Lotca

Loewenstein Occupational Therapy Cognitive Assessment
Presented by: Ramon Alfredo S. Amores - UST OT Intern Batch 2012
Brief Background
Developed by staff members of the OT Department at Loewenstein Rehabilitation Hospital (LRH) in Israel
Purpose: evaluating basic cognitive
abilities in brain injured cells

Basic cognitive functions are thought to be prerequisite for managing every day encounters with the environment.
History
1973 Israeli soldiers with head injuries admitted to LRH; led to development of LOTCA 1990 LOTCA Battery first published 2000 Second edition released
Provides a profile of the clients cognitive status

Useful for:
Establishing a baseline for treatment Planning treatment goals Monitoring changes during treatment
Six main areas

Orientation Visual Perception Spatial Perception Motor Praxis Visuomotor Organization Thinking Operations
Also contains 26 sub-tests
Originally for clients with brain damage (e.g., TBI, CVA, brain tumors) Suitable for assessment in other populations where cognitive status has to be established (e.g., SCI, degenerative and psych dse, underachieving students)
Administration
3o to 45 minutes Can be divided into 2-3 sessions or lesser time if necessary Procedures for assessing aphasic clients are incorporated
Administration
Scoring sheet provides profile of clients performance No additional cues should be given for any subtest READ carefully BEFORE administration Side-by-Side most sub-tests Face-to-face - spatial perception and praxis subtests
Administration Examiner should be alert for clients motor slowing or restlessness and continue the assessment at a later time
Administration
At the end of the assessment
Indicate length of time taken Indicate if additional sessions are needed
Rate appropriate level of attention and concentration based on observation
Scoring
Most tests =
1 (low) to 4 (high)
Three categorization tests =

1 to 5
Two orientation sub-tests =

1 to 8
TESTS
Orientation Visual Perception Spatial Perception Motor Praxis Visuomotor Organization Thinking Operations Attention Span and Concentration
Orientation
Awareness of self in relation to ones surroundings Requires consistent and reliable integration of attention, perception and memory
Orientation
Deficits are among the most frequent symptoms of brain diseases Impaired awareness of time and place
Most common Accompanies every brain disorder in which attention or retention is affected
Orientation
Impaired orientation strongly suggestive of cerebral dysfunction Good orientation not evidence of cognitive or attentional competence
Orientation
Test items are impossible to administer if client has comprehension difficulties (e.g. receptive aphasia). If clients comprehension is good and he/she has only expressive difficulties, he/she may respond with yes or no to multiple choices provided by examiner.
Subtests for Orientation
1. Orientation for Place 2. Orientation for Time
Orientation for Place (OP)

a. Client is asked where he/she is now (i.e., the name of the hospital and name of city in which it is located)
Where are you now? What city are we now?

b. Client is asked where does he/she live (the full address) and where he/she was before arriving at this place (e.g. if client has been hospitalized in another hospital, examiner will ask client to name the hospital).
Where do you live? What is your exact address? Where were you before you came here?

c. If client is unable to answer the questions (because of memory problems or aphasia), examiner will use multiple questions, asking client to choose the correct answer.

Questions for multiple choice for clients with language or memory disorders:
Examiner will provide three options for recognition One of the options should be the correct answer.
OP Scoring
2 points for every correct answer 1 point only if answer was given by way of multiple choice
OP Scoring
Minimal performance Maximal performance 1 point No correct answer 1 correct answer by multiple choice 8 points Answered correctly all questions without the need for multiple choice
Orientation for Time (OT) a. Client is asked for the full date.
What day is today? What month? What year? What season is it now?
Orientation for Time (OT)
b.Client is then asked to estimate the time (without looking at the watch).
What is the hour now?
Orientation for Time (OT) c. He/she is also asked how long he/she is hospitalized.
How long have you been hospitalized?

d. In case client is an out-patient, he/she will be asked when he/she was injured, or for how long he/she has been ill, or has had difficulties.
How long have you been ill? How long have you had difficulties?

Questions for multiple choice for clients with language or memory disorders:
Examiner will provide three options for recognition One of the options should be the correct answer.
OT Scoring
2 points for every correct answer 1 point only if answer was given by way of multiple choice
OT Scoring
Minimal performance Maximal performance 1 point No correct answer 1 correct answer by multiple choice 8 points Answered correctly all questions without the need for multiple choice
Total disorientation for place and time indicates a confusioned state. Generally, OP improves before OT.
Visual Perception
Active process of: searching for the corresponding information, distinguishing the essential features of an object, comparing the features with each other, creating appropriate hypotheses, and then comparing these hypotheses with the original data.
Visual Perception
Perceptual abilities tested range from the identification of clear pictures of objects to identification of objects photographed from unusual angles, distinction of overlapping figures, and recognition of spatial relations.
Subtests for Visual Perception Object Identification (OI) Shape Identification (SI) Overlapping Figures (OF) Object Constancy (OC)
Object Identification (OI)
Requires:
OI Cards Test Booklet (pages 1-4)

a. Client is shown cards of 8 everyday objects: chair, teapot, watch, key, shoe, bicycle, scissors, and glasses.

b. Client is asked to name each object.
Numbers on the back of cards are not to be used as sequence numbers. Follow the card sequence given above.

c. If client has expressive problems and is not able to name objects:
The first two boards of the test booklet is shown. Client is asked to point to the objects named by the examiner.
Examiner asks, Where is the chair?; Where is the watch?; etc. This procedure is used for each of the eight objects.

d. If client has receptive problems:
Examiner shows client the eight cards which are similar to pictures on the first two pages of the booklet. Examiner shows one by one and asks, Where is this?
Client has to point to the similar object on the board.

e. If client is unable to identify similar objects:
Examiner presents the next two boards in the test booklet which are identical to the ones on the cards. Examiner asks, Where is this? Client has to do exact matching.

Clients unable to recognize the objects most probably suffer from visual agnosia. At which point, examination will stop. For further and more detailed examination, examiner should present client concrete objects for identification.
OI Scoring
1 point <4 objects by exact matching 2 points 5-8 objects by exact matching 3 points 4-7 objects by naming, understanding, or similar matching 4 points 8 objects by naming, understanding or similar matching.
Shape Identification (SI) Requires:

SI Cards Test Booklet (pages 5-8)
Shape Identification (SI)

a. Client is shown 8 shapes illustrated on separate cards:
square, triangle, circle, rectangle, diamond, semi-circle, trapezoid, and hexagon.

b. On each card, examiner asks client, What is the name of this shape?

c. If client is unable to name the shapes because of expressive problems:
Examiner asks client to point to the target shape on the boards in the test booklet. x Show me the circle etc.

d. If client has receptive problems and is unable to identify the shapes by understanding:
Examiner shows him/her the eight cards of similar shapes. Client is asked to point out the similar shape on the board.

e. If client is unable to identify the shapes by similar matching:
Client is shown the eight cards with the exact shapes as on the boards. Client is asked to point to the target shape on the board.
x Examiner will show the cards in the exact spatial orientation as on the board.

Usually, clients have no problem identifying the simple shapes. Have difficulties identifying the more complex ones.
SI Scoring
1 point < 4 shapes by exact matching 2 points 5-8 shapes by exact matching 3 points 4-7 shapes by naming, pointing or similar matching 4 points 8 shapes by naming, pointing, or similar matching.
Overlapping Figures (OF)

Simplified version of the Poppielreuter (1917) Overlapping Figures Test Also used by Christensen (1975) in her systematization of Lurias examination methods.

Designed to assist in the determination of deficits in visual perception on a more complex level. Client has to analyze the figure/ground relationship in order to distinguish the figure from the interfering elements.

Clients with severe dysfunction may misinterpret the information on the card and combine it to one wrong form. Less severe clients are able to identify only part of the objects.
Requires:
OF Cards Test Booklet (pages 9-10)

a. Examiner shows client two cards with three overlapping objects on each:
Card 1: banana, pear, apple Card 2: pliers, hoe, saw
b. Examiner asks client, What is drawn on the card?

If client has difficulties in identifying the figures:
Examiner shows client a board with the six separate figures. Client is then instructed, Point to the objects that you see in the card. Repeat procedure for the second card.
OF Scoring
1 point o figures identified or < 3 with board 2 points 3 figures with board 3 points 4 figures without board or all figures with board 4 points all figures with board
Object Constancy (OC)

Photographs used are taken from angles that do not emphasize the most characteristic features of the objects.
Requires: Test Booklet (pages 11-19)

a. Client is shown four photographs of objects taken from unusual angles: car, hammer, telephone, and fork. b. For each of the photographs, client is asked, What do you see in the photograph?

c. If client has language disabilities (e.g. aphasia), and only in that case:
Examiner should use the multiple-choice boards. Examiner asks client, Point to the small photograph in which you see the same object as in the big photograph.

d. There is only one correct answer for each object.

Clients have difficulties in recognizing all or parts of the four photographs according to the severity of the brain damage.
OC Scoring
1 point 0-1 objects identified 2 points 2 objects identified 3 points 3 objects identified 4 points 4 objects identified
Spatial Perception
Difficulty in right-left discrimination
incapacity to apply this distinction to symmetrical parts of the body disorder of spatial orientation related to own body or a confronting person
Spatial Perception
Visual spatial agnosia
Deficit in perceiving spatial relationships between objects or between objects and self Difficulties in spatial relations on the own body Difficulties in judging distances and in depth perception
Spatial Perception
Perceptual functions are the most basic of cognitive abilities. Client who exhibits difficulties in this part of the battery will most probably demonstrate further difficulties in the following parts.
Spatial Perception
Perception disabilities influence clients functioning in everyday life, e.g.:
Severe perception d/o (visual agnosia) problems in all areas of everyday life Figure ground discrimination problems fail to find a desired object among several others. Spatial perception problems disabilities in ADL, including dressing, ambulation, etc.
Spatial Perception
More common in right hemisphere lesions Frontal lobe lesions poor perception secondary to:
Motivation Initiation Integration
Face to face
Subtests for Spatial Perception

Directions on Clients Body (SP1) Spatial relations: Between client and objects near space (SP2) Spatial relations: Represented on a picture (SP3)
Directions on Clients Body (SP1)

a. Examiner can change what is left to right according to clients physical problems. b. Examiner asks client:
Show me your right hand. Show me your left leg. Put your right hand on your left ear. Put your left hand on your right leg.
SP1 Scoring
1 point given for every correct response Minimal performance 1 point Maximal performance 4 points
Spatial relations: Between client and objects near space (SP2)

a. Examiner points to four different objects in four different directions (left, right, front, back) in the room. b. Examiner asks client:
On which side of you is (for example) the door? On which side of you is (for example) the window? On which side of you is (for example) I am sitting? On which side of you is (for example, any clear object in the room.)
SP2 Scoring
Spatial relations: Represented on a picture (SP3)

a. Examiner shows client the picture of a man sitting in front of a table. b. Examiner asks client:
What is in front of the man? What is on the left side of the man? On what side of the man is the computer? What is behind the man?
SP3 Scoring
Motor Praxis
Apraxia
disturbance of purposeful expressive functions breakdown of motor integration and executive functions integral to the performance of complex learned acts Confusing terminology with the use of ideometer, ideational and idiokinetic apraxia in different ways Test will use the term in a descriptive way (Lezak, 1983)
Motor Praxis
Praxis motor planning ability to execute motor functions
Subtests for Motor Praxis

Motor Imitation (P1) Utilization of Objects (P2) Symbolic Actions (P3)
Motor Imitation (P1)

a. Client and examiner sit face-to-face. b. Examiner instructs client, Imitate my movements as if you were looking in a mirror. c. If client does not understand, examiner shows him/her and says: When I move my left arm, you make the same movement with your right arm.
Motor Imitation (P1)

d. The Movements
Grasping the ear lobe on the same side with thumb and forefinger. Sequential movement: the palm of the hand is placed behind the neck and then on the opposite shoulder. The dorsal aspect of the hand is placed on the opposite cheek with fingers in extension. The thumb opposes the middle and then the ring finger examiner repeats these movements three times.
P1 Scoring
Utilization of Objects (P2)

a. Examiner shows client the following objects, each at a time:
x x x x a comb scissors and a paper an envelope and a paper a pencil and an eraser
b. Examiner says, Show me how you use these objects.

c. For the use of a pencil and an eraser, examiner says, Draw a line on the paper, and then erase it.
P2 Scoring
Symbolic Actions (P3)

Examiner asks client:
Show me how you brush your teeth.
x Examiner will ask client to show the whole action, from putting the tooth paste on the brush, bringing it to the mouth and brushing.
How do you open a door with a key? How do you cut a loaf of bread with a knife? How do you use a telephone?
Examiner will ask client to show the whole action, from lifting the receiving, dialing, and bringing the receiver to the ear.
P3 Scoring
Full score can be given for mirroring and contralateral imitation. (Sub-test is for measuring praxis, not right/left discrimination).
Visuomotor Organization
Embraces three large classes of activities: Copying Drawing Building or assembling Variability in the tendency of problems in these classes to occur together makes it important to evaluate these activities together (Lezak, 1983).
Combines perceptual activity with motor response and always has a spatial component Damage to either left or right brain hemisphere may cause difficulties in constructional performance.
Right hemisphere damage piecemeal, fragmented approach, losing the overall gestalt of the construction task Left-sided lesions may get overall idea, but tend to lose details, and in general turn out a shabby production
Frontal lobe syndrome tend to fragment, simplify, and usually need support in order to perform the construction Difficulties are usually expressed in ADL tasks as well as in the performance of complicated activities of any kind
Subtests for Visuomotor Organization

Copy Geometric Forms (GF)
Reproduction of a Two-Dimensional Model (TM)
Pegboard Construction (PC) Colored Block Design (CB) Plain Block Design (PB) Reproduction of a Puzzle (RP) Drawing of a Clock (DC) In all subtests, time of performance must be measured and written into the scoring sheet.
Copy Geometric Forms (GF) Requires:

GF Cards

1. Examiner puts in front of client a sheet of paper and a pencil. 2. Examiner says, I am going to show you five forms. Please copy each form on the paper.

3. Examiner shows the form in the following order:
circle triangle diamond cube complex form

Most clients will copy the three simple forms correctly. If not, the common errors are in the closure of the forms or in positioning them in the right angles.

Most of the difficulties are demonstrated in copying the cube and the complex form. Clients tend to copy the cube as a square and to distort the complex form.
In copying the cube, good performance is considered only if client copied the form with all the lines in the proper angles; i.e., the client perceived the three-dimensional perspective
GF Scoring
1 point zero to one form copied 2 points two or three forms copied 3 points four forms copied 4 points all five forms copied

Requires: Test Booklet (page 20)
a. Examiner shows client a design that consists of a circle, a rectangle and two triangles and the corresponding shapes. b. Examiner says, Construct this pattern beside the design.
c. If client fails to do it, examiner instructs client, Now try to construct it on the design.

Main difficulties are in spatial positioning of shapes
Clients with severe damage show problems already in placing the square in the right position. Clients with lesser disabilities exhibit difficulties in finding the correct position of the triangles.
TM Scoring
1 point unable to reproduce pattern 2 points able to reproduce pattern only on the design 3 points reproduces the pattern correctly but with trial and error 4 points good performance
Pegboard Construction (PC)

Uses a pegboard with equally spaced holes, pegs, and a card of the same size as the board with a design of a triangle. Requires: Test Booklet (page 21)

a. Examiner puts in front of client a pegboard, pegs, and a design of a triangle. b. Examiner instructs client, Construct the pattern.

Several typical errors may be observed in test performance:
difficulties by integrating the dots into a total form x peg-by-peg fashion, in little reference to total form itself difficulties in closing the form x angles of triangle remain uncompleted

inability to construct oblique line
x obliques develop later than vertical and horizontal lines x clients may succeed constructing vertical and horizontal lines, but hesitate or unable to construct the oblique
Client able to construct shape, but does not locate the right position in the board
PC Scoring
1 point unable to perform 2 points able to reproduce only the vertical and horizontal lines; he/she fails to reproduce the oblique lines and/or fails to close the angles 3 points reproduces the form correctly, but does not locate it in the right place on the board 4 points good performance
Colored Block Design (CB)

Consists of a three-dimensional design of colored cubes on a card, and the actual blocks to build the design (DLM). Requires:
Test Booklet (page 22)

a. Examiner shows client a design of colored cubes and actual blocks. b. Examiner instructs client, Construct the design.

Some problems exhibited by clients with impaired ability to construct in 3D are parallel to those made on 2D construction and drawing tasks
simplification neglect of half of model misinterpreting the spatial relations between the cubes
Another common error is the tendency to build the pattern on the surface without relating to height and/or depth
CB Scoring
1 point unable to reproduce the design 2 points builds flat on the table, without height and depth, or partially flat 3 points builds with height only or depth only 4 points good performance
Plain Block Design (PB)

Consists of a three-dimensional design without color, using plain blocks (DLM). Requires:
Test Booklet (page 23)

a. Examiner shows client all the ten blocks and the corresponding design in the test booklet. b. Examiner asks: How many cubes are needed to build the design?
Now build it.

Some clients are able to perceive design correctly, but fail to build it due to spatial organization deficits Most clients fail to perceive the design initially, but the performance leads them to build it correctly.
PB Scoring
1 point unable to reproduce the design and does not count correctly 2 points builds what he sees but does not build invisible blocks 3 points does not count correctly but builds correctly or vice versa 4 points good performance
Reproduction of a Puzzle (RP)

Consists of a design of a colored butterfly, divided into nine squares and nine corresponding pieces. Requires:
Test booklet (page 24)

Examiner shows client a design of a colored butterfly and the corresponding nine pieces. Examiner then instructs client,
Construct the puzzle on the design.

Main difficulties arise from the symmetrical design
Symmetry enables clear expression of directional problems Many clients are able to construct correctly the middle of the design, but hesitate or fail to construct its sides
RP Scoring
1 point unable to perform 2 points only able to put in the three central vertical pieces 3 points performs with trial and error but achieves good performance 4 points good performance without trial and error
Drawing of a Clock (DC)

Requires: Test Booklet (page 25)
Used as master. Make copies for testing.
a. Examiner gives client a pencil and a drawing of a circle (page 25 of the test booklet).
b. Client is instructed, Fill in the numbers of the clock and put the hands of the clock at 10:15.

Exposes unilateral visual inattention problem
Clients have difficulties rounding out the left side of the clock and spacing the numbers properly
Meaningful difference between clients who make a primary organization of the clock and clients who start performing with any initial planning

Marking the hour at 10:15 gives additional information about:
the clients time orientation capacity to process numbers and number/time relationships
Clients with left hemisphere lesions involving aphasia and dysgraphia may have difficulties in writing numbers
DC Scoring
1 point unable to perform 2 points performs the general scheme, but the organization within it is not correct 3 points organizes the numbers of the clock correctly, but fails to mark the hour; or vice versa; marks the hour correctly, but the numbers are not placed exactly right 4 points good performance
Thinking Operations
Thinking
Not tied to specific neuroanatomical systems unlike other intellectual systems (Luria, 1966) Function of the entire brain (Gloring & Hoff, 1969)
Thinking Operations
Basic level of thinking operations process of conceptualization
Identify discrete features of objects Appreciate object hierarchically Classify objects into basic categories
Thinking Operations
More advanced level
Client deals with logical operations Demands apprehension of sequence
Thinking Operations
Two basic thinking operations (Piaget)
Classification Seriation
Thinking Operations
Three kinds of test for assessing thinking operations
Categorization tests
x Objects categorization x Forms classification
Sequential tests
x Pictorial sequence x Geometrical sequence
Logical questions using numbers
Thinking Operations
Brain damage
Reduces the level of performance of cognitive tasks Reduces the ability to process information that is needed for grouping things in relevant categories Limits the ability to organize the information required for planning acts
Subtests for Thinking Operations

Categorization (CA) Riska Object Classification (ROC)
ROC, Unstructured (RU) ROC, Structured (RS)
Pictorial Sequence (PS)

Pictorial Sequence A (PS1) Pictorial Sequence B (PS2)
Geometrical Sequence (GS) Logic Questions (LQ)
Categorization (CA)
a. Examiner spreads randomly on the table 14 cards with these representations:
boat, helicopter, airplane, bicycle, ship, train, car, hammer, scissors, needle, screwdriver, wheelbarrow, hoe, rake
b. Examiner gives the following instructions:

Sort the cards into groups. Name the groups.
Categorization (CA)
c. After client has done the first grouping, examiner asks:
Is there another possible way to sort them? Name the groups.
Categorization (CA)
Attention is paid to whether client:
Sorts according to what criterion Can formulate the criterion Follows criterion constantly
Client is expected to shift concepts and sort the objects according to another criterion. There are various levels at which the common features of objects can be abstracted
Categorization (CA)
Main problems exhibited:
Determining a criterion Preserving a criterion Shifting concepts Verbally conceptualizing Client may be able to sort into small groups, but unable to shift to larger groups (needs higher level of abstraction) May be able to generalize one group but fail to do it in the other one
CA Scoring
1 point unable to perform 2 points able to do partial grouping (either large groups or small groups) 3 points able to do both tasks, but shifts only with a cue, and/or is unable to complete the groupings 4 points able to perform, with or without a cue, but is unable to verbally conceptualize the criterion 5 points Good performance. Client can perform and verbalize the criterion. If client did not get max score due to language problems, examiner will add comment beside the score.
Riska Object Classification (ROC)

ROC test
Utilizes forms in addition to the categorization sub-test which consists of pictures of concrete objects. Open part which provides more alternatives for classifying and shifting between criteria Evaluation of the quality of the thinking process
Riska Object Classification (ROC)

Two parts
x Unstructured sub-test (RU) x Structured sub-test (RS)
Both tests together enable a more complete assessment of the classification ability.
ROC, Unstructured (RU)

Allows client to manipulate the objects in a variety of ways a. Makes use of 18 pieces in three colors (dark brown, light brown, and cream) and three shapes (arrow, oval, and quarter donut). b. All shapes are placed in a random fashion in front of client.
ROC, Unstructured (RU)

c. Examiner says, Put these objects into groups that are alike. d. After client finishes arranging the groups, he/she is asked, How are your groups alike? e. After client gives the criterion, examiner says, Now make different groups that are alike.
RU Scoring
Highest score of any of the various trials is given when client is able to perform and state the criteria (except in cases of aphasia).
RU Scoring
1 point Identification: i.e., exact matching (pairs of color and shape), and/or collections (e.g., uses pieces to make a picture like a house or flower) 2 points sorts according to one incomplete criterion (leaves some pieces out or mixes two criteria)
RU Scoring
3 points sorts according to one criterion with spatial arrangement (e.g., arranges the oval shapes in one line or row and the arrows underneath) 4 points sorts according to one criterion with random arrangement and is able to shift to another criterion (color and then shape, for example) 5 points sorts according to two criteria or more simultaneously (e.g., shape and color using more than two in a group)
ROC, Structured (RS)

Classification criteria are selected by examiner a. Makes use of same pieces as RU. b. Examiner makes a group in front of client: one dark brown arrow, one cream quarter donut, one light brown oval. c. Examiner says, I made this. Now you make as many groups as you can that are like mine.

d. If client is able to arrange all groups, examiner asks, How are your groups like mine? e. If client states the criterion of three different shapes and three different colors, the test is ended. f. If not, examiner says, Your groups are like mine in some ways, but not in others. Try to make them more like mine.

g. If a few of the groups are incomplete, examiner can give a cue by saying, Use all the pieces.
RS Scoring
1 point identifies, i.e., exact matching (pairs of color and shape), and/or collections (e.g., uses pieces to make a picture like a house or flower) 2 points sorts according to one incomplete criterion (leaves some pieces out or mixes two criteria) 3 points sorts according to one criterion
RS Scoring
4 points sorts according to two criteria simultaneously only on second trial, after examiner has offered a clue 5 points sorts according to two criteria simultaneously on first trial
Pictorial Sequence (PS) Telling the story enables examiner to evaluate clients ability to verbally organize sequentially ordered visual data
Pictorial Sequence A (PS1)

Requires: PS Cards A a. Client is given five cards representing a short story.
The cards are laid out in the following order:
5 2 4 1 3 b. Examiner then gives these instructions:

Arrange the pictures in the right sequence.
Tell the story.
Pictorial Sequence A (PS1)

There are clients who are able to tell the story correctly, but find it difficult to arrange the cards. Clients with severe dysfunctions will not understand that the cards are concerned with one special event, and therefore fail the task
PS1 Scoring
1 point unable to perform 2 points uses only some of the cards, but does not refer to the whole sequence 3 points able to tell the story, but is not able to arrange the cards correctly; or able to arrange the cards, but unable to tell the story 4 points good performance
Pictorial Sequence
Second sequence of six cards is given:
If client has score of 4 Aphasic clients arranged the cards but were not able to tell the story
Pictorial Sequence B (PS2)

Same instructions as PS1, only that pictorial sequence is presented in the following order: 5 1 4 2 6 3
PS2 Scoring
Same as PS1 Examiner will write in comments if client did not get the max score because of language problems If the score on PS1 is less than 4, PS2 should have no score
Geometrical Sequence (GS)

Paper and pencil test consisting of two geometrical sequences:
Sequence of 3 geometrical forms : client has to understand that forms appear in a constant order, and continue it accordingly Sequence of vertical and horizontal arrows : client has to understand two components of the sequence:
x change in arrows position (vertical or horizontal) x number of the arrows increases

Required: Test Booklet (pages 26 and 27)
Used as master. Make copies for testing.
a. Examiner gives client a pencil and the first geometrical sequence (page 26). b. Examiner says, In this line, the forms are drawn in a special order. Continue the sequence according to this order.

c. Repeat this procedure for the second sequence (page 27)
CORRECT RESPONSES: x First sequence: circle, square x Second sequence: 5 horizontal arrows, 5 vertical arrows

d. In the second sequence, if client did not understand the order of the sequence and therefore did not continue it in the right way (e.g. client starts from the beginning or relates only to one of the components), examiner should ask him/her, Is there another possible way to continue the sequence?

Clients with severe dysfunction are unable to understand the rule in each of the sequences More difficulties are often exhibited in the second sequence Other clients relate to only one of the two sequence components
GS Scoring
1 point unable to perform 2 points performs only the first sequence 3 points performs both sequences, but with trial and error 4 points good performance For the second sequence, client must show at least two more shapes (line sets) to be scored.
Logic Questions (LQ)

a. Examiner presents client with the page of questions and reads with him/her one question at a time. b. Client may solve the problems either verbally or in writing on the page according to his/her preference.

Questions:
John was born in 1930. In what year was John 35? Peter was born in 1950. How old is he now? Mary has 5 apples; Susan has 3 apples fewer than Mary. How many apples do both of them have in all? Nancy was born before Janet and after Sarah. Who is the oldest? Which one is the middle? Who is the oldest?

Clients with language deficits may show difficulties. LQ Scoring
1 point given for each correct response Minimal performance 1 point Maximal performance 4 points
Attention Span and Concentration Score is based on observation during assessment.
Attention Span and Concentration

Scoring
1 point Very short attention span
cannot concentrate for more than five minutes needs continued repetitions of instructions Stop the testing.
2 points able to pay attention for short periods

can concentrate for up to 15 minutes needs some repetitions of instructions Divide into 2 sessions.
Attention Span and Concentration

3 points shows slight difficulties in attention and concentration, but is able to go through the test by refocusing from time to time 4 points No attentional or concentration problems.
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Loewenstein Occupational Therapy Cognitive Assessment

Presented by: Ramon Alfredo S. Amores - UST OT Intern Batch 2012

Purpose: evaluating basic cognitive

abilities in brain injured cells

Provides a profile of the clients cognitive status

Six main areas

Rate appropriate level of attention and concentration based on observation

Three categorization tests =

Two orientation sub-tests =

Subtests for Orientation

1. Orientation for Place 2. Orientation for Time

Orientation for Place (OP)

Orientation for Place (OP)

Orientation for Place (OP)

Orientation for Place (OP)

Orientation for Time (OT)

Orientation for Time (OT)

Orientation for Time (OT)

Object Identification (OI)

Object Identification (OI)

Object Identification (OI)

Object Identification (OI)

Object Identification (OI)

Object Identification (OI)

Object Identification (OI)

Shape Identification (SI) Requires:

Shape Identification (SI)

Shape Identification (SI)

Shape Identification (SI)

Shape Identification (SI)

Shape Identification (SI)

Shape Identification (SI)

Overlapping Figures (OF)

Overlapping Figures (OF)

Overlapping Figures (OF)

Overlapping Figures (OF)

Overlapping Figures (OF)

b. Examiner asks client, What is drawn on the card?

Overlapping Figures (OF)

Object Constancy (OC)

Requires: Test Booklet (pages 11-19)

Object Constancy (OC)

Object Constancy (OC)

Object Constancy (OC)

Object Constancy (OC)

Subtests for Spatial Perception

Directions on Clients Body (SP1)

Spatial relations: Between client and objects near space (SP2)

Spatial relations: Represented on a picture (SP3)

Subtests for Motor Praxis

Motor Imitation (P1)

Motor Imitation (P1)

Utilization of Objects (P2)

b. Examiner says, Show me how you use these objects.

Symbolic Actions (P3)

Subtests for Visuomotor Organization

Copy Geometric Forms (GF) Requires:

Copy Geometric Forms (GF)

Copy Geometric Forms (GF)

Copy Geometric Forms (GF)

Copy Geometric Forms (GF)

Reproduction of a Two-Dimensional Model (TM)