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Alexia, agraphia, acalculia and amnesia

Alexia is an acquired reading disorder that in most cases can be considered a consequence of aphasia. With relatively mild manifestations of aphasia, reading is possible, but there are omissions and rearrangements of letters (literal paralexia), omissions and substitutions of words (verbal paralexia), and misunderstanding of what is read. In severe cases of aphasia, reading both aloud and silently becomes impossible.

Alexia in combination with agraphia in the absence of aphotic disorders may be a consequence of one of the variants of visual agnosia, known as letter agnosia. It occurs when the cortex of the posterior part of the angular gyrus of the parietal lobe (field 39) of the dominant hemisphere is damaged, while the patient does not recognize letters when reading and writing or makes mistakes when differentiating letters with similar designs (I-N-P, 3-E, Sh -Shch-1D, etc.). There may also be a disorder in the adequate perception of numbers and musical notes. This form of pathology is known as optical, or parietal, aphasia. It was described in 1919 by the Austrian psychiatrist O. Potzl (Potzl O., 1877-1962).

Alexia without agraphia is extremely rare, in which the pathological focus is located in the cortex of the medial part of the occipital lobe and in the splenium corpus callosum. Alexia in such cases is accompanied by right-sided hemianopsia and color agnosia.

Agraphia

Agraphia is an acquired impairment of the ability to write correctly in form and meaning while maintaining the necessary motor functions. Usually combined with aphasia (except in cases of letter agnosia) and alexia. With severe manifestations of aphasia, the patient is not able to write at all; in milder cases, writing is possible, but literal and verbal paragraphs are identified, manifested by substitutions, omissions, and rearrangements of letters and words. Sometimes, usually with damage to the posterior parts of the middle frontal gyrus of the left hemisphere (field 6), isolated agraphia is noted.

Acalculia

With damage to the posterior parts of the parietotemporal region of the dominant hemisphere, acalculia is possible - a violation of the ability to carry out counting operations, especially those based on internal spatial schemes, in particular operating multi-digit numbers, in which the meaning of each digit is determined by its digit. Acalculia is often combined with semantic aphasia and optical alexia. Described by the Swedish pathologist F. Henschen (born in 1881).

Amnesia

Memory is complex mental process, characterized by fixation, consolidation (consolidation), preservation and subsequent extraction and reproduction of unconscious information and perceptions, ideas, and thoughts arising on its basis. Memory provides the opportunity to accumulate experience and knowledge, and contributes to the understanding of newly received information by comparing it with previously acquired information. It allows you to place all events along the time axis.

There are different types of memory: short-term (operative, fixation) and long-term, mechanical and logical (semantic), voluntary and emotional.

Memory disorder - hypomnesia or amnesia (Gren, amnesia - forgetfulness, memory loss) - a violation of one or another link in the process called memory, or all its constituent elements.

It manifests itself, in particular, in Korsakoff syndrome, described in 1889 by S.S. Korsakov in patients with alcoholism. With this syndrome, as S.S. wrote. Korsakov, “the memory of the recent is almost exclusively upset, while impressions of the past are remembered quite well.” In such cases, current information is usually stored for 2 minutes, after which it is “erased”.

There may also be disturbances in the retention of previously acquired information or its recall, retrieval, as well as the sense of time and order of past events, associated with this confabulation (replacement of memory lapses with fiction, which the patient himself perceives as a probable fact), paramnesia (a generalized name for false memories and memory lapses ).

Amnesia usually occurs with damage to the mediobasal hemispheres big brain, especially the parahippocampus and other structures that make up the hippocampal circle, or the circle of Peipitz, which also includes the fornix, the medial structures of the thalamus and the mammillary body. Understanding how it is possible to store information in memory and retrieve it has not yet been achieved. It is assumed that the place of long-term storage of information is the protein molecules of brain cells, possibly glial cells, most likely astrocytes.

Global memory disorders are modality-nonspecific. Modality-specific forms of amnesia are also possible. The main ones are visual (figurative, iconic) and auditory amnesia, with the first of them the patient is unable to imagine a visual image of a person or object, with the second - to retain sounds, intonation, and melody in memory.

Variants of memory impairment are retrograde and antegrade amnesia, which often appear after traumatic brain injury. Retrograde amnesia is amnesia that precedes an event, antegrade amnesia is a memory disorder that manifests itself after an event. The event that causes these disorders is usually a traumatic brain injury accompanied by loss of consciousness. Anterograde amnesia is a combination of retro- and antegrade forms of memory impairment. Episodic (periodic) amnesia is also possible.

Chronic, progressive memory loss can be combined with manifestations of dementia. This combination is typical for toxic and dyscirculatory encephalopathy, presenile and senile psychoses, in particular in Alzheimer's and Pick's diseases (see Chapter 26).

Acalculia refers to diseases resulting from damage to certain areas of the cerebral cortex. A feature of the disease is impaired ability to perform computations, lack of understanding of the bit structure of numbers and arithmetic operations.

Patients often confuse visually similar numbers, for example, 416 and 614, and have difficulty counting. Depending on the type, the disease can act as a single symptom or be part of the structure of neuropsychological syndromes. The disease often develops due to traumatic brain injury.

Neuropsychological aspects of the syndrome

The disease was first mentioned by psychiatrist F. Henschen in 1919. Thanks to his research on violations of the analysis and synthesis of computational operations, the scientist identified two main types of acalculia:

• primary;
• secondary.

The primary form of the syndrome is observed when the parietal, occipital and temporal areas of the cortex are affected. A feature of this type of disease is a violation of the analysis and synthesis of spatial representations. It becomes quite difficult for the patient to distinguish numbers and carry out computational manipulations with them. An interesting fact is that violation of counting operations is often combined with a lack of understanding of the differences between “left” and “right”, “up” and “down”, “behind” and “in front”.

The most significant disturbances in the primary form of the syndrome are observed in children. The formation of the parts of the brain responsible for the concept of space may not occur by the time the child enters school. In such cases, in the first year of study, difficulties may arise in understanding numbers and arithmetic operations.

The main symptoms of the primary form of the disease:

• lack of understanding of the difference between numbers, for example, the numbers 245 and 254 seem the same to the patient;
• inability to distinguish place value structures of numbers;
• violation of the concept of spatial coordinates;
• difficulties with arithmetic operations;
• lack of concept of numbers;
• violation of the concept of “more” - “less”.

When the parietal region is damaged, difficulties are observed in analyzing the differences between numbers. It is quite difficult for patients to evaluate numbers that contain the number “zero”, for example, they understand 2050 as 250. They also have difficulty understanding which number is greater and which is less, so 300 may be less than 500. The primary form of the disease leads to a disorder objective digit assessment of numbers. The patient perceives a number in the form of an object, for example, 10 houses, 50 kopecks, etc. With this disease, the understanding of all computational operations suffers; only in rare cases does adding numbers remain possible. Most challenging task for patients is to perform a subtraction operation, especially if the numbers differ from each other by ten. Sometimes the primary form of acalculia occurs in combination with speech impairment.

When the frontal region of the brain is damaged, patients are able to perform basic arithmetic calculations and understand the principle of number digits. However, certain difficulties arise when manipulating more complex numbers and actions.

The secondary form of the disease occurs against the background of already existing neuropsychological syndromes. This form of acalculia is associated with lesions of the following parts of the brain:

• occipital;
• temporal;
• prefrontal.

When the occipital region is affected, a disturbance in the visual perception of numbers is observed; as a rule, the secondary form of the disease occurs against the background of alexia and optical agnosia. The patient cannot visually distinguish numbers with similar spellings, although the place value concept of numbers is often intact. Quite often, this syndrome occurs in combination with amnesia for the names of numbers.

If the temporal region of the cerebral cortex is affected, the patient has a defect in the auditory perception of numbers. Mainly found in acoustic-mnestic and. Damage to the prefrontal areas indicates impairment in the understanding of arithmetic operations. This syndrome is usually observed when the dominant hemisphere of the brain is affected. For left-handed people, the predominant right hemisphere, for right-handed people – left.

Restoring the concepts of number and counting in patients with acalculia

Therapy for the syndrome should be aimed primarily at eliminating the underlying disease (trauma, tumor). Restoration of computing abilities is carried out depending on the form of the syndrome. The disease is treated by psychiatrists, neuropsychologists, defectologists, and clinical psychologists.

The main goal of therapy for the primary form of the syndrome is to restore the concept of number and its digit structure. Let's consider the main methods of training and rehabilitation of patients:

• visual method;
• method of working with numbers;
• a method of understanding the digits of numbers.

In severe forms of the disease, special learning methods based on visual memory are used. So, for example, cards with numbers and images of objects corresponding in number are laid out in a row in front of the patient. For children to be more effective, this method can be carried out in a playful way. So, for example, the number 2 is depicted on the card, and under it there are two balls; preferably, all objects should be bright and varied in color scheme, since color plays a big role in perception and memory.

The method of working with numbers is based on the fact that the patient needs to break any number into all possible variations. This exercise is carried out using chopsticks: the patient is told a number and asked to break it down into numbers; all manipulations are recorded in a diary. Thus, the patient is asked to break the number 5 into all possible variations using sticks: 1 p. + + 4 p. = 5; 2p. + 3p. = 5p. etc. If over time the patient begins to make progress, verbal commentary on arithmetic operations is used instead of sticks. In other words, all counting operations are spoken out loud, then in a whisper, and so the patient is led to try to count in his head.

Often, difficulties with analyzing the digits of numbers occur in combination with a violation of their names. All numbers up to 100 are spoken out to patients, thereby the defectologist explains the difference between tens and ones. Also used special exercises, in which the patient must write the names of numbers under the words, so under the word “two hundred forty-five” you must put “245”, etc.

The visual-figurative nature of the classes is carried out 2 to 3 times, then patients gradually switch to vocal voicing of computational operations. As a rule, mild stages of acalculia in adult patients are easier to correct than in children.

Restoration of counting and numerical concepts in secondary forms of the syndrome depends on the location of the brain lesion.

For occipital lesions of the secondary form of the disease, correction should be aimed at the visual features of numbers and correct spelling. Among the main methods used: subject counting, manipulation with numbers and tasks, exercise with motor image of number, etc. The method of voicing numbers is quite effective, in which the patient must imagine the number in his mind; this exercise relies on intact auditory perception, imagination and visual memory.

When the temporal regions are damaged, there is a decrease in the auditory perception of numbers, which is not such a significant disorder and often does not require specialized therapeutic recovery.

Patients with prefrontal lesions initially learn a simple understanding of numbers, gradually moving on to arithmetic exercises where numbers act as objects. Next, the defectologist transfers the patient to arithmetic examples with sequential actions.

Manipulating objects along with numbers allows the patient to analyze arithmetic operations not only with the help of the usual object characteristics, but also with an objective digit understanding of number. Thus, with the help of interiorization, that is, the transition from external actions to the internal program of consciousness, the patient moves from the primary objective assessment to a spatial, categorical characteristic. Gradual learning promotes effective recovery understanding and manipulating numbers.

This disorder is acquired; acalculia is expressed in a malfunction of the brain. In this case, the patient has difficulty performing the simplest mathematical problems, for example, subtraction and addition, difficult multiplication, comparison prime numbers. Acalculia differs from dyscalculia in that it is acquired by the patient during life, as the person receives neurological injuries, and this is especially true for stroke. As for dyscalculia, it occurs in children with impaired brain development during the acquisition of mathematical knowledge. That is, the child is practically deprived of the opportunity to receive such knowledge.

As is known, the ability to count is the integration of several different cognitive skills. A person suffering from acalculia experiences significant difficulties in four areas. The same can be said for people with dyscalculia. One area is understanding what each number is, what it represents, immediately registering that meaning in the mind. Another area to consider is number comparison, that is, understanding a numerical value in relation to another number. The association of the number designation with the name pronounced orally is also important. Basically, acalculia is related to damage to the frontal and parietal lobes, often representing early sign dementia.

In rare cases, acalculia can be observed as a single disease; most often, the disease is detected as a whole series of diseases. In this case, we can call agnosia, agraphia, and sometimes even aphasia. A person suffering from acalculia, or having dyscalculia, generally lives a full life normal life. They have problems when they have to calculate something in their head.

basis this violation There are various mechanisms, and the main determining factor is the violation of counting operations. It all depends on where the lesion is located. It is known that if the disorder occurs in the left hemisphere, the occipito-parietal regions are affected, or there is a bilateral focus, then primary acalculia occurs. If the occipital region is affected, the optical image of the number disappears, and the number ceases to be a sign for the patient, reflecting a specific quantity. A person does not recognize numbers well; in his perception they are mixed. This is especially true for those that are close in design, for example, six and nine.

Experts note that such a disorder is optical-gnostic in nature, therefore there is a similarity with optical alexia, or a combination of both is observed. Another type of acalculia is based on an impaired representation of the perception of numbers in space. For example, seeing a multi-digit number, a person can read it as individual numbers. Problems also arise with multi-digit numbers containing same numbers. For example, the numbers one hundred eighty-seven and seven hundred eighty-one may seem the same. In addition, a major difficulty with acalculia is the evaluation and recognition of elements contained in Roman numerals. Patients are unable to identify the difference, evaluate them incorrectly, or simply confuse them.

When writing Roman numerals, the same errors occur. According to scientists, the basis for this manifestation of acalculia is the presence of general apraktoagnostic disorders, which are typical for the left hemisphere of the parietal lobe.

Features of types of acalculia

The third type of acalculia deserves special attention. It is related to the violation of counting described above, but at the same time it can also arise in the case when the meaning of simple number symbols is preserved. In this case, the patient loses the ability to perform simple arithmetic operations; it is difficult for him to perform basic mental calculations. The most serious violations are observed if the patient conducts counting operations that go to tens. Also, a person cannot count in columns; operations with fractions are extremely difficult for him.

Secondary acalculia is detected in aphasia various forms, and it is closely related to speech disorders. Treatment of acalculia, primary and secondary type First of all, it means eliminating the patient’s underlying disease. Reasons for the violation brain activity always different. These are hemorrhages traumatic lesions, neoplasms. To choose the right therapy, a consultation with a neuropsychologist is required.

In case of acalculia, corrective action should begin without delay, especially if the problem arose after a stroke or injury. With an early start of rehabilitation training, it is possible to prevent the occurrence of a number of complications and prevent pathological condition speech symptoms. In particular, this refers to agrammatism, paraphasia, speech embolus. The work of a speech therapist for acalculia can last up to three years.

Prevention of disease

To overcome acalculia, a neuropsychologist and speech therapist carry out labor-intensive and lengthy work with the patient. The attending physician must cooperate not only directly with the patient, but also with his relatives. The sooner you start similar treatment, the better the prognosis for recovery, which is determined by the size of the affected area. In addition, a significant role is played by the patient’s age and the degree of speech disorder. It is known that patients young demonstrate better dynamics. In addition, if the disease occurs at a young age, then a gross violation may subsequently occur. speech development, since acalculia is often combined with aphasia.

Preventive measures primarily involve preventing brain injuries, to prevent vascular accidents. If tumors are present, they must be identified immediately. Acalculia can be treated if you address this problem in a timely manner without delaying a visit to a specialist.

AKALKULIA - from Greek. a - negative particle + lat. calculatio - counting, calculation. Author. S. E. Henschen (1919). Neuropsychological disorder. Characterized by violation of counting operations.

Kinds: - primary acalculia as a symptom independent of other disorders of higher mental functions, it is observed with damage to the parieto-occipital-temporal cortex of the left hemisphere and represents a violation of the understanding of spatial relationships, the transition through ten associated with the bit structure of a number, non-discrimination of arithmetic signs, etc.;

- secondary acalculia, included in the structure of one or another neuropsychological syndrome, can occur with damage to the temporal cortex cerebral hemispheres, when oral counting is impaired, the occipital regions, when numbers similar in spelling cannot be distinguished, and the prefrontal regions, when purposeful activity, planning of counting operations and control over their implementation are impaired.

Text of dictionary entries I.M. Kondakov “Psychological Dictionary” Copyright © 2004-2006 LANI, SPIIRAN Copyright © 2004-2006 ExOS group Design - Z-Vector http://vocabulary.ru/dictionary/487/word/

· DYSCALCULIA http://vocabulary.ru/dictionary/487/word/

Inability INABILITY In general, any lack of ability to perform some function. This term may be used... to education in which a childCHILD A person aged: 1. From birth to adulthood. 2. From birth to puberty. 3. Agree... of average or above average intelligence has excessive difficulty learning basic arithmetic. Should be distinguished from acalculia. See arithmetic disorder DISORDER - 1. Violation of the structure, order of constructing something. 2. Causing damage to anything; violation of developmental pores.

ARITHMETIC DISORDER, AGE

Syndrome name SYNDROME A group of SIGNS and SYMPTOMS that usually appear together. The syndrome itself is not...characterized by the fact that the child is a CHILD person aged: 1. From birth to adulthood. 2. From birth to puberty. 3. Agree... shows significantly lower success SUCCESS 1. Execution, goal achievement. 2. See achievement level. in arithmetic, than would be expected based on standardized tests, age AGE - in psychology - a category meaning a qualitatively specific stage of development of ontogenetic..., school, coefficient COEFFICIENT - 1. In mathematics - usually a constant or known quantity that serves as a multiplier for another, customs... intelligence, etc. (Oxford Explanatory Dictionary of Psychology / Edited by A. Reber, 2002)

5. Principles of teaching mathematics to students with speech disorders

PRINCIPLES OF RESTORATIVE LEARNING

1. Neuropsychological qualificationQUALIFICATION - 1) the degree and type of professional training (preparedness) of the individual, whether he has knowledge ... of the defect,

2. Reliance on preserved forms of activity,

3. External programming of the restored function.

4. Reliance on the patient’s personality, taking into account his knowledge, intellectual experience,

5. The principle of interaction and mutual influence between the teacher and the student.

"2.1. Optical acalculia 12

Impairment and restoration of counting functionwith damage to the occipital cortex

Among the nonspecific forms of acalculia, we note four forms - sensory, acustic-mnestic, optical and conditional frontal, in which the counting is violated, but not primarily, but due to secondary mechanisms of violation.

Diagnosisoptical acalculia associated with a number of difficulties. Firstly, it can be confused with primary - spatial - acalculia; secondly, optical acalculia rarely occurs in its pure form, but more often occurs as optical-spatial, which in its clinical picture is close to primary acalculia, but is based on more complex mixed mechanisms. ...

Optical acalculia occurs when the occipital regions of both the left (more often) and right hemispheres are damaged. In case of defeat occipital brain systems there is no such gross disintegration of the concept of number; awareness of the connections and relationships of numbers is maintained; Counting operations are also less affected. In this form of acalculia, the main defects in the process of number perception are optical and sometimes optical-spatial disorders, and therefore this group patients experience specific difficulties associated with differentiated perception of the optical structure of a number, i.e. they cannot evaluate the meaning and name numbers (numbers - S. Ts.) that are similar in their design (cf.: Zi8,7i1,2i8,4i1, etc.). There are often defects in optical recognition of numbers (recording numbers - S. Ts.), which differ from each other only in the spatial arrangement of individual elements (cf.: 6 and 9, 3 and 5, 66 and 96, etc.), and defects in evaluation of numbers indicated by Roman numerals (cf.: IX and XI, IV and VI, etc.). This form of acalculia usually occurs in the syndrome of optical object agnosia and less often - optical-spatial agnosia.

If, along with purely optical defects, optical-spatial errors, albeit insignificant, are detected (in the estimation of numbers, the values ​​of which differ only in the spatial arrangement of the elements: 3 and 5, 6 and 9, XI and IX, etc.; in counting operations - errors in spatial origin; or when given a task, arrange a series of numbers sequentially from left to right (1, 2, 3, etc.) and, conversely, from right to left (9, 8, etc.) - errors or delays in completing the task), then in these cases, there is not pure optical, secondary acalculia, but mixed - optical-spatial. With this form of acalculia, there are no gross primary defects in the concept of number, its psychological content, spatial defects in counting numbers in numerical operations (calculations - S. Ts.), but, nevertheless, these symptoms are possible, and then acalculia takes on a complex complex form. ... All this requires a different methodological approach to restorative and formative education.

A different picture is found in children with damage or underdevelopment of the occipital areas of the brain. As a rule, this group of children exhibits gross violations of object gnosis, defects in actions with objects, understanding of the surrounding objective world, and speech disorders. In this syndrome, secondary violations of counting and counting operations will occur, caused by the described defects, as well as a violation of ID (ID - intellectual activity) in the level of general behavior, immature personality, etc. Therefore methods for restoring counting in children are fundamentally different from methods for teaching counting in adult patients with local brain lesions. (emphasis added by us - S. Ts.)

To summarize, we note the following.

Clinical picture characterized by difficulties in differentiating, assessing and naming numbers and figures that are similar in configuration. This defect leads to difficulties in numerical operations (calculations - S. Ts.). Sometimes optical difficulties in recognizing digits and numbers are complicated by defects in the spatial perception of numbers and their evaluation.

Neuropsychological picture. Here, the syndrome of optical disorders comes first - optical agnosia, agraphia, alexia, as well as symptoms of optical alienation of the meaning and meaning of a number. Main Factor counting disorders - a violation of differentiated visual perception of numbers. In this case, the following are most often found: symptoms: impairment of number and number recognition; difficulties in differentiating numbers that are similar in configuration; replacing one digit with a similar one; defects in isolating essential features of a figure; equalizing the characteristics of similar numbers (example: two numbers are given - 3 and 8 - and to the question: “What is the distinctive feature of the number 3 and the number 8?” the patient answers: “They are the same”). Alienation of the meaning of a number, its misrecognition, arises due to defects in visual perception and identification of essential features. Optical acalculia syndrome includes both a violation of the naming of digits and numbers (secondary), and a violation of numeral (counting) operations due to these defects.

Psychological picture. This form of acalculia is a consequence of a disturbance in the processes of visual (visuo-spatial) perception. In this case it is violated image of number perception, but its image-representation remains. Alienation of the meaning of a number and naming errors arise due to defects in isolating its essential features while maintaining the global perception of the perceptual image and the image-representation of the number.

The described picture of optical acalculia, its syndrome, symptoms and mechanism of the disorder allowed us to develop methods for counting restoration that are adequate to the mechanism of the defect, the main idea of ​​which is rational restorative training.

The Science of Restorative Education

Restorative training is based on a number of important principles developed by domestic psychologists and neuropsychologists. Training should take into account the different structure of the HMF disorder, including counting, and its dependence on the topic of brain damage and the factor that underlies the disorder. In this regard, a differentiated approach to restoring affected functions is necessary.

When starting training, you should:

1. Study the defect - its mechanism (factor); for this he is qualified, i.e. the factor and the primary, central defect are isolated on the basis of a neuropsychological - qualitative analysis of the defect. A simple description of the clinical picture of the disorder will not help much here.

2. Find that link in the psychological structure of the process that turned out to be broken. To do this, you need to know the normal structure of the process, which will allow you to identify the link that needs to be restored, and those preserved links in the structure of the account or counting operations that can and should be relied upon in training.

3. Know the genesis of the account and counting operations, the process of their formation, interaction with other financial institutions. The support for learning should be those HMFs with which the counting function interacts both in ontogenesis and in the process of its implementation. Thus, success in overcoming a defect in the level of visual perception of numbers can be achieved if we include in the system of sign (number) recognition kinesthetic motor sensations, which once (in ontogenesis) took part in the formation of the concept of number in a child and went into the reserve fund of afferentations in an adult , or include the number being studied in an arithmetic operation, or in the operation of ordinal counting, etc. Reliance on the preserved components of the counting structure, on material and materialized forms of action, the widespread use of preserved and most strengthened forms of activity in past experience are the most important principles of rehabilitation training for patients with local brain lesions.

4. Use such an important principle of restorative (or formative in children) education as relying on the personality of the patient, taking into account his knowledge, intellectual experience, and relying on his emotional-volitional processes. Successful restoration of functions is possible only by influencing the patient’s personality, his motives, interests, and it is necessary, first of all, to “... restore activity and direct his activity” 1. Since all HMF, including counting, are formed in objective activities, and the assimilation of knowledge and skills occurs through the subject’s own activities, during rehabilitation training it is necessary to rely on the principles of organizing the activities of patients, objective activities.

This is especially important when the patient’s activity is impaired (or not formed) and needs to be organized. Organization of activities patients - adults and children - is one of the most important principles of rehabilitation education.

In order to organize activities and intensify them, it is recommended to use a very effective programmed learning method, those. learning, which is controlled externally through the interaction of two or three or more people. Programs are a series of sequentially executed operations. The operations are written down on a card lying in front of the patient, or are sequentially spoken to the patient by the teacher. The implementation of these operations leads to the restoration of the broken link in the account structure, and subsequent work with programs is reduced in the composition of operations, moving from the material (subject) level to the internal level of execution “in the mind.” At the end of training according to the programs, the patient performs the impaired action independently. The psychological essence of such programs lies in the fact that they reveal the content of the patient’s activity (or actions), i.e. answer the question What do we have to do(to, for example, identify a number, or name it, or carry out an arithmetic operation) and indicate the path and methods, answering the question - how to do it. Another important principle used in remedial training is the principle of interaction and mutual influence between teacher and student. The best results of restorative training are achieved when “dividing the affected function into two” (and in group classes for 3 - 5 people).

We emphasize that targeted remedial training must be preceded by a detailed study of the structure of the defective function.

Methods of restorative learning to count with optical acalculia 13

The central task of teaching counting and counting operations during optical calculus is restoration of clear and differentiated perception of the configuration (form) of a number and its recording, generalization and constancy of the perception of a number, restoration of the image-representation of a number and numbers. To do this, it is recommended to use the methods we have developed, which are based on intact proprioceptive and kinesthetic sensations, on the motor basis of writing numbers, on actions with numbers and numbers.

With all forms of acalculia, it is necessary to begin work with practical actions with objects, designating their quantities, and only after that proceed to actions with numbers and numbers. The following methods are very effective.

Subject counting method which consists in counting all the objects lying on the table or in the room, and counting their total number, after which the corresponding number is found (among those written on the cards) and written down.

Method of operating with numbers (digits), consisting in performing ordinal counting based on written numbers, compiling a given number from numbers written on cards, etc.

Problem solving method, which consists in giving simple problems like “The housewife bought 3 kg of fruits and 2 kg of vegetables. How many kg did the hostess buy? Gradually the tasks need to be made more difficult.

In the listed and some other methods, the figure and number are the subject of action with them. The psychological essence of these methods lies in the fact that the subject (object) of attention here is not a figure or number, but action recalculation, counting, adding (or subtracting) objects, etc. It is useful to use these methods not only at the beginning of training, but in every lesson throughout the entire training period. The main characteristic of these methods - action, activity with numbers - must be preserved, and tasks must change and become more complex in the process of progress in learning. Let us dwell on the analysis of specific methods.

Method of motor (motor) image of a number. Procedure (operation program): the name of the number is pronounced out loud; required: a) quickly “write” it in the air with your hand (motor memory, motor image of a number) with your eyes closed; b) find this number among the three numbers lying on the table - with your eyes closed, by touch; c) feel it; d) name; d) write off; e) write from memory. Long-term work on the sequential execution of all operations of this program allows you to restore the effect of recognizing and naming numbers. Gradually, the number of operations decreases, the action of recognizing a number becomes more abbreviated and less arbitrary due to the internalization of some operations.

This method and a number of others similar to it are based on the joint work and interaction of the kinesthetic, auditory, visual analyzers and use an arbitrary level of speech (verbal form of recording operations, naming a number, perceiving its name by ear). Afferentations from this system of analyzers in the process of performing operations occur in response to these stimuli and create a new functional system for the perception and recognition of numbers. Thus, this method uses a number of supports on intact analyzers in order to create a new functional system, as well as to transfer action to the most strengthened and involuntary levels (motor image, etc.) and voluntary speech.

Digit reconstruction method includes techniques for actually reconstructing a given digit and obtaining a number of other digits from it. For example, the number “3” and a number of elements are given (semicircles, circles, sticks, etc.); The task is to complete a given number first to any number, and later to a specific, given one. This system of techniques ends with a verbal comparative analysis of the structure of the resulting and original digits (a general description of the configuration of the compared digits, including highlighting similarities and differences, highlighting the essential element in each digit). The proven methods for identifying numbers are fixed in such exercises, as a digital dictation of signs that are close and distant in optical image, emphasizing the common and different in given numbers, recognizing a number by feeling, naming and writing a given number (digit), including worked numbers in subject counting operations and other actions.

Number construction method differs from the previous one (reconstruction method) in that the patient is offered various elements from which he needs to construct a number: either according to a model, or according to speech - according to the word name of the number, and subsequently - according to his own choice, i.e. according to the image-representation. In the latter case, the task is to construct a number from elements cut out of wood, plastic, cardboard (the texture and shape of which should be clearly felt by the hand). After completing the task, the correctness of execution is monitored, a comparative verbal analysis of the constructed figure is carried out by answering the questions: what other figure is it similar / dissimilar to and why?

Often defects in optical number perception are accompanied by amnesia for their names. In these cases, the training should include support for speech - use children's poems and songs preserved in the speech experience of patients, in which there are names of numbers: “One, two, three, four, five, the bunny went out for a walk”, “One, two, three , four, five, I’m going to look.” Reading poems or singing songs is accompanied by corresponding numbers. The dates of national holidays are used very successfully (“May 1 is our great holiday,” “September 1 is for school, kids,” “March 8 is a special day,” etc.).

… Method of playing digital lotto. The program that implements the method consists of the following operations: numbers and figures are spoken aloud; the patient carries out: a) searching for the heard number (with eyes closed) by feeling and choosing the required number from the three given to him; b) search for the corresponding cell (correlating the auditory image of the number with the visual one). At first the game is played on a small volume (one card) and each time with a choice of only three chips, later the volume increases.

(a + lat. calculo - to count) is presented in the form of a neuropsychological symptom, the peculiarity of which is the loss of the ability to perform arithmetic operations due to lesions of the cerebral cortex. A synonym for acalculia is dyscalculia.

Patients lack the ability to compare numbers, subtract and add them, and solve basic mathematical problems.

• association of number and its spoken name;
• comparison of numbers with different numerical values;
• registering the meaning of a number in the mind and understanding its essence;

The symptoms of acalculia are often a precursor to dementia, the cause of which is the presence of lesions in the frontal or parietal lobe of the brain.

Classification

Acalculia, as a term, was discovered in 1919 by F. Henschen. Research activities about the violation of the synthesis and analysis of computational operations made it possible to distinguish two types of pathology - primary and secondary.

1. Primary acalculia is the result of disturbances in the temporal, occipital and parietal cortex. Key Feature is a violation of the synthesis and analysis of spatial representations. The patient has difficulty performing computational processes and distinguishing numbers. In the vast majority of cases, the patient does not understand the difference between concepts such as front and back, down and up, right and left.
2. Secondary acalculia is the result of existing syndromes of a neuropsychological nature.

Symptoms

It is in children that the primary form of the pathology in question manifests itself most clearly. By the time a young patient enters school, the parts of the brain responsible for understanding spatial phenomena may not have had time to develop. The result is a challenge in understanding arithmetic operations and the meaning of numbers in the first year. The following symptoms are also observed.

Manifestations of the primary form:

• the concept of more is less in relation to arithmetic operations is violated;
• the concept of numbers is missing;
• arithmetic operations are carried out problematically;
• the concept of spatial coordinates is violated;
• there is no difference in the bit structures of numbers;
• there is no understanding of the difference between numbers if the parietal region is affected;
• difficulties in evaluating arithmetic objects containing the number zero;
• figurative perception of a number in the form of an object, for example, 50 roses, 10 hryvnia;
• occasionally there remains the possibility of addition;
• serious problems in the process of subtraction, especially if you have to work with numbers separated by ten;
• Acalculia in this form is rarely combined with speech disorders.

If this pathology is the result of damage to the frontal part of the brain, the patient understands the principle of numerical digits, basic arithmetic calculations are available to him. More complex actions and manipulations cause serious difficulties.

Symptoms of the secondary form

The secondary form is caused by lesions in the prefrontal, temporal or occipital regions of the brain.

1. Problems in the occipital region lead to impaired visual perception of numbers. The underlying disease may be optical agnosia or alexia. The patient may not be able to distinguish numbers that are similar in spelling visually; their place value understanding of numbers is retained. Often such problems are accompanied by amnesia for the names of numbers.
2. A defect in auditory understanding of numbers is observed with damage to the temporal cortex. The main disease is sensory or acoustic-mnestic aphasia.
3. Problems in the prefrontal area lead to impaired understanding of arithmetic operations. The dominant hemisphere is most often affected. For right-handers, it is the left hemisphere, and for left-handers, it is the right.

Treatment

Acalculia requires therapy based on eliminating the underlying cause. The form of the syndrome directly affects how computational abilities are restored. Responsibility for this lies with clinical psychologists, speech pathologists, neuropsychologists and psychiatrists.

Therapy of the primary form

In this case, the key goal is to restore understanding of numbers and their place value structure. Among the most effective methods the following:

• method of understanding digits;
• method of working with numbers;
• visual method.

Special techniques based on visual memory are usually used in severe forms of the disease. These can be cards laid out in a row in front of the patient with the image of the number of objects and the corresponding numbers.

The game form in the case of children brings a more tangible effect. For example, under the number 4 there will be 4 books on the card.

The color scheme of objects should be bright and varied, since color plays an important role in the process of memorization and perception.

The essence of the method of working with numbers is the need for the patient to break any number into the maximum possible variations. Sticks are great for this exercise. For example, the patient is asked to break the number 7 into possible variations.

All completed actions must be recorded in a diary. Over time, the sticks can be disposed of and replaced with verbal commentary on the arithmetic operation if the patient makes progress. All counting operations will need to be spoken out loud, then you can switch to a whisper, and as a result, the person learns to count in his head.

If the inability to analyze the digits of numbers is accompanied by a violation of their names, it is important to pronounce all numbers up to 100, and the work of the speech pathologist will be to identify the difference between ones and tens.

An equally effective exercise is when the patient needs to write the name of the number under its name. For example, under the inscription three hundred and forty-seven, the patient should write 347.

Only the first 2-3 lessons are conducted in a visual-figurative style, after which a gradual transition to vocal voicing of processes is relevant. In adults, acalculia mild stage corrected more effectively than in children.

Treatment of the secondary form of acalculia

In the secondary form, the location of the brain lesion directly affects the nature of the recovery of numerical concepts and counting.

1. Occipital lesions require correction of correct spelling and visual perception. Most effective techniques– exercise with motor imagery of numbers, manipulation with tasks and numbers, as well as object counting. The method of voicing is no less effective, when the patient imagines a number in his mind. The result is possible with well-developed visual memory, imagination, and also with intact auditory perception.
2. Problems with auditory perception numbers are typical for lesions of the temporal zones. Specialized therapeutic restoration is not relevant in this case, since the violation is insignificant.
3. Prefrontal lesions require patients to be taught a simple understanding of numbers; arithmetic operations are gradually introduced, where numbers act as objects. At the final stage, the defectologist introduces arithmetic operations with sequential actions.

The patient will analyze arithmetic operations both through an objective digit understanding of numbers and through habitual object characteristics, if manipulation of objects is introduced along with numbers.

One can move from the primary subject assessment to a digit, spatial characteristic by switching to the internal program of consciousness from external actions. Gradually, arithmetic manipulations are restored, as is their understanding.