Effects of categorization training in traumatic brain injury rehabilitation
Thomas, Robin D.
SourceJournal of Head Trauma Rehabilitation
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Objectives: To demonstrate that (1) the Categorization Program (CP) is an effective method to improve categorization abilities in patients with moderate-severe traumatic brain injury (TBI), (2) postacute rehabilitation is beneficial to patients with moderate to severe TBI as evidenced by improved functional outcome and neuropsychological performance. Hypotheses: Postacute rehabilitation will result in improved functional performance in TBI. Patients receiving the CP training will improve categorization abilities to a greater degree than TBI controls. Patients receiving the CP training will demonstrate generalizability of new skills to new tasks as compared to TBI controls. Participants: Two groups of subjects with moderate-severe TBI (experimental n = 14, and control n = 10) and one group of noninjured normal ss participated, n = 13. TBI ss were randomly assigned into the experimental or the control group and were matched on critical variables and severity indices. There was no difference between TBI ss in pre-tx performance on dependent measures such as the MPAI-3, CIQ, or the categorization tasks CP Test 1 and CP Test 2. Methods: The experimental TBI group received the CP training. TBI subjects in the control group did not receive the CP training; instead they received cognitive tasks traditionally used in their facility. Subjects were monitored to receive similar amounts of cognitive treatment. Subjects received about 10 weeks of postacute rehabilitation. Ss were assessed before rehabilitation and at the end of 10 weeks. Results: MANOVA yielded significant gains on total post-CIQ for both groups (P = .0001). Pairwise t tests showed significant changes on the 3 subscales for the experimental group. TBI controls improved only in Productivity subscale. MANOVA on the MPAI-3 resulted in significant improvement for both groups on all subscales. Experimental ss performed significant better on the categorization tests, CP 1 and CP 2 at the end of the study (P = .017 and P = .011). Also, TBI experimental ss improved across the 3 probe tasks (P = .006). Control ss did not show improvement on the probe tasks, indicating difficulty in generalizing (P = .888). Conclusions: Subjects enrolled in postacute rehabilitation demonstrated improvement in functional performance. However, those who received the CP training demonstrated greater improvement on categorization skills and on certain aspects of functional cognitive abilities. Performance of experimental ss approximated the baseline performance of normal ss on some tasks. This study supports the use of the systematic categorization training in postacute rehabilitation.