Gill-Thwaites & Elliott Consultants Ltd

Our Services

Gill-Thwaites & Elliott Consultants Ltd is committed to the provision of a high quality, comprehensive service to meet the needs of the individual with a PDOC. Our consultancy can offer one-to-one consultation, assessment, treatment packages, and a range of training programmes for the carers and/or the team. Alongside advice and practical help, we can recommend other specialist services and resources, as required.

Our Services

  1. Medico-legal assessment/Assessment of awareness
  2. Sensory programmes
  3. Bespoke treatment programmes
  4. Monitoring and evaluating treatment or care programmes
  5. Advisory service
  6. Education and training packages
1. Medico-legal assessment/Assessment of awareness

We will undertake a thorough assessment of the individual’s level of awareness using a carefully selected standardised measure such as SMART. This tool provides extensive information on the individual’s current status in terms of responses to basic stimuli and those behaviours identified by the team and the family. The outcome of the assessment will provide a suggested diagnosis, differentiating between Vegetative State (VS), Minimally Conscious State (MCS), or those showing signs of emergent MCS. This information may be used to identify the individual’s level of awareness and potential ability, to allow case managers, specialist lawyers, and the associated care team to plan future requirements. Additionally, the results can be used to support the expert physician in cases where the withdrawal of artificial nutrition and hydration is being considered. We have undertaken a number of prominent medico-legal assessments and Expert Witness assessments identifying the level of awareness of individuals. These findings have contributed to the court’s decision on the issue of withdrawing artificial nutrition and hydration, and providing direction for future care planning to optimise the quality of life and potential for the individual.

2. Sensory programmes

Gill-Thwaites & Elliott Consultants Ltd will work with the family and the care team to devise a sensory programme, which helps to use daily activities and specific adaptations to the environment to produce the best conditions for the individual with a PDOC to respond. We liaise with the family and the care team to create a programme that integrates the individual’s likes and interests to provide balanced, structured and meaningful stimulation. An appropriate sensory programme will help family members and the care team to identify if responses occur and to recognise any changes that may arise in the individual’s level of awareness.

3. Bespoke treatment programmes

Our consultants are able to work with the family and the care team to provide an individual treatment programme that will focus on encouraging potential communication and functional movement of individuals who have been diagnosed as being in MCS. We work with the care team to build on the individual’s strengths, identified through assessment as being the most likely aspects to initiate a positive response. We involve the family in undertaking aspects of the programme, if appropriate. The programme will enable the care team and family members to be aware of any changes in the individual’s abilities and to monitor functional capability.

4. Monitoring and evaluating treatment or care programmes

For those individuals requiring long-term care, further assessments can be completed at set intervals to provide information for formal reviews or if a change in the individual’s awareness has been identified. Advice and educational programmes can also be delivered within the care setting to ensure that changes are monitored and optimum care environments are created. We are keen to involve families throughout the process to gain a full picture of the current and future needs of the individual.

5. Advisory service

Gill-Thwaites & Elliott Consultants Ltd specialises in the assessment, treatment and management of individuals in VS and MCS. We are able to identify the current and on-going client needs for this group of individuals. Through our advisory service, we can discuss your requirements and recommend the most appropriate specialist services for your client/patient or relative. An example of this might be a review of complex/bespoke seating, or an assessment by an expert technological assessor to identify the most appropriate means of communication and/or interaction with the environment. Our consultants can provide advice and/or an assessment to ensure the individual receives the best opportunities and care available.

6. Education and training packages

We have an extensive range of expertise in the assessment, treatment and management of individuals in VS and MCS, and are able to create learning packages suitable for professionals, support staff and families. In recognition of the requirements identified in the RCP guidelines (2013), for clinicians working with PDOC individuals to be appropriately trained, and for families and carers to be suitably informed, we can provide courses that are focused on your needs.


Gill-Thwaites & Elliott PDOC Learning Hierarchy

All education and training courses strive to build on knowledge, develop understanding of the environment and create reasoned, structured intervention. The courses are underpinned by the Gill-Thwaites & Elliott SMART philosophy, to facilitate the best possible opportunity and optimal environment for the individual with a PDOC, to fulfil their potential and receive high quality service provision.

We believe that:

  • Skilled intervention is founded on a robust knowledge base and an understanding of the impact of environmental factors
  • The care team have a responsibility to provide the optimum environment for the individual to respond
  • Assessors should be skilled in the recognition and interpretation of behavioural responses and understand the specific nature of assessment of PDOC
  • When appropriate, the family should be included in the programme of intervention receiving timely information to support their involvement and decision-making

Through our extensive experience, we have recognised that it is essential that the clinical and care teams contribute to the understanding of the individual’s awareness and responses. Careful observation of behaviour and provision of optimal conditions during interventions increases the accuracy of identifying defined behavioural responses and patterns of awareness. We are delighted, therefore, to offer innovative and unique courses in the observation and facilitation of responses in PDOC. We recognise the whole contribution of the team and, consequently, offer courses at different levels for professional staff and for support staff or families.


Module 1: Gill-Thwaites & Elliott PDOC Sensory Observer Course
- 1 day (click here for more information)

Module 2: Gill-Thwaites & Elliott PDOC Sensory Programmer Course
- 1 day (click here for more information)

These two courses can be taken individually, although it is necessary to have completed Module 1 in order to proceed to Module 2.


On completion of these two courses, you will have gained confidence in your ability to discriminate between the different levels of responses in the PDOC patient. We will provide you with a framework to monitor these observations to help you to record and promote these responses in everyday activities. You will also create a draft guidance document for working with this client group and establish the resources needed to provide a stimulating sensory programme and environment for your specific workplace. These two courses have been specifically designed to meet the assessor skill specification outlined in the Royal College of Physicians’ guidelines required for all professionals involved in the assessment of the PDOC patient. Attendance on these two courses is highly recommended to ensure effective use of standardised assessments for individuals with PDOC. To further your skills, it is recommended if appropriate to your working context, that you undertake the SMART assessors course.


These courses are suitable for Occupational Therapists, Physiotherapists, Speech and Language Therapists, Psychologists, Nurses and any professional involved in observation and interventions with individuals with PDOC. Relevant clinical fields that would benefit include those involved with brain injury, paediatrics, learning disabilities and dementia care.


Having achieved the learning outcomes for the course, you will possess the knowledge to ensure more accurate observation of this client group, and will have developed skills in the facilitation of responses within the optimum environments you have created. You will build upon your existing skills and begin to develop your ability to differentiate between behaviours recognising potential, and considering strategies for eliciting optimal responses from your patient. Your observation, facilitation and recording of responses will contribute to the objective evidence-gathering for your patient and complement the formal assessment conducted by the team.

You will:

  • Create working guidelines applicable to your patients/service, and be familiar with observation recording forms for structured and unstructured observations, and return with these to your workplace
  • Be confident in your ability to feed back objectively in meetings, or to the team, regarding levels and quality of responses
  • Have identified the resources that you need to facilitate responses and provide a stimulating environment for your patients
  • Be able to set up a patient-specific sensory programme, knowing how to adapt the programme for different patients’ needs
  • Have the chance to reflect upon your own abilities, and consider your development opportunities in observation facilitation skills and standardised assessment

1 day: Gill-Thwaites & Elliott PDOC Sensory Facilitator Course


The PDOC Sensory Facilitator Course has been developed to provide support workers or families with an awareness of the value of observation and recognition of the behaviours that need to be identified and recorded as part of a team. The course will also explore the potential for facilitating responses in everyday activity and consider the conditions that need to be created in order to enable potential responses to occur.


Mode of delivery: Presentation, workshop, small group work

Learning outcomes – by the end of the course the participant will be able to:

  • Discuss the importance of accurate observation over time and consider the challenges with this client group
  • Explain the strategies for approaching and communicating with an individual with a PDOC
  • Understand the range of observable motor and sensory responses of a person with a PDOC
  • Describe the responses observed during activities or at rest and record essential information
  • Recognise the roles of the MDT and contributions of the support worker and the family in gaining an accurate understanding of the pattern and quality of responses
  • Identify methods for facilitating the opportunity for the individual to respond in everyday activities

Please contact us for further details about these courses or any of the other training programmes that we offer.