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NSCA's Essentials of Training Special Populations
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Neuromuscular Conditions and DisordersPatrick 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.
The nervous system is a complex, highly specialized organized network of nerve cells responsible for the
coordination of all volitional and involuntary actions and functions of the human body. The nervous
system anatomically consists of the central nervous system (CNS), made up of the brain and spinal cord,
and the peripheral nervous system (PNS), which includes nerves that connect the CNS with the rest of
the body, including skeletal muscle and organs. Functionally, the PNS is divided into the somatic system,
which mediates volitional movement; the autonomic system, which is responsible for control of internal
organs; and the enteric system, which regulates the gastrointestinal system. The PNS is also composed
of ascending (afferent or sensory) and descending (efferent or motor) neural tracts. Neuromuscular
disorders are medical conditions that result in a decline in functioning of the body’s various nervous
systems or the muscular system. These medical conditions may arise from biological causes or from
genetic defects. Neurological disorders may also be caused by injuries to the brain or spinal cord or in
some cases by degenerative diseases. The location and severity of the tissue damage determine the
short-term outcomes of the injury or disease process, as well as the long-term potential for recovery.
Direct trauma to the brain may result in cerebral palsy if the injury occurs during pregnancy, during
childbirth, or within the rst three years of life. Injury to the adult brain produces traumatic brain injury,
while interruption of blood ow to the brain may result in a stroke. Multiple sclerosis and Parkinson’s
disease are neurological disease processes that affect the peripheral nerves and the brain tissue in
different populations. Neuromuscular disorders can be classied as either progressive or nonprogressive.
Progressive neurological disorders are conditions that involve a continuing and progressive deterioration
of functioning. These disorders include multiple sclerosis, Parkinson’s disease, and muscular dystrophy.
These progressive neuromuscular conditions vary in rate of development and commonly have periods of
relapse and periods of remission. Progressive neuromuscular disorders are generally caused by disease
processes or genetic factors. Nonprogressive neurological disorders are conditions that do not continue
to exhibit declining neurological functioning following an initial episode of disease or mechanical injury.
There are signicant reductions in function with an initial episode with no further primary declines
thereafter. These nonprogressive conditions include cerebral palsy, stroke, head injury, and spinal cord
injury. Nonprogressive disorders are generally a result of traumatic injury to the CNS, either the brain or
spinal cord. Key Point Common progressive neuromuscular disorders include multiple sclerosis,
Parkinson’s disease, and muscular dystrophy. Cerebral palsy, traumatic brain injury, stroke, and spinal
cord injury are nonprogressive neurological disorders. MULTIPLE SCLEROSIS Both voluntary and
involuntary actions of the human body are controlled and coordinated by the nervous system. The
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