Comparison of SMART and WHIM as measurement tools in routine assessment of PDOC patients

ABSTRACT

Background: Royal College of Physicians guidelines on PDOC recommended repeated assessments of patients in PDOC are undertaken by skilled clinicians. The Wessex Head Injury Matrix (WHIM) and the Sensory Modality Assessment and Rehabilitation Technique (SMART) are the most commonly used measures within UK.

Objective: To evaluate the use of WHIM and SMART to identify potential changes in PDOC patients.

Methods: Twelve PDOC patients admitted to a post-acute regional neuro-rehabilitation unit were assessed using WHIM and SMART. Eight of 12 patients were diagnosed with a primary hypoxic ischemic brain injury (HIBI).

Results: Overall for the total group there was no significant correlation between patient’s highest ranked behaviour and any SMART domain. Initial WHIM total observed behaviour was significantly correlated with SMART tactile domain. Patient’s final WHIM and SMART domains were not significantly correlated. Among HIBI subgroup, initial WHIM highest ranked behaviour and WHIM total observed behaviour were significantly correlated with the SMART communication domain. Final WHIM highest ranked behaviour was positively correlated with SMART visual and tactile domains. Final WHIM total observed behaviour was significantly correlated with the SMART visual domain.

Conclusions: Both measures show sensitivity to change in PDOC patients. Larger long-term follow-up of HIBI patients is highlighted.

KEYWORDS:

• PDOC
• brain injury
• Wessex Head Injury Matrix
• SMART

Acknowledgements

The help and support of Dr Donncha Hanna, Lecturer in the School of Psychology, Queen’s University Belfast is gratefully acknowledged. At the time of file audit and data collection, the first author was a Trainee Clinical Psychologist based at Queen’s University, Belfast on clinical placement in the Regional Acquired Brain Injury Unit.

Disclosure statement

The second author is involved in WHIM-II study.