Soviet Review

ISSN: 0038-5794 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/mrss19

Rehabilitative Education and Its Importance for

Psychology and Pedagogy

A. R. Luriia & L. S. Tsvetkova

To cite this article: A. R. Luriia & L. S. Tsvetkova (1966) Rehabilitative Education and Its
Importance for Psychology and Pedagogy, Soviet Review, 7:2, 3-12

To link to this article: http://dx.doi.org/10.2753/RSS1061-142807023

Published online: 09 Dec 2014.

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A. R. Luriia and L. S. Tsvetkova
REHABILITATIVE EDUCATION AND ITS IMPORTANCE
FOR PSYCHOLOGY AND PEDAGOGY
Recent decades have seen the development of a
new branch of pedagogy that has both special and
general significance. We refer to the rehabili-
tative education of persons who, as a result of
local affections (wounds, hemorrhages, tumors)
of the brain, have lost the complex s k i l l s and
habits of speech, writing, reading, and counting.
It is known that destroyed brain cells do not
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regenerate. The loss of complex skills and
habits as a result of affections of important
areas of the brain was considered to be irre-
versible; persons who suffered severe traumas,
hemorrhages, or tumors of the brain were con-
sidered to be invalids whose destroyed skills
and habits could not be restored. As a result
of the workof Soviet researchers (B.G. Anan’ev,
1947; L. V. Zankov, 1948; V. M. Kogan, 1948,
1962; A. R. Luriia, 1948; E. S. Bein, 1964) it has
become clear that a rationally constructed sys-
tem of reeducation leads to the reconstruction
and completion of the damaged processes in a
The authors are associated with Moscow
(M. V. Lomonosov) State University.
3
Sovetskaia pedagogika, 1965, No. 12
new intact system of brain areas, and to the
restoration of the destroyed skills and habits
on the new cerebral foundation. This has been
verified in practice, and in the course of the
last 25 years (especially in recent years) hun-
dreds of persons who have suffered from severe
cerebral diseases have been able, within cer-
tain limits, to restore lost functions. Herein
lies the great special significance of rehabilita-
tive education.
However, rehabilitative education also has an-
other, much more general significance. Brain
affections destroy that cerebral apparatus whose
preservation is necessary for the performance
of complex skills and habits, and the process of
rehabilitating the lost s k i l l s assumes new fea-
tures which allow one to examine certain gen-
eral psychological mechanisms of instruction
in much greater detail that is the case in the
norm. “The pathological,” said I. P. Pavlov,
“often reveals to us, through resolution and
simplification, that which is shielded from us,
blurred and complicated, in the physiological
norm” (Lectures on the Work of the Large
 Cerebral Hemispheres [ Lektsii o rabote bo1’-
shikh polusharii mozga], Moscow, Publishing
House of the Academy of Sciences of the USSR,
1949, p. 316). The general significance of re-
habilitative education consists in this possibility
of more closely revealing certain general psy-
chological features of the acquisition of skills
and habits, and of approaching an analysis of
their psy chophy siological mechanisms.
1.
The first and basic peculiarity of persons with
local cerebral affections is the fact that complex
skills and habits disintegrate in different ways,
depending on which part of the cortex has been
destroyed.
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A s is now widely known, the cerebral cortex is
the central areaof all the individual’s analyzers;
the cells which form them assure the possibility
of isolation from the surrounding environ-
ment of important “signal” indicators, their
synthesis into complex sets, the creation of pro-
grams of necessary activities, and the utiliza-
tion of necessary skills. It has been established
by many investigations that complex forms of
activity are secured by the whole system of
jointly operating sections of the brain, with the
separate sections securing the various condi-
tions which a r e necessary for complex forms of
psychic activity. Thus, the formations which lie
at the depths of the brain (the so-called reticular
formation of the brainstem) supply the cortex’s
tone, which is necessary for the preservation of
a healthy condition and for the fulfillment of dif-
ferentiated forms of activity. The r e a r sections
of the brain (the sincipital, temporal, and occi-
pital cortex) secure the analysis and synthe-
sis of kinetic, acoustic, and visual stimuli, and
the sincipitial- temporal-occipital sections of
the cortex of the left hemisphere permit the
realization of those forms of analysis and syn-
thesis of these stimuli that lie at the foundation
of the speech processes. The portions of the
forward areas of the cerebral cortex, which
form the “motor analyzer,” ensure the fulfill-
ment of precise movements and motor skills.
Finally, the frontal lobes of the cortex, accord-
ing to all available data, a r e most closely in-
volved in the formation of complex programs
of activity, in the control of the results of ac-
tion, and in the correction of mistakes that have
been made. An affection in any of the mentioned
areas of the cerebral cortex entails the distur-
bance of one or another component (factor) of
psychic activity.
An essential fact, however, is that any given
local affection of the brain disturbs only those
skills and habits whose psychological structure
includes the corresponding factor that is con-
nected with the work of the given portion of the
cortex, If the structure of the s k i l l or habit
does not include that factor which was connected
with the work of the destroyed part, then they
a r e preserved. Thus, if an analysis of the sound
composition of a word is necessary for writing
dictation (or even for writing independently),
then affections of the cortex of the left temporal
region (the end of the gray matter of the acous-
tic- speech analyzer) inevitably lead to a disinte-
gration of the ability to write. However, they do
not lead to the disintegration of drawing skills,
for which participation of sound analysis is not
necessary. On the other hand, an affection of the
the sincipital- occipital portions of the cortex
(the gray matter portions of the visual-spatial
analyzer) inevitably leads to the disintegration
of the s k i l l s of drawing and of operating with
geometrical and numerical diagrams, for which
the preservation of spatial analysis is necessary,
but it has no impact on the sound analysis of
words or musical skills, for which the participa-
tion of visual- spatial relationships is not neces-
sary.
Thus, studying how skills and habits disinte-
grate during local cerebral affections is a means
of analyzing their psychophysiological structure,
in other words, of establishing exactly which
psychophysiological components enter into their
make-up. That which is sometimes very diffi-
cult to establish while studying the normal flow
of psychic activity is easy to establish while
studying the separate forms of i t s disruption
in cerebral affections.
This basic position of neuropsychology (the
study of the cerebral mechanisms of psychic

activity) also has great significance for the anal-
y s i s of the psychophysiological foundations of
education. If a corresponding process that is a
part of a given s k i l l or habit, and is damaged
during a certain cerebral affection, can be as-
sumed in some other way, relying on the intact
portions of the brain, then it is possible to re-
habilitate the destroyed skill o r habit as a result
of a special system of instruction which recon-
structs the destroyed function. Thus, for exam-
ple, the analysis of the sound composition of a
word, which in the norm is brought about through
the leading role of the temporal (acoustic) areas
of the cortex, may be rehabilitated by teaching
the patient to read with his lips, to analyze kinet-
ic sensations which arise during the pronuncia-
tion of a word, or to analyze the visual (letter)
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content of written words. Disturbances in calcu-
lating, which arise with affections of the
sincipital-occipital areas of the cortex, may be
overcome to a certain degree by resorting to the
resolution of calculating operations into their
simplest elements and to the successive analysis
of each step included in a calculating operation.
In all of these cases, rehabilitative education
brings in new and intact zones of the cortex for
fulfilling the necessary operation, and a careful
analysis shows which new methods or new forms
of psychic activity may be brought in for rehabili-
tating skills and habits. The important signifi-
cance of rehabilitative education for the general
psychological foundations of didactics consists
in this opportunity to analyze the psychophysiolog-
ical composition of s k i l l s and habits and to es-
tablish various new methods of acquiring s k i l l s
and habits.
2.
Disturbances of skills and habits with local af-
fections of the brain differ in yet another feature,
making the analysis of these cases especially
valuable for elucidating the general laws of edu-
cation. In all affections of the brain which de-
stroy a certain group of cells of the cerebral cor-
tex, the course of psychic activity loses that auto-
mated, abbreviated character which is typical for
the normal psychic processes, and the fulfillment
5
of this or that task takes on a de-automated,
extended nature, in which the application of cer-
tain methods or auxiliary means becomes espe-
cially accessible to observation. By virtue of
this, analysis of the performance of certain
operations by a patient with a local affection
of the brain acquires significance for elucidating
all the details of the course of skills and habits
and for revealing those elements of s k i l l s and
habits which, in the norm, are almost inacces-
sible for analysis.
Numerous investigations carried out in recent
decades in Soviet psychology (L. S. Vygotskii,
1956, 1960; A. N. Leont’ev, 1959, 1965; and
others) have convincingly shown that the forma-
tion of every s k i l l or habit in the individual in-
volves at least three stages: at f i r s t they are
brought about by means of a s e r i e s of extensive
external (material o r materialized) operations;
then the external operations a r e gradually ab-
breviated, and they begin to be performed with
the aid of external speech; and, finally, they are
carried to internal speech and begin to be per-
formed as abbreviated, automated mental opera-
tions. This process of automation leads to a
situation in which the majority of skills and
habits in the mature individual take on such an
abbreviated nature that an analysis of those
operations which they entail becomes almost
impossible. It is sufficient to try to answer the
question of which psychological components a r e
included in the structure of the act of reading,
writing, reckoning, o r solving problems in
arithmetic, in order to have all the difficulties
of a detailed analysis of abbreviated and auto-
mated s k i l l s and habits become clear.
The observation of how these same actions are
performed in the presence of local affections of
the brain reveals a completely different picture.
The patient, in whom one of the essential com-
ponents for the mastering of a skill or habit has
been lost (or has been partially disturbed), loses,
first of all, smoothness of action; he is not able
to perform a necessary task immediately, and he
appears compelled to successively complete all
those steps which go into its formation, deliber-
ately and arbitrarily turning to each of them.
One need only observe how patients with local
 6
affections of the brain write or count in order
to have the de-automated and extensive nature
of the pathologically altered habit become clear.
A patient with a disturbance of his phonemic
hearing (arising with affections of the cortex
of the left temporal region) makes attempts to
distinguish the necessary sound and to find its
supporting signs; he includes the uttering of each
sound, looks for its external form, and finds the
necessary sound composition of the word after
a whole series of extensive successive opera-
tions. A patient with an affection of the anterior
(pre-motor) regions of the cortex is found to be
unable to write a whole word immediately, with
one smooth motion; instead, he completes each
stroke with an arbitrary effort, deliberately
switching over to the next stroke, so that the
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writing of each letter (and more so, each word)
begins to be completed by means of a whole
chain of isolated arbitrary impulses; in the
norm these impulses are concealed, becoming
a part of complex and smoothly performed
motor skills. A patient with an affection of
the sincipital- occipital regions of the brain
and with a disturbance of his powers of spatial
analysis and synthesis loses the automation of
calculating habits and begins to perform even
relatively simple reckoning operations with the
aid of a whole series of successive operations,
each of which begins to be realized with the aid
of special external supports and extensive de-
vices which rely on certain auxiliary means.
Experience has shown that this extensive and
successive chain of devices used by the patient
is the necessary condition for his rehabilitation
through education, and that it suffices to omit
any link of the necessary action, o r to prema-
turely curtail a habit which is being dealt with,
in order to render impossible the action being
rehabilitated. That is why, as systematic ob-
servations have shown, even prolonged rehabili-
tative education of such patients leads to the re-
sult that the patient again becomes capable of
performing the skill which had earlier been
lost, but he is not able to perform the operation
with-theformer smoothness, and it continues to
have this extensive and external nature for
many years.
For the person investigating the psychological
structure of s k i l l s and habits, such a limited
opportunity to curtail and automate an action
is of special interest. It allows him to deter-
mine, in detail, which components make up the
necessary skill or habit, what the order of suc-
cession of these components is, and what ensues
from the omission of a certain component, that
is, what significance each of them has in the
structure of the action. It is easy to s e e that
such a detailed analysis of the operations nec-
essary for the completion of a corresponding
action, and of their sequence, is of special
importance for one of the most urgent problems
of contemporary education - the programmed
formation of s k i l l s and habits. In the norm,
such a detailed analysis of all the component
elements of a completed action is particularly
difficult and, therefore, the observations ob-
tained in the process of rehabilitative education
acquire particular interest.
3.
In order that rehabilitative education of patients
with local affections of the brain should have the
necessary effect, one must strictly observe two
fundamental rules which follow from what has
been said above.
1. Rehabilitative education must be strictly
differentiated; in other words, it must proceed
from an analysis of the peculiarities of a dis-
turbance and the isolation of that factor whose
destruction was basically responsible for the
loss of the s k i l l or habit. (1)
Both the problems and methods of rehabilita-
tive education have a completely different char-
acter in cases where a lapse of various factors
is basically responsible for the loss of skills
and habits, and an insufficient consideration of
the psychological structure of the disturbance
may render instruction completely ineffective.
Thus, if the disintegration of acoustic analysis
and synthesis causes the disturbance of the
ability to write, it is senseless to have the
patient practice copying a text; however, if
disintegration of visual- spatial analysis and
synthesis or a disturbance of the dynamic

transference of the nerve processes (pathologi-
cal inertness of the frequency of arising stereo-
types) is responsible for the disturbance of the
ability to write, then practice in analyzing the
sound composition of a word will be superfluous
and ineffective.
2. Rehabilitative education must rely on the
application of external means and only gradually
switch over from an extensive process, with
isolation of all of its components, to an abbre-
viated, curtailed process. This second rule may
also be formulated as the need for maximum
programming of the process of education, in
which all elements of the s k i l l being rehabili-
tated must be “scheduled” and brought out, and
must be supported by a chain of special ex-
ternal means.
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Experience has shown that the ways of re-
habilitating disturbed skills and habits among
patients prove to be so extensive, and the com-
pletion of a given action begins to be so depen-
dent on external supporting means, that the
omission of even an insignificant element, on
the assumption that the patient will complete
it himself, may lead to the disintegration of
the entire activity being rehabilitated.
Only gradually, at later stages of instruction,
does the activity being rehabilitated begin to be
curtailed; separate supporting elements a r e
shed from the program, which previously in-
cluded the whole list of external auxiliary means,
and the process slowly and successively begins
to be curtailed internally; then it ceases to
depend on the external supporting means, but
for a long time the uttering of a successive
chain of operations is still necessary.
Both these demands not only assure success
in rehabilitating the skills and habits of patients
with local affections of the brain, but they also
provide the opportunity to trace the psychologi-
cal peculiarities of the formation of skills and
habits, thereby making rehabilitative education
a process of great interest in the comprehen-
sion of several fundamental questions of in-
struction in general.
W e shall dwell on two examples, with which
we can illustrate the processes of rehabilitative
education. For this purpose we shall select the
7
process of the rehabilitation of complex spatial
abilities (constructive activity, closely con-
nected with descriptive geometry) and the pro-
cess of rehabilitating the understanding of logi-
cal-grammatical structures.
The first of these examples illustrates the
ways of rehabilitating s k i l l s of graphic thought,
and the second illustrates ways of rehabilitating
intellectual operations.
4.
All constructive activity demands of the indi-
vidual highly developed visual- spatial analysis
and syntheses. In order to construct a certain
geometric structure, the individual must analyze
the visual information which reaches him, put
its elements into a known system of codes, and
re-code the elements of the immediate impres-
sion into the elements of a spatially organized
construction. The omission of any one of the
elements of this process can, it would seem,
make the simplest task unrealizable.
Thus, if a student is asked to obtain figure a
from the elements b (Fig. l ) , he must first of-
all overcome the immediate impression that the
proposed structure consists of three elements
of different colors (the two small bright tri-
angles and the one large dark triangle). He
must convert the elements of his immediate
impression into the elements of the construc-
tion, which, in the given case, are the blocks
of two-colored figures (b,). He must expand the
given construction, not into the three elements
of his immediate impression, but into the two
blocks of the construction, mentally dividing the
immediately perceived figure (the large d a r k
triangle) and carrying over each of the isolated
parts to the different blocks of construction -c.
I I
A B C
Fig. 1
He must, furthermore, accurately orientate the
contours of each geometric figure in space,
 8
clearly having learned that one side of the large
dark triangle goes from the lower left to the
upper right side ( P ) ,and that the second side
goes in the opposite direction (L). Only when
all these elements of constructive activity are
preserved can the given problem be solved. It
is natural that, under normal conditions, all
these processes flow smoothly and in an abbre-
viated manner, and only the practice of com-
posing programs for high speed calculating-
solving mechanisms shows the productivity
of such a detailed analysis of all the operations
required for the completion of a complex action.
In pathological conditions, and above all in
affections of the sincipital- occipital areas of
the cerebral cortex (the central apparatus of
visual- spatial analysis), the state of affairs
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changes considerably. The patients a r e found
to be unable to separate individual component
elements from the immediate impression; they
a r e still less able to orient themselves in the
spatial correlationships of the separate elements
of the construction. All this makes the process
of a quick, abbreviated visual- spatial analysis
of the construction inaccessible to them.
Special investigations have shown the com-
plete failure of these patients in solving those
constructive problems in which they a r e asked
to construct, following the given model, a geo-
metric figure of greater or lesser complexity
from blocks, the sides of which a r e of different
colors (Kos’s test). The complexity of the
solution of the given constructive problem lies
in the fact that in order to correctly solve it,
it is necessary to first re-cipher the immediate
impression from the model into elements
(blocks) of the construction, and this poses the
greatest difficulty for patients with affections
of the sincipital-occipital systems. This is pre-
cisely why, despite the preservation of the pa-
tients’ orientation in the task, their ability to
retain the final goal and to create a general
scheme of activity, and also the attempts to
control their own actions, the problem of
building figures from blocks was, for all prac-
tical purposes, not solved by the patients. All
the difficulties began just as soon as the pa-
tients switched from analysis of the general
conditions of the solution of the problem to the
concrete operations of construction, which de-
manded the ability to orientate the separate
elements of the construction in space according
to the given model. The active searching ac-
tivity of these patients remained intact, as was
indicated in numerous tests in the constructing
of a figure; these tests, however, could not lead
to the correct perception of the spatial distribu-
tion of the elements of a figure and of a con-
struction. The patients often changed the spa-
tial location of each block in their search for
the right one, and they sometimes accidentally
found the correct position for the block, but
they were unable to realize and evaluate this
position. All of their constructive activity
looked purposeful, but it did not lead to success
because of defects in their spatial analysis.
First row 1 4
Second row 2 5
3 6
Fig. 2
The attempts of one of the patients to con-
struct the first row of the figure are given in
Figure 2.
These defects of the visual-spatial skills and
habits constitute the object of specially orga-
nized rehabilitative education. A program of
such rehabilitative education was worked out
in detail and tested on a large number of pa-
tients with similar disturbances. It consists
in the disintegration of all required activity in
a series of successive problems and in the ap-
plication of a chain of external methods which
make possible the substitution of the disturbed
spatial representations with a number of opera-
tions which make use of external supports. This
program has the following content:
1. Find the f i r s t row in the model.
2. Cover all the lower rows with a piece of
paper.
3. Point out the main figure in the first row.
4. Draw that figure.
5. Each such figure consists of separate

“angles” (triangles).
6. Form the f i r s t row. Construct the basic
figure from the “angles.”
7. For this purpose, determine which way
each “angle” i s facing.
ink- or Lout
Fig. 3
Fig. 4
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8. In exactly the same way, construct the
second, third, etc., rows.
Such a program provides for the compensation
of the defect in the simultaneous visual- spatial
perception of a geometric figure by means of
breaking it down into separate operations, which
form the structure of the process of the percep-
tion of spatially distributed figures. This struc-
ture has been carried over externally, and it is
materialized in form and extensive in its forma-
tion. The successive completion of these opera-
tions also leads to the rehabilitation of the ability
to orientate blocks in space. T e s t s have shown
that the seventh point of the program is its most
essential part, because precisely this complex
of operations teaches the patient the analysis of
the spatial distribution of the blocks. The most
difficult element in the construction of the figure
in the problem w a s finding the spatial distribu-
tion of those triangles into which the corre-
sponding side of the block broke down, and
bringing this into accordance with the model.
Therefore, the program also taught the patients
the ability to find the position of the triangles by
means of an analysis of the spatial position of
the right angle of the triangle. The ability to
find the correct orientation of “angles” w a s the
central point, conditioning the correct con-
struction of the whole figure, and teaching this
ability is the central task of rehabilitative
education.
9
The task of the instruction consisted not only
in composing a program which was adequate for
the structure of the defect, but also in assuring
the conditions for its mastery and for the in-
ternalization of the activity being rehabilitated.
One such condition was strict observance of the
system for staging the rehabilitation of a dam-
aged activity that w a s worked out by P. Ia.Ga1’-
perin and his colleagues. The activity gradually
switched from the more accessible, at the be-
ginning of instruction, materialized level of the
completion of operations, to a higher level -
to the speech level. The completion of an activ-
ity in the mind proved to be impossible for the
described patients. It was performed, in the
best case, with the program whispered aloud,
and the composition of the required operations
was sharply curtailed at this time. At the end
of instruction, the s e t method of action (the pro-
gram), which had allowed for compensation of
a defect of spatial perception, became the prop-
erty of the patient.
5.
The understanding of logical-grammatical lan-
guage patterns is formed in childhood; it comes
about in the process of practical speech inter-
course and usually does not require any special
methods of instruction. Among schoolchildren
and adults, an understanding of relatively com-
plex logical-grammatical constructions which
use prepositions and conjunctions (“the notebook
under the book,” “spring before summer,” “sick-
ness as a result of the cold,” etc.) o r inflections
(“the motorcycle’s owner,” “the father’s
brother,” etc.) is developed quickly in an ab-
breviated manner, and directly. Only a special
psycholinguistic analysis shows that different
forms of logical-grammatical constructions are
of unequal complexity and apparently demand
different psychological operations for their
understanding.
The construction “the foundation under the
house” is simpler than the construction ‘the
triangle under the circle”: the idea of #under”
is already present in the word “foundation,”
while the triangle can occupy any position in
 10
relation to the circle, and the understanding of
the given construction as a whole depends on the
use of formal syntactical patterns of language.
The same thing may be said about inflected con-
structions. The expressions ‘‘a piece of bread”
and “the father’s brother” make use of the geni-
tive case, and they may be superficially evalu-
ated as being equal in difficulty. However, a
closer analysis shows that the first one (the so-
called genitive particle) is mastered immedi-
ately and easily, because the word “piece” it-
self includes the idea of a portion, and the co-
relationship between the two words does not call
up any new concept. At the same time, the sec-
ond expression, “ the father’s brother,” using
the so- called “genitive attributive,” assumes
the completion of a complex cycle of psychologi-
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cal operations; the conversion of the name
“father” into the attribute “the father’s,” the
establishment of complex relationships between
two named objects (“father” and “brother”), and
the discovery of a third concept (“uncle”), which
is not directly mentioned in the given construc-
tion, but expresses the relationships which enter
into it.
These differences in the difficulty of various
logical-grammatical constructions, only vaguely
entering into the process of their understanding
by normal schoolchildren or adults, acquire a
pronounced character among patients with af-
fections of several areas of the cerebral cortex.
Prolonged investigations (A. R. Luriia, 1947,
1962) have shown that patients with affections of
the sincipital-occipital areas of the cerebral
cortex do not experience the noted difficulties
in understanding the first group of constructions
(“the foundation under the house” and “a piece
of bread”), but they a r e almost totally unable to
grasp the meaning of the second group of con-
structions (“the triangle under the circle,” “the
father’s brother,” etc.). They easily perceive
the meaning of each separate word ((‘triangle,”
“circle,” “brother,” ‘father”), but they are un-
able to catch the relationships into which these
words a r e placed under the influence of the
prepositions or inflections. Not possessing the
necessary spatial representation, and proving
to be unable to synthesize separate impressions
into complex systems of correlations which a r e
included in known codes, such patients are com-
pletely helpless when they are given a logical-
grammatical construction whose meaning can
only be mastered on the basis of a quick “grasp-
ing” of the meanings which lie behind the syn-
tactical devices applied. This is precisely why
such patients, lacking the possibility of per-
forming the necessary operations in the manner
of a curtailed mental operation, try to solve this
difficult task by means of extensive reasoning.
‘A triangle under a circle”... well, this means
...
that here is a triangle and “under a circle”. ..
that means a circle... but this “under a cir-
.
cle”...under... what does “under” mean?.. and
“under a circle”... is that above or below?... no,
I don’t know what a “triangle under a circle”
is.... Naturally, such an inability to grasp at
once the logical-grammatical relationship for-
mulated in the construction gives rise to the
need to employ a s e r i e s of special extensive
devices that will elicit the signs lying behind the
expression “under” or the inflection Ufather’s,n
and that will replace abbreviated mental activity
with an extensive chain of external methods.
This chain of methods, which is described in
detail in a number of works (V. K. Bubnova,
1946; A. R. Luriia, 1948; L. S. Tsvetkova, 1965,
19661, led to the creation of a special program
of rehabilitative education which resulted in the
finding that the understanding of complex logical-
grammatical constructions becomes possible
even in those cases where the spontaneous
grasping of complex correlations remains dis-
turbed. This program of rehabilitative educa-
tion can be reduced to the following: the process
of the spontaneous perception of the relation-
ships of the words in a phrase, and of their
meanings, breaks down into a number of suc-
cessive operations, the completion of which,
with the use of external aids, gradually creates
a basis for the realization of the meanings
which lie behind these words o r other logical-
grammatical constructions. Most often, and in
a more pronounced form, our patients have a
disturbance of the understanding of prepositional
constructions: the understanding of the mean-
ings of the prepositions “under” and “over”

suffers particularly. Therefore, a special pro-
gram was elaborated for the rehabilitation of
spatial representations. Compensation for the
defect in the understanding of the meanings of
the prepositions “over” and “under” proceeded
simultaneously on this basis. The program had
the following content:
1. Look carefully at the figure (the patient
has a figure before him - see Fig. 6). Indicate
the number of parts into which the figure is
divided.
2. Read the names of thege parts.
3. Name the object which is located at the
top.
4. Indicate where this object is located- at
the top or at the bottom.
5. Look at Diagram 2. Read which preposi-
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tion is substituted for the words “at the top”
(top)
6. Form a sentence with the words “at the
top.’
7. Now replace it with the necessary preposi-
tion and include the second object (at the bottom)
in your sentence.
8. Once again form a sentence with the cor-
-
responding preposition the main object is
located at the top.
9. Find the diagram which corresponds to
your sentence.
Fig. 5
10. Name the object which is located in Part
2 of the diagram (at the bottom).
11. Indicate where this object is located (a
complete sentence).
12. Replace the words ‘at the bottom” with
the corresponding preposition.
13. Once again form a sentence with a prepo-
sition; the main object is located at the bottom.
14. Draw the corresponding diagram.
After several sessions we obtained a dis-
tinctly positive effect. The patients mastered
the main part of the program: the need for
successive, extensive reasoning, and the divi-
sion of space into two parts. They memorized
11
Diagram 1 I Diagram 2
under
I I
I
Fig: 6
their names and mastered the direct inter-
changeability of these names with certain prepo-
sitions and the necessity of singling out the
main object in determining the location of the
.
obj e cts
After additional exercises in consolidating
the given mode of action, and the spatial rela-
tionships of objects and their expression in
speech, which were conducted only on the basis
of the program, we shifted the patients to work
with the abbreviated form of the program, which
demanded more active, independent work and
the application of already acquired knowledge:
1. Divide the figure into two parts -
top and
bottom.
2. Write down which part is the “top” and
which the ‘bottom.”
3. Write the prepositions which correspond
to these words.
4. Form a sentence with the corresponding
preposition i f the main object is located at the
top (that is, using the necessary preposition,
answer the question: “Where is the main object
located?”).
5. Draw a diagram which corresponds to the
position of the main object.
6. Do the same thing with the object which is
located a t the bottom.
The mastery of the given programs was ac-
companied by frequent exercises for the patients
in forming phrases with the necessary preposi-
tions, in finding the spatial positions of objects,
and so on. For this purpose, appropriate draw-
ings were used which portrayed the spatial
 12
correlations of objects and the actual objects
and their orientation in space. Situations were
mastered in which objects were not only located
in the relationship “under” and “over,” but also
in spatial relationships which are expressed by
the prepositions ‘in,” ‘on,” ‘by,” ‘near,” and
s o on.
The patients gradually mastered the pro-
gram9smethod of determining the meaning of
prepositions, and their activity was curtailed
in content (by shedding operations which had
proved to be unnecessary) and automated in
form. However, even at the end of the instruc-
tion the patients could complete operations only
by uttering the mode of action. The mode of
operation given in the program became their
own, but the activity only proceeded at the level
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of whispered speech.
6.
We could easily add other examples involving
rehabilitation of the skills of writing and read-
ing, reckoning, and solving arithmetical prob-
lems to the two examples of rehabilitative educa-
tion which we have presented.
What we have said allows us to proceed to
several important conclusions, which have, f i r s t
of all, a direct relation to one of the most urgent
-
problems of contemporary pedagogy the prob-
lem of programmed instruction.
Soviet science, with every right, disputes the
opinion that programmed instruction is instruc-
tion which strictly follows the logic of the forma-
tion of the corresponding discipline. In agree-
ment with theses which have become established
in Soviet pedagogical science (A. N. Leont’ev
and P. Ia. Gal’perin, 1964), the programmed
mastering of knowledge and skills is a system
in which the process of the mastery of necessary
concepts and knowledge, or of the formation of
necessary skills and habits, relies on the strict
succession of those psychological operations
which a r e necessary in order that the given
knowledge and skills a r e formed in full-valued
psychological processes. As experience shows,
this is ensured by the strict succession of opera-
tions and the application of psychologically valid
methods which make the completion of these
operations possible.
Rehabilitative education, relying on the strict
succession of a number of differentiated methods
of recreating skills and habits, and making
possible the observation of those methods by
which s k i l l s and habits that have been disturbed
as a result of the shedding of a particular psy-
chophysiological condition (factor) may be re-
habilitated, is the most valuable method for a
detailed psychophysiological analysis of the
processes which lie at the basis of their forma-
tion. It permits the detailed observation of
their internal mechanisms, which a r e barely
accessible f o r analysis under normal conditions,
and it can prove to be an invaluable aid in elab-
orating the scientific psychological foundations
for programmed instruction.
Footnotes
1) F o r a detailed analysis of the factors
which lie at the foundation of complex psychic
processes, s e e A. R. Luriia, Vysshie korkovye
funktsii cheloveka, published by Moscow Uni-
ver sity.
* * *