Noomi Katz, Sarah Averbuch, Asnat Bar-Haim Erez; Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (DLOTCA–G): Assessing Change in Cognitive Performance. Am J Occup Ther 2012;66(3):311-319. doi: 10.5014/ajot.2012.002485.
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© 2018 American Occupational Therapy Association
OBJECTIVE. We studied the internal consistency reliability and construct validity of the new Dynamic Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (DLOTCA–G), a dynamic version of the Lowenstein Occupational Therapy Cognitive Assessment–Geriatric Version (LOTCA–G), and examined the properties of the mediation system.
METHOD. Participants included 61 clients hospitalized after stroke in three rehabilitation centers (mean age = 77.6 yr, standard deviation [SD] = 6.2) and 52 healthy control participants (mean age = 77.8 yr, SD = 6.4). All participants were assessed with the DLOTCA–G.
RESULTS. Internal consistency reliability showed moderate to high α coefficient levels in all domains (αs = .68–.85) except the Memory domain (α = .26). Both groups benefitted from mediation, but the stroke clients needed more concrete levels of mediation (Levels 3–5).
CONCLUSION. The addition of mediation to the LOTCA–G is effective in providing insights into clients’ cognitive status and learning potential. Our findings are similar to the results of the validation study for the DLOTCA for adults and support the use and benefits of the dynamic version.
Identify the cognitive abilities and disabilities of the person in the different domains.
Measure learning potential and change.
Recognize thinking strategies through the use of dynamic assessment.
Identify the person’s level of awareness of his or her condition and cognitive disabilities.
Level 1: General intervention—“Pay attention, don’t hurry….”
Level 2: General feedback—“Is that exactly the same?” “How many parts do you see?” “Where is the … ?”
Level 3: Specific feedback—The examiner points to the error: “You made a mistake here… . Try and correct it.”
Level 4: Structured category—The examiner gives cues through the use of key points.
Level 5: Copying or subtracting amount—The examiner performs the task and then asks the client to perform it, or the examiner reduces the number of stimuli (e.g., the number of cards in the categorization task) and then asks the client to complete the task. (Katz, Livni, et al., 2011, p. 16)
This form of valuation, in which clinicians explore how best to assist clients in improving their cognitive performance and learning, creates a link between evaluation and treatment. Practitioners can translate information about which level of mediation best assists a specific client into more effective treatment.
This study also highlighted the benefits of dynamic assessment for the healthy participants, who also improved their performance as a result of the mediation process. The static portion of the assessment indicated that a certain percentage of the healthy participants exhibited some cognitive decline; however, after mediation, the performance of almost all of them reached normal levels. This finding suggests that the use of appropriate approaches and strategies can enable older adults who exhibit normal declines resulting from aging to perform well.
Levy (2011) argued that the intervention strategies occupational therapists use are meant to help older adults better understand the changes they are undergoing and develop alternative strategies to manage the cognitive problems they experience that interfere with overall occupational performance, productivity, and quality of life. She called on practitioners to introduce specific intervention strategies to enable older adults to compensate for their increased problems, particularly those that interfere with the learning and retrieval of newly acquired information. Thus, practitioners need to include new methods of assessment like the DLOTCA–G that shed light on the type of treatment that can facilitate learning and improved performance.
We suggest that using dynamic assessments in evaluating older adults is essential to reveal their abilities and learning potential and provides practitioners with the optimal tools for intervention planning (Toglia, 2005; Toglia & Cermak, 2009).
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