Nutrition
Nutritional Assessment After Brain Injury
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A clinical nutritionist/registered dietitian (RD) is an important member of the Intensive Care Unit staff and also of a rehabilitation team. The RD has a minimum of a college degree, followed by an internship in nutrition prior to becoming registered. Often, the person will also have an advanced degree in nutrition. On the rehab team, the RD's role is assessment of nutritional status, management of nutritional care, and education of the patient and family.
Nutrition assessment of the person after a brain injury revolves around three questions:
- What was the nutritional status prior to the accident/ injury?
- What is the current nutritional status and how will it impact recovery and functioning?
- What would the team, the patient and family like the nutritional status to be?
Considerations in evaluating the nutritional status in the past include age, height and weight, previous eating habits and the nutrition support during the acute phase of injury. Was the person overweight or underweight at the time of the injury? The usual weight will also be used to compare to the current weight and it will be used to help determine a goal weight. For children and teens, height and weight are also compared to age-specific growth guidelines. Previous food preferences and intolerance histories, as well as oral motor skills, are used in the reintroduction of foods after injury. Previous food favorites can be used to encourage a person to eat.
After getting the history, the registered dietitian will compare the previous weight to the patient's current weight. It is not uncommon for a brain-injured patient to lose weight as a metabolic response during the acute phase of injury. This can include the loss of muscle from extended immobility and the stress of the initial injuries. Previous to the acute or comprehensive rehabilitation phase, has the person been fed by vein, by feeding tube or by mouth? How many calories? What are the estimated calorie and protein needs at this point of recovery? What route(s) is appropriate for nutrition support now? Some will need continued tube feeding. Some will need blended or chopped diets, and others may need their liquids thickened for swallowing safety.
In all cases, the RD establishes an estimate of the patient's calorie, protein, fluid goals based upon healing and weight needs. Special nutrients for wound healing , anemia, fluid imbalances or other medical problems should be included. The RD will also review any tube feedings if the patient is not on a full oral diet.
The final step of the nutritional assessment is determining a nutritional care plan for the future. Weight is often part of this plan. If the patient is significantly underweight, slow weight gain is preferred, rather then rapid gain which leads to excessive deposits of fat stores. In children, normal increases are plotted on the height-weights charts and used as goals. If the adult or teenager is above the ideal weight for height, then a plan for modest calorie reduction is developed. The care plans are adjusted as health, skills and overall activity improve. Suggestions for meeting and maintaining the goals at home should be reviewed with the patient and family before discharge from the acute or comprehensive rehabilitation program. Ideally, a nutritionist or dietitian remains available in the community for later questions or needs.