**2.4 Altered physical activity and energy metabolism in clients with degenerative disorders**

There is a direct proportional relationship between energy requirements and physical activity. More energy is required in individuals who engage in physical activity whether voluntary or involuntary. Clients with neurological conditions, by virtue of the impact on the musculoskeletal system, may either be more or less active and directly have varying energy needs. Clients diagnosed with SCA may experience neurological impact resulting in hyperactivity characterized by involuntary movements. Individuals who are diagnosed with these conditions may experience tremors, muscle spasms and other movement disorders as symptoms of the condition. Moreover, the psychopharmacotherapy used in the treatment of spinocerebellar ataxia has negative side effects including tardive dyskinesia, restlessness and aggression. Alternatively, some clients exhibit reduction in motor activity and dysarthria, limited voluntary activity while on the same medications [11, 32]. These symptoms are at dipoles and require different nutritional therapeutic interventions to meet the physiological needs of the affected clients. In clients with reduced physical activity such as those who experience slow, sluggish movement, energy intake needs to be reduced to prevent obesity and positive energy balance while in clients who experience increased physical engagement as a consequence of increased involuntary activity, increased energy intake through the global increase of all macronutrients is the ideal nutritional therapy suited to these clients. Macronutrients are energy producing nutrients and include protein, carbohydrates and fats that are provided in the diet mainly from eating starches, animal and plant based foods and fruits. Due to the supportive role that micronutrients, especially water soluble B vitamins, play in macronutrient metabolism their requirements are also increased in accordance with energy requirements. These micronutrients serve as cofactors and coenzymes in energy metabolism so that energy can be increase from consuming the calorie containing foods [33]. Alternatively, another physiological feature of SCA, that results in reduced dietary intake is reduced swallowing capacity and coordination. This limits the client's ability to prepare food and feed themselves as well as to earn for the provision of meals. Additionally, dietary intake may be negatively affected by features of dependence and reliance on caregivers [11, 32]. Dietary modification such as textures; mechanically soft or pureed; are ideal for swallowing difficulties while nutrient dense economical meals, such as stewed legumes or low costs subprimal or retail animal, are recommended in financial resource restrictions.

Clients experiencing degenerative neurological disorders utilize higher or lower values of energy either due to the pathophysiology of the condition or the therapeutic cost of managing the condition. A personalized treatment approach is necessary dependent on the pole of the energy utilization spectrum that the client is on; higher energy intake is required in more metabolically active individuals and energy/calorie restrictions in individuals who consume or require less energy.
