Occupational therapy aims to help people to participate in the things they want and need to do through the therapeutic use of everyday activities. But what can an occupational therapist do for someone with a disorder of consciousness who cannot participate in meaningful activities?.
Assessment and diagnosis in disorders of consciousness (DOC): The Sensory Modality Assessment and Rehabilitation Technique (SMART) was developed by occupational therapists at the Royal Hospital for Neuro-disability it is both an assessment and treatment tool specifically designed to assess a person’s sensory, motor and communicative abilities through a graded assessment and regulated sensory stimulation programme. Using SMART the OT assesses the current level of consciousness; helps to get more consist movements and functional communication in people with a minimally conscious state; and also helps to differentiate between spontaneous and purposeful movement patterns for patients with severe neuro-disability. SMART is one of the tools recommended to assess people with DOC by the Royal College of Physicians Prolonged disorders of consciousness – national clinical guidelines (2013).
Treatment in disorders of consciousness: The OT will devise a specifically designed sensory programme with meaningful stimuli for each person. This programme is not only provided to help get a response but also to enrich a persons sensory world and to provide structured input. The sensory regulation programme optimises stimulation sessions with alternating resting periods.
Physical Management: Occupational therapists do range of movement exercises, splinting and casting of the arms and hands with people with disorders of consciousness. Occupational therapists also work with physiotherapists to choose an appropriate seating system, and devising bed and seating positioning guidelines. This postural management programme is designed to reduce or prevent neuromuscular complications such as tight and shift joints (contractures, spasticity) and prevent the bone from growing where it shouldn't be (heterotrophic ossification) that can appear after a severe brain injury.
LILIANA DA CONCEIÇÃO TEIXEIRA MSc
Occupational Therapist and Expert SMART Assessor