07 July 2017
Service users within our complex neuro-rehabilitation homes benefit from high nurse to service user ratios, with SMART assessments and ongoing SMART treatment
programmes to ensure their care plans are personally developed and monitored to ensure they achieve their individual goals.
The Sensory Modality Assessment and Rehabilitation Technique (SMART) is a unique standardised assessment used to support people with disorders of consciousness following severe brain injury and can be used across the broad spectrum diagnosis of Vegetative State and Minimally Conscious State. SMART has been designed to fully explore any pre-diagnostic conditions which may impact on the person’s ability to demonstrate their full potential, elicits behavioural responses to a comprehensive range of stimuli in the SMART formal assessment and fully investigate the family/teams’ observations of the person.
SMART is recommended in the Royal College Physician national clinical guidelines for people in Prolonged Disorders of Consciousness (2013) as a tool of choice in the assessment of adults in prolonged disorders of consciousness.
Glenside has an accredited SMART assessor who can identify the type and quality of behaviours and sensory responses seen and provides a bespoke structured treatment plan to ensure all findings are fully explored and responses enhanced, to both identify evidence of awareness and optimise the person’s potential for both communication and motor function activity. A programme to educate the team and the family/carers is also implemented, where required.
A service user was admitted to Glenside 18 weeks post injury following a road traffic collision. The SMART was used to provide a base line diagnosis. This assessment gave an indicative diagnosis of vegetative state. However, within the visual functioning there were singular unverified occurrences of tracking and focusing. A programme of visual activities were put together using a spectrum of visual stimulus which supported the service user’s emergence from vegetative state. After eight months, the service user was able to communicate using movements of her head, turn pages in a magazine and show pleasure through smiling.
Our Activities Organiser’s on the unit liaise with each of the families to understand what activities their family member previously enjoyed and aim to take each service user out for regular external community trips, aiming for a minimum of one trip a month.
Our Activities Organiser’s facilitate the service user’s participation in a wide range of on-site activities, including newspaper reading group, film afternoon, art group, manicure sessions amongst other activities. This may include spending time in our various outdoor communal gardens, or enclosed patio space which has been planted with a range of flowers, herbs and vegetables chosen and planted by some of the service users to provide a safe, relaxing outdoor environment.
A sensory room has been created which provides a controlled environment for people with disorders of consciousness where prescribed stimulus can be applied to elicit or enhance responses. The person supported by the multidisciplinary team can draw on tactile, visual, olfactory, auditory, vestibular and proprioceptive sensory equipment. It provides an environment where findings from SMART and other assessments can be further explored to enhance the potential of the people we support.