Global Impact: The History of KF-NAP® Manual and Its Influence on Assessing Spatial Neglect

Adding comprehensive guidance and standardized methods significantly improved clinicians’ ability to effectively administer the Catherine Bergego Scale

By Diana Jordan, Assistant Digital Media Editor, Media/Communications Department

Picture of Peii (Peggy) Chen, PhD, senior research scientist — Peii (Peggy) Chen, PhD, senior research scientist, Center for Stroke Rehabilitation Research at Kessler Foundation.

In the world of stroke rehabilitation, early detection and measurement of spatial neglect, a common neurobehavioral disorder after stroke, can be crucial in determining effective treatment strategies. That's where the introduction of Kessler Foundation Neglect Assessment Process (KF-NAP^®) provided a significant leap in enhancing evaluation methods. Developed by Peii (Peggy) Chen, PhD, senior research scientist in the Center for Stroke Rehabilitation Research at Kessler Foundation, and Kimberly Hreha, EdD, assistant professor in occupational therapy, Duke University School of Medicine, KF-NAP has improved the way clinicians identify the presence and severity of spatial neglect in individuals who have sustained a brain injury due to stroke or other causes.

The roots of KF-NAP can be traced back to 2008 when Drs. Chen and Hreha were involved in a clinical trial utilizing the Catherine Bergego Scale as an outcome measure. Originally developed by a team of researchers in France, this scale includes a checklist for clinicians to detect presence and extent of spatial neglect during observation of everyday life situations. However, Drs. Chen and Hreha soon realized the need for a more comprehensive guide to facilitate the administration and scoring process for using the scale.

The development of KF-NAP Manual stemmed from this realization. The goal was not to create a new scale, but to craft instructions on effectively utilizing the Catherine Bergego Scale. “Drawing from our knowledge in the field of spatial neglect, our approach focused on blending additional instructions and practical setup information seamlessly into the observation and scoring process,” stressed Dr. Chen. “The inclusion of comprehensive manual guidance could significantly improve clinicians’ ability to effectively administer the scale.”

“To develop these instructions, we reviewed each of the 10 assessment points included in the Catherine Bergego Scale, making note of what we felt was difficult to score with the original direction,” emphasized Dr. Hreha.

The positive impact of KF-NAP assessment process quickly echoed throughout the stroke and brain injury rehabilitation community, drawing the attention of clinicians worldwide. Over the years since its inception, lectures, courses, and workshops were conducted, fostering fruitful dialogues with clinicians, researchers, and student users, which helped shape the evolution of KF-NAP Manual. The manual has been refined and edited to provide additional guidance, incorporating questions and suggestions from industry peers. Today, the resource is available in seven languages, including Italian, Korean, Japanese, Danish, Greek, Czech, and Chinese, ensuring that clinicians across diverse cultures and regions can utilize KF-NAP Manual to detect and measure spatial neglect effectively.

Visit Kessler Foundation Learning Center to review the latest, newly revised 2023 KF-NAP Manual.