The sensory modality assessment and rehabilitation technique (SMART): a valid and reliable assessment for vegetative state and minimally conscious state patients

Primary objective: To establish the reliability and validity of the Sensory Modality Assessment and Rehabilitation Technique (SMART) as a tool for discriminating awareness in patients with profound brain damage. Research design: A comparative prospective study was conducted. Method and procedures: Sixty subjects diagnosed in vegetative state (VS) on admission were assessed at 2-monthly intervals. Rancho level ratings derived from referring physicians, SMART and Western Neuro Sensory Stimulation Profile (WNSSP) scores were compared. Main outcomes and results: The intra-observer intra class correlation (ICC) was 0.97 and inter-observer ICC was 0.96, implying very little within and between observer scoring variations. A modest, although significant correlation was established between SMART and either physician or WNSSP scores. However, the correlation between the WNSSP and SMART was higher (r = 0.70) than that between WNSSP and physicians scores (r = 0.451) or between SMART and physicians (r = 0.474). Conclusion: SMART is a valid and reliable assessment for discriminating awareness in VS and Minimally Conscious State (MCS).