Spinal Cord Injury (SCI) Patient care
Whilst early nutrition confers significant benefits following a spinal cord injury, most patients will suffer from a paralytic ileus (intestinal paralysis preventing food being absorbed) for a minimum of 48 hours which makes early feeding difficult. A dietitian is required at this stage to assess alternative routes of feeding, Parenteral Nutrition (feeding via the veins) or Enteral Nutrition (feeding into the gut). Dietitians are the experts at recommending the correct feeding method, nutrition volume, monitoring clinical parameters and to ensure best practice when providing these forms of nutrition.
Weight and Muscle Loss
Weight loss can average up to 5.3kg for paraplegic and 9.1kg tetraplegics during the acute phase of injury (Cox et al, 1985). Without adequate nutrition, this weight loss is accelerated further leading to poorer patient outcomes and delays rehabilitation.
Dietitians are not only experts in treating these co-morbidities, but are equipped with the knowledge of what supplements, vitamins, minerals and medication can be provided to manage these conditions whilst optimising nutrition. During the acute phase of SCI, a dietitian regularly monitors the amount of nutrition taken (orally, enterally), anthropometry measurements (weight, mid upper arm circumference), biochemical status and can make suggestions to improve common problems such as constipation, nausea, poor appetite and bloating.
Without a dietitian available, there is increased risk of delayed wound healing, pressure sores, impaired immune function, depression and post-operative complications.
Whilst patients are undergoing rehabilitation it is vital to ensure patients receive adequate nutrition to achieve their physical goals. During this phase, it is important that a dietitian is available to provide advice about healthy nutrition and hydration to assist with regular bowel movement, prevent skin breakdown and catheter related infections. As all SCI patients will have lost muscle mass and possibly reduced physical activity, education is required to discuss a new ideal weight range and the avoidance of returning to previous eating habits to prevent excessive weight gain.
Follow Up/Outpatient setting
One study found that the annual incidence of pressure sores amongst this group is between 30-46%, that increases with age and the average length of stay in hospital was 4.5 months per admission (Gibson 2002). Regular dietetic input to provide healthy eating plans, encourage normal growth patterns in children and promote lifestyle changes to prevent long term health problems – such as heart disease, obesity, diabetes and pressure sores can reduce prolonged inpatient stays in the clinical environment. The delivery of health promotion and preventative nutritional advice in outpatient clinics can be cost effective.
Service Specification No. D13 Specialised Spinal Cord Injury Care Response by the Spinal cord injuries group of Dietitians 18.1.13.