The Sensory Modality Assessment and Rehabilitation Technique (SMART): a valid and reliable assessment for vegetative state and minimally conscious state patients.
OBJECTIVE
To establish the reliability and validity of the Sensory Modality Assessment and Rehabilitation Technique (SMART) as a tool for discriminating awareness in patients with profound brain damage.


METHODS
A comparative prospective study was conducted.


METHODS
Sixty subjects diagnosed in vegetative state (VS) on admission were assessed at 2-monthly intervals. Rancho level ratings derived from referring physicians, SMART and Western Neuro Sensory Stimulation Profile (WNSSP) scores were compared.


RESULTS
The intra-observer intra class correlation (ICC) was 0.97 and inter-observer ICC was 0.96, implying very little within and between observer scoring variations. A modest, although significant correlation was established between SMART and either physician or WNSSP scores. However, the correlation between the WNSSP and SMART was higher (r = 0.70) than that between WNSSP and physicians scores (r = 0.451) or between SMART and physicians (r= 0.474).


CONCLUSIONS
SMART is a valid and reliable assessment for discriminating awareness in VS and Minimally Conscious State (MCS).
Gill-Thwaites
H
H
Occupational Therapy Department, Royal Hospital for Neuro-disability, London, UK. hgill@rhn.org.uk
Munday
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001364:Awareness / Q000502:physiology; D001519:Behavior / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015588:Observer Variation; D018458:Persistent Vegetative State / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D015203:Reproducibility of Results; D012677:Sensation / Q000502:physiology; D012720:Severity of Illness Index