Spinal Cord Injury

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SCI: Introduction (2009)

Guideline Overview

Guideline Title

Spinal Cord Injury (2009) Evidence-Based Nutrition Practice Guideline

Guideline Narrative Overview

The focus of this guideline is on medical nutrition therapy (MNT) for adults with spinal cord injury (SCI) in the acute care, rehabilitation,  and community-dwelling phases of injury. 

Nutritional assessment of the spinal cord-injured person is challenging, because the physiological responses to the injury have an overriding effect on the usual indices of nutrition assessment. There are physiological, psychological and environmental factors that can influence nutritional status.   

  • Primary goals of nutrition therapy for adults with SCI are:
     
    • To prevent or correct malnutrition and/or nutrient deficiencies
    • To achieve and/or maintain appropriate nutritional parameters such as body weight and nutrition-related laboratory values
    • To prevent or contribute to treatment of nutrition-related complications of SCI such as pressure ulcers
    • To enhance, to the maximum extent possible, independence and quality of life, including nutrition quality of life 
    • To define the role and cost-effectiveness of the dietitian in the provision of MNT for the spinal cord-injured person
    • To promote the availability and provision of MNT across the continuum of care for spinal cord-injured persons

MNT is based on:

  • The patient’s individualized nutrition goals as determined by the patient, the dietitian, and the interdisciplinary care team
  • Appropriate interventions and strategies to achieve nutrition goals
  • The patient’s ability and motivation to implement nutrition therapy recommendations

Guideline Development 

This guideline is intended for use by Registered Dietitians (RDs) involved in providing MNT to adults with spinal cord injury.  Clinical judgment is crucial in the application of these guidelines.  Careful consideration should be given to the application of these guidelines for patients with significant medical comorbidities.  This guideline must be individualized based on the needs of the adult with SCI, but it will assist the Registered Dietitian in the task of integrating MNT into the overall medical management of SCI. 
 
Topics include:
 
  • Caloric and protein needs in the acute and rehabilitation phases of SCI
  • Lipid abnormalities in SCI
  • Role of the Registered Dietitian in SCI
  • Cranberry juice and urinary tract infections
  • Fiber/fluid and neurogenic bowel
  • Nutrition care for pressure ulcers
  • Nutrition care to prevent overweight in SCI
  • Physical activity and SCI
The recommendations are based on the work performed by the American Dietetic Association Spinal Cord Injury expert working group. The number of supporting documents for these topics is below:
  • Recommendations: Twenty-five (25)
  • Conclusion Statements: Thirteen (13)
  • Evidence Summaries: Thirteen (13)
  • Article Worksheets: Eighty-seven (87).

The expert working group based their recommendations upon a systematic review of the literature in multiple practice areas.  The expert working group was assisted in their literature review by evidence analysts who abstracted individual research articles and by lead analysts who summarized the evidence in evidence tables and evidence summaries.

To view the guideline development and review process, click here.

Application of the Guideline

This guideline will be accompanied by a set of companion documents (i.e., a toolkit) to assist the practitioner in applying the guideline. The toolkit will contain materials such as the Medical Nutrition Therapy protocol, documentation forms, outcomes management tools, client education resources and case studies. The toolkit is currently under development and will undergo pilot-testing through the ADA's Dietetic Practice-Based Research Network prior to publication.

Revision

The literature search will be repeated for each guideline topic on an annual basis to identify new research that has been published since the previous search was completed. Based on the quantity and quality of new research, a determination will be made about whether the new information could change the published recommendation or rating.

If a revision is unwarranted, then the search is recorded, dated and saved until the next review and no further action is taken. If the determination is that there could be a change in the recommendation or rating, then the supporting evidence analysis question(s) will be re-analyzed following the standard ADA Evidence Analysis Process (see ADA Evidence Analysis Manual in the Methodology section).

When the analysis is completed, the expert workgroup will approve and re-grade the conclusion statements and recommendations. The guideline will undergo a complete revision every three to five years.

Medical Nutrition Therapy and Spinal Cord Injury

Scientific evidence supports the importance of the Registered Dietitian (RD) as a member of the interdisciplinary team caring for adults with spinal cord injury.
 
The registered dietitian plays an integral role on the interdisciplinary care team by determining the optimal nutrition prescription and developing the nutrition care plan for spinal cord-injured patients in all phases of injury. Based on the patient’s plan for treatment, potential for rehabilitation, and concurrent comorbidities, the dietitian monitors and evaluates the effectiveness of the nutrition care plan in promoting the patient’s nutritional health and quality of life. Based on the results of his/her ongoing monitoring and evaluation of the patient’s nutritional status, the dietitian adjusts the nutrition care plan as necessary to achieve desired outcomes.  
 

Populations to Whom This Guideline May Apply

This guideline applies to adult with spinal cord injury.

Other Guideline Overview Material

For more details on the guideline components, click an item below:

  • Scope of Guideline
  • Statement of Intent
  • Guideline Methods
  • Implementation of the Guideline
  • Benefits and Harms of Implementing the Recommendations.

Contraindications

Clinical judgment is crucial in the application of these guidelines.  Careful consideration should be given to the application of these guidelines for patients with significant medical co-morbidities.