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The Naturalistic Action Test: A standardised assessment for everyday action impairment

The Naturalistic Action Test (NAT) measures everyday action impairment associated with damage to higher cortical functions. The tasks, procedures and scoring system were developed through extensive research. An earlier research instrument (the Multi-Level Action Test) was streamlined to create the NAT, which is scored for steps accomplished and for commission of a small set of recognised errors. This paper describes the NAT's psychometric properties, based on a study of 100 patients undergoing rehabilitation for TBI, left CVA, or right CVA (Part 1) and a follow-up study with approximately half of the original cohort (Part 2). Psychometric properties with respect to scoring reliability, internal consistency, and concurrent criterion validity were measured in Part 1 and found to be acceptable. Construct validity was assessed against a battery of attention tests; significant correlations were obtained between NAT scores and measures of arousal, visuospatial attention, and working memory. Part 2 showed that NAT scores succeeded in predicting functional outcome above and beyond motor disability and age, and that it outperformed other tests in this regard, including those that measure specific attentional capacities. We discuss the potential uses of the NAT in the clinic and as a screening tool for research.