Gill-Thwaites and Elliott, the originators of the SMART assessment used to determine the extent of PDOC across the range of persistent vegetative state (PVS) and minimally conscious state (MCS). They are often asked to make assessments of patients whose overall clinical management is sub-optimal. This can make it difficult for patients to response to stimulation and therefore makes the SMART assessment process less effective.

They find that a specialist medical assessment is required but that this is difficult to arrange given the lack of available neurological rehabilitation physicians.

National Neurological Rehabilitation Chambers is responding to this need by offering its members to ensure:

* no ongoing acute medical condition e.g. respiratory, urinary or soft tissue infection,

* optimization of chronic condition management e.g. seizures or pituitary dysfunction,

* minimization of potential stimuli to pain e.g. contractures, spasm and heterotopic ossification,

* minimization of the use of sedative medication used in pain, spasm and spasticity management,

* due consideration to the incidence of non-brain injury primary pathology e.g. cancer and heart disease.