About Recolo

• Set up by child neuropsychologists to provide community neuropsychological rehabilitation to children and young people.

Mission

To provide a high quality highly effective community neuropsychological

rehabilitation service to children and young people. Our service aims to

produce the best possible outcome for children and young people with a

neurological disability.

Founding members

• Dr Jonathan Reed

• Dr Katie Byard

• Dr Howard Fine

P.E.D.S Model

P Physical Brain

E Executive Functions

D Development

S Systems

P = The brain as a physical organ

The brain requires

• Blood supply – exercise

• Nutrition – “You are what you eat”

• Rest - sleep patterns

• Regulation – fatigue, temperature, mood

E = Executive Functions

• Associated with front area of brain- particualarly vulnerable to injury.

• 2 main areas– Ventrolateral cortex - emotional and

behavioural regulation.– Dorsolateral cortex - working or short term

memory, planning, organisation.

Executive function

Implications

• Difficulties for the child or young person to manage themselves.

• Need to structure the environment to support the person.

Implications 2

• Organise environment- e.g. structured timetable.

• Avoid situations that trigger difficulties.

• Provide computer systems to help with organisation

• Use support workers to compensate for organisation/ regulation difficulties.

Development

Development

• Need to understand how the brain and its psychological functions develop.

• With brain injury the developmental sequence often gets stuck.

• Need to identify where stuck and try to move on.

Development 2

• Language - Children’s vocabulary predicts grammar and lateralisation.

• Maths – counting, basic addition, automatic number facts.

• Reading - phonics- fluency- comprehension.• Visual motor - lines-circles-triangles-2

shapes-houses. Or Picking up bricks, stacking towers, building houses.

Development 3

• Use error free learning to promote development.

• Need to be at the right developmental level to start.

• Use of computer games - neurogames.co.uk

Systems

Systems 1• Children with TBI don’t live in a vacuum.

– Live in families, go to school, have friends, involved with therapy / medical / legal teams, etc.

• Childhood TBI affects entire family.

• Families play an important role in rehabilitation.

Systems 2

• Facilitate recovery / rehabilitation in familiar surroundings. – Integrate therapy into child’s everyday activities &

routines at home, school, work & community life.

– Empower parents / carers as integral members of rehab team.

Systems 3

• If the family is functioning well, this will impact on child’s functioning and recovery.– Need to support family members in

process of adjustment / adaptation.– Support family to effectively manage child’s

emotional / behavioural functioning.

Case Example - Background • Mar 2004 involved in RTA, aged 15y.• Suffered severe TBI: extensive contusions &

haemorrhage involving brain stem, basal ganglia and left frontal and temporal lobes.

• Following initial recovery, transferred to in-patient rehabilitation setting in May 2004. Discharged home May 2005.

• Neuropsychology intervention started late 2005.

P.E.D.S • P - Diet, joined gym with personal trainer, rest periods

built into day. • E - Structured timetable of activities managed by team

of support workers who plan, initiate and monitor. • E- Support workers manage situations to prevent

behavioural difficulties- avoid triggers and deescalate. • E - apple i-mac and i-phone.

• D - provide support in terms of education, social

interaction and containment re behaviour.

Mood ratings

P.E.D.S

CONTAINMENT

P.E.D.S• Behavioural management

• Psycho-education – neuropsychology, impact of TBI.

• CBT – mood management.

• Quality of Life.

• Systemic approach – roles, power, structure, communication patterns, family strengths, ‘storying’ TBI.

• Regular coordination meetings with rehab

team including parents.

Outcome• Improved mood.• Adjustment / adaptation – more realistic expectations

of son; acceptance of rehab programme.

“…although it is hard to listen to things you don’t want to accept and face realities … it is helping me to understand and adapt to my feelings with advice”

• Improved communication (in family and team). • A more integrated story of TBI.• Quality of life worsened –work in progress.

Mood & Quality of Life ratings

Summary of outcomes• More stable mood; decreased anxiety.

• Evidence of adjustment / adaptation.

• Implementation of rehabilitation in context of specific neuropsychological difficulties.

• Integrated rehabilitation team including parents & support workers.

• Moving towards independent living plus 24 hour care package.

References• Byard, K., Fine, H. & Reed, J., (In Press). Taking a developmental and

systemic perspective on neuropsychological rehabilitation with children with brain injury & their families. Journal of Child Clinical Psychology & Psychiatry.

• Reed, J., Byard, K., & Fine, H. The PEDS model of Child Neuropsychological Rehabilitation. In The British Association of Brain Injury Case Managers Newsletter / Autumn, 2007, (36), 1, 5-6.

• Reed, J. & Warner-Rogers, J. (2008). Child Neuropsychology: Concepts, Theory & Practice. Wiley-Blackwell.

• Look out for following research groups:– Keith Yeates and colleagues (including H. Taylor & S. Wade)– Mark Ylvisaker and colleagues– Vicky Anderson and colleagues