Investigation Into Metabolic and Nutritional Changes Following Acute Stroke.

Metabolic injury responses were examined over a seven day period, in a selected, nondiabetic group of first strokes, attributed predominantly to cerebral infarctions of slight to moderate neurological injury severity. Comparisons were made with responses following surgery for fractured femur in a similar age group. Limited evidence for a post stroke metabolic response was obtained, for changes in blood glucose, serum cortisol, insulin and β hydroxy-butyrate concentrations, which were consistent with responses seen in other types of injury of limited severity. The duration and magnitude of response was less than that observed following surgical intervention for femoral fracture. An ordinary scaled assessment instrument was developed to quantify the severity of eating disability following acute stroke. In conjunction with measurement of weighed food intakes, this was used to identify determinants of dietary energy and protein, provision and consumption on days 8-10 following admission. Dietary energy and protein consumption demonstrated negative correlations with the severity of eating disability; patients with severe eating problems consumed significantly less. Dietary energy and protein provision and consumption in patients with severe eating disabilities was below 50% of estimated average requirements. Food textures supplied to some cases with chewing and swallowing problems were inappropriate and may have exerted adverse effects on energy intakes. An investigation into the nursing support offered to stroke patients at meal times found that responsibilities for assisting patients were devolved mainly to unqualified nursing staff; more than half the meals were selected by ward receptionists and nurses. High levels of nursing engagement in activities related to postural support and arm impairment were observed; but few activities were engaged in assisting dysphagic patients to swallow or in the compensation of visual field or perceptual problems. Limited provision of aids to eating and lack of involvement of paramedical staff in mealtime support activities was recorded. An in-depth study of eight cases during the acute phase of stroke recovery found that individuals who had sustained the most severe strokes, had more eating disabilities, consumed less energy and protein in relation to reference values and experienced a deterioration in nutritional status. Patterns of recovery suggested associations between stroke severity, nutritional status, functional improvement and occurrence of sepsis. Documentation of nutritional problems in clinical records was limited. Recommendations for further research and implications for clinical practice have been identified