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Assessment review
LOTCA – Assessment review
Georgina Wrack
University of the Sunshine Coast
LOTCA Summary Page
The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) is a series of tests designed for occupational therapists to look at a person’s cognitive processing ability and to determine whether a person is able to carry out everyday functional tasks (LOTCA Manual, 2000). The battery can also be used to determine where to begin in intervention, to help set goals for intervention and as a follow up tool to check for improvement during intervention. It was originally designed by Katz, Elazar, Everbach and Itzkovich to be used on brain injured clients, but can be used with many different clients such as: patients following stroke, spinal cord injured, individuals with dementia or brain degeneration, traumatic brain injury patients, brain tumour patients, individuals with CNS dysfunction, individual’s with intellectual disability, mental illness patients, and children with learning difficulties. The LOTCA can be used on persons above age 6 through to age 70 years. There is a geriatric version called the LOTCA-G suitable for age 71-90years, and an adapted version can be used for children or adults with intellectual impairment and language difficulties (LOTCA Manual, 2000).
The original LOTCA was developed in 1990 and consists of 20 sub-tests within 4 areas; orientation, perception, visuomotor organization and thinking operations, however, the revised edition LOTCA-II consists of 26 sub-tests within 6 areas: Orientation (2 items); Visual Perception (4 items); Spatial Perception (3 items); Motor Praxis (3 items); Visuomotor Organization (7 items); and Thinking Operations (7 items) . It is scored on a scale from 1-4 (1 being poor performance, through to 4, being optimal performance), except for 3 categorizing tests, which score on a 1-5 scale and 2 orientation sub-tests which score on a 1-8 scale. At the end, the scores are tallied to give a possible score between 26 and 115. The LOTCA and LOTCA-II take approximately 45 minutes to administer. The LOTCA-G takes approximately 30-45 minutes to administer. There are specific instructions and specifications to consider when administering the LOTCA, these are all located in the administration section of the manual.
Several studies have been carried out on the use of the LOTCA/LOTCA-II providing reliability, validity and standards of performance for brain injured and CVA Adults patients, healthy adults and healthy children ages 6-12years (Averbuch & Katz, 1991: Cermak, Katz, McGuire, Greenbaum, Pertalta & Flangan, 1995; Katz, Itzkovich, Averbuch & Elazar, 1989 as cited in; Katz, Elazar, & Itzkovich, 1995). Studies have also been carried out validating the reliability of the LOTCA-G version for elderly patients. The strengths of the LOTCA are that it provides a comprehensive analysis of cognitive function in a relatively short amount of time and weaknesses are that it doesn’t incorporate memory testing and doesn’t pick up mild cognitive deficiencies.
Overall, the LOTCA/LOTCA-II is a good Micro-battery that the OT can use in conjunction with informal/formal interviewing processes and functional/observational assessments of the client, to establish their cognitive ability to perform daily occupations. Furthermore, to establish goals for intervention and as a screening tool, during and after intervention.
The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)
Background information and client groups
The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) is a series of tests designed for occupational therapists, to look at a person’s cognitive processing ability and to determine whether a person is able to carry out everyday functional tasks (LOTCA, 2011). The Battery was developed using information gathered from clinical experience, neuropsychological and developmental theories. In addition to determining a patient’s abilities and deficits, the battery can be used to develop intervention goals for therapy and as a follow up screening tool during intervention to detect for improvement (Annes, Katz & Cermak, 1996). It was initially developed, by the Loewenstein Rehabilitation hospital (LRH), as a tool for evaluating brain injured clients following the war in Israel. However, today the LOTCA is used on a variety of client’s where cognitive status has to be established (Lotca Manual, 2000). It can be used in; patients following stroke, spinal cord injured, individuals with dementia or brain degeneration, traumatic Brain injury patients, brain tumour patients, individuals with CNS dysfunction, individual’s with intellectual disability, mental illness patients, and children with learning difficulties (LOTCA, Manual, 2000).
The LOTCA is considered a valid cognitive assessment tool for persons above age 6 through to age 70 years, there is a geriatric version called the LOTCA-G suitable for ages 71-90years, and an adapted version can be used for children or adults with intellectual impairment and language difficulties (LOTCA Manual, 2000). However, culture can affect construct reliability when used in a paediatric population (Josman, Abdallah & Engel-Yeger, 2011). The original LOTCA was developed by Itzkovich, Averbuch, Elazar and Katz in 1990 and consists of 20 sub-tests within 4 areas; orientation, perception, visuomotor organization and thinking operations, however, the revised edition LOTCA-II consists of 26 sub-tests within 6 areas: Orientation (2 items) looking at the individuals orientation to place and time; Visual Perception (4 items) looking at the individuals ability to identify pictures of everyday objects, objects photographed from unusual angles, distinguish between overlapping figures, and recognize spatial relations between objects; Spatial Perception (3 items) looking at the individuals ability to differentiate between right and left and to determine spatial relationships between objects and self; Motor Praxis (3 items) looking at the individuals ability to imitate motor actions, use objects and perform symbolic actions; Visuomotor Organization (7 items) looking at the individuals ability to copy geometric figures, reproduce a 2D model, copy a coloured block design and a plain block design, reproduce a puzzle, complete a pegboard task, and draw a clock; and Thinking Operations (7 items) looking at the individuals ability to complete tasks including sorting, categorization, picture and geometric sequences (LOTCA Manual, 2000). It is scored on a scale from 1-4 (1 being poor performance, through to 4, being optimal performance), except for 3 categorizing tests, which score on a 1-5 scale and 2 orientation sub-tests which score on a 1-8 scale. At the end, the scores are tallied to give a possible score between 26 and 115 and the time taken to perform specific tasks on the test is noted. The LOTCA and LOTCA-II take approximately 45 minutes to administer. The LOTCA-G takes approximately 30-45 minutes to administer. There are specific instructions and specifications to consider when administering the LOTCA; these are all located in the administration section of the manual.
Research, Psychometric properties, strengths and weaknesses
Several research studies have been carried out on the LOTCA battery, providing normative data and validity and reliability of the assessment tool. Two major studies were carried out at the time of development of the original battery in Israel. The first study by Katz, et al., 1989, as cited in the LOTCA Manual, 2000 looked at the reliability and validity of the LOTCA, whilst comparing the performance of Brain-injured patients with normal patients. The sample consisted of three groups, 2 groups of brain injured adults, 20 with Cranio-Cerebral injury (CCI) and 28 with Cerebro-vascular accident (CVA), and a control group of 55 normal adults (Katz et al., 1989 as cited in LOTCA Manual, 2000). Results indicated that among normal subjects, years of education, was related to perceptual cognitive performance and in the patient groups none of the variables were significantly related to performance, indicating the level of brain damage(Katz et al., 1989 as cited in LOTCA Manual, 2000). The control group performed almost perfectly on all sub-tests except for categorization, classification and geometrical sequencing and the client groups show impairment on almost all sub-tests in the first assessment and showed some improvement on average, more so in the CCI than the CVA after 2 months (Katz et al., 1989 as cited in LOTCA Manual, 2000).
Inter-rater reliability ranged from .82 to .97 on the spearman’s rank and observation by six OT’s of a patient caring out an assessment reached agreement levels of 100% in 14 subtests, 86% in 4 sub tests and 86% in 1 sub-test, indicating acceptable reliability (Katz et al., 1989 as cited in LOTCA Manual, 2000). High alpha co-efficient levels were found on three of the sub-domains (perception, visuomotor and thinking operations) respectively .87, .95 and .85 lending support to the battery (Katz et al., 1989 as cited in LOTCA Manual, 2000). Validity was tested through the Wilcoxon’s two-sample test and the Kruskal Wallis test among three groups and they both showed the same level of significance of .001 at both assessment times, thus lending support to validity in assessing perceptual cognitive impairment and differentiating between groups (Katz et al., 1989 as cited in LOTCA Manual, 2000).
Another study by Annes, Katz, and Cermak (1996) compared younger and older healthy American adults on the LOTCA. Specifically, looking at performance and comparing to normative data found on Israeli subjects. They found that it took older adults significantly longer than younger adults on six of the seven sub-tests and also that performance of normal adult Americans was similar to Israeli adults, thus