Karin Axelsson

Eating after a stroke—Towards an integrated view

Good nursing is of paramount importance for the clinical outcome in patients who have had a stroke. We have experiences from a non-intensive stroke unit where a strategy involving improved nursing care, very early rehabilitation and extensive psychosocial support to the patient and his/her family in combination with structured medical treatment has been adopted. This approach is successful in reducing the need for long-term hospitalization after a stroke. Thus, in a controlled study, we found that 39% of the surviving patients remained hospitalized three months after the stroke if they had initially been admitted to general medical wards, while only 15% remained in hospital if they had been treated in the stroke unit (Strand et al., 1983). It appears that determined efforts to improve patient care-in its broadest sense-during the critical first weeks after stroke are highly productive. One of the most critical factors in the care of stroke patients is eating. This applies to the early as well as the late phase of the syndrome. Stroke sequelae are the second most common cause for permanent spoonfeeding in nursing homes in our hospital region (Norberg and Backstrom, in preparation). It is conceivable that a determined approach to manage eating problems during the acute phase may prevent some of the detrimental long-term effects of a stroke on eating. The total care of a stroke patient is multifarious (O’Brien and Pallett, 1978; Hamrin, 1981; Sjogren, 1982) but detailed studies of eating and feeding in this condition have not been performed. In this overview, we outline some common eating problems in stroke patients and we suggest an integrated theoretical model as a guide to further structured studies on this subject. Patients and methods A theoretical model of eating problems after a stroke was developed based on observations made at our stroke unit and on others’ experiences reported in the literature.

Outcomes of individualized interventions in patients with severe eating difficulties

The aim of this case study is to describe the outcomes of individualized interventions for patients with severe eating difficulties. The participants were 15 patients who had severe eating difficulties following a stroke or brain tumor and were receiving oral feeding or tube feeding. Interventions focused on training functions needed for eating, activities in eating, and discussions with the patient improvements were especially noted in eating activities, and some improvements were noted in oral movements and nutritional status. Before the interventions, none of the patients ate regular food afterward, six did, and in four patients, the feeding tube was removed The patients said eating was easier and they could eat in a safe way. Furthermore, they appreciated the attention to their experience during meals. Although the impairments were not always alleviated, the patients found means to cope with their eating difficulties.

Nutrient Intake and Weight Development in Children During Chemotherapy for Malignant Disease

The aim of the study was to assess the actual daily oral intake of energy, protein, fat and carbohydrate in relation to current recommendations in children with malignant disease during chemotherapy and to follow their weight development. Dietary information was collected for 21 consecutive days via 7-day recording in 14 children, aged 5-16 years. The number of days with loss of appetite, vomiting, and the number of days on anti-emetic drugs were also recorded. The average daily energy intake decreased from 91% of the recommendation of the Swedish Nutrition Recommendations (SNR), before chemotherapy to 69% after start of chemotherapy. During days spent at home, the energy intake increased to 77% of SNR. Twenty-two per cent of the total energy intake during the hospital days came from sucrose. On average, the children experienced loss of appetite on 50% of the days, vomiting on 12%, and received anti-emetic drugs on 38%. On admission, the average SD score for body weight for the whole group was -0.09. The mean weight reduction after 1 week was 0.19 SD (P = 0.05) compared to the admission weight. The weight reduction 6 weeks (n = 10) and 3 months (n = 13) after the start of chemotherapy was 0.10 SD and 0.37 SD (P = 0.04), respectively.