Module 8: Part 2 and 3 / MNT for Traumatic Brain Injury (TBI) / MNT for Spinal Cord Injury (SCI) fully solved questions with 100% accurate solutions(Latest Update)

Traumatic Brain Injury (TBI)

Penetrating or closed head injuries caused by accidents, falls, violence, firearms, or sports.

U.S. TBI statistics

2.8 million ED visits in 2013; 60% occur in males.

Severity of TBI

Usually requires ICU care, has high morbidity, and commonly leads to long-term disability.

Long-term disability prevalence

1.1% of the U.S. population lives with TBI-related long-term disability.

Primary injury (TBI)

The initial injury to brain tissues due to penetration or the brain thrashing against the skull.

ex: Contusions, being struck by objects, collisions, falls, gunshot wounds.

Secondary injury (TBI)

Damage resulting from the brain's response to the initial insult.

Components: Cerebral edema, ischemia, hemorrhage, hematomas, infection, increased ICP, impaired blood flow.

Initial symptoms of TBI

Loss of consciousness, headache, dizziness, blurred vision, dilated pupils, slurred speech, nausea/vomiting, confusion, agitation, fatigue, memory or behavioral changes.

Potential long-term consequences of TBI

Hemiparesis; cognitive decline; changes in speech, movement, sensory function, emotions, and personality.

Diagnostic tools for TBI

CT scan, X-rays.

Glasgow Coma Scale (GCS)

Used to rate extent of trauma.

GCS score 14–15

Minor head trauma.

GCS score 9–13

Moderate head trauma.

GCS score <8

Severe head trauma.

Prognosis and GCS

Higher GCS scores correlate with better outcomes.

Acute treatment priorities

Stabilize patient, ensure oxygenation and blood flow, prevent shock.

Medical interventions

Mechanical ventilation, fluid resuscitation, blood pressure medications.

Surgical interventions

May require removal or repair of hematomas or contusions.

Rehabilitation

Multidisciplinary team: PT, OT, speech therapy, psychiatry, MD.

Role of nutrition therapy

Integral part of TBI management.

Metabolic Response to TBI

Systemic response to TBI

Triggers intense inflammatory response proportional to injury severity.

Metabolic consequences

Hypermetabolic, hypercatabolic, hyperglycemia, insulin resistance.

LBM losses in TBI

Up to 15% lean body mass lost in first week.

Catabolism timeline

Peaks around week 2; slows thereafter.

Nitrogen balance

May not be achieved until week 3 even with feeding.

Nutrition support significance

Critical for blunting inflammation and limiting loss of LBM and fat stores.

Energy Needs in TBI

Energy requirement range

140–200% above REE.

When decreased needs may occur

Use of paralytics, barbiturates, or sedatives may reduce needs by 12–32%.

Options for estimating energy needs

Indirect calorimetry (preferred)

Penn State equation if on a ventilator

Harris-Benedict REE × 1.4 OR 25–30 kcal/kg

Macronutrient Needs in TBI

Protein requirement

1.5–2.5 g/kg/day to reduce LBM loss.

Carbohydrate guidelines

Provide a maximum of 5 mg/kg/min of CHO.

Glucose target

140–180 mg/dL (per ICU recommendations).

Effect of hyperglycemia in TBI

Worsens outcomes.

Lipid recommendation

Provide 25–40% of kcal, with emphasis on omega-3 fatty acids.

Micronutrient recommendation

Meet DRI levels for vitamins and minerals.

Nutrition Support During TBI

Preferred feeding method

Enteral nutrition (EN) if possible.

Timing for EN initiation

Start within 24–48 hours of injury.

Tube placement recommendation

Jejunal feeding may improve tolerance.

EN goal

Reach full caloric needs by day 7 post-injury.

Long-term support

If unable to eat orally after several weeks, PEG/PEJ placement is recommended.

EN Formula Recommendations

Formula type for TBI

High-protein EN formula with immunonutrition additives.

Key immunonutrition components

Omega-3s, arginine, glutamine, nucleotides.

Benefits of immunonutrition in TBI

Decreased infection ratesDecreased inflammation (lower CRP & IL-6)

Long-Term Nutrition Concerns

Appetite control after TBI

Brain injury can disrupt long-term appetite regulation.

Potential long-term metabolic outcomes

Weight changes, obesity, diabetes, hypertension, dyslipidemia.

Functional impairments affecting nutrition

Difficulty shopping, preparing meals, cooking, or following complex recipes.

Nutrition education needs

Meal planning, weight maintenance, chronic disease management (HTN, DM, CVD).

Spinal Cord Injury (SCI)

Fracture or compression of vertebrae resulting in nerve damage.

Determinant of Symptoms in SCI

Level of injury determines the signs and symptoms the patient experiences.

Annual SCI Incidence (U.S.)

17,000 new cases per year.

Most common cause of SCI

Motor vehicle accidents (MVAs).

Gender distribution of SCI

Over 80% occur in males.

Complete SCI

Total loss of motor and sensory function below the level of injury.

Incomplete SCI

Some residual motor or sensory function remains below the level of injury.

Tetraplegia (formerly quadriplegia)

Paralysis of all four extremities.

Paraplegia

Paralysis of the lower extremities only.

Metabolic Impact of SCI

Metabolic response in SCI

Similar inflammatory and metabolic stress response as seen in TBI.

Timing of nutrition assessment

Complete within 48 hours of injury.

Acute phase metabolism (0–4 weeks)

Reduced metabolic activity (≥10% below predicted) due to denervated muscle.

Energy reductions

Depend on the amount of denervated muscle.

Energy needs in polytrauma

May be higher if SCI occurs with additional trauma.

MNT for SCI - Energy Needs

Best method to determine energy needs

Indirect calorimetry.

If indirect calorimetry is unavailable (acute phase)

Use predictive equation (HB or MSJ) × 1.1 (activity factor) × 1.2 (injury factor).

Energy needs in rehabilitation phase

• Tetraplegia: ~22.7 kcal/kg

• Paraplegia: ~27.9 kcal/kg

Monitor for unwanted weight change.

MNT for SCI - Protein Needs

Acute protein needs

~2 g protein/kg IBW/day.

Maintenance protein needs

0.8–1.0 g protein/kg body weight/day.

Protein needs with pressure ulcers or infection

Increase to 1.25–1.5 g protein/kg body weight/day.

Common Nutrition Diagnoses in SCI

• Increased energy needs

• Hypermetabolism

• Excessive energy intake

• Inadequate intake of energy, protein, fiber, vitamins/minerals

• Swallowing difficulty

• Altered GI function

• Altered nutrition-related lab values

• Overweight/obesity

• Impaired ability to prepare food/meals

• Self-feeding difficulty

Long-Term Nutrition Considerations After SCI

↑ Fat mass

↓ Muscle mass

↓ Energy needs and metabolic rate

↓ Body weight initially (due to LBM loss)

↑ Weight and obesity risk later

↑ Risk of DM and CVD

↑ Risk of pressure ulcers and osteoporosis

Overweight and Obesity in SCI

Cause

Lower energy needs + unchanged or increased food intake (boredom, depression, inactivity).

Risks

Metabolic syndrome, DM, CVD.

Treatment

Adjust energy intake to maintain optimal BMI.

High-risk BMI for SCI patients

BMI > 22 indicates high obesity risk.

Assessment

Evaluate food security and screen for malnutrition regularly.

Ideal Body Weight in SCI

Standard IBW/BMI use

Not appropriate for SCI patients.

Determining ideal weight

Use Metropolitan Life tables.

Ideal weight for paraplegia

5–10% or 10–15 lb less than standard ideal range.

Ideal weight for tetraplegia

5–10% or 15–20 lb less than standard ideal range.

Pressure Injuries in SCI

Cause

Prolonged pressure and reduced blood flow.

Prevention

Adequate kcal, protein, and fluids; maintain normal BMI.

Treatment

• 30–40 kcal/kg

• 1.25–1.5 g/kg/day protein

• 1 mL/kcal or 30 mL/kg fluids

Supplement needs

Give a standard MVI; supplement specific vitamins/minerals only if deficient.

Neurogenic Bowel in SCI

Denervation or inactivity → reduced bowel motility and constipation.

Fiber needs

Start with 15 g/day, gradually increase to 30 g/day.

Fluid needs

1 mL/kcal + 500 mL/day OR40 mL/kg + 500 mL/day.

Spasticity in SCI

Tight muscles and hyperactive reflexes.

Prevalence

Occurs in 65–78% of individuals with SCI.

Impacts

Increases fatigue, risk of pressure injury, sleep disturbance.

Nutritional effect on kcal needs

More movement may ↑ kcal needs; muscle relaxants may ↓ kcal needs.

Functional impact

May impair ability to prepare meals or eat.