The problems of motor neurone disease.

The course of Motor Neurone Disease (MND) is described in 22 patients in respect of the extent and duration of the disabilities. The average stay in hospital in the terminal phase in 20 patients followed to the time of their death was 6.6 months for men and 4.7 months for women. The total duration of the disease ranged from 11 to 45 months, with an average of 28.7 months for men and 22.2 months for women. Between the bulbar cervical lumbar and mixed forms of the disease at the onset there emerged no difference in average survival. On woman of 32 is still alive 10 years after the onset, and one after 2-1/2 years. The hospital staff were exposed over many months to the progressive deterioration in breathing, swallowing, posture and mobility, and emotional crises and dysarthria aggravated the problems of management. Pain was a feature in one-third of the patients. In the treatment, physiotherapy with the accent on passive movements was found helpful. Although formal occupational therapy was not accepted by half of the patients, it was important to talk to them frequently, and encourage any means of expression such as painting, writing or dictating diaries, poems or essays. The indications for gastrostomy feeding are discussed, and the problem is raised of assisted respiration in this disease.