Donate Now

SMART

The Sensory Modality Assessment and Rehabilitation Technique (SMART)

The Sensory Modality Assessment and Rehabilitation Technique (SMART)

SMART is the only  prolonged disorders of consciousness (PDOC) assessment is an award-winning standardised, clinical investigative 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 It provides a comprehensive extended and detailed assessment and investigation of behavioural responses, culminating in a measurable intervention and/ or management strategy. It is clinically more sensitive 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) possess the  following unique features:

Frequent and  Time limited Assessment Phase – 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. 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 leading to misdiagnosis. Unlike other PDOC assessment 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  <https://nextcloud.rhn.org.uk/index.php/s/igs5PjcmMpXbMWk> 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 capabilities are identified to provide a more accurate diagnosis.

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 addresses all of these factors in the investigative process to ensure no stone is unturned in the assessment phase:

  • 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. 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 on diagnosis and provide a score of 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. 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.

SMART Assessors List <<link to latest List of Accredited SMART Assessors on website>> illustrates those accredited assessors, who can be contacted via their LinkedIn pages and who are able to conduct medico legal and/or interventions for PDOC patients:

SMART Assessor

Advanced SMART Assessor

Expert SMART Assessor

Master SMART Assessor

Course

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

Publication

A range of publications relating to SMART are available here:

Past neuro-research – Royal Hospital for Neuro-disability

Recent Neuro-research – Royal Hospital for Neuro-disability

Anna Harlow
Royal Hospital for Neuro-disability
West Hill
Putney
London SW15 3SW
tel 020 8780 4500 ext 5140
fax 020 8780 4569
email [email protected]