Amyotrophic lateral sclerosis (ALS), known as motor neurone disease (MND) in Britain, poses special problems in rehabilitation by virtue of its nature, trajectory and the age of patients with the disease. Many practical difficulties of ALS are well known, but there has been little research on the psychological parameters of the disease. This study of 181 ALS patients, from a national register in England and Wales, indicates that, contrary to some previous research, psychological distress (measured by the General Health Questionnaire) is widespread among patients at all stages of the disease. Severity of functional impairment is significantly related to psychological distress, but explains only a small part of the variance. Rehabilitation in relation to ALS must take account of the high incidence of psychological difficulties, as well as the considerable functional problems associated with the disease.