[Current status and future development of the comprehensive rehabilitation of transverse paralyzed patients]

The principles developed some 40 years ago by Sir Ludwig Guttmann and Ernest Bors for the treatment of spinal cord injured persons have in the Federal Republic of Germany been taken up, in the fifties, by a few doctors as well as the Central Association of Industrial Injuries Insurance Institutes. Their efforts have brought about a radically different situation concerning life expectancy and life-styles of SCI patients, not only the accident-injured but increasingly also for persons with disease-related spinal lesions. The emphases of development have been: improved mechanisms for referral to specialized facilities, rescue system progress, new findings in diagnosis and therapy, improvement of social and vocational re-integration, growing mutual understanding of paraplegics and their environments, as well as increased self-assertiveness of the paraplegic population. These aspects are examined more closely. Further improvements may be achieved through: admission to specialized treatment facilities immediately following onset, appraisal of relevant issues pertaining to indications for, and techniques of spinal surgery, improved preventive efforts relative to thromboses and embolism, control of the paralytic bladder, a smoother provision of adapted living conditions outside the clinic-based special facilities, and through extension as well as lifelong availability of adequate aftercare services. In the event of certain illnesses, up-to-date treatment of paraplegics must be ensured by the hospital departments concerned with the basis illness. Recreational facilities, and inclusion of psychological and psychotherapeutic services in residential rehabilitation programmes for SCI patients require further attention.