Search

Central nervous system (CNS) atrophy provides valuable additional evidence of an ongoing neurodegeneration independent of lesion accrual in persons with multiple sclerosis (PwMS). However, there are limitations for interpretation of CNS volume changes at individual patient-level. Patients are receiving information on the topic of atrophy through various sources, including media, patient support groups and conferences, and discussions with their providers. Whether or not the topic of CNS atrophy should be proactively discussed with PwMS during office appointments is currently controversial. This commentary/perspective article represents perspectives of PwMS, providers and researchers with recommendations for minimizing confusion and anxiety, and facilitating proactive discussion about brain atrophy, as an upcoming routine measure in evaluating disease progression and treatment response monitoring. The following recommendations were created based on application of patient's and provider's surveys, and various workshops held over a period of 2 years: (1) PwMS should receive basic information on understanding of brain functional anatomy, and explanation of inflammation and neurodegeneration; (2) the expertise for atrophy measurements should be characterized as evolving; (3) quality patient education materials on these topics should be provided; (4) the need for standardization of MRI exams has to be explained and communicated; (5) providers should discuss background on volumetric changes, including references to normal aging; (6) the limitations of brain volume assessments at an individual-level should be explained; (7) the timing and language used to convey this information should be individualized based on the patient's background and disease status; (8) a discussion guide may be a very helpful resource for use by providers/staff to support these discussions; (9) understanding the role of brain atrophy and other MRI metrics may elicit greater patient satisfaction and acceptance of the value of therapies that have proven efficacy around these outcomes; (10) the areas that represent possibilities for positive self-management of MS symptoms that foster hope for improvement should be emphasized, and in particular regarding use of physical and mental exercise that build or maintain brain reserve through increased network efficiency, and (11) an additional time during clinical visits should be allotted to discuss these topics, including creation of specific educational programs.

The present study examined the effects of a Classwide Student Tutoring Teams (CSTT) program on the academic performance of 28 mildly handicapped (MH) and 63 nondisabled students enrolled in three 9th and 10th grade math classes. Effects were analyzed using multiple baseline designs across settings with a withdrawal of treatment in one classroom. Analyses of group and individual results indicated that the implementation of CSTT resulted in average increases of 20 percentage points on weekly math exams. The percentage of students earning A grades rose abouve 40% while CSTT was in effect, and failing grades were virtually eliminated. No mildly handicapped students received a failing grade on their report cards during CSTT instruction, whereas eight MH students maintained averages about 90%. Anecdotal student and teacher comments indicated that Classwide Student Tutoring Teams was an acceptable classroom intervention. Educational implications for secondary mainstreamed students and teachers are discussed.

Effects of classwide peer tutoring (CWPT) on the academic performance of 14 mildly handicapped and 36 nondisabled students enrolled in three 10th-grade social studies classrooms were examined. Effects were analyzed using a multiple baseline design across settings with a withdrawal of treatment in two classrooms. Analysis of results indicated that the implementation of CWPT produced an average increase of 21 points on weekly tests. With CWPT 60% of all students earned “A” grades, failing grades were virtually eliminated, and no mildly handicapped students received grades below “C”. Anecdotal student and teacher comments were positive. Implications for secondary, mainstreamed students and teachers were discussed.

This article focuses on the role peer-mediated instructional approaches may play in improving the academic and social performance of secondary learning disabled students. Two peer-teaching programs, Classwide Peer Tutoring and Classwide Student Tutoring Teams, are described, as well as findings from recent investigations in mainstream and resource room settings. Implications for teacher preparation are reviewed.