All voluntary movement in the body is controlled by the brain.

Nerve cells
in the brain called upper motor neurons initiate movement for the release of
chemical signals called neurotransmitters. The signal is passed from the upper
motor neurons to the lower motor neurons in the spine. Nerve fibres extending
from the spine called axons extend into the muscles. A point where the axons
and muscles fibres connect is the neuro muscular junction. When the signals
reaches the neuro muscular junction it causes the muscle to contract resulting in
a voluntary muscle movement. ALS is degenerative disease of both the upper
and lower motor neurons, as more and more motor neurons become affected,
they are unable to send signals for movement to the muscles, lost of voluntary
movement and coordination develop. Overtime, muscle weakness and spasm
develop. Patients are unable to perform routine activities such as walking and
getting out of a chair. Eventually paralysis develops interfering with the ability to
swallow and breathe.