Nutrition and Personal Care for Brain Injury Individuals

1. Nutrition and Personal Care in Individuals with Brain Injuries Acquired Brain Injury Medicaid Waiver Training Kentucky Department of Mental Health and Mental Retardation 2005

2. Developed by the Brain Injury Association of Kentucky under contract from the Department for Mental Health and Mental Retardation Services. Approved for one hour of Acquired Brain Injury Waiver Continuing Education Training. 2

3. This module will provide you with information about issues that affect the nutrition and personal care of individuals with brain injury. It will take you approximately one hour to complete this entire module. 3

4. Before you begin, you must take a pretest. Ask your supervisor for the pretest that corresponds to this module. Complete the pretest and turn it in to your supervisor before beginning this module. 4

5. When you have completed the pre-test and given it to your supervisor, ask for the test that corresponds to this module. You may take the test as you complete the training module. When you complete the training, turn the test in to your supervisor. 5

6. Brain injury is the silent epidemic It is a largely unrecognized major public health problem in the US. 6

7. No one is immune… Approximately 1 in every 10 individuals is touched by brain injury. 7

8. Basic functions of the brain • There are two basic functions of the brain: • The brain monitors and controls the inner body functions to meet the body’s needs • And • It monitors and directs a person’s response to the environment 8

9. Areas of the Brain There are 3 main areas of the brain: • Brain Stem • controls basic life functions such as heart and lungs • Cerebellum • controls balance and coordination • Cerebral hemispheres • controls senses (e.g., seeing, hearing) and organizing/controlling actions 9

10. The Brain Hemispheres The brain is the control center for all of the body’s actions and functions. Cerebellum Brain Stem 10

11. How does a brain injury affect the brain? Injury to the brain stem may cause problems with many things including • breathing, • heart rate • sleep. Brain Stem 11

12. Injury to the cerebellum affects several areas including • balance • coordination • skilled motor activity Cerebellum 12

13. Injury to the cerebral hemispheres may lead to problems with • judgment • self-monitoring • attention • senses – touch, vision • memory • sequencing Cerebral hemispheres 13

14. Nutrition and Personal Care Due to the affects of the injury, many people with brain injury have trouble monitoring nutrition intake. In addition, individuals may also have trouble in the area of personal care or hygiene. 14

15. Health Habits After a brain injury, it is important to keep healthy. Eating correctly with a balanced diet and exercising, even if from a wheelchair or with a walker or cane, is important. Eating well and exercising energizes the body. 15

16. Tips to Healthy Habits Some healthy habits include: • get at least 8 hours of sleep at night • eat a healthy diet • exercise • take a multivitamin tablet daily • limit caffeine • don’t smoke 16

17. Sleep A good nights sleep is essential to ongoing recovery after brain injury. • Depending on the area of the brain that is injured, insomnia may be an ongoing problem. A person may need more than 8 hours of sleep. • Ongoing tiredness and fatigue is a common problem. 17

18. This might be a problem for years after the injury. • Physical fatigue may also cause mental fatigue. • Both can lead to irritability. • Long and active days may now be difficult for the individual. 18

19. How can you help? • Talk with your supervisor, case manager or team. Suggest making an appoint with a physician to ensure there are no underlying medical problems. • If insomnia is the problem, a sleep medication may be appropriate. Check with the doctor. 19

20. Arrange a rest period during the day • It doesn’t matter if the individual sleeps; rest might be what is needed. 20

21. Make sure the person is in a quiet area when resting. • If possible, the person should be alone when resting. • If the person is in a day program, a rest period can still be arranged. 21

22. Weight management Weight issues my effect an individual with a brain injury. This could be weight gain or weight loss. 22

23. Weight gain Weight gain may be attributed to the following: • side effects of certain medication • lack of exercise due to physical inability to move around • boredom because the person is at home now 23

24. Depending on where the injury to the brain has occurred: • a brain injury could cause impulsivity which causes a person to eat more often • a brain injury could cause a person not to feel full after eating 24

25. Excessive weight gain may cause various problems: • increased risk of diabetes and heart disease • fatigue • decreased mobility • inability to fit into an existing wheelchair 25

26. Weight Loss Weight Loss may be attributed to the following: • a brain injury may cause a person to forget to eat • a brain injury may cause the person to have a damaged sense of smell that causes loss of appetite • there may be side effects of medication 26

27. How can you help? For weight gain • Talk to your supervisor, case manager or team. Suggest a consultation with a physician or dietitian for recommendations. • Encourage the individual to decrease sugary food and snacks. • Use something other than food as a reward. • Suggest decreasing caffeine. • Try to control portion size & second helpings. 27

28. Encourage the preparation of healthy meals. • Divide fruits, cheese, crackers or other healthy items into single portions and store in baggies or plastic container. • Assist the individual to make healthy choices when food shopping. 28

29. For weight loss: • Talk with your supervisor, case manager or team. Suggest a consult with a physician for a medical work-up to eliminate any medical problems or side effects of medications. • Consult a dietitian for correct diet and daily calorie needs. • Develop a schedule for meals to ensure the person eats. 29

30. Make meals and freeze them so the person has access to food when he or she wants it. • If the person lives alone, set an alarm clock to cue the person to eat, put notes on the cabinet or refrigerator. • Let the individual develop the menu with you, to ensure there is food on hand he or she enjoys. 30

31. Cholesterol High cholesterol is a problem for a healthy life. Bad cholesterol, or LDL, are foods that clog arteries such as fatty red meat, bacon, whole milk products. Good cholesterol, or HDL, helps the body remove the bad cholesterol. These foods include whole grains and low or no fat dairy-products. 31

32. How can you help? • Suggest that a physician do a cholesterol check. • Help the individual avoid unhealthy foods such as • fatty red meats, bacon, sausage and other processed meats • butter and lard products • fried foods 32

33. whole milk and whole milk products, such as ice cream, cheese, yogurt, sour cream • encourage the use of vegetable and olive oils 33

34. Healthy eating tips Encourage the following healthy eating habits such as: • drinking plenty of water each day • limiting decaffeinated drinks – soda, tea, coffee • using low fat or fat-free dairy products 34

35. when filling a plate, fill ½ with fruits and vegetables, ¼ with protein and ¼ with carbohydrates such as brown rice or whole grain pastas • limit sweets 35

36. Exercise Exercise is important to a healthy lifestyle. • Check with a physician before suggesting an exercise program. • Choose exercise that a person will like. • Make sure the individual is physically able to exercise. • Set a regular time for exercise, at least 3 times a week. • Listen to music or a video to help give guidance. 36

37. Personal Care /Hygiene Problems with balance and coordination may result in difficulty with personal hygiene activities such as bathing, dressing and brushing one’s teeth. When judgment, self-monitoring, attention span, sense of touch, vision, memory, and sequencing are impaired, problems with completing personal care may occur. 37

38. Examples While these tasks may seem simple to you, they may be very difficult for a person with a brain injury. • showering • taking a bath • brushing teeth • combing hair • dressing 38

39. Ask yourself….. Try to decide if a person is having difficulty because of motivation or because of a skill deficit. • Skill deficit • a person is no longer able to perform the task due to memory or other impairments 39

40. Difficulty with motivation • a person still has the ability to do the task at times, but due to fatigue or other issues is not consistently willing to do the task 40

41. How can you help? • If the person is still receiving rehabilitation services, it is likely that a treatment team is involved, including an occupational therapist, social worker, behavior analyst, speech-language pathologist, or others. • Check to see if there are recommendations from these professionals for you to follow regarding how to teach or motivate. 41

42. Training strategies for you to use It is often helpful to break large tasks into smaller steps. It might be easier for an individual to learn these smaller steps than to learn the entire task. 42

43. Breaking down a task for dressing • Retrieve shirt and pants from the closet • Lay clothes on the bed • Retrieve underwear and socks from the dresser • Lay clothes on the bed • Remove pajamas • Put on underwear, shirt and pants • Put on socks • Put on shoes 43

44. Breaking down the task for brushing teeth • Remove toothpaste, toothbrush and cup from cupboard • Apply the toothpaste to the brush • Brush the outside surfaces of the teeth • Brush the inside surfaces of the teeth • Fill the cup with water • Rinse the mouth • Rinse the toothbrush • Put toothbrush, toothpaste and cup in cupboard 44

45. Teaching tasks If you are trying to teach John to put toothpaste on the toothbrush • ask John to do the step independently • if he is unable to do the step, show him • if he is still unable to complete the step, help him • if he is still unable to complete the step, do it for him 45

46. Each time the step is done, assist a little less until John is able to complete the entire step independently. Begin to group steps to form larger and larger steps until the entire task can be completed. 46

47. Motivation When an individual is asked to do a task that is difficult it often requires additional motivation. The most basic, effective and easily used motivation is positive reinforcement. 47

48. Positive reinforcement occurs when a behavior is followed immediately by something enjoyable. As a result, the behavior occurs more often in the future. 48

49. Example of Positive Reinforcement Ann does not want to brush her teeth. Mom makes a weekly chart and marks off every time Ann brushes her teeth. She tells Ann they can go to a movie every time she brushes her teeth 5 days in a row. Ann likes to go to the movies. She is likely to begin to brush her teeth each day. 49

50. How do you choose a reinforcer? First, ask what an individual wants to earn Second, ask others such as family members Third, try it If it doesn’t work, then it isn’t a reinforcer! 50