Neurology Patients

Example cases for Nutrition support

Cancer Anorexia Nutrtion support

Tube feeding in neurological patients

Patients with neurological diseases are often affected by impaired nutrition. Resulting consequences have a negative impact on morbidity and thus on the patients’ mortality. For this reason, implementing appropriate nutritional management is a matter of significant importance.1
Implications of malnutrition are numerous. Cognitive impairments but also difficulties in swallowing play an important role. Patients concerned with dysphagia caused, for example by neurological diseases like amyotrophic lateral sclerosis or dementia and stroke, are therefore exposed to a heightened risk – not least by an increased risk of infections, frequent hospital admissions and accelerated functional decline. For example, 2/3 of patients with strokes are affected by dysphagia and therefore are at a higher risk of mortality. In these cases, enteral tube feeding is able to compensate for impaired swallowing.2,3

 

 

The following four example cases illustrate how patients in the field of neurological diseases may benefit from tube feeding:

Clinical summary: Presentation/Clinical history

 

Mr H, 57 years, physical activity teacher, current weight: 75.3 kg (BMI 24.0 kg/m2)

 

Diagnoses: motor neurone disease/amyotrophic lateral sclerosis, dysphagia, chest infections

PEG sited for feeding overnight

Weight loss total approx. 12.4% from onset of symptoms

 

Mr H -patient with progressive neuromuscular disease

After 3 weeks no problems with feeding using Fresubin 2 kcal HP Fibre and Mr H's swallowing has not deteriorated significantly but Mr H is well aware of progressive nature of disease.

Outcome8 weeks post discharge

  • Mr H’s motor neurone disease progressing slowly. Continues to use lightwriter for communication and with a pureed diet and stage 2 (mildly thick) fluids
  • No further reports of any chest infections
  • Weight relatively stable at approx. 72–73 kg

 

 

Download the complete and detailed patient case here

Patient case Progressive neuromuscular disease.pdf

Download the complete and detailed patient case here

Filename
Patient case Progressive neuromuscular disease.pdf
Size
1 MB
Format
pdf

Clinical summary: Presentation/Clinical history

 

Mr J, 37 years, satellite technician, current weight: 104.3 kg (BMI 34.9 kg/m2)

 

Diagnoses: severe skull, left tibia and left humorous fractures

Intracranial epidural haematoma diagnosed and surgery completed

A nasogastric tube in situ due to an induced coma and oral ventilation

Weight loss: 3.4 % – not significant

 

Mr J - patient at neuro-rehabilitation

Supplemental tube feeding combined with a mildy thick oral diet and texture modified ONS helped Mr J to meet his nutritional requirements.

Outcome: 3 months post admission

  • Rehabilitation successful – walking with minimal assistance (walking stick) and discharged home with carers to help with personal care
  • Oral intake improved and managing minced and moist diet with stage 1 (mildly thick) fluids and Fresubin thickened ONS 1–2 x daily
  • Tube remains in situ feeding 1000 ml Fresubin Original Fibre
  • Weight stable at approx. 105 kg, BMI 35 kg/m2

 

 

Download the complete and detailed patient case here

Patient case Neuro-rehabilitation.pdf

Download the complete and detailed patient case here

Filename
Patient case Neuro-rehabilitation.pdf
Size
1 MB
Format
pdf

Clinical summary: Presentation/Clinical history

 

Mrs K, 72 years, grandmother living with dementia, current weight: 61.1 kg (BMI 21.9 kg/m2)

 

Admitted to hospital for IV antibiotics for a recent severe chest infection

Nutritional screening: identified as high risk as she has lost 11.4 % of body weight in the past 6 months. Oral intake is minimal.

 

Mrs K - patient with dementia

Supplemental tube feeding for 14 days helped improve nutritional status and support Mrs K through a short period of acute illness where her nutritional requirements were increased and transition to a texture-modified diet took place.

Outcome1 month post discharge

  • Outpatient, living with the support of her daughter and continuing on a minced and moist diet with mildly thick (stage 1) fluids 
  • No longer requires oral nutritional supplementation and is able to maintain nutritional status through her texture modified diet with food fortification advice
  • Current weight: 62 kg

 

 

Download the complete and detailed patient case here

Patient case Dementia.pdf

Download the complete and detailed patient case here

Filename
Patient case Dementia.pdf
Size
1 MB
Format
pdf

Clinical summary: Presentation/Clinical history

 

Mrs L, 63 years, retired nurse, current weight: 53 kg (BMI 22.1 kg/m2)

 

Admitted with sudden onset dysarthria and right-sided weakness

Diagnoses: left-sided ischaemic stroke, no oral intake

Enteral feeding commenced via nasogastric tube within 24 hours of admission

Mrs L - patient after stroke

Mrs L met her nutritional needs within 2 days.

Outcome8 weeks post treatment

  • Weight increased and stable at 55.5 kg, BMI 23.1 kg/m2 and able to meet full nutritional requirements within 2 days of commencing tube feeding
  • Continues to meet full nutritional requirement via PEG tube and due to this Mrs L is able to participate in rehabilitation including physiotherapy

 

 

Download the complete and detailed patient case here

Patient case Stroke rehabilitation.pdf

Download the complete and detailed patient case here

Filename
Patient case_Tube feeding with depression.pdf
Size
1 MB
Format
pdf


 

Download the comprehensive booklet here with the four example cases mentioned above

The following four example cases illustrate how different patients in the field of neurological diseases may benefit from tube feeding:

  • Tube feeding in progressive neuromuscular disease
  • Enteral nutrition on neuro-rehabilitation
  • Short-term nasogastric feeding during acute illness in dementia
  • Long-term feeding in stroke rehabilitation

Patient cases Neurology.pdf

Fresubin tube feeding in neurological patients. What Fresubin can do for your patients.

Filename
Patient cases Neurology.pdf
Size
5 MB
Format
pdf

Fresubin tube feeding in neurological patients. What Fresubin can do for your patients.





References:

1) Rosenfeld J, Ellis A. Nutrition and dietary supplements in motor neuron disease. Phys Med Rehabil Clin N Am. 2008;19(3):573–589.
2) Nunes G, Santos CA, Grunho M, Fonseca J. Enteral feeding through endoscopic gastrostomy in amyotrophic lateral sclerosis patients. Nutr Hosp. 2016;33(5):1015–1021.
3) Dionyssiotis Y, Papachristos A, Petropoulou K, Papathanasiou J, Papagelopoulos P. Nutritional Alterations Associated with Neurological and Neurosurgical Diseases. Open
Neurol J. 2016;10:32–41.





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