Adequate nutrition and hydration helps make rehabilitation more cost effective by supporting clients to get the most out of all of their therapeutic input.  Just like an athlete needs a steady supply of nutritious food for his/her body to function at its peak, so do clients after a catastrophic injury.  Dehydration, deficiencies of certain vitamins and minerals and/or gut problems such as constipation, are all quite common in clients after a catastrophic injury and can make fatigue, “brain fog” and spasticity worse.  You want to make sure these basics are covered before seeking out more expensive therapies and pharmaceuticals to solve the problem.

Dietetic assessment reports include information on the following:

• Anthropometrics (eg. weight, height, BMI, waist circumference).
• Biochemistry (eg. recent blood test results)
• Clinical information (eg. medical history, medication).
• Dietary information (eg. whether nutrient needs are being met).
• Skin integrity (eg. wounds, pressure sores)
• Bowel health (eg. constipation, diarrhoea, irritable bowel syndrome)
• Dysphagia/swallowing issues
• Nausea/vomiting
• Oral health issues (eg. oral thrush; dentures which don’t fit)

Client appointments are available as:

• Home visits
• Video-conferencing appointments are the most cost effective option when appropriate.

Case Study #1

A client who has been under an NHS dietitian for several years continues to be underweight in spite of being prescribed several oral nutrition supplements and being reviewed every 3 months.   His diet is quite limited due to oral sensory issues and an erratic sleep patterns meaning meals and nutrition supplements often get missed.

• Solution: I worked with the neuropsychologist to implement a sleep schedule, trialed the client on alternative nutrition supplements, trained support workers on the importance of healthy food and the need for nutrition supplements to be given consistently like medication, and worked with the client and support workers to increase the variety of foods offered.

Case study #2

The family of a child with cerebral palsy want a second opinion after the paediatrician says the child needs to have a gastrostomy tube placed.  In spite of being under an NHS dietitian and being prescribed oral nutrition supplements, the child is not gaining sufficient amounts of weight.  Her food intake at school is also significantly less than what she eats at home.

• Solution: I observed the child’s food intake at home and at school, addressed factors which were reducing food intake (such as where and how food was offered at school), requested blood tests from the GP, trialed the child on different nutrition supplements, arranged for a sleep monitor to see if fatigue was reducing her food intake, and held MDT meetings with the paediatrician, school nurse, speech and language therapist and school so that everyone was working together. 

Case study #3

A care home requests support from a dietitian when a resident with a brain injury is on multiple daily laxatives and has chronic diarrhoea.  The diarrhoea is preventing him from using hydrotherapy and affecting his ability to access the community, while the associated abdominal distension and bloating are contributing to agitation levels.

• Solution: I worked with the GP to switch laxatives to PRN and change the type of laxatives prescribed; worked with the care home staff to implement a low FODMAP diet specifically for someone with Irritable Bowel Syndrome and developed accompanying menus, recipes and lists with what foods the staff were allowed to give him.

Case study #4

A client with type 2 diabetes is steadily increasing in weight.  It is unknown whether she has capacity to understand the consequences of her food choices so the support workers just let her choose whatever she wants to eat at mealtimes.  Soon she will require a bariatric wheelchair and two support workers for transfers instead of one.  Her positioning in her moulded wheelchair is currently compromised because of her weight and she is at higher risk of developing pressure sores.

• Solution: I conduct a capacity assessment, trained staff on type 2 diabetes, developed a plan with meal and snack ideas, and ensured her diet was meeting her nutrient requirements to preserve skin integrity.