title: Methylphenidate effect on attention deficit in the acutely brain-injured adult.
abstract: OBJECTIVE
  To determine the efficacy of methylphenidate in improving attention and functional outcome in acutely brain-injured adults.
  
  
  METHODS
  Prospective multiple baseline design (A-A-B-A) utilized on a consecutive sample of patients.
  
  
  METHODS
  Acute brain injury rehabilitation unit in a large academic medical center.
  
  
  METHODS
  Eleven acutely brain-injured adults were included by performing below two standard deviations of the age equivalent norms on 4 of 5 neuropsychological tests for attentional capacity. One subject was withdrawn after developing tachycardia.
  
  
  METHODS
  After a 1-week baseline assessment, subjects were placed on increasing doses of methylphenidate (Ritalin) so that on Day 7 all patients received a dose of 15 mg at 8 am and 12 pm.
  
  
  METHODS
  Nine neuropsychological subtests measured attention on admission, at 1 week, while on methylphenidate, and 1 week after its discontinuation. Functional outcome was evaluated utilizing the Disability Rating Scale (DRS) at the same intervals.
  
  
  RESULTS
  Digit Span, Mental Control, and Symbol Search scores improved significantly (p < .05) on methylphenidate (A-B) as compared with the pre-methylphenidate (A-A) period. This advantage remained when the drug was removed. The mean improvement in DRS scores on methylphenidate approached a significant difference (p < .06) from that change in the DRS scores between baseline 1 and 2.
  
  
  CONCLUSIONS
  Use of methylphenidate in acutely brain-injured adults was well tolerated and demonstrated a significant improvement in attention compared to natural recovery in a rehabilitation setting. Methylphenidate also correlated with faster functional recovery as measured by the Disability Rating Scale although the improvement did not achieve statistical significance.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Richmond, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Kaelin
authors.forename: D X
authors.initials: DX
authors.lastname: Cifu
authors.forename: B
authors.initials: B
authors.lastname: Matthies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001288:Attention / Q000187:drug effects*; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D000697:Central Nervous System Stimulants / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008774:Methylphenidate / Q000494:pharmacology* / Q000627:therapeutic use; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate