It is difficult for patients to change old habits, or to establish new ones, especially if there has been physical or emotional trauma with cognitive challenges, which are frequently seen in the rehabilitation setting. Behavior modification should be implemented incrementally. Patients should be discouraged from attempting sudden or dramatic change. Incremental lifestyle modification should begin with realistic goal setting, followed by analysis of current habits, and finally by strategizing how to implement chosen modifications.

In the chronic outpatient setting, for example, if a patient does not regularly eat breakfast, the patient should be instructed to start with a cup of yogurt or a piece of fruit and then to build it up over a few weeks to a full hot breakfast.

If a patient does not regularly exercise, the patients should be instructed to initiate a chosen new physical activity once a week for 2 weeks, then increase frequency and intensity to twice a week until physical activity goals are realized. This should be carefully balanced with physical and/or occupational therapy objectives in the particular phase of rehabilitation the patients is in as well as realistic expectations based on the patient’s impairment.

Development of new habits should be established over time, not overnight and should be accompanied by gradual reduction of bad habits (eating late at night, overeating, not having daily regular physical activities, not having enough sleep, etc.). These behavioral activities can also be extended to the patient’s bad medical habits, which may have negative influences on their overall recovery.

Patients should be encouraged to maintain a journal where daily progress can be charted and analyzed retrospectively to analyze trends and to make adjustments as needed.

Patients should be counseled not to get discouraged if goals are not achieved as initially planned. Patients should be encouraged to acknowledge and to reflect upon positive progression and reminded of the importance of pacing to realize substantive and meaningful change.

Patients should be advised to maintain good eating habits, and off-cycle or excessive consumption of any food should be avoided. Nutrition should include a balanced spectrum of nutrients, which are the building blocks for cells, and should come from a variety of food sources. Given global agricultural trade, availability of fresh produce has grown in most developed countries. However, when possible, patients should be advised to try and eat locally. In general, sourcing of food locally is most beneficial for patients, because of the following:

When a person is generally healthy, lifestyle modifications include nutrition management. When a person is sick or in pain, lifestyle modifications include diet therapy. In both situations, attention should be paid to portion sizes, to consistency in food consumption, to quality of food, to combination of different foods, and finally in food preparation.

Patients should receive specific counseling on appropriate hydration. Liquid consumption should be adjusted to a patient’s physical and mental load throughout the day, gender, weight, and height, and based on climate.

Many health issues can be treated by addressing nutritional intake through appropriate consumption of the vitamins, minerals, and amino acids, which are essential for proper nutrition. Table 48.2 illustrates the effects of some vitamins and minerals on some functions of the body [8–10]: