Sirotyuk A. L
This technique is multidimensional and
designed to evaluate:
visuospatial
(constructive) skills,
spatial organization,
visuospatial memory,
management functions (planning and
organization of activities, arbitrary
activity regulation)
ability to handle complex
information and learning.
The complex figure of Rey-Osterreich
The subject is presented with a figure to draw,at the same time, it is performed with 5-6 pencils of various
colors. By changing colors, it is estimated
drawing sequence of different sections
figures are thus evaluated approach to
organization of information. After drawing the figure
the sample is removed for 3 minutes, after which
a blank sheet of paper is provided and a figure is asked
draw from memory, also with a change of color
pencils in a certain order.
The implementation of the methodology is evaluated not only by
the end result, but also the process itself
execution. . Beyond the drawing sequence
various elements of the figure are also noted
various copying errors as quality
parameter to evaluate. Shape Drawing Strategies:
1) the subject starts from the main
rectangle and draws details according to
relation to it (configurative page);
2) the subject starts with the detail
attached to the main
rectangle, or from a plot
rectangle and then ends
rectangle and proceed to others
parts adjacent to it;
3) the subject starts with a general contour
figures without differentiating the main
rectangle and then draws the inner
details inside the contour; 4) the subject attaches the parts to each other
a friend without an organizing structure;
5) the subject copies free-standing
parts of the figure without highlighting the structure;
6) the subject replaces the drawing of the figure with
a drawing of a familiar object, for example,
houses or boats;
7) the subject produces an unrecognizable
drawing.
Criteria for evaluation:
Accuracy of copying and reproduction.Organization (location of main
lines of the figure in relation to each other).
Style (drawing strategy and
figure reproduction).
"Errors" when copying and
playback (rotation, offset,
associations, perseverations).
Conclusions obtained from the analysis of the results:
1) reproduction of the figure "in parts" (notconfig) is very rare
in children over 9 years of age. Moreover,
regardless of age (from 6 years old)
more commonly used in playback
configurative strategy;
2) Errors and distortions are not typical for
copying conditions. Matthews et al. (2001) studied three groups of children with
brain damage:
diffuse, frontal, and temporal.
In the group with diffuse lesions compared with
the norm was underestimated the performance of the organization and
accuracy in copying and reproduction,
those. all major indicators were underestimated.
In the group with frontal lesions were underestimated
organization indicators, as well as figures were
copied and reproduced in fragments (according to
style criteria), with a lack of function
planning.
In the group with temporal lesions, copying, in
in general, did not differ from the norm, but
playback was much worse.
10. Principles of neuropsychological interpretation of the results and processes of implementing this technique
Three axis:1. Lateral (right - left hemisphere),
2. Anterior - posterior (frontal lobes -
occipital lobes),
3. Cork - subcortical.
11. Lateral axis
1) Preference for one or another part of the sheet for reproduction orcopying a figure correlates, as a rule, with a more active
this child's information processing hemisphere. So,
drawings shifted to the left side of the sheet are combined with
problems characteristic of dysfunction of the left
hemisphere, with a more active right hemisphere. drawings,
shifted to the right side of the sheet, combined with problems,
characteristic of violations of the functions of the right hemisphere, with more
active left hemisphere. (Full copy and
the reproduction of a figure requires both normally functioning
hemisphere.)
2) The predominance of errors in one or another half of the figure, as
usually speaks of violations associated with contralateral
hemisphere. However, it is necessary to take into account the age
aspect: up to 7-8 years old, mistakes in the right side of the figure are quite common
are found in the norm. In addition, the playback quality
the order of copying can affect: sometimes those elements that
the last ones (or the first ones) were copied, they are reproduced better.
3) Normally, the vast majority of children older than 9 years old begin
draw the shape from its left side.
12.
4) The predominance of the configuration strategy (singling out the mainstructure of the figure) is characteristic of the right hemisphere method
information processing. Normally begins to predominate with age
just such an approach. Up to 8 years, however, by configuration strategy
may be considered to highlight the contour of the figure, and not its main
structures (a rectangle and the lines that divide it and
diagonal lines).
5) With right-hemisphere pathology, the child copies or
reproduces (replay is more diagnostic
informative regarding laterality) individual elements
figures, but cannot isolate its single structure,
configuration. With left hemispheric pathology, the child may
copy or reproduce the main configuration of the figure, but
cannot reproduce or copy parts correctly.
6) Problems with the integration of information between the hemispheres, often
associated with a violation of the formation of commissural connections,
may be reflected in the absence when copying or
reproduction of the elements of the middle part of the figure.
7) Rotation of the entire pattern by 90 degrees, i.e. its vertical
reproduction or copying is common in children with
violation speech development and functions of the left hemisphere. IN
Normally, such a rotation is often found in preschoolers and
first graders.
13. Anterior-rear axle
1.2.
3.
4.
With violations of the functions of the frontal (especially prefrontal) zones,
violated right attitude elements to each other, but
this (in contrast to the right hemispheric pathology described above, and
from parietal pathology), there is a general configuration of the figure.
In case of violation of the parietal zones, the general configuration and
the relationship of elements to each other.
In violation of the functions of the frontal lobes, it is also characteristic
perseverations, omissions of significant elements of the figure, replacement
figure elements to images of familiar objects.
Normal copying, but poor reproduction is typical
with preservation of the functions of the frontal lobes and impaired functions
temporal lobes. Poor, disorganized copying, with
normal playback, typical in violation of the functions
frontal lobes and preservation of the functions of the temporal lobes.
“Attaching” a picture to one of the edges of the sheet may not be
only, and not so much as evidence of dysfunction of one or another
hemisphere, how much evidence of frontal pathology.
14. Cortico-subcortical axis
Playback problems may occur whenslow copying, sometimes associated with insufficient
information coding efficiency. Such problems
may be associated with dysfunction of the brainstem
activating systems, as well as a violation of the thalamocortical systems.
The presence of "intrusions", i.e. foreign elements, including
perseveration, often occurs in violations of the subcortical
structures (often these can be systems that include frontal
lobes and basal ganglia).
Tendency to micrograph when copying or
reproduction may involve infringement or
unformed subcortical systems that support
graphomotor function.
The interpretation must take into account
interaction along all three axes, as well as within each of
RHEA-OSTERRIETA AND ITS PSYCHODIAGNOSTIC SIGNIFICANCE FOR THE QUALIFICATION OF NEUROCOGNITIVE DEFICIENCY
L.I. Wasserman, T.V. Cherednikova (St. Petersburg)
Annotation. Introduced short review Literature on the Rey-Osterriet "Complex Figure" method, widely known abroad as a valid tool for psychodiagnostics of various types of neurocognitive deficits, its qualitative and psychometric assessment in both adults and children, for the purposes of differential diagnosis, functional prognosis, monitoring of dynamics and correction cognitive dysfunctions during treatment and rehabilitation.
Keywords: test "Complex figure" Rey - Osterrieta; neurocognitive deficit; neuropsychological diagnostics.
Among the variety of neuropsychological research methods, a special place is given to the Rey-Osterriet "Complex Figure" (KFR-O) method. The adequacy of its use for scientific and practical purposes is emphasized in the specialized literature, including the fact that it is included in the international list of tools for assessing cognitive dysfunctions in neurology, psychiatry (adult and child) in the examination and testing of new drugs: antipsychotics and antidepressants. In this regard, KFR-O is of interest to domestic specialists. They are offered a brief overview of the materials on this multidimensional non-verbal neuropsychological technique, the adaptation and re-standardization of which was carried out by the authors of the article on the basis of international cooperation.
Short description test and its psychometric properties. In foreign scientific literature, you can find a variety of names for this test: "Complex Figure Test" (Complex Figure Test - CFT), "Rhea figure" (Rey Figure - RF), "Rhea - Osterrieta figure", "Rhea - Osterrieta complex figure" (ROCF), Boston Qualitative Scoring System for the Rey - Osterreith Complex Figure (BQSS) test. In domestic literature, the names "Rey's figure - Osterrits" or "Rey's test - Osterrits" are mentioned. The author of this technique and the figure itself is A. Ray, who created a test in 1941 to study the age-related characteristics of visual perception in children. He suggested first copying a complex graph
a physical figure from the proposed sample, and then draw it from memory after a 3-minute interval. Later, P. Osterriet modified the Ray test. He introduced quantitative estimates for the accuracy of copying and reproducing a figure from memory and ranked the styles of copying a figure according to the criterion of their age development, highlighting its seven levels. Subsequently, E. Taylor improved this evaluation system.
Differences in tasks, procedures, test figures. Currently, there are various versions of this test, which differ not only in scoring systems, but also in the number of tasks, application procedures, and even test figures. For example, more than five variants of the test figure itself are known (Taylor figure, four figures of the Medical College of Georgia, etc.), which are designed to replace each other equally in repeated tests in order to avoid training effects. However, there is an incomplete equivalence of these versions and a more complex, non-verbalizable character of Ray's figure, which for this reason turns out to be more sensitive to neurocognitive deficits. The number of tasks in different versions of the test varies from 2 to 4: copying, immediate reproduction, as well as delayed memory of the figure and recognition of its parts. The researchers emphasize that a delayed memory may be more sensitive to various memory impairments than an immediate one. Because very little difference is normally found between immediate and delayed recall, impairment of delayed recall may be clinically significant. Some authors also introduce a recognition task, which is presented after a delayed recall in order to dilute the effects of forgetting (actual loss of information) and recall difficulties caused by side factors. In addition, the recognition condition turned out to be sensitive to brain pathology in general and to lateral lesions in particular. Thus, the success of recognition in organic pathology of the brain tends to be higher than the success of remembering a figure, which is not typical for the norm. In different procedures for the use of CFR-O, the delay time for reproduction varies: up to 3 minutes for immediate recall and from 15 to 60 minutes for delayed recall, which does not significantly affect the results in the indicated ranges. Another modification of the test procedure is its use in the learning paradigm, when the subjects are warned about the need to remember the figure and are given several time-limited attempts to copy it for this.
Assessment systems. There are many different scoring systems for Ray's "complex figure", among
Non-verbal technique "Complex figure"
them - specially designed only for children's sample. All assessment systems offer different criteria for quantifying the accuracy of copying and recall, as well as organization as manifestations of the frontal regulation of neurocognitive functions. Separate systems, such as Boston (BQSS), supplement these estimates with the ability to measure the qualitative features of the pattern. The Boston version of the Ray test (BSTS) includes 6 total assessments of various cognitive functions and 17 parameters for assessing the qualitative features of a figure drawing, being the most multidimensional, detailed and strictly standardized among all available assessment systems for the KFR-O test. This determined the choice of the Boston assessment system for the Ray test for its adaptation and subsequent introduction into the practice of psychodiagnostics in our country.
Among the qualitative features of the drawing, various authors most often distinguish the parameters of style and level of organization. Style is ranked in different categories: from detailed orientation (drawing a figure in parts, fragments) to purely configurative orientation (consistent transition from a general whole to a particular one when depicting a figure). Between these styles, mixed intermediate drawing styles are distinguished. Detailed assessments of the organization are presented in. It is noted that in some cases of brain pathology, the index of organization is more sensitive than the assessment of image accuracy. It is generally agreed that the parameters of style and organization are also valuable in assessing the level of cognitive development of children.
In the literature, there are data on different types of reliability of measurements according to the CFR test. Most studies show a high intratest (for different assessors) and intertest (between different systems) correlation of assessments in relation to general quantitative indicators and a wide spread of correlations for individual qualitative parameters, which indicates insufficient rigor and clarity of the criteria for their assessment. At the same time, short and simple early versions of assessment are in high agreement with modern and more complex systems. Retest reliability is recognized as acceptable in the interval from six months to 1 year with repeated measurements. For shorter retests, alternative versions of the Ray figure are preferred, and the reliability of measurements on these versions of the test figure (eg, the Taylor figure) is highly rated for both children and adults.
The construct validity of the test. Currently, the test finds the greatest application in evaluating visual-spatial, visual-constructive abilities, visual memory, perceptual, motor, control functions: strategic
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problem solving, planning, integration, etc. . The results of factorial and correlation studies confirm the construct validity of the test in measuring visual-constructive functions, organization (under conditions of copying) and memory (under conditions of recall and recognition). In studies of healthy children and adults, as well as patients with neurological pathology, significant positive correlations were found between the results of copying in the CFR-O test with assessments of memory techniques, for example, with the Wechsler Memory Scale, and visual-spatial tests (Cubes, figure addition, etc.) .
Accounting for side factors. The researchers note the need to take into account a number of side effects on the results of neuropsychological diagnostics using the KFR-O test, in particular, on the part of intelligence, education, gender, age, and factors of right-handedness-left-handedness and culture.
1. Intelligence. So, the total indicators of the accuracy of copying and reproducing the figure correlate with the indicators of non-verbal and general intelligence of adults. In children with low and high intelligence, there are also significant differences in the performance of the Ray test, in particular, in the number of correctly reproduced details and errors, especially rotations of the entire figure or its individual elements when copying.
2. Education. The effect of education on Ray test scores is less certain. Some researchers report a decrease in grades in subjects with a low level of education, but others do not confirm this in conditions when the influence of intelligence is equalized in different educational groups.
3. Gender. Data on the effect of gender on the results of the test by adult subjects are contradictory. Some authors note that men better women perform the task. But the rest agree that this advantage is insignificant, manifests itself selectively or is completely absent. Such conflicting data may be due to the large individual variability in estimates within the same sex. More definite results were obtained in the children's sample, where in some age subgroups (in the range from 5.5 to 12.5 years), girls copied Ray's figure better than boys. This is associated with possible differences between children of different sexes in the rate of maturation of the cerebral hemispheres, in the use of neuropsychological strategies, etc.
4. Right-handedness - left-handedness. A number of scientists believe that in addition to the gender factor, one should take into account the influence of right-handedness, family right-handedness and academic specification (in mathematics / exact sciences, etc.) on the results of the KFR-O test. In foreign studies large group healthy children (n = 840) in
Non-verbal technique "Complex figure"
At the age of 5.5 to 12.5 years, in different age sections, a better copying of the Ray figure by right-handed children compared to left-handed children was revealed.
5. Cultural factors. There are data in the literature on the presence of intercultural differences in the CFR test. Thus, on a larger sample of older people (over 56 years old), residents of the capital of Colombia, Bogotá, standards were standardized for three test parameters: copying accuracy, copying time, and immediate recall accuracy, assessed by the Taylor system. The estimates were significantly lower than those obtained for the same conditions in the North American sample. Researchers believe that this discrepancy is determined by cultural and educational differences, as well as socio-economic ones, which is also confirmed by comparisons of the North American sample with the domestic one.
Age standards. In the literature, there are numerous age standards for quantitative indicators of the accuracy of performing different variants of the KFR-O test, which changes with age in children and adults. When referring to normative data, the user should keep in mind the differences in test versions, since immediate recall norms, for example, are not suitable for interpreting delayed recall scores, and an initial immediate recall trial improves delayed recall scores by about 2-6 points. Therefore, standards for delayed recall derived from studies with two conditions of recall and copying are not suitable for use in conditions of only delayed recall and copying. The most complete standards indicating the boundaries of the clinical interpretation of estimates for the Ray figure and 4 tasks were obtained on a sample of 601 people. aged 18 to 89 and presented in . So far, very few have proposed standards for qualitative assessments, for example, the authors of the Boston Grading System.
Neuropsychological potential of the KFR-O technique. The use of the test in neuropsychological diagnostics has shown its adequacy for the purpose of determining neurocognitive deficit in various mental and neurological disorders, including diffuse, lateral and local brain pathology of various origins in children, adults and, it should be emphasized, elderly patients.
Lateral lesions. Researchers point to the possibility of distinguishing unilateral brain lesions based on estimates of individual parameters of a drawing made in different test tasks: copying, remembering and recognizing KFR.
1. Condition of copying. The element-by-element pattern of copying can indicate both right hemisphere and left hemisphere pathology. At the same time, right hemispheric lesions are associated with large
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distortions in the left half of the figure or with less copying accuracy due to the effect of ignoring the contralateral side of the visual field. Those patients with right-hemispheric pathology who ignore the left half of the visual field in tasks for crossing out letters also show an increase in omissions of elements on the left when copying the Ray figure, as well as the effect of right-sided attention preference (they begin to draw the figure from right to left).
2. Conditions of remembrance. In right-hemispheric pathology, there is a tendency to recall the figure worse than in left-sided lesions, and to demonstrate less accuracy in recalling the left half of the pattern. However, the test is not a perfect tool for predicting the side of the lesion. For example, in the study of right- and left-temporal epilepsy using the index of global / local (right-hemispheric / left-hemispheric) errors, no significant differences were found in the accuracy of recall and copying of figure components different in “globality - locality”.
More reasonable conclusions about the side of the lesion allow us to make an analysis of the qualitative features of reproducing the pattern from memory (disturbance of the general configuration, errors in the arrangement of elements). If the previous attempt at copying was performed satisfactorily, then errors in location and form disturbances in recall indicate a right hemispheric deficit rather than a left hemisphere deficit. At the same time, quantitative indicators of the asymmetry of errors with a lesser degree of probability allow diagnosing right-hemisphere lesions of the brain than a set of indicators of qualitative errors in the performance of the Ray test, determined, for example, by 11 points of a special assessment system.
The effects of lateralized brain lesions are detected using the Ray test and in a children's sample. It was found, for example, that children with right and left hemisphere lesions, as well as with spastic diplegia in cerebral palsy, are characterized by different profiles of visuospatial dysfunctions. The group with left hemispheric lesions had a particularly pronounced decrease in detail reproduction, or processing of visuospatial information at the local level. This was not observed in children with right hemispheric disorders, who were characterized by general difficulties in the analysis and synthesis of visual-spatial information at the global level. All this is consistent with similar facts found in an adult neurological sample, and speaks of the general patterns of functional specialization of the cerebral cortex in the process mental development.
Non-verbal technique "Complex figure"
The dominant point of view is that CFR-O is not always an effective tool for predicting the side of the lesion due to the high heterogeneity of the test, which, however, ensures its high sensitivity to brain pathology.
Local lesions. In adults with temporal lobe epilepsy, as well as with frontal lesions, specific visuospatial memory impairments were identified in the KFR-O test. The researchers note that although both the figurative and spatial components of the figure depend on the right-sided mediobasal lesions of the temporal lobe, the effects of this influence are more reflected in the spatial components of the figure, which are less verbalizable than the shape features. Therefore, patients with parietal-occipital brain lesions have greater difficulty with the spatial organization of the pattern, while frontal lesions are more likely to cause planning difficulties when copying. In a children's sample (from 7 to 14 years old) with left temporal epilepsy, a significant decrease in visual-spatial memory was revealed not only in comparison with the norm, but also with the group of generalized epilepsy. According to MRI of the brain, it was also established that the level of hippocampal atrophy (with moderate lesions in adults) negatively correlates with overall ratings memories in the CFR-O test.
Diffuse brain lesions and mental disorders. Patients with diffuse cerebral pathology of organic origin perform both memory tasks (immediate and delayed with a 3- and 30-minute delay) worse than the group with chronic psychiatric disorders (schizophrenia, mono- and bipolar depressive disorder), and the latter have lower scores, than in the group of healthy subjects. However, according to other indicators (copying, copying time and recognition), the norm and psychopathology do not differ from each other, however, their differences with the neurological sample (traumatic brain injuries) turn out to be significant. Using qualitative assessments (configurative, fragmented and missing elements), L. Binder revealed differences in the type of errors that healthy subjects and patients with cerebrovascular lesions (consequences of acute cerebrovascular accident) make in the Ray test. In addition, the sensitivity of individual test parameters to a history of cerebral pathology, for example, associated with the consequences of traumatic brain injuries, convulsive seizures, cerebral vascular anomalies, drug dependence or cocaine abuse, has been established. For example, recognition scores can distinguish groups of patients with consequences of traumatic brain injury from groups healthy people and the mentally ill.
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The Ray test is effective in diagnosing various clinical features of neurocognitive deficit, which, for example, may depend on both the severity and the statute of limitations of traumatic brain injury. It was found that within 21 months after the injury, the volume of immediate memory is significantly reduced in mild lesions. But in a later period - 2-5 years after the injury - the indicators of delayed memory with moderate severity of injury significantly improve in comparison with severe injuries, which indicates the action of compensatory mechanisms and mechanisms of brain plasticity. Another example is demonstrated by indicators of visuospatial memory, which are significantly lower in alcohol dependence than in the norm. At the same time, memory deficit after abstinence is less long-term and less pronounced in young patients, indicating greater brain plasticity in young people.
In children, the test is widely used to identify the features and degree of neurocognitive deficit in learning disorders, attention deficit hyperactivity disorder, hearing impairment, life-time injuries and prenatal brain damage, intellectual developmental disorders and mental disorders, severe somatic diseases, etc. . For example, performance deficits are found in attention deficit disorder (ADD/D). In particular, adolescent girls differed from their healthy peers in the index of errors in CFR copying, especially perseveration errors, which indicated planning problems, i.e. problems of one of the most important control functions. In ADHD/H, there is not only a performance deficit, but also visuospatial memory disorders in the CFR-O test, which is associated with a large load of the attention factor on the visual memory function when encoding information.
A significant decrease in visual-spatial analysis and synthesis of Ray's figure compared to the norm was noted in the sample of mixed mental development disorder. With specific speech disorders (dyslexia and dysgraphia), children and adolescents aged 714 were less accurate and, as a rule, used immature (fragmentary) strategies when copying Ray's figure, and also less often than normal used an integrated strategy when reproducing the figure from memory, which suggests they have a lack of control functions.
Geriatrics. In the elderly, there is some decrease in copying scores with age, immediate and delayed recall, and the configurative approach tends to be less common. At the same time, some authors find that such deterioration, and then to a very small extent, begins only after
Non-verbal technique "Complex figure"
70 years. Presumably, memory impairment in the elderly is, at least in part, due to an impairment in the ability to retain information. They also have some decrease in organizational abilities, in particular, the integration of individual parts into a coherent structure.
With age, when remembering, the reproduction of details also deteriorates, especially those that are externally related to the main figure, and recognition indicators also easily decrease. All this points to age-related biological changes in the brain mechanisms of cognitive activity in older people.
It is noted that the CFR-O test distinguishes, according to the degree and nature of neurocognitive deficit, groups of healthy elderly people, people with consequences of traumatic brain injuries and patients with Alzheimer's, Parkinson's and Hettington's diseases. However, different test parameters may have unequal diagnostic value in relation to these neurological disorders. For example, visuo-spatial assessment is sensitive to brain lesions in Alzheimer's and Parkinson's diseases, as well as to undifferentiated brain lesions and to temporal pathology in epilepsy. While assessments of visual-spatial memory are important for the diagnosis of lateral, especially right-hemispheric, brain lesions, the consequences of craniocerebral injuries, as well as Huntington's disease. Revealed, in addition, that in patients with Alzheimer's disease, memory and copying is worse than with moderately severe brain injuries. At the same time, patients with traumatic brain injury perform immediate recall as well as healthy subjects, but have a significant decrease in recall volume with delayed recall. Parkinson's disease is characterized by a fragmented copying strategy, which significantly reduces the success of figure memorization.
Neuropsychology of development. Experimental studies confirm the assumptions of the authors of the test about the possibility of its application in the diagnosis of various aspects of development and its anomalies. So, it was found that usually teenagers (from 13 years old) and literate adults begin to draw a figure from left to right. In addition, younger children are more likely to copy the piece piece by piece, and with age there is an increasing tendency to show a configurative approach to drawing. After 9 years, a fragmentary style of drawing is extremely rare. Around the age of 13, the tendency to start drawing with a basic rectangle and then add more details to it becomes clear. However, some researchers notice that the influence of development manifests itself in two directions: in what kind of details are distinguished by children of different ages, and in
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but in how they integrate them into the whole. It was found that already
At 6 years of age, children demonstrate both aspects of visuo-spatial analysis and synthesis, only at a younger age they integrate smaller parts of the figure.
In older children and adults, errors and distortions in the shape of elements are usually observed when remembering, but rarely when copying. In a sample of 5- and 8-year-old children, a relationship was found between the act of copying itself and the success of remembering the figure. Thus, children who were asked at first only to memorize a drawing, without copying it, then drew the figure better and more configuratively than those who first copied and then remembered. On the other hand, children who used a piecemeal approach to copying a figure were less likely to reproduce it. Thus, the researchers believe that the configurative, holistic approach in children is more productive for memorization than the sequential, element-by-element (from parts to the whole).
With brain pathology in children, age-related tendencies in the development of visual-constructive functions in the Ray test are observed similar to the norm, which indicates the relative preservation of brain plasticity even in violations of the mental development of organic genesis. Thus, compared with a group of children 7-10 years old, at the age of 1114 years, the number of errors when copying the Ray figure decreased, copying and reproduction of key groupings of internal elements of a complex figure, such as the central part (when copying), as well as the right and left sides, improved. figures (when remembering).
affective disorders. Poor memory of a figure in the CFR-O test can be associated not only with organic brain lesions, but also with emotional disorders. Thus, war veterans with post-traumatic stress disorder are worse than healthy ones in performing a task with immediate recall, but not copying. In patients with epilepsy, there is a relationship between self-assessment of the level of emotional disorders (depression, paranoia) and a decrease in memory. Elderly patients with depression have been found to have a slight decrease in delayed memory retrieval. Studies in a group of healthy volunteers found a modest correlation between Beck Depression Scale scores and recognition scores. According to other authors, psychological distress in healthy people (anxiety, depression) does not affect the performance of the Rey Figure test, but the subjects' attitudinal behavior, decreased motivation, and simulation can worsen the CFR-O test scores. Thus, subjects who received instructions to simulate the presence of a brain injury significantly differed from neurological patients in the profile of those demonstrated. They noted
Non-verbal technique "Complex figure"
a decrease in the level of accuracy, the speed of drawing, worsened delayed reproduction and recognition.
Functional forecast. It should be especially noted that recognition scores in the CFR-O method correlate with the general functional level of patients. Thus, the better the recognition, the more independent in their functioning the individuals. At the same time, assessments of memory and organization predict the success of rehabilitation, and the deficit of visual-constructive abilities directly correlates with the difficulties of adapting patients to household activities. Thus, the use of the CFR-O test makes it possible to obtain important information not only for differential neuropsychological diagnosis, but also for various aspects of functional prognosis.
Thus, an analytical review of the literature shows that the CFR-O test is very effective and in demand in clinical trials, medical and rehabilitation work with patients with psychiatric and neurological profiles. The use of a multidimensional and accurate quantitative assessment of different aspects of neurocognitive deficit makes it possible to track the effectiveness, direction and dynamics of its drug correction, as well as to predict its impact on the socio-psychological functioning of patients in Everyday life And labor activity.
The study of neurocognitive deficit, especially its weakly structured manifestations, is an urgent task of medical psychodiagnostics in many areas of psychiatry, neurology, narcology and neurosology, in particular, in various systems of medical examination, rehabilitation, medical pedagogy and professional selection. This is due to the important differential diagnostic value of the parameters of cognitive activity for making clinical decisions, especially in comparative (comparable) studies. It should also be emphasized the undoubted psychodiagnostic value of the CFR-O test for scientific neuropsychological research, the purpose of which is to study structural and functional correlations in various brain pathologies, especially in their relationship with neuroimaging data and other methods aimed at diagnosing the relationship of neurocognitive dysfunctions with affective pathology and disorders. personality. Such studies are currently being carried out by employees of the Psychoneurological Research Institute
them. V.M. Bekhterev and the Faculty of Psychology of St. Petersburg State University. The results of this study are the subject of future publications.
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THE NON-VERBAL REY-OSTERRIETH "COMPLEX FIGURE" TEST AND ITS PSYCHODIAGNOSTIC SIGNIFICANCE FOR THE NEUROCOGNITIVE DEFICITS QUALIFICATION
Wasserman L.I. (St. Petersburg), Cherednikova T.V. (St. Petersburg)
summary. The article provides a brief review of the literature on Rey-Osterrieth "Complex Figure" test. It is widely known abroad as a valid psychodiagnostic tool of various neurocognitive deficits, its qualitative and psychometric evaluation of both adults and children, with a view of the differential diagnosis, functional prediction, monitoring of the dynamics and correction of cognitive dysfunctions in the process of treatment and rehabilitation.
Key words: Rey-Osterrieth "Complex Figure" test; neuropsychological deficit; neurocognitive diagnostic.
All the described tests are aimed at the study of elementary motor functions and objective actions. In life, a person most often has to perform more complex movements and actions, which are already whole programs, and they obey internal schemes. These movements already require the participation of speech - either external or internal, and they are carried out by the work of the highest levels of brain organization. These arbitrary complex programs of action are most often found to be inconsistent with lesions, dysfunctions, or underdevelopment of the frontal and frontotemporal areas of the brain. The role of speech regulating these movements is also violated.
The most complex type of movements (actions) are movements according to the type of reaction of choice according to a speech instruction. These tests are aimed at studying the highest levels of organization of voluntary actions that regulate the role of speech in the motor system.
The study of the motor sphere
1. Kinesthetic praxis.
Praxis of postures according to a visual pattern (4-5 years).
Instructions: Do as I do. The child is sequentially offered several poses of the fingers, which he must reproduce. Both hands are examined in turn. After performing each pose, the child freely puts his hand on the table.
Praxis of postures according to the kinesthetic pattern.
Instructions: Close your eyes. Can you feel how your fingers are folded? then the hand is “smoothed out” and he is asked to reproduce the previously set pose.
Oral praxis.
Instructions: Do as I do. The experimenter performs the following actions: smiles, pulls his lips into a tube, puts his tongue straight, raises it to his nose, runs it over his lips, puffs out his cheeks, frowns, raises his eyebrows, etc. An option may be to follow a verbal instruction.
2. Dynamic (kinetic) praxis.
Test "Fist-rib-palm" (from 7 years old).
Instruction: “Do as I do,” then a sequential series of movements is performed. Twice you complete the task with the child slowly and silently, then invite him to do it himself and at a faster pace. Then - with a fixed tongue (slightly bitten) and closed eyes. Both hands are examined in turn.
Reciprocal (multidirectional) hand coordination.
Instructions: Put your hands on the table (one hand in a fist, the other in a palm). Do as I do. Several times you and your child do reciprocal fist and palm changes, then invite him to do it on his own.
Heda's test (from 8 years old).
Instruction: "What I will do with my right hand, then you will do with your (touch) right hand, what I will do with your left hand, you will do with your (touch) left hand." It is proposed to perform one-handed, and then two-handed tests. After each test, a free pose is taken. Poses:
1) Right arm vertically up at chest level;
2) Left hand horizontally at chest level;
3) The right hand is horizontal at the level of the chin (then the nose);
4) Left hand vertically at the level of the nose;
5) The left hand holds the right shoulder (then the right ear);
6) The left hand is vertically at chest level - the right hand horizontally touches the palm of the left;
7) The right hand is vertically at chest level - the left one touches the palm of the right with a fist;
3. Spatial praxis (somatognostic functions)
Tauber's test.
You touch two places on the child's body several times at the same time and ask him to show where you touched. In this case, it is important to take into account both touches, since the test is aimed at identifying the phenomenon of ignoring in the tactile sphere.
Foerster's test.
The experimenter draws figures (triangle, cross, circle) or numbers with a finger (stick) either on the right or on the left hand of the child and asks them to name what they have drawn. A prerequisite is the fixing of the signs drawn in the memory of the child.
Touch projection.
Instructions: Close your eyes. I will touch you, and you will show this place on a little man. (Figure standard A4).
Reciprocal hand coordination.
Instructions: “Fold your left hand into a fist, put your thumb aside, turn your fist with your fingers towards you. With your right hand, with a straight palm in a horizontal position, touch the little finger of your left. After that, simultaneously change the position of the right and left hands for 6 - 8 changes of positions.
4. Constructive praxis (copying figures)
Denmann test (up to 7 years). Placed in front of the child Blank sheet paper.
Instruction: "Draw these figures" Copying is done first with one hand, then (on a new sheet) with the other.
Taylor test (from 7 years old). A Taylor figure and a blank sheet are placed in front of the child. Instruction: "Draw the same figure." The child is offered a set of colored pencils, which the experimenter changes during the copying process for subsequent analysis of the drawing (in the order of the colors of the rainbow: red, orange, yellow, green, blue, indigo, violet). Sample reversals are not allowed; manipulations with own sheet are strictly fixed. Throughout the experiment, the psychologist refrains from any comments.
The copy time is fixed.
Rey-Osterritz test. (from 7 years old). After copying the Taylor figure, the child is asked to copy the Rey-Osterritz figure with the other hand.
Copy images rotated 180°. The experimenter and the child sit opposite each other, between them is a sheet of paper. The experimenter draws a sketchy little man facing himself. Instruction: "Draw yourself the same" little man ", but so that you see your drawing, as I see mine." After the child has completed the first stage of the task, the instruction is given: “And now I will draw a hand for my little man. Where will your little man's hand be? if the child performs the task incorrectly, his mistakes are explained to him. Then a complex triangle is offered for copying. Instructions: "turn this figure over to you."
5. The reaction of choosing movements according to speech instructions (motor programs)
Instructions: “Raise your hand for one knock and immediately lower it. Two knocks - do not raise your hand. When I raise my fist, show me your finger, and when I raise my finger, show me your fist.
Praxis is understood as purposeful action. A person learns in the process of life a lot of special motor acts. Many of these skills, being formed with the participation of higher cortical mechanisms, are automated and become the same inalienable human ability as simple moves. But when the cortical mechanisms involved in the implementation of these acts are damaged, peculiar motor disorders arise - apraxia, in which there are no paralysis, no violations of tone or coordination, and even simple voluntary movements are possible, but more complex, purely human motor acts are violated. The patient suddenly finds himself unable to perform such seemingly simple actions as shaking hands, fastening buttons, combing his hair, lighting a match, etc. Apraksin occurs primarily with damage to the parietal-temporal-occipital region of the dominant hemisphere.
Due to the violation of the action plan, when trying to complete the task, the patient makes many unnecessary movements. IN individual cases parapraxia is observed when an action is performed that only remotely resembles this task. Sometimes perseverations are also observed, i.e. stuck on any action. For example, the patient is asked to make an alluring hand movement. After completing this task, they offer to wag a finger, but the patient still performs the first action.
For the study of praxis, a number of tasks are offered. They also present tasks for actions with imaginary objects. Evaluate how the child can imitate the actions shown.
Thus, special psychological techniques are also used to study praxis. In these methods, it is of great importance how the child performs the task: whether he acts according to the trial and error method or according to a certain plan.
It is important to remember that praxis is formed as the child matures, so young children cannot perform such simple actions like combing, buttoning, etc. Apraxia in its classical form, like agnosia, occurs mainly in adults.
Description of the technique
The technique is designed to assess the concentration and stability of attention. There are 25 intertwined curvy lines on the form, numbered on the right and left sides of the form (from No. 1 to No. 25). It is necessary with a glance, without the help of a foreign object or finger, to trace the path of each line from left to right and determine at which number on the right field of the form it ends.
History of creation
A. Ray's test - a test of interlaced lines. It is very well known to domestic psychologists, but either without mentioning the author, or under the names of other authors, or in a modified version and, accordingly, a changed name.
The test was proposed to study the concentration of visual attention by A. Rey in 1958. The same author developed norms for the Swiss population (see J. Schwanzara et al. 1978). This test consists of 16 intertwined broken lines. The main indicators taken into account in the study and analysis of the results are the time spent on 16 lines and the number of errors made during this.
In domestic psychological practice, a similar technique of “entangled lines” is used, proposed by K.K. Platonov in 1980, but using not broken, but 25 curved lines, in addition, there are no standards for children for this version of the methodology. In domestic sports psychodiagnostics, the results of this technique are evaluated in points, depending on the number of correct answers in 7 minutes of completing the task, based on the use of the form proposed by K.K. Platonov, with 25 intertwined curved lines (V.L. Marishchuk, Yu.M. Bludnov et al., 1984).
Procedure
To conduct the study, you need a "Form of intertwined lines", a stopwatch, paper and a pen.
Instruction
Instructions: “There are 25 intertwined winding lines on the form, numbered on the right and left sides of the form (from No. 1 to No. 25). It is necessary with a glance, without the help of a foreign object or finger, to trace the path of each line from left to right and determine at which number on the right field of the form it ends. Suppose that you traced line No. 5 and made sure that it ends in the right margin of the form against No. 19. In this case, near No. 5 on the left margin of the form, you need to write No. 19 through the dash (shows). By this you are asserting that the line marked on the left side of No. 5 ends on the right side near No. 19. All lines end in the right margin of the form. If you can’t trace any line in any way, then go to the next one, while observing the order of the numbers on the left margin of the form. The work continues for 10 minutes. If you trace all the lines before, raise your hand, I will determine the time for the task. The purpose of the work is to quickly and accurately trace the maximum number of lines. You will start working on my command “Start”.
Processing of results.
KEY to the technique "Intertwined lines":
The indicator of activity productivity (P) is calculated according to the formula:
Where T is the task execution time in seconds
N is the number of correctly traced lines.
From 861 and above- low level of concentration (low productivity);
From 455 USD 860- the average level of concentration of attention (average productivity);
From 454 and less- high level of concentration (high productivity).
Spatial Gnosis
1. Sample "Mirror letters" AND.: "Show which of the letters is spelled correctly." A more difficult option is to find "wrong" numbers and letters in syllables and words.
2. Test "Blind hours". The experimenter closes the reference dial and asks the child to say what time the hands on the "blind clock" show. With severe difficulties, the standard is opened for comparison.
Here one should be very attentive to whether the definition of hours in this variant has been consolidated in the child's experience.
3. Benton test. The experimenter shows the child one of the upper samples, then closes it and asks to show this sample on the lower standard. In case of difficulty, the sample is not closed and remains open for comparison.
On the right is a more complex version; it can be used after 7-8 years.
self drawing The child is offered an unlimited choice of colored pencils (felt-tip pens), simple pencil, pen. Color preferences during interpretation bring the following tests closer to the Luscher test. In addition, topological, constructive and stylistic features drawing with right and left hands.
1. The child is offered (first right hand, then left hand) draw: flower, tree, house, bicycle.
2. Test "Rugs". A standard sheet of paper is placed in front of the child (A4 format), folded in half, each half of which depicts large rectangles.
I.: "Imagine that this is a rug. Please paint it." Upon completion of coloring with one hand, the sheet is turned over and a similar procedure is carried out with the other hand.
A variant of this test is to provide the child with a sheet of paper without a frame.
3. Sample "Mandala". Place a piece of paper in front of the child (A4) with a circle 10 cm in diameter drawn in the center.
I .: "Paint (paint, paint) this, please." To any questions the child is given the answer: "Do as you like."
Upon completion of coloring, a similar test is carried out with the other hand.
4. Sample "Homunculus". Performed with the dominant hand. A sample sheet format (A 4) is placed in front of the child. I .: the same as in paragraph 3.
At the end of the coloring, the child is asked the following questions:
§ Who did you draw? The name of? How many years?
§ What is he doing now? What does he generally do?
§ Favorite and least favorite occupation?
§ Is he afraid of anything?
§ Where does he live? Who does he live with?
§ Who do you love the most? With whom is he friends (plays, walks)?
§ What is his mood like? His most cherished wish?
§ If he had a choice, how would he protect himself from enemies?
§ How is his health? What and how often does it hurt?
§ What is good and bad about it? Who does he remind you of?
5. Sample "Drawing of a man". Performed with the dominant hand.
I.: "Draw, please, a man." At the end, the same questions are offered as in paragraph 4.
copying
1. Denmann test. A picture with the image of figures and a blank sheet of paper is placed in front of the child.
AND.: "Draw these figures." Copying is done first with one hand, then (on a new sheet of paper) another.
The test is very effective for studying copying processes in children under 5-6 years old.
2. Taylor and Rey-Osterritz tests. The tests are applicable for children from 6 years of age.
The figure of Taylor is placed in front of the child and (below) Blank sheet.
AND.: "Draw the same figure." To fix the copying strategy, the child is offered a set of colored pencils, which the experimenter changes during the copying process. (in order of colors of the rainbow). Manipulations of the child with his own sheet of paper are strictly recorded. The experimenter refrains from any comments. It is useful to note the time of copying.
After copying the Taylor figure, the child is also asked to copy the Rey-Osterritz figure with the other hand.
3. Copying projection images.
The child is invited to copy the "cube" and "house" with his right and left hands
