Early neurological and neurosurgical rehabilitation after severe brain injury of traumatic, hemorrhagic, ischemic, neoplastic, inflammatory, or hypoxic origin fills the gap between acute treatment and traditional rehabilitation services. During the last years, specific treatment modalities began to develop, directed at the key problems of severely brain injured patients: for example, stabilization of vegetative regulation, treatment of spasticity, swallowing disorders, disturbances of perception and communication, coping, and conditioning of the relatives. Procedures are gradually emerging to facilitate assessment, documentation of progress, and results. Prognosis is still very uncertain, especially in patients in a vegetative state. As a rule of thumb, about three out of four patients will improve substantially during the treatment.

In a prospective study 30 patients suffering from a lumbar disc-prolapse and typical neurological symptoms were examined with regard to the predictors of the outcome 15 months postoperatively. Alongside the clinical examination and the raising of illness-anamnesis the Giessen pain questionnaire (Giessener Beschwerde-Bogen), the Giessen-Test, the Freiburg Personality Inventory (Freiburger Persönlichkeits-Inventar), the Mainz pain questionnaire und a pain scale were used. By means of the pain questionnaires two groups were formed. Patients without (N=15) and patients with (N=14) postoperative impairment. On the basis of selected scales of the Giessen pain questionnaire and the characteristic "psychosomatic disorder in the anamnesis" for 90% of the patients the outcome could be correctly predicted. For the estimation of the outcome by means of the estimation of global functioning level the likelihood of correct prediction was 83%. Medical and demographic parameters as well as the other results of psychological testing did not correlate with the outcome. The great importance of psychosomatic factors in a wider sense for the outcome is found to be confirmed in the literature. The significance of this result for the coping is debated with a background of the concept of "somatizing" versus "symbolizing". The conditions in therapy should lower psychological stress in order to reduce the necessity for "somatization" and facilitate "symbolization". This is specified as well for the treatment in regular surgical departments as for specialized pain-programs.