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.
Pathophysiology of Multiple Sclerosis Multiple sclerosis is most commonly seen in Caucasian women
(224). Women are two to three times more likely to develop the disease than men, and Caucasians are
twice as likely to develop the disease as any other race (181). The disease is most often diagnosed
between the ages of 20 and 40 and is the most prevalent neuromuscular disease seen in young adults
(72, 202). The National Multiple Sclerosis Society estimates that 2.3 million people are affected
worldwide (138, 166). Although MS is most commonly seen in adults, estimates suggest that 8,000 to
10,000 individuals under 18 years old suffer from this disease (164). The denitive cause of MS is
unknown; however, scientists offer four possible explanations for its origin: immunologic,
environmental, infectious, and genetic (228). Some speculate that individuals with MS experience an
abnormal immune-mediated response in which myelin and nerve bers are attacked by the body (202).
Specically, the myelin sheath is attacked by a white blood cell group called T cells. In turn, this causes
tissue damage and inammation, leading to scar tissue (sclerosis) and blockage in signal transmission.
This blockage in signal transmission causes messages to become lost or distorted, leading to the
symptoms of MS. Secondly, scientists hypothesize that MS may be caused by environmental factors. (9).
This theory originated from epidemiological data showing that persons are more susceptible to MS the
farther they live from the equator. (219). Along the same lines, it was also theorized that these
individuals get less sunlight, leading to less vitamin D, and therefore do not receive the positive impact
that vitamin D has on immune function. (9). In addition, a pattern of children being born in an
environment with a low risk for developing MS and moving to a highrisk environment before puberty
increased their chances of developing the disease (5, 10). Scientists have also shown that demyelination
and inammation can be caused by viruses; therefore they are looking at several different viruses or
bacteria as a possible cause for MS: measles, canine distemper, human herpes virus-6, EpsteinBarr, and
Chlamydia pneumoniae (9, 100). Finally, the role of a person’s genetics in relation to developing MS is
being explored (79). Individuals may be genetically susceptible to but may not directly inherit MS;
however, there may be certain gene markers making a person more susceptible to developing MS if
exposed to the necessary stimuli. For example, if a person has a rst-degree relative with the disease, the
chances increase from 1 in 750 to 1 or 2 out of 40 that he or she will also develop the disease (165).
Common Medications Given to Individuals With Multiple Sclerosis Multiple sclerosis is a disease process
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.
Pathophysiology of Multiple Sclerosis Multiple sclerosis is most commonly seen in Caucasian women
(224). Women are two to three times more likely to develop the disease than men, and Caucasians are
twice as likely to develop the disease as any other race (181). The disease is most often diagnosed
between the ages of 20 and 40 and is the most prevalent neuromuscular disease seen in young adults
(72, 202). The National Multiple Sclerosis Society estimates that 2.3 million people are affected
worldwide (138, 166). Although MS is most commonly seen in adults, estimates suggest that 8,000 to
10,000 individuals under 18 years old suffer from this disease (164). The denitive cause of MS is
unknown; however, scientists offer four possible explanations for its origin: immunologic,
environmental, infectious, and genetic (228). Some speculate that individuals with MS experience an
abnormal immune-mediated response in which myelin and nerve bers are attacked by the body (202).
Specically, the myelin sheath is attacked by a white blood cell group called T cells. In turn, this causes
tissue damage and inammation, leading to scar tissue (sclerosis) and blockage in signal transmission.
This blockage in signal transmission causes messages to become lost or distorted, leading to the
symptoms of MS. Secondly, scientists hypothesize that MS may be caused by environmental factors. (9).
This theory originated from epidemiological data showing that persons are more susceptible to MS the
farther they live from the equator. (219). Along the same lines, it was also theorized that these
individuals get less sunlight, leading to less vitamin D, and therefore do not receive the positive impact
that vitamin D has on immune function. (9). In addition, a pattern of children being born in an
environment with a low risk for developing MS and moving to a highrisk environment before puberty
increased their chances of developing the disease (5, 10). Scientists have also shown that demyelination
and inammation can be caused by viruses; therefore they are looking at several different viruses or
bacteria as a possible cause for MS: measles, canine distemper, human herpes virus-6, EpsteinBarr, and
Chlamydia pneumoniae (9, 100). Finally, the role of a person’s genetics in relation to developing MS is
being explored (79). Individuals may be genetically susceptible to but may not directly inherit MS;
however, there may be certain gene markers making a person more susceptible to developing MS if
exposed to the necessary stimuli. For example, if a person has a rst-degree relative with the disease, the
chances increase from 1 in 750 to 1 or 2 out of 40 that he or she will also develop the disease (165).
Common Medications Given to Individuals With Multiple Sclerosis Multiple sclerosis is a disease process
