Repeated Clinical Assessment Using Sensory Modality Assessment and Rehabilitation Technique for Diagnosis in Prolonged Disorders of Consciousness.

Purpose: The recommended way to assess consciousness in prolonged disorders of consciousness is to observe the patient's responses to sensory stimulation. Multiple assessment sessions have to be completed in order to reach a correct diagnosis. There is, however, a lack of data on how many sessions are sufficient for validity and reliability. The aim of this study was to identify the number of Sensory Modality Assessment and Rehabilitation Technique (SMART) assessment sessions needed to reach a reliable diagnosis. A secondary objective was to identify which sensory stimulation modalities are more useful to reach a diagnosis. Materials and Methods: A retrospective analysis of all the adult patients (who received a SMART assessment) admitted to a specialist brain injury unit over the course of 4 years was conducted (n = 35). An independent rater analyzed the SMART levels for each modality and session and provided a suggestive diagnosis based on the highest SMART level per session. Results: For the vast majority of patients between 5 and 6 sessions was sufficient to reach the final clinical diagnosis. The visual, auditory, tactile, and motor function modalities were found to be more associated with the final diagnosis than the olfactory and gustatory modalities. Conclusion: These findings provide for the first time a rationale for optimizing the time spent on assessing patients using SMART.

The role of occupational therapy in leisure adaptation with complex neurological disability: a discussion using two case study examples.

This article looks at the importance of leisure as a key principle within occupational therapy practice. A review of current literature and two in-patient case studies are used to discuss the role of the Occupational Therapist in adapting leisure occupations for individuals with complex neurological disability. The article highlights the use of leisure as an occupation through which therapeutic goals can be achieved. Goals should underpin leisure, enabling an individual to participate in their chosen leisure occupations. It is recognised that there is importance in using a client-centred approach to ensure that meaningful occupations are used and that the occupation fits the needs of the individual and not the other way around. Working in this way, there is a benefit to individuals, assisting them to cope with loss and the onset of disability and also preventing occupational deprivation.