Loewenstein Occupational Therapy Cognitive Assessment

Presented by: Ramon Alfredo S. Amores - UST OT Intern Batch 2012

Brief Background
‡ Developed by staff members of the OT Department at Loewenstein Rehabilitation Hospital (LRH) in Israel

‡ Purpose: evaluating basic cognitive

abilities in brain injured cells
‡ Basic cognitive functions are thought to be prerequisite for managing every day encounters with the environment.

History
‡ 1973 ± Israeli soldiers with head injuries admitted to LRH; led to development of LOTCA ‡ 1990 ± LOTCA Battery first published ‡ 2000 ± Second edition released

Provides a profile of the client·s cognitive status ‡ Useful for: Establishing a baseline for treatment Planning treatment goals Monitoring changes during treatment .

Six main areas Orientation Visual Perception Spatial Perception Motor Praxis Visuomotor Organization Thinking Operations ‡ Also contains 26 sub-tests .

TBI. CVA..g. underachieving students) ..‡ Originally for clients with brain damage (e. degenerative and psych dse. brain tumors) ‡ Suitable for assessment in other populations where cognitive status has to be established (e. SCI.g.

Administration ‡ 3o to 45 minutes ‡ Can be divided into 2-3 sessions or lesser time if necessary ‡ Procedures for assessing aphasic clients are incorporated .

spatial perception and praxis subtests .Administration ‡ Scoring sheet ± provides profile of client¶s performance ‡ No additional cues should be given for any subtest ‡ READ carefully BEFORE administration ‡ Side-by-Side ± most sub-tests ‡ Face-to-face .

Administration ‡ Examiner should be alert for client¶s motor slowing or restlessness and continue the assessment at a later time .

Administration ‡ At the end of the assessment ± Indicate length of time taken Indicate if additional sessions are needed ‡ Rate appropriate level of attention and concentration based on observation .

Scoring ‡ Most tests = 1 (low) to 4 (high) ‡ Three categorization tests = 1 to 5 ‡ Two orientation sub-tests = 1 to 8 .

TESTS Orientation Visual Perception Spatial Perception Motor Praxis Visuomotor Organization Thinking Operations Attention Span and Concentration .

Orientation ‡ Awareness of self in relation to one¶s surroundings ‡ Requires consistent and reliable integration of attention. perception and memory .

Orientation ‡ Deficits are among the most frequent symptoms of brain diseases ‡ Impaired awareness of time and place Most common Accompanies every brain disorder in which attention or retention is affected .

Orientation ‡ Impaired orientation ± strongly suggestive of cerebral dysfunction ‡ Good orientation ± not evidence of cognitive or attentional competence .

‡ If client¶s comprehension is good and he/she has only expressive difficulties. he/she may respond with ³yes´ or ³no´ to multiple choices provided by examiner.Orientation ‡ Test items are impossible to administer if client has comprehension difficulties (e. receptive aphasia). .g.

Orientation for Place 2.Subtests for Orientation 1. Orientation for Time .

the name of the hospital and name of city in which it is located) Where are you now? What city are we now? . Client is asked where he/she is now (i.e.Orientation for Place (OP) a..

examiner will ask client to name the hospital). Where do you live? What is your exact address? Where were you before you came here? . if client has been hospitalized in another hospital.g. Client is asked where does he/she live (the full address) and where he/she was before arriving at this place (e.Orientation for Place (OP) b.

asking client to choose the correct answer. . examiner will use multiple questions. If client is unable to answer the questions (because of memory problems or aphasia).Orientation for Place (OP) c.

.Orientation for Place (OP) ‡ Questions for multiple choice for clients with language or memory disorders: Examiner will provide three options for recognition One of the options should be the correct answer.

OP Scoring ‡ 2 points for every correct answer ‡ 1 point only if answer was given by way of multiple choice .

OP Scoring Minimal performance Maximal performance 1 point No correct answer 1 correct answer by multiple choice 8 points Answered correctly all questions without the need for multiple choice .

Orientation for Time (OT) a. Client is asked for the full date. What day is today? What month? What year? What season is it now? .

Orientation for Time (OT) b.Client is then asked to estimate the time (without looking at the watch). What is the hour now? .

Orientation for Time (OT) c. He/she is also asked how long he/she is hospitalized. How long have you been hospitalized? .

In case client is an out-patient. or for how long he/she has been ill.Orientation for Time (OT) d. or has had difficulties. he/she will be asked when he/she was injured. How long have you been ill? How long have you had difficulties? .

.Orientation for Time (OT) ‡ Questions for multiple choice for clients with language or memory disorders: Examiner will provide three options for recognition One of the options should be the correct answer.

OT Scoring ‡ 2 points for every correct answer ‡ 1 point only if answer was given by way of multiple choice .

OT Scoring Minimal performance Maximal performance 1 point No correct answer 1 correct answer by multiple choice 8 points Answered correctly all questions without the need for multiple choice .

. OP improves before OT.‡ Total disorientation for place and time indicates a confusioned state. ‡ Generally.

distinguishing the essential features of an object. . creating appropriate hypotheses. and then comparing these hypotheses with the original data.Visual Perception ‡ Active process of: searching for the corresponding information. comparing the features with each other.

and recognition of spatial relations. distinction of overlapping figures. .Visual Perception ‡ Perceptual abilities tested range from the identification of clear pictures of objects to identification of objects photographed from unusual angles.

Subtests for Visual Perception ‡ Object Identification (OI) ‡ Shape Identification (SI) ‡ Overlapping Figures (OF) ‡ Object Constancy (OC) .

Object Identification (OI) ‡Requires: OI Cards Test Booklet (pages 1-4) .

Client is shown cards of 8 everyday objects: ‡ chair.Object Identification (OI) a. key. teapot. scissors. watch. . and glasses. bicycle. shoe.

Follow the card sequence given above. Client is asked to name each object. Numbers on the back of cards are not to be used as sequence numbers. .Object Identification (OI) b.

. This procedure is used for each of the eight objects. ³Where is the chair?´. Client is asked to point to the objects named by the examiner. ³Where is the watch?´. Examiner asks.Object Identification (OI) c. etc. If client has expressive problems and is not able to name objects: The first two boards of the test booklet is shown.

Object Identification (OI) d. Examiner shows one by one and asks. ³Where is this?´ Client has to point to the similar object on the board. If client has receptive problems: Examiner shows client the eight cards which are similar to pictures on the first two pages of the booklet. .

Object Identification (OI) e. . ³Where is this?´ Client has to do exact matching. Examiner asks. If client is unable to identify similar objects: Examiner presents the next two boards in the test booklet which are identical to the ones on the cards.

. ‡ For further and more detailed examination.Object Identification (OI) ‡ Clients unable to recognize the objects most probably suffer from visual agnosia. At which point. examination will stop. examiner should present client concrete objects for identification.

OI Scoring ‡ 1 point ± <4 objects by exact matching ‡ 2 points ± 5-8 objects by exact matching ‡ 3 points ± 4-7 objects by naming. . understanding or similar matching. or similar matching ‡ 4 points ± 8 objects by naming. understanding.

Shape Identification (SI) ‡ Requires: SI Cards Test Booklet (pages 5-8) .

semi-circle. trapezoid.Shape Identification (SI) a. and hexagon. triangle. circle. . diamond. Client is shown 8 shapes illustrated on separate cards: square. rectangle.

examiner asks client. Follow the card sequence given above. ³What is the name of this shape?´ Numbers on the back of cards are not to be used as sequence numbers. On each card. .Shape Identification (SI) b.

Shape Identification (SI) c. If client is unable to name the shapes because of expressive problems: Examiner asks client to point to the target shape on the boards in the test booklet. x ³Show me the circle´ etc. .

If client has receptive problems and is unable to identify the shapes by understanding: Examiner shows him/her the eight cards of similar shapes. Client is asked to point out the similar shape on the board.Shape Identification (SI) d. .

Client is asked to point to the target shape on the board. x Examiner will show the cards in the exact spatial orientation as on the board. . If client is unable to identify the shapes by similar matching: Client is shown the eight cards with the exact shapes as on the boards.Shape Identification (SI) e.

‡ Have difficulties identifying the more complex ones. clients have no problem identifying the simple shapes.Shape Identification (SI) ‡ Usually. .

.SI Scoring ‡ 1 point ± < 4 shapes by exact matching ‡ 2 points ± 5-8 shapes by exact matching ‡ 3 points ± 4-7 shapes by naming. pointing or similar matching ‡ 4 points ± 8 shapes by naming. pointing. or similar matching.

.Overlapping Figures (OF) ‡ Simplified version of the Poppielreuter (1917) Overlapping Figures Test ‡ Also used by Christensen (1975) in her systematization of Luria¶s examination methods.

‡ Client has to analyze the figure/ground relationship in order to distinguish the figure from the interfering elements.Overlapping Figures (OF) ‡ Designed to assist in the determination of deficits in visual perception on a more complex level. .

. ‡ Less severe clients are able to identify only part of the objects.Overlapping Figures (OF) ‡ Clients with severe dysfunction may misinterpret the information on the card and combine it to one wrong form.

Overlapping Figures (OF) ‡Requires: OF Cards Test Booklet (pages 9-10) .

saw b. Examiner shows client two cards with three overlapping objects on each: Card 1: banana. hoe. apple Card 2: pliers. Examiner asks client. ³What is drawn on the card?´ . pear.Overlapping Figures (OF) a.

.´ Repeat procedure for the second card.Overlapping Figures (OF) ‡ If client has difficulties in identifying the figures: Examiner shows client a board with the six separate figures. ³Point to the objects that you see in the card. Client is then instructed.

OF Scoring ‡ 1 point ± o figures identified or < 3 with board ‡ 2 points ± 3 figures with board ‡ 3 points ± 4 figures without board or all figures with board ‡ 4 points ± all figures with board .

‡ Requires: Test Booklet (pages 11-19) .Object Constancy (OC) ‡ Photographs used are taken from angles that do not emphasize the most characteristic features of the objects.

hammer. Client is shown four photographs of objects taken from unusual angles: car. and fork. b.Object Constancy (OC) a. client is asked. telephone. ³What do you see in the photograph?´ . For each of the photographs.

g. If client has language disabilities (e. and only in that case: Examiner should use the multiple-choice boards.´ .Object Constancy (OC) c. aphasia). Examiner asks client. ³Point to the small photograph in which you see the same object as in the big photograph.

Object Constancy (OC)
d. There is only one correct answer for each object.

Object Constancy (OC)
‡ Clients have difficulties in recognizing all or parts of the four photographs according to the severity of the brain damage.

OC Scoring
‡ 1 point ± 0-1 objects identified ‡ 2 points ± 2 objects identified ‡ 3 points ± 3 objects identified ‡ 4 points ± 4 objects identified

Spatial Perception ‡ Difficulty in right-left discrimination incapacity to apply this distinction to symmetrical parts of the body disorder of spatial orientation related to own body or a confronting person .

Spatial Perception ‡ Visual spatial agnosia Deficit in perceiving spatial relationships between objects or between objects and self Difficulties in spatial relations on the own body Difficulties in judging distances and in depth perception .

. ‡ Client who exhibits difficulties in this part of the battery will most probably demonstrate further difficulties in the following parts.Spatial Perception ‡ Perceptual functions are the most basic of cognitive abilities.

etc. .Spatial Perception ‡ Perception disabilities influence clients¶ functioning in everyday life.g. Spatial perception problems ± disabilities in ADL. ambulation.: Severe perception d/o (visual agnosia) ± problems in all areas of everyday life Figure ground discrimination problems ± fail to find a desired object among several others. e. including dressing.

Spatial Perception ‡ More common in right hemisphere lesions ‡ Frontal lobe lesions ± poor perception secondary to: Motivation Initiation Integration ‡ Face to face .

Subtests for Spatial Perception ‡ Directions on Client¶s Body (SP1) ‡ Spatial relations: Between client and objects near space (SP2) ‡ Spatial relations: Represented on a picture (SP3) .

Directions on Client·s Body (SP1) a.´ ³Show me your left leg. Examiner asks client: ³Show me your right hand. b.´ ³Put your right hand on your left ear.´ .´ ³Put your left hand on your right leg. Examiner can change what is left to right according to client¶s physical problems.

SP1 Scoring ‡ 1 point ± given for every correct response ‡ Minimal performance ± 1 point ‡ Maximal performance ± 4 points .

back) in the room. Examiner asks client: ³On which side of you is (for example) the door?´ ³On which side of you is (for example) the window?´ ³On which side of you is (for example) I am sitting?´ ³On which side of you is« (for example.)´ . any clear object in the room.Spatial relations: Between client and objects near space (SP2) a. Examiner points to four different objects in four different directions (left. right. front. b.

SP2 Scoring ‡ 1 point ± given for every correct response ‡ Minimal performance ± 1 point ‡ Maximal performance ± 4 points .

b. Examiner shows client the picture of a man sitting in front of a table.Spatial relations: Represented on a picture (SP3) a. Examiner asks client: ³What is in front of the man?´ ³What is on the left side of the man?´ ³On what side of the man is the computer?´ ³What is behind the man?´ .

SP3 Scoring ‡ 1 point ± given for every correct response ‡ Minimal performance ± 1 point ‡ Maximal performance ± 4 points .

Motor Praxis ‡ Apraxia disturbance of purposeful expressive functions breakdown of motor integration and executive functions integral to the performance of complex learned acts Confusing terminology with the use of ideometer. ideational and idiokinetic apraxia in different ways Test will use the term in a descriptive way (Lezak. 1983) .

Motor Praxis ‡ Praxis motor planning ability to execute motor functions .

Subtests for Motor Praxis ‡ Motor Imitation (P1) ‡ Utilization of Objects (P2) ‡ Symbolic Actions (P3) .

³Imitate my movements as if you were looking in a mirror. If client does not understand. examiner shows him/her and says: ³When I move my left arm.´ . Examiner instructs client.Motor Imitation (P1) a. b. you make the same movement with your right arm. Client and examiner sit face-to-face.´ c.

The Movements ± Grasping the ear lobe on the same side with thumb and forefinger. The dorsal aspect of the hand is placed on the opposite cheek with fingers in extension. .Motor Imitation (P1) d. The thumb opposes the middle and then the ring finger ± examiner repeats these movements three times. Sequential movement: the palm of the hand is placed behind the neck and then on the opposite shoulder.

P1 Scoring ‡ 1 point ± given for every correct response ‡ Minimal performance ± 1 point ‡ Maximal performance ± 4 points .

´ c.´ . ³Show me how you use these objects. Examiner says. ³Draw a line on the paper. and then erase it. Examiner shows client the following objects. For the use of a pencil and an eraser. examiner says. each at a time: x x x x a comb scissors and a paper an envelope and a paper a pencil and an eraser b.Utilization of Objects (P2) a.

P2 Scoring ‡ 1 point ± given for every correct response ‡ Minimal performance ± 1 point ‡ Maximal performance ± 4 points .

from lifting the receiving.´ x Examiner will ask client to show the whole action. ‡ ³How do you open a door with a key?´ ‡ ³How do you cut a loaf of bread with a knife?´ ‡ ³How do you use a telephone?´ Examiner will ask client to show the whole action. bringing it to the mouth and brushing. . from putting the tooth paste on the brush. and bringing the receiver to the ear.Symbolic Actions (P3) ‡ Examiner asks client: ³Show me how you brush your teeth. dialing.

. not right/left discrimination).P3 Scoring ‡ 1 point ± given for every correct response ‡ Minimal performance ± 1 point ‡ Maximal performance ± 4 points ‡ Full score can be given for mirroring and contralateral imitation. (Sub-test is for measuring praxis.

. 1983).Visuomotor Organization ‡ Embraces three large classes of activities: Copying Drawing Building or assembling ‡ Variability in the tendency of problems in these classes to occur together makes it important to evaluate these activities together (Lezak.

Visuomotor Organization ‡ Combines perceptual activity with motor response and always has a spatial component ‡ Damage to either left or right brain hemisphere may cause difficulties in constructional performance. .

and in general turn out a shabby production . but tend to lose details.Visuomotor Organization ‡ Right hemisphere damage ± piecemeal. fragmented approach. losing the overall gestalt of the construction task ‡ Left-sided lesions ± may get overall idea.

simplify.Visuomotor Organization ‡ Frontal lobe syndrome ± tend to fragment. and usually need support in order to perform the construction ‡ Difficulties are usually expressed in ADL tasks as well as in the performance of complicated activities of any kind .

.Subtests for Visuomotor Organization ‡ Copy Geometric Forms (GF) ‡ Reproduction of a Two-Dimensional Model (TM) ‡ ‡ ‡ ‡ ‡ ‡ Pegboard Construction (PC) Colored Block Design (CB) Plain Block Design (PB) Reproduction of a Puzzle (RP) Drawing of a Clock (DC) In all subtests. time of performance must be measured and written into the scoring sheet.

Copy Geometric Forms (GF) ‡ Requires: GF Cards .

Copy Geometric Forms (GF) 1. Examiner puts in front of client a sheet of paper and a pencil. Examiner says. 2. ³I am going to show you five forms.´ . Please copy each form on the paper.

Copy Geometric Forms (GF) 3. Examiner shows the form in the following order: circle triangle diamond cube complex form ‡ Numbers on the back of cards are not to be used as sequence numbers. Follow the card sequence given above. .

. If not.Copy Geometric Forms (GF) ‡ Most clients will copy the three simple forms correctly. the common errors are in the closure of the forms or in positioning them in the right angles.

the client perceived the three-dimensional perspective . ‡ Clients tend to copy the cube as a square and to distort the complex form. good performance is considered only if client copied the form with all the lines in the proper angles.e..Copy Geometric Forms (GF) ‡ Most of the difficulties are demonstrated in copying the cube and the complex form. In copying the cube. i.

GF Scoring 1 point ± zero to one form copied 2 points ± two or three forms copied 3 points ± four forms copied 4 points ± all five forms copied .

´ c. If client fails to do it. ³Construct this pattern beside the design. Examiner says. Examiner shows client a design that consists of a circle.Reproduction of a Two-Dimensional Model (TM) ‡ Requires: Test Booklet (page 20) a. examiner instructs client. a rectangle and two triangles and the corresponding shapes. b. ³Now try to construct it on the design.´ .

. ‡ Clients with lesser disabilities exhibit difficulties in finding the correct position of the triangles.Reproduction of a Two-Dimensional Model (TM) ‡ Main difficulties are in spatial positioning of shapes ‡ Clients with severe damage show problems already in placing the square in the right position.

TM Scoring
‡ 1 point ± unable to reproduce pattern ‡ 2 points ± able to reproduce pattern only on the design ‡ 3 points ± reproduces the pattern correctly but with trial and error ‡ 4 points ± good performance

Pegboard Construction (PC)
‡ Uses a pegboard with equally spaced holes, pegs, and a card of the same size as the board with a design of a triangle. ‡ Requires: Test Booklet (page 21)

Pegboard Construction (PC)
a. Examiner puts in front of client a pegboard, pegs, and a design of a triangle. b. Examiner instructs client, ³Construct the pattern.´

in little reference to total form itself difficulties in closing the form x angles of triangle remain uncompleted .Pegboard Construction (PC) ‡ Several typical errors may be observed in test performance: difficulties by integrating the dots into a total form x peg-by-peg fashion.

but does not locate the right position in the board . but hesitate or unable to construct the oblique Client able to construct shape.Pegboard Construction (PC) inability to construct oblique line x obliques develop later than vertical and horizontal lines x clients may succeed constructing vertical and horizontal lines.

PC Scoring ‡ 1 point ± unable to perform ‡ 2 points ± able to reproduce only the vertical and horizontal lines. but does not locate it in the right place on the board ‡ 4 points ± good performance . he/she fails to reproduce the oblique lines and/or fails to close the angles ‡ 3 points ± reproduces the form correctly.

and the actual blocks to build the design (DLM). ‡ Requires: Test Booklet (page 22) .Colored Block Design (CB) ‡ Consists of a three-dimensional design of colored cubes on a card.

´ . b.Colored Block Design (CB) a. ³Construct the design. Examiner instructs client. Examiner shows client a design of colored cubes and actual blocks.

Colored Block Design (CB) ‡ Some problems exhibited by clients with impaired ability to construct in 3D are parallel to those made on 2D construction and drawing tasks simplification neglect of half of model misinterpreting the spatial relations between the cubes .

Colored Block Design (CB)

‡Another common error is the tendency to build the pattern on the surface without relating to height and/or depth

CB Scoring
‡ 1 point ± unable to reproduce the design ‡ 2 points ± builds flat on the table, without height and depth, or partially flat ‡ 3 points ± builds with height only or depth only ‡ 4 points ± good performance

Plain Block Design (PB)
‡ Consists of a three-dimensional design without color, using plain blocks (DLM). ‡ Requires:
‡ Test Booklet (page 23)

b. Examiner asks: ³How many cubes are needed to build the design?´ ³Now build it.´ .Plain Block Design (PB) a. Examiner shows client all the ten blocks and the corresponding design in the test booklet.

but fail to build it due to spatial organization deficits ‡ Most clients fail to perceive the design initially. but the performance leads them to build it correctly.Plain Block Design (PB) ‡ Some clients are able to perceive design correctly. .

PB Scoring ‡ 1 point ± unable to reproduce the design and does not count correctly ‡ 2 points ± builds what he sees but does not build invisible blocks ‡ 3 points ± does not count correctly but builds correctly or vice versa ‡ 4 points ± good performance .

Reproduction of a Puzzle (RP) ‡ Consists of a design of a colored butterfly. divided into nine squares and nine corresponding pieces. ‡ Requires: Test booklet (page 24) .

³Construct the puzzle on the design.´ .Reproduction of a Puzzle (RP) ‡ Examiner shows client a design of a colored butterfly and the corresponding nine pieces. ‡ Examiner then instructs client.

but hesitate or fail to construct its sides .Reproduction of a Puzzle (RP) ‡ Main difficulties arise from the symmetrical design Symmetry enables clear expression of directional problems Many clients are able to construct correctly the middle of the design.

RP Scoring ‡ 1 point ± unable to perform ‡ 2 points ± only able to put in the three central vertical pieces ‡ 3 points ± performs with trial and error but achieves good performance ‡ 4 points ± good performance without trial and error .

´ . Examiner gives client a pencil and a drawing of a circle (page 25 of the test booklet). Client is instructed. b. ³Fill in the numbers of the clock and put the hands of the clock at 10:15. Make copies for testing.Drawing of a Clock (DC) ‡ Requires: Test Booklet (page 25) Used as master. a.

Drawing of a Clock (DC) ‡ Exposes unilateral visual inattention problem Clients have difficulties rounding out the left side of the clock and spacing the numbers properly ‡ Meaningful difference between clients who make a primary organization of the clock and clients who start performing with any initial planning .

Drawing of a Clock (DC) ‡ Marking the hour at 10:15 gives additional information about: the client¶s time orientation capacity to process numbers and number/time relationships ‡ Clients with left hemisphere lesions involving aphasia and dysgraphia may have difficulties in writing numbers .

but fails to mark the hour.DC Scoring ‡ 1 point ± unable to perform ‡ 2 points ± performs the general scheme. marks the hour correctly. but the organization within it is not correct ‡ 3 points ± organizes the numbers of the clock correctly. or vice versa. but the numbers are not placed exactly right ‡ 4 points ± good performance .

1966) Function of the entire brain (Gloring & Hoff.Thinking Operations ‡ Thinking Not tied to specific neuroanatomical systems unlike other intellectual systems (Luria. 1969) .

Thinking Operations ‡ Basic level of thinking operations ± process of conceptualization Identify discrete features of objects Appreciate object hierarchically Classify objects into basic categories .

Thinking Operations ‡ More advanced level Client deals with logical operations Demands apprehension of sequence .

Thinking Operations ‡ Two basic thinking operations (Piaget) Classification Seriation .

Thinking Operations ‡ Three kinds of test for assessing thinking operations Categorization tests x Objects categorization x Forms classification Sequential tests x Pictorial sequence x Geometrical sequence Logical questions using numbers .

Thinking Operations ‡ Brain damage Reduces the level of performance of cognitive tasks Reduces the ability to process information that is needed for grouping things in relevant categories Limits the ability to organize the information required for planning acts .

Structured (RS) ‡ Pictorial Sequence (PS) Pictorial Sequence A (PS1) Pictorial Sequence B (PS2) ‡ Geometrical Sequence (GS) ‡ Logic Questions (LQ) .Subtests for Thinking Operations ‡ Categorization (CA) ‡ Riska Object Classification (ROC) ROC. Unstructured (RU) ROC.

hammer. needle. train. helicopter. hoe. car. Examiner spreads randomly on the table 14 cards with these representations: boat.´ . scissors. bicycle. rake b. Examiner gives the following instructions: ³Sort the cards into groups. ship.Categorization (CA) a. airplane. screwdriver.´ ³Name the groups. wheelbarrow.

After client has done the first grouping.Categorization (CA) c.´ . examiner asks: ³Is there another possible way to sort them?´ ³Name the groups.

Categorization (CA) ‡ Attention is paid to whether client: Sorts according to what criterion Can formulate the criterion Follows criterion constantly ‡ Client is expected to shift concepts and sort the objects according to another criterion. ‡ There are various levels at which the common features of objects can be abstracted .

Categorization (CA) ‡ Main problems exhibited: Determining a criterion Preserving a criterion Shifting concepts Verbally conceptualizing Client may be able to sort into small groups. but unable to shift to larger groups (needs higher level of abstraction) May be able to generalize one group but fail to do it in the other one .

and/or is unable to complete the groupings ‡ 4 points ± able to perform. . ‡ If client did not get max score due to language problems. but shifts only with a cue. Client can perform and verbalize the criterion.CA Scoring ‡ 1 point ± unable to perform ‡ 2 points ± able to do partial grouping (either large groups or small groups) ‡ 3 points ± able to do both tasks. but is unable to verbally conceptualize the criterion ‡ 5 points ± Good performance. examiner will add comment beside the score. with or without a cue.

Riska Object Classification (ROC) ‡ ROC test Utilizes forms in addition to the categorization sub-test which consists of pictures of concrete objects. Open part which provides more alternatives for classifying and shifting between criteria Evaluation of the quality of the thinking process .

Riska Object Classification (ROC) ‡ Two parts x Unstructured sub-test (RU) x Structured sub-test (RS) ‡ Both tests together enable a more complete assessment of the classification ability. .

light brown. Makes use of 18 pieces in three colors (dark brown. Unstructured (RU) ‡ Allows client to manipulate the objects in a variety of ways a.ROC. and cream) and three shapes (arrow. All shapes are placed in a random fashion in front of client. . b. and quarter donut). oval.

Unstructured (RU) c. After client finishes arranging the groups. After client gives the criterion. ³Now make different groups that are alike.ROC. ³Put these objects into groups that are alike. ³How are your groups alike?´ e. Examiner says.´ . he/she is asked. examiner says.´ d.

RU Scoring ‡ Highest score of any of the various trials is given when client is able to perform and state the criteria (except in cases of aphasia). .

. uses pieces to make a picture like a house or flower) ‡ 2 points ± sorts according to one incomplete criterion (leaves some pieces out or mixes two criteria) .g. and/or collections (e.e. exact matching (pairs of color and shape).RU Scoring ‡ 1 point ± Identification: i..

for example) ‡ 5 points ± sorts according to two criteria or more simultaneously (e.g. shape and color using more than two in a group) .. arranges the oval shapes in one line or row and the arrows underneath) ‡ 4 points ± sorts according to one criterion with random arrangement and is able to shift to another criterion (color and then shape..RU Scoring ‡ 3 points ± sorts according to one criterion with spatial arrangement (e.g.

Structured (RS) ‡ Classification criteria are selected by examiner a. Makes use of same pieces as RU. c.´ . Examiner says. Examiner makes a group in front of client: one dark brown arrow. one light brown oval.ROC. Now you make as many groups as you can that are like mine. b. ³I made this. one cream quarter donut.

Structured (RS) d. examiner asks. If client is able to arrange all groups.´ .ROC. ³Your groups are like mine in some ways. f. If client states the criterion of three different shapes and three different colors. Try to make them more like mine. If not. examiner says. but not in others. ³How are your groups like mine?´ e. the test is ended.

ROC. Structured (RS) g. ³Use all the pieces. If a few of the groups are incomplete.´ . examiner can give a cue by saying.

and/or collections (e.g.RS Scoring ‡ 1 point ± identifies.e.. exact matching (pairs of color and shape). i. uses pieces to make a picture like a house or flower) ‡ 2 points ± sorts according to one incomplete criterion (leaves some pieces out or mixes two criteria) ‡ 3 points ± sorts according to one criterion ..

after examiner has offered a clue ‡ 5 points ± sorts according to two criteria simultaneously on first trial .RS Scoring ‡ 4 points ± sorts according to two criteria simultaneously only on second trial.

Pictorial Sequence (PS) ‡ Telling the story enables examiner to evaluate client¶s ability to verbally organize sequentially ordered visual data .

Examiner then gives these instructions: ³Arrange the pictures in the right sequence. The cards are laid out in the following order: 5 2 4 1 3 b. Client is given five cards representing a short story.´ .Pictorial Sequence A (PS1) ‡ Requires: PS Cards A a.´ ³Tell the story.

‡ Clients with severe dysfunctions will not understand that the cards are concerned with one special event. but find it difficult to arrange the cards. and therefore fail the task .Pictorial Sequence A (PS1) ‡ There are clients who are able to tell the story correctly.

PS1 Scoring ‡ 1 point ± unable to perform ‡ 2 points ± uses only some of the cards. but does not refer to the whole sequence ‡ 3 points ± able to tell the story. but unable to tell the story ‡ 4 points ± good performance . but is not able to arrange the cards correctly. or able to arrange the cards.

Pictorial Sequence ‡ Second sequence of six cards is given: If client has score of 4 Aphasic clients arranged the cards but were not able to tell the story .

Pictorial Sequence B (PS2) ‡ Same instructions as PS1. only that pictorial sequence is presented in the following order: 5 1 4 2 6 3 .

PS2 Scoring ‡ Same as PS1 ‡ Examiner will write in comments if client did not get the max score because of language problems ‡ If the score on PS1 is less than 4. PS2 should have no score .

Geometrical Sequence (GS) ‡ Paper and pencil test consisting of two geometrical sequences: Sequence of 3 geometrical forms : client has to understand that forms appear in a constant order. and continue it accordingly Sequence of vertical and horizontal arrows : client has to understand two components of the sequence: x change in arrows position (vertical or horizontal) x number of the arrows increases .

a. Make copies for testing. Continue the sequence according to this order. the forms are drawn in a special order. Examiner says.´ . ³In this line.Geometrical Sequence (GS) ‡ Required: Test Booklet (pages 26 and 27) Used as master. b. Examiner gives client a pencil and the first geometrical sequence (page 26).

5 vertical arrows . Repeat this procedure for the second sequence (page 27) CORRECT RESPONSES: x First sequence: circle.Geometrical Sequence (GS) c. square x Second sequence: 5 horizontal arrows.

Geometrical Sequence (GS) d. examiner should ask him/her. ³Is there another possible way to continue the sequence?´ . client starts from the beginning or relates only to one of the components). In the second sequence. if client did not understand the order of the sequence and therefore did not continue it in the right way (e.g.

Geometrical Sequence (GS) ‡ Clients with severe dysfunction are unable to understand the rule in each of the sequences ‡ More difficulties are often exhibited in the second sequence ‡ Other clients relate to only one of the two sequence components .

GS Scoring ‡ 1 point ± unable to perform ‡ 2 points ± performs only the first sequence ‡ 3 points ± performs both sequences. . but with trial and error ‡ 4 points ± good performance ‡ For the second sequence. client must show at least two more shapes (line sets) to be scored.

Client may solve the problems either verbally or in writing on the page according to his/her preference. .Logic Questions (LQ) a. Examiner presents client with the page of questions and reads with him/her one question at a time. b.

In what year was John 35?´ ³Peter was born in 1950. How many apples do both of them have in all?´ ³Nancy was born before Janet and after Sarah. How old is he now?´ ³Mary has 5 apples. Susan has 3 apples fewer than Mary.Logic Questions (LQ) ‡ Questions: ³John was born in 1930. Who is the oldest? Which one is the middle? Who is the oldest?´ .

Logic Questions (LQ)
‡ Clients with language deficits may show difficulties. ‡ LQ Scoring
1 point ± given for each correct response Minimal performance ± 1 point Maximal performance ± 4 points

Attention Span and Concentration ‡ Score is based on observation during assessment.

Attention Span and Concentration
‡ Scoring
‡ 1 point ± Very short attention span
cannot concentrate for more than five minutes needs continued repetitions of instructions Stop the testing.

‡ 2 points ± able to pay attention for short periods
can concentrate for up to 15 minutes needs some repetitions of instructions Divide into 2 sessions.

but is able to go through the test by refocusing from time to time ‡ 4 points ± No attentional or concentration problems.Attention Span and Concentration ‡ 3 points ± shows slight difficulties in attention and concentration. .

F I N I S H .

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