Effect of upper extremity posturing on measured resting energy expenditure of nonambulatory tube-fed adult patients with severe neurodevelopmental disabilities

Abstract

PURPOSE: To ascertain the effect of upper extremity posturing on measured resting energy expenditure (MEE) for patients with severe neurodevelopmental disabilities. METHODS: Twenty-four nonambulatory adult patients with severe neurodevelopmental disabilities referred for evaluation of enteral tube feeding and who had a steady-state MEE performed were studied. Steady-state indirect calorimetry measurements were done through a canopy system. Patients were stratified according to the topography of their neuromotor impairment and motor function as having either fixed upper extremity contractures (Fixed UE) or with preservation of limited functional and nonfunctional upper extremity movement (Preserved UE). RESULTS: Despite a similar age, weight, height, and gender distribution between groups, those patients with Fixed UE (n = 13) had a significantly lower MEE than those with Preserved UE (n = 11): 893 +/- 91 versus 1144 +/- 262 kcal/d (p < .01), respectively. The Harris-Benedict equations' predicted energy expenditures were similar to MEE for patients with Preserved UE (1212 +/- 156 versus 1144 +/- 262 kcal/d, respectively, p = N.S.). Patients with Fixed UE had a significantly lower MEE than predicted by the Harris-Benedict equations (893 +/- 91 versus 1128 +/- 123 kcal/d, respectively, p < .01) CONCLUSIONS: Patients with fixed upper extremity contractures have a significantly lower MEE than those with preserved upper extremity movement. MEE for nonambulatory tube-fed adult patients with severe neurodevelopmental disabilities and fixed upper extremity contractures is significantly lower than predicted by the Harris-Benedict equations.

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JPEN. Journal of parenteral and enteral nutrition

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