Our Model

Recolo UK Ltd bases its neuropsychological assessment package on the PEDS model. We can supply expertise in the provision of a total package of high quality neuropsychological community rehabilitation of children and young people with brain injury and their families.

Physical Brain: The brain is a physical organ connected to the rest of the body, so a healthy body results in a healthy brain. We look at diet, exercise and rest in a holistic approach to promote development and recovery.

Executive Function: When the brain hits the skull at speed, the front part of the brain is most vulnerable to injury. Executive systems, which include skills like planning, organisation and self control of behaviour, are often impaired as a result of injury to the front areas of the brain. Expecting an injured child or young person to rely on these systems to improve their life does not work. Our programmes are designed specifically to take the burden of change and control directly off the child or young person. We do this by managing their environment, ensuring that they have structured activity (often in form of a structured timetable) and preventing difficulties from occurring where ever possible.

Development: Brain and neuropsychological development occurs within stages (see Reed and Warner Rogers Child Neuropsychology in press). Children with brain injury often get stuck at a certain stage. There is a need to understand what stage the child is at in order to provide strategies and teaching to help them develop on to the next stage. Our rehabilitation programmes use this approach to promote recovery and development.

Systems: Children and young people exist within different systems. We believe it is vital to take account of these systems in order to produce change. The systems around a child or young person include the family system, the education system, the child's peer group and his or her carers. Our experience shows the need to work directly with these systems in order to produce change, so our rehabilitation programmes work with the different systems as well as the individual to provide optimum recovery and development. Our rehabilitation takes place within the family system in the community and not within an institution removed from these systems.

Research supporting the PEDS model

Executive Functioning: There is an increasing body of research stressing the importance of context-sensitive neuropsychological intervention (e.g. Ylvisaker 2003, Ylvisaker et al, 2005). This approach argues that the best form of rehabilitation is that which integrates therapy into the child's normal activities of daily life (ADLs) and routines at home, school, work and within the community (Feeney et al, 2001, Feeney and Ylvisaker 2003). Furthermore, the context-sensitive approach recognises the role of the family in the care and rehabilitation of the child with a brain injury (Feeney et al, 2001, Feeney and Ylvisaker 2003). It is acknowledged that because of these new responsibilities, the family must be assessed, prepared and empowered by the rehabilitation team to take its place as an integral part of the caring and rehabilitating process.

With respect to managing behaviour, the focus has shifted to one of managing the environment (to prevent triggers to behaviour), rather than trying to shape and change behaviour. There is mounting evidence of the efficacy of this type of behaviour management (Feeney and Ylsivaker 1995, Ylsivaker and Feeney 2003) including in the school environment (Ylsivaker et al. 2001). It is also recognised that children with damage to the frontal lobes as a result of a traumatic brain injury have particular difficulty in planning and organising, so positive behaviour supports can include providing predictable and paced daily routines, using graphic organisers and telephones and teaching organisational strategies. Again, there is evidence of the efficacy of these types of organisational strategies (Feeney and Ylsivaker 1995, Ylsivaker and Feeney 2003).

Development: The timing and nature of the brain injury interacts with the social context of the child and their stage of skills development to determine the outcome for the child following injury (Eslinger et al. 1999, Ylvisaker and Feeney 2002). The interaction between brain injury and development is exemplified by the finding that the profile of behavioural, psychiatric and emotional disturbance (a common and persistent sequelae of child brain injury) may worsen over time (see Ylvisaker et al 2005 for review). These difficulties are usually associated with damage to the frontal lobes, an area of the brain typically affected in closed head injury.

Systems: In childhood brain injury, the child is contextualised by their development and by the very fact that they exist within different 'systems' including their family and peer groups, professionals involved in their care and in education. In the literature it is regarded as essential to apply a developmental and systems perspective in neuropsychological rehabilitation in order to produce change in childhood brain injury (Anderson and Catroppa 2006, Ylsivaker et al. 2005).

Family functioning plays an important role in recovery in childhood brain injury and it is recognised that there is a reciprocal relationship between family functioning and the neuro-behavioural disturbance of the child with brain injury (Anderson et al. 2001). Previous anecdotal evidence of the role of family functioning on brain injury recovery is now established in the literature such that there are significant benefits in the scholastic, behavioural and emotional functioning of the child when the family is supported, for example, through cognitive and behavioural strategies to cope with and manage the child and their behaviour more effectively (Taylor et al. 2002 , Wade et al. 2005, 2006 a,b, c).

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Last updated: 21/09/07