SMART

The Sensory Modality Assessment and Rehabilitation Technique (SMART)

SMART is an award-winning standardised, clinical investigative PDOC assessment tool, pioneered at the RHN since 1987 by Dr Karen Elliott, Helen Gill-Thwaites MBE, and Ros Munday MBE. It was primarily designed specifically as a clinical tool for the assessment and rehabilitation of people with PDOC following severe brain injury. SMART provides a comprehensive extended and detailed assessment and investigation of behavioural responses, culminating in a measurable intervention and/or management strategy. It is clinically the most sensitive tool in diagnosis of the PDOC patient, having identified 40% more patients having awareness than the CRS according to the only clinical comparative study conducted by Godbolt et al( date (2012). It’s precision has made it one of the assessment tools of choice as recommended in the Royal College of Physicians (RCP) national clinical guidelines (2020).

Assessment of PDOC patients is defined as “Detective work at its Best” (Freeman (87) and SMART possess the following unique features:

Frequent and Time limited Assessment

SMART consists of ten behavioural observation assessments to devise a list of the patient’s behavioural repertoire at rest and to an extensive sensory assessments conducted over a defined time limited assessment phase of one-to-three-weeks only.

Accredited and consistent Assessor

SMART is applied by the same accredited and trained SMART assessor over these 10 SMART sessions, to ensure they are fully attuned to the patient’s frequency and reproducibility of responses. Other PDOC assessments are often conducted by a series of different assessors, sometimes with limited experience, resulting in the trends in the patients’ behavioural patterns and responses not being identified and leading to misdiagnosis. Unlike other PDOC assessments, the SMART assessor will have received mandatory training to help to meet the RCP guidelines (2020) criteria for PDOC assessor or Expert PDOC Assessor (dependent on clinical experience). This process ensures adherence to the SMART Standards of Practice and a proficient assessment.

Providing the widest range of stimuli to elicit optimal response

SMART provides the widest range of stimuli across all PDOC assessments to give the patient the best opportunity to demonstrate their responses. Any potential awareness of those patients defined as being in VS and MCS are fully explored, and all motor and communication responses are recorded in detail.

Capturing the widest range, level, and frequency of responses

The SMART assessment captures the fullest range of observed responses than other PDOC assessment and will defines the level and frequency of responses to help add accuracy ot diagnosis and provide a clear trajectory over time.

SMART is the only tool which adheres to the RCP guidelines (2020) to address and the following factors in the investigative process to ensure that no stone is unturned and nothing is left to chance in the assessment process:

External Factors – Fully investigates external factors which may impact responses, such as positioning, time of day, routine, and influences on fatigue for each session and records actions for any factors which need to be addressed in the future.
Involves family and Team – SMART Includes the families and teams’ observations and their knowledge of the individual from the beginning of the assessment phase. SMART investigates and compares observations of responses and perspectives of the family, carers and multi-disciplinary teams through comprehensive interviews and exploration of reported responses.
Provides both a diagnosis and placement on diagnostic spectrum – SMART places all responses on a diagnostic spectrum for VS,MCS-,MCS+ lower, mid, and upper MCS+ and investigate emergence from MCS+ for both motor and functional communication responses.
Comprehensive reports of level and frequency of response – SMART will not only report the level and frequency of responses, but will also provide a summary of all of the patients’ behaviours at rest and responses to stimuli . The information will define what the patient can do, to what stimuli, how they respond and how frequently they respond to illustrate the range and the quality of responses within each diagnostic criterion, rather than a broad diagnosis or score. It is only by doing so that careful analysis of trajectory of responses can be conducted.
Provides intervention and management plan – The comprehensive information from the assessment culminates in an intervention and/or management plan to provide clear guidance for teams, families, funders, case managers, and legal teams. Following a SMART assessment the team and family will know where the individual is placed on the PDOC spectrum, what responses have potential for exploration and or intervention and suggested programme changes, therefore supporting clinical decision making, resource allocation and best interest meetings.
Rather than a score, SMART provides clear answers to the best interest questions required for important decision making.

The SMART Assessors List Update October 2025 illustrates all accredited assessors, and those listed below can be contacted via their LinkedIn page and are able conduct medico legal and or interventions for PDOC patients.

Master SMART Assessor

Helen Gill-Thwaites (UK)

Please note you can also contact Dr Karen Elliott, Master SMART Assessor via Helen’s LinkedIn page.

Expert SMART Assessor

Kerry Anderson Kay (Australia)
Susanna Booysen (UK)
Alison McCann (Ireland)

Advanced SMART Assessor

SMART Assessor

Nicola Withey (Ireland)

List of SMART Accredited Units (who have more than one Accredited SMART Assessor)

Some Units have advanced assessor who do not need to reaccredit. Contact Units for more details.

Courses

The range of courses provided include the following and can be viewed on our website:

https://www.rhn.org.uk/events/

SMART Case Managers Course

Prolonged Disorders of Consciousness (PDOC) Observers Course for HCA, Carers and Rehabilitation assistants

Module 1: PDOC Observer Course – Advancement of MDT Skills in Observation and Analysis of Behavioural Responses”

Module 2: PDOC Assessors Course – Attainment of PDOC Assessors Skills and SMART Assessor Course – Assessor Training

Module 3: PDOC Assessors Course – Refining Assessment, Observation and Goal Setting Skills and Implementation of intervention and management strategies