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

Objectives: 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: Participants (N=121) 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 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 3 scales were correlated. Symptoms of spatial neglect (KF-NAP>0) were present in 67.8% of the participants at admission and 47.2% at discharge. 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 FM 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. (C) 2015 by the American Congress of Rehabilitation Medicine