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Stroke Research - Network for Spatial Neglect

Spatial neglect is a debilitating neurocognitive disorder frequently occurring after a stroke with unilateral brain damage.  About 50-70% of right-brain-damaged stroke survivors and about 20-40% of left-brain-damaged stroke survivors present spatial neglect. This disorder is manifested with a failure to attend to, perceive, and/or respond to stimuli presented on the contralesional side of personal (body parts or on the body surface), peri-personal (within arm’s reach) and extra-personal spaces (beyond arm’s reach). Individuals with spatial neglect may also fail to generate or maintain a normal representation of the contralesional side of mental images.  Therefore, neglect patients with right-brain damage may leave their left limb hanging off of the wheelchair, forget personal belongings to the left of their current position, fail to dress themselves appropriately on the left side, care relatively less about their appearance on the left side, show gaze preference to the right side, present slowed or no reaction to sudden noises from the left, ignore food on the left side of the plate, and/or collide into furniture or a wall on the left side. Unfortunately, stroke survivors with spatial neglect are more likely to stay hospitalized longer and have worse rehabilitation outcomes than those without spatial neglect.

The Network for Spatial Neglect is an initiative developed by Dr. A. M. Barrett, Dr. Peii Chen, Ms. Kimberly Hreha, and Ms. Robin Hedeman, first presented in the 2011 annual conference of the American Society for Neurorehabilitation (ASNR). We aim to advocate the need for accurate detection of spatial neglect, for direct translation of research to practices, and for effective treatments tailored to people with various types of spatial neglect. In September 2012, our Kessler Foundation Neglect Assessment Process (KF-NAP™) was published in Topics in Stroke Rehabilitation. Since then, we have continued working on refining the assessment. In addition, we have established the manual and devices for the Kessler Foundation Prism Adaptation Treatment (KF-PAT™).


The Kessler Foundation now makes the KF-NAP™ 2014 and 2015 Manuals free. The KF-NAP™ 2015 Tutorial Video will be ready soon.


It is recommended that the KF-NAP™ be administered by trained individuals only. The KF-NAP™ may help clinicians to make a diagnosis related to spatial neglect.  The Kessler Foundation is not responsible for a clinical diagnosis.


The Kessler Foundation also makes the KF-PAT™ available to order for use in your facility or organization. Please contact us to find out how.


If you would like to know more about the KF-NAPTM, the KF-PAT™, and the related journal articles, please provide us with your information via the link “nsn application” on the left selection column of this webpage. That information will function as an application to obtain the login for downloading the material. 


You are welcome to contact us with additional questions.

Peii Chen, PhD, Project PI

Kimberly Hreha, MS, OTR, Stroke Clinical Research Coordinator

A.M. Barrett, MD, Stroke Rehabilitation Program Director


Research work leading to the KF-NAP™ and KF-PAT™ is supported by the National Institutes of Health (NIH/NINDS, R01NS055808; NIH/NICHD/NCMRR, K24HD062647) and the Department of Education/ National Institute on Disability, Independent Living and Rehabilitation Research and Rehabilitation Research (NIDRR, H133G120203). Contents in the manual do not necessarily represent the policy of the Department of Education, and one should not assume endorsement by the federal government.


Selected publications from our research team (in chronicle order):

Chen, P., Chen, C. C., Hreha, K., Goedert, K. M., & Barrett, A. M. (in press). Kessler Foundation Neglect Assessment Process measures spatial neglect during activities of daily living. Archives of Physical Medicine and Rehabilitation.

Barrett, A. M., & Muzaffar, T. (2014). Spatial cognitive rehabilitation and motor recovery after stroke. Current Opinion in Neurology, 27(6), 653-658. doi: 10.1097/wco.0000000000000148

Chen, P., Goedert, K. M., Shah, P., Foundas, A. L., & Barrett, A. M. (2014). Integrity of medial temporal structures may predict better improvement of spatial neglect with prism adaptation treatment. Brain Imaging and Behavior, 8(3), 346-358. doi: 10.1007/s11682-012-9200-5

Oh-Park, M., Hung, C., Chen, P., & Barrett, A. M. (2014). Severity of spatial neglect during acute inpatient rehabilitation predicts community mobility post stroke. PM&R. doi: 10.1016/j.pmrj.2014.01.002

Goedert, K. M., Chen, P., Boston, R., Foundas, A. L., & Barrett, A. M. (2014). Presence of motor-intentional aiming deficit predicts functional improvement of spatial neglect with prism adaptation. Neurorehabilitation and Neural Repair, 28(5), 483-492. doi: 10.1177/1545968313516872

Galletta, E. E., Campanelli, L., Maul, K. K., & Barrett, A. M. (2014). Assessment of neglect dyslexia with functional reading materials. Topics in Stroke Rehabilitation, 21(1), 75-86. doi: 10.1310/tsr2101-75

Chen, P., McKenna, C., Kutlik, A. M., & Frisina, P. G. (2013). Interdisciplinary communication in inpatient rehabilitation facility: Evidence of under-documentation of spatial neglect after stroke. Disability and Rehabilitation, 35(12), 1033-1038. doi: 10.3109/09638288.2012.717585

Barrett, A. M. (2013). Picturing the body in spatial neglect: descending a staircase. Neurology, 81(15), 1280-1281. doi: 10.1212/WNL.0b013e3182a82571

Shah, P., Spaldo, N., Barrett, A. M., & Chen, P. (2013). Assessment and functional impact of allocentric neglect: A reminder from a case study. The Clinical Neuropsychologist, 27(5), 840-863. doi: 10.1080/13854046.2013.783120

Barrett, A. M., Goedert, K. M., & Basso, J. C. (2012). Prism adaptation for spatial neglect after stroke: translational practice gaps. Nature Reviews Neurology, 8(10), 567-577. doi: 10.1038/nrneurol.2012.170

Chen, P., & Goedert, K. M. (2012). Clock drawing in spatial neglect: A comprehensive analysis of clock perimeter, placement, and accuracy. Journal of Neuropsychology, 6, 270-289. doi: 10.1111/j.1748-6653.2012.02028.x

Chen, P., Hreha, K., Fortis, P., Goedert, K. M., & Barrett, A. M. (2012). Functional assessment of spatial neglect: A review of the Catherine Bergego Scale and an introduction of the Kessler Foundation Neglect Assessment Process. Topics in Stroke Rehabilitation, 19(5), 423-435. doi: 10.1310/tsr1905-423

Das, A., & Chen, P. (2012). The eyes in the scanner: Latent conjugate eye deviation. Neurology India, 60(3), 343-344. doi: 10.4103/0028-3886.98536

Goedert, K., Chen, P., Botticello, A., Masmela, J. R., Adler, U., & Barrett, A. M. (2012). Psychometric evaluation of neglect assessment reveals motor-exploratory predictor of functional disability in acute-stage spatial neglect. Archives of Physical Medicine and Rehabilitation, 93, 137-142. doi: 10.1016/j.apmr.2011.06.036

Fortis, P., Chen, P., Goedert, K. M., & Barrett, A. M. (2011). Effects of prism adaptation on motor-intentional spatial bias in neglect. Neuroreport, 22(14), 700-705. doi: 10.1097/WNR.0b013e32834a3e20

Fortis, P., Goedert, K. M., & Barrett, A. M. (2011). Prism adaptation differently affects motor-intentional and perceptual-attentional biases in healthy individuals. Neuropsychologia, 49(9), 2718-2727. doi: 10.1016/j.neuropsychologia.2011.05.020

Goedert, K. M., Leblanc, A., Tsai, S. W., & Barrett, A. M. (2010). Asymmetrical effects of adaptation to left- and right-shifting prisms depends on pre-existing attentional biases. Journal Of The International Neuropsychological Society, 16(5), 795-804. doi: 10.1017/s1355617710000597

Hreha, K., Eller, M., & Barrett, A. M. (2010). Treating post-stroke spatial neglect: Establishing a clinical research-clinical partnership program. ADVANCE for Occupational Therapy Practitioners, 26(7), 16.

Barrett, A. M. (2009). Rose-colored answers: Neuropsychological deficits and patient-reported outcomes after stroke. Behavioural Neurology, 22(1-2), 17-23. doi: 10.3233/ben-2009-0250

Barrett, A. M., & McKenna, C. (2009). Hidden danger: Spatial neglect can complicate recovery after stroke. Advance for Directors in Rehabilitation, 18(10), 19-21.

Khurshid, S., Longin, H., Crucian, G. P., & Barrett, A. M. (2009). Monocular patching affects inattention but not perseveration in spatial neglect. Neurocase, 15(4), 311-317. doi: 10.1080/13554790902776888

Adair, J. C., & Barrett, A. M. (2008). Spatial neglect: Clinical and neuroscience review: a wealth of information on the poverty of spatial attention. Annals of the New York Academy of Sciences, 1142, 21-43. doi: 10.1196/annals.1444.008

Barrett, A. M., Buxbaum, L. J., Coslett, H. B., Edwards, E., Heilman, K. M., Hillis, A. E., . . . Robertson, I. H. (2006). Cognitive rehabilitation interventions for neglect and related disorders: Moving from bench to bedside in stroke patients. Journal Of Cognitive Neuroscience, 18(7), 1223-1236. doi: 10.1162/jocn.2006.18.7.1223


Updated by Peii Chen, PhD, March 3rd, 2015