Advisor(s)
Mohanraj Thirumalai
James Hill
Committee Member(s)
Elizabeth Davis
James Rimmer
Paula Chandler-Laney
Stacey Cofield
School
School of Health Professions
Document Type
Dissertation
Department (new version)
Nutrition Sciences
Date of Award
1-6-2025
Abstract
Spinal cord injury (SCI) is a global condition affecting millions of people and leading to life-altering health complications. It profoundly alters body composition and metabolic rate, which need to be addressed with SCI-specific nutritional strategies. Muscle atrophy, fat accumulation, and decreased energy expenditure often lead to secondary health complications such as chronic diseases and SCI-related health problems, including pressure injuries and bowel dysfunction. Although nutrition plays a critical role in SCI management, our understanding of specific dietary needs for this population remains incomplete. This dissertation aims to comprehensively investigate the nutritional challenges and needs of individuals with SCI, ultimately developing consensus-based dietary recommendations. We employed a mixed-method approach and included three aims. Aim 1 is a qualitative analysis of interviews with registered dietitian nutritionists (RDNs) who have experience providing counseling to people with physical disabilities (PWPD), including those with SCI. By examining their perspectives, we uncovered disability-related counseling challenges and the need for more inclusive nutritional resources to enhance dietary counseling for individuals with SCI. Accessibility, personalization, simplified energy calculations, and enhanced communication channels were some of the themes we identified. Aim 2 unitized data from the National Spinal Cord Injury Model Systems (SCIMS) database and explored how body mass index (BMI) relates to bowel health in individuals with SCI. The findings revealed that individuals with moderate and high severity SCI have a significantly lower BMI compared to those with least severity SCI (p <0.001). The higher severity of SCI was strongly associated with longer bowel evacuation times (p<0.01), higher frequencies of bowel incontinence (p<0.01), and a higher need for bowel management assistance (p<0.01). Higher life satisfaction scores were linked to better outcomes, including a higher frequency of emptying the bowel (P<0.05), shorter bowel emptying times (p<0.01), fewer bowel accidents (P<0.01), and less frequent need for bowel management assistance (P <0.01). As the severity of injury impacts BMI and bowel health outcomes, while life satisfaction correlates with better bowel function, the findings highlight the complex interplay between physical and psychosocial factors in bowel health management in the SCI population. In Aim 3, we generated 18 nutrition recommendations for community-dwelling adults with chronic SCI who can ingest food orally from the published literature and then conducted an online Delphi panel that reviewed and rated these recommendations. The recommendations covered SCI-specific energy needs, macro and micronutrient intake, and dietary factors affecting common health issues such as constipation and pressure injuries. The response rate for the Delphi panel (N=15) was 100%. The recommendations received consensus scores ranging from 4.14 to 8.13 on a 9-point Likert scale, indicating varying levels of agreement, allowing healthcare providers to interpret them based on the specific needs of individuals with SCI. Together, this series of studies contributes to the growing knowledge of SCI nutrition and offers practical guidance for healthcare professionals.
ProQuest ID
Recommended Citation
Zengul, Ayse Gul, "Exploring Nutritional Needs In Spinal Cord Injury: Dietitian Perspectives, Bowel Health, And Dietary Recommendations" (2025). All ETDs from UAB. 7303.
https://digitalcommons.library.uab.edu/etd-collection/7303
