AlAdawi-vol5no1 3/8/05 4:11 PM Page 61 on …The Journal of Applied Research•Vol.5,No.1,2005 61 The Effect of Methylphenidate on Attention in Acquired Brain Injury as Recorded by

The Journal of Applied Research • Vol. 5, No. 1, 2005 61

The Effect of Methylphenidate on Attention in Acquired Brain Injury as Recorded by Useful Field of ViewSamir Al-Adawi, PhD*†

Ron Calvanio, PhD†

Atsu S. S. Dorvlo, PhD‡

Russell E. Costa, BSc†

Jennifer J Mello, MS, CCC-SLP†

Charlie C. Huynh, MD†

Mrugeshkumar K. Shah, MD†

Heechin Chae, MD†

David T. Burke, MD†

*College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman†Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital,Harvard Medical School, Boston, Massachusetts

‡Department of Mathematics and Statistics, College of Sciences, Sultan Qaboos University,Muscat, Oman

Patients: A series of 16 patients diag-nosed with traumatic brain injury (n = 12) and subarachnoid hemorrhage(n = 4) were followed before and aftertaking methylphenidate, as a part oftreatment for clinically identified atten-tional deficit.

Results: The introduction ofmethylphenidate correlated with animprovement in processing speed loss,divided attention loss, and selectiveattention loss on the UFOV test.Methylphenidate use was further corre-lated with improvement on FIMCognition and FIM Activity of DailyLiving subscales.

Conclusions: Methylphenidate use, in aninpatient population of patients withABI, resulted in a significant improve-

KEY WO R D S : acquired brain injury,traumatic brain injury, s u b a r a c h a n o i dh e m o r r h a g e, m e t h y l p h e n i d a t e, U s e f u lField of Vi e w.

Objectives: To assess the ability of theUseful Field of View (UFOV) test tomeasure change in attention of patientswith acquired brain injury (ABI) whengiven methylphenidate in an inpatientrehabilitation unit.

Design: This study reviewed data fromconsecutive patients who were givenmethylphenidate while being monitoredfor visual processing speed, dividedattention, and selective attention withthe UFOV test. Changes in UFOVscores were also compared with changesin Functional Impairment Measures(FIM).

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Vol. 5, No. 1, 2005 • The Journal of Applied Research62

ment in attention and divided attention,which can be measured by the UFOV.This change in attentional ability seemsto correlate with improvement in thecognitive and the Activity of DailyLiving subscales of the FIM.

INTRODUCTIONIn the United States approximately70,000 to 90,000 individuals incuracquired brain injury (ABI) every year,resulting in long-term substantial loss offunctioning.1 One of the intransigent andpervasive sequels of ABI is hypoatten-tion. This is often seen as a serious barri-er to the management, rehabilitation,and vocational adjustment of patientswith ABI.2 Impaired attentional func-tioning is likely to simulate or amplifyother cognitive and emotional impair-ments, as well as intensify difficultieswith activities of daily living.3 The long-term outcome of patients with ABI isthought to be limited as much byhypoattention as by physical or othercognitive impairments.4

At present, the neuropsychologicalliterature does not offer a clear accountof which aspects of attention are mostvulnerable to ABI5 despite the fact thatsuch information might shed some lighton paths for appropriate strategies forrehabilitation. One reason for this lackof clarity is that clinicians andresearchers do not have a sufficientlybroad and efficient set of assessmenttools with which to measure differentforms of attention impairment.2 With therapid growth of outcome evaluation inthis era of predictive medicine,6 there isa need for comprehensive measure-ments and outcome tools that are clini-cally meaningful, easy to use, and validin a wide variety of settings.

Ball et al7 have operationalized theconcept of attention in terms of thespeed of processing, the ability to divideattention between central and peripher-al targets, and the ability to detect stim-

uli embedded within a cluttered back-ground. Such conceptualization has cul-minated into a visual field or useful fieldof view (UFOV) measurement tool.Although the UFOV is essentiallydesigned to diagnose and measure theseverity of attentional impairmentamong elderly motor vehicle drivers, itsapplication has generally been found tobe useful in a wide range of geriatricpopulations.8,9 Numerous studies haveestablished that UFOV is one of thebest, and most consistent, indices ofassessing motor vehicle accident riskamong elderly drivers10, suggesting eco-logical validity of the UFOV. Morerecently, it has also been employed fordriving readiness in ABI populations.11-15

These reports support the use of UFOVin ABI patients. However, it is moresalient to clinicians to ask whether theUFOV test might be of benefit in theassessment of clinically relevant atten-tion impairment in patients with ABI.

Both experimental and clinicalreports have suggested that drugs withaffinity to catecholaminergic neurotrans-missions have a strong influence in mod-ulating attention of both ABI patients16

and children with attention deficit disor-der.17 It is plausible that injury to thebrain, due to tearing and shearing, maycompromise the integrity of the neu-ronal projections involved in attention.18

In parallel with these observations, otherstudies have shown that various neuro-transmission systems can be dramatical-ly affected by brain injury.19,20 It may behypothesised from these findings thatABI disruption of catecholaminergicfunctioning may have consequences forgoal-directed behaviour, with patientsshowing poor attention in a wide rangeof situations. Catecholamines, whichinclude dopamine, noradrenaline, andadrenaline, are important neurotrans-mitters and hormones that regulate vis-ceral functions, motor coordination, andarousal in adults.21,22 Disruption of the



relevant circuitry involved in cate-cholaminergic transmission would haveobservable effects at the three levels ofattention as detected with the UFOV;namely, processing speed, divided, andselective attention.

Several studies have reported areversal of diminished attention withmedications that release catecholamine(eg, amantadine, amphetamine, bupropi-on, methylphenidate, and selegiline) forattentional deficits following ABI.23,24 Asprevious studies of the UFOV have sug-gested that the UFOV can provide aquick quantitative measure of attentionand divided attention,25 it would be use-ful to know whether the UFOV could beused to measure the influence of the cat-echolaminergic medications on thisimportant index of cognition. In doingso, albeit indirectly, the usefulness of theUFOV in delineating attention deficitsin the ABI population can be ascer-tained while using drugs with an affinityto catecholaminergic transmission aspharmacological challenge.26 To ourknowledge, there are no studies thathave examined the effect of these com-pounds on the performance of theUFOV in an ABI population.

The present study was designed totest, using quantitative measures in aconsecutive series of patients with atten-tion impairment following ABI, whethertreatment with methylphenidate, wouldincrease a patient’s UFOV score. If so,this would not only substantiate thereports available so far on the effect ofmethylphenidate on attention,16 but itwould the first study to examine theability of the UFOV to quantify theeffect of methylphenidate on specificmeasures of attention. As this study isalso one of the first to apply the UFOVto an ABI patient population, in explor-ing these predictions, an essential part ofthis research is to gauge the clinical utili-ty of this tool. The variations betweenfield of view score before and after

treatment with methylphenidate wasused as measures of the treatmentimpact and, by implication, treatmentvalidation.26 As there are a paucity ofstudies examining how UFOV mayaffect day-to-day functioning,27 thisstudy also examined whether the fluctu-ations in the attentional abilities meas-ured by the UFOV test would in tandemimpact indexes of functional independ-ence as measured with FunctionalIndependent Measures (FIM).28

The specific aim of this pilot study is(1) to examine whether the UFOV canserve as a useful repeatable measure ofan important cognitive variable duringinpatient rehabilitation, (2) to examinewhether improvement in attentionoccurs in tandem with improvementwith Functional Independent Measure,the “gold standard” of functional out-comes assessment in medical rehabilita-tion, and (3) to examine whetherattention impairment, as indexed byUFOV, is amendable to pharmacologicalintervention with methylphenidate.

METHODSDesignThe study sample consisted of inpatientswith a single-incident brain injuryreceiving rehabilitation at the SpauldingRehabilitation Hospital Brain InjuryUnit, in Boston, Massachusetts. Patientsidentified clinically as manifesting per-vasive inattention in therapy and activi-ties of daily living, not obviouslysecondary to other medical and neuro-logical conditions, were routinely considered for treatment withmethylphenidate.

A series of 16 consecutive patientswere assessed using identical single-casemethodology; a repeated measure, multi-ple baseline, AAB Single CaseExperimental Design.29 As part of theirroutine clinical assessment, baselineassessments were conducted twicebefore initiating methylphenidate.



Baseline testing was initiated across aperiod of 14 to 21 days to establish thatthe patient’s performance was stableand to evaluate the impact of possiblepractice effects. Methylphenidate wasthen introduced at doses of 5 mg twiceper day to 10 mg twice per day. Patientswere reassessed on one further occasion,after two weeks from medication initia-tion. Since this assessment was intro-duced as part of the clinical process,there were variations in the timing ofthe follow up UFOV testing. As thepresent study reports on clinically gath-ered data, there was no attempt to con-trol for the heterogeneity of the sampleof patients, the time since injury, or theetiology and loci of the brain injury.Staff and patients were therefore notblinded to the treatment condition.

As the respondents were required togive meaningful responses, the injuriesof most of the patients were either mildor moderate in severity. It was not theaim of this study to directly investigatethe relationship between clinical anddemographic information and theassessment of attention; this will be thesubject of a future study. We classifiedseverity of injury according to theGlasgow Coma Scale (GCS).30 A scoreof 13 to 15 was rated as mild, 9 to 12 wasrated as moderate, and eight or less wasrated as severe on the GCS.

DRUG REGIMENMethylphenidate is an amphetamine-like central nervous system stimulantthat is believed to act by releasingdopamine and norepinephrine from cat-echolaminergic neurons. More details ofthe pharmacology of methylphenidatecan be found in previous studies.24,31

Methylphenidate is a preferred medica-tion for improving cognitive functioningbecause of its rapid onset of action andrelative short half life; however, thecomplete mechanism by which

methylphenidate exerts its effectremains unknown.31

ASSESSMENT MEASURESUseful Field of View (UFOV)Useful field of view is an area of thevisual field in which visual informationcan be acquired and processed withouteye and head movement10 using a visualattention analyzer (Visual Resources,Inc., Chicago Ill). As detailed else-where,7,32 the primary factors are thelength of time that the display is visible,the difficulty of the central vision task,the eccentricity of the peripheral target,and the presence or absence of clutter inthe field. Performance is expressed as afunction of 3 variables: the minimumtarget duration required to perform thecentral discrimination task (ProcessingSpeed Loss, PSL), the ability to divideattention between central and peripher-al tasks successfully (Divided AttentionLoss, DAL), and the ability to filter outdistracting stimuli (Selective AttentionLoss (SAL). Performance in each of the3 subtests is scaled from 0 to 30.10 Inaddition, performance in the 3 subtestsis non-independent because speed ofprocessing is relevant to all 3 tests, andattention abilities are relevant to sub-tests 2 and 3. Performance in the overalluseful field of view task is a compositescore expressed as percent reduction(0%-90%) of a maximum 30 degreesfield size (maximum field size of the testapparatus screen at the viewing dis-tance). These assessments have beenshown to compensate for practiceeffects.7

Functional Independent Measures The functional assessment instrumentincluded is in the Uniform Data Set forMedical Rehabilitation. It is composedof 18 items that are rated on a seven-level scale representing gradations fromdependent (1) to independent (7) func-



tion. The three subsets of FunctionalIndependence Measure (FIM)28 thatwere analyzed were the Activities ofDaily Living subscale (FIM ActivityDaily Living; FIM items 1-6), Mobilitysubscale (FIM Mobility; FIM items 9-13), and Cognition subscale (FIMCognition; FIM items 14-18). The use ofFIM as a measure of a patients’ func-tional status has been validated in theliterature.33 These procedures have beenpreviously described.34

STATISTICAL ANALYSISStatXact 5 used for statistical analyses.35

In the presentation of data below, scoresare presented for the following occa-sions: two baseline assessments and theassessment two weeks after initiation ofmaximum methylphenidate doses.Friedman’s36 non-parametric test wasused to test for differences between theassessment scores at baseline-one, BL1,baseline-two, BL2, and after the admin-istration of methylphenidate, ME. Post-

hoc procedures were used to find specif-ic differences between BL1, BL2, andME scores. A conservative probabilitylevel of 0.01 was adopted.

RESULTSTable 1 presents patient’s demographicand clinical details. Of the 16 patientsreceiving treatment, 12 were males and 4were females with an age range from 18to 75 (mean = 42.06 ± 19.85). In termsof ethnicity, 12 (75%) were European-American, 2 (12.5%) Asians, one wasHispanic, and the other was AfricanAmerican. Ten (62.5%) were single andsix (37.5%) were married. The GlasgowComa Scale scores were available foronly 6 patients. Six patients (37.5%)were on antiepileptic medications pre-scribed as a prophylactic. There was nostatistical difference in scores of UFOVand FIM in those subjects who were tak-ing medication for seizures and thosewho were not. The P value for all thetests was greater than 0.042. Also there

Table 1. Clinical Information for Each Patient*

Time sincePatient Age/Sex Cause of injury injury in days Maximum dosage

#1 18/M Anoxic 150 10 mg twice per day #2 37/F SAH 30 5 mg twice per day#3 44/F SAH 60 10 mg twice per day#4 74/M SAH 90 10 mg twice per day#5 45/M SAH 16 10 mg twice per day#6 75/F SAH 60 10 mg twice per day#7 19/F TBI 120 5 mg twice per day#8 72/M TBI 80 5 mg twice per day#9 30/M TBI 25 5 mg twice per day#10 60/M TBI 90 10 mg twice per day#11 51/M TBI 30 5 mg twice per day#12 19/M TBI 180 10 mg twice per day#13 40/M TBI 50 5 mg twice per day#14 33/M TBI 45 5 mg twice per da#15 38/M TBI 36 10 mg twice per day#16 18/M TBI 27 10 mg twice per day

*F indicates female; M, male; TBI, traumatic brain injury; and SAH, subarachnoid hemorrhage.



was no significant difference betweenmales and females. All the P values werealso greater than 0.058. The number ofdays since injury range from 16 to 180(mean = 68.06 ± 47.76). There was norelationship between the indexes ofUFOV and duration since injury. Thetime from baseline 1 to baseline 2ranged from 7 to 16 days (mean = 8.94 ±3.36).

Useful Field of ViewProcessing Speed Loss (PSL)The Friedman’s test disclosed significantreversal in the PSL after the introduc-tion of the methylphenidate (c2 = 24.75,P < 0.001). Post hoc contrasts confirmedthat there was no significant changeacross the baseline periods (t = 0.201,P = 0.842). However, there was a highlysignificant increase from BL2 tomethylphenidate (t = 8.66, P < 0.001).Case-by-case inspection revealed that allpatients showed improvement over thistime period. Figure 1 graphically showsthe mean loss score for UFOV process-ing speed for the BL1 was 9.50 and 9.31for the BL2. The mean loss score duringmethylphenidate was reduced to 1.19.There was a dramatic decrease in thePSL, almost a 90% decrease.

Divided Attention Loss (DAL) Figure 1 shows DAL for 16 patientsacross all assessment occasions. There

was a significant difference between theoccasions (c2 = 22.06, P < 0.001). Posthoc contrasts confirmed no significantchanges across the baseline period, buthighlighted a significant increase aftermethylphenidate was introduced; BL2 tomethylphenidate (t = 6.55, P < 0.001).Indeed, all 16 patients showed adecrease in DAL from BL2 tomethylphenidate.

Selective Attention Loss (SAL) Figure 1 shows stable baseline butincreased selective attention upon inter-vention with methylphenidate. Therewas a significant difference between thelevels of occasion (c2 = 31.39, P < 0.001).Post hoc contrasts confirmed no signifi-cant changes across the baselines period(t = 1.41, P < 0.168) and highlighted asignificant increase after methylpheni-date was introduced (BL2 tomethylphenidate; t = 33.23, P < 0.001).Indeed, all 16 patients showed adecrease in SAL from BL2 tomethylphenidate.

Functional Independent MeasuresThere were general improvements in thefunctional independence measures.Table 2 shows the detailed results of thecomparisons. Figure 2 displays the rela-tive improvement in Cognition andActivity of Daily Living subscale and noimprovement in Mobility subscale.

Table 2. Friedman’s Test Results*

Post hoc

Friedman’s Test BL1 to BL2 BL1 to ME BL2 to ME

C h i - s q u a r e P v a l u e t P v a l u e t P v a l u e t P v a l u e

Processing Speed Loss 24.75 0.000 0.201 0.842 8.000 0.000 8.660 0.000

Divided Attention Loss 22.06 0.000 0.936 0.357 7.490 0.000 6.554 0.000

Selective Attention Loss 31.388 0.000 1.414 0.168 34.649 0.000 33.232 0.000

FIM Cognition 17.294 0.000 0.849 0.403 4.669 0.000 5.515 0.000

FIM Activity of Daily Living 23.333 0.000 5.883 0.000 8.825 0.000 2.942 0.006

FIM Mobility 0.059 0.971 0.118 0.907 0.118 0.907 0.235 0.816

*BL1 indicates baseline 1; BL2, baseline 2; and ME, methylphenidate.



FIM CognitionThe Friedman’s test did disclose signifi-cant difference for FIM Cognition sub-scale (c2 = 17.294, P < 0.001). Post hoccontrasts confirmed that there were nosignificant changes across the baselineperiods (t = 0.849, P = 0.403). However,there was highly significant increase inFIM Cognition score from BL2 tomethylphenidate (t = 5.515, P = < 0.001).Case-by-case inspection revealed that80% of the patients showed improve-ment.

FIM Activity of Daily LivingFriedman’s test did disclose significantdifferences for FIM Activity of DailyLiving (c2 = 23.333, P < 0.001). Post hoccontrasts showed that the two baselinemeasures were not stable (t = 5.883, P <0.001). There was a significant increasein the FIM Activity of Daily Livingscore from BL2 to methylphenidate (t = 2.942, P < 0.006), suggesting thatpharmacological intervention did have asignificant impact on the patients’ activi-ty of daily living. However, in the lightof unstable baseline, such increment

cannot be solely attributed to the drugintervention.

FIM MobilityFriedman’ test did not disclose maineffects of occasion for FIM Mobility (c2 = 0.059, P = 0.971). Post hoc con-trasts confirmed that there were no sig-nificant changes across the baselineperiods (t = 0.118, P = 0.907). Also, therewas no significant increase in FIMMobility score from BL2 tomethylphenidate (t = 0.235, P = 0.816),suggesting the drug did not impact theindexes of Mobility.

DISCUSSIONAs there is growing literature stressingthe importance of accurately determin-ing patients’ level of cognitive function-ing and its role in appropriaterehabilitation and long-term manage-ment, rehabilitation specialists oftenneed a rapid and reliable way of check-ing whether patients are suffering fromattention impairment; and if so, deter-mining how severe is this impair-ment.13,37 UFOV has been specifically

Figure 1. Useful Field of View—Indexes of attention across assessment occasions.



devised to measure how people detectinformation within their radial visualfield under conditions that simulate thevisual clutter of the real world.Specifically, the useful field of view is ameasure that detects decline in visualsensory function, slowed visual process-ing speed, and impaired visual attentionskills. In a previous study,38 we were ableto demonstrate that the UFOV could beused by patients with ABI, and the scoreon this test could provide informationthat was partially accessed by neuropsy-chological examinations. This study didindicate that a good deal of the variancefor length of stay was accessed by thedivided attention task of the UFOV.

One principal aim of the presentstudy was to examine whether theUFOV could provide useful informationconcerning the effect of methylpheni-date, introduced during the clinical careof patients in an acquired brain injuryunit. The variations between UFOVscore before and after treatment withmethylphenidate were used as one ofseveral clinical measurements of the

impact of the medication. All 16 consec-utive patients treated withmethylphenidate for alleviation of atten-tion responded favorably to low doses ofmethylphenidate (5 mg to 10 mg twiceper day). The patients were of bothsexes, with differing etiology and loci ofbrain injury. The time since initial injuryvaried between approximately twoweeks to three months. It is most unlike-ly that the changes simply reflectedspontaneous recovery since two consec-utive baseline measurements wereshown to be statistically stable. Theresult thus collaborate some clinicalindication that medications that releasecatecholamine may relieve symptoms ofhypoattention.3

As this study applied a new assess-ment measure, an essential part of thisstudy is also to determine the usefulnessof UFOV in an ABI population. In theabsence of a gold standard, the useful-ness of this assessment measure is estab-lished by assessing the degree to whichthe scale correlates with other existingmeasure of related or unrelated enti-

Figure 2. Functional Independence Measures—Indexes of attention across assessment occasions.



ties.39 In a previous study, we determinedthat the UFOV was correlated with visu-al attention measures determined withneuropsychological testing and that thisvisual attention ability is correlated withlength of stay at the rehabilitation unit.40

An alternative measure of the utility ofa measurement is ‘pharmacological vali-dation’ in which changes are observedduring drug intervention. If the scorefluctuates as a consequence of the inter-vention, a change in the criterion vari-able is the essence of such validation.The rational of pharmacological valida-tion has been detailed elsewhere.26,41 Atface value, the scores of the UFOV sig-nificantly increased with low doses ofmethylphenidate, a compound presumedto trigger neurotransmission in centersinvolved in arousal and attention. Whileothers have suggested that there is nosignificant practice effect with repeatedtesting with the UFOV,7-9 their datawere collected on a geriatric populationthat did not involve brain injury. It wastherefore important for our clinical eval-uation as well as for the evaluation ofthese data that we could demonstrateneither a practice effect nor healingprocess that was occurring before theintroduction of the medication. It isimportant that no changes in score werenoted with repeated testing with theUFOV. Albeit indirectly, the presentfindings lend credence to the view thatUFOV is likely to detect attentiondeficits in ABI that is emendable to apharmacological agent. It was postulatedthat the mechanism underlying theseassociations is catecholaminergic circuit-ry, activation of which is thought to beinvolved in goal directed behavior.Reduced efficiency in the functioning ofthis circuitry, arising either from focalstructural damage to relevant neuronalpathways or from disruption to the syn-thesis, release, or metabolism of cate-cholaminergic itself, would impact onthe functioning of the entire system and

thus have observable effects at the threelevels of attention described.

As we have noted in previous workthat the UFOV scores do correlate withthe patient’s length of stay, we postulatethat any medication that improved theabilities measured with the UFOVwould in fact improve at least some ofthe measures of progress at the rehabili-tation unit. As the FIM is the standardmeasurement tool at our unit, we wereable to compare the changes before andafter the introduction ofmethylphenidate. Therefore, the secondintent of this study was to examinewhether pharmacological influences onattention as indexed with UFOV wouldcoincide with improvements in thepatients functional performance. Thedata from this study showed animprovement in functional abilities inboth FIM cognition as well as the FIMActivity of Daily Living. With the FIMCognition scores, there was a reasonablystable baseline such that we could deter-mine that the change in the FIMCognition scores was correlated with theintroduction of the medication andchanges in the UFOV scores. Just aswith FIM cognition, it appears thatmethylphenidate did impact activity ofdaily living, namely eating, grooming,bathing, transferring, and dressing.However, as the baseline scores werenot stable, the influence on attentioncannot be solely attributed to pharmaco-logical intervention. It is possible thatthe patients were experiencing sponta-neous recovery, though the data do sug-gest that the rate of recovery may havebeen accelerated by the introduction ofthe medication. Future studies are need-ed to clarify the effect of the medicationon the patients’ FIM Activity of DailyLiving.

Methylphenidate did not raise thescore of mobility despite stable base-lines. It is beyond the scope of this paperto assess the reasons why the FIM



Mobility scores did not change in a simi-lar fashion as the FIM Cognition andFIM Activity of Daily Living. It is possi-ble that there was motor tract involve-ment or deconditioning that resulted ina more layered involvement of recovery.It could be argued that the level ofstrength needed to increase ambulationmay need to be in place before a signifi-cant recovery of FIM Mobility could beachieved, while such a change in themuscular system would not need to beas significant for the FIM Activity DailyLiving and certainly not for the cogni-tive tasks. To analyze this, it would havebeen instructive to assess the motor aswell as the cardiovascular ability of eachindividual, as well as any other pertinentcomorbidity that might have affectedthe capacity of the patient to engage inambulation. Further studies are requiredto isolate these.

A major caveat in interpreting thefindings is that the treatment was notgiven in a blinded manner. While theUFOV is given in a standardized wayand is scored automatically by comput-er, the open design of these results leaveroom for differences in demand charac-teristics on the part of the staff who col-lected the data. It does seem unlikely,however, that this limitation couldaccount for the improvements in theirentirety. The validity and use of this sin-gle case type of trial is well-documented.42 The single case designmodel appears to be the intervention ofchoice, with its great flexibility and tai-lored approach to each individual case.Although the present assessment meas-ure may have been influenced by boththe researchers’ and patients’ expecta-tions, such “demand characteristics” ofthe treatment may have motivatedpatients to perform better.Notwithstanding this view, these patientswere selected (before drug treatment)for being poor in attention. The objec-tive computerized scoring for UFOV in

each case reduces scope for inadvertentdistortion of the data by the researchers.Nevertheless, it is clearly important thatthis study’s findings be more rigorouslyevaluated via a double blind, random-ized and controlled trial.

SUMMARYThis study demonstrates that, with aclinical population of patients with ABIthe UFOV test can provide assessmentof attention, which seems able to cap-ture and to quantify the effects of theintroduction of methylphenidate. Thesedata seem to further support our previ-ous work suggesting that the UFOV testmay be an efficient and important toolfor the measurement of a cognitive vari-able critical for the recovery of patientswith ABI.

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