Visual Perceptual Assessment
OCT 1172
February 1, 2005
Gianna Knibbs
Shannon McCready
Jeffrey Mills
Melissa Peressotti
Presentation Outline


Description of Perception &
Approaches/Theories of Perception
Motor-Free Visual Perceptual Assessment
(MVPT)


Loewenstein Occupational Therapy
Cognitive Assessment (LOTCA)



General features and application to theories
General features and application to theories
Comparison chart of psychometrics (LOTCA,
MVPT)
Two practical applications
Definitions

Perception

“The dynamic process of receiving the
environment through sensory impulses and
translating those impulses into meaning based
on a previously developed understanding of
that environment” (Bouska et al., 1990)
Definitions (2)

Visual Perception

“ability to identity, organize, interpret and
comprehend visual information received by a
person through his or her eyes”
(Hammill et al., 1993)
Approaches to Understanding
Perception

Bottom-Up Processing



Primary perceptual processes convert sensation into
perception
Assessment and treatment approached by evaluating
individual domains of function
Top-Down Processing


Our learned experiences narrow possible
interpretations of the sensory stimuli in the
environment
Assessment and treatment through observation of a
person engaging in function
Theories of Perception

Luria’s Functional Systems Model
(1975)
Model based on brain functioning
 Interaction of various regions in the brain is
the cause of all human cognition and
functioning
 Grouped areas into 3 distinct functional units
 Each unit does NOT work in isolation of each
other

Theories of Perception (2)

Luria cont’d

First Functional Unit:
Brainstem & reticular formation
 Arousal and activation
 Involved in regulating tone, waking, and mental
states


Stimulates us enough so we can do what we have/need
to do
Also responsible for basic need states (hunger,
fight/flight responses)
 Brain injury often results in deficits in the 1st
functional unit

Theories of Perception (3)

Luria cont’d

Second Functional Unit:

**Where [visual] perception comes into play**
Posterior cortex; including the occipital, parietal,
and temporal lobes
 Occipital lobe is key for visual perception
 Sensation and perception
 Each lobe is made up of 3 areas: primary,
secondary, tertiary

Theories of Perception (4)

Luria cont’d

Primary:


Secondary:



Registers basic sensory information (ie. Auditory, visual,
tactile)
Sensations are integrated into actual perceptions
Ex. Sensations of light and structure becomes a perceived
object
Tertiary:



Complex integration and elaboration of information
Ex. Reaching in your pocket and picking out a penny as
opposed to a dime
Ex. Interpreting verbal and nonverbal aspects of
communication – ie. Smile (happy)
Theories of Perception (5)

Luria cont’d

Third Functional Unit:
Comprised of the frontal lobes
 Maintains executive functioning and control over
thought processes & actions
 Main function is to inhibit unwanted information
and behaviour.
 It is involved in programming, regulating and
verifying behaviour

Theories of Perception (6)

Piaget’s Theory of
Cognitive Development
Jean Piaget (Developmental psychology)
 “How we come to know”
 “Abstract symbolic reasoning”
 Assimilation & Accommodation

Motor-Free Visual
Perceptual Test (MVPT)


Authors: R. Colarusso
& D. Hammill
1972
MVPT (2)

Purpose
To measure visual perception free of
motor involvement
 Used for screening, diagnostic, and for
research purposes.

MVPT (3)
Domains



Figure Ground:
 Ability to distinguish an object from its background
Spatial Relationships:
 Ability to switch the position of objects in relation
to oneself and/or other objects
 Orienting one’s body in space & to perceive the
positions of objects in relation to oneself & to
others
Discrimination:
 Ability to distinguish dominant feature in different
objects
MVPT (4)
Domains cont’d



Visual Closure:
 Ability to identify an incomplete figure when only
parts of it are present
Visual Memory:
 Ability to recall dominant features of one stimulus
item or remember sequence of several items
Chosen because at time test was developed, they
were the most prominent theoretical constructs in the
literature
MVPT (5)

Target Population
 Standardized on a sample of 4 children aged
8 years old.
 A revised edition was developed for use with
the adult population (Bouska & Kwatny, 1983)
 MVPT-R was published in 1996 by the original
authors
Addresses issues of incomplete and outdated
normative data (increasing ages of children to 9-11
years)
 Also, added 4 more items
 NO re-standardization from the 1972 data

MVPT (6)

Administration Procedures
Administered individually/ approximately 10
minutes
 Well-lit, distraction free environment
 Testing books in the client’s midline
 Examiner on left or right client, providing clear
information
 If client has hemianopsia, examiner should sit
on client’s intact side

MVPT (7)
40 multiple choice questions each with a
stimulus and 4 possible answers
 Assessor points to each – “look at this”
 Assessor then points to 4 potential responses –
“find it here”
 Client points to his/her response
 Scoring:

Assessor circles client’s responses on scoring sheet
 Only correct answers are recorded
 Raw score is calculated (sum of correct answers)

MVPT (8)

Motor-Free Assessment of Visual
Perception
Other tests purport to measure visual
perception but have a motor component (i.e.:
drawing) which acts as a confounder for
measuring visual perception.
 Practically most perceptual abilities are
integrated with motor systems’ abilities

MVPT (9)

Not comprehensive – Body Scheme and
Right/Left Discrimination are not assessed
Recommended to not be used exclusively to
assess visual perceptual abilities
 Recommended that it be used with measures
of functional performance (i.e. FIM)

MVPT (10)

Many researchers have attested that
seeing an object alone is of little practical
use if you can’t perceive its shape,
location, movement, or colour
MVPT: Bottom-Up
Processing


MVPT assesses visual perception by
testing clients on domains of function such
as figure-ground discrimination, etc.
The authors of the test argue that these
are the most prominent theoretical
domains of visual perception when the
test was designed.
MVPT: Bottom-Up
Processing (2)


However, the scores from each domain are
added together, resulting in a single global
score which means that the ability for the
client to perform in any one domain is
lost.
Brown, Rodger, and Davis (2003) argue
that this may mean that the test therefore
has little practical or clinical use.
MVPT: Bottom-Up
Processing (3)


The authors state that it is not
comprehensive (it does not measure body
scheme or right/left discrimination)
The MVPT was designed as a general
screening and can serve this purpose by
looking at skills in several bottom-up
processes
MVPT: Top-Down
Processing



MVPT does not really assess top-down
processing of visual information
The results can be used to predict possible
function
The Introduction to the test states that
the test should be used in conjunction
with functional assessment to determine
the true state of their visual perceptual
abilities.
MVPT: Top-Down
Processing (2)

Therefore, using other assessment tools to
look at Top-down processing such as the
Functional Independence Measure (FIM) is
essential for predicting functioning in
clients.
MVPT: Luria’s Model of Brain
Functioning




Recognizes the cooperation & integration
of various systems in brain functioning
MVPT assesses visual perception in a
motor-free way
Systems involving perception are
interrelated with other systems such as
the motor system.
Assessing visual perception occurs at the
2nd functional unit in Luria’s model.
MVPT: Luria’s Model of Brain
Functioning (2)

RECALL:






3 increasing levels of integration in each lobe involved in
this unit.
Registration of visual stimuli occurs at the primary area
The secondary area turns sensations into perceptions.
MVPT measures visual perception fitting here in Luria’s
model.
The tertiary area involves complex integration of these
percepts.
MVPT does not assess its integration with other
systems, therefore, such visual perceptual abilities as
interpreting non-verbal communication (ie.
smile=happiness),is not assessed.
MVPT: Luria’s Model of Brain
Functioning (3)


Scoring in the MVPT are dichotomous; ie.
either right or wrong
Makes it difficult to assess the
complexities of perception



Dichotomy limits MVPT from assessing some
types of agnosia
Agnosia - Impaired object recognition not
related to visual loss
Can generate an adequate internal
representation of a stimulus, but cannot
recognize it
MVPT: Luria’s Model of Brain
Functioning (4)

Associative Agnosia
Failure to recognize meaning of what is
perceived
 Ex. A client with an ABI recognizes circles
from squares, but does he know that what he
is looking at is a circle/shape?
 Ability to match objects is assessed in the
MVPT (clients w/ Associative are able to do)
 Associative is not directly assessed since it
does not assess whether clients actually
understand the meaning behind what they are
perceiving

MVPT: Luria’s Model of Brain
Functioning (5)
Apperceptive Agnosia
Failure to even perceive
visual stimuli
 Able to sense and register
sensory stimuli from the
environment but cannot
connect sensations to
actual percepts.
 Thus the ability to perceive
is deficient.

MVPT: Luria’s Model of Brain
Functioning (6)
MVPT assesses visual apperceptive agnosia
indirectly
 The domains the MVPT assesses determine
whether or not clients can perceive stimuli
from the environment
 However, MVPT’s dichotomous scoring does
not allow clinicians to understand the
reasons for their answers

MVPT: Luria’s Model of Brain
Functioning (7)

Not congruent with visual perception having
many shades of grey with the levels of
processing ranging in complexity of
integration

Researchers found that clients’ who perform well
on tests assessing visual processing of inanimate
objects (as does MVPT), perform poorly on tests
that assess animate objects (such as the Benton
Facial Recognition) (Duchaine et al., 2003)
 This questions the validity of the MVPT and the
generalizability of the findings to all visual
stimuli
Neuroanatomy of
Visual Perception
The MVPT tests clients on perceptual
abilities that may result from damage to
different brain regions
 Figure Ground
 Lesion:
 Spatial
non-dominant occipital lobe
Relationships
 Tertiary
zone perceptual deficit: related to
impaired depth perception (lesion: right
hemisphere visual cortex)
Neuroanatomy of
Visual Perception (2)
 Visual
Discrimination
 Parietal
and temporal lobe damage. A
disorder in visual discrimination involves an
inability to attend to slight variations in
form.

Therefore, by asking the client to match
shapes tests their ability to tell the
difference between different forms.
MVPT Findings:
Driving Abilities


Safe driving requires the driver to
integrate complex visual processing skills
Mazer et al. argue that visual perceptual
skills such as figure-ground discrimination,
visual discrimination, spatial relations (all
tested by the MVPT) determine the ability
to notice and react to objects in the visual
field which is required when driving.
MVPT Findings:
Driving Abilities (2)



People who failed the on-road driving test
performed more poorly on the MVPT than
those who passed in people who had
suffered a stroke (Mazer et al.)
However, the scores were not highly
predictive of a pass.
MVPT does not look at colour agnosia,
simultagnosia, metamorphosia.
MVPT: Driving Abilities


Driving, in addition to perceptual skills,
requires judgment, and behavioural and
cognitive skills that the MVPT does not
test.
However, the MVPT seems to cover many
of the visual perceptual skills required for
driving.
MVPT: Driving Abilities (2)

Visual Discrimination
 Need
to see shapes to distinguish signs
and cars from other moving objects, see
stop lights, etc.

Figure Ground
 To
see lines on the road, objects on the
road that may be hazards
MVPT: Driving Abilities (3)

Visual Memory
 To
find one’s way around, follow
landmarks and directions

Spatial Relationships
 Ability
to avoid hazards, find way
around, change lanes, etc
Professional Opinion

Mandy Lowe
Toronto Rehabilitation Institute

Important to build rapport to determine which MVPT to
utilize


Scoring – sum of all parts:




Level of difficulty varies for each
Does not inform intervention
Norms are based on overall score (all domains)
Easy to transport; bring to bedside
Consent – risks and benefits:


Results can be upsetting
Could also be less upsetting than finding out on a functional task
Loewenstein Occupational
Therapy Cognitive Assessment


Authors: Itzkovich, M., Averbuch, S., & Elazar, B.
1974
Loewenstein Occupational
Therapy Cognitive
Assessment (LOTCA)

Purpose



Evaluating patients who have experienced braininjuries (ie. traumatic head injuries, CVA, tumours)
Provides an initial profile of the cognitive abilities of
an individual; used as a starting point for OT
intervention as well as a screening test for further
assessment
Provides a valid profile of a client's abilities and a
measurable assessment of specific deficits to help
plan treatment.
LOTCA (2)

Focus

Four areas; 20 subtests
Orientation
 Visual & Spatial Perception (6 subtests)
 Visuomotor Organization
 Thinking Operations


Target Populations
Paediatric ( 6 y/o)
 Adult

Evaluation Approach
of LOTCA


30-45 min to administer (for entire test)
“Perception” is the active process of:
 Searching for the corresponding info,
 Distinguishing essential features of an object,
 Comparing the features with each other,
 Creating appropriate hypotheses,
 Comparing these hypotheses with original data
(Luria, 1973)
Evaluation Approach
of LOTCA (2)

Administration of LOTCA
Components: cards, pictures, scissors & paper,
picture “puzzle”
 Important to eliminate influence on the client
during the test
 Scoring: 1 (low) – 4 (high) [ordinal]
 based on client’s ability for (independent)
success with each test
 subtests can be altered to assist client
 normative scores available

Piaget’s Theory of
Cognitive Development

Jean Piaget (1896-1980)

Developmental psychology

Interest  “how we come

to know”
Ability to do “abstract
symbolic reasoning”
Piaget’s “Cognitive
Development” (2)



Began to work with children and
investigate their thought processes
Noted young children’s answers were
qualitatively different than those of
older children
Younger children answered differently
because they thought distinctively, not
because they were less knowledgeable
Piaget’s “Cognitive
Development” (3)

Two aspects to Piaget’s theory:
1. Process of coming to know, and
2. Stages we move through as we gradually acquire this
ability

Process of Cognitive Development:


“Intelligence” = how an organism adapts
to its environment
Believed behaviour is controlled through schemes
Piaget’s “Cognitive
Development” (4)


“Equilibration” = drive to obtain balance
between schemes and the environment
Assimilation


Transforming and placing the environment in
pre-existing cognitive structures
Accommodation

Changing cognitive structures in order to
accept something from the environment
Piaget’s “Cognitive
Development” (5)
Schemes
(more complex)
Structures
(more complex)
Hierarchy
Luria’s Theory of Functional
Systems


Brain = Organized system
3 “Blocks”
1. Brainstem
2. Area posterior to central sulcus
3. Area anterior to central sulcus
Luria’s
“Functional Systems” (2)

Functional Units (‘Blocks’)


Interact with one another to produce optimal
performance on a task
1st Functional Unit

Role in attention and memory, in part by
processing information according to its
salience (relevance, importance and novelty)
Luria’s
“Functional Systems” (3)

2nd Functional Unit
Primary role in perception
 Registers & integrates sensory information
into perceptions


3rd Functional Unit
Executive control
 Control over complex sequences of activity

Influence of Piaget & Luria’s
Theories on LOTCA

Piaget
Young vs old children; qualitative vs quantitative
 Use of schemes, assimilation & accommodation
 Schemes  Structures  Hierarchy


Luria
2nd Functional Unit: primary role in perception
 3rd Functional Unit: executive functions
 Interplay between Functional Units

Domains of the LOTCA

6 Subtests
 Visual Identification of Objects
 Visual Identification of Shapes
 Overlapping Figures
 Object Constancy
 Spatial Perception
 Praxis
Two Types of
Visual Testing Areas


Visual Object Agnosia – inability to
recognize objects presented visually,
although primary visual skills are intact
Visual Spatial Agnosia – defect in
perceiving spatial relationships between
objects, or objects and self
 Visual Identification
of Objects

What It’s Measuring
 Associative Visual Agnosia (some Aperceptive
Agnosia)
Example: individual with associative agnosia, able
to copy pictures but cannot recognize object
 Visual Identification
of Objects (2)

Example: Name these common animals
 Visual Identification
of Objects (3)

Neuroanatomical cause


Lesions typically located in right
hemisphere in posterior multimodal
association area
How to Administer
Client shown 8 cards with common objects
(chair, teapot, watch, key, shoe, bicycle,
scissors, glasses)
 Name objects

 Visual Identification
of Objects (4)


If Client is Having Difficulty
 Person has global or receptive/expressive
aphasia
Problems with Test
 Does not test for Prosopagnosia (inability to
identify known individuals by face)
 Trial and error of matching board
 Unsure what test can be measuring
 Visual Identification
of Shapes

What it is Measuring

Visual Agnosia
Example: Individual unable to copy and match
simple forms (letters) and geometric shapes
Visual Identification
of Shapes (2)

Neuroanatomical Cause


Lesions typically located in right
hemisphere in posterior multimodal
association area
How to Administer
Client shown 8 cards with solid geometric
shapes (square, triangle, circle, rectangle,
diamond, semi-circle, trapezoid, hexagon)
 Name objects

Visual Identification
of Shapes (3)

If Client is Having Difficulty
Client cannot verbally name shape due to
aphasia, expressive problems, or educational
background
 Use matching board


Problems with Test

Test consists of four easy shapes and four
more complex ones

However, a score of ‘4’ can be attained if patient
identifies shapes by naming and/or matching
 Overlapping Figures

What It’s Measuring


Figure-Ground
Neuroanatomical Cause

Damage/lesion to non-dominant occipital lobe
 Overlapping Figures (2)

How to Administer
Two cards with three overlapping figures on
each card (a. banana, pear, apple; b. pliers, hoe,
saw)
 Client is asked to name all figures seen on card


If Client is Having Difficulty
Board is shown with 6 figures (3 are figures on
the card, 3 are different figures)
 Client has to point to what figures are seen on
the card

 Overlapping Figures (3)

Problems with Test

Does not:
 Incorporate real, ”everyday”
images/pictures, and pictures
with colour
 Include objects that have
more similar features to one
another
Example: What objects do you
see?
 Object Constancy

What It’s Measuring

Form Constancy Dysfunction
 Object Constancy (2)

Neuroanatomical Cause


How to Administer



Lesion in right parietal, temporal, and occipital lobe
areas
Client shown photographs of objects taken from
unusual angles (car, hammer, telephone, fork)
Asked what is seen in photograph
If Client is Having Difficulty

If client has aphasia, he/she is asked to match the
picture to the one that suits the big one on a board
that has 4 pictures
 Object Constancy (3)

Problems with Test
 Does not test for letters and numbers
Example: Point out letters O, Q, and D
 Spatial Perception

What It’s Measuring
R-L Discrimination
 Somatogonosia
 Position in Space Dysfunction


Neuroanatomical Cause
Typically parietal lobe and/or posterior
temporal lobe
 Left hemisphere

 Spatial Perception (2)

How to Administer
a) OT asks client to perform simple
movements (recognize directions on
themselves)
b) Orientation between objects (box &
pencil)
c) Recognizing directions on person in
front of them
 Spatial Perception (3)

Problems with Test
 Client with language barrier or severe receptive
aphasia may not understand instructions
 Clients with arthritis and/or poor fine motor
abilities may have difficulties
 Items with larger surface-areas
 Praxis

What It’s Measuring
Praxis = motor planning
 Measures the ability to execute motor
functions
 Associative visual agnosia


Anatomical Cause
Motor apraxia = caused by lesion to the
premotor cortex on the opposite side of the
affected limb
 Frontal Lobe  motor planning & executive
functioning

 Praxis (2)

How to Administer
a) Motor imitation – client imitates movements
by experimenter (hand to ear/head/shoulder)
b) Object utilization – experimenter presents
pairs of objects and asks client how to use
them (scissors & paper, envelope & paper)
c) Symbolic actions – client is asked what they
would do when they smell flower, open door
with key
 Praxis (3)

Problems with Test
If receptive aphasia exists client may have
difficulty with understanding or following
instructions
 Possibility exists that lesion to frontal lobe
may be the (major) cause of having difficulty
with the test; may not be a perceptual issue
 Motor dysfunction

What’s Missing?

Test for Simultagnosia?
 Patient
cannot interpret visual stimulus
as a whole
 Could only point out individual letters or
features
Test for Colour Agnosia?
 Test for Metamorphosia?

 Object
may be recognized accurately,
but appears larger or smaller than it
actually is
 Potential problems with ADL functioning
Potential Difficulties



Cultural barriers (i.e. person may not be
familiar with the object being shown)
Language barriers (ESL-individual may
know what object is, but cannot express
in English)
Some subtests would not be feasible to
adapt for persons with receptive/
expressive aphasia, and individuals with
fine/gross motor difficulties
Potential Difficulties (2)
Questionable if test can really assess how person
would perform in actual situations (top-down
component should be added)
 Underlying problems, such as unilateral spatial
neglect, may skew results if unknown by examiner
(Katz, 1999)
 Stewart & Schindler found that individuals without
brain injury did not attain a perfect score on the
LOTCA

LOTCA Findings:
Dressing Oneself


Successful and efficient dressing requires
utilizing integration of perceptual skills
One’s abilities in visual perceptual skills
are related to particular aspects of
identifying and selecting specific articles of
clothing
LOTCA Findings:
Dressing Oneself (2)

Visual Identification of Objects &
Visual Identification of Shapes
Inability to find clothes (identifying shape of
pants, belt, ties, long-sleeved vs shortsleeved)
 Recognition of clothing – if individual cannot
recognize the article of clothing, he/she may
not know its purpose and how to wear it
(where do socks go on one’s body?)

LOTCA Findings:
Dressing Oneself (3)

Overlapping Figures
Difficulty locating clothes in closet, dresser
(socks/underwear in drawer)
 Experience increased difficulties if clothes are
similar in colour to other articles of clothing
and/or where they are stored (closet, drawer)

LOTCA Findings:
Dressing Oneself (4)

Object Constancy
Difficulty recognizing clothes/items in various
arrangements (ie. shirt folded vs on hanger)
 Orientate clothing incorrectly (put on inside
out, backwards)
 Select “wrong” items  wear spouse’s clothes

LOTCA Findings:
Dressing Oneself (5)

Spatial Perception
Put shoes on wrong feet; difficulties putting
sweater on (ie. video with gentleman)
 Unawareness of own body parts may exist
and client may have difficulty with concepts
related to body positions and deciphering
between ‘left’ and ‘right’

LOTCA Findings:
Dressing Oneself (6)

Praxis
May have difficulty putting a t-shirt on
(bringing hands to head)
 Confusion with respect to knowing how to put
a belt through the pant loops

Professional Opinion

Mandy Lowe
Toronto Rehabilitation Institute






Important to tread carefully and use the appropriate
test at the appropriate level of functioning
(frustration, self-esteem issues)
Identifies difficulties in real life (ecological validity)
Correlated with FIM & Mini-Mental
No overall score; need motor control/abilities
Doesn’t touch much on processing speed
Need table/area to move items around
Professional Opinion (2)

Nicky Brookes
Hospital for Sick Children
Paediatrics; prefers LOTCA for 10-16 y/o
 However, she feels the variation in scores at the
ends of the age-range makes it less
reliable/valid and prefers LOTCA for 13 & 14 y/o
 ‘Visual & Spatial Perception’ section in LOTCA is
similar to other tests
 Believes it is a valid and reliable assessment
tool; easy to administer; enjoys using it

Psychometrics – LOTCA & MVPT
LOTCA
Validity
Good construct
validity
(Katz et al., 2000; Su
et al.,; & Katz et al.,
1989)
 Ecological validity:
some pictures of reallife objects (e.g.:
cars, eating utensils,
etc.)

MVPT
Versions keep
changing therefore little
up-to-date research on
validity.
 Less ecologically
valid: abstract shapes,
function not directly
addressed.

LOTCA
Reliability
Inter-rater =
ranged from .82
to .97 (Katz et al.,
1989)
 Internal
consistency =
.85-.95 (Katz et
al., 1989)
 Test-Retest=?
 Score sheet
contains space to
write additional
comments/
observations

MVPT
Versions keep changing
therefore little up-to-date
research on reliability
 Moderate test-retest
reliability for the MVPT-R
was found with more
stability in visual perceptual
scores for children with
learning disabilities (Burtner
et al., 2002)
 Inter-rater percentages of
agreement were high
during pilot testing of the
MVPT-R (Burtner et al.,
2002)

LOTCA
Clinical
Utility
Children (>6) and
adults who have brain
injury, CCI, and CVA
 LOTCA-G developed
for geriatric population
(Itzkovich et al., 1996)
 Easy to administer
(no training required)
 Can perform in a
variety of clinical
settings
 Subtests scored
separately so OT can
know what kind of
treatment intervention
is required

MVPT
Motor-free; good for clients
with motor impairments
 Cannot isolate domains thus
limits specificity of intervention
(Brown et al., 2003)
 Short in length, quick to
administer (Burtner et al.,
2002)
 Provides detailed, objective
and standardized information
that can be readily
communicated to other
professionals
 Can be used by any qualified
OT or SLP without having had a
specialist training in RPAB
administration

Thank You
References




Brown, G.T., Rodger, S., & Davis, A. (2003). Motor-free Visual
Perception Test-Revised: An overview and critique. British
Journal of Occupational Therapy, 66(4), 159-167.
Burtner, P.A., Ortega, S.G., Morris, C.G., Scott, K., & Qualls, C.
(2002). Discrimination validity of the Motor-Free Visual
Perceptual Test Revised in children with and without learning
disabilities. Occupational Therapy Journal of Research, 22, 161163.
Burtner, P.A., Qualls, C., Ortega, S.G., Morris, C.G., & Scott, K.
(2002). Test-retest reliability of the Motor-Free Visual Perception
Test Revised (MVPT-R) in children with and without learning
disabilities. Physical and Occupational Therapy, 22, 23-36.
Kamble, R., Goswami, S., Saigal, J., Sarin, R., & Jalali, R. (2003).
Prospective neuro-cognitive assessment (using LOTCA) and
quality of life (QOL) and activities of daily living (ADL) in children
with brain tumour treated with surgery and localized highprecision radiotherapy. The Indian Journal of Occupational
Therapy, 25, 10-12.
References (2)


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Itzkovich, M., Elazar, B., & Averbuch, S. (1993). LOTCA:
Loewenstein occupational therapy cognitive assessment.
Pequannock, NJ: Maddak Inc.
Katz, N., Itzkovich, M., Averbuch, S., & Elazar, B. (1989).
Loewenstein Occupational Therapy Cognitive Assessment
(LOTCA) battery for brain-injured patients: Reliability and validity.
The American Journal of Occupational Therapy, 43, 184-192.
Leonard, P., Foxcroft, C., & Kroukamp, T. (1988). Are visualperceptual and visual-motor skills separate abilities? Perceptual
and Motor Skills, 67, 423-426.
Mazer, B.L., Korner-Bitensky, N.A., & Sofer, S. (1998). Predicting
ability to drive after stroke. Archives of Physical and Medical
Rehabilitation, 79, 743-749.
Su, C.Y.; Chang, J.J., Chen, H.M., Su, C.J., Chien, T.H., & Huang,
M.H. (2000). Perceptual differences between stroke patients with
cerebral infarction and intercerebral hemorrhage. Archives of
Physical and Medical Rehabilitation, 81, 706-714.