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A Priory Occupational Therapist discusses how his SMART® Assessor accreditation will benefit residents with severe brain injuries

Matthew Dowd, Occupational Therapist at Cleveland HouseMatthew Dowd, resident Occupational Therapist at Priory Adult Care’s Cleveland House, is now licensed as a SMART® Assessor, having recently undergone training with The Royal Hospital for Neuro-disability. Cleveland House is one of our Brain Injury Services located in Southport, which provides specialist residential support for individuals with an acquired brain injury, traumatic brain injury or prolonged neurological condition.

Matthew works with the residents at Cleveland House to help them access activities of daily living and communicate their needs, so they can progress on their journey towards rehabilitation, and achieve a higher level of independence.

“I applied to do the SMART® course, so that we could ensure we have the right toolkit to work with individuals whose consciousness has been severely affected by their brain injury,” says Matthew. “SMART® helps you develop an appropriate rehabilitation plan, and provides a better way of understanding the individuals we support.”

Understanding prolonged disorders of consciousness

Some of the people who live at Cleveland House have prolonged disorders of consciousness (PDoC). This means that their consciousness has been impacted by their brain injury. The severity of this can vary; some individuals in a PDoC state may be completely unresponsive to external stimuli, whereas others may show an inconsistent or minimal degree of responsiveness.

In cases where a person presents with a PDoC, it is important to develop a deeper understanding of that individual’s degree of responsiveness and awareness. This enables the professionals that work with the person to tailor treatment and support to their individual needs, giving them the best chance of emerging from the PDoC.

PDoC states are often considered a spectrum of consciousness, across which many individuals with a brain injury may fluctuate in presentation. This is one of the reasons why it can be difficult to assess a person’s level of consciousness by observation alone. Tools such as SMART® can be used to overcome these difficulties, giving a greater insight into a person’s awareness and their potential to communicate.


SMART® stands for ‘Sensory Modality Assessment and Rehabilitation Technique’, and is a standardised tool recommended by The Royal College of Physicians to assess individuals with a PDoC. The approach consists of ten behavioural observation assessments and ten extensive sensory assessments, carried out over a period of a few weeks.

In addition to the formal assessments, the assessment also involves an informal component, which considers the opinions of caregivers, family members and other stakeholders. Finally, the tool also requires the assessor to look at external factors which may affect the individual’s responses, such as their positioning, time of day and environmental factors.

The outcomes of the assessments enable the assessor to create a bespoke intervention and management plan, targeted around the person’s individual profile of responses. The assessor then works with the multidisciplinary team and care staff to implement all the recommended actions. The assessment can also be repeated, giving the assessor the opportunity to compare the assessments and note changes in the individual’s responsiveness over time.

Ian Watson, Home Manager at Cleveland House, says “Previously, the home had to use observation and clinical assessment to ascertain an individual’s awareness of their surroundings. This standardised tool gives them a score and enables us to predict an individual’s rehabilitation potential quicker.

“This allows Matthew, our Occupational Therapist, to make informed choices on what areas to focus on in the person’s rehabilitation, and provides measurable goals with which to track their progress.”

Benefits of SMART®

The training that Matthew has undertaken to gain his accreditation will have huge benefits for the individuals supported by Cleveland House. “Someone might come to us with the umbrella diagnosis of PDoC, but this doesn’t give an indication of what this person can do,” says Matthew. “SMART® pinpoints the different responses to sensory input, and their ability to engage in functional communication. This gives you an in-depth look into a person, providing a general overview of their rehabilitation potential.”

Additionally, this method means that the care staff and families are also involves in the initial assessment. “In SMART®, the assessments are not just based on my observations as the Occupational Therapist; families also are interviewed about behaviours they have noticed,” Matthew says. “I work quite closely with the family to get as much detail as I can to find out what responses they are noticing in their loved one.”

The results of the assessment also provide insights for the staff, informing that individual’s day-to-day care, as well as further work conducted within occupational therapy, and beyond. “What you’re trying to do is improve the person’s awareness of their surroundings, by building their tolerance for sensory input. If we can figure out what a person responds to best, we can do more work in this area,” explains Matthew. “It’s all about trying to improve their awareness of their environment so that they can engage with it.”

Achieving positive outcomes at Cleveland House

Now that Matthew is accredited to use SMART®, individuals that come to Cleveland House with a PDoC will be able to receive specialised support, tailored to their individual needs, faster. “I appreciate the support I got from Priory to do the course. I think it’s a benefit that anyone that works with PDoC patients,” Matthew says.

Matthew’s training isn’t the only new development at Cleveland House; the home has also recently started using a new piece of assistive technology within its occupational therapy programme. The home’s new Rainbow Digital Tablet, a large tablet with a 40-inch screen, can be used for everything from cognitive assessments to therapeutic activities.

Rachael Skinner, Activities Coordinator and Rehabilitation Assistant at Cleveland House says, “Having participated in a Zoom demonstration with the Rainbow Digital team along with Matthew, the many positive attributes of this device and the advantages it would bring to our residents became apparent.”

The new tablet is large enough to be used for group activities, and is accessible to individuals with visual impairments, as well as those with a variety of seating accommodations. The device will also be used for video-conferencing, enabling residents to stay in touch with family members, as well as connect with medical professionals.

Matthew and Rachael hope to make use of the many therapeutic apps available, which can help residents work on their cognition, motor skills and social interaction. “The ability to tailor activities to specific patients, or groups of patients, means that this device could provide another level of rehabilitation potential,” explains Rachael.

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For more information on the specialist services Priory Adult Care provides across the UK to support adults with a range of needs, please contact us today on 0808 208 2147. Alternatively, click here to complete a short enquiry form and we will get back to you as soon as possible.