Effects of Systematic Categorization Training on Cognitive Performance in Healthy Older Adults and in Adults with Traumatic Brain Injury

Table 2

The eight levels of the categorization program (adapted from Constantinidou et al. [38] and Constantinidou et al. [12]).

Part A: object categorization tasks	This part consists of 5 different levels. The tasks begin with teaching perceptual features in order to describe objects or living things and move to higher levels of abstraction.
Level 1: perceptual feature training and application	The purpose of this section is to train perceptual feature identification thereby building a framework for cognitive structures. The retraining of basic categorization abilities will build the foundation for more abstract functions and will facilitate communication during word-finding difficulties. The patient will learn eight perceptual features and then consistently apply all the features to describe common objects. Objects are presented via a range of stimulus types including real objects, color photos, line drawings, written words, and spoken words.
Level 2: similarities and differences	The purpose of this level is to apply the eight perceptual features trained in Level 1 to compare objects. Identification of similarities and differences between two objects of the same and of different categories using the eight perceptual features is utilized in order to train conceptual thinking. The process of applying the trained perceptual features is the next layer of the continuum of concrete to abstract functional abilities. Stimulus types include colored photos, written words, and spoken words.
Level 3: functional categorization	The purpose of this task is to identify functional categories and maintain the delineations within that category. There are two specific foci in this level which require the consideration of the features of the objects trained and applied in Levels 1 and 2: the application of retrieval strategies to generate novel items that belong in a given category and the mental flexibility required to generate alternate uses for the objects in a given category. This task enhances functional problem-solving and mental flexibility.
Level 4: analogies	The purpose of this level is to apply both the categorization abilities trained in Levels 1-3 and inductive reasoning skills in order to identify and match the concepts represented in analogies. The analogies progress from concrete to abstract in order to train word abstraction. Stimulus materials include multiple choice responses for each analogy that will aid in the training process of word abstraction as needed.
Level 5: abstract word categorization	This level further develops concept formation and abstract conceptual thinking. The goal is to identify similarities and differences in abstract verbal concepts. The generation of similar word pairs using synonyms that represent the relationship between the words is incorporated to enhance cognitive and linguistic flexibility.
Part B: new category learning tasks	Under each level of the new category learning, there are 5 steps that increasingly demand a higher level of rule-governed responses. Errorless learning principles and cueing hierarchies are applied under each step.
Level 1: progressive rule learning 1	The stimuli for Level 1 vary along two dimensions: shape and color. The nine stimuli include squares, circles, and triangles that are red, white, and black. Each stimulus is presented individually, and a formulation of the rule that classifies each stimulus into either Category A or Category B follows.
Level 2: progressive rule learning 2	The stimuli for Level 2 of Part B are gauges that include two dials that must be interpreted as a single unit. This level forces generalization into a real world situation by simulating the reading of gauges at a power plant. The determination of operational or not operational for each stimulus is utilized, and the cumulative interpretation of each judgment leads to the formulation of the rule that classifies the stimuli for each of the five conditions.
Level 3: progressive rule learning 3	The final explicit rule task contains the same underlying structure as the earlier two levels; however, this time, a judgment is made using stimuli constructed from dimensions of language. This further abstracts the rule formulation and forces generalization of training to a real world situation. The stimuli in this task consist of a summary of three laboratory tests (lung capacity, heart fluid, and bone marrow count) and their orthogonal combination with two measurement adjectives (low and high).