The dietitian is involved in two aspects of stroke rehabilitation and recovery.  These are hydration- nutrition and secondary prevention. 

Dehydration is common after stroke, due to consequences of stroke such as swallowing impairment, immobility, and communication difficulties.  Dehydration has been associated with poor outcomes post stroke, and therefore fluid supplementation by appropriate methods should be used to prevent dehydration and treat it as well.  

Malnutrition is also associated with worse outcomes, and can lead to negative effects such as weakness, infections, pressure sores, increased length of stay, and also increased mortality.  All patients with acute stroke should be screened for malnutrition and there are a number of validated tools available.  Patients at risk, including those with dysphagia, should be referred to a dietician for assessment and ongoing management.

High protein, high energy diets including nutritional supplements may be indicated, and should be offered if patients have poor nutritional status or are deteriorating. 

If dysphagia has affected a patient’s ability to attain adequate nutrition and fluid, enteral feeding by nasogastric tubes or percutaneous endoscopic gastrostomies may be indicated.  Evidence for which method of feeding is most appropriate is actually unclear but generally it’s accepted that nasogastric tubes be used in the short term, and PEG tubes are practical for long term, if people do not regain swallow.  

It’s a complex ethical and quality of life debate so it’s important that the team discuss these decisions and that the family and the patient ultimately decide the outcome.  More research is actually required regarding the benefits of early enteral feeding and the possible negative outcomes.  

The dietician will recommend an appropriate method of feeding and advise appropriate enteral feeding regimes, and in liaison with speech pathology we work on transitioning the patient to oral diet as their rehab progresses.  If a patient is discharged from our unit with a PEG tube the dietician will review the patient on a regular basis to monitor weight and dietary intake.  We also ensure that they have access to enteral feed formula.  

In terms of secondary prevention, every person with a stroke should be assessed and informed of their risk factors and possible strategies to modify their risk factors.  The dietician can provide nutritional counselling in relation to high cholesterol, hypertension, obesity and diabetes.