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Nutritional Management in Spinal Injuries.
After a spinal cord injury, three primary areas of nutritional concern are: regulation of bowel habits, skin care, and weight management. Dietary habits affect how these problems are prevented and managed.

  • After SCI: Changes and Concerns

After a spinal cord injury most individuals normally lose some weight. Men usually lose more than women. Immediately after the injury the body requires energy and nutrients to repair itself and fight infection. The spinal cord injury puts stress on the body. When the body is stressed, the metabolic rate is higher. This means that the body burns calories faster. Often during this time newly injured patients are not able to eat a regular diet. Paralyzed muscles also atrophy which causes additional weight loss. The loss of weight slows after 3 to 4 weeks.

Individuals with SCI experience changes in how their different body systems work. Many of the changes that the body experiences can be managed by eating healthy meals and snacks. Eating the proper foods, in the correct amount, every day, provide the body with the essential nutrients.

Special health concerns that individuals with spinal cord injury have are:

  • Bowel Management

It is common for constipation to occur following severe spinal cord injury (SCI). Al though a bowel management program including a high fibre diet is an integral part of rehabilitation, the effect of a high fibre diet on large bowel function in SCI has not been examined. Bowel management is an everyday concern for those with a spinal cord injury. The time required for food to move through the gut is slower after a spinal cord injury. If the bowel is not emptied on a regular basis, hard stools, and impaction may occur. Sometimes diarrhea occurs with impaction. This type of diarrhea may be incorrectly treated with an anti-diarrheal medication.

Drinking water and eating high-fiber foods such as fruits, vegetables, whole grains and legumes may help to soften the stools, making it easier for them to pass through the intestines. They also make the stool bulkier, which stimulates movement of the bowel. In addition, peristalsis can be stimulated with vegetables, fruits (especially dried fruits), caffeine and warm fluids with lemon juice.

If high fiber foods are eaten only on occasion, loose stools and incontinence can occur.Therefore, fibrous foods should be gradually increased in the diet until the stools are soft and formed. Adequate fluid illthe diet is also essential to help prevent impaction. Once the bowel program and diet are established, eating habits should not be radically altered so that the extremes of constipation and incontinence can be avoided.

  • Skin Care

Immobility is a major risk factor for pressure sore development, especially when malnutrition is present. Lack of sufficient nutrients can be the reason that a wound does not heal completely. Nutrients particularly necessary for the health of skin include protein, vitamin C, vitamin A, and zinc:
Adequate fluid intake is also necessary for keeping the skin healthy. In healing, the work of the vitamins and minerals depend upon the presence of water in the body. In preventing pressure sores, water strengthens the skin, making it less susceptible to breakdown.

  • Weight Management

After a spinal cord injury, eating habits are especially important in preventing unwanted weight gain. The goal is to get enough nutrients needed for health without consuming a lot of calories. For this reason, the diet should consist primarily of highly nutritious, low-calorie foods like fruits and vegetables, whole grains, and low-fat proteins. This type of diet is in contrast to a high-fat, high-sugar diet that offers little nutrition, but can easily cause weight gain.

Overall, a diet that contains plenty of water, fruits and vegetables, whole grains, and is low in fat and sugar supports the goals of regulated bowel habits, skin care, and weight management.
  • Functional Outcome of Patients with SCI

All patients ideally should be totally independent with all transfers and wheelchair maneuvers both indoors and outdoors. The functional grade depends on the patient's age, stature, amount and control of spasticity, any pre-existing medical condition and the individual's motivation.

Patient's with lesion at T6 - T9 will probably walk with the aid of crutches and calipers. Ultimately, patients with lesions at TIO and below can achieve a better functional. gait and may also need locomotor aids.

Descriptions of Gait pattern possible

Level of InjuryGait Used
Dl - D8Swing to with calipers and rollator; may use crutches if spasticity is controlled.
D8 - D10 Swing through on swing to gait with full length calipers and crutches.
D10- L2 Swing through or 4 point gait with calipers and crutches.
L2 -L4 Below knee calipers with crutches or sticks-4 point or 2 point gait pattern.
L4 - L5 May require sticks or other walking aids / may or may not require calipers.

Functional Ability and Expected level of Independence of Tetraplegic Patients
Level of injury

Complete lesion below C3Dependent on others for all care - diaphragm paralyzed, needs tracheostomy with permanent ventilation or diaphragm pacing chin, head or breath controlled electric wheel chair required.
Complete lesion below C4Dependent on others for all care. Can breathe independently using diaphragm, can shrug shoulders, can use electric wheel chair with chin control, can type / use computer using a mouth stick, needs environmental control system by shoulder shrug or mouth piece. To turn on heights, open doors, etc.
Complete lesion below CS Can move shoulders and flex elbows, can eat with a feeding strap./ universal cuff, can wash face, comb hair, using feeding strap, can write using individually designed splint and wrist support, can help in dressing upper half of body, can push manual wheel chair short distances on a flat surface, provided pushing gloves are used. May be able to transfer across level surfaces, using sliding board and a helper. Electric wheel chair needed for functional mobility.
Complete lesion below C6 Can extend wrists, still needs strap to eat but may not need wrist support. Can dress upper half of body unaided, can help in dressing lower half, can propel wheel chair, can be independent in bed, car transfers, can drive with hand controls.
Complete lesion below C7 Full wrist movement and some hand function, but no ftnger flexion or hand movement, can do all transfers,
Complete lesion below C8 All hand muscles except intrinsics preserved wheel chair independent, but difficult going up and down kerbs, can drive with hand controls.
Complete lesion below Tl Complete innervation of arms, totally independent in wheel chair, can drive car with hand controls.
L4 - L5 May require sticks or other walking aids / may or may not require calipers.
T4 - T6 Self - care independence. Independence in standard wheel chair and transfers, may stand with braces and crutches and ambulate for short distances but not practical for mobility, can work and do some heavy lifting from sitting position, drive car with adaptations, independent in light house keeping.
L4 - L5 May require sticks or other walking aids / may or may not require calipers.
T7 -L2 Independence in self-care, personal hygiene, sports, work and housekeeping activities possible. Ambulates with difficulty using braces and crutches but wheel chair is ambulation of choice for speed and energy conservation.
L8 - L4 Independent in all activities, can ambulate with short leg braces, using crutches or canes, may still use a wheel chair for convenience, energy conservation and sports.
L5 - 53 Independent in all activities, no equipment needed if plantar flexion is sufficiently strong for push off in ambulation.

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