Neuromuscular Conditions and Disorders
Patrick L. Jacobs, PhD, CSCS,*D, FNSCA Stephanie M. Svoboda, MS, DPT, CSCS Anna Lepeley, PhD, CSCS
After completing this chapter, you will be able to ◆ describe the physiological characteristics of the
various neurological disorders; ◆ discuss the health-related consequences for each of the special
populations with neurological disorders; ◆ explain how different neurological disorders affect the ability
to exercise, acute exercise responses, and chronic adaptation to exercise training; ◆ explain the benefits
of appropriate exercise conditioning in persons with various neurological disorders; and ◆ design
appropriate exercise programming specific to the needs of individuals with particular neurological
disorders.
Pathology of Multiple Sclerosis Multiple sclerosis (MS) is a progressive autoimmune disorder
characterized by deterioration of the myelin sheath. The myelin sheath covers billions of nerve cells in
the body, and its purpose is to aid in the speed and transmission of CNS signals. In individuals with MS,
the myelin sheath and the underlying neurons undergo demyelination that leads to a breakdown in
signal transmission. Individuals aficted with the disease experience a wide array of symptoms that vary
between individuals (36, 84). These symptoms are due to the breakdown in nerve signal transmission
and depend on where exactly the demyelization occurs. Individuals most commonly experience fatigue,
numbness, walking problems, balance impairments, coordination impairments, bladder dysfunction,
bowel dysfunction, vision problems, dizziness, vertigo, sexual dysfunction, cognitive dysfunction, pain,
emotional changes, spasticity, and depression (12, 24, 36, 42, 84, 112, 195). In addition, other less
common symptoms may be seen, such as speech disorders, swallowing problems, headache, hearing
loss, seizures, tremors, breathing problems, and itching (11, 60, 178). Despite these symptoms, people
with the disease experience a normal life span. It is often difcult to diagnose MS, as these symptoms can
appear similar to symptoms of other diseases. Individuals affected by MS also experience a wide range
of disease courses and outcomes. There are four types of MS: relapsing–remitting, secondary
progressive, primary progressive, and progressive– relapsing. Eighty-ve percent of cases are initially
diagnosed as relapsing–remitting MS (26). In these cases, patients experience clearly dened
exacerbations or are-ups. These are times when the CNS experiences inammation and in turn, previously
seen symptoms rapidly worsen or new symptoms arise. Exacerbations vary among
individuals and can last anywhere between days and months. Exacerbations are interrupted by
remission periods, or times in which patients’ neurological functions stabilize and do not worsen. During
remission, people may return to their preexacerbation condition with no symptoms, or they may
experience some small ongoing symptoms (166). Fifteen percent of MS cases are diagnosed as primary
progressive, which is a type of MS in which neurological function deteriorates from disease onset
without any signicant remissions, although the symptoms may briey plateau or possibly even appear to
be temporarily improved. Otherwise, these patients experience slowly deteriorating neurological
function (166). Of the 85% of relapsing–remitting MS cases, 50% will be considered as secondary
progressive within the rst 10 years of diagnosis and 90% within 25 years (240). These individuals will
Patrick L. Jacobs, PhD, CSCS,*D, FNSCA Stephanie M. Svoboda, MS, DPT, CSCS Anna Lepeley, PhD, CSCS
After completing this chapter, you will be able to ◆ describe the physiological characteristics of the
various neurological disorders; ◆ discuss the health-related consequences for each of the special
populations with neurological disorders; ◆ explain how different neurological disorders affect the ability
to exercise, acute exercise responses, and chronic adaptation to exercise training; ◆ explain the benefits
of appropriate exercise conditioning in persons with various neurological disorders; and ◆ design
appropriate exercise programming specific to the needs of individuals with particular neurological
disorders.
Pathology of Multiple Sclerosis Multiple sclerosis (MS) is a progressive autoimmune disorder
characterized by deterioration of the myelin sheath. The myelin sheath covers billions of nerve cells in
the body, and its purpose is to aid in the speed and transmission of CNS signals. In individuals with MS,
the myelin sheath and the underlying neurons undergo demyelination that leads to a breakdown in
signal transmission. Individuals aficted with the disease experience a wide array of symptoms that vary
between individuals (36, 84). These symptoms are due to the breakdown in nerve signal transmission
and depend on where exactly the demyelization occurs. Individuals most commonly experience fatigue,
numbness, walking problems, balance impairments, coordination impairments, bladder dysfunction,
bowel dysfunction, vision problems, dizziness, vertigo, sexual dysfunction, cognitive dysfunction, pain,
emotional changes, spasticity, and depression (12, 24, 36, 42, 84, 112, 195). In addition, other less
common symptoms may be seen, such as speech disorders, swallowing problems, headache, hearing
loss, seizures, tremors, breathing problems, and itching (11, 60, 178). Despite these symptoms, people
with the disease experience a normal life span. It is often difcult to diagnose MS, as these symptoms can
appear similar to symptoms of other diseases. Individuals affected by MS also experience a wide range
of disease courses and outcomes. There are four types of MS: relapsing–remitting, secondary
progressive, primary progressive, and progressive– relapsing. Eighty-ve percent of cases are initially
diagnosed as relapsing–remitting MS (26). In these cases, patients experience clearly dened
exacerbations or are-ups. These are times when the CNS experiences inammation and in turn, previously
seen symptoms rapidly worsen or new symptoms arise. Exacerbations vary among
individuals and can last anywhere between days and months. Exacerbations are interrupted by
remission periods, or times in which patients’ neurological functions stabilize and do not worsen. During
remission, people may return to their preexacerbation condition with no symptoms, or they may
experience some small ongoing symptoms (166). Fifteen percent of MS cases are diagnosed as primary
progressive, which is a type of MS in which neurological function deteriorates from disease onset
without any signicant remissions, although the symptoms may briey plateau or possibly even appear to
be temporarily improved. Otherwise, these patients experience slowly deteriorating neurological
function (166). Of the 85% of relapsing–remitting MS cases, 50% will be considered as secondary
progressive within the rst 10 years of diagnosis and 90% within 25 years (240). These individuals will
