Kostya N., 7 year old. Diagnosis - minimal mental dysfunction (MMD), hypertensive syndrome, vertebrobasilar insufficiency, neurasthenic syndrome, retarded mental development. Before transcranial micropolarization (tDC) the results of two years - learning with speech-language pathologist (defectologist) and speech teacher were poor concerning general and speech development.
He had low motivation for learning, small volume of all types of memory; limited vocabulary, speech with wrong grammar. He couldn't retell what he heard and understand the story content. Besides, he couldn't remember images of letters and numbers and couldn't articulate the sound "r".
He was recommended to study at school for children with retard mental development (RMD). During 18 months he had 12 sessions of tDC with small currents exposure (for 20 minutes per each session). Just after the first session Kostya showed interest to environment. After four sessions his night phobia disappeared, his motor coordination improved. He became more careful and diligent, his vocabulary increased, he began retelling small stories; there was marked progress in his mental activity and phonemic hearing.
Moreover, the improvement was noticed in his speech grammar and letters remembering; he began to write and count up to 10. His constructive pracsis and gnosis, connected speech were also improved. He learned to pronounce the sound "r". His tiredness decreased. His motor functions became almost normal. Two months after the first tDC session it was marked step acceleration of his mental development. He was recommended to study in the first form of secondary school at the age of 8 year old.
The results of Kostya's testing in the first form: neat handwriting, slow reading and writing, not quite good understanding of the texts but nevertheless, he coped with the basic programme in Russian language and mathematics. His phonemic hearing was normal. He continued his classes with the psychologist and the speech teacher. He had good marks at the end of the first form.
Kirill N. was about 7 years old when they applied to our institute with the complains of developmental delay, inactivity, lack of curiosity, poor memory, learning
problems.
Anamnesis:
prenatal and perinatal risk - threat of pregnancy termination (treatment in a hospital), chronic pyelonephritis, a prolonged anhydrous period during labor
(12 hours). The boy had been followed up by a neurologist, constantly receiving pharmacological and osteopathic treatment since his birth.
The objective diagnostic findings showed:
- Immature developmental biorhythm structure, instability of CNS functional status including a tendency to paroxysmal status changes.
- The initial index of blood circulation according to REG (rheoencephalogram) was within age norm, but when the boy turned his head to the left, blood flow
in left arteriavertebralisfell by 30 % of initial level, when he threw his head back - by 55-60%, in the right one – byr 40% of initial level.
The neurologist’s diagnosis
before the first course of tDCS (transcranial direct current stimulation) was: MCD (minimal cerebral dysfunction) with residual-organic pathology,
encephalasthenia syndrome, Slight pyramidal insufficiency, hypertension syndrome, neuropsychic developmental delay, common speech underdevelopment.
Speech teacher:
the boy while undergoing the assessment was quiet, adequate. His behavior was characterized by passive perception of information, lack of inquisitiveness
and motivation to cognitive activity, game activity prevailed. The boy distracted easily – he could work effectively only 15-20 min, then got tired.
His vocabulary wasl imited, there were agrammatisms in his speech. He could not pronounce sound [r].All types of memory were weakened. On listening the
story the boy couldn't distinguish the main idea, tried to retell the text literally, spelled while reading, didn't remember symbols of letters and
figures. He was able to distinguish the cause-effect relations in the text, but was at a losswhen coming across unfamiliar pictures. He could count
forward, but couldn't find numbers adjacent to "4". Kirill hardly coped with school preparation program.
The diagnosis: delay of mental development. F 83.0 (ICD 10).
The first tDCS course
included six sessions in a standard scheme. Here we are describing positive dynamics in detail because of the rapid development, despite their late
application for help. From session to session we observed changes embrace a wider range of mental processes and functions and social adaptation.
Unfortunately, it does not happen always.
So, only 3 days later after the first tDCS the boy’s relatives noted improved coordination of movements: his gait became less clumsy, the boy learned to
climb over barriers, jump on a window sill. His fine motor skills dexterity got better: Kirill began to collect a mosaic of smaller pierces, to cope with
doing fasteners and laces more successfully. Remedial gymnastics doctor marked that Kirill could understand and carry out her instructions better.
The boy got interested in surrounding objects: Kirill for the first time ever used a chair when getting subjects from high shelves in the cup board. He
began to watch the street events and ask a lot of questions. He demanded more attention to himself. The boy remembered and described the events which had
occurred 2-3 months before. He began to think quicker, but he could not select proper words, halts in the speech renewed.
The boy’s speech also changed, namely, it began to be accompanied by gestures, his active vocabulary grew(i.e. parenthetical words appeared), the phrase
became more developed, the boy started commenting other people's speaking. According to Kirill’s parents, the boy spokenon-stop at home.
Positive shifts were observed also in social adaptation, e.g., it was for the first time when he took part at morning performance in the kindergarten,
participated in relay race (he did everything correctly, though slowly). He began to defend his interests - he opposed when somebody tried to take his toys
(usually he had not done it before), however, firstly his mother took it for aggression.
During the next month further improvements of motor activity and orientation in space were observed (the boy learned to ride a skateboard with dexterity).
He wanted badlyto communicate with children, but he was still very shy.
Speech teacher
after the 1st course of tDCS marked considerable improvement of mental activity (comparison, generalization, analysis and synthesis), phonemic hearing, a
grammatical system of speech. Kirill became more diligent, attentive, started retelling small texts, remembering letters, figures. He tried to read, wrote
elements of letters. He could do sums within ten, count forward and back within twenty. His constructive praxis and gnosis had improved, there appeared an
ability to carry out several actions simultaneously. He began to pronounce a sound [r], and halts in the speech disappeared. His coherent speech improved
considerably, reasoning became more logical. Fatigue decreased significantly, cognitive abilities improved. Motor functions came nearer to age norm,
including properties of a small and articular motility.
Acoustic therapy course was conducted because of complaints of uneasiness and difficulties of communication with children. Kirill’s drawings after a course
of therapy showed decrease in intensity and aggression expectation (reduction of sharp lines in drawing), improvement of intellectual, graphic skills that
allowed Kirill to draw amen and a tree in a more realistic way (fig.).
The control assessment of the child 2 months later showed further spasmodic acceleration of the rates of nervous-psychological development. So it became
possible for Kirill to study in a correctional class from 8 years with the subsequent transition to a comprehensive school. Though initially, before the
course of tDCS, he was recommended to a special school!.
The second course of 3 session tDCS
was conducted half a year later when Kirill went to the first form. His parents decided to avoid a correctional course at the nearest school and they
brought Kirill to the school where athletes and musicians studied without attending lectures, driving about on competitions and tours. The new teacher
treated Kirill's problem swith understanding, but the process of studying was carried out at home.
The speech teacher
found that for last half a year period the boy became even more dexterous, self-assured, efficient. Writing skill had improved: handwriting became smooth,
accurate, within line limits. The boy could cope with the tasks on Russian language and Mathematics, counted well within 10. He could distinguish the main
signs of subjects (size,shape, quality). There were, however, problems with reading: he read syllable-by-syllable. Kirill didn't maintain sentence
intonation, didn't understand many words, he caught the sense of complex and compound sentences with difficulty. When reading, he couldn’t follow a line,
lost it without a bookmark. He retold the text mechanically, from memory.
The boy began speaking even more, his parents had a feeling that their son kept thinking of something important. He got angry being recalled from this
occupation. He became quicker atdoing sums, remembering words and melodies. The boy became more active, reached after children, fantasized. He studied
better at home being easily distracted at school. By the end of the 2nd course Kirill began to read quickly and to retell without stutter. His
exercise tolerance had increased. His behavior in games became reckless without yawning, persuasive movements. The child had learned quickly to work with
the computer keyboard.
The psychologist
marked that though the boy wrote with the right hand, his leading hand was left. Work rate was slow for his age, working capacity was reduced (the child
got exhausted easily). The boy’s leading motivation of activity is not educational, but game. His volition had not been formed enough, but when interested,
he could overcome fatigue. His memory was initially weakened (involuntant memory – he remembered 4 pictures, arbitrary memory - 6). But it had grown after
a course respectively to 7 and 10 units. Thinking characteristics compared with the norm were as follows: analysis-synthesis skills were formed
insufficiently (he couldn’t collect split pictures from 6-7 pierces). He could make a generalization within one concept, with a support on external signs.
He couldn’t do assortment quite well, e.g., he used 1 feature instead of 2. Kirill couldn’t establish cause-effect relations (from 3 consecutive pictures).
Logic hadn’t been formed. He performed the Raven test by 50% (it evaluates his thinking development at the average level).
Thus, the pupil’s thinking was visual-active and eye-mindedness. Nevertheless, the diagnosis still was the same - mental retardation despite achieved
success: we raised a bar of achievements, but the diagnosis wasn’t over passed.
Two months later the speech teacher marked that Kirill’s reading speed was insufficient, he read 1-2-syllabic words, but he read more complex words
-syllable-by-syllable. He wrote accurately, but too slowly. The boy’s phonemic hearing had developed according to his age: he could distinct sounds and
syllables aurally, whereas in a dictation he wrote all words together. Texts for reading at school and at home were quite difficult and the boy couldn’t
remember and retell them, without understanding their sense.
After the following short course of tDCS in the 1st form the boy got five-pointer marks in Russian and Mathematics. He has extracurricular
activities, though he does his homework with mother. Kirill’s communication with children became better, he calls them by phone.
The boy now goes to the theater. He finished academic year without three-pointer marks.
The patients haven’t come to this course of tDCS any more (it was their own decision). In the second form the boy had three-pointer mark in Maths: for it
was difficult for him to do sums with two operations. Nevertheless he was quick at collecting puzzles of 80 pieces. He did already his homework by himself,
without mother. He studied unsteadily, began to write more carelessly, but by the end of the 2nd form his marks in Maths became higher.
According to his parents in the third form Kirill studied well, without three-pointer marks.
He read fluently, but he still understood badly what he had read. He had some problems with Russian, especially while copying. The sluggishness remained.
In his forth year at the same school lhe studied without three-pointer marks as well, his parents are planning to change the school after the 5th form. He
has passed test in regional psychoneurologic dispensary, but, alas, the diagnosis was the same - mental retardation.
Kirill was one of our first patients so we inspected his destiny with keen interest. We didn’t expect any significant improvement because they applied for
the help quite late. Nevertheless the boy began to catch up with the school mates quickly enough, and the initial gap in progress reduced, but didn't
disappear at all. Probably, there could be also a further improvement, but the parents left the treatment almost for two years, being fond of East
technicians, and psychological trainings which, having exhausted all possibilities, slowed down the general process. The boy was trained on reading, doing
standard mathematical tasks. Though he got at a loss at any deviation from the learnt standard and when he had to draw a logical conclusion.
Besides, the parents’ desire to hide the initial diagnosis brought them to the school where almost all educational process took place at home. And at home
mother can organize attention, help, prompt, force, i.e. creates the hothouse conditions far from real school where Kirill's problems would emerge soon and
would force parents to correct the choice. But time has been wasted. Mother continues to spoon-feed 12-year-old Kirill who will soon overgrow her in
height. There are, of course, some delights that children remain dependent on us long enough. And then, what will mother be engaged in if she stops being
the nurse?
Diagnosis: Speech Developmental Delay (F 80.1 ICD-10)
Kate E.
Her first visit to the Institute was at the age of 3 years 4 months with the complaints of speech developmental delay and emotional instability.
In the anamnesis there was a wide range of negative factors: mother's pregnancy pathology, prenatal infection, prematurity, a prolonged anhydrous period
during labor, both side intraventicular hemorrhage, cephalhematoma in the right parietal area. Postnatal health status was quite serious with CNS
depression syndrome. The artificial lung ventilation was applied practically at once. After leaving the maternity clinic the child was under the care of a
neurologist with the diagnosis of hypoxic-traumatic encephalopathy with concomitant diseases of bronchopneumonia, anemia and so on.
Inspite of all this the girl was able to sit at the age of 8 months and at 14 months she began walking and could say her first words.
By the time the parents came to our Institute the girl had been examined in a number of institutions.
As a result:
- duplex ultrasonography screening showed regulation distortion of brain vessels activity and internal arteria carotis and vertebralis tortuosity at left.
- Head scan elicited mild brain residual impairments (which is quite common in children with perinatal encephalopathy) and mild distention in left
ventricle.
- EEG showed that electrogenesis is appropriate to the girl's age.
Because of the Speech Delay diagnosis the girl was not accepted to a kindergarten and her parents were advised to visit a local psychiatrist. The
specialist stated that any treatment was no use because of the child’s mental debility.
But, the parents did not give up. They came to our institute.
During the primary inspection our neurologist made a diagnosis: residual organic brain pathology of perinatal origin, left-side hemisyndrome, 1st level
psycho-speech delay, worn type dysarthria.
The girl went to the kindergarten, where psychologist and speech teacher marked that the girl could understand speech, she used imitation when following
instructions and in speech. In her speech there were word pieces, she could keep syllable word structure. Sensory perception by imitation were formed: she
could recognize colors, show geometric figures. She used imitation while building up nesting blocks, nested doll, split pictures or counting 4-5 subjects.
She could classify wild and domestic animals, pieces of furniture, clothes, items of dishware. She contacted with the outside world when interested,
communication was situated playing. Sometimes there were problems with paying attention, attention switch. Diagnosis: sensomotor alalia, polymorphic
sounding disorder.
Because of the distinction in the diagnoses the girl was examined once more by our psychologist who did not find any serious disorders in non-verbal mental
functions.
The speech teacher examination showed that the girl did articulatory exercises according to her age, but she showed phonemic unawareness and syllable
disorder (she missed the 1st syllable though the word intonation was correct). Her speech was softened and quite primitive: she used 2-3 word
sentences. The diagnosis was: a slight speech development delay.
So it was a substantial ‘relief’ in diagnosis.
After the diagnostic testing we used 5-session tDCS (transcranial direct current stimulation) according to a standard scheme: 20 minutes once a week with
with a remedial teaching. During the 1st tDCS the girl could distinct colors, shapes, sizes. After the 1st tDCS her parents noticed
that the girl had become more active, and got calm more easily. She started to speak with 3-4 word sentences. She began to use suffixes after the 2 nd tDCS. Her vocabulary increased, she started pronouncing words more distinctly.
By the end of the treatment the psychologist registered increased cognitive interest, decrease of fatigability, increased speech activity: the girl became
more sociable, less shy, she liked singing and being tested. She became more independent at home. Improvements did not stop after the end of the treatment
and the child was accepted into the logopedic group of the kindergarten.
Her next visit to our institute was 5 years later, when the girl went to school. It was a specific school with 2 foreign languages been taught. Moreover
she joined painting and musical classes (flute). According to her mother in the kindergarten there were no logopedic problems, but the school speech
teacher marked “phonetic-phonemic alalia”, smoothed speech, syllable structure disorder (the girl missed syllables in complicated words). The level of
phonemic audition was lower than her age standard. The girl mixed similar sounds while writing. There were difficulties with retelling, reciting, doing
sums.
During the 2nd course of tDCS she started reading books very quickly. Even that the girl has got older, she reacts on the tDCS as well as
before, but the speech was initially destroyed and was not completely compensated lately hence the problems with learning.
