[Early rehabilitation of coma patients on the neurosurgical intensive care station. On the philosophy and practice of interdisciplinary cooperation].

The concept of early rehabilitation is an important task of humanity for neurosurgical intensive care patients emerging from coma. In Germany only little experience in this field has been reported, although the concept of early rehabilitation is well known in the other western European countries and the USA. In connection with the author's teaching activities at the pedagogical and psychological departments of the University of Oldenburg, an interdisciplinary concept of communicative "cooperative dialogues" was established for early rehabilitation, beginning in the earliest phases of coma at the neurosurgical intensive care unit. Although the results could not be evaluated statistically yet, the clinical course and outcome of emergence from primary or postoperative coma have improved rapidly by single patients, based on mobilization of neuronal plasticity and self-organized processes. Because of a significant lack of possibilities of early rehabilitation in the northwestern part of Germany, especially for young head injured adults, our efforts will continue. The philosophy and practice of early rehabilitation propose a new interpretation of neurosurgical patients emerging from coma, i.e. a dynamic process of a "second human creation". Early rehabilitation is an important task for the neurosurgically working doctor. Also for the neurosurgical profession the concept of early rehabilitation has to be integrated interdisciplinary to medical teaching at university level as soon as possible.