Dynamic Loewenstein Occupational Therapy Cognitive Assessment

Authors: Katz, N., Livni, L., Erez, A.B.N., & Averbuch, S. 

Year of Publication: 2011 (original LOTCA 1996)

Publisher: Maddok

Type of Assessments: 

• Standardized

• Norm-referenced

• Performance-based

Cost: $399.00

How to Access: https://www.hospeq.com 

Age: Adults (18-69)

Diagnoses: Alzheimer's, Progressive Dementia, Stroke, TBI, CVA, Non-specific populations at risk of cognitive decline

Setting: Acute care & rehab, outpatient neuro-rehab, SNFs, memory care units, home health, inpatient rehab

Areas Assessed:

• Orientation

• Awareness

• Visual Perception

• Spatial Perception

• Praxis

• Visuomotor Construction

• Thinking Operations

Time: 45 mins - 1.5 hrs (depends on mediation needed) - can be administered in more than one session if needed.

Group/Individual: Individual 

Subtests: 28 subtests within 7 cognitive areas  

Instructions: At the beginning of the session, the examiner should tell the client: "In our meeting, I'll ask you questions and also ask you to do things. Some of them are easy, and others are more difficult. Please answer or do what you know. If you have difficulties, I will help you."

• Should only offer help as it falls within the means of mediation and not during the initial structured phase.

• Read instructions exactly as they are written in the manual to abide by standardized processes

• Administration notes are recorded - prompts required, attention, length of time required, & trial and error

• Structured (Static) Phase:

  • Performance should be observed and scored without prompting or assistance

• Dynamic (Mediated) Phase:

  • On tasks that the client presents difficulty with during the static phase will be redone through mediation where a graded cueing system is utilized to include general encouragement and focusing attention.

  • The amount of mediation needed is required as well as the client's responsiveness

• This will be repeated through all seven subtests

Materials: 

• Battery kit

• Stopwatch/watch

• Pencil & eraser

• Jar for pegs with 5 pegs

• White A4 paper

• 2 copies of geometric sequence A

• 3 copies of geometric sequence B

• 4 copies of the clock page

• Envelope with folded paper inside

• Scoring sheet

User Qualifications: Ability to interpret results and possess sound clinical judgment

How to Score: Each of the seven cognitive domains is assessed through structured subtests. 

• Each subtest has a predetermined scoring system (usually from 1 to 4 or 1 to 5) which reflects the person’s baseline performance without cues

  • 1 = Severe impairment or cannot perform

  • 2 = Moderate difficulty

  • 3 = Mild difficulty

  • 4 = Normal or independent performance

• After the initial attempt (structured score), the examiner provides graded cues or mediation to assess the client's learning potential and cognitive modifiability

  • The mediation is scored based on how much assistance was needed:

    • Minimal → Moderate → Maximal

  • Or coded from 1 (low responsiveness) to 5 (high responsiveness)

• No total scores are identified

Score Indications: Higher structured scores indicate greater cognitive ability and performance. Dynamic scores indicate the level of assistance needed to complete tasks, with lower scores indicating minimal assistance while higher scores indicate maximal assistance needed. Areas of strengths & limitations are identified.

Reliability: 

• Interrater: High - r=0.98

• Internal Consistency: High - Cronbach's = .602-.813 (except for Visual Perception = .313

Validity: 

• Criterion: r =.68-.78

Strengths:

• Modifications for elderly client's accounts for age-related cognitive decline and sensorimotor difficulties

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

• Static & dynamic scores provide a holistic view of what a person can do now and how much they can improve with guidance

• Covers multiple cognitive domains to be applicable to many conditions that experience cognitive deficits

• Versions have 

Weaknesses:

• Time-consuming which can be daunting and frustrating for clients with cognitive deficits

• Not applicable to children and adolescents

• Very costly

• Shirley Ryan Ability Lab. (2024, January 14). Dynamic Lowenstein occupational therapy cognitive assessment. https://www.sralab.org/rehabilitation-measures/dynamic-lowenstein-occupational-therapy-cognitive-assessment 

• Katz, N., Erez, A.B., Livni, L., & Averbuch, S. (2012). Dynamic Lowenstein occupational therapy cognitive assessment: Evaluation of potential to change in cognitive performance. The American Journal of Occupational Therapy, 66(2), 207-214. https://doi.org/10.5014/ajot.2012.002469 

• Katz, N., Erez, A.B., Livni, L., & Averbuch, S. (2011). Dynamic Lowenstein Occupational Therapy Cognitive Assessment (DLOTCA). Pequannock, NJ: Maddak Inc.

• Asher, I. E. (2014). Asher’s occupational therapy assessment tools: An annotated index (4th ed.). AOTA Press.