Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for brain-injured patients: reliability and validity.

The purpose of this study was to determine the reliability and validity of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery. The battery provides an initial profile of the cognitive abilities of the brain-injured patient that can be used as a starting point for occupational therapy intervention and as a screening test for further assessment. The LOTCA consists of 20 subtests and is divided into four areas: orientation, visual and spatial perception, visuomotor organization, and thinking operations. The battery takes 30 to 45 minutes to administer. Subjects in the study consisted of two patient groups (20 traumatic head injury patients and 28 cerebrovascular accident patients) and one control group (55 non-brain-injured adults). Results showed interrater reliability coefficients of .82 to .97 for the various subtests and an alpha coefficient of .85 and above for the internal consistency of the areas of perception, visuomotor organization, and thinking operations. The Wilcoxon two-sample test showed that all subtests differentiated at the .0001 level of significance between the patient groups and the control group. This supported the LOTCA's validity. Furthermore, factor analysis provided initial construct validation for three areas of the battery: perception, visuomotor organization, and thinking operations.

Criteria for referral of CVA patients for rehabilitation.

A multi-stage follow-up project is in progress at the Loewenstein Rehabilitation Hospital. In the first stage, a group of 153 patients was examined while in the acute phase of CVA (1 to 5 days from stroke), and again 6 months later, by a physician, a physiotherapist and an occupational therapist. Medical, demographical and functional profiles were determined. The most severe cases were admitted for rehabilitation and those with apparently good functioning ability were discharged to their homes. Six months later, the group referred for rehabilitation remained at a very low functional level (35% of them were still at the rehabilitation hospital); on the other hand, those sent home were lacking in general function (37%), in spite of their good ADL and hand performance. Most strikingly, 72% were not engaged in any meaningful activity. Age proved to be a strongly limiting factor. A more selective criterion for referral is required, while allowing patients with medium-grade cognitive and locomotor disturbances the chance of admission to rehabilitation.