Download - About Recolo
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.
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.
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
• 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 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.
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.
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