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 PPhysical Brain EExecutive Functions DDevelopment SSystems

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

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 Discharged home May 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 behav iour.

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