Stähelin H B
Geriatrische Universitätsklinik Kantonhospital, Basel.
Z Gerontol Geriatr. 2000;33 Suppl 1:24-7.
Rehabilitation aims at the restoration of maximal independence and autonomy after functional loss due to illness or accident. In old age losses of independence in daily life and autonomy are accounted for up to 60% by personal deficits in cognitive abilities. Functional losses in cognitive abilities represent a higher risk of having an accident or becoming ill. Cognitive performance proves to be predictive for success of rehabilitation, independent of functional state. Using the example of a fracture of the femur it can be shown that sensory and cognitive deficits increase the risk of accidents and that executive abilities co-influence long-term results. Strokes are more frequent if cognitive deficits have existed before and the resulting damages are stronger. Long-term results generally depend on complex abilities like everyday competence, reasoning and memory. Experiences with patients with dementia undergoing a memory training show that learning strategies are rarely generalized. Therefore in rehabilitation specific disorders, as for example cortical or subcortical patterns, have to be treated by different rehabilitation methods in the sense of differential rehabilitation. For this an early neuro-psychological assessment of the geriatric rehabilitation patient is needed. The cognitive-psychological findings only scarcely and insufficiently enter diagnostics and therapy. The diverse cognitive disorders have to be taken in account more frequently in education and differential rehabilitation methods have to be developed for geriatric patients with cognitive deficits.
康复旨在使因疾病或事故导致功能丧失的患者最大程度地恢复独立和自主能力。在老年人中，日常生活中独立能力和自主能力的丧失有高达60%是由认知能力的个人缺陷造成的。认知能力的功能丧失会增加发生事故或患病的风险。事实证明，认知表现对康复成功具有预测性，与功能状态无关。以股骨骨折为例，可以看出感觉和认知缺陷会增加事故风险，并且执行能力会共同影响长期康复效果。如果之前就存在认知缺陷，中风会更频繁，且造成的损害也更严重。长期康复效果通常取决于日常能力、推理和记忆等复杂能力。对患有痴呆症的患者进行记忆训练的经验表明，学习策略很少能得到推广。因此，在康复过程中，对于特定的疾病，如皮质或皮质下模式，必须采用不同的康复方法进行差异化康复治疗。为此，需要对老年康复患者进行早期神经心理学评估。认知心理学的研究结果在诊断和治疗中很少且不充分地得到应用。在教育中必须更频繁地考虑各种认知障碍，并为有认知缺陷的老年患者开发差异化的康复方法。
