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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
Finestone H. M., Greene-Finestone L. S.
Department of Physical Medicine and Rehabilitation, London Health Sciences Centre, University Campus, University of Western Ontario, London, Ontario, Canada
Nutritional and dietary issues are important to consider in the rehabilitation of patients who have sustained a stroke. Stroke patients are nutritionally vulnerable because they have a large number of neurologic deficits that can contribute to decreased dietary intake and, eventually, malnutrition. This article focuses on general principles of nutritional assessment and the specific nutritional and dietary concerns of stroke patients. Among factors contributing to eating difficulties and nutritional impairment, dysphagia is common after acute stroke. Other neurologic deficits that may adversely affect the stroke patient’s ability to self-feed include upper extremity paralysis or paresis, apraxia, agnosia, right and left disorientation, depression, and visual neglect or denial of the paralysed extremity. Stroke patients sometimes exhibit eating-related behaviour problems such as attention-concentration deficits, eating too fast or too slowly, or forgetting to swallow. In the acute metabolic response to general injury, initially there is a decline in energy (caloric) expenditure and increased activity of the sympathetic nervous system, including elevated cortisol output. A hypermetabolic phase follows in which energy expenditure and nitrogen excretion are increased. This results in net losses from the protein and fat compartments of the body. The goal of the nutritional assessment is to help the patient attain or maintain a sufficient level of energy and nutrients (normal nutrition status) to reduce the risk of adverse outcomes associated with poor nutrition and promote an optimal level of health. The nutritional assessment may take different forms, ranging from brief screening tools to comprehensive evaluation. Anthropometric and biochemical measurements as well as physical examination and medical and dietary histories are useful in assessing nutritional status. Even though dietary intakes can sometimes appear to be adequate on assessment, certain drugs, disease states, or dietary components can affect ingestion, absorption, transportation, utilization, or excretion of nutrients. One of the easiest ways to estimate nutritional status is to monitor weight and degree of weight change over time. The Body Mass Index (BMI) scale is a recommended method of assessing weight status. Unfortunately, it is not validated for adults over 65 years, who form the majority of stroke patient population. Undernutrition is predictive of poorer functional status outcome and reduced functional improvement rate in acute stroke patients and those undergoing rehabilitation. Finestone et al. studied the relationship between MBI scores and malnutrition on a rehabilitation service: malnourished patients consistently demonstrated lower MBI scores than adequately nourished patients at all intervals at which they were evaluated: admission, 1 month, 2 months, and 2-4 months of follow-up. They also had significantly longer lengths of stay (p<0.01). The risk of dehydration in stroke patients is often underappreciated. This is particularly true of dysphagic patients receiving all nutrition by mouth. Guide-lines for the nutritional management of stroke patients are described.