental processes and their connection with individual brain systems; developed as a branch of neurology. Neuropsychology studies the features of disturbances in mental processes of states and the personality as a whole with local brain lesions. The most popular and general definition of neuropsychology is the science of the connection between the brain and the human psyche. Neuropsychology is a related science to pathopsychology.

In Western neuropsychology, the dominant formula is that behavior as a whole is ensured by the functioning of the brain.

In domestic neuropsychology, we are not talking about behavior, but about specific mental functions. A.R. Luria was able to show using clinical material that each mental function can be associated with the work of different parts of the brain, which are organized into a system; This system ensures the functioning of one or another mental function. So neuropsychology deals not just with the study of the relationship between brain function and behavior as a whole, but with the role that each individual part of the brain plays in ensuring a particular mental function. It is understood that each part of the brain is responsible for something different, and Luria defined this “its own” as a “neuropsychological factor.” The goal of Russian neuropsychology is to find all these factors, describe all the functions of different parts of the brain, and understand how the brain provides mental health. Only in the 2nd half of the 19th century. In connection with the successes of studying the brain and the development of clinical neurology, the question was raised about the role of individual parts of the cerebral cortex in mental activity. Pointing out that when certain zones of the cortex of the left (leading) hemisphere are damaged in a person, certain mental processes (vision, hearing, speech, writing, reading, counting) are disrupted, neurologists suggested that these zones of the cerebral cortex are the centers of the corresponding mental processes and that “mental functions” are localized in certain limited areas of the brain. This is how the doctrine of the localization of mental functions in the cortex was created. However, this teaching, which was of a “psychomorphological” nature, was simplified.

Modern neuropsychology proceeds from the position that complex forms of mental activity, formed in the process of social development and representing the highest forms of conscious reflection of reality, are not localized in narrowly limited areas (“centers”) of the cortex, but represent complex functional systems in the existence of which the complex takes part jointly working areas of the brain. Each region of the brain makes a specific contribution to the construction of this functional system. Thus, the brain stem and reticular formation provide the energy tone of the cortex and are involved in maintaining wakefulness. The temporal, parietal and occipital areas of the cerebral cortex are an apparatus that ensures the receipt, processing and storage of modality-specific (auditory, tactile, visual) information that enters the primary sections of each cortical zone, is processed in more complex “secondary” sections of these zones and combines and synthesizes in “tertiary” zones (or “overlap zones”), especially developed in humans. The frontal, premotor and motor areas of the cortex are an apparatus that ensures the formation of complex intentions, plans and programs of activity, implementing them in the system of corresponding movements and making it possible to exercise constant control over their course. Thus, the entire brain is involved in the performance of complex forms of mental activity.

Neuropsychology is important for understanding the mechanisms of mental processes. At the same time, by analyzing disturbances in mental activity that arise from local brain lesions, neuropsychology helps to clarify the diagnosis of local brain lesions (tumors, hemorrhages, injuries), and also serves as the basis for the psychological qualification of the resulting defect and for restorative training, which is used in neuropathology and neurosurgery.

Pediatric neuropsychologyis one of the branches of neuropsychology, a science that studies the brain organization of mental processes. In recent years, child neuropsychology has been actively introduced into psychological services in the education system and is involved in providing assistance to children with developmental disabilities. The most effective assistance from neuropsychologists is for children who demonstrate pronounced disproportions in the development of mental functions, who have disorders such as mental retardation (MDD) and speech retardation (SSD), as well as when working with underachieving students and gifted children. A neuropsychologist is not satisfied with stating the weakness of one or another HMF, but is able to conduct an analysis that makes it possible to discover which structural and functional component suffers primarily and leads to underdevelopment of a given HMF as a whole. Then, based on this analysis, he develops an individual-oriented strategy and tactics for correctional and developmental work. Neuropsychological research can identify the affected functional link, but its topic can only be indicated in a probabilistic way.

neuropsychological study personality lesion

2. Neuropsychological research and its role in pathopsychological practice

Almost any nervous or mental illness necessitates a neuropsychological examination. Child neuropsychology objectively identifies the causes of brain disorders - complicated pregnancy and childbirth, previous traumatic brain injuries, seizures, infections and other diseases of the nervous system, as well as taking certain medications. Neuropsychological research allows us to reveal the essence of various medical diagnoses (for example, minimal brain dysfunction, attention deficit hyperactivity disorder, etc.), determines the level of the child’s current mental development, and most importantly, finds ways and specific methods for psychological correction of identified disorders.

It has now been established that successful schooling is possible only at a certain level of maturity of higher mental functions, which is not observed in every child at the age of 6-7 years. In this case, special attention is required for left-handed children and children who have previously been identified as having a delay in mental and (or) speech development.

Immaturity or deficiency of any mental function can significantly complicate, and sometimes make it impossible, even for children with high intelligence, to successfully study at school. Consequently, a neuropsychological study of preschoolers allows us to identify the level of development of each higher mental function (memory, attention, thinking, etc.) at a given time and, if necessary, eliminate existing problems by the time the child enters school.

Neuropsychological research of schoolchildren reveals the causes of difficulties in learning, determines the degree of development of memory, attention, intelligence and finds ways to correct the identified disorders, allowing to increase the success of studies in each specific case.

Thus, child neuropsychology actually helps to fully study school subjects and develop the student’s abilities, and also develops personality traits such as self-confidence and self-esteem. These personality qualities are directly related to the breadth of knowledge and skills, and the ease of mastering educational material. Therefore, it is important to note that a qualified analysis of educational difficulties helps to solve the general problems of the education and development of the student.

The results of neuropsychological studies of patients with local brain lesions made it possible to describe various types of learning disorders with lesions of different brain structures and thereby laid the foundation for a differentiated approach to the difficulties of school learning associated with brain dysfunction, which is currently given great importance in the genesis of school failure. The neuropsychological approach aims to both study the mechanisms underlying difficulties in school learning and find optimal ways to correct them. The theoretical basis of this method is the idea that all mental processes have a complex multicomponent structure and are based on the work of many brain structures, each of which makes its own specific contribution to their course. According to this idea, each symptom (lack of praxis, gnosis, etc.) can occur with dysfunction of various parts of the brain, but in each of these cases it manifests itself specifically, qualitatively different from the characteristics of its manifestation when other brain structures are involved.

But, unfortunately, all these processes will become simply impossible or distorted if there is no neurobiological preparedness of the brain systems and subsystems that provide them. In other words, the development of certain aspects of the child’s psyche clearly depends on whether the corresponding brain substrate is sufficiently mature and complete. It should be borne in mind that the brain is not only the well-known cortex, subcortical formations, corpus callosum, etc., but also various neurophysiological, neurochemical and other systems, each of which makes its own specific contribution to the actualization of any mental function . Consequently, for each stage of a child’s mental development, the potential readiness of a complex of certain brain formations to support it is first of all necessary. But, on the other hand, there must be a demand from the outside (from the outside world, from society) for a constant increase in the maturity and strength of one or another psychological factor. If this is absent, distortion and inhibition of psychogenesis in different variants are observed, entailing secondary functional deformations at the level of the brain. Moreover, it has been proven that in the early stages of ontogenesis, social deprivation leads to brain degeneration at the neural level.

The neuropsychological method is the only valid apparatus today for assessing and describing this entire multifaceted reality, since it was originally developed by A.R. Luria and his students for a systematic analysis of the interaction of the brain and psyche as an interdependent unity.

The experience of neuropsychological counseling of children with developmental disabilities has proven the adequacy and information content of this particular approach to this population. Firstly, the differential diagnostic task is almost unambiguously solved: as a result of the examination, basic pathogenic factors are identified, and not the current level of knowledge and skills. After all, externally, the pathocharacterological characteristics of the child, and pedagogical neglect, and the primary failure of phonemic hearing can manifest themselves in the same way - "two in Russian" Secondly, only a neuropsychological analysis of such a deficiency can reveal the mechanisms underlying it and approach the development of specific, specially oriented corrective measures. Let us emphasize this indispensable condition: it is the syndromic approach that is important, otherwise, as experience shows, distortions, one-sidedness of results, and an abundance of artifacts are inevitable.

Neuropsychological research allows us to more accurately carry out differential diagnostic work, establish the basic, primary defect that prevents the child from fully adapting, and, most importantly, model the hierarchy and stages of psychological and pedagogical influence.

Before we begin to describe the scheme of a neuropsychological examination, let us note in the most general form several points that are fundamental for qualifying a child’s impairment.

The psychologist needs to establish the presence or absence in the child of such phenomena as:

hypo or hypertonicity, muscle tension, synkinesis, tics, obsessive movements, pretentious poses and rigid bodily attitudes; the usefulness of oculomotor functions (convergence and amplitude of eye movement);

plasticity (or, on the contrary, 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;

severe vegetative reactions, allergies, enuresis; failures of breathing up to its obvious delays or noisy “pre-breathing”; somatic dysrhythmias, sleep formula disorder, dysembryogenetic stigmas, etc.

Various pathophenomena of this circle, as well as a number of other similar ones, always indicate a prepathological state of the subcortical formations of the brain, which necessarily requires targeted correction. After all, the above, in fact, is a reflection of the basal, involuntary level of human self-regulation. Moreover, the level is largely strictly genetically programmed, i.e. functioning against the will and desire of the child. Meanwhile, its full status largely predetermines the entire subsequent path of development of higher mental functions (HMF). This is due to the fact that by the end of the first year of life, these structures practically reach their “adult” level and become the fulcrum for ontogenesis as a whole.

It is necessary to note how inclined the child is to simplify a program given from the outside; does it easily switch from one program to another or inertly reproduces the previous one. Does he listen to instructions to the end or does he impulsively get to work without trying to understand what is required of him? How often does he get distracted by side associations and slip into regressive forms of response? Is he capable of independently systematically performing what is required under the conditions of “deaf instructions”, or is the task available to him only after leading questions and detailed prompts from the experimenter, i.e. after the original task is divided into subroutines.

Finally, is he able to give himself or others a clearly formulated task, check the progress and outcome of its implementation; slow down your emotional reactions that are not adequate to the given situation? Positive answers to these questions, along with the child’s ability to evaluate and monitor the effectiveness of his own activities (for example, to find his mistakes and independently try to correct them), indicate the level of formation of his voluntary self-regulation, i.e. to the maximum extent reflects the degree of his socialization in contrast to those basal processes mentioned above.

The sufficiency of the listed parameters of mental activity indicates the functional activity of the prefrontal (frontal) parts of the brain, primarily its left hemisphere. And, although the final maturation of these brain structures is stretched according to neurobiological laws up to 12 - 15 years old, by 7 - At 8 years of age, children normally already have all the necessary prerequisites for their optimal status within the appropriate age range.

Speaking about the child’s understanding of instructions and their implementation, it is necessary to emphasize that the primary task is to differentiate primary difficulties from those (secondary) that are associated with, for example, insufficient memory or phonemic hearing. In other words, we must be absolutely convinced that the child not only understood, but also remembered everything you said regarding the upcoming task.

As is known, the development of mental functions and their individual components (factors) proceeds according to the laws of heterochrony and asynchrony. Relying on this will help the researcher assess the state of a particular functional link not in general, but in accordance with age standards that were obtained during a neuropsychological examination of well-performing students in public schools and preschool institutions.

When studying motor functions, it was found that various types of kinesthetic praxis are fully accessible to children as early as 4 years old. - 5 years, and kinetic only at 7 (and the test for reciprocal hand coordination is fully automated only by 8 years).

Tactile functions reach their maturity by 4 - 5 years, while somatognostic - by 6. Various types of objective visual gnosis cease to cause difficulties for the child by 4 - 5 years; It must be emphasized here that the confusion that sometimes arises is not due to a primary deficit in visual perception, but to a slow selection of words. This circumstance may also reveal itself in other samples, so it is extremely important to separate these two reasons. Until 6 - 7-year-old children demonstrate difficulties in perceiving and interpreting plot (especially serial) pictures.

In the sphere of spatial representations, structural-topological and coordinate factors mature first (6 - 7 years), while metric concepts and strategy of optical-constructive activities - by 8 and 9 years, respectively.

The volume of both visual and auditory-verbal memory (i.e., retention of all six standard words or figures after three presentations) is sufficient in children already at 5 years old; By the age of 6, the strength factor for storing the required number of elements reaches maturity, regardless of its modality. However, only by 7 - At the age of 8 years, selectivity of mnestic activity reaches its optimal status.

Thus, in visual memory, a child, having well retained the required number of reference figures, distorts their original image, unfolding it, not observing proportions, not completing some details (i.e., demonstrates a lot of paragraphs and reversions), confusing the given order. The same is true for auditory-verbal memory: up to the age of 7, even four-time presentation does not always lead to full retention of the order of verbal elements; a lot of paraphasia occurs, i.e. replacing standards with words that are similar in sound or meaning.

The most recent of the basic factors of speech activity in a child mature: phonemic hearing (7 years), quasi-spatial verbal synthesis and programming of independent speech utterance (8 years). - 9 years). This is especially clearly manifested in cases where these factors should serve as a support for such complex mental functions as writing, solving semantic problems, composing, etc.

The next requirement is related to the need to include sensitized conditions in a neuropsychological examination in order to obtain more accurate information about the state of a particular parameter of mental activity. These include: increasing the speed and time of task completion; exclusion of visual (closed eyes) and verbal (fixed tongue) self-control.

The success of completing any task under sensitized conditions (including memory traces) primarily indicates that the child’s process under study is automated, and therefore, among other advantages, can be a basis for corrective measures.

A necessary condition is also to perform any manual tests (motor, drawing, writing) with both hands alternately. This will be specially discussed in the further description, but here I would like to emphasize that the use of bimanual tests is close in information content to dichotic listening, tachistoscopic experiment, etc., and neglecting them - to the inadequate qualification of existing phenomenology.

In all experiments that require the participation of the subject's right and left hands, the instructions should not specify which hand to begin performing the task with. Spontaneous activity of one or another hand at the beginning of the task provides the experimenter with additional, indirect information about the degree of formation of the child’s manual preference. The same information is contained in “sign language”: the researcher must note which hand “helps” the child enrich his speech with greater expressiveness.

Tasks should be alternated so that two identical ones (for example, memorizing two groups of 3 words and memorizing 6 words) do not follow one another.

It is extremely important to take as an axiom the fact that the child is always included in the whole system of interpersonal and social relationships (parents, teachers, friends, etc.). Therefore, the success of the survey (and subsequent correction) will clearly correlate with how completely the relevant data will be presented in it. First of all, this means establishing partnership contact with parents, especially with the child’s mother. It is she who is able to provide the most important information about his problems, and subsequently - become one of the central participants in the correction process.

Conclusion

So, neuropsychological research solves the following main problems:

Identifying immature or impaired areas and functions of the brain, as well as determining the causes of a child’s learning and developmental difficulties.

Organization of special teaching methods that can help in overcoming these difficulties.

In the process of neuropsychological research, a differential diagnostic problem is solved: as a result of the examination, basic pathogenic factors are identified, and not the current level of knowledge and skills. After all, externally, the pathocharacterological characteristics of the child, pedagogical neglect, and the primary failure of phonemic hearing can manifest themselves in the same way. Neuropsychological analysis of such a deficiency can reveal the mechanisms underlying it and approach the development of specific, specially oriented corrective measures.

So, neuropsychological research allows us to more accurately carry out differential diagnostic work, establish the basic, primary defect that prevents the child from fully adapting, and, most importantly, model the hierarchy and stages of psychological and pedagogical influence.

Bibliography

1. Astapov V.M. Introduction to defectology with the basics of neuro- and pathopsychology. - M.: International Pedagogical Academy, 1994.

2. Zeigarnik B.V. Pathopsychology. Fundamentals of clinical diagnosis and practice. - M., Eksmo Publishing House, 2008.

Karvasarsky B.D. Clinical psychology. Textbook. Publisher: Peter, 2007.

4. Korsakova N.K., Moskovichiute L.I. Clinical neuropsychology. - M., 1988.

5. Methods of adapted neuropsychological research for pediatric neurologists. Methodological recommendations / compiled by: Simernitskaya E.G., Skvortsov I.A., Moskovichiute L.I. and others - M., 1988).

Neuropsychology today / ed. Khomskoy E.D. - M.: Publishing house of Moscow State University, 1995.

7. Semenovich A.V. Neuropsychological diagnostics and correction in childhood. - M.: Academy, 2002.

Khomskaya E.D. Neuropsychology. M., 1987.

Tags: Possibilities of using neuropsychological research in pathopsychological practice

Neuropsychology– a specific area of ​​knowledge where the subject is the study of the brain organization of mental processes, emotional states and personality based on the material of pathology, primarily 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) of the early twentieth century prepared the ground for its formation.

The first neuropsychological studies were carried out back in the 20s by L.S. Vygotsky, however, the main merit of creating neuropsychology 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 higher mental states are formulated. human functions. He first expressed the idea that the human brain has a new principle of organizing functions, which he designated as the principle of “extracortical” organization of the psyche. processes(using tools, signs and language).

Observations on mental processes. child development led Vygotsky to the conclusion about the sequential (chronological) formation of higher psyches. human functions and consistent lifetime changes in their brain organization as the main pattern of psyche. development. He formulated position on the different influence of the focus of brain damage on higher mental health. functions in childhood and in adults.

The central task of neuropsychol. research is to determine the qualitative specificity of the disorder, and not just to state the fact of a disorder of a particular function.

Main tasks of neuropsychology .

The study of changes in mental processes during local brain lesions, which allows us to see with which brain substrate this or that 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 groups of methods, used in neuropsychology. The first includes those methods with the help of which basic theoretical knowledge was obtained, and the second includes the methods that are used by neuropsychologists in practical activities.

In the first group, the comparative anatomical research method, the irritation method and the destruction method are distinguished.

In the practical activities of neuropsychologists, the method of syndromic analysis proposed by A. R. Luria is used, or, in other words, the “battery of Luriev methods.” A. R. Luria selected a number of tests, combined into a battery, which allows you to assess the condition 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 for 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 emerged, 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 report on the possibility of treatment, recovery and prognosis of the future fate of patients. The main method is the method of clinical neuropsychological research.

Experimental neuropsychology (neuropsychology of cognitive processes). Main objective: experimental study of various forms of disturbances of mental processes in local brain lesions. Thanks to the work of A.R. Luria and his students, memory and speech have been the most studied. In experimental N., on the initiative of Luria, it was created psychophysiological direction - this is a direction whose task is to study the physiological mechanisms of disorders of higher mental functions.

Rehabilitation neuropsychology . Main task: restoration of HMF in case of local brain lesions. The principles and methods of speech restoration have been most developed.

Ecological neuropsychology assesses the influence of various unfavorable environmental factors on the state of mental functions and on the emotional and personal sphere from the perspective of neuropsychology.

Developmental neuropsychology . The task is to identify patterns of brain development.

In recent years, it has emerged as an independent area neuropsychology of childhood . This is a new area of ​​neuropsychology that studies the specifics of mental dysfunction in local brain lesions in children. Research in this area makes it possible to identify patterns of localization of higher mental functions, as well as to analyze the influence of the localization of the lesion on mental function depending on age.

Finally, recently it has become increasingly established neuropsychology of individual differences (or differential ney ropsychology ), which studies the brain organization of mental processes and states in healthy individuals based on theoretical and methodological achievements of domestic neuropsychology.

Practical tasks facing differential neuropsychology are associated, first of all, with psychodiagnostics, with the use of neuropsychological knowledge for the purposes of vocational selection, career guidance, etc.

Neuropsychology was formed due to the demands of practice, primarily the need to diagnose local brain lesions and restore impaired mental functions.

In the conceptual apparatus of neuropsychology we can distinguish two class of concepts . The first one isconcepts common to neuropsychology andgeneral psychology; the second one isactually neuropsychologicalideas, conditioned by the specifics of its subject, object and research methods.

The first class of concepts includes the following:

higher mental function;

mental activity;

psychological system;

mental process;

speech mediation;

meaning;

personal meaning;

psychological tool;

• action;

  operation;

interiorization and many others.

Second class of conceptsmake upactually neuropsychologicalconcepts, which reflected the application of general psychological theory to neuropsychology. The basis of this theory is the position about the systemic structure of higher mental functions and their systemic brain organization.

In neuropsychology, as in general psychology, under the highest psi chemical functions are understood as complex forms of conscious mental activity, carried out on the basis of compliance ing motives, regulated by appropriate goals and programs and subject to all the laws of mental activity.

Higher mental functions have three main characteristics:

* they are formed during 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 and interchangeability of their components.

The pattern of formation of higher mental functionsis thatinitially they exist as a form of interactionactions between people (i.e., as an interpsychological process) and onlylater - as a completely internal (intrapsychological) process.

The functional system in neuropsychology is understood as a diseasephophysiological basis of higher mental functions (i.e. the totalitythe nature of various brain structures and the physiological processes occurring in themprocesses), which ensures their implementation.

These provisions are central totheories of systemic dynamic localization of higher mental functions.

The second class of concepts - actually neuropsychological - includes the following.

Neuropsychological symptom- a violation of mental function that occurs as a result of local damage to the brain (or due to other pathological causes leading to local changes in the functioning of the brain).

Primary neuropsychological symptoms- mental dysfunctions directly related to damage (loss) of a certain neuropsychological factor.

Secondary neuropsychological symptoms- disorders of mental functions that arise as a systemic consequence of primary neuropsychological symptoms according to the laws of their systemic relationships.

Neuropsychological syndrome- a natural combination of neuropsychological symptoms caused by damage (loss) of a certain factor (or several factors).

Neuropsychological factor- a structural and functional unit of brain function, 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 discover a common basis (factor) explaining the origin of various neuropsychological symptoms; studying the qualitative specificity of disorders of various mental functions associated with damage (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 location of the brain lesion (topical diagnosis).

Functional system- a morphophysiological concept borrowed from the concept of functional systems by P.K. Anokhin (1968, 1971, etc.) to explain the brain 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.(morphophysiological basis of mental function) - a set of morphological structures (zones, areas) in the cerebral cortex and subcortical formations and the physiological processes occurring in them, included in a single functional system and necessary for the implementation of this mental activity.

10. Localization of higher mental function(cerebral organization of higher mental function) - the central concept of the theory of systemic dynamic localization of higher mental functions, which explains the connection of the brain with the psyche as the relationship of various links (aspects) of mental function with different neuropsychological factors (i.e., principles inherent in the work of a particular brain structure - cortical or subcortical).

11. Multifunctionality of brain structures- the ability of brain structures (and, above all, the associative zones of the cerebral cortex) to rearrange their functions under the influence of new afferent influences, as a result of which intrasystem and intersystem restructuring of the affected functional systems occurs.

Norm of function- 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 the “normal function” associated with the premorbid (gender, age, type of interhemispheric organization of the brain, etc.).

Interhemispheric brain asymmetry- inequality, qualitative difference in the “contribution” that the left and right hemispheres of the brain make to each mental function;

differences in the brain organization of higher mental functions in the left and right hemispheres of the brain. Functional specificity of the cerebral hemispheres

- specificity of information processing and brain 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 uniting the left and right hemispheres of the brain into a single integrative, holistically working system, formed under the influence of both genetic and environmental factors. The listed concepts are included in .

basic understandingtical apparatus of the theory of systemic dynamic localization of higherhuman mental 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 specific contribution to the implementation of this function;

various elements of the functional system can be located in areas of the brain that are sufficiently distant from each other and, if necessary, replace each other;

When a certain area of ​​the brain is damaged, a “primary” defect occurs - a violation of a certain physiological principle of operation characteristic of a given brain structure;

As a result of damage to a common link included in different functional systems, “secondary” defects may occur.

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, it was developed general structural-functionalnal model of the brain as a substrate of mental activitysti, according to which the entire brain can be divided into three main structural and functional blocks :

I- energy block, or block for regulating the level of brain activity,

II- a block for receiving, processing and storing exteroceptive (i.e., coming from outside) information;

III- a block of programming, regulation and control over the course of mental activity.

Each higher mental function (or complex form of conscious mental activity) is carried out with the participation of all three blocks of the brain, contributing to its implementation.

Energy block includes non-specific structures of different levels:

reticular formation of the brainstem;

nonspecific structures of the midbrain and its diencephalic sections;

limbic system;

* mediobasal 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 basal, or orbital, parts of the frontal lobes of the brain)belongs totheir structure lies mainly in the ancient type of bark, withconsisting of five layers.

Functional meaningfirst block in ensuring mental functions consists, firstly, in the regulation of activation processes, in maintaining the general tone of the central nervous system 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 apparatus, modulating their work and providing complex forms of conscious activity.

The first block of the brain is involved in the implementation of lyua fight in mental activity, especially in the processes of attention, memory, regulation of emotional states and consciousness in general.

The second block is the receiving, processing and storage block exterocepbeer(T.e.coming from the external environment)information - located in the outer sections of the new cortex (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 the reception and analysis of information coming from outside), secondary zones (performing the functions of synthesizing information from one analyzer) and tertiary zones, the main task of which is complex synthesis of information.

A distinctive feature of the devices of the second block is modal specificity and narrow specialization. The first means that the nerve cells of the primary zones respond to stimulation of only one modality (one type), for example, only visual or only auditory. The second assumes that these neurons respond only to a single feature of a stimulus of one type (for example, only to the width of a line or the angle of inclination, etc.). Thanks 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 principleprinciple: they consist ofperipheral (receptor) and centregional departments.

Peripheral departmentsanalyzers analyze and discriminate stimuli based on 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 their maximum complexity and detail in the cerebral cortex. Analyzer systems are characterized by a hierarchical structure principle, while the neural organization of their levels is different.

The posterior cerebral cortex has a number of common features that make it possible to combine it into a single brain block. It distinguishes “core zones” of analyzers and “periphery” (in the terminology of I. P. Pavlov), or primary, secondary and tertiary fields (in the terminology of A. V. Campbell). The core zones of analyzers include primary and secondary fields, and the periphery - tertiary fields.

The third block is a block of programming, regulation and control complex forms of activity are associated with the organization of purposeful, conscious mental activity, which includes in its structure a goal, a motive, a program of actions to achieve a goal, a choice of means, control over the implementation of actions, and correction of the result obtained. The third block of the brain serves to ensure these tasks.

The apparatuses of the third functional block of the brain are located anterior to the central frontal gyrus and include includesmotor, premiummotor and prefrontal regionsbarkfrontal lobes of the brain. The frontal lobes are characterized by great structural complexity and many bilateral connections with cortical and subcortical structures. The third block of the brain 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 plans and goals of mental activity, in its regulation and monitoring the results of individual actions, as well as all behavior in general.

Various stages of voluntary, speech-mediated, conscious mental activity are carried out with the obligatory participation of all three brain blocks:

it begins with the phase of motives, intentions, plans (1 block);

then these motives, intentions, plans are transformed into a specific program (or “result image”) of reality, including ideas about how to implement it (block 3);

* after which it continues as the implementation phase of this program using certain operations (block 2);

* mental activity ends with the phase of comparing the results obtained with the original “image of the result.” If these data do not correspond, mental activity continues until the desired result is obtained.

The defeat of one of the three blocks (or its department) affects any mental activity, as it leads to disruption of the corresponding stage (phase, stage) of its implementation.

Isolation of a neuropsychological factor that determines the nature of symptoms and syndromes arising as a result of brain pathology can be carried out using a wide range of techniques for examining a subject or patient, described as methods of neuropsychological diagnostics. The problems solved with their help in the systematic analysis of violations of the mental function can be grouped as follows (Glozman):

Topical diagnosis of damage or underdevelopment (atypical development) of brain structures;

Differential early diagnosis of a number of diseases of the central nervous system, differentiation of organic and psychogenic disorders of mental functioning, its individual differences, normal and pathological aging;

Description of the picture and determination of the level of mental dysfunction: determination of the affected (unformed) brain block (in the understanding of Luria’s term), the primary defect and its systemic influence;

Determination of the causes and prevention of various forms of abnormal mental functioning: disadaptation, school failure, etc.;

Assessment of the dynamics of the state of mental functions and the effectiveness of various types of targeted therapeutic or corrective effects: surgical, pharmacological, psychological and pedagogical, psychotherapeutic, etc.;

Development, based on a qualitative analysis of impaired and preserved forms of mental functioning, of a strategy and prognosis for rehabilitation or correctional measures;

Development and application of systems of differentiated methods of restorative or correctional-developmental education that are adequate to the structure of the mental defect.

Depending on the task and focus of the neuropsychological examination, the methods used can be standardized (the same tasks for all patients) or flexible (different tasks specific to each patient); can be grouped or selected individually to assess a highly specialized function and carried out as an individual examination; can be quantitative (psychometric), that is, focused on achieving a result (completing or failing to complete a test in a normatively specified time) or qualitative, focused on the process and specific features of the patient’s performance of the task, qualification of errors made during testing, and based on neuropsychological theory.

The most developed and widespread methods for assessing syndromes in neuropsychology include a system of techniques, compiled by Luria into a logically integral block and aimed at characterizing the clinical “field of factors”, that is, identifying and describing the fundamental aspects of mental losses in local brain lesions without an explicit accurate quantitative assessment of them. This scheme includes:

1) a formal description of the patient, his medical history and the results of various laboratory and instrumental examinations (EEG, biochemistry, etc.);

2) a general description of the patient’s mental status - state of consciousness, ability to navigate place and time, level of criticism and emotional background;

3) studies of voluntary and involuntary attention;

4) studies of emotional reactions based on the patient’s complaints, according to his assessment of faces in photographs, plot paintings;

5) studies of visual gnosis - using real objects, contour images, upon presentation of various colors, faces, letters and numbers;

6) studies of somatosensory gnosis using tests of recognition of objects by touch, by touch;

7) studies of auditory gnosis when recognizing melodies, localizing a sound source, and repeating rhythms;

8) studies of movements and actions when performing the latter according to instructions, when setting a pose, as well as assessment of coordination, results of copying, drawing, object actions, adequacy of symbolic movements;

9) speech research - through conversation, repetition of sounds and words, naming objects, understanding speech and rarely encountered words, logical and grammatical structures;

10) study of writing - letters, words and phrases;

11) reading studies - letters, meaningless and meaningful phrases and misspelled words;

12) memory studies - for words, pictures, stories;

13) research into the counting system;

14) research into intellectual processes - understanding stories, solving problems, correct endings of phrases, understanding analogies and opposites, figurative and general meaning, ability to classify.

The proposed methods are addressed primarily to the voluntary, conscious, that is, speech-mediated level of mental functions, and to a lesser extent to involuntary automated or unconscious mental functions. To expand the range of use of measuring procedures, special sensitized conditions can be additionally created - the rate of delivery of stimuli and instructions can be accelerated, the volume of stimulus material can be increased, and it may be offered in a noisy form. In recent years, the system of neuropsychological research methods has been enriched with new developments, involving both the improvement of already known techniques and the introduction of new measurement procedures into practice. Quantitative criteria for performing tests were developed, taking into account the principles of standardization of research and the comparability of the results obtained, diagnostic coefficients and age norms were introduced, methodological principles were substantiated that facilitate the development of new research tools, including special experimental equipment (Wasserman, Dorofeeva, Meyerson, Glozman).

The problem of the composition and focus of a set of techniques adequate to achieve a particular neuropsychological diagnostic goal is solved in each specific case, based on an individual approach, systematicity in the dynamic organization of functions and the comprehensiveness of the coverage of symptoms, the development of which is subject to prediction. It is advisable to plan the study so that it allows not only to record the disorder, but also to identify its mechanisms. In the case of a damaged brain, the interpretation of the results obtained should also reflect compensatory consequences, which are especially relevant during long periods of illness.

14.1. GENERAL PRINCIPLES OF NEUROPSYCHOLOGICAL DIAGNOSTICS

The practical orientation of neuropsychology largely lies in the ability to adequately qualitatively and quantitatively reflect possible neuropsychiatric disorders caused by various brain lesions, or, based on recorded changes in mental functions, probabilistically predict the cortical or subcortical localization of the lesion. In relation to childhood, practical problems often shift towards assessing the functional insufficiency of individual systems of the developing brain (ZPR), the specifics of their heterochronic formation, taking into account the zone of proximal development, which allows a neuropsychologist on this basis to give a reasoned conclusion, for example, about the child’s readiness for school, the need for certain correctional or rehabilitation measures, better construction of educational programs in general and specialized educational institutions, etc.

Isolation of a neuropsychological factor that determines the nature of symptoms and syndromes arising as a result of brain pathology can be carried out using a wide range of techniques for examining a subject or patient, described as methods of neuropsychological diagnostics. The problems solved with their help in the systemic analysis of violations of the mental function can be grouped as follows (Zh. M. Glozman):

□ making a topical diagnosis of damage or underdevelopment (atypical development) of brain structures;

□ differential early diagnosis of a number of diseases of the central nervous system, differentiation of organic and psychogenic disorders of mental functioning, its individual differences, normal and pathological aging;

BASICS OF NEUROPSYCHOLOGY

□ description of the picture and determination of the level of mental dysfunction: determination of the affected (unformed) brain block (in Lurie’s understanding of the term), the primary defect and its systemic influence;

□ determination of the causes and prevention of various forms of abnormal mental functioning: maladjustment, school failure, etc.;

□ assessment of the dynamics of the state of mental functions and the effectiveness of various types of targeted therapeutic or corrective effects: surgical, pharmacological, psychological-pedagogical, psychotherapeutic, etc.;

□ development, based on a qualitative analysis of impaired and preserved forms of mental functioning, of a strategy and prognosis for rehabilitation or correctional measures;

□ development and application of systems of differentiated methods of restorative or correctional-developmental education that are adequate to the structure of the mental defect.

Such problems can be effectively solved only by mastering specific methods and techniques that are selectively sensitive to numerous forms of cognitive, mnestic, affective-motivational, motor and personality disorders generated by local lesions of brain tissue. Correct interpretation of qualitative and quantitative indicators obtained as a result of neuropsychological diagnostics requires knowledge of typical symptoms, syndromes and neuro-psychological factors that generally represent the main semantic load in the work of certain functional brain systems or neural ensembles. The principles of dynamic systemic localization of functions and the multimodality of the phenomenology of mental disorders in local brain lesions are mandatory theoretical prerequisites both for the general approach to any clinical case and for the interpretation of a specific painful manifestation.

Depending on the task and focus of the neuropsychological examination, the methods used can be standardized (the same tasks for all patients) or flexible (different tasks specific to each patient); can be grouped into a battery or selected “piece by piece” for the assessment of a highly specialized function and carried out as an individual examination; can be quantitative (psychometric), that is, focused on achieving a result (completing or failing to complete a test in a normatively specified time), or qualitative, focused on the process and specific features of the patient’s performance of the task, qualification of errors made during testing, and based on neuropsychological theory.

The most developed and widespread methods for assessing syndromes in neuropsychology include the system of techniques summarized by A. R. Luria in

a logically integral block and aimed at characterizing the clinical “field of factors”, that is, identifying and describing the fundamental aspects of mental losses in local brain lesions without an explicit accurate quantitative assessment of them. This proposed scheme briefly includes:

□ a formal description of the patient, his medical history and the results of various laboratory and instrumental examinations (EEG, biochemistry, etc.);

□ general description of the patient’s mental status - state of consciousness, ability to navigate place and time, level of criticism and emotional background;

□ studies of voluntary and involuntary attention; Q studies of emotional reactions;

□ studies of visual gnosis;

□ studies of somatosensory gnosis;

□ studies of auditory gnosis;

Q movement and action studies;

□ speech research;

□ writing research;

□ reading studies; Q memory research;

□ study of the counting system;

□ study of intellectual processes.

The proposed methods are addressed primarily to the voluntary, conscious, that is, speech-mediated level of mental functions, and to a lesser extent to involuntary automated or unconscious mental functions. Having received worldwide recognition, this complex was subsequently subjected to attempts at changes and revisions, of which the most famous version is the Luria-Nebraska neuropsychological battery, criticized for the well-known vulgarization of the original theoretical premises and conceptual principles of A. R. Luria, as well as due to the excessive formalization of the quantitative approach in relation to registered changes in the psyche.

In recent years, the system of neuropsychological research methods has been enriched with new developments, involving both the improvement of already known techniques and the introduction of new measurement procedures into practice. Quantitative criteria for performing tests were developed, taking into account the principles of standardization of research and the comparability of the results obtained, diagnostic coefficients and age norms were introduced, methodological principles were substantiated that facilitate the development of new research tools, including special experimental equipment (L. I. Wasserman, S. A . Dorofeeva, Ya. A. Meerson; Zh. M. Glozman). Attempts have been made to develop comprehensive methods for neuropsychological research in children (L. S. Tsvetkova; N. K. Korsakova, Yu. V. Mikadze, E. Yu. Balashova).

BASICS OF NEUROPSYCHOLOGY

Complexes of standardized techniques developed in accordance with the mentioned principles are usually considered as holistic, logically ordered psychometric batteries. At the same time, this circumstance is not an obstacle to combining techniques borrowed from various sources, if this meets specific diagnostic purposes.

In recent years, one of the leading directions in improving neuropsychological diagnostic tools has become a quantitative approach based on scale assessments, in which the criteria are variously detailed scoring gradations of test performance. In this case, either quantitative parameters that are truly accessible for accurate measurement (for example, the time to complete a test or the number of errors made) or qualitative signs, the presence of which is characterized by experts as a more severe consequence of brain damage, act as a sign of deterioration in the assessment. In the latter case, since we are talking about either cumulative or individual clinical experience, the question of the adequacy of assigning a given score to a given qualitative sign always remains open to criticism.

According to L.I. Wasserman et al., the main requirements that a set of neuropsychological tests must meet to solve topical diagnostic problems should be as follows.

Selective reliability and validity in relation to those HMFs whose characteristics of disorders make it possible to assess their significance in the dynamics of treatment. This requirement allows us to minimize the number of samples themselves.

Availability for execution by any adult, practically healthy subject, which implies standardization of tests on a normative sample, taking into account the educational and cultural level of the individuals of whom it consists.

Inclusion in the set of samples reflecting not only severe and moderately severe disorders of the HMF, but also mild ones that are not detected during routine clinical and psychological research (using sensitized techniques).

Suitability for comparative characterization of HMF disorders in their dynamics, during treatment and rehabilitation, which is achieved by standardizing the research procedure.

Consistency of qualitative, structural analysis of the registered syndrome with quantitative assessment of the severity of disorders of higher cortical functions.

The possibility of using pathopsychological and test methods not included in the standard set for the purposes of neuropsychological diagnostics.

To expand the range of use of measuring procedures, special sensitized conditions can be additionally created - the rate of delivery of stimuli and instructions can be accelerated, the volume of stimulus material can be increased, it may be offered in a noisy form, etc.

In addition to such requirements specific to neuropsychological diagnostics, it, as a psychological diagnostic, is extended

CHAPTER 14. METHODS OF NEUROPSYCHOLOGICAL EXAMINATION

The system of rules for treating a subject or patient as an object of research is also changing: the individuality of the approach, the comprehensiveness and integrity of the coverage of the processes, functions and conditions being studied, the optimal choice of research strategy, adherence to ethical standards, etc. For example, examination of children should begin with an assessment of play activity and be carried out taking into account the age characteristics and interests of the child, in some cases the national characteristics and ethnic specificity of the culture of the subject must be taken into account.

14.2. BASIC TECHNIQUES OF NEUROPSYCHOLOGICAL DIAGNOSTICS

Below are examples of well-known neuropsychological diagnostic procedures that can assess various aspects of the connection between possible deviations of mental functions and options for their systemic dynamic localization in the human brain. The short lists of techniques proposed below cannot be considered as a research battery, but only as an illustration of a number of areas of neuropsychological diagnostics.

General description of the patient (according to Zh. M. Glozman)

During a standardized conversation with the patient, the state of three areas of mental functioning is assessed: orientation in place, time, details of one’s medical history; criticality; adequacy of behavior and emotional reactions in the examination situation. The presence or absence of the following symptoms is recorded:

□ violation of time orientation;

□ violation of orientation at the location;

□ defects in reproducing medical history and biographical data;

□ confabulation;

□ field behavior;

□ negativism;

□ reasoning;

□ violation of the sense of distance;

□ disinhibition, general agitation;

□ puerility, mannerism;

□ obsessiveness;

□ absence of active complaints;

BASICS OF NEUROPSYCHOLOGY

□ absence (reduction) of experiencing one’s defects, euphoria;

□ emotional lability;

□ violent emotional reactions: crying, laughing;

□ emotional dullness, indifference;

□ tension, confusion, anxiety.

Visual gnosis

Studies of this function suggest a differentiated approach to the nature of the stimulus material, which can probabilistically reflect various variants of the localization of the cortical lesion. The most common sign of “interest” in functional structures focused on complex forms of processing visual stimuli is defects in the recognition of real objects and their images. A sensitized version of such tests is the recognition of superimposed outlines of objects in various modifications of Poppelreiter pictures, isolating images from a noisy background (in this case, the density of “noise” can change arbitrarily) or recognizing objects with missing details. An indicator of varying depths of visual object agnosia can be not only a complete lack of recognition of real objects or their images, but also the fragmentation of their perception, or attempts to complement the whole by guess.

Special tasks in the neuropsychological diagnosis of visual gnosis are:

□ identification of color agnosia: for more severe disorders - identification of pure colors (red, blue, yellow, etc.), for which small sets of colored cards (5-8, for example, from the Luscher technique, colored pencils, etc.) can be used. P.); to diagnose less pronounced variants of color agnosia - special sets of color cards (for example, fragments from color albums), which allow, according to instructions, to select shades from pure tones, or to classify colors by shade, or to correctly name rarely encountered colors;

□ exclusion or confirmation of facial agnosia - recognition of familiar and unfamiliar faces, for which sets of small-sized portraits of outstanding and well-known domestic writers (Tolstoy, Gogol, etc.) are used, as well as photographs or two-color portraits of persons unknown to the test subject, presented to him as standards for memorization and further recognition among previously unpresented samples of similar stylistic design. The time of presentation of the standards can be varied, increasing or decreasing the sensitivity of a given sample;

□ exclusion or confirmation of optical-spatial agnosia (the ability to navigate in space relying on the visual analyzer) using a test, recognition of time on “schematic

clocks without numbers”, “blind” compasses, in the images of which only one part of the world is arbitrarily indicated (for example, southeast - SE) and an arrow, the direction of which requires identification, recognition of a rotated or inverted image of an everyday object. Research into this quality of gnostic functions can begin with asking the patient to orient himself in the real space where he is now (draw a plan of the department or apartment, tell how to get from this office to the exit, etc.), asking him to indicate which of the visible objects are closer or further away. This same group of methods includes drawing, according to instructions, simple geometric figures connected by spatial relationships (“a circle to the left of the square”, etc.).

In addition to those described above, studies of visual memory may involve the exclusion of the verbal factor, which mnemotechnically improves the test results. For a similar purpose, sets of non-verbalizable or semi-verbalizable graphic images (variably broken curves, amoeboid figures, etc.) are presented to the subject for memorization and further recognition among other images of the same set. A clear weakening of operations of this kind indicates disorders of the functioning of the temporo-parietal parts of the right hemisphere (in right-handed people). At the same time, the pathology of specific, in this case, visual mnestic functions is considered as an integral part of gnostic disorders, although formally it could be presented in the section of studies of memory pathology.

Similar classification contradictions may arise when studying such a complex disorder from the point of view of neuropsychological organization as agnostic alexia or letter agnosia, the structure of which contains both visual and speech components. Common tests aimed at diagnosing them include recognition of letters when they are presented autonomously and simple texts that include letters of different mixed styles (by size, slant, uppercase and lowercase, with varying weight, with and without serifs, etc.) .

Failure to recognize or mix up numbers, reflecting damage of an optical-gnostic nature, can be characterized as one of the prerequisites for acalculia caused by damage to the occipital-parietal parts of the left hemisphere.

The role of the simultaneous factor in visual perception can be assessed by recognizing and understanding the content of the plot picture, for which the patient needs to establish semantic connections between all its components and verbalize their general meaning through mental operations. As a rule, patients are offered copies of famous paintings by Russian authors, conventional and even schematic plot drawings as stimulus material. Another option for stimulus material is a series of paintings united by a common plot, which requires

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patient more active mental work to restore the subjectively justified and explainable course of events given by this series. Difficulties in forming visual representations, that is, recalling images stored in long-term specific memory, can also serve as the basis for judging a defect in visual gnosis. For such purposes, the patient or test subject is usually asked to imagine and describe several objects that are often encountered in everyday life (for example, a telephone, a chair, a cucumber, or others).

Acoustic gnosis

Studies of this function, in addition to relatively simple tests for memorizing and reproducing various rhythmic structures, tapped with palms or a pencil on the table (this test cannot be used if the patient has already registered perseverations that are not associated with “specific” disorders), assume the presence of sound-reproducing equipment, usually a tape recorder, on which complex acoustic stimuli can be recorded (the noise of a passing car, pouring water, the voices of animals and birds, etc.), or widely known and normally recognizable melodies (the first phrases of songs). Tests for the reproduction of sound rhythms can also be considered as examples of the study of a successive factor.

A significant role in the diagnosis of arrhythmia, auditory agnosia or amusia is played by the preservation of auditory attention, defects of which can lead to the rapid loss or confusion of the presented samples, to the loss of the meaning and significance of objective sounds. Research into pitch sensitivity is only possible using special equipment.

Somato-sensory gnosis

Thanks to the extremely complex and multimodal organization of the skin-kinesthetic analyzer, various techniques can be used to diagnose disorders on the part of its cortical component, the focus of which is determined by the specifics of possible clinical manifestations - both from the side of various qualitative components of symptoms and syndromes, and from the position of the height of the lesion of the parietal lobes .

To establish the most common form of somatosensory gnosis disorder - tactile agnosia - tests are used to palpate flat and three-dimensional objects with eyes closed. A variety of available materials can be used as stimuli - a key, glasses, small toys, profiles of geometric shapes that are easily recognizable by touch (square, circle, star), etc., specially cut out of plywood or thick cardboard. Preferably in sets presented for these

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The purpose of objects is to have such objects that, for a healthy person, differ noticeably in the nature (texture) of their surface.

To analyze the simpler components of somatosensory gnosis, touching various parts of the body is used with a request to the patient to determine the place of touch or the distance between the points of two simultaneous touches (for the second version of the test, a special compass is usually used, which allows one to quantify individual threshold values ​​and compare them with normative data for a specific area of ​​the body). If a person tends to ignore one of two simultaneous touches to symmetrical points on two hands, then this may indicate disorders of tactile simultaneous synthesis or disorders of corresponding specific attention.

If, during a clinical examination, conversation or requests to the patient to show parts of his own body or describe their location in space with his eyes closed, it turns out that such a task is impossible for him (this usually relates to the left half of the body), then we can talk about signs of autotopagnosia, caused by damage to the right superior parietal lobe of the brain.

Memory

Neuropsychological methods for studying memory involve two ultimate objectives of their application: identifying specific and nonspecific memory disorders. If the first ones are effectively assessed with tests that operate on the quality of the stimulus corresponding to the analyzer (visual, acoustic, tactile, etc.), then with regard to the second layer of mnestic processes there is no such certainty and their assessment can be made based on the aggregate results of several tests that leave no doubt about the level of damage functional structures of the brain. In any case, the presentation of material for memorization will be mediated by the operation of one or more analyzing systems.

In addition to information gleaned from a conversation with the patient, frequent and varied complaints about memory disorders (for example, such as Korsakov's syndrome), a quantitative assessment of the latter is usually made using tests for short-term or long-term voluntary memorization: increasing number series, sets of words, meaningless syllables, figures or objects, short stories, rhythms or musical passages, series of movements, etc. Some of these tests can be carried out in both visual and verbal-acoustic versions.

Disorders of the motivational component of memory associated with brain lesions are less amenable to instrumental fixation, and their analysis is based on observations of human behavior (for example, the number of uncompleted actions, correlation of intentions with results, etc.). It must be borne in mind that when studying this component of psychological

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In chemical activity, interpenetrating memory disorders and attention disorders are poorly differentiated from each other.

Reproduction of memorized material may be accompanied by phenomena that provide the experimenter with additional information about the degree and nature of brain damage. These include perseverations, replacement of forgotten elements based on external (including acoustic) similarity or semantic proximity, difficulties in reproducing sequences, etc. Research on involuntary memory, the role and importance of which is especially high in childhood, requires more formal assessment the fine organization of a diagnostic experiment, one of the varieties of which is one when the subject is asked to reproduce a fragment of stimulus material that is not specified in the instructions.

Attention

The most common methods for studying attention, adopted both in general psychology and in neuropsychology, are two blank methods: counting according to Kraepelin (the addition of pairs of vertically located numbers, the fundamental possibility of which must be confirmed by the integrity of calculation functions) and different versions of proofreading tests - with broken in different directions with rings (Landoldt), numbers, letters, geometric shapes or profile figures of animals (for children). What they have in common is the monotony of the operations performed, which can relatively quickly cause fatigue and provoke distractions to extraneous stimuli, and in some cases, manifestations of asthenia. The pace of work, fluctuations in stability, decrease in volume and disturbances in switchability of attention, studied with their help, make it possible to obtain a general picture of the mental process under consideration, expressed in quantitative criteria. Valuable information is contained in productivity curves that can be constructed for arbitrarily specified time periods of working with techniques (usually 30 or 60 s).

Schulte tables (“searching for numbers”) represent a more complex technique in terms of the required mental processes. In it, in addition to attention, a certain role is played by the nature of sensorimotor reactions and orienting-search movements of the gaze, the functional execution of which requires the coordinated work of many areas of the brain. Therefore, in addition to formally recording the time spent working with each table and the number of errors made, the experimenter is required to carefully observe the patient’s style of working with the technique - the presence of unexpected pauses, emotional reactions, opportunities to improve activity using loud speech, etc., as well as taking into account external motives or lack thereof.

To analyze modality-specific attention disorders that differ from gnostic disorders, tests with double stimulation are traditionally used, that is, the simultaneous presentation of two visual, two

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two or two tactile stimuli (E. D. Chomskaya), while one of the stimuli is ignored, which does not happen when they are presented successively.

In recent years, computer versions have begun to occupy a certain place among methods for studying attention, expanding the possibilities of presenting stimuli and equating the experimental procedure to a hardware one.

An instrumental study of emotions at the psychological level, due to their exceptional subjectivity, is one of the most difficult diagnostic procedures. As a rule, the subject of research is the adequacy of the emotional response to important stimuli that are well differentiated by sign by healthy subjects. The direct material presented to patients can be photographs or drawings of faces with positive or negative facial expressions, plot pictures in which a known affective background is obviously present or in which the emotional roles of the characters are sufficiently defined. Stimulus materials of projective procedures, for example, such as the Thematic Apperception Test (TAT), can also become a source for assessing emotional adequacy.

In addition to the verbal characteristics of the depicted emotions, the subject may be asked to identify his state with one of the characters or portraits, with emotionally charged phrases pre-recorded on a tape recorder. Some research works devoted to the neuropsychology of emotions use an indicator of the reaction time to emotionally significant words with any association or the productivity of memorizing emotionally significant words. A special direction in the diagnosis of emotions is represented by differentiation techniques that make it possible to clarify the connection between disorders of affective response and the lateralization of the lesion in the cortex of one of the hemispheres.

Thinking

The variety of diagnostic techniques that assess thought disorders in brain lesions is determined by the versatility of aspects of the most “intellectual” of the gnostic processes, the large number of its forms and component operations. Often the dominance of figurative or verbal-logical components in the stimulus material is the determining factor for judging the effectiveness of the functioning of the right or left hemisphere or their interaction.

Traditional tests that evaluate the qualitative and quantitative aspects of mental activity are: classification of understanding

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ties or images, the strategy of which, by its prerequisites, goes into the dominance of the left or right hemisphere; exclusion of a (superfluous) concept or image, which requires the operation of searching for a generalizing factor for some of the stimuli presented in the task; search for analogies, which involves the need to establish logical connections between the proposed pairs of concepts; understanding the meaning of stories, plot pictures, figurative meaning of proverbs, sayings, metaphors, morality of fables and humor. The results of the last series of tasks, in addition to the brain organization of mental operations themselves, bear the imprint of dependence on the level of education, characteristics of upbringing and social experience, which should be taken into account even before the start of the examination. In the same vein, it is necessary to interpret the patient’s understanding of the logic of sequential events, established by the ordering of an integral series of plot pictures.

The calculation function, due to its specificity, occupies a special place in the series of mental operations. Its instrumental implementation can be represented both by simple arithmetic examples and by quite complex mathematical problems with a detailed structure of conditions.

During the process of studying mental activity, a neuropsychologist must, in addition to quantitative parameters, also analyze the qualitative aspects of test execution - the presence of perseverations when performing counting operations, the need for external stimulation during aspontaneity in intellectual activity, the impossibility of organizing the execution of test tasks exactly as a program, etc.

Being largely a reflection of thought processes, speech in its implementation is determined by the work of many brain mechanisms, each link of which carries a relatively independent load. Due to this circumstance, outwardly similar manifestations of speech disorders (in particular, aphasia) may be a consequence of damage to different functional systems of the brain.

Differential diagnostic techniques, the significance of the results of which can play a role in attributing recorded symptoms to the syndrome of one or another form of aphasia, are the following: characteristics of spontaneous speech, which can be determined in a dialogical study using a series of standard questions (the goal is to assess speech activity, the decrease of which possible, for example, with dynamic aphasia); naming objects or object images, forgetting of which (but not distortion of the sound composition of the word) is likely in amnestic aphasia; tests for automated speech (pronunciation of such “patterns” as number series, days of the week, months, etc.), which are important for gross afferent motor aphasia; tests to understand the meaning of words (with the exception of

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alienation of the meaning of words), identified defects of which may indicate signs of receptive aphasia; tests that include complex turns of speech, reflecting various variants of spatio-temporal and other relationships between the concepts presented in the phrase (genitive case, earlier/later, above/under, inverted constructions, etc.), lack of understanding of which is typical of semantic aphasia.

Mental acts in the structure of which speech plays a leading role include writing and reading. Disorders detected in their framework include graphic and alexical errors detected during appropriate tests, literal or verbal paragraphs, reading by “guess,” paralexia, jumping the gaze from one section of text to another or ignoring one half of the visual field (text). As mentioned above, one of the sensitive tests for assessing the ability to process written speech information is a test for reading text (or classifying letters) written in different fonts. An important differentiating procedure for analyzing the patient’s ability to fundamentally understand at the verbal level (but not acoustically perform what is understood) is to lay out captions under the plot pictures. Dictation and naming of shown objects are widely used.

None of the neuropsychological tests for speech disorders, taken out of the context of the entire complex of studies, can serve as a basis for making a particular diagnosis.

A complete list of methods for studying speech function, reduced to a special rating scale, as well as quantitatively assessed patterns of symptoms with scores for various forms of aphasia, are given by L. I. Wasserman et al. (1997). Quantitative criteria for specific speech tests were developed by Zh. M. Glozman (1999).

Praxis and affirmative action

Motor or behavioral activity of a person is the final effect of all mental processes occurring in the human brain and body. Therefore, in a broad sense, any systematic deviation from the norm in actions or behavior can be interpreted as a disruption in the functioning of some part of the central or peripheral nervous system. At the same time, this gives rise to an infinite variety of symptomatic manifestations, the inclusion of which in a psychotic, neurotic, neurological or other context confronts the researcher with the task of differentiating the random and the typical, specific to a particular nosological form or dispersed in a wide layer of pathology. In neuropsychological terms, we are usually talking about ways to reduce the recorded motor or behavioral pathology to one form or another of apraxia.

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The most general praxis of posture can be assessed by the patient repeating the body and limb poses that the researcher assumes (in dynamics, these are Head tests for spatial organization of movements), or by repeating the postures of the fingers. Reciprocal hand coordination is established by the Ozeretsky test: simultaneous tapping on the table with the right palm clenched into a fist and the left palm open, and then vice versa. The insufficiency of the successivity factor can be noticed when the patient is asked to repeat serial movements of the “fist-rib-palm” type.