CHAPTER 54: LOEWENSTEIN OCCUPATIONAL THERAPY COGNITIVE ASSESSMENT (LOTCA) I AND II

Description

The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), developed by Katz, Itzkovich, Averbuch, and Elazar (1989), is based on Luria’s and Piaget’s neuropsychological and developmental theories and is designed to measure cognitive abilities such as that which is defined as the intellectual functions thought to be prerequisite for managing everyday encounters with the environment (Najenson, Rahmani, Elasar, & Averbuch, 1984). Originally validated with traumatic brain injury subjects, information from the battery as well as the evaluation of an individual’s engagement in activities of daily living can be used to plan occupational therapy treatment (Katz et al., 1989). The LOTCA consists of 20 subtests divided into four domains: (1) orientation, (2) visual and spatial perception, (3) visuomotor organization, and (4) thinking operations and includes such items as object identification, shape identification, overlapping figures, copying geometric forms, reproducing a 2-dimensional model, constructing a pegboard design, constructing a colored block design, constructing a plain block design, reproducing a puzzle, and drawing a clock (Katz et al., 1989). To address inherent shortcomings of the original, the revised LOTCA-II by Itzkovich et al. (2000) was developed which consists of 26 items grouped into 6 subtests: (1) orientation (2 items); (2) visual perception (4 items); (3) spatial perception (3 items); (4) motor praxis (3 items); (5) visuomotor organization (7 items); and (6) thinking operations (7 items). Both tests are similar and take approximately 45 minutes to administer. For the LOTCA-II each item is rated on a scale from (1) low to (4) high, except for the orientation subtest, which is scored on a scale from 1 to 8, as well as 3 items in the thinking operations subtest that are scored on a scale from 1 to 5 (Su, Chen, Tsai, Tsai, & Su, 2007). Scores for both are graded according to criteria based on the degree to which the subject correctly answers questions and performs tasks. A subtest score as well as a total score is achieved that can range from 26 to 115. Higher scores suggest less impairment in basic executive abilities (Su et al., 2007).

Psychometrics

Initial research into the battery found good inter-rater reliability coefficients of r = 0.82 to 0.97 across the 19 subtests with an alpha coefficient of 0.85 and above for the areas of perception, visuomotor organization, and thinking operations (Katz et al., 1989). A subsequent study of people with intellectual disabilities (n = 140) concluded that results showed good internal consistency for the items of orientation (α = 0.82), visual perception (0.74), spatial perception (0.76), visuomotor organization (0.86), and thinking operations (0.80); however, internal consistency of the motor praxis subscale was only α = 0.48 (Yuh, J., Jen-suh, C. & Keh-chung, 2009). A study by Wang et al. (2014) showed that LOTCA scores were strongly and positively correlated (r = 0.93) with Mini-Mental State Exam in patients with cognitive impairment (n = 60). LOTCA-II test-retest reliability from a subsample of 48 persons with schizophrenia was r= 0.95 (total score), for the orientation subtest, the intra-class correlation coefficient was 0.63, visual perception it was 0.77, spatial perception 0.49, motor praxis 0.67, visuomotor organization 0.87, and for the thinking operations subtest it was 0.89. (Su et al., 2007). Weak to moderate correlations were also found between scores on the LOTCA-II and the Wechsler Adult Intelligence Scale—Third Edition subscales with values ranging from 0.37 to 0.69, the Wisconsin Card Sorting two subtests (-0.56 and 0.42), the Allen Cognitive Level Screen (0.55), and the Daily Living Function Scale (0.55).

Advantages

There is a significant amount of research in support of the LOTCA assessments for use in clinical practice and several versions are also available for the adult population such as the LOTCA, LOTCA-II, and the LOTCA-G (geriatric version). Another value of the LOTCA batteries are their ability to measure client strengths and weaknesses across several constructs of orientation, perception, visuomotor organization, thinking operations, and attention where results can then be used to establish starting points for rehabilitation, to formulate specific goals, monitor treatment effects, and serve as a screening for further assessment (Hooper, 2012).

Disadvantages

Both versions are lengthy assessments and the original may be confusing to some as clearly established testing procedures and established norms are limited. Su et al. (2007) found that substantial ceiling effects existed in their LOTCA-II study of subjects with schizophrenia. One possible explanation was that the items studied may have been too easy for that sample. Low internal consistency was also noted for the visual perception, spatial perception, and motor praxis subtests which only had a range of α = 0.20 to 0.45.

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