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Treating ischemic stroke we could compare a (control-)group of 318 patients under up to date hemodilution therapy to a group of 100 patients receiving exactly the same treating scheme but including an add-on administering of Cerebrolysin. It proved a statistically validated better outcome within the Cerebrolysin add-on treated group evaluated by the Barolin-Neuro-Rehabilitation Scale. 1) More effect on social and occupational parameters than on motor functions, but also including some of those. 2) Cerebrolysin accelerates recovery and therewith offers better starting points for rehabilitation. As stroke is one of the main social-medical neuro-rehabilitation and gerontological problems of our days these results should be recognized in a general therapeutical use.

There are rationally treatable fears arising from the acute situation (especially in rehabilitation patients) as well as the irrational anxieties of the mainly endogenous depressive. In the condition which we have come to call "concomitant depression", especially in neuro-rehabilitation, we can find both types of fear and anxiety, often in the same patient with mutual overlapping. In dealing with the fears of the incurably ill patient it is essential to know the phase-related progression in order to give empathy and help in entering the further phases at the appropriate times. It is important to know the "typical anxieties of the elderly" and to take them into account in concomitant psychotherapy, whereby group therapy has proved to be especially useful. On the other hand, the anxieties of the doctors themselves have to be dealt with, which opens a wide field for psychodynamic supervision and the Balint-groups. Apart from psychodynamic components there should however be a distinctly defined teaching program for the health profession, as well. On the therapeutic sector, we have to mention the organismic therapies, which have a good anxiolytic quality (therapy by hypnoid states and/or relaxation). Anxiety is by no means the only known contra-productive psychodynamic factor, but it is a point of onset for a desirable integrative approach in medicine, as a counterbalance against present tendencies towards over-specialisation, which at time can be counter-productive and detrimental to the patient. To achieve this, psychotherapy has to leave its ivory tower in order to radiate into all medical disciplines. It is not our task to eradicate anxiety in its pathological overflow by therapy; but to recognize and acknowledge it as an existing human dimension, thereby preventing it from turning into counter-productive moxiousness. Essential in this process are self-reflexion, empathy, training and systematic application of therapeutic techniques in efficient combination.

The clinical outcome of 65 patients with malazia alba of the brain was documented by the use of our "Valduna-Disability-Score" examining the patients at defined points of time. Simultaneously several rheological parameters of venous blood gained by punction of the cubital veine were examined before and after hemodilution therapy using dextran 40. The items or progress concerning clinical outcome and changes of the rheological parameters were correlated. There was not found any significance. We conclude, that the changes of rheological parameters in venous blood are not able to predict the clinical outcome after hemodilution therapy. The important role of disability scores--in our case the "Valduna-disability-score"--is to be stressed.

Our slogan of rehabilitation to be "holistic and permanent", in terms of its holistic aspect, expresses inclusion of the patient's total environment--relatives, politics, administration, legislation. The aspect of permanence may involve periods of many years, and is not amenable to standardization; meaningful limitation is subject to the individual needs, based on critical scientific follow-along of rehabilitation. The emergence of "rehabilitation hospitalism" may best be prevented by proper attention to the patient's emotional situation and social environment, with special regard also to experiences of frustration, to regressive tendencies, "associated depression". Well-versed rehabilitative management should therefore include the dimensions of pleasure and diversity. We have been able to realize some of the above in the "Vorarlberg Rehabilitation Model", in terms, on the one hand, of the scientific identity of rehabilitation, and of individualized, optimum patient-orientedness on the other. An important step forward has moreover been the inauguration of a "Ludwig Boltzmann Institute for Neuro-Rehabilitation and -Prevention" at the Landes-Nervenkrankenhaus Valduna, of Rankweil, Austria.