Methylphenidate effect on attention deficit in the acutely brain-injured adult

Objectives: To determine the efficacy of methylphenidate in improving attentio Design: Prospective multiple baseline design (A-A-B-A) utilized on a consecutive sample of patients. Setting: Acute brain injury rehabilitation unit in a large academic medical center. Patients: 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 One subject was withdrawn after developing tachycardia. Intervention: 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 15mg at 8 am and 12 pm. Main Outcome Measures: 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 (AB) 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. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation