1. Nutrition & Stroke Cwm Taf University Health Board 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  Consequences of stroke on nutrition  Malnutrition  Importance of Screening  Nutritional management  Prevention of stroke

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

4. Consequences of stroke Deficits Perceptionmay not recognise food as food may not recognise utensils, drinking cup etc Spacial deficitsDifficulty feeding self i.e. moving fork/spoon to mouth Difficulty judging where the plate/cup is in relation to themselves in space Planning & Sequencing Difficulty with actions of food onto fork, to move fork to mouth etc NeglectTypically eat ½ plate of food Assess their ability to eat with one hand BehaviourAltered behaviour with food e.g. not using it as food or eating non-food items

5. Consequences of stroke continued DyspraxiaInability to make skilled movements with accuracy Dysphagiadifficulty swallowing Dysphasia‘expressive’ – unable to communicate what they want to eat or when they are hungry or thirsty ‘receptive’ – unable to understand what food and drinks are offered HemiplegiaDifficulty cutting food HemianopiaAbsence of ½ visual field in both eyes AtaxiaShaky/unsteady movements Psychological Issues Low mood/depression – decreases appetite

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

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

8. Nutritional Screening  Recommendations set out by NICE guidance on Stroke and RCP Clinical Guidelines.  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  Tube feeding should be initiated within 24hrs of admission if unable to take adequate oral nutrition & fluids

9. Nutritional Management  NICE guidelines – Nutrition support in adults  Nutritional assessment  Fortified foods  Oral supplements  Modified texture diets & fluids  Tube Feeding & Ethics  Monitoring

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

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

12. References 1. Royal College of Physicians. National Clinical Guidelines for Stroke, 4 th edition. Prepared by the Intercollegiate Stroke Working Party. London: RCP 2012. 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.

13. 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.