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Table 6.35 The Effect of Methylphenidate on Executive and General Cognitive Functioning Post ABI

Author

Year

Country

Research Design

PEDro

Sample Size

Methods Outcome

Dymowski et al.

(2017)

Australia

RCT

PEDro=9

NInitial=11, NFinal=10

Population: TBI. Methylphenidate Group (n=6): Mean Age=35 yr; Gender: Male=4, Female=2; Mean Time Post Injury=366 d; Mean Worst GCS=4.83. Placebo Group (n=4): Mean Age=32.5 yr; Gender: Male=2, Female=2; Mean Time Post Injury=183.5 d; Mean Worst GCS=4.50.

Treatment: Participants were randomly assigned to receive either methylphenidate (0.6 mg/kg/d rounded to the nearest 5mg with maximum daily dose of 60 mg) or placebo (lactose). Outcomes relating to processing speed, complex attentional functioning, and everyday attentional behaviour were assessed at baseline, 7 wk (on-drug), 8 wk (off-drug), and 9 mo follow-up.

Outcome Measure: Symbol Digit Modalities Test (SDMT), Trail Making Test (TMT) A and B; Hayling (A, B, error),  Digit Span (DS-Forward, Backward, Sequencing, Total), Ruff 2&7 Selective Attention Test Automatic Speed Raw Score (2&7 ASRS), Ruff 2&7 Selective Attention Test Controlled Speed Raw Score (2&7 CSRS), Simple Selective Attention Task Reaction Time (SSAT RT), Complex Selective Attention Task Reaction Time (CSAT RT), N-back 0-back RT, N-back 1-back RT, N-back 2-back RT, Rating Scale of Attentional Behaviour Significant Other (RSAB SO).

1.        After applying Bonferroni corrections, no significant differences between groups from baseline to 7 wk, baseline to 8 wk, or baseline to 9 mo were observed for SDMT, TMT A, TMT B, Hayling A, Hayling B, Hayling error, DS Forward, DS Backward, DS Sequencing, DS Total, 2&7 ASRS, 2&7 CSRS, SSAT RT, CSAT RT, N-back 0-back RT, N-back 1-back RT, N-back 2-back RT, or RSAB SO.

Zhang and Wang

(2017)

China

RCT

PEDro=10

NInitial=36, NFinal=33

Population: TBI; Severity: mild to moderate. Methylphenidate Group (n=18): Mean Age=36.3 yr; Gender: Male=13, Female=5. Placebo Group (n=18): Mean Age=34.9 yr; Gender: Male=14, Female=4.

Treatment: Participants were randomly assigned to receive methylphenidate (flexibly titrated from 5 mg/d at the beginning, then gradually increased by 2.5 mg/d until reaching 20 mg/d) or placebo for 30 wk.

Outcome Measure: Mental Fatigue Scale (MFS), Choice Reaction Time (CRT), Compensatory Tracking Task (CTT), Mental Arithmetic Test (MAT), Digit Symbol Substitution Test (DSST), Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAMD).

1.        At baseline, there were no significant differences between groups in terms of demographics, MFS, CRT, CTT, MAT, DSST, MMSE, BDI, or HAMD.

2.        Post-intervention, the experimental group had significantly lower scores compared to control group for MFS (p=0.005), CRT (p<0.001), CTT (p<0.001), BDI (p=0.040), and HAMD (p=0.005).

3.        Post-intervention, the experimental group had significantly higher scores compared to control group for MAT (p=0.020), DSST (p<0.001), MMSE (p<0.001).

Speech et al.

(1993)

USA

RCT

PEDro=7

N=12

Population: TBI; Mean Age=27.6 yr; Gender: Male=5, Female=7; Mean Time Post Injury=48.5 mo.

Intervention: In a crossover design, participants were randomly assigned to receive 0.3 mg/kg methylphenidate, 2×/d, for 1 wk, followed by 1wk of placebo, or receive the treatment in a reverse order.

Outcome Measure: Gordon Diagnostic System, Digit Symbol and Digit Span subtests of the Wechsler Adult Intelligence Scale-Revised, Stroop Interference Task, Sternberg High Speed Scanning Task, Selective Reminding Test, Serial Digit Test, and Katz Adjustment Scale.

1.        No significant differences were found between methylphenidate and placebo condition in any of the outcome measures studied.
PEDro=Physiotherapy Evidence Database rating scale score (Moseley et al., 2002).