Effects of chronic cerebellar stimulation (CCS) setting on the gait and speech of a spastic cerebral palsy adult.

A single (N = 1) spastic cerebral palsy adult who had experienced Chronic Cerebellar Stimulation (CCS) for 9 years without any change in the stimulator settings was assessed at six different stimulator settings. These voltage settings varied from 0 volts to 40 volts and frequencies of stimulation from 0 to 200 Hz. Stimulation was with bipolar rectangular pulses with less than 0.2 C/mm2 charge per phase. Responses measured at each setting were quantitative gait, speech, and somatosensory evoked potential measurements. Additional clinical assessments were done by a neurologist and speech therapist. Alteration in stimulator settings occurred 1 week apart to allow for stabilization and all assessments were completed in the same sequence each day. None of the individual stimulator settings were known to any of the assessors or to the patient. The results showed consistently that the patient's gait and speech were poorest when the stimulator was switched off completely. Switching on the stimulator caused improved function according to all assessments. There was consistent improvement in gait and speech when the rate of the cerebellar stimuli was high (for voltages between 0 and 40 V). Changing the voltage (within the range 0 to 40 V), while keeping the frequency of stimulation constant, did not appear to have as much effect. This preliminary evaluation suggests that the technique of CCS is safe and can improve function in a measurable manner.

The communicative effectiveness index: development and psychometric evaluation of a functional communication measure for adult aphasia.

Groups of aphasic patients and their spouses generated a series of communication situations that they felt were important in their day-to-day life. Using criteria to ensure that the situations were generalizable across people, times, and places, we reduced the number of situations to 36 and constructed an index that allowed the significant others of 11 recovering and 11 stable aphasic individuals to rate their partners' performance in the situations on two occasions 6 weeks apart. These data were then used to evaluate the psychometric properties of the Communicative Effectiveness Index (CETI) as a measure of change in functional communication ability. Further application of a generalization criterion reduced the final index to 16 situations. Results showed the CETI to be internally consistent and to have acceptable test-retest and interrater reliability. It was valid as a measure of functional communication according to the pattern of correlations found with other measures (Western Aphasia Battery, Speech Questionnaire, and global ratings). Finally, it was responsive to functionally important performance change between testings. Further research with the CETI and its usefulness for clinicians and researchers are discussed.