1. Nutrition & Stroke 15/2/10 This is not an Agored Cymru publication. It has been developed by colleagues from Cwm Taf University Health Board and is currently being hosted by Agored Cymru until a more suitable site becomes available.

2. Content Causes Causes Consequences of stroke on nutrition Consequences of stroke on nutrition Malnutrition Malnutrition Importance of Screening Importance of Screening Nutritional management Nutritional management Prevention of stroke Prevention of stroke

3. Causes of stroke Hypertension Hypertension Hyperlipidaemia Hyperlipidaemia Diabetes Diabetes Obesity Obesity Inactivity Inactivity

4. Consequences of stroke Location and extent of damage Location and extent of damage Neurological deficits – how do they affect food intake? Neurological deficits – how do they affect food intake? PerceptionSpacial deficits Planning & sequencing NeglectBehaviour DyspraxiaDysphagia Dysphasia Hemiplegia HemianopiaAtaxia Psychological influences

5. Practical In pairs, take turns being fed and feeding each other. In pairs, take turns being fed and feeding each other. Aims Aims –To experience eating and drinking with; Hemiplegia Hemiplegia Hemianopia Hemianopia Expressive Dysphasia Expressive Dysphasia

6. Malnutrition 15% of admissions are malnourished, increasing to 30% over the 1 st week (RCP) 15% of admissions are malnourished, increasing to 30% over the 1 st week (RCP) Associated with weight loss,  infections & pressure sores. Associated with weight loss,  infections & pressure sores. Muscle wasting and lethargy reduces rehabilitation potential Muscle wasting and lethargy reduces rehabilitation potential Slower recovery and  Length of Stay Slower recovery and  Length of Stay

7. Nutritional Screening Recommendations set out by NICE guidance on Stroke and RCP Clinical Guidelines. Recommendations set out by NICE guidance on Stroke and RCP Clinical Guidelines. All patients, on adm, should be screened for: All patients, on adm, should be screened for: –swallowing ability –nutritional status (then repeated weekly) Nutritional support should be initiated for any patient at risk of malnutrition Nutritional support should be initiated for any patient at risk of malnutrition Tube feeding should be initiated within 24hrs of admission if unable to take adequate oral nutrition & fluids Tube feeding should be initiated within 24hrs of admission if unable to take adequate oral nutrition & fluids

8. Nutritional Management NICE guidelines – Nutrition support in adults NICE guidelines – Nutrition support in adults Nutritional assessment Nutritional assessment Fortified foods Fortified foods Oral supplements Oral supplements Modified texture Diets & Fluids (local policies vary) Modified texture Diets & Fluids (local policies vary) Tube Feeding & Ethics Tube Feeding & Ethics Monitoring Monitoring

9. Prevention of Stroke Body weight Body weight Dietary fat Dietary fat Dietary salt Dietary salt Fruit & vegetables Fruit & vegetables Fish Fish Alcohol Alcohol

10. Summary How neurological deficits affect nutrition How neurological deficits affect nutrition Nutritional management of stroke Nutritional management of stroke Tube feeding & Ethics Tube feeding & Ethics Prevention of stroke Prevention of stroke

11. References 1. Royal College of Physicians. National Clinical Guidelines for Stroke, 3 rd edition. Prepared by the Intercollegiate Stroke Working Party. London: RCP 2008. 2. Department of Health. National Service Framework for Older People, Standard Five: Stroke. London: Department of Health 2001. 3. National Institute for Clinical Excellence. Nutrition Support in Adults: NICE Guideline. London: National Institute for Clinical Excellence 2006. 4. National Institute for Clinical Excellence. Stroke. NICE Guideline. London: National Institute for Clinical Excellence 2008.

12. References cont. 5. Joint Working Group of Royal College of Speech and Language Therapists & British Dietetic Association. National Descriptors of Texture Modification in Adults. BDA 2002. 6. The FOOD Trial Collaboration. Routine oral nutritional supplementation for stroke patients in hospital (FOOD): a multicentre randomised controlled trial. Lancet 2005, 365(9461):755-63. 7. General Medical Council. (2002) Withholding & withdrawing life-prolonging treatments: good practice in decision-making. London: General Medical Council. 8. The FOOD Trial Collaboration. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial. Lancet 2005, 365 (9461):764-72.