**3. Final remarks and conclusion**

Neurological degenerative disorders affect a relatively small segment of the global population but accounts for extensive disability in the affected cohort. The management of degenerative disorders has primarily surrounded pharmacotherapy, neurostimulation and gene therapy with little focus on nutritional therapy. Recent evidence

### *Nutritional Care and Intervention in Spinocerebellar Ataxia DOI: http://dx.doi.org/10.5772/intechopen.111734*

suggests that this is likely due to the fact that the field of nutritional neurological research is relatively new [34]. Nevertheless, both classic and contemporary evidence points to a strong link between nutritional intake, status, and neurological health outcomes. Consequently, the management of degenerative neurological disorders should be comprehensive and include a multi-team approach. The team of health care workers who are essential to the nutritional wellbeing of clients with neurological disorders include the phlebotomist, physician, nurse, home care assistant and the dietitian. These team members must collaborate to assess, diagnose, prescribe, treat and support the nutritional needs of the ill client towards impacting his overall clinical outcome. The treatment plan is geared at client centered approach that matches nutritional interventions to the pathophysiological changes of the client with neurological disorders.

The main nutritional recommendations for the support and management of neurological disorders includes but is not limited to:

Multiteam collaborative support including a nutritionist and/or dietician to assess nutritional needs and status and create nutrition plans and interventions targeted and personalized to each client to support their recovery or prevent the occurrence. This approach ideally may reduce the course, progress, and outcome of the disease inasmuch as nutrition is employed as a therapeutic strategy. It includes the assessment of the clinical progress of the client, energy needs based on weight, physical activity and diseased state and matches the physiological needs of the client to the ideal nutrition care strategy for optimization of health. The nutrition prescriptions usually match both need for energy (from macronutrients) and the need for micronutrients.

The current evidence suggests worsening neurological decline in clients with SCA where energy and micronutrient intake may be below physiological level which negatively impacts health outcomes. This progressive decline affects dietary intake as well as nutrient requirements. A strategy to improve client overall health results is to offer healthy small packaged foods frequently especially to those exhibiting dependency and reduced appetite in order to limit dietary impact. Foods including dark chocolate, and cheeses have been found to be associated with improved neurological outcomes and meet the needs of clients who require more accessible options. Dark chocolate, in particular, has been found to improve antioxidant levels and is thought to positively affect prooxidant activities in these disorders [35].

For clients with specialized nutritional needs such as those with swallowing difficulties and increased needs for micronutrients, nutrition therapy is critical for recovery and improvement. One element of nutrition therapy is meal planning. Nutritional meal planning is an essential tool that can be utilized to support neurological health and recovery. Meal planning is a structured activity that involves forecasting and preparing nutritionally adequate meals designed to meet the dietary needs of clients. In the first instance, the principle and technique can be taught to the client by an expert and for sustained outcomes adopted and practiced by the affected clients.

The technique allows for energy balance, variety and moderation among other positive outcomes which are beneficial to mental health.

Routine biochemical assessments are essential to health maintenance and management of neurological disorders. Interventions, to be most beneficial, must be grounded in the evidence and client specific data. Biochemical tests may provide information concerning micronutrient status, deficiency or toxicities which are crucial for designing strategies to promote neuronal health and wellness and are likely risk factors in SCA with increased needs, utilization in the face of reduced intake. Some biochemical tests that may be beneficial in the assessment of SCA clients include Complete Blood Counts, Urea and Electrolyte analysis and Nutrition Panel as well as screens for other micronutrients. Results of biochemical analyses are critical for guiding the use of supplements.

Most of the plans to promote neurological health in SCA client addresses balance and increased intake but the comprehensive nutritional guide must also address targeted dietary restrictions such as energy restrictions in the face of inactivity or reduced physical activity.

Pharmacological side effects must be monitored and treated collaboratively to prevent a decline in nutritional status and the related biochemical impact in these diseases.

Finally, the group of clients affected by SCA forms a unique population of health care clients with physiological needs impacting biochemistry and functionality. These expand to present unique nutritional impact affecting status which is direct predictor of health outcomes. The management of the client with SCA must be multifaceted and incorporate nutrition as an essential therapeutic prong. The comprehensive targeted individualized nutritional support including client centered assessment, prescription, adjustment and evaluation, is the best strategy for the nutritional management of degenerative neurological disorders including SCA where the focus is on both micronutrient and macronutrient intake.
