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Intervention

Goal: increase energy by X increase protein by X HEHP, nutrition oral supplements, texture modification motivational interviewing Coord: psych, EP for CVA, OT, social worker, GP for follow up biochem, speechie for follow up

PESS

- Inadequate energy and protein - Malnutrition - Inadequate oral intake As related to NIS on the BG of nuerological disorder, as evidenced by SGA, biochem, wt loss, EEI, EPI

Neurological conditions

Parkinsons - 18% affected are of working age - Progressive neurological condition. Motor and non-motor symptoms - Factors: environmental (toxin induced neuron damage) behavioural, genetic - Dopamine agonists side effects: Nausea, vomiting, sleepiness, HTN, confusion - Anticholinergic agents: Block acetyl Ch < dopamine effectiveness

Huntington's disease - 20-40 years of age - Faulty chromosome of 4 - Speech difficulties, mental deterioration, cognitive decline associated w/ dementia - Impaired ability to self-feed, depression, aggression, antisocial behaviour - EE raise (mitochondria less efficient/more demanding?)

MND- Motor neuron disease AKA amyotrophic lateral sclerosis - Degeneration of motor neurons in the brain stem and SC - Weakness and wasting of muscles - 20% of MND develop malnutrition - 70-80% develop dysphagia

MS- multiple sclerosis MOST common in young adults - Disease of white matter on CNS affecting brain and SC - Immune system attacks myelin sheath; impaired nerve translation Symptoms: fatigue, bladder & bowl issues, muscle weakness, spasticity, ataxia, tremor, neuropathic pain, mood swings. Intervention: Vit D can help in severe cases

Stroke/CVA - Ischaemic (70% of cases)= obstruction of cerebral blood flow= heart attack - Haemorrhagic: rupture of weakened blood vessels - Weakness, paralysis, speech difficulties, dysphagia, impaired cognition

Anthro

Wt decrease wt % decrease Check SGA BMI- CVA could be as same as CVD

Diet

EER, EPI, EFI Not hypermetabolic CVA E: 100-125kJ/Kg/day P: 0.8-1g/Kg/day Moderately hypermetabolic post opperative >14days E: 125-145kJ/Kg/day P: 1.2-1.5g/kG/day

Client hx

“Olol”- B blockers “pril”- ACE inhibitors “statin”- HMG-CoA reductase inhibitors Clopidogrel- Anti-platelet agent Aspirin/dipyridamole- anti-platelet agent Levadopa (Parkinson’s) mimics dopamine

Social hx - smoker? Occupation, family at home, food accessibility, PAL NIS- lip seal, muscle weakness, tremors Medical- what type of neurological disorder? Fam medical hx- ND, HTN, T2DM etc.

clinical presentation

Impact- impaired ability to obtain, prepare and consume food safely

Paralysis Immobility Abnormal motor dysfunction Neuropsychological disorders (depression) Oropharyngeal dysphagia Dysphasia (speech comprehension/generation impairment) Disordered swalloing Oral phase usually 1-2 sec, pharyngeal <1s, Oesophageal 8-10s Aphasia- speech impairment

Biochem

Na (135-145mmol/L) Urea (3.0-8.5mmol/L) K (3.5-5.0mmol/L) PO4 (0.75-1.5mmol/L) CRP, Alb Cholesterol Triglycerides