Moving from a continuum to a community: reconceptualising the provision of support

The notion of the continuum is applied to special education in diverse contexts across many nations. This paper explores its conceptual underpinnings, drawing upon a systematic search of the literature to review recurring ideas associated with the notion and to explicate both its uses and short-comings. Through a thematic analysis of the literature the research team derived twenty-nine continua, situated within six broad groupings (space, students, staffing, support, strategies and systems). This provides a clear structure for reconsidering the issues which the notion of the continuum is supposed to describe and enables a reconceptualisation of how the delivery of services is represented. We present the initial underpinnings for a community of provision, in which settings and services work together to provide learning and support for all children and young people in their locality

Subthalamic nucleus deep brain stimulation in early stage Parkinson's disease

BACKGROUND: Deep brain stimulation (DBS) is an effective and approved therapy for advanced Parkinson’s disease (PD), and a recent study suggests efficacy in mid-stage disease. This manuscript reports the results of a pilot trial investigating preliminary safety and tolerability of DBS in early PD. METHODS: Thirty subjects with idiopathic PD (Hoehn & Yahr Stage II off medication), age 50–75, on medication ≥ 6 months but < 4 years, and without motor fluctuations or dyskinesias were randomized to optimal drug therapy (ODT) (n=15) or DBS+ODT (n=15). Co-primary endpoints were the time to reach a 4-point worsening from baseline in the UPDRS-III off therapy and the change in levodopa equivalent daily dose from baseline to 24 months. RESULTS: As hypothesized, the mean UPDRS total and part III scores were not significantly different on or off therapy at 24 months. The DBS+ODT group took less medication at all time points, and this reached maximum difference at 18 months. With a few exceptions, differences in neuropsychological functioning were not significant. Two subjects in the DBS+ODT group suffered serious adverse events; remaining adverse events were mild or transient. CONCLUSIONS: This study demonstrates that subjects with early stage PD will enroll in and complete trials testing invasive therapies and provides preliminary evidence that DBS is well tolerated in early PD. The results of this trial provide the data necessary to design a large, phase III, double-blind, multicenter trial investigating the safety and efficacy of DBS in early PD