Category: Advancing Modules

Diet Quiz

Q. Select true or false for each of the options listed below.

The eatwell plate quiz

Q. The eatwell plate illustrates the types and proportions of foods we should eat to achieve a balanced diet. It is based on the five food groups.

The eatwell plate

Q. The eatwell plate illustrates the types and proportions of foods we should eat to achieve a balanced diet. It is based on the five food groups.

Diet

Diet and secondary prevention of stroke

  • Scotland’s diet is a major cause of poor health in the country.
  • The Scottish diet is traditionally high in fat, salt and sugar, and low in fruit and vegetables.
  • Scottish Government (2018) A healthier future: Scotland’s diet and healthy weight delivery plan.  This plan sets out ways Scottish Government will work with partners in the public and private sector to help people make healthier choices about food.
  • The risk of having a second stroke can be reduced by modifying life style factors. It is the interaction between cholesterol, high blood pressure and smoking that creates the biggest risk.
  • Diet has an important role in reducing the risk of second strokes and improving the management of hyperlipaemia, diabetes and hypertension.
  • Evidence suggests that high salt content, low fruit and vegetable intake and high alcohol consumption increases the risk of stroke.
  • A fifth of men (20%) and a quarter of women (24%) in Scotland consume the recommended amount of five or more portions of fruit and vegetables per day.
  • Being overweight increases the risk of developing hypertension and diabetes but even a small reduction in weight has significant health benefits; the aim should be to achieve and maintain weight loss of 5-10% or 5-10kgs
  • The success of making and sustaining changes to diet (and other lifestyle factors) is influenced by many factors including readiness to change, financial issues, food preferences and cultural influences.

Conclusion

Conclusion - Completed jigsaw

You should now have an understanding of how muscle works and how changes after stroke can affect muscle tone including the possible development of spasticity. You should know when to refer to specialist spasticity services for intervention.

Each member of the multidisciplinary or care team looking after a stroke patient will influence tone by their actions. This influence can be helpful or not and may affect long term recovery. Early active interventions such as positioning, stretching, functional techniques, use of appropriate equipment and medications can make a significant difference to the patient’s outcome. You should be aware of the signs which indicate a change or exacerbation of tone problems and the potential trigger factors which could cause them. Undesirable actions or poor communication could cause adverse outcomes for tone and the patient’s recovery.

It is also important to manage tone effectively for health economic reasons. NHS inpatient costs can range from £2900 to £3653 for a short episode of treatment. Specialist neurorehab services can cost £656 per day. These costs also apply to community services for example a visit from a reablement team has an average cost per service user of £2131 and adult day care for physical support costs £87 per person per visit (all 2016 data from PSSRU Personal Social Services Research Unit).

Successful stroke management, including tone management, requires every person who is in contact with the patient and their carers to do the right thing at the right time from day one. Every patient contact has the potential to have a positive or negative effect on the management of muscle tone.

Key aspects of good practise when treating abnormal tone following stroke are:

  • Careful observation
  • Early interventions
  • Recognise and treat factors which exacerbate tone issues such as pain or infection
  • Regular review by all the multidisciplinary team
  • Communication within your multidisciplinary team
  • Working with your patient and their carers to encourage self-management of tone

Six months later

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Function at home

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Dave is discharged

Dave has been discharged from the acute stroke unit after 8 weeks and from the general ward at 12 weeks.

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