GOALS

     As spinal shock subsides, abnormal muscle hyperactivity and spastic reflexes can occur. The daily energy expenditure of chronic spinal cord injured patients is significently lower than in able-bodied persons due to lower levels of physical activity, lower resting metabolic rate, and lower thermal effect of food (Monroe, et al 1998).  However, in persons with incomplete SCI whey and carbohydrate ingestion after fatiguing ambulation enhanced ensuing ambulation. (Nash, et al 2007). Following are long term nutritional goals for SCI patients.

1. Caloric Intake
   • A range of energy expenditure from 19.3 - 35.8 kcal/kg has been reported for SCI patients, depending on level of injury and physical activity. Approximately 23 kcal/kg may be used for quadriplegics and 28 kcal/kg for paraplegics, with adjustments as needed based on weight changes
   • A range of weekly weight gain, from 1.28 kg for paraplegics to .84 kg for quadriplegics, has been reported for SCI patients during rehabilitation on unrestricted diets
   • A range of 23% body fat for sedentary paraplegics to 15.6% body fat for wheelchair athletes has been reported

2. Protein Intake
   • High-protein supplements, together with nutrition counseling and high-calorie supplements, may be necessary for SCI patients at high risk for pressure sores
   • High-protein diets should be prescribed cautiously. They may promote urinary calcium excretion and may indirectly promote osteoporosis. SCI patients with proteinuria have more impaired renal function and increased mortality compared with SCI patients without proteinuria. Predictors for the development of proteinuria are chronic indwelling bladder catheters, number of decubitus ulcer procedures, hypertension, and older age (Wall, et al 1999).

3. Treating Dysphagia with:
   • Diet modifications and progression of foods
   • Enteral support via nasogastric tubes, percutaneous endoscopic gastrostomy, or feeding distal to the pylorus to reduce the risk of aspiration