Dynamic Lowenstein Occupational Therapy Cognitive Assessment
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Dynamic Lowenstein Occupational Therapy Cognitive Assessment

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Purpose

The Dynamic Lowenstein Occupational Therapy Cognitive Assessment (DLOTCA) is an occupational performance measurement battery designed to assess basic cognitive skills and visual perception in adults with neurological deficits.

Acronym DLOTCA

Area of Assessment

Cognition
Occupational Performance
Vision & Perception

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$399.00

Cost Description

The cost for the test kit and scoring forms for the DLOTCA is $399.00 and for the DLOTCA-G it is $420.00. They may be purchased from HOSPEQ Medical Equipment and Supplies at https://www.hospeq.com (cost determined January 2024)

CDE Status

Not a CDE—last searched 5/3/2023.

Populations

Stroke
Older Adults and Geriatric Care

Key Descriptions

  • The original LOTCA was designed to assess the cognitive performance of adults with neurological deficits and most psychometric studies have been conducted on this version of the test. It was updated to the LOTCA-II, and now has become the DLOTCA. There are versions for children (DLOTCA-Ch) and older adults (DLOTCA-G).
  • DLOTCA is a series of cognitive tests that allow the therapist to evaluate a patient's cognitive level to enable planning for intervention, management, and maintenance.
  • A further development of the original LOTCA, the dynamic components of the DLOTCA allow therapists to measure learning potential and thinking strategies through meditations. Additionally, this assessment can identify the level of awareness the patient has and cognitive disability.
  • DLOTCA consists 7 subtests: orientation, awareness, visual perception, spatial perception, praxis, visuomotor construction and thinking operations.
  • A dynamic component in the later 5 subtests uses mediation to measure learning potential and recognize thinking strategies. For the mediation component, the administrator provides systematic cues and graded task conditions as needed.
  • Administration notes are recorded including prompts required, attention, length of time required, and trial and error.
  • For visuomotor construction and thinking operations subtests, 2 minutes are allowed prior to initiating mediation.
  • Scoring consists of 3 components: both before and after mediation scores (scales vary, higher score is better performance) and mediation required (1=less mediation, 5=extensive mediation)
  • The geriatric version (DLOTCA-G) is used with clients age 70 and older and addresses physical and mental factors that accompany aging. It provides large components, reduced pictorial detail, multi-choice questions, and requires shorter time.

Number of Items

DLOTCA: 28 subtests; 7 cognitive domains: Orientation, Awareness, Visual Perceptions, Spatial Perception, Praxis, Visuomotor Construction, and Thinking Operations.

DLOTCA-G: 24 subtests; 8 cognitive domains which adds Memory to the 7 domains of the DLOTCA.

Equipment Required

  • 1 manual
  • 1 test booklet
  • 1 CD-ROM
  • 1 peg board
  • 1 jar with five blue pegs
  • 1 pencil
  • 10 plain wooden blocks
  • 1 package of green pegs
  • 1 white envelope
  • 1 photo booklet
  • 1 pair of scissors
  • 1 package of picture cards
  • 1 comb
  • 1 picture puzzle (9 pieces)
  • 1 package of plastic pieces in various sizes and shapes (22 pieces)
  • 1 score sheet

Time to Administer

1-2 hours

The DLOTCA takes approximately 1-2 hours to administer depending on the level of mediation required for the client’s best completion of each task.

Required Training

Reading an Article/Manual

Age Ranges

Adults (DLOTCA)

18 - 69

years

Elderly Adults (DLOTCA-G)

70 +

years

Instrument Reviewers

Reviewed by Amber Sheehan, OTR/L on 4/30/2017. Updated 4/5/2023 by Jessalyn Medina, Tenzin Pema, Mariela Saenz, and Isabella Rosas under the direction of Susan Magasi, PhD, FACRM, Professor and Head of Occupational Therapy, University of Illinois at Chicago.

ICF Domain

Activity

Measurement Domain

Cognition
Participation & Activities
Sensory

Professional Association Recommendation

AOTA Mental Health Special Interest Section

Considerations

Although the DLOTCA can be time-consuming to administer, it can be completed over multiple sessions.

The dynamic portion of the assessment can be helpful in the development of cognitive remediation interventions for the plan of care.

Dynamic testing, like the DLOTCA’s mediation component, has been shown in other assessments to be a better predictor of community reintegration than static testing.

DLOTCA is the most recent version of the test; however, it has been studied in stroke and geriatric populations (Katz et al., 2012a and Katz et al., 2012b).

Stroke

back to Populations

Normative Data

Acute Stroke: (Katz, N, Bar-Haim, E., Livni, L., & Averbuch, S. (2012b); n = 83 hospitalized following first stroke; Mean Age = 57.7(8.33); n = 45 healthy control participants; Mean Age = 62.7(9.22); no previous psychiatric or neurological conditions; score >24 for dementia on Mini Mental State Examination; DLOTCA version of test)

Domain (score range)

Healthy Participants Mean(SD)

Participants Post-Stroke Mean(SD)

Orientation (0–2)

1.98(0.05)

1.91(0.23)

Visual Perception (1–4)

3.96(0.10)

3.83(0.24)

Spatial Perception (0-1)

0.95(0.08)

0.91(0.13)

Praxis (0-2)

1.74(0.23)

1.83(0.17)

Visuomotor Construction (1-5)

4.21(0.76)

3.96(0.84)

Visuomotor Construction (time in seconds)

57.24(26.48)

77.26(31.35)

Thinking Operations (1-5)

3.85(0.71)

3.78(0.80)

Thinking Operations (time in seconds)

68.44(21.00)

81.81(31.78)

Interrater/Intrarater Reliability

Acute Stroke: (Katz et al., 2012b)

  • Excellent interrater reliability (ICC = 0.90-0.98)

Internal Consistency

Acute Stroke: (Katz et al., 2012b)

  • Poor internal consistency of spatial perception (Cronbach’s alpha = 0.665)
  • Poor internal consistency of praxis (Cronbach’s alpha = 0.665)
  • Excellent internal consistency of visuomotor construction (Cronbach’s alpha = 0.813)
  • Adequate internal consistency of thinking operations (Cronbach’s alpha = 0.737)
  • Poor internal consistency of visual perception (Cronbach’s alpha = 0.313)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Post-Right Hemisphere Stroke: (Katz, Hartman-Maeur, Ring, & Soroker, 2000; n = 40 participants post-right hemisphere stroke, all right hand dominant; 19 with neglect (Mean Age = 57.4(10.1) and 21 without neglect (Mean Age = 58.6(8.0) per Behavioral Inattention Test (cut off <129); original version of LOTCA)

  • Poor concurrent validity of orientation (r = 0.26), perception (r = 0.23), visuomotor (r = 0.26)  and thinking (r = 0.07) subtests with Functional Independence Measure (FIM) motor score for participants without neglect at admission to inpatient rehabilitation
  • Adequate concurrent validity of visuomotor (r = 0.54) and thinking (r = 0.37) subtests with FIM motor score for participants without neglect at discharge from inpatient rehabilitation
  • Poor concurrent validity (r = 0.26) of orientation subtest with FIM motor score for participants with neglect at admission to inpatient rehabilitation
  • Adequate concurrent validity of perception (r = 0.33), visuomotor (r = 0.48) and thinking (r = 0.49) subtests with FIM motor score for participants with neglect at admission to inpatient rehabilitation
  • Adequate concurrent validity of orientation (r = 0.42) and thinking (r = 0.41) subtests with FIM motor score for participants with neglect at discharge from inpatient rehabilitation
  • Excellent concurrent validity of perception (r = 0.75) and visuomotor (r = 0.66) subtests with FIM motor score for participants with neglect at discharge from inpatient rehabilitation

Construct Validity

Discriminant validity:

Acute Stroke: (Katz et al., 2012b)

  • Adequate discriminant validity (p > 0.05) for pre-mediation scores of participants post-stroke compared to controls. Of note, data was not provided for the awareness subtest. Further, pre-mediation scores of the timed subtests (visuomotor construction and thinking operations) did not discriminate between groups with statistical significance, however time required did.

Responsiveness

Acute Stroke: (Katz et al., 2012b)

  • Large effect size for visual perception subtest (d = 2.11)
  • Large effect size for spatial perception subtest (d = 1.52)
  • Moderate effect size for praxis subtest (d = 0.43)
  • Moderate effect size for visuomotor construction subtest (d = 0.70)
  • Moderate effect size for thinking operations subtest (d = 0.35)

Older Adults and Geriatric Care

back to Populations

Normative Data

Older Adults: (Katz et al., 2012a; n = 61 stroke victims from three rehabilitation centers (mean age = 77.6 (6.18) years, mean years of education = 10.11(4.66)) and n = 52 healthy volunteers as controls (mean age = 77.8 (6.36) years, mean years of education = 11.10 (3.86)); inclusion criteria = score of >24 on Mini-Mental State Exam (MMSE) and age = >69 years)

Performance on DLOTCA-G Domains Before and After Mediation, by Group

Domain

Healthy Participants Mean (SD)

Participants with Stroke Mean (SD)

Orientation  [0–2]

1.96 (0.14), n = 52

1.67 (0.58) , n = 61

Visual Perception 

(before mediation)  [1–4]

3.90 (0.22) , n = 52

3.60 (0.59) , n = 61

Visual Perception (after mediation)   [1–4]

3.79 (0.40) , n = 12

3.49 (0.75) , n = 33

Spatial Perception (before mediation) [0-1]

0.96 (0.11) , n = 52

0.85 (0.22) , n = 61

Spatial Perception (after mediation) [0-2] 

1.00 (0.00) , n = 10

0.77 (0.37) , n = 30

Praxis (before mediation)   [0–2] 

1.74 (0.17) , n = 52

1.48 (0.41) , n = 61

Praxis (after mediation)  [0–2]

1.74 (0.45) , n = 48

1.63 (0.43) , n = 55

Visuomotor Construction (before mediation) [1–5] 

4.08 (0.84) , n = 52

3.49 (1.10) , n = 61

Visuomotor Construction (after mediation) [1–5] 

4.19 (1.15) , n = 48

3.75 (1.20) , n = 59

Thinking Operations (before mediation) [1–5] 

4.07 (1.06) , n = 51

2.95 (1.27) , n = 60

Thinking Operations (after mediation) [1–5]

4.26 (1.15) , n = 29

3.73 (1.41) , n = 53

Memory [1–4] 

3.89 (0.24) , n = 51

3.67 (0.48) , n = 61

  

Internal Consistency

Older Adults: (Katz et al., 2012a); n = 61 stroke victims from three rehabilitation centers (mean age = 77.6 (6.18) years, mean years of education = 10.11(4.66)) and n = 52 healthy volunteers as controls (mean age = 77.8 (6.36) years, mean years of education = 11.10 (3.86))

  • Excellent for Spatial Perception (α = .85)
  • Adequate for Praxis (α = .79)
  • Excellent for Visuomotor Construction (α = .83)
  • Poor for Thinking Operations (α = .68)
  • Adequate for Visual Perception (α = .71)
  • Poor for Memory (α = .26)

Construct Validity

Discriminant validity:

Older Adults: (Katz et al., 2012a; n = 61 stroke victims from three rehabilitation centers (mean age = 77.6 (6.18) years, mean years of education = 10.11(4.66)) and n = 52 healthy volunteers as controls (mean age = 77.8 (6.36) years, mean years of education = 11.10 (3.86))

  • Significantly better performance for healthy group compared to stroke group for all domains prior to mediation (t = 3.24 to 4.98, p < .01)
  • Healthy subjects performed better, needing less remediation and having shorter performance times.
  • Quartile data showed that healthy participants received maximum scores at the 50% quartile, while participants with stroke received maximum scores at the 75% quartile.

Responsiveness

Older Adults: (Katz et al., 2012a; n = 61 stroke victims from three rehabilitation centers (mean age = 77.6 (6.18) years, mean years of education = 10.11(4.66)) and n = 52 healthy volunteers as controls (mean age = 77.8 (6.36) years, mean years of education = 11.10 (3.86))

  • Significant improvement in scores following remediation for subjects with stroke for Praxis (t = 3.61, p < .001)
    • Moderate effect size for Praxis (d = 0.51)
  • Significant improvement in scores following remediation for subjects with stroke for Visuomotor Construction (t = 2.58, p < .05)
    • Moderate effect size for Visuomotor Construction (d = 0.23)
  • Significant improvement in scores following remediation for subjects with stroke for Thinking Operations (t = 7.06, p < .001)
    • Moderate effect size for Thinking Operations (d = 0.55)
  • Significant improvement in scores following remediation for healthy control subjects for Spatial Perception (t = 3.45, p < .05)
    • Large effect size for Spatial Perception (d = 1.58)
  • Significant improvement in scores following remediation for healthy control subjects for Thinking Operations (t = 4.54, p < .001)
    • Large effect size for Thinking Operations (d = 0.80)

Bibliography

Katz, N., Averbuch, S., & Bar-Haim Erez, A. (2012a). Dynamic Lowenstein Occupational Therapy Cognitive Assessment-Geriatric Version (DLOTCA-G): assessing change in cognitive performance. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 66(3), 311–319. https://doi.org/10.5014/ajot.2012.002485

Katz, N. Bar-Haim, A., Livni, L., & Averbuch, S. (2012b). Dynamic Lowenstein Occupational Therapy Cognitive Assessment: Evaluation of potential to change in cognitive performance. American Journal of Occupational Therapy, 66, 207-214. doi: 10.5014/ajot.2012.002469

Katz, N., Hartman-Maeur, A., Ring, H., Soroker, N. (2000). Relationships of cognitive performance and daily function of clients following right hemisphere stroke: Predictive and ecological validity of the LOTCA battery. OTJR: Occupation, Participation and Health, 20, 3-17.

Katz, N., Itzkovich, M., Averbuch, S., & Elazar, B. (1989). Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for brain-injured patients: Reliability and validity. American Journal of Occupational Therapy, 43, 184-192.

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