| [Background]The cognition is a kind of activity that people understand the exoteric alternative, it is the process of acquisition, organization and application for knowledge too. It can show the intelligence process of the function and behavior. The patients who have the brain injure and cerebrovascular disease will have the impediment in the sense, speech, memory and thinking to influence the function of cognition because of the damaged central nervous system. Therefore, it is must be selected a valid method to assess that type of patient to definite the exist problem. Then, making the pertinacious of the treatment project reduces the degree of difficulty of feeling the boundary environment and raising the adaptability of the life and society.The measure of the cognition impediment can be used by scale commonly. Currently, there is some more extensive scale for domestic and international clinical researching such as Mini-Mental State Examination(MMSE), Functional Independence Measure(FIM), Neurobehavioral Cognitive Status Examination(NCSE) and Loewenstein Occupational Therapy Cognitive Assessment(LOTCA). Especially, LOTCA is a kind of cognition assessment method in 1989 which was published by Israeli Hebrew University Loewenstein Hospital Rehabilitation Center. Compares with the other methods, Its biggest characteristics is to lead several occupational tasks into the cognition assess and have the advantages of effective affirmation, simple operating and clear entries. Its excellent reliability and validity had be confirmed extensively in many countries. Currently, the LOTCA researchers have manufacturedthe second version from the foundation of the first version. The second version LOTCA include Orientation,Visual perception, Spatial perception, Motor praxis, Visuomotor organization and Thinking operations 6 domains. The test Sub-item also increased from 20 items of the first Version to 26 items of the second Version. But there are some disadvantages in the second version LOTCA. For examples, it is much longer to use LOTCA during the clinical work, the pretermission and mistake come out frequently in the assessing process and the artificial test equipment depreciate quickly too. However applying the computer and suitable software system to the LOTCA should be a valid pathway for resolving above these problems.At the same time, the rehabilitation scale convert into the application software have became a kind of trend in the medical realm accompanying with the medical realm informatization and the popularization of computer. For this reason, we conceive to cooperate with the software engineer to develop the second version LOTCA test tool to be a Chinese computer software test system. It can be applied in the patients who got the brain disease to accept to the test of the reliability and validity. At the same time, it should be discussed the possible advantages of this software system comparing with the original one for providing the new method and way of clinic cognitive assess. [Purpose]1. Development of a Chinese computer application software of LOTCA and providing the platform to communicate people with the computer during the assessing cognition.2. Research on the reliability and validity of the LOTCA computer application software and its potential advantages compare to the original version for supplying the theories to expand its utilization in clinic.3. Building up the file of cognition data of the Chinese patients with brain disease to offer the technique support for the clinic research.[Method] 1. The Compilation of the softwareThe workgroup is made of 4 physiatrist who master in the LOTCA and 1 software engineer, 3 physiatrist according to the thoughts and method of the LOTCA to make it convert into the computer technological process separately adopting the blind method, another physiatrist (senior clerk) will do the compare and analysis alone and organize each member discussion for the different article to draw up the first process and the back up process. The software engineer convert the technique progress into the initial edition of Chinese computer software of LOTCA.2. The debugging of the software19 patients with brains disease such as brain injury, cerebrovascular disease, brain tumour become the research object firstly while the initial edition software have be produced, they will be test by the LOTCA computer software (Computer version) and the artificial original version (Original version) successively. The patients will answer the question and give the feedback to tester after each testing. The method of the test is: Divide the research object into 2 groups(A&B) randomly, the group A would be tested with the original version firstly and be tested with computer version after 2 weeks, by contraries the group B would be tested with the computer version firstly and be tested with original version test after 2 weeks.After getting the result of test, the workgroup will compare the scores of all entries between computer and original version test to analyze the criteria validity of computer version. The scores of items which have low correlation with original version will be recomposed and debugged. At the same time, the initial edition of software will be perfected according to the feedback of testee and become to be the formal version.3. The reliability and validity of the software and its advantagesThere are 45 testees who got the brain disease (patient group) to be researched by the formal computer version have be produced. They have be divided into the group A and B randomly and followed the method of the first test to do the computer and original version test. After each test, they would answer the questionnaire. Group A would be accepted the computer version test again after 2 weeks to check upthe test-retest reliability. At the same time let 44 persons (control group) who have no brain disease become the test object. The control group do the same test with the original and computer version successively according to the random cross test method of patient group and answer the same questionnaire. When received the test result, the criteria validity of the computer version was analysed again, it also must be compared with the scores of computer version test between the patient group and control group to check up the discriminant validity. According to the questionnaire result, compare to the test time, the tired degree during the examination and choose ratio by the testee between computer version and original version test in 2 groups to analysis for the advantages of the computer version. [Result]The 19 testee have received the first test when initial version of LOTCA computer software has created. The result showed the total scores of computer version and original version had high correlation(r=0.970, P<0.01), scores of most items between the two version also had high correlation (r=0.682 — 0.960, P<0.05 ). but except below items: Copying Geometric Forms (r= 0.269, P = 0.266), Plain Block-Design (r= 0.437, P=0.061) and Drawing a Clock (r= 0.408, P=0.083) . However, the Wilcoxon singed rank test showed there is no obvious difference between the scores of all entries between the version test( Z=0.312 —1.897, P>0.05).After the computer version has been recomposed and debugged according to the first test, 45 patient cases and 45 control cases in total 90 testees were received the test by the computer and original version respectively. Among these testees there are 4 patient cases and 1 control cases missing the test. The rest of them complete the original and computer version test follow the criterion. The data of those cases who miss the test be deleted in statistics analyse.The second examination of criteria validity showed not only the total scores but also the scores of all items had the high correlation (r=0.608—0.983, F<0.01) . otherwise, Wilcoxon singed rank test showed that there is no significant difference on the every items of scores between the two version test between 41 patient cases and44 control cases. (Z=0.227—1.807, P>0.05) .Compared to the scores of computer version test with Mann-Whtiney U test showed there were significant differences( Z = 4.802 - 8.301, P<0.01)between patient group and control group.It proved that the computer version LOTCA had the good discriminant validity.20 cases from the patient group A to do the computer version test again after 2 weeks and found there were high correlation between the scores of two computer version test (r=0.805—0.952, P<0.01) and the Wilcoxon singed rank test showed that scores of each items between two tests had no significant differences (Z—0.378— 1.732, P>0.05), It reflected that computer version test had good test-retest reliability.There were 85 research objects complete all test during this research. The control group and patient group average test time of the computer version is 1864±185s and 2243±197s respectively. The control group and patient group average test time of the original version of is 2506±195s and 2990±360s respectively. The paired — samples t test showed whatever control group(t=26.75)or patient group (t=13.05), the average test time of computer version is observably lower than the original version (P<0.01).It is issued 90 questionnaires in this research and taking back 85 valid feedbacks. (The rate of feedback is 94.44%).After the test of the computer version and original version, let the two groups of testees grade the tired degree in the testing process respectively. 1 mark is no tiredness and 5 marks are exceeding tiredness. In the feedback of the questionnaires, the control group and petient group marked the tired degree of the original version 3.34±0.99 and 3.22±1.06 respectively. However, they marked the computer version are 2.30±0.90 and 2.51±1.00 respectively. The Mann-Whtiney U test showed that whatever control group(Z=4.76) or the patient group(Z=3.125), the tired degree marks of the computer version is much lower than the original version during the testing process(P<0.01).In the questionnaire, there is a question that is if you will receive another LOTCA test, which version you would like to receive. 70 out of 85 testees(82.35%)would choose the computer version including 34 testees from the patient group(82.93%) and 36 testees from the control group(81.82%). The x 2-test showed that there is no significant difference on the choice rate of computer versions between the tow groups ( x2=0.018, P>0.05) . Otherwise, 38 out of 85 testees had the experience of using the computer and 31(81.58%) among these cases choose computer version testing. 39 (82.99%) out of the rest 47 testees who had no experience of using the computer choose the computer version testing. The x 2-test indicate that whatever cases had used or never used the computer, there is no obvious influence for them to choose the computer version ( x 2=0.028, P>0.05) .[ Conclusion ]The Chinses computer software of LOTCA which had be compiled in this research had satisfying retesting reliability, criteria validity and discriminant validity in Chinese patients with brain injure and cerebrovascular disease, compare to the original version of LOTCA it can decrease the test time and reduce the test tiredness, so it is worth being research continuously and use widely in the clinic. |
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