Aim: To understand the impact Acquired Brain Injury can have on nutrition and hydration, including problems arising from dysphagia and other neurological sequelae and how best to support the person with brain injury in the management of these difficulties.

All patients should undergo nutritional screening on admission to hospital following ABI and throughout their inpatient stay.  The purpose of screening is to identify those who may potentially be at risk of nutritional deficiencies.

Within Scotland the Food Fluid and Nutritional Care Standards state that nutritional screening should be carried out within 24hrs of admission using the Malnutrition Universal Screening Tool – MUST (British Association of Parenteral and Enteral Nutrition) or another validated screening tool.  This should be carried out by the nursing team.  Following screening, referral to dietetics should be made if indicated and appropriate intervention implemented to address any nutritional deficiencies.

Nutritional Management
Acquired Brain Injury may cause abnormal regulation of nervous, endocrine, and inflammatory systems. The person may therefore have considerable and varying nutritional support needs.  The person’s nutritional support needs will vary according to the stage of recovery.  Stages of recovery can be divided into the following phases:

Acute Phase (Catabolic Phase of Metabolism)
Post-Acute Phase (Anabolic Phase of Metabolism)
Rehabilitation Phase

The requirement for nutritional support may decrease as the person progresses through these three phases.  However, some people will continue to have a lifelong requirement for nutritional support and management.

Nutritional Support
Transition from Hospital to Community

Dysphagia
Following brain injury, a comprehensive assessment of dysphagia should be carried out if the patient:

  • Demonstrates any potential symptoms suggestive of dysphagia.
  • Appears reluctant to eat or drink.
  • Exhibits behavioural difficulties in the context of eating or drinking.

Dysphagia may be effectively masked by other sequelae of brain injury.  Interpretation of changes to normal patterns of eating or drinking may be erroneously attributed to:

It is important to note that following brain injury patients may not demonstrate the usual symptoms of dysphagia (e.g. coughing, choking may not occur).  Aspiration may be ‘silent’.

References
Thomas B  &  Bishop J (eds) (2007) Manual of Dietetic Practice – 4th Edition Blackwell Publishing Ltd.

Lothian Enteral Tube Feeding Best Practice Statement for Adults and Children 2013.

Whitehurst, E , BJNN January (2009) Vol 5 No 1 The importance of nutrition support in the head injured patient.

Brody, RA & Touger-Decker, R   Topics in Clinical Nutrition (2008) Vol 23 No 1 An Evidence-Based Approach to the Nutritional Management of Head Injury.

Kirby DF, Creasey L, Abou-Assi SG (2007) Gastrointestinal & nutritional issues, in Zasler ND et al (eds) Brain Injury Medicine, Demos, New York.

Perel P et al (2006) Cochrane Database of Systematic Reviews. Nutritional support for head injured patients.

Dennis et al. FOOD Trial Collaboration (2005) Lancet 2005. 365:p755-763
Routine oral nutritional supplementation for stroke patients in hospital: a multicentre randomised controlled trial.