2019/9/23 Nutritional Management in the Rehabilitation Setting: Practice Essentials, Overview, Nutritional Screening

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Nutritional Management in the

Rehabilitation Setting
Updated: Nov 01, 2018
Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Stephen
Kishner, MD, MHA more...

OVERVIEW

Overview
Nutrition in a rehabilitation setting often involves patients who could be on either end of the nutritional
spectrum, with debilitated patients who are undernourished at one end, and patients who have
recently been admitted for complications of obesity, such as coronary artery disease and stroke, at the
other end. In between are patients in whom current clinical conditions require optimum nutritional
support for recuperation and to enable effective participation in rehabilitation exercise programs.

This discussion will focus mainly on relevant nutritional issues ranging from standard nutritional
intervention to aggressive nutritional support, available nutritional interventions, and the process of
nutritional screening and support as they pertain to rehabilitation medicine.

There is no discussion of nutritional rehabilitation per se, but some of the issues discussed are of
great relevance.

While nutritional support is often through the oral route, there may be instances in which this route is
not available and others may need to be used.

There are special nutritional issues peculiar to the elderly and mentally handicapped owing to a variety
of factors, such as poor intake, poor chewing abilities, swallowing difficulties, [1] associated debilities,
and mental apathy.

Recent research
In an international, prospective, observational cohort study, Jones et al examined whether practices in
158 adult intensive care units (ICUs), in 20 countries, were similar to Canada's evidence-based
Critical Care Nutrition Clinical Practice Guidelines. [2] According to the report, which involved nearly
3,000 mechanically ventilated adult patients, practices regarding the preferential use of enteral
nutrition over parenteral nutrition, glycemic control, and the administration of hypocaloric parenteral
nutrition were particularly close to guideline recommendations.

However, other practices in the units often were not in sync with the guidelines. For example,
practices regarding the use of glutamine supplementation and fish oil–enriched enteral formulas, the
timing of supplemental parenteral nutrition, and the avoidance of soybean oil–based parenteral lipids
coincided poorly with the guidelines. Moreover, the average nutritional adequacy for energy and
protein was 59% and 60.3%, respectively, among the ICUs.
https://emedicine.medscape.com/article/318180-overview#a2 1/2
2019/9/23 Nutritional Management in the Rehabilitation Setting: Practice Essentials, Overview, Nutritional Screening

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