Categorization Training and Neuropsychologic Performance in Traumatic Brain Injury Rehabilitation.

Abstract

Objectives: To test whether a systematic categorization program will improve categorization abilities and neuropsychologic performance in patients with traumatic brain injury (TBI). Design: Before-after control trial. Setting: Postacute residential rehabilitation programs. Participants: 16 patients who received categorization program training and 13 control subjects. Intervention: Subjects received 6.5 hours of cognitive treatment per week for 12 weeks. Subjects in experimental group received 2 hours of categorization training as part of their cognitive treatment. Main Outcome Measures: 2 categorization tests (test 1, test 2) and 3 probe tasks (to check generalization of skills) were constructed for the categorization program. Extensive neuropsychologic battery and functional outcome measures including: Mayo-Portland Adaptability Inventory−3 (MPAI-3), Community Integration Questionnaire (CIQ), Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI), Woodcock-Johnson III Tests of Cognitive Abilities (WJ-III), Booklet Category Test (BCT), Rey-Osterrieth Complex Figure Test (RCFT), Controlled Oral Word Associations Test, and the Symbol Digit Modalities Test (SDMT). Results: There was no significant difference between groups at baseline. Multivariate analysis of variance showed that subjects in the experimental group improved significantly on the categorization program tests 1 and 2 compared with controls (P=.017, P=.011). Furthermore, subjects in the experimental group improved across the 3 probe tasks as they progressed on the categorization program training (P=.006). In contrast, controls did not demonstrate generalizability to new tasks, and their performance did not change (P=.888). Subjects in the the experimental group showed significant (α=.01) improvement on 14 neuropsychologic measures including the SCATBI, WJ-III, BCT, SDMT, and RCFT. In contrast, controls improved on 10 measures. Furthermore, several neuropsychologic measures correlated significantly with categorization program tasks. Both groups improved on their CIQ (P=.000) and MPAI-3 (P=.000) scores. However, the experimental group demonstrated greater change on certain aspects of functional outcome measures. Conclusions: The present study provides additional support for systematic hierarchical categorization training in TBI rehabilitation.