Traumatic Brain Injury A to Z - Swallowing/Appetite & Weight

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Dizziness

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It’s not unusual for patients to feel dizzy during TBI recovery. Watch as Tracy and the group explore strategies for managing dizziness.
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Dizziness

Julie
You know Michelle, now that Tom’s awake he’ll probably be moving around more. You may find that he complains about dizziness.

Tracy
That’s right, Julie. Dizziness is a very common effect of TBI. Tom may complain that the room is spinning, moving, you know causing that sense of vertigo. So if that happens, he could lose his balance, he could fall. You just want to “fall-proof” the house.

Carl
Julie had me get rid of all her area rugs and electrical cords, things that Sam could slip or trip on. We also put on non-slip mats on the shower and bath floors.

Tracy
Good idea, Carl. Good idea. Also, you want to make sure that the room is well lit. That Tom is encouraged to use any of the assistive devices that his team might’ve provided for him.

Travis
What’s an assistive device?

Tracy
Oh things like canes, walkers…equipment that may help your Dad get around when he comes home.

Okay, just a few more things… You’ll want to remind your Dad to avoid sudden movements. It can also help to sit for a few minutes before walking. You know it just gives the brain time to adjust. So encourage him to sit or to lie down as soon as he feels dizzy.

Julie
Sam didn’t seem to get dizzy very often at first, but once he started walking again, he couldn’t seem to keep his balance. They had this kind of belt like contraption that Carl would hold onto while Sam walked up and down the halls in the hospital. It was a good part of Sam’s therapy.

Carl
Heck, it was good therapy for me, too. At least I felt like I was doing something.

Tracy
Something very helpful, Carl. Sam’s lack of balance is pretty common. Our brains control our physical movement, our balance, so obviously a TBI can cause problems with that. Now fortunately, those problems usually go away over time and with physical therapy.

In fact, many of the effects that you see may improve over time. Some of the others might be sensory changes, spasticity, vision problems, seizures, a variety of cognitive effects are some of the possibilities. So you’ll find a description of what to expect, along with those tips on how to manage those conditions, in the Managing Less Common Effects of TBI in your Guide for Caregivers.

Okay, I think this is a good point to take a break.

This week please take some time to write in your journal. It’s important. If you haven’t started one yet, you’ll find a template in your Guide for Caregivers. Keep track of the progress that your family member is making - - even those… those small steps. And write down your experiences, your feelings. But do take time for yourself.

Julie
Along that line, Tracy, we use a website called caringbridge.org. When Sam first got hurt, everyone in our family was calling every day, trying to get information. And it was just too much; it was overwhelming. Carl and I couldn’t keep up, and stay with Sam at the same time. Then the people at the Fisher House in Landstuhl, told us about caringbridge. It’s great. You can download pictures, and create a website for your injured soldier, and keep everyone posted. Every day I go on there and write in my journal. It’s good therapy for me, and our entire family can check up on Sam’s progress.

Tracy
That’s terrific, Julie. Yeah, I’ve met many people who’ve used both caringbridge and another website, called caringpages.com. It’s really helped in a couple of ways - - keeping family and friends updated, serves as a journal for the caregiver. You know if you have a chance, check the sites out. I think they’ll help.

So next week lets talk about taking care of yourself, which is key to being an effective caregiver. Okay. Thanks everybody for coming. And remember, I’m here for you if you need anything, you know where to find me. Okay.
 

Swallowing/Appetite & Weight

Many people with traumatic injuries do not drink or eat for a period of time. As a result, they lose weight.

Once the person is fully awake and able to follow directions, swallowing can be evaluated. It is important to fully evaluate swallowing before the injured person drinks or eats.

The purpose of evaluating the person’s ability to swallow is to make sure that what he or she eats goes into the stomach, not into the lungs. When food or fluid slips into the lungs, it often results in pneumonia.

A speech or occupational therapist evaluates swallowing. This may be done in the person’s hospital room.

If not, the therapist may escort your family member to the x-ray department for a video fluoroscopy. Your family member will consume a barium-laced liquid or food that will light up on an x-ray. The x-ray helps the therapist to see precisely where it is going.

Once your service member/veteran is cleared to drink or eat, he or she may only be able to consume certain types of liquids and foods. Most people do best with medium consistencies, rather than thin fluid or very chewy, tough foods.

With practice, most people will return to a normal diet.

Appetite can be affected. Some people with TBI complain of a reduced appetite. Others gain weight due to boredom, memory problems, and an increased appetite.

Work with the health care team to learn how to help your service member/veteran have a healthy diet and a healthy weight.

What you might see:

  • Choking or coughing during meals
  • Pocketing of food inside the mouth and/or drooling
  • Decreased interest in eating
  • Weight loss, without trying to lose weight (possibly due to loss of taste and smell)
  • Overeating, resulting in weight gain
  • Memory problems: failure to remember when to eat or when last ate

How you can help:

  • Do not offer fluids or food until your service member/veteran has been cleared to drink and eat.
  • If on a special diet with restricted fluids and foods, work with the therapists and dietitians to learn what foods are allowed. Learn how to assist your family member to drink and eat if special strategies are needed (i.e., eat slowly, chin tuck during swallow, double swallow, follow every bite of food with fluid).
  • Short-term changes in appetite are common. Don’t worry about early weight loss. Most often, the weight is regained once the person is home.
  • Monitor your service member/veteran’s body weight and learn what his or her ideal weight range is from the dietitian.
  • Report appetite changes to the health care team. These may be a sign of depression, general emotional distress, medication problems, or other medical conditions.
  • Ask for a dietitian to review dietary intake and to learn more about meal preparation and a balanced diet.
  • It is common to have reduced taste and smell following TBI. Talk with the dietitian about how to use spices and flavorings to perk up the taste of food.
  • Weight gain following TBI is common. It is usually due to lack of physical activity. But sometimes it is due to boredom. Work with your service member/veteran to remain physically active and engaged in outside activities. Establish set meal times. Discourage overeating or too many snacks.
  • Encourage your service member/veteran to be involved, as able, in grocery shopping and meal planning/preparation.
  • Write meal times in the planner/memory book. Check off meals when finished.
Related Information:
Dizziness
Other Physical Effects
Glossary
Frequently Asked Questions
"In the very beginning, I didn’t want to know anything because I was so scared. But a little while later… the doctors would throw out tidbits to me, like he might never speak again and he might never walk again… but I couldn’t understand why. So then I wanted to understand the part of the brain that was injured and why he was having these symptoms or why he was having this diagnosis." -  Patty H.

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