Nutrition for

Spinal Cord
Injuries (SCI)
ALYSSA LAING
 INTERESTING FACTS
The Spinal Cord1
• 250,000-400,000 people living
with an SCI
 Spinal Cord Function • 82/100 are male
 Link between brain and nerves • 18/100 are female

 Protected by bones, discs, etc.

 Causes of Injury
 Traumatic
 MVA’s cause 44 / 100 SCI’s
 Ischemia, contusion, fractures, dislocation
 Non-traumatic
 Diseases: MS, ALS, etc.
 Degeneration, infections, tumors
Spinal Cord Injury1
 Complete:
 Loss of sensation and movement
 No function below level of injury
 Incomplete:
 Anterior Cord
 Front part of spinal cord is damaged
 Central Cord
 Middle part of spinal cord is damaged
 Brown Sequard
 One half of spinal cord damaged
Tetraplegia vs. Paraplegia
Tetraplegia/Quadriplegia
 Above thoracic vertebra
 Paralysis to some degree in all 4
limbs
 Abdominal and chest muscles
affected
 Breathing and coughing
Paraplegia
 Below the first level of thoracic
 Varying degrees of loss of
sensation or movement
 Legs, bowels, bladder, sexual
region
 Can move arms and hands
SCI’s Affect on
the Body2
 Hyperreflexia
 Nerve messages to go up to
the brain are blocked
 Altered temperature
regulation
 Neurogenic shock
 Low heart rate and blood
pressure
SCI’s Affect on Body r/t Nutrition
 Paralytic Ileus2
 Stomach / intestines may stop moving
 Dysphagia
 Higher cervical injuries
 22.5-30% of patients
 NG tube or g-tube for long term
 Bowel Control2
 Bowel problems occur in 27-62% of SCI
patients1
 Constipation (42-81%)
 Incontinence (0-75%)
SCI’s Affect on
Body r/t nutrition
cont. 2
 Heartburn
 Incomplete upper
esophageal sphincter
relaxation
 Delayed gastric emptying
 Fecal impaction
 Bowel Program
 Megacolon
 Loss of appetite / nausea
Bowels3
Specific Injuries Affecting Bowels
 Above T-12, ability to feel when
rectum is full may be lost
 Anal sphincter muscle remains tight
 When bowel is full, defecation reflex
will occur
 Bowel incontinence
 Below the T-12, relax anal sphincter
 Areflexic bowel
 More frequent attempts to empty
bowel
Bowel Programs
 Time of day that fits normal bowel
habits
 Individualized per person
 Begins with suppository followed by
waiting period 5-10 min
 Digital simulation is performed every
5-10 min
 Prevent or correct malnutrition /
nutrient deficiencies

Maintain appropriate nutritional

parameters: body weight, lab values
Primary Goals of
Nutrition In SCI4 Prevent or treat nutrition related SCI
complications- pressure ulcers

Enhance quality of life

Calorie Needs5
 Acute Phase
 Small study showed Harris Benedict equation
 Admission weight, AF of 1.1, and injury factor 1.2
 Rehabilitation phase
 Reduced metabolic activity d/t denervated muscle
 Energy expenditure 10% below predicted Interesting Fact
 Tetraplegia: 22.7 kcal/kg
• No adjusted SCI BMI
 Paraplegia 27.9 kcal/kg
guidelines or chart
 Take into consideration: • Recent research suggests a
 Acuteness of injury BMI of 22 defines obesity
among SCI
 Level of injury
 Gender
 Physical activity
Weight
Guidelines4
 Metropolitan Life Desirable
Weight Tables
 Paraplegia 5-10% less
 Tetraplegia 10-15% less
Protein Needs 5
 Acute phase: negative nitrogen balance ~7 weeks
 D/t changes in BW and loss of lean body mass
 Aggressive nutrition support unsuccessful, may result in
overfeeding
 2.0 g/kg of IBW appropriate

 0.8-1.0 g/kg for maintenance

 1.0 – 1.5 g/kg if pressure ulcers develop
Fluid / Fiber Recs4
FLUID
 500mL a day greater than general guidelines
 1.5 L per day showed significant improvements in bowel function

FIBER
 Chronic bowel dysfunction 60% in SCI population
 15 g per day with gradual increase as tolerated
 High fiber diets associated with longer transit time in SCI patients
Urinary Tract Infections4
 Cause
 Meeting fluid needs
 Cranberry Juice
 Adherence of bacteria to uroepithelial cells significantly decreased in
SCI patients
 250mL, three times a day
 Small study size, funded by cranberry juice manufacturer
 Cranberry Extract Supplements
 3 studies found tablet or capsule form ineffective
 1200mg & 1600 mg
Higher Risk For…6

Obesity Diabetes Heart Weight gain Osteoporosis

Disease
Recommendations4
 Exercise!
 Wheelchair sports, swimming, etc.
 Adequate calcium
 Fluid and fiber
 Same recs as general population
 Variety of protein, grains, fruits, veggies
 Portion sizes
 Limit sugar sweetened beverages
References
1. University of Iowa Hospitals & Clinics. (2018). What happens to the spinal cord?. [online]
Available at: https://uihc.org/health-topics/what-happens-spinal-cord [Accessed 26 Sep. 2019].
2. Ebert, E. (2012). Gastrointestinal Involvement of Spinal Cord Injury: A Clinical Perspective. [online]
Jgld.ro. University of Medicine New Jersey. Available at: http://www.jgld.ro/2012/1/13.pdf
[Accessed 26 Sep. 2019].
3. Rehab.washington.edu. (n.d.). Patient Care - Education - SCI bowels. [online] Available at:
http://rehab.washington.edu/patientcare/patientinfo/articles/sci_bowels.asp [Accessed 26 Sep.
2019].
4. Andeal.org. (2009). Spinal Cord Injury (SCI) Guideline 2009. [online] Available at:
https://www.andeal.org/topic.cfm?menu=5292&cat=3485 [Accessed 26 Sep. 2019].
5. Barton, V. (2011). Nutrition for Individuals with Spinal Cord Injury. [online] Sci.washington.edu.
Available at: http://sci.washington.edu/info/forums/reports/nutrition_2011.asp [Accessed 26 Sep.
2019].
6. Nutrition.va.gov. (2015). Nutrition and Spinal Cord Injury. [online] Available at:
https://www.nutrition.va.gov/docs/UpdatedPatientEd/NutritionandSCI01-15.pdf [Accessed 26
Sep. 2019].