OBJECTIVE--To identify unmet needs in the care of severely disabled people aged 16-64. DESIGN--Detailed personal interview and physical assessment of physically disabled adults; personal or telephone interview with carers. SETTING--Somerset Health District. SUBJECTS--181 severely disabled adults and their carers. MAIN OUTCOME MEASURES--Independence in activities of daily living; identity of requirements for assessing communication disorders; appropriate provision of services and allowances. RESULTS--53 (29.3%) of the 181 disabled subjects had unmet needs for aids to allow independence in activities of daily living-namely, 43% of subjects (41/95) with progressive disorders and 14% of subjects (12/86) with non-progressive disorders. The prevalence of unmet need was higher among subjects whose sole regular professional contact was with health services personnel (48 (40.3%) of 119 subjects). Only 18 (31.6%) of the 57 subjects with communication disorders had ever been assessed by a speech therapist. CONCLUSIONS--This study shows that the needs of severely physically disabled adults in the community--especially those with progressive disorders--are being monitored inadequately by health professionals.