I am one of the dieticians at the Royal Hospital for Neuro-disability. B.I.G thought it would be good to give you a bit of insight into the problems and solutions to making sure their loved ones were fed and watered properly. So here you are – I hope you find it interesting and maybe useful.
In profound brain injury the person is unable to swallow so eating and drinking has to be done by tube. Some go on to be able to eat and drink a little by mouth, but the chances are all or most of their food and drink will need to be taken by tube. Fortunately this method of feeding is very effective and once established, quite simple and practical.
Because the brain injured person is being fed artificially by tube there is no appetite to go by and they can’t tell us when they are hungry or full up. So it is very important to set a target weight and then to monitor their weight on a regular basis. This is where the relatives are so important as they can give the dietician a good idea of what sort of build their loved one normally is so a suitable target can be agreed on.
We have special scales with a big platform with ramps so you can wheel the wheelchair on to it, that way the person can be weighed in the chair. Once the wheelchair alone is weighed the person’s actual weight can be calculated.
Typically just after a very serious brain injury people lose weight so usually we are trying to get the person to gain weight and they may need a lot of calories. As they settle down and become more stable they often need a really low intake. So with regular weighing and by making adjustment to the amount they are given, the dietician can make sure the person is getting the right amount of calories to meet, or stay within their target weight range.
There are nutritional standards for how much protein, vitamins and minerals people need so the dietician will have to make sure a tube fed person is getting enough of these nutrients. We are very fortunate in this country in that there are lots of ready-made products that are designed for tube feeding so by using the right prescription, the dietician can make sure the person is getting enough of all the nutrients they need.
It is very important that anyone has enough to drink but brain injured people do tend to need rather more especially in the earlier stages. They often have infections and the brain injury itself may make them sweat a lot so it is especially important to make sure they have plenty of fluid.
Firstly there is the feeding tube. This goes straight into the stomach and can be tucked away under clothing so is not necessarily visible. To put the tube in the stomach, the person would need a minor operation in a specialist unit in hospital. Just a bit of sedative and a local anaesthetic is needed and it takes about 20 minutes to do. The tube stays in the stomach all the time but other tubing can be attached when the person needs food or water. Nutrition is given in liquid form to make sure it goes through the tube OK and usually it is pumped with special equipment designed specifically for tube feeding. All the equipment can be put into a knapsack and hung on the back of the wheelchair so feeding can carry on discretely anywhere if wanted.
Good nutrition and hydration underpins everyone’s health and wellbeing so it is very fortunate that usually it is possible to make sure that a severely brain injured person can be well fed and hydrated.