Kessler Foundation Neglect Assessment Process Uniquely Measures Spatial Neglect During Activities of Daily Living

Abstract

Objective To explore the factor structure of the Kessler Foundation Neglect Assessment Process (KF-NAP), and evaluate the prevalence and clinical significance of spatial neglect among stroke survivors. Design Inception cohort. Setting Inpatient rehabilitation facility (IRF). Participants 121 participants with unilateral brain damage from their first stroke were assessed within 72 hours of admission to an IRF, and 108 were assessed again within 72 hours before IRF discharge. Interventions Usual and standard IRF care. Main Outcome Measures During each assessment session, occupational therapists measured patients’ functions with the KF-NAP, Functional Independence Measure (FIM™) and Barthel Index (BI). Results The KF-NAP showed excellent internal consistency with a single-factor structure. The exploratory factor analysis revealed the KF-NAP to be unique from both the FIM and BI even though all three scales were correlated. 67.8% of the participants at admission and 47.2% at discharge presented with symptoms of spatial neglect (KF-NAP > 0). Participants showing the disorder at IRF admission were hospitalized longer than those showing no symptoms. Among those presenting with symptoms, the regression analysis showed that the KF-NAP scores at admission negatively predicted FIM scores at discharge, after controlling for age, FIM at admission, and length of stay. Conclusions The KF-NAP uniquely quantifies symptoms of spatial neglect by measuring functional difficulties that are not captured by the FIM or BI. Using the KF-NAP to measure spatial neglect, we found the disorder persistent after inpatient rehabilitation, and replicated previous findings showing that spatial neglect adversely affects rehabilitation outcome even after prolonged IRF care.

Impact of Spatial Neglect on Stroke Rehabilitation: Evidence From the Setting of an Inpatient Rehabilitation Facility

“…This disorder occurs in approximately 50% of right brain-damaged and 30% of left brain-damaged stroke survivors. 1 Individuals with disordered spatial cognition, which can affect perception and mental representation of spatial information, as well as planning and execution of motor actions, demonstrate failure or slowness to respond, orient, or initiate action towards contra-lesional stimuli, 2 and they may have difficulty in generating contra-lesional mental imagery. 3 Although features of spatial neglect may vary between individuals, the clinical syndrome is defined by deficits that disrupt functions essential in daily life, such as mobility (walking, 4,5 wheelchair use, 6 and driving), 7 reading, 8,9 or appropriate social interactions.…”

Reliability and Validity of the Korean Kessler Foundation Neglect Assessment Process

“…Although these tests are clinically popular, they have limitations in assessing unilateral spatial neglect in patients' daily living, and it is difficult to diagnose unilateral spatial neglect related to auditory, proprioceptive, or motor functions [11]. For this reason, the tests used to confirm the presence of hemispatial neglect in the clinical setting have a low sensitivity, and clinicians show low consistency in their assessments [14].…”

“…The KF-NAP is an assessment tool for hemispatial neglect developed by the Kessler Foundation by modifying and complementing the CBS [11]. Because this tool was developed for use in the western countries, adaptation and standardization for use in Korea is needed.…”

“…The severity of neglect is determined (absent, mild, moderate, or severe) based on the final score [11]. Statistical analysis was performed using SPSS 17.0 (SPSS Inc., Chicago, IL, USA).…”

“…The KF-NAP addresses the limitations of the CBS, and assesses the perception of left and right space and asymmetrical behaviors by directly observing patients while they voluntarily explore space with eye and head movements in their daily lives. The KF-NAP has been reported to not only assess daily living functions, but also the presence and severity of spatial neglect, and to predict independent functional outcomes at discharge [11]. Thus, we aimed to develop the Korean version of the KF-NAP, which enables a more functional assessment of unilateral spatial neglect, through Korean translation followed by statistical standardization.…”