The Sensory Modality Assessment and Rehabilitation Technique (SMART)

SMART is an award-winning standardised, clinical investigative tool, pioneered at the RHN, by Helen Gill-Thwaites MBE, Dr Karen Elliott and Ros Munday MBE

The SMART has been clinically designed and developed for the assessment and rehabilitation of people with prolonged disorders of consciousness following severe brain injury. It is an extended detailed assessment and investigation of behavioural responses, culminating in a measurable intervention and or management strategy. Its precision has made it one of the assessment tools of choice as recommended in the Royal College of Physicians (RCP) national clinical guidelines (2020).


  • Consists of ten behavioural observation assessments (at rest) and ten extensive sensory assessments carried out over a one-to-three-week period.
  • Is applied by the same accredited SMART assessor who adheres to the SMART standards of practice and meets the RCP guidelines (2020) criteria of expert PDOC assessor.
  • Identifies any potential awareness in adults with severe brain damage who are in a vegetative state and identifies the functional and communication capabilities of patients in a minimally conscious state.

SMART is the only tool currently available that:

  • fully investigates external factors such as positioning, time of day, routine and influences on fatigue
  • Includes, documents and compares observations of responses and perspectives of the family, carers and multi-disciplinary teams.
  • Places all responses on a diagnostic spectrum and carefully identifies the quality of responses within each diagnostic criterion to allow for careful analysis of trajectory, to support future intervention and management plans and support best interest meetings.

SMART full version April 2024

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

The SMART accreditation process has been developed to ensure competency in the application of SMART and comprehensive knowledge and skills working with the PDOC patient to maintain the SMART standards of practice and meet the expert PDOC assessor specification outlined in the RCP guidelines (2020).

Who can apply for the three-day training course?

  • occupational therapists
  • speech and language therapists
  • physiotherapists
  • clinical psychologists
  • nurses
  • physicians
  • clinical researchers

Requirement to be accredited as a SMART Assessor

In the process of developing and standardising SMART and considering the research regarding misdiagnosis in PDOC, it became apparent that valid and reliable administration and accurate interpretation of SMART results require a specified degree of competency. This is now also reflected in the specifications of competencies for all assessors working with the patient with a Prolonged Disorder of Consciousness (PDOC) stated in the Royal College of Physicians guidelines (RCP2020).

SMART is the only standardised assessment of the PDOC patient which requires mandatory training to ensure the RCP competencies are fully met. Therefore, to become a registered SMART Assessor the following criteria must be met:

  1. The minimum requirements outlined in the SMART Assessor Person Specification
  2. Mandatory attendance of a SMART Course
  3. Completion of the SMART Accreditation process following a SMART Course
  4. Re-accreditation as SMART Assessor demonstrating evidence of application of SMART during registration period
  5. Meeting the SMART Standards of Practice

The SMART course has been developed to provide the SMART assessor with the relevant skills and knowledge to learn how to conduct the SMART Assessment to a competent standard. In addition, attendees will also become more familiar with and skilled in the observation and assessment of this client group. The course has therefore been designed to:

  •  Increase awareness of the relevant terminology
  • Optimise understanding of the principles and considerations for assessment of the Vegetative state (VS) and Minimally Conscious state (MCS) patient.
  • Identify responses observed in patients in VS and MCS
  • Develop the ability to categorise the level and meaning of these responses.
  • Develop competency with the application of all aspects of SMART processes
  • Examine the SMART processes for inclusion of the family’s knowledge and perspectives
  • Practice the analysis of SMART data and methods of presentation
  • Construct a clinically relevant intervention and management plan derived from evidence gained in the assessment and investigation period.

SMART Accreditation and Reaccreditation Process and SMART Assessor Standards.

Please check our events section for upcoming training dates.

A summary of the course by Helen Gill and how they are linked together
If you need further details on the SMART assessment tool, training courses and kits, please contact:

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