About Recolo

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

3. 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.

4. Founding members • Dr Jonathan Reed • Dr Katie Byard • Dr Howard Fine

5. P.E.D.S Model P Physical Brain E Executive Functions D Development S Systems

6. P = The brain as a physical organ

7. The brain requires • Blood supply – exercise • Nutrition – “You are what you eat” • Rest - sleep patterns • Regulation – fatigue, temperature, mood

8. 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.

9. Executive function

10. Implications • Difficulties for the child or young person to manage themselves. • Need to structure the environment to support the person.

11. 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.

12. Development

13. 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.

14. 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.

15. 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

16. Systems

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. Mood ratings

23. P.E.D.S CONTAINMENT

24. 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.

25. 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.

26. Mood & Quality of Life ratings

27. 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.

28. 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