Spinal Cord Injury

SCI: Scope of Guideline (2009)

Below, you will find a list of characteristics that describe the scope of this guideline.

Guideline Category

Assessment of Therapeutic Effectiveness, Counseling, Evaluation, Management, Prevention, Treatment

Clinical Specialty

Neurological Surgery, Neurology, Nutrition, Physical Medicine and Rehabilitation

Intended Users

Registered Dietitians, Advanced Practice Nurses, Health Care Providers, Nurses, Occupational Therapists, Physical Therapists, Physician Assistants, Physiatrists, Physicians, Respiratory Care Practitioners, Speech-Language Pathologists, Students

Guideline Objective(s)

Overall Objective

To provide MNT guidelines that result in positive clinical outcomes in the acute, rehabilitation, and community-dwelling stages of spinal cord injury

Specific Objectives

To define evidence-based nutrition recommendations specific to spinal cord injury for Registered Dietitians to implement in collaboration with other healthcare providers as part of the interdisciplinary care team
- - To guide practice decisions that promote good clinical outcomes
  - To reduce variations in practice among RDs
  - To promote the best possible nutrition quality of life in spinal cord-injured persons
  - To provide the RD with guidelines for making recommendations to adjust MNT or for recommending other therapies to achieve desired outcomes
  - To assist the RD in customizing nutrition strategies to each individual patient’s type and level of injury, ability to consume nutrients, metabolic profile, potential for rehabilitation, current lifestyle, and personal preferences
  - To define guidelines for interventions that have measurable clinical outcomes
  - To define the highest quality of care within cost constraints of the current healthcare environment

Target Population

Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Adults in the acute, rehabilitation, or community-dwelling phases of spinal cord injury

Interventions and Practices Considered

This guideline is based on ADA’s Nutrition Care Process and Model, which involves the following steps:

Nutrition Assessment
Nutrition Diagnosis
Nutrition Intervention
Nutrition Monitoring and Evaluation.

This guideline addresses topics that correspond to the following areas of the Nutrition Care Process. Please refer to the Algorithms in this guideline for a more detailed view of the recommendations and their application within the Nutrition Care Process.

I. Referral to a Registered Dietitian
II. Medical Nutrition Therapy

A. Nutrition Assessment, Monitoring and Evaluation

Below you will find the most prevalent nutrition assessment, monitoring and evaluation terminology related to spinal cord injury from the International Dietetics and Nutrition Terminology Manual: Standardized Language for the Nutrition Care Process. Third Edition. Possible nutrition assessment, monitoring and evaluation terms for persons with spinal cord injury are not limited to the link below.

1. Food/Nutrition-related History (FH)

Diet history (FH-1.1)
Diet order (FH-1.1.1)
Diet experience (FH-1.1.2)
Eating environment (FH-1.1.3)
Energy intake (FH-1.2)
Total energy intake (FH-1.2.1.1)
Food and beverage intake (FH-1.3)
Fluid/beverage intake (FH-1.3.1)
Food intake (FH-1.3.2)
Enteral and parenteral Nutrition Intake (FH-1.4)
Bioactive substance intake (FH-1.5)
Caffeine intake (FH-1.5.3)
Macronutrient intake (FH-1.6)
Fat and cholesterol intake (FH-1.6.1)
Protein intake (FH-1.6.2)
Carbohydrate intake (FH-1.6.3)
Fiber intake (FH-1.6.4)
Micronutrient intake (FH-1.7)
Medication and herbal supplement use (FH-2)
Food and nutrition knowledge (FH-3.1)
Beliefs and attitudes (FH-3.2)
Behavior (FH-4)
Adherence (FH-4.1)
Avoidance behavior (FH-4.2)
Restrictive eating (FH-4.2.2)
Mealtime behavior (FH-4.4)
Social network (FH-4.5)
Factors affecting access to food and food/nutrition-related supplies (FH-5)
Food/nutrition program participation (FH-5.1)
Safe food/meal availability (FH-5.2)
Food and nutrition-related supplies availability (FH-5.4)
Access to assistive eating devices (FH-5.4.2)
Access to assistive food preparation devices (FH-5.4.3)
Physical activity and function (FH-6)
Nutrition-related ADLs and IADLs (FH-6.2)
Physical activity (FH-6.3)
Nutrition-related patient/client-centered measures (FH-7)

2. Anthropometric Measurements (AD)

Height/length (AD-1.1.1)
Weight (AD-1.1.2)
Frame size (AD-1.1.3)
Weight change (AD-1.1.4)
Body compartment measurements (AD-1.1.7)

3. Biochemical data, medical tests and procedures (BD)

Electrolyte and renal profile (BD 1.2)
Gastrointestinal profile (BD 1.4)
Glucose/endocrine profile (BD 1.5)
Inflammatory profile (BD 1.6)
Lipid profile (BD-1.7)
Metabolic rate profile (BD-1.8)
Mineral profile (BE-1.9)
Nutritional anemia profile (BE-1.10)
Protein profile (BE-1.11)
Vitamin profile (BE-1.13)

4. Nutrition-focused physical findings (PD)

5. Client history (CH)

Personal history (1)
Patient/Client/Family Medical/Health history (2)
Treatment/therapy/alternative medicine (2.2)
Social history (3)

6. Comparative standards (CS)

Estimated energy needs (CS-1.1.1)
Estimated fat needs (CS-2.1)
Estimated protein needs (CS-2.2)
Estimated carbohydrate needs (CS-2.3)
Estimated fiber needs (CS-2.4)
Estimated fluid needs (CS-3.1)
Estimated vitamin needs (CS-4.1)
Estimated mineral needs (CS-4.2)
Ideal/reference body weight (CS-5.1.1)

B. Nutrition Diagnosis

Below you will find the most prevalent nutrition diagnoses related to spinal cord injury care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process. Third Edition. Possible nutrition diagnoses for persons with spinal cord injury are not limited to the list below.

1. Intake (NI)

Energy balance (1)
Increased energy expenditure (NI-1.2)
Inadequate energy intake (NI-1.4)
Excessive energy intake (NI-1.5)
Oral or nutrition support intake (2)
Inadequate oral food/beverage intake (NI-2.1)
Excessive oral food/beverage intake (NI-2.2)
Inadequate intake from enteral/parenteral nutrition (NI-2.3)
Excessive intake from enteral/parenteral nutrition (NI-2.4)
Inappropriate infusion of enteral of parenteral nutrition (NI-2.5)
Fluid intake (3)
Inadequate fluid intake (NI-3.1)
Excessive fluid intake (NI-3.2)
Excessive bioactive substance intake (NI-4.2)
Excessive alcohol intake (NI-4.3)
Nutrient (5)
Increased nutrient needs (specify) (NI-5.1)
Malnutrition (NI-5.2)
Inadequate protein-energy intake (NI-5.3)
Decreased nutrient needs (specify) (NI-5.4)
Imbalance of nutrients (NI-5.5)
Fat and cholesterol (5.6)
Excessive fat intake (NI-5.6.2)
Inappropriate intake of fats (NI-5.6.3)
Protein (5.7)
Inadequate protein intake (NI-5.7.1)
Excessive protein intake (NI-5.7.2)
Carbohydrate and fiber (5.8)
Inadequate carbohydrate intake (NI-5.8.1)
Excessive carbohydrate intake (NI-5.8.2)
Inappropriate intake of types of carbohydrate (specify) (NI-5.8.3)
Inconsistent carbohydrate intake (NI-5.8.4)
Inadequate fiber intake (NI-5.8.5)
Excessive fiber intake (NI-5.8.6)
Vitamin (5.9)
Inadequate vitamin intake (specify) (NI-5.9.1)
Excessive vitamin intake (specify) (NI-5.9.2)
Mineral (5.10)
Inadequate mineral intake (specify) (NI-5.10.1)
Excessive mineral intake (specify) (NI-5.10.2)

2. Clinical

Functional (1)
Swallowing difficulty (NC-1.1)
Biting/chewing (masicatory) difficulty (NC-1.2)
Altered GI function (NC-1.4)
Biochemical (2)
Weight (3)

3. Behavioral-environmental (NB)

Knowledge and beliefs (1)
Physical activity and function (2)
Food safety and access (3)

C. Nutrition Intervention (Planning and Implementation)

Below you will find the most prevalent nutrition interventions related to spinal cord injury care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process. Third Edition. Possible nutrition interventions for persons with spinal cord injury are not limited to the list below.

Individualized prescription based on:

1.      Food/Nutrition Intervention

2.      Physical activity Interventions

3.      Behavioral Interventions

4.      Pharmacotherapy, when indicated

1. Food and/or nutrient delivery

Meals and snacks (1)
General/healthful diet (1.1)
Modify distribution, type, or amount of food and nutrients within meals or at specified time (ND-1.2)
Specific foods/beverages or groups (ND-1.3)
Enteral and Parenteral nutrition (2)
Medical food supplements (3.1)
Vitamin and mineral supplements (3.2)
Bioactive substance supplements (3.3)
Feeding assistance (4)
Feeding environment (5)
Nutrition-related medication management (6)

2. Nutrition education (E)

Initial/brief nutrition education (1)
Comprehensive nutrition education (2)

3. Nutrition counseling (C)

Theoretical basis/approach (1)
Strategies (2)

4. Coordination of nutrition care (D)

Coordination of other care during nutrition care (1)
Discharge and transfer of nutrition care to new setting or provider (2)

D. Monitoring and Evaluation

Below you will find the nutrition monitoring and evaluation terms related to spinal cord injury care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process. Third Edition. .