Improving rehabilitation outcomes… Is food and nutrition the missing link?

Sheri is the Director of Specialist Nutrition Rehab and a Specialist Rehab Dietitian. Sheri leads a team of dietitians who provide comprehensive and cuttingedge medical nutrition therapy in the community for clients after a brain injury, spinal cord injury or orthopaedic injury.

How many of your clients have seen a dietitian since their initial hospitalisation? When someone is recovering from a brain injury or spinal cord injury, nutrition is not usually the first Sheri therapy to come to mind. However, eating habits and weight can have a massive impact on recovery, rehab potential and even the energy levels needed to engage with physio, neuropsychology and other forms of therapy. TOP 7 NUTRITIONAL CHALLENGES FACED BY CLIENTS AFTER A BRAIN INJURY OR SPINAL CORD INJURY:

dehydration, all of which can prevent the client from achieving their rehab goals. 1. Weight and body composition High levels of inflammation from the trauma, combined with insufficient calories or protein and reduced mobility, means many clients lose significant amounts of muscle mass in the first 3-6 months after their injury. As muscle mass is what burns the calories, clients then HERE’S WHY NUTRITION IS IMPORTANT… end up with calorie requirements as much as 50% lower than Think of your body like a house with a 24-7 live in their pre-injury levels. Many clients struggle to adjust to this renovation team. Anytime there is and many end up gaining significant a dent or something breaks down, After someone has amounts of weight in the years that your renovation team is there experienced a brain injury or follow. This not only affects their repairing the damage as quickly as possible. After someone has spinal cord injury, their body support package (eg. Do they need two support workers to transfer or one), but experienced a brain injury or spinal (or “house” in this analogy) also whether they need standard grade cord injury, their body (or “house” in this analogy) has been through has been through the or bariatric equipment. It also increases their risk of developing type 2 diabetes the equivalent of a hurricane. equivalent of a hurricane. and cardiovascular disease. There is cosmetic damage, structural damage and damage inside the “house.” As you can well imagine, the quality of the repair job that their renovation team is going to be able to do, will be highly 2. GUT ISSUES Abdominal pain and constipation are incredibly common after a major trauma. Nerve function to contingent on the building materials that the client makes the gut can be impaired and clients are often prescribed available to them. Are your clients consuming a diet high pain medication which contributes to constipation. in vegetables, fruit, protein, healthy fats and calcium-rich Combine this with a low fibre diet and inadequate fluid, foods? As these are the nutritional equivalent of high- and clients can end up extremely constipated and on quality building materials like brick, marble and high-quality multiple laxatives. Abdominal pain often comes from the paint. They provide key building blocks and materials which constipation itself, the laxatives and/or Irritable Bowel will help repair damage within the body. Syndrome (which often develops after a major stress or

Sadly, due to pain, fatigue and other issues, many clients trauma). This pain can prevent clients from engaging in end up consuming diets high in processed foods. These other forms of physical therapy. foods provide inadequate levels of the necessary building materials, such as protein, vitamins and minerals, needed to repair the damage. The consequence of this can be the development of nutrient deficiencies (such as iron 3. FATIGUE While many clients after a brain injury may experience neuro-fatigue, all clients should have the or vitamin D deficiency), reduced muscle mass and even following blood tests completed to make sure that other

medical factors are not contributing to the problem: full blood count, ferritin, urea and electrolytes, vitamin B12/ folate, thyroid function (including T3 and T4 for people with a brain injury), Hba1C (for blood sugar levels) and vitamin D. After all, you can have more than one thing wrong with you at a time. For example, you can have a brain injury AND you can have iron deficiency anaemia. You can have a spinal cord injury AND be deficient in vitamin D.

4. TASTE AND SMELL LOSS Taste and smell loss are incredibly common, particularly after a brain injury where the olfactory (smell) nerves are often damaged. Since the sense of smell actually provides over 70% of the flavour from food, a reduced or absent sense of smell results in food ‘tasting’ bland. Smell training, combined with compensation strategies that focus on stimulating the trigeminal nerve of the tongue, can help give clients some joy and pleasure with eating again.

5. HIGH BLOOD SUGAR LEVELS If a client loses muscle mass and gains significant amounts of body fat, their risk of pre-diabetes and diabetes goes up considerably. Even clients who are under the GP and on medication for diabetes, often still have high blood sugar levels (eg. routinely over 10mmol/L). High blood sugar levels can contribute to fatigue, challenging behaviour, urinary tract infections and slow would healing, not to mention cause permanent damage to the eyes, kidneys and nerves.

6. SLOW WOUND HEALING Skin is literally made out of nutritional building blocks, which means clients will need extra protein, vitamin C and zinc if their pressure sores (and other wounds) are going to heal. The dressings provided by the district nursing team will have a limited effect without adequate nutrition.

7. DYSPHAGIA Speech and Language Therapists are the ones who actually diagnose whether someone has dysphagia and determine if texture modified food or fluid are required. Dietitians can then help ensure that clients are consuming a varied, delicious and nutritious diet. Don’t let clients get stuck in a rut of mashed potatoes, yogurt and nutrition supplements. Texture-modified diets can be beautifully presented and delicious with the right advice and support. For more information, to make a referral, or to sign up for a free e-newsletter for case managers and solicitors, go to:

www.specialistnutritionrehab.co.uk.

WHEN AND WHERE TO REFER?

Nutrition can be quite an unregulated industry, with many people giving conflicting advice. “Dietitian” is a legally protected title which denotes someone has a degree in nutrition and is regulated by the Health and Care Professions Council around conduct, ethics and continuing professional development. Clients in need of nutrition advice after a brain injury or spinal cord injury, should be referred to a dietitian (NHS or private). This is so that their medical history, medication and blood test results can all be considered in combination with their eating habits. Here’s what case managers and solicitors should be looking for to know when to refer:

1. Is the client overweight, underweight or has there been an unintended weight change of 10% or more in the last 3-6 months?

2. Is the client experiencing any gut related issues, such as constipation, diarrhoea or abdominal pain?

3. Does the client have a chronic disease requiring nutritional management, such as diabetes or coeliac disease?

4. Does the client have excessive fatigue interfering with their rehab?

5. Does the client have taste and/or smell loss?

6. Does the client have a Grade 3 or Grade 4 pressure sore or a slow healing wound?

7. Is the client struggling to eat a nutritious diet because of dysphagia, limited food preferences, lack of mental capacity, limited cooking skills or another reason?

Nutrition and eating habits, while often overlooked, can significantly improve a client’s rehab and recovery.

Call us on 0121 384 7087 or Email: info@specialistnutritionrehab.co.uk Web: www.specialistnutritionrehab.co.uk