Low Awareness and Impaired Consciousness

A patient in the vegetative state appears to be wakeful, with cycles of eye closure and opening resembling those of sleep and waking but there is no sign of awareness or of a functioning mind. There is no evidence that the patient can perceive the environment or his/her own body, communicate with others, or form intentions. Usually the patient can breathe spontaneously and has a stable circulation.

Services offered for Low Awareness

St Cyril's Rehabilitation Unit offers the Sensory Modality Assessment and Rehabilitation Technique (SMART) a comprehensive assessment and treatment tool developed specifically for identifying awareness in vegetative state (VS) or minimally conscious state (MCS) patients following severe brain injury.

Patients in low awareness states are often difficult to diagnose. Their behaviour may suggest they are not aware of themselves or their environment. Unless provided with a comprehensive and structured assessment, meaningful responses can be missed, leading to misdiagnosis. The SMART assessment tool was developed in order to provide the best opportunity to demonstrate a patient's awareness and to enable them to communicate their needs. It is carried out by an accredited assessor who conducts a formal assessment using an extensive range of techniques to analyse and record the patient's behavioural repertoire, responses to a series of sensory modalities, functional ability and level of wakefulness.

A unique feature of the SMART assessment tool is the involvement of relatives, friends, carers and other members of the multidisciplinary team. Their feedback and observation of behaviours are incorporated into the final analysis. The tool provides a standardised approach ensuring that all potential abilities are fully explored, functional and communication capacity is optimised so that an accurate diagnosis is made and an effective rehabilitation programme is formulated to optimise the patient's potential.