Resumo
SMART an internationally recognized assessment, treatment
and diagnostic tool - Empowering OTs in Disorders of Consciousness.
Helen Gill- Thwaites
The Sensory Modality
Assessment and Rehabilitation Technique (SMART (1), is a validated,
internationally recognised assessment and treatment tool, designed by
Occupational Therapists (OTs), to detect evidence of awareness, optimise
communicative and functional potential and provide a suggested diagnosis for
patients with Disorders of Consciousness (DOC) following brain injury.
In a study investigating rates
of misdiagnosis (2) SMART identified awareness in 43% of patients deemed to
have been in Vegetative State by physicians using their own assessments
processes. The Royal College of Physicians guidelines (3) heralded SMART as a
tool of choice when physicians were “in doubt” over their diagnosis, in cases
considering withdrawal of nutrition and hydration.
Evidence has
indicated that in order to optimise accuracy of assessment and reduce the
incidence of misdiagnosis (4) there is a need for the accredited SMART assessor
to optimise the patient’s environmental factors, such as their postural
management, observe and monitor meaningful behaviours over time and have the
ability and skill to facilitate active motor function.
Whilst SMART training is provided for experienced
allied health professionals from units worldwide, the historical foundations of
the profession demonstrate that OTs possesses the core skills required to
ensure a comprehensive application of SMART.
Mosey (5) described the professions’ five areas of performance
components as being sensory integration, neuromuscular, cognitive,
psychological and social interaction. Yerxa (6) emphasised the OT’s role as
“teasing out, facilitating and releasing the patient’s optimal potential”.
The benefit of
SMART as a mandatory aspect of assessment protocols for DOC patients worldwide
is evident. At the very least we may be condemning patients who are
aware, to inappropriate placement in a nursing home, with no opportunity to
communicate their needs for their entire lifetime. In some medico legal cases,
where withdrawal of nutrition and hydration is a consideration, an inaccurate
assessment and diagnosis can lead to more serious outcomes for a patient with
undetected awareness. OT as a profession has a
unique opportunity to utilise the SMART tool to play a key role worldwide in
the provision of robust assessment, treatment and diagnosis of the DOC patient
in the future.
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