Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)

Purpose of the measure

The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) is a cognitive battery that measures basic cognitive skills required for everyday function including orientation, visual perceptual and psychomotor abilities, problem-solving skills and thinking operations. Development of the battery was based on information from clinical experience and neuropsychological and developmental theories. The LOTCA is typically used in the initial phase of patient assessment but can also be used to establish therapeutic goals and to review cognitive status over time (Annes, Katz & Cermak, 1996; Zwecker et al., 2002).

Available versions

The original LOTCA was developed by Itzkovich, Averbuch, Elazar and Katz for use with individuals below the age of 70 years with neurological dysfunction and consisted of a total of 20 items within 4 areas: Orientation (2 items); Perception (6 items); Visuomotor Organization (7 items); and Thinking Operations (5 items).

The LOTCA-II was modified by separating the Perceptual area into three separate areas (Visual Perception, Spatial Perception and Motor Praxis), revising items and including an additional Thinking Operations subtest. The LOTCA-II consists of a total of 26 subtests 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).

The LOTCA-II includes multi-choice questions in the Orientation area to accommodate language difficulties. The manual has been updated to provide more accurate assessment and administration guidelines (Su, Lin, Chen-Sea & Yang, 2007).

Features of the measure

Description of Tasks:
The original LOTCA contains 20 subtests in 4 areas. The LOTCA-II contains 26 subtests in 6 areas:

    • Orientation (2 subtests): Assesses the individual’s orientation to place and time.
    • Visual Perception (4 subtests): Assesses the individual’s 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 subtests): Assesses the individual’s ability to differentiate between right and left to determine spatial relationships between objects and self.
    • Motor Praxis (3 subtests): Asesses the individual’s ability to imitate motor actions, use objects and perform symbolic actions.
    • Visuomotor Organization (7 subtests): Assesses the individual’s ability to copy geometric figures, reproduce a 2D model, copy a coloured block design and a plain block design, reproduce a puzzle and complete a pegboard task, and draw a clock.
    • Thinking Operations (7 subtests): Assesses the individual’s ability to complete tasks including sorting, categorization, and picture and geometric sequences (Annes et al., 1996).

Scoring and Score Interpretation:
Most subtests of the LOTCA are scored from 1 to 4, where:

  • 1 = Patient fails to perform the task
  • 2 = Patient is able to perform part of the task
  • 3 = Patient is able to perform most of the task
  • 4 = Patient demonstrates good performance of the task

However, three Thinking Operations subtests (Categorisation, Risk Object Classification – ROC – Unstructured, ROC Structured subtests) are scored on a scale from 1 to 5 (Josman, Abdallah & Engel-Yegar, 2010; Zwecker et al., 2002).

Most subtests of the LOTCA-II are also scored from 1 to 4 using the scale above. However, Orientation subtests are scored on a scale from 1 to 8 and three Thinking Operations subtests (Categorization, ROC Unstructured, ROC Structured) are scored on a scale from 1 to 5. Accordingly, the overall LOTCA-II score ranges from 26 to 115 points. Task completion through trial-and-error is penalized in three subtests. Performance elements such as the number of prompts provided to the individual to assist him/her in completing the task, the individual’s attention/concentration and length of time taken to complete the assessment are also recorded.

Results are provided as a profile for each subtest, where higher scores indicate less cognitive impairment (Su et al., 2000). While summation of subtest scores is accepted, the authors warn that analysis of a total score impacts on the ability to identify the individual’s aptitude for each cognitive area (Katz, Itzkovich & Averbuch, 2002).

LOTCA scores were normed on an Israeli population of adults aged 20 – 70 years (Annes et al., 1996), and have since been deemed suitable for use with the US population (Annes et al., 1996; Cermak, Katz, McGuire, Greenbaum, Peralta & Maser-Flanagan, 1995; Katz et al., 1997). Age-related change in scores is not accounted for, as score norms are provided for one group of all individuals aged 20 – 70 years.

The LOTCA and LOTCA-II take approximately 45 minutes to administer, with a reported range from 30 to 90 minutes (Annes et al., 1996; Zwecker et al., 2002).

The LOTCA kit contains testing materials (card decks, coloured blocks, pegboard set and other materials) and a manual that includes definitions of the cognitive domains assessed, instructions for administration and specific scoring guidelines.

Alternative forms of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)

The LOTCA Geriatric version (LOTCA-G) is a modified version of the original LOTCA that was designed for use with individuals aged 70 – 91 years. The LOTCA-G was developed in response to difficulties that elderly patients experienced using the LOTCA (e.g. difficulty seeing and using small materials, and duration of assessment). Accordingly, it contains modifications to allow for age-related cognitive decline and sensorimotor difficulties including larger materials to compensate for visual and motor deficits, less visual detail, shorter subtests, multiple-choice questions, and additional memory tests not included in the original LOTCA (Cooke et al., 2006a, b; Bar-Haim Erez & Katz, 2003).

The LOTCA-G includes 23 subtests in 7 cognitive areas:

  • Orientation (2 subtests): Orientation to place; and orientation to time
  • Visual Perception (4 subtests): Object identification; shape identification; overlapping figures; and object consistency
  • Spatial Perception (3 subtests): On self; on examiner; and self and surroundings
  • Praxis (3 subtests): Motor imitation; utilization of objects; and symbolic actions
  • Visuomotor Organization (6 subtests): Copy geometric forms; two-dimension model pegboard construction; block design (colour); reproducation of a puzzle; and drawing a clock
  • Thinking Operations (2 subtests): Categorization; and pictorial sequencing
  • Memory (3 subtests): Famous personality; personal possession; and everyday objects

The Orientation subtests are scored from 1 – 8 while all other subtests of the LOTCA-G are scored on an ordinal scale from 1 to 4, where 1 indicates severe deficit and 4 indicates average performance. The LOTCA-G takes approximately 30-45 minutes to administer (Bar-Haim Erez & Katz, 2003, Cermak, et al., 1995). It is available in English and Hebrew.

Client suitability

Can be used with:

  • Patients following stroke (Bar-Haim Erez & Katz, 2003)
  • Older individuals with dementia (Bar-Haim Erez & Katz, 2003)
  • Individuals with traumatic brain injury (Annes et al., 1996)
  • Individuals with CNS dysfunction (Annes et al., 1996)
  • Individuals with intellectual disabilities (Jang, Chern & Lin, 2009)
  • Individuals with mental illness (Jang et al., 2009; Josman & Katz, 2006)
  • An adapted version has also been developed for use with children with learning difficulties (Josman et al., 2010)
  • Patients with aphasia – procedures for assessing the patient with aphasia are included (Jang et al., 2009).

Should not be used in:

  • An individual’s culture can affect the construct validity of the LOTCA when used with a pediatric population (Josman et al., 2010)
In what languages is the measure available?
  • English
  • Spanish
  • Hebrew
  • Chinese (Mandarin)
  • Taiwanese
  • Iranian