RU2786957C1 - Method for development and improvement of fine motor skills of hands in children with cerebral palsy - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: invention relates to medicine, in particular to neurology; it can be used for development and improvement of fine motor skills of hands in children with cerebral palsy (hereinafter – CP). Complexity and number of tasks are selected individually for each child. A monitor window for performing exercises is launched, on which an image of a keyboard with colorful keys is given, while colors of keys are made in accordance with colors of hand fingers on right and left sides of the represented keyboard. Next, a real keyboard is installed in front of a child, which coincides with the represented keyboard on the monitor screen. Then, the child is offered to perform exercises of three levels of complexity with five blocks of tasks at each level, providing for sequential pressing colorful keys on the represented keyboard with fingers with the corresponding color. After each block of exercises, dynamics of a level of development of fine motor skills is tracked.

EFFECT: method provides development and improvement of fine motor skills of hands in children with CP, allows for expansion of functional capabilities of existing methods, correction of sensory perception mechanisms, and organization of subject-manipulative activity of hands in children with CP, with stepwise complication of tasks.

1 cl, 4 tbl

Description

The invention relates to the field of medicine, in particular neurology, and can be used to develop and improve fine motor skills of the hands in children with cerebral palsy (hereinafter referred to as cerebral palsy).

For the development and improvement of motor functions, first of all, it is necessary to perform repetitive purposeful movements, which provide for a gradual complication of the performed tactile actions.

A method of rehabilitation correction of fine motor skills of the hand is known from the prior art (RF patent No. 2616338, published on April 14, 2017), which consists in the fact that the course of tactile interaction of the patient with the touch panel of a digital graphics tablet is carried out by sequentially performing exercises by the patient aimed at developing motor skills hands, and motivation for the active purposeful activity of the patient, where the exercise consists in the fact that the patient touches the surface of the tablet panel with his finger at a given point and continues to move his finger along a given trajectory so that the color of the points of the trajectory line changes to a given one as the finger moves - indicating a positive performance of the exercise; at the same time, the sequence of performing exercises - from simple movements to complex ones.

This method allows you to restore and improve the functions of movements of the hands, forearm, shoulder, form manual skills, get a psychological effect, which is manifested in the fact that the patient sees the results on the monitor in real time and can evaluate the speed of completing the task.

However, this method has limited functionality for the development and improvement of fine motor skills of the hands, since it involves teaching basically one skill - brushing your teeth. At the same time, the child touches only the smooth surface of the tablet with his fingers, which does not allow the formation of more accurate tactile sensations for the development of grasping reflexes and other interaction with three-dimensional objects. That is, this method does not provide for the complication of operations aimed at the further development of tactile sensations and fine motor skills of the fingers, which are necessary to perform everyday tasks that a child with cerebral palsy or a person who has had a stroke and has gross impairment of motor functions may encounter.

There is a known method of teaching children with autism spectrum disorders (hereinafter referred to as ASD) (RF patent No. 2722673, published on 06/02/2020), which consists in the fact that training is carried out in stages, taking into account the characteristics of the health and developmental level of the child, at the first stage, he is immersed in virtual space with the help of a hardware-software complex for performing tasks on a computer, fix the result, being out of sight of the child, who, using the keyboard, mouse, foot pedals, joystick and microphone, performs the tasks received from the virtual character on the computer, then form a reaction a virtual character so that the child understands whether he coped with the task; at subsequent stages, real toys, pictures and objects identical to those with which the child worked in a computer program are connected to the tasks, then the skill of performing tasks with objects in the virtual world is transferred to performing tasks with objects in the real world, and the reaction to the actions of the child is replaced by a virtual character on the computer, first to the reaction of the virtual character on the computer and the teacher, and then only to the reaction of the teacher.

The considered method allows to increase the degree of education and habilitation of children with ASD, to establish the interaction of the child with others. At the same time, when using real objects, motor reflexes, reaction speed for performing incoming tasks, and the development of a psychological effect develop.

However, this method involves the same type of tactile interaction of the child with real objects identical to what is shown on the computer screen, without gradually complicating tasks related to the development of finger movements, which are necessary for further development of reaction speed and improvement of fine motor skills of the fingers.

There is a known method for the development of fine motor skills in children and adults with neurological abnormalities and pathology of the motor sphere (Internet resource https://rpk-atlant.ru/p91575176-saundbim-soundbeam.html, published on 10/23/2015, viewed on 09/15/2020 ), taken as the closest analogue to the claimed solution, which consists in the fact that color pictures are shown on the monitor and tactile buttons are used, painted in the same color as the pictures on the monitor. At the same time, tactile buttons are ultrasonic sensors that send a stream of ultrasonic pulses and receive information about movement.

The considered method and the Soundbeam system that implements it make it possible to create music due to body movements in space. The use of this method as a whole leads to the development of fine motor skills and the suppression of involuntary movements (hyperkinesis), the improvement of the patient's overall mobility, concentration, and the development of communication skills.

However, this method involves the development of coordination actions of the whole body in space. Direct interaction with the screen and colored tactile buttons on it occurs for a limited amount of time and does not imply a gradual complication of tasks that would lead to the development and improvement of precisely fine motor skills of the hands.

The technical problem of the present invention is the creation of a method for the development and improvement of fine motor skills of the hands in children with cerebral palsy, which allows expanding the functionality of the existing methods, correcting the mechanisms of sensory perception and organizing object-manipulative activity of the hands in children with cerebral palsy with a gradual complication of tasks.

The technical result of the invention is the implementation of the specified purpose.

The technical result is achieved by using a method for developing and improving fine motor skills of hands in children with cerebral palsy, which consists in selecting the complexity and number of tasks individually for each child, depending on the nature of the existing hand defect, then launching a monitor window for performing exercises, on which they give an image of a keyboard with colored keys, while the colors of the keys are performed in accordance with the colors of the fingers on the right and left sides of the depicted keyboard. Next, a real keyboard is installed in front of the child, which coincides with the depicted keyboard on the monitor screen. Then the child is offered to perform exercises of three levels of complexity with five blocks of tasks at each level, which involve consecutive pressing of colored keys on the depicted keyboard with fingers of the corresponding color, which is realized when the child presses the keys of a real keyboard. In this case, the sequence of images of colored keys on the displayed keyboard is formed before the start of the exercises according to the settings of the available fingers and the rules for expanding the range of keys assigned to the fingers. Moreover, the first block of exercises includes monosyllabic tasks for precise coordinated actions with the fingers, pressing keys with a minimum time interval and minimizing errors, the second block of exercises includes tasks for developing coordination of finger movements and printing short two-word phrases, the third block of exercises includes tasks for developing typing speed and printing phrases without punctuation marks of 3-6 words, the fourth block of exercises includes tasks for learning to print punctuation marks and numbers and printing phrases with punctuation marks and numbers, the fifth block of exercises includes tasks that involve printing an excerpt from text. After each block of exercises, the dynamics of the level of development of fine motor skills is monitored.

Regular performance of specialized exercises according to the claimed method for the development of fine motor skills of the hands in combination with the work of the visual system involves the development of a motor stereotype in the trainee and represents a set of coordinated actions of the nervous, muscular and skeletal systems, which favorably affects the development of fine motor skills of the hands of children with cerebral palsy.

The duration of the rehabilitation course according to the claimed method is 6 months, once a day with a duration of 15-20 minutes.

Before using the proposed method, all children perform tests. Upon completion of the rehabilitation course, it is planned to repeat the tests to assess the effectiveness of the work performed.

For a test study of the child's capabilities, the "Working Fingers" test is carried out using a computer keyboard. The child is invited to perform a series of keystrokes on the keyboard with his fingers. The data allow us to evaluate the performance of each finger, where 0 is the absence of working fingers in the hand, 1 is the presence of 1 working finger, 2 is the presence of 2 working fingers, 3 is the presence of 3 working fingers, 4 is the presence of 4 working fingers, 5 is all fingers of the hand work . The test is a modern modification, which was based on the practical experience of honored figures in the field of examining the level of formation of motor and sensory processes in children - Professor N.I. Ozeretsky and Professor M.O. Gurevich.

Also, to diagnose the working set of fingers, that is, the number of fingers of the right and left palms involved in daily work, a number of tests can be performed:

Test 1 - "Mobility of the fingers" - allows you to determine the function of the muscular apparatus of the hands by assessing the mobility of the fingers. The mobility of the fingers is determined first as a whole, and then considers the mobility of each joint separately. The child is invited to press the palm firmly against the table, spread all the fingers and raise the hand and each finger separately above the table. The nature of the performance of actions is recorded and evaluated according to a 4-point system. 0 points - movements are impossible, which indicates the presence of functional disorders; 1 point - significant difficulty in movement and their inferiority; 2 points - great mobility and difficulty in raising some fingers above the surface; 3 points - all muscles and nerves are functioning.

Test 2 - "Grip-test" - involves assessing the child's ability to take the object extended to him by performing a large grip of the object with five fingers. The scores also had an inverse scale of the scoring system: from 5 points (“I took it confidently, quickly, purposefully, gripping with all fingers”) to 0 (“I did not take it” (W.D. Memberg, 1997)).

Test 3 - "Dice shifting test" - is used to assess not only the five-finger grip of the hand, but also the activity and correctness of the task. In addition, it is used to assess the stability of attention and other movement parameters, which are generally provided by various structures of the nervous system, as well as their well-coordinated work, and manifest themselves in a stable ability to perform a task well and quickly, which indicates the correct formation of visual-motor connections. Estimates also have a reverse scale of the scoring system: from 5 points (“I took the Cube from the box on the right side with my right hand, shifted it to my left hand, transferred it to the box on the left. I took it confidently, quickly, purposefully, grasping with all fingers”), to 0 (“ I didn’t take it, I couldn’t transfer the cube from one hand to the other”).

Test 4 - Neuropsychological method of opto-kinesthetic organization of physiological posture tests "Goat", "Scissors", "Ring". The ability to qualitatively repeat the pose is evaluated. The child is invited to reproduce the position of the fingers according to the visual image in three positions: "Goat", "Scissors", "Ring". The results of the test are recorded, and then an assessment is made in points from 0 to 2, where 0 - failed, 1 - succeeded with one hand, 2 - succeeded with both hands. The presence of absolute zero and the increase in values also made it possible to classify the obtained data as metric.

The user part of the program contains a task execution window and an image of a keyboard with colored keys. The colors of the keys correspond to the colors of the fingers of the palms depicted on the right and left sides of the keyboard. These images are generated dynamically on the server side prior to working with this page. Images are formed according to the settings of available fingers (performed by the administrator on the corresponding page) and the rules for expanding the ranges of keys assigned to fingers in case of their incomplete set.

At the same time, a real keyboard is placed in front of the child, which exactly repeats the keyboard shown on the monitor screen. The child compares the depicted keyboard with colored keys and colored fingers with a real keyboard and his own real fingers. During operation, the desired key of the depicted keyboard is highlighted with a color corresponding to the color of the finger with which it is necessary to press it. Pressing the right key with the right finger on the actual keyboard presses the colored key on the depicted keyboard. Further, after such a pressing of one colored key on the depicted keyboard, the program shows the next colored key on the depicted keyboard, which must also be pressed with the desired finger having the corresponding color. This process is repeated until the end of the task.

Exercises for the development of fine motor skills of the hands according to the claimed method are built on the principle of increasing complexity of execution: exercises consist of a simple, medium and complex level, each of which involves the completion of five blocks of tasks.

The exercises of the first block are easy to perform and contain monosyllabic tasks, such as: find the letter “o” on the keyboard, add a space to the letter “o”, type the word “goal”, etc. The exercises in this block are aimed at precise, coordinated finger movements and keystrokes with a minimum time interval and the absence of errors.

The exercises of the second block contain tasks for the development of coordination of movements. Well-coordinated finger movements are essential for daily activities. It is known that fine motor skills contribute to the development of attention, thinking, optical-spatial perception and the development of speech. In this block of exercises, phrases that are short in their content are used, such as “gadfly by the water”, “gadfly sting”, “water vapor”, etc.

The third block includes exercises to develop typing speed. This block uses phrases without punctuation marks, consisting of three words at the first level of complexity, 3-4 words at the second and 4-6 words at the third level of complexity, which allows you to improve precise finger movements, develop tactile sensitivity and rhythmic typing. For example, “mom washed the frame”, “puppy nods on command”, “Timoshka Troshka crumbles crumbs into okroshka”.

The fourth block contains exercises for learning to print punctuation marks and numbers. If all 10 fingers are working, then the shift, caps lock, tab, “e”, “1” buttons are assigned to the little finger of the left hand; to the ring finger of the left hand - the key "2"; to the middle finger of the left hand - the key "3"; to the index finger of the left hand - the keys "4" and "5"; to the index finger of the right hand - the keys "6" and "7"; to the middle finger of the right hand - the key "8"; to the ring finger of the right hand - the key "9"; to the little finger of the right hand - the keys "0", "-", "=", backspace, \, enter, shift. If the little fingers are not able to perform the exercises, then the keys are pressed with the ring fingers. For example, phrases such as “Happiness is ...”, “Water is two hydrogen atoms, one oxygen”, “We are going, going, going to distant lands. Cheerful neighbors, happy friends, etc.

The exercises of the fifth block contain an excerpt from the text, small in volume for exercises of the first level of complexity, medium - for the second and more voluminous - for the third level of complexity. The execution of this block assumes the coordinated work of the fingers, rhythmic typing, and the absence of difficulty in finding the necessary characters on the keyboard.

In order to trace the dynamics of the level of development of fine motor skills, the computer program used after each block of exercises includes a diagnostic block consisting of four tasks:

- printing of the line "d j j j ..." - 28 characters;

- printing of the line "hot hot ..." - 20 characters;

- printing of the line "true true ..." - 27 characters;

- printing of the line "seine seine ..." - 29 characters.

The program captures both the time and the number of clicks, which allows you to determine the number of errors.

When performing exercises, animated assistants can be used that respond to the actions of the student and provide the necessary support in the form of movements and cues, resulting in an impact on the child's sensory systems, which in turn contribute to the development of attention, memory, and creative abilities. Animated assistants are presented in the form of fingers (three boys - thumb, index, nameless and two girls - middle and little fingers), drawings of children with cerebral palsy visiting the Sochi rehabilitation center for children and adolescents with disabilities were taken as the basis for the animation sketches. All "fingers" are capable of performing some actions, such as blinking eyes, smiling, talking. When performing exercises, they pronounce the phrases: “well done”, “clever”, “excellent”, “excellent”, “wonderful”, “correct”, “good” and only one phrase “try again” is pronounced when the exercise fails, calling engaged not to be upset, but to rest and perform the exercise again.

During the exercise, every 15 minutes, the timer built into the program is activated, which blocks work with the main window, i.e. exercise page and transfers the practitioner to a page with an animated assistant offering to perform several relaxing and strengthening exercises for the hands and eyes, since according to sanitary rules and regulations, continuous work with video display terminals or personal electronic computers should not exceed the specified time. The page also contains an illustrated diagram of the exercise (a static image) and the "Exercise completed!" button, by which you can go to the next exercise or return to the main work page. The output of this page is carried out every 15 minutes of working with the application, but cannot be performed during the exercise (in this case, the output will occur after the completion of the exercise on which the timer worked).

To confirm the effectiveness of the proposed method for the development and improvement of fine motor skills in children with cerebral palsy, appropriate clinical studies were conducted.

50 sick children with a diagnosis of cerebral palsy (46 boys and 4 girls) aged 6 to 10 years were selected for classes (spastic diplegia in 45 cases (90%) and hemiparetic form - in 5 (10%).

All study participants were disabled children with intact intelligence. In accordance with the system of classification of gross motor functions (GMFCS), 4 levels of motor disorders were established in children: level I in 38 children (76%), II - in 6 (12%), III - in 4 (8%), IV - in 2 (4%). Also, the participants of the study were found to have sensory-motor disorders, such as: praxis disorder - in 27 cases (54%), trunk ataxia - in 30 (60%), impaired sense of position or movement of parts of one's own body - in 38 (76%) , violation of chewing function - in 11 (22%), dysphagia - in 21 (42%), dysarthria - in 20 (40%), speech development delay (SRR) - in 16 (32%). In addition, sensory disturbances were noted: strabismus in 20 children (40%), myopia in 6 (12%), nystagmus in 4 (8%), ptosis in 4 (8%), high-frequency hearing loss in 4 ( 8%), violation of tactile sensitivity - in 29 (58%), violation of stereognosis - in 20 (40%).

All children were assessed for physical development: carpal dynamometry, height, body weight, chest circumference. Tests were carried out for the hands: "Mobility of fingers", "Grip-test", "Shifting cubes", "Working fingers". Spatial praxis was determined using the neuropsychological technique of opto-kinesthetic organization of physiological postural tests "Goat", "Scissors", "Ring".

Depending on the application of corrective actions, patients with cerebral palsy were divided into 2 groups (main and control), which were comparable in frequency of sensory-motor and sensory disorders.

To correct the mechanisms of sensory perception and organization of movements through the development of object-manipulative activity, the children of the main group were engaged in the method of improving the fine motor skills of children's hands and performed specialized exercises of the computer program "Perst".

Children of the main group were engaged according to the claimed method for 15-20 minutes a day for 6 months daily. Exercises had a complex effect on the body of those involved, including emotional, mental and cognitive activity, sensory systems in the training process, and their mechanical implementation contributed to the development of coordination and accuracy of hand movements.

Children of the control group were under observation and did not perform exercises according to the claimed method.

After 6 months, when examining the main and control groups at the beginning of the study, the anthropometric indicators of children corresponded to the physiological manifestations of growth and development characteristic of this age. An analysis of the variability of height and body weight, as well as chest circumference at the beginning and end of the study, made it possible to speak about the expected process of growth and physical development in the absence of significant differences (Table 1).

Comparison of the results of assessment of sensory-motor disorders in patients of the main group at the beginning of the study with the data obtained after 6 months revealed a number of significant differences. Thus, a violation of the implementation of purposeful motor acts (praxis), observed at the beginning of the study in 13 children (52%), at the end of it was noted only in 4 (16%); dysarthria and RDD, which occurred initially in 9 (36%) and 8 children (32%), after 6 months were observed in 2 (8%) and 1 (4%), respectively.

After conducting classes according to the claimed method for the development and improvement of fine motor skills of hands in children with cerebral palsy, a comparison of the main and control groups showed significant differences (p<0.05) in the ability to perform targeted motor acts (praxis), dysarthria and RRR.

There were no significant differences among other sensory-motor disorders (Table 1).

In addition, after a course of classes, there was a positive trend in such types of sensory disorders as tactile sensitivity and impaired stereognosis. In the main group, there were initially 14 (56%) children with distortion of tactile sensitivity and 11 (44%) with impaired stereognosis. After 6 months these disorders were noted in 11 (44%) and 5 (20%) patients, respectively (p>0.05).

In the control group, six months later, the number of children with kinesthetic disorders did not change (Table 1).

A test of the opto-kinesthetic organization showed that out of 25 patients with cerebral palsy in the main group, only 6% of children could repeat the pose - "Goat" with the right and 2% with the left hand; finger pose "Scissors" was performed by 9% of children with the right and 0% with the left hand; finger pose "Ring" was performed by 18% of children with the right and 6% with the left hand. After 6 months, children of the main group showed significant positive dynamics in all tests (p<0.05) in the tests "Goat", "Scissors", "Ring" of the right and left hands.

In the control group, there were no significant differences in all these tests.

After the study, a comparison of the main and control groups showed significant differences (p<0.01) in all postural tests for both hands (Table 2).

According to the results of the "Working fingers" test, the mobility of the fingers of the right and left hands of the children of the main group improved. The greatest improvement in mobility on the right hand was noted in the middle finger, the mobility of which in 5 (20%) children became better than before the exercise according to the claimed method. 4 (16%) children began to use the ring finger better, 3 (12%) children - with the thumb, 2 (8%) with the index finger, 1 (3%) with the little finger. The mobility of the fingers of the left hand increased to the maximum in the middle finger in 7 (28%) patients with cerebral palsy, in the ring finger - in 3 (12%), in the index finger - in 2 (8%), in the little finger - in 1 (4%).

When assessing the mobility of the hands of patients with cerebral palsy in the control group at the beginning and end of the study, there were no significant differences in the total mobility of the fingers of both the right and left hands (Table 3).

Analysis of the results of carpal dynamometry in children with cerebral palsy of the main group at the end of the study showed an increase in muscle strength of the right hand from 6.5±4.0 to 8.1±3.7 kg (p<0.01) after doing exercises for 6 months; in the left hand, muscle strength increased from 4.1±3.5 to 6.4±3.1 kg, respectively (p<0.01).

When testing the children of the control group, a positive change in the tested indicators was noted in dynamics, which could be associated with the overall growth and development of children. However, the differences were not statistically significant. So, with the initial carpal dynamometry, the muscle strength of the right hand was 6.9±3.9 kg, and that of the left hand was 5.6±3.8 kg; when measuring muscle strength after 6 months, no significant differences were found, it was 7.0±3.9 and 5.6±3.8 kg, respectively (table 4).

The time of a simple visual-motor reaction (VVR) on the Neurosoft-Psychotest software and hardware complex decreased by 172.59 ms, so before the start of training, the average reaction time was 883.3 ± 73.2 ms, after training it was 710, 7±67.6 ms (p<0.01), which indicated an increase in attention and concentration (Table 4).

The performance of the "Mobility of fingers" test improved from 1.7±0.9 to 2.2±0.8 points (p<0.01), the "Changing blocks" test from 9.7±5.6 to 17.2± 10.2 points (p<0.01). "Grip-test" of the left hand before training was 2.8±1.3 points, and the right hand - 2.6±1.2 points; at the end of the training, the test performance improved to 4.2±0.6 points (p<0.01) and 4.2±0.9 points (p<0.01), respectively. Test assessment of fine motor skills, VVMR and finger mobility of the control subgroup of children with cerebral palsy at the beginning and end of the observation period did not show significant differences between the analyzed features. Comparison of the main and control subgroups after 6 months showed significant differences in carpal dynamometry (hand muscle strength) of the right and left hands, PZMR, "Grip-test" on both hands, and "Cubes" test at p<0.01 and mobility fingers at p<0.05 (Table 4).

The results of assessing the speed of performing exercises and the frequency of making mistakes when performing tasks in the test blocks after completing each block of exercises of the proposed method in the main subgroup of children with cerebral palsy showed a significant improvement in the skills of reproducing printed text, including by improving fine motor skills by the fifth exercise of the first block of exercises ( at p<0.01), the time of this exercise was 3.37±0.96. Also, the formation of a stable skill for the fourth exercise of the second block of exercises was recorded (at p<0.01), the time to complete this exercise was 3.30±0.53. From the fourth task of a simple level of complexity, children with cerebral palsy made significantly fewer mistakes when performing exercises (at a high level of significance, p<0.01).

The number of errors in the following test blocks decreases in all exercises, in comparison with the first, which indicates the formation of a stable skill in reproducing printed text.

Parents of 22 sick children with cerebral palsy from the main group noted that the children began to show independence in doing household chores, such as putting things in order in their room, holding cutlery. Parents of 8 children participating in the study reported that after three months of regular classes, the children learned to read in syllables and write, that is, to form words from cards with letters.

Thus, the improvement in the mobility of the fingers and the ability to perform purposeful coordinated motor acts were due to the development of manipulative activity of the hands in patients with cerebral palsy.

The results obtained showed the effectiveness of the proposed method for the development and improvement of object-manipulative activity of the hands of children with cerebral palsy. The proposed physical exercises in the mode - one session per day (15-20 minutes) for 6 months were optimal for disabled children and contributed to the development of purposeful precise movements of the fingers.

The inventive method in children with cerebral palsy had an impact on the tactile-kinesthetic processes of the fingers and speech-motor disorders by increasing the reverse kinesthetic afferentation. This was expressed in a significant improvement in the mobility of the fingers and the ability to perform purposeful coordinated motor acts, as evidenced by the obtained results of improving object-manipulative activity and reducing the number of patients with dysarthria and delayed speech development among patients with cerebral palsy in the main subgroup.

Thus, the claimed method can be recommended for the development of fine motor skills of the hands in patients with cerebral palsy, as well as in patients with delayed mental and speech development, and other disabilities.

Claims (1)

A method for developing and improving fine motor skills of hands in children with cerebral palsy, which consists in selecting the complexity and number of tasks individually for each child, depending on the nature of the existing hand defect, then launching a monitor window for performing exercises, on which an image of a keyboard with colored keys, while the colors of the keys are performed in accordance with the colors of the fingers on the right and left sides of the depicted keyboard, then a real keyboard is installed in front of the child, which matches the depicted keyboard on the monitor screen, after which the child is offered to perform exercises of three levels of complexity with five blocks of tasks at each level, assuming sequential pressing of colored keys on the depicted keyboard with fingers with the corresponding color, which is realized when the child presses the keys of the real keyboard, and the first block of exercises includes monosyllabic tasks: find a letter on the keyboard, add to the beech space, type a word containing the specified letter and involving keystrokes with a minimum time interval, the second block of exercises includes tasks for printing phrases of two words, the third block of exercises includes tasks for printing phrases without punctuation, consisting of three words on the first level of complexity, 3-4 words at the second level of complexity and 4-6 words at the third level of complexity, the fourth block of exercises includes tasks for printing phrases with punctuation marks and numbers, the fifth block of exercises includes tasks that involve printing an excerpt from the text, with At the same time, after each block of exercises, the dynamics of the level of development of fine motor skills is monitored.