Relationships of cognitive performance and daily function of clients following right hemisphere stroke: Predictive and ecological validity of the LOTCA battery

The purpose of this study was to determine the relationship of cognitive performance, as measured by the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery, to daily function in patients following right hemisphere stroke. Furthermore, to explore the predictive power of cognitive performance using the LOTCA at the first rehabilitative stage after stroke to long-term functional outcomes. The method was a longitudinal research design at 3 points in time: admission to rehabilitation; discharge from the rehabilitation hospital; and at follow-up, six months after discharge, which in some cases reached one year post onset. Subjects were 40 consecutive patient admissions to a rehabilitation hospital. All patients were right- handed adults with a CT-proven, first, single, right hemispheric stroke. Based on their total cutoff score in the Behavioral Inattention Test (BIT) for unilateral spatial neglect, patients were divided into 2 subgroups: 19 with neglect and 21 without neglect. Instruments included the LOTCA, the Functional Independence Measure (FIM), the Rabideau Kitchen Evaluation and Phone use. Results showed that right hemispheric stroke patients with unilateral spatial neglect performed at a lower level than patients without neglect on all measures of cognitive skills, as well as daily functional tasks as measured by the FIM and kitchen tasks. Differences were significant in all testing periods. Relationships between cognitive and functional measures showed that visuomotor organization and thinking operations correlated at moderate to high levels in both subgroups. The predictive results from admission to follow-up suggest that unilateral spatial neglect is the major predictor of activities of daily living (ADL) and instrumental activities of daily living (IADL) task performance, however cognitive skills, especially the more complex integrated visuomotor and thinking skills, were significantly related to functional outcomes in the non-neglect group. Thus, they are crucial in the assessment of stroke patients. The predictive and ecological validity of the LOTCA battery was supported.