The most common cause of death in patients with rapidly progressive neuromuscular disease has been respiratory failure. The medical community and society as a whole have not yet recognized the possibilities for markedly extended life expectancy and prolonged productivity in severely disabled neuromuscular patients with proper medical management and rehabilitation. In a population of 120 patients with early childhood onset, rapidly progressive muscular dystrophy, 29 were in the most advanced stage requiring mechanical ventilation 24 hr/day and had vital capacities of less than 10% predicted for age and height. Of these patients with severely weakened bulbar innervated muscles, 10 have been receiving positive pressure ventilation via indwelling tracheostomy tubes for an average of 3 years. The average age of the 29 patients is 27 years with a range of 15 to 54 years. Of the 29 patients, 24 live in the community. Three are married and have a total of 5 children. Some patients are in professional careers, or active in political and community organizations. The management of and potential for improved quality of life and increased longevity in these patients are discussed.