Smart Way To Diagnose Vegetative State

Tuesday, 08 August, 2000

A Smart kit that diagnoses whether brain damaged patients are capable of communicating or are in a permanent vegetative state (VS) has been developed at London's Royal Hospital for Neuro-disability.

The Sensory Modality Assessment and Rehabilitation Technique (Smart) kit tests patients over a two-week period for the five senses as well as movement, communication and wakefulness. The kit also monitors the patient's ability over 24 hours to demonstrate a consistent, meaningful and functional response to stimuli.

Under trial, the Smart kit has had success in enabling patients believed to be in a permanent VS state to communicate with their families. In a sample survey, researchers found that 43% of brain-injured patients had been misdiagnosed.

Although there are many types of VS, the ailment is usually divided into three categories: congenital, degenerative (usually in the elderly where VS is preceded by dementia and followed by coma) or acute onset.

The Smart kit is based on a protocol that requires a Smart assessor (usually a senior occupational therapist), a multidisciplinary team and the patient's friends and relatives to record and evaluate patient response to sensory and environmental stimuli over an intense 24 hour period. As well as test cards, assessment forms and treatment monitoring for assessors, a sensitive buzzer is used to assess patients' reactions. The button is placed under the chin if they are only opening and closing the mouth, or against the temple if the patient can turn the head from side to side. Patients can also be taught to respond by blinking their eyelids.

Once the assessment is made, a rehabilitation program is devised involving occupational therapists, speech therapists and psychologists.

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