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Biomedical subjects

G S Barolin

Publications and source records attributed to G S Barolin.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Neurorehabilitation/geriatric rehabilitation--goals achieved and aims from the viewpoint of the so-called "Vorarlberg Model"].

Together with building up a first neurological department in one of the Austrian states we could introduce and organize the 1st scientific institute in literature for neuro-rehabilitation and -prophylaxis. 80% of the neuro-rehabilitation-patients are geriatrics. Hence overlapping of neuro-rehabilitation with rehabilitation in old age is to be postulated. "Rehabilitation of old age groups" as well has been named by us for the 1st time in scientific literature. Moreover we operate such activities on a large scale within a practical and social medical context. As worldover (at least within the civilized countries of high standards) the problem of old age groups is a steadily increasing and important, we are working on a very important scientific sector. Our slogan: "Holistic and permanent" is practically operated as follows: 1. Fluent transition of rehabilitation-adequate acute treatment towards a systematic specialized rehabilitation. 2. Schooling of relatives and follow up rehabilitation service. 3. Introducing rehabilitative thoughts as well in university, teaching as (by separate schoolings) within medical profession and all the other health professions. 4. We emphasize a plurality of methods; to be named here as main examples: integrated physiotherapy as well as integrated psychotherapy. Emphasizing more scientific values for (high age-)rehabilitation, we emphasize as well that it must not be banned into "high age ghettos". Contrarely rehabilitation adapted thinking must be integrated within all the health professions. 5. Innovation, phantasy and pleasure must be introduced into our work. We report of work with lay-groups, animal-visits, hippo-therapy, music, etc. This forms a large interesting territory for an upraising young generation in health professions.

Adult↗
PubMed1994

[The myth of the lust for free life and so-called self-realization].

There exists a present tendency for immediate satisfaction of desires and pleasures, as well in our western civilization in general, as propagated by some commercialized psychotherapy (with good sales results of books with title and contents as "Don't be good!" [?]; interrogation-mark set by me). Such educational tendency is opposed to a number of human inborn laws such as 1) need of getting to know one's limits and to accept them, 2) evolution of tolerance for frustration without which interhuman communication can not be kept alive, 3) the law that human beings are social beings. By no means we want to propagate a rigid doctrinary and mainly frustrating system of education. The golden path in between the extremes is here (as always) the most difficult. The "integrated psychotherapy", inaugurated and advocated by us, wants to show this way in psychotherapy. Outside psychotherapy too, within the general rules of (academic) education, the here given words may help to find this "golden path in between".

Attitude↗
PubMed1994

[Headache: classification/nomenclature].

Our multidimensional classification of headache uses on the one hand the phenomenological main criteria. Id est: attack-featured headaches versus the more permanent headaches. On the other hand the main etiological factors have to be traced: heredity, vasomotor-dysfunction, disturbances of cervical spine, metabolic disturbances, psychodynamics. As the majority of 90% chronical headaches have a multifactorial etiology, these factors have to be taken into consideration one by one. Usually more than one is to be found. Such differential diagnosis forms already a clear way into differentiated therapy. Our classification is conform to patient and to daily medical practice, easy to execute and, last not least, has a statistically proven small inter-examiner variation. The nowadays discussed IHS-classification we see contrarely to ours and to the demands of a good classification. Same counts for the classification that is put on by the ICD-9. First is to big, second is to small to be useful. Moreover, both show quite a number of clearly definable faults, which are opposite to clinical reality.

Diagnosis, Differential↗
PubMed1993

[Integrated physical therapy in psychiatry, neuro-rehabilitation and rehabilitation of the aged].

Physiotherapy forms a main part of modern therapy, however it only can be optimal in full integration with pharmacotherapy, psychotherapy and sociotherapy. Gerontopsychiatry offers a large field for physiotherapists. Besides highly specialised physiotherapy the dimension of recreation, fun-giving and amelioration of life quality must not be forgotten in physiotherapy. These possibilities from an important function within a human and humanitarian medicine. A further main condition for amelioration is to involve relatives fully in the therapeutical concept. Our experience has shown that within the domestic surrounding rehabilitative progress can well arrive; however, only if systematically prepared and uninterrupted stimulated.

Adult↗
PubMed1993

[Rehabilitation for the elderly, why?].

Within human culture the attitude towards the aged has been very different up to now, ranking from ritual slaughter to worshipping of the wise old persons. Ambivalence persists till now. We have introduced the terminus "rehabilitation of the old" to indicate a principal which is adequate in the medical sense as it is adequate to humanity. Our slogan runs: nursing alone (meaning isolated care for vegetative necessities) is inhuman in old people. Rehabilitative view points and activities must come into the care for the aged on all levels there are: from readaptation to profession, "over independence and being socially adequate" up to the resting last possibility of having fun. Rehabilitation of the old can only succeed if there is an integrative set up which means (again as a slogan): We want rehabilitation of old to invade all hospitals and all human groupements instead of bringing the old out of these groupings and separate them in senior ghettos. This must go hand in hand with specialization and scientific identification of geriatrics and rehabilitation; specially neuro-rehabilitation and rehabilitation of the old, which are in close connex. Quite a number of administrative barriers have to be removed, new possibilities must be created. There must be a complete new viewing of the matter and new goals in medical education, as well pregraduate as postgraduate. A new generation of doctors can find here a big good chance. However, it can only be successful in close collaboration with a progressive politic administration.

Aged↗
PubMed1993

[Discussion and summary of the first inquiry into "rehabilitation of the elderly"].

Financial amelioration is important but not the only important. We need a better prestige of rehabilitation of old age in society and in science. We need a better motivation. Last but not least permanent accompanying standardization and evaluation. Better schooling and post graduate education has to take place within all degrees of health professions, mainly in doctors and other leading people, eventually "obligatory". We want no "ghettos for aged" which means purely geriatric wards. A modern human (as well scientifically as sociologically appropriate) way is to have mixed populations in the wards. Modern concept should include more phantasy, more individualism instead of standardization. We want new trends not only in scientific thinking but as well and even more in political and social thinking towards these goals.

Activities of Daily Living↗
PubMed1993

[Psychotropic drugs outside of psychiatry, especially in advanced age].

The following main rules will optimate use of psychopharmaca: 1) The 3 main groups of psychopharmaca have to be ordered according to clear cut target symptoms: tranquilizer, neuroleptics, antidepressants. 2) Dosage must be rational and individual. Administration has to be long enough (antidepressants) and short enough (tranquilizers) according to chemical group, to secure efficacy and to avoid addiction. 3) The 2 polar dimensions: more agitating and more tireding, have to be used deliberately. 4) Danger of drug addiction and other unfavourable side effects must be kept in mind.

Aged↗
PubMed1993

[Animals--humans, the physician and ethics].

Ethics and humanitarianism are indivisible. They have to refer to the entire animated and inanimate environment likewise. This has moral as well as essential ecological consequences which are of special actuality at present, with mankind being on the verge of total ecological self-destruction. Key-word: eco-ethics. The worship of the Golden Calf by name of economic growth has to be replaced at last by an acceptance of "shrinking into recovery". Unfortunately, human cruelty is not to be confined to the historical past of the Third Reich, but becomes evident continuously before our very eyes. To shut one's eyes to it is a tendency as widespread as the habit of averting one's eyes from avoidable man-made suffering of animals. We need better education and enlightenment (in the sense of resistance at the very beginning), better control and better execution of better regulations. The health professions, together with educational, ecclesiastical and military professions are called upon to direct attention to this aspect of moral hygiene.

Altruism↗
PubMed1992

[Chronified headache].

Paroxysmal headache of the migraine type as well as permanent undulating headache (which we call cephalea) can lead to chronification, both often mixes within the chronification. Existence of psychogenic factors (in the broader sense) favourises chronification of headache. A self supporting circulus vitiosus may arise, in combination with the cervical column, depressivity, whiplash-injury, chronical over-use of drugs (often not without an iatrogenic component), expertise situations. Therapeutically we emphasise a polypragmasy orientated on target-symptoms. Analgesics and tranquilizers want to be excluded as much as possible. Clearly indicated antidepressant are of great value, physiotherapy and psychotherapy as well. As ultima ratio we administer a neuroleptic sleeping cure.

Combined Modality Therapy↗
PubMed1992

[Rehabilitation and psychotherapy].

Especially the chronically ill and disabled deserve to benefit from "socially integrated psychotherapy" in view of their specific situation of distress, which has often arisen without warning and unexpectedly. Dealing with bodily impairments, there are the so-called "organismic" methods using the hypnoid state as major component that have proven to be highly efficient. Dealt with are autogenic training, guided affective imagery, respiratory feedback and hypnosis. Hypnoid states can be regarded as a third basic state of consciousness in humans (besides waking and sleep). They play a major role in many forms of psychotherapy. The knowledge and selective use of underlying mechanisms enhance the potentialities of psychotherapy. The psychotherapeutic basic dialogue stays in constant accompanying function. We are opposed to a widespread misconception that psychotherapy is a method for the treatment of psychogenic disorders only. We obtained good results in the treatment of palsied patients of extrapyramidal and pyramidal type with hypnosis or autohypnosis as well as with our own model of group psychotherapy (autogenic training with concomitant analytic discussion, over a period of up to nine months). In this set-up we successfully mix patients with psychogenic and with somatogenic disorders. Although not a primarily psychotherapeutic method, respiratory feedback also makes use of the hypnoid state. Good results have been achieved with patients in rehabilitation and chronic pain sufferers. Occasional experience with guided affective imagery have been encouraging. We can conclude that psychotherapy with organically ill patients is indicated and promising. We need more appropriate training, supervision and concomitant scientific research.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1992

[Introduction of the Valduna-Reha Scale].

We present a rating scale for the progress in rehabilitation which has been developed and tested in the course of several years. It is of special suitability for the documentation of rehabilitation in cases of dysfunction of the central nervous system due to various syndromes arising from vascular, post-traumatic and post-operative causes. It comprises the essential somatic as well as psychological data and differentiates between specific (e.g. localised) symptoms and their effects on the individual's global functioning, especially within his (her) social sphere. Under this aspect our scale appears to be of optimal use, especially with regard to the requirement: "as simple as possible and as comprehensive as necessary". It modifies the criteria of the WHO regarding the threefold differentiation between impairment, disability and handicap, by the use of two levels of documentation, thereby gaining in validity.

Activities of Daily Living↗
PubMed1992

[Psychotherapy in advanced age].

The ageing patient, especially in rehabilitation, faces an unknown and sometimes critical situation, in which he is as much in need of psychotherapy as he can benefit by it. Combinations of hypnoid techniques together with group interactions and analytically orientated verbal therapy have proved to be most suitable, bringing into action the somatotropic as well as the psychotropic effects of psychotherapy. Pleasure-orientation, variety and imagination as psychotherapeutic dimensions have to be integrated into rehabilitation, which otherwise would remain incomplete patchwork. We need a renaissance of general communicative culture in the first place, additionally specific verbal techniques for special (critical) situations, e.g. when talking to the incurably diseased, to his family, etc. Psychotherapeutic reasoning and acting must become part of the training and a permanent concomitant factor in all health professions. The same must hold good for public life, politics and society, if we strive for generally effective achievements for the ever-increasing number of elderly patients. It opens vast new fields of action for a new generation of psychotherapists who will be prepared to shed antiquated prejudiced stereotypes.

Adaptation, Psychological↗
PubMed1992

[Concomitant depression and its treatment].

Accompanying depression is especially common in elderly, chronically ill patients and rehabilitation patients, where a physical illness and/or disablement is accompanied by depression. Treatment should always be focussed in a "polypragmatic" manner on both physical or psychic symptoms. In particular psychotherapy (see article by Barolin), pharmacotherapy (referred to in this article) and physiotherapy (described further in other literature) are of importance here. Advantage is to be taken of the polar dimensions of different types of antidepressant drugs, namely the increase in drive or sedating effects. However, the increased rate of side effects from some drugs among elderly patients is not to be ignored. Taking the above into consideration, the new antidepressant, Fluctine (Fluoxetine), has proved to be effective among our randomly selected patients. This is on account of its relatively fast onset of action, minimal side effects and its slight increase in drive. The group of non-responders (one third of the patients) showed no decrease in depressive symptoms when other antidepressants were substituted. As expected those patients suffering organic-brain illness responded worse and represent a large percentage of the non-responders. These data prove the results of previous findings that patients with organic-brain illness generally respond worse to antidepressant medication. Thus Fluctine can be recommended for elderly patients with accompanying depression.

Adaptation, Psychological↗
PubMed1991

[15-year-factor analysis of multiple sclerosis].

The authors have conducted a longitudinal survey for a period of 14 years with 171 patients suffering from multiple sclerosis. In each case, therapeutic and diagnostic procedures were in accordance with the latest development. In almost half of the cases with a duration of illness up to 20 years the degree of impairment can be regarded as minimal, which can be used as an argument in favour of conscientious and continuous rehabilitative measures, including psychotherapy (this in opposition to a "rehabilitative pessimism"). Two thirds of the patients have been in employment with full working capacity during the first ten years of their illness. The consequences for social medicine and social policy are self-evident and imperative. In accordance with earlier studies, motor pareses are predominant among the first symptoms of multiple sclerosis, whereas disorders of cranial nerves, of urinary excretion and of cerebral function appear later in the course of the disease. Factor analysis did not yield any clues with respect to the predictability of the development of illness. Psychoreactive depression is relatively common in the earlier stages, later we can find somatogenic (psycho-organic) depressions, which respond relatively poor to treatment. Among the diagnostic tool, analysis of the critical flicker fusion frequency (CFFF) has proved to be very sensitive, by far not as cumbersome as visually evoked potentials and at least as reliable as the later. Therapeutic strategies should include: early treatment of any acute attack, consequent long-term care with modern nursing methods and rational concomitant medication, prophylaxis against infection. Multiple sclerosis represents itself as a problem of long-term rehabilitation, thus emphasizing the necessity of increased commitment to rehabilitation within a general framework of health care, which should include: a) better representation of rehabilitation as a discipline at the universities. b) systematic concomitant research in rehabilitation, c) legal and administrative adaptations, d) the development of a general "rehabilitation mentality" (as we have come to call it), which means involvement with the patient and his environment throughout his entire life-span.

Adult↗
PubMed1991

[The confused and the demented patient as a problem in neuro-rehabilitation. Old-age rehabilitation].

Organic psychosyndromes may be classified 1) by the state of vigilance (agitated or reduced), 2) by the progress in time (episodic versus progressive), 3) by the presence or absence of brain-local or vegetative accompanying phenomena, 4) by etiology. The most frequent forms are: multi-infarct-dementia and primary degenerative dementia of Alzheimer's type. We must be aware that this didactic differential diagnosis in reality mostly shows overlapping criteria. Either more to the one side or more to the other. Etiological therapy (as well "vasoactive" as "nootropic") should in most cases be combined with therapy of underlying internistic (cardiac for example) and accompanying (infection for example) symptoms. Depression as a special frequent dimension needs special attention. Furthermore there are complex therapeutic possibilities in the social, recreative, psychologic, rehabilitative, psychotherapeutic etc. field. Relatives need to be treated concommitantly. Only thus scientific as well as human implications for rehabilitation can meet.

Aged↗
PubMed1991

[The horse as an aid in therapy].

Physiotherapy on the back of the moved horse has two important dimensions: 1) The somatotropic effect regards mainly spasticity, ataxia, the vertebral column, the basis of the pelvis and the skin. 2) A general psychotherapeutic and psychohygienic effect is created by joy, change and new impetus in rehabilitation and by the emotional contact with the "comrade animal". Or unit was the first to introduce hippotherapy with adults in Austria. There is specially good experience with the spastic atactic component in multiple sclerosis. However other diagnosis as well showed good profit, such as stroke, etc. Some good effects in cephalaea patients indicate transition to riding as a medical pedagogic instrument with further transitions to psychosomatic patients. We want to proceed in this direction. Well organized hippotherapy is cheaper than the hydrotherapy (being current almost everywhere. Therefore opposition against the valuable hippotherapy by reasons of economics should be ruled out. Today's medicine goes farther and farther away from natural possibilities (slogan: "overtechnologized"). We see in hippotherapy an important counterweight in the sense of a valuable methodology towards holistic therapy especially in rehabilitation.

Animals↗