Multidisciplinary management from day one: the Neuro-care approach to motor neurone disease.

The Neuro-care approach offers a holistic, multidisciplinary, patient-centred, continuous strategy of care to unselected groups of neurological patients and their families including those with motor neurone disease (MND). The strategy for MND patients is an adapted version of one piloted on patients with Parkinson's disease. Between April 1990 and September 1992 12 MND patients were diagnosed, of whom five have died. The main features of the care strategy and the guidelines for giving the diagnosis are described. The characteristics of the patient group are identified and the high level of team activity vis-a-vis other patient groups is noted. The maintenance of patients in the community and the lack of resort to permanent institutional care are also recorded. Ethical issues arising during the project are discussed and the problems of measuring outcomes of care are acknowledged. General conclusions for MND management are drawn.