Nutrition and Spinal Cord Injuries

A patient’s nutrition following significant trauma such as spinal cord injury can play a major role in their recovery. It is important to assist spinal cord injured patients with rehabilitation plans which consider nutrition and provide practical recommendations for weight management and the promotion of physical wellbeing.

Whilst nutrition is a core principle of a healthy lifestyle, this is particularly relevant for people who have experienced significant trauma such as a spinal cord injury. After major trauma, the human body works harder to recover and so has higher nutritional requirements.

Spinal cord injured patients have a tendency not to eat well directly after an accident for various reasons such as increased sleep needs and physical limitations. This may result in immediate post-accident malnutrition, which then manifests as fatigue and low energy. It is important in instances such as this for an early assessment to be made for nutrient deficiencies.

Impact on immune function and recovery

The immune system of patients suffering from spinal cord injury can also become compromised by a failure to prioritise nutrition. This can lead to increased recovery times or incomplete rehabilitation plans if a patient is continually falling ill or in some cases, requiring recurrent hospitalisation. This can be further compounded in patients with existing chronic diseases such as diabetes.

There is also a tendency for spinal cord injured patients to lose high amounts of muscle mass post-accident, which is usually caused by high levels of inflammation following the injury and significantly increased rest requirements. On average, a patient in ICU will lose 2% of muscle mass per day. In these instances, a patient’s weight will initially go down. When inflammation subsides approximately 6 weeks to 6 months post-accident, depending on the severity of the injuries, a patient will have a lower muscle mass, and a lower caloric intake will subsequently be required. Despite caloric intake being reduced by up to 50%, most patients go back to their normal, pre-accident eating habits post-recovery, and so weight gain can then start to appear quite quickly.

Difficulties can however arise in the practicalities of weight management itself. Poor access to wheelchair and hoist scales to even allow patients to keep track of their weight is commonplace, and food preparation can be a problem in non-adapted homes. These things should be accounted for in costs estimates early on in cases involving spinal cord injured claimants to counterbalance access issues. Support workers can also assist, but it is important to establish whether they have capacity to cook themselves and they understand the nutritional needs of the particular injured person.

Risks associated with weight loss injections

The recent rise in popularity of weight loss injections naturally means they may be considered to manage weight in spinal cord injured patients, but this also carries significant risk. These injections work primarily by mimicking natural hormones to suppress appetite and increase fullness, which can result in further malnutrition to patients with altered metabolisms. The quicker a patient loses weight, the more muscle mass they are also losing. Research suggests that after stopping weight loss injections (usually within 12 months of initial use) the speed at which weight regain takes place is approximately 0.8kg per month, and all weight lost is typically regained after around 18 months.

General overview/insights 

From a claims perspective risk management is a primary focus for insurers, and the recovery of claimants in spinal cord injury claims will have a huge impact on reserve estimates and decision making. The likely timeline for the recovery of spinal cord injured claimants will differ significantly between individual cases, and so implementing steps to promote recovery at an early stage of matters will be crucial for insurers.

Insurers will be keen to address these issues at an early stage, where complex injuries can give rise to wide-ranging adverse implications for claimants. Establishing a definitive nutrition plan early on in cases involving spinal cord injury will assist in facilitating this. It seems clear that the implementation of proper nutrition following spinal cord injury can both aid in a claimant’s recovery and expedite it.

The role of a dietician in preparing a nutrition plan is therefore something which should be considered and reviewed on a case by case basis.