Ritalin and neurobehavioural therapy in the treatment of low arousal following severe brain injury

Abstract

Objective: To investigate the therapeutic effects of methylphenidate (Ritalin) in the treatment of prolonged low arousal state following a severe brain injury. To implement a behavioural program, designed to train communication skills to this patient.Study Design: A single case withdrawal design was conducted in a hospital setting with a patient with a severe brain injury. Titrated doses of Ritalin were administered, and a modified arousal scale was designed to monitor the patient's status.Results: Results indicated improvements in arousal during the treatment phase. This improvement in arousal allowed implementation of a behavioural program, designed to train communication skills to this patient. Following the neurobehavioural program reliability for yes and no responses increased to 58% and 73% respectively.Conclusions: Improvement in arousal was achieved which allowed implementation of a behavioural program, designed to train communication skills to this patient.

The Use of Methylphenidate During Inpatient Rehabilitation After Pediatric Traumatic Brain Injury: Population Characteristics and Prescribing Patterns

“…Past research, though limited by study design and sample size, has supported the use of MPH in patients in low cognitive states (ie, UWS, MCS). An observational study in adults in “low arousal states” (published prior to definition of MCS) found that patients' reliability of “yes” and “no” responses increased by 58% and 73%, respectively, after MPH administration 9. Another study found that 2 children in “low response states” following TBI had significant improvement in responsiveness after MPH initiation 10…”

“…An observational study in adults in "low arousal states" (published prior to definition of MCS) found that patients' reliability of "yes" and "no" responses increased by 58% and 73%, respectively, after MPH administration. 9 Another study found that 2 children in "low response states" following TBI had significant improvement in responsiveness after MPH initiation. 10 We found that patients in emerged states (PTA and ACI) at inpatient rehabilitation admission had lower frequency of receiving MPH during inpatient rehabil-itation than their DOC (UWS and MCS) counterparts.…”

“…[4][5][6][7] The neurostimulant methylphenidate (MPH), which increases release and reuptake of synaptic dopamine and norepinephrine in the central nervous system (CNS), has been used to address impairments in cognition, specifically attention, memory, concentration, and mental processing, following pediatric TBI. [7][8][9] The activating nature of MPH, specifically via CNS dopamine signaling, has also prompted exploration of MPH as a promising candidate for intervention in patients with disorders of consciousness (DOC). 4,10 However, the use of MPH for DOC after pediatric TBI has been limited to case series and reports of the use of MPH and MPH prescription practices are informed by the adult literature.…”

“…In the rehabilitation setting, several medications have been proposed to improve recovery from acquired brain injury 4–7. The neurostimulant methylphenidate (MPH), which increases release and reuptake of synaptic dopamine and norepinephrine in the central nervous system (CNS), has been used to address impairments in cognition, specifically attention, memory, concentration, and mental processing, following pediatric TBI 7–9. The activating nature of MPH, specifically via CNS dopamine signaling, has also prompted exploration of MPH as a promising candidate for intervention in patients with disorders of consciousness (DOC) 4,10…”