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New technique helps to assess vegetative state

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7255.196 (Published 22 July 2000) Cite this as: BMJ 2000;321:196
  1. Zosia Kmietowicz
  1. London

    Doctors and relatives of patients with brain injury can now determine more accurately whether they have any awareness thanks to a technique developed by staff at the Royal Hospital for Neuro-Disability in London.

    The sensory modality assessment and rehabilitation technique (SMART), which took 10 years to develop, is the brainchild of occupational therapists in the brain injury unit at the hospital. Dissatisfied with the lack of a standardised tool for assessing patients with brain injuries, they set about making their own.

    In 1996 a study showed that after assessment with SMART 43% of the patients who had been admitted to the brain injury unit and believed to be in a vegetative state had been wrongly diagnosed (BMJ 1996; 313:13-6).

    Dr Keith Andrew, director of medical and research services, who carried out the study, commented: “The slow-to-recover patient is often incorrectly labelled as being in vegetative state. Although aware of their surroundings, they are unable to communicate their needs whatsoever. As a consequence, patients' potential for recovery and interaction with their environment is not identified, and they may spend a lifetime trapped in a damaged body, with poor quality of life.

    “The frustration of understanding what is being said and done around them, but being unable to express their needs and thoughts or indeed respond in any way has been described by patients whose potential to communicate was unlocked by SMART.”

    The technique, which has been refined and developed over the past four years, provides a structured sensory programme that records patients' response to sensory and environmental stimulation over two weeks. If they respond in a consistent and meaningful way it will be picked up. Means of communicating with the patient can then be set up that improves their quality of life.

    The programme encourages relatives and carers to participate in the assessment, often giving them greater purpose at a time when events seem out of their control.

    The SMART kit will be available to other hospitals by the end of the year. About 1500 patients in the United Kingdom are thought to have been in a vegetative state for more than three months.

    For more information see http://www.smart-therapy.org.uk/


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    Physiologist Professor Frances Ashcroft of Oxford University and artist Benedict Rubbra collaborated to produce this abstract painting of insulin secretion now on show at the University Museum of Natural History, Oxford. The subject of Professor Ashcroft's research is the release of insulin from the b cells of the pancreas in response to sugar in the bloodstream. Rubbra created two paintings, which symbolise “the unfolding drama of the living cell at work,” after conversations with Professor Ashcroft and visits to her laboratory. The exhibition continues until 31 July.

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