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 .

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

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 .

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

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 .

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. ‡ If client¶s comprehension is good and he/she has only expressive difficulties. .g. receptive aphasia).

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

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

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

asking client to choose the correct answer. If client is unable to answer the questions (because of memory problems or aphasia). . examiner will use multiple questions.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. What day is today? What month? What year? What season is it now? . Client is asked for the full date.

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

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

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

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

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

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

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) .

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

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

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) c. ³Where is the chair?´. Client is asked to point to the objects named by the examiner. This procedure is used for each of the eight objects. etc. Examiner asks. ³Where is the watch?´. .

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

. 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. Examiner asks.Object Identification (OI) e. ³Where is this?´ Client has to do exact matching.

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

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

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

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

Shape Identification (SI) b. 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. examiner asks client. . On each card.

Shape Identification (SI) c. x ³Show me the circle´ etc. . 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.

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

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. 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.

‡ 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. or similar matching. pointing or similar matching ‡ 4 points ± 8 shapes by naming. pointing.

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. .

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

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

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

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

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

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 .

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

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

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

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. .

g. Spatial perception problems ± disabilities in ADL. etc.Spatial Perception ‡ Perception disabilities influence clients¶ functioning in everyday life.: 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. including dressing. ambulation. . e.

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.´ ³Put your right hand on your left ear. Examiner asks client: ³Show me your right hand. b.´ ³Put your left hand on your right leg.´ ³Show me your left 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 .

right. any clear object in the room. back) in the room.)´ . front.Spatial relations: Between client and objects near space (SP2) a. Examiner points to four different objects in four different directions (left. 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. b.

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

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?´ . Examiner shows client the picture of a man sitting in front of a table. b.Spatial relations: Represented on a picture (SP3) a.

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

ideational and idiokinetic apraxia in different ways Test will use the term in a descriptive way (Lezak. 1983) .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.

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

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

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

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

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

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

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

and bringing the receiver to the ear. from lifting the receiving. dialing.Symbolic Actions (P3) ‡ Examiner asks client: ³Show me how you brush your teeth. bringing it to the mouth and brushing.´ x Examiner will ask client to show the whole action. . from putting the tooth paste on the brush. ‡ 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.

. 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.

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. . 1983).

.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.

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

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 . simplify.

. time of performance must be measured and written into the scoring sheet.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.

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

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

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. .Copy Geometric Forms (GF) 3.

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

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

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 .

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

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. ‡ Clients with lesser disabilities exhibit difficulties in finding the correct position of the triangles. .

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 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. but does not locate the right position in the board .

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.

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

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

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. Examiner shows client all the ten blocks and the corresponding design in the test booklet.Plain Block Design (PB) a.

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

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 .

divided into nine squares and nine corresponding pieces.Reproduction of a Puzzle (RP) ‡ Consists of a design of a colored butterfly. ‡ 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 .

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

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 .

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

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 .

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

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

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

‡ There are various levels at which the common features of objects can be abstracted .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.

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 .

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. . Client can perform and verbalize the criterion. with or without a cue. but shifts only with a cue. and/or is unable to complete the groupings ‡ 4 points ± able to perform. but is unable to verbally conceptualize the criterion ‡ 5 points ± Good performance. examiner will add comment beside the score. ‡ If client did not get max score due to language problems.

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. .

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

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

.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).

exact matching (pairs of color and shape). and/or collections (e.RU Scoring ‡ 1 point ± Identification: i..g. 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) ..e.

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. for example) ‡ 5 points ± sorts according to two criteria or more simultaneously (e.RU Scoring ‡ 3 points ± sorts according to one criterion with spatial arrangement (e.g..g. shape and color using more than two in a group) ..

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

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

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

exact matching (pairs of color and shape). 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 .e.RS Scoring ‡ 1 point ± identifies.. and/or collections (e..g. i.

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 .

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

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

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 is not able to arrange the cards correctly. or able to arrange the cards. but unable to tell the story ‡ 4 points ± good performance .

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 .

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 .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.

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

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

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

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 .

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

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.

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?´ . How many apples do both of them have in all?´ ³Nancy was born before Janet and after Sarah. In what year was John 35?´ ³Peter was born in 1950. How old is he now?´ ³Mary has 5 apples.

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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