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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Special legal problems in a closed setting for neurosurgical early rehabilitation

Spezielle rechtliche Probleme auf einer geschlossenen Station in der neurochirurgischen Frührehabilitation

Meeting Abstract

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  • corresponding author Kunibert Niklaus - RehaNova Köln, Neurologisch/Neurochirurgische Rehabilitationsklinik, Köln
  • T. Rommel - RehaNova Köln, Neurologisch/Neurochirurgische Rehabilitationsklinik, Köln

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.01.04

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Niklaus et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




In addition to common medical problems of ethic and law in closed setting treatment, it appears to be necessary to compromise between the autonomic decision of free movement and physical security.


All patients treated from 1999 to October 2003 in a closed neurorehabilitative ward were classified for psychopathological reasons for closed treatment, the reason which required committal to a closed ward and the frequency of it's occurrence was compared to the total number of cerebral patients with the same underlying illness treated in the clinic. Legal decisions of will for the special clinical situation were evaluated.


During a period of 4 years 314 patients with a typical indication were treated in closed setting. Their spectrum of diagnosis did not differ from those of the whole group of clinic patients. The reasons for the need for committal were: 1. tendency to disappear by lack of orientation (247 pat., 78%), 2. lack of criticism (38 pat. 12 %), 3. aggressive outbursts (21 pat. 7%). Most of the patients in closed ward suffered from brain injury (46 pat. 15%), cerebral anoxia (34 pat. 11%), cerebral ischaemia (25 pat. 8%), subarachnoidal haemorrhagia (22 pat. 7%) and spontaneous intracerebral haemorrhage (16 pat. 5%).

Only one patient did not need the decision from the Guardianship Court/GC (VG), according to the court itself. All others needed the decision of the GC (§1906 BGB of FRG). Only 7 patients had a legal authority with power of attorney but none of them anticipated the situation exactly, so that in these cases a decision from the GC was necessary too.

Only 54 patients could leave the ward and enter an open therapeutic setting. 82 patients were able to live in a family in spite of their psychopathological problems.


Committal to closed setting enables neuro-/neurosurgical rehabilitation, even in patients with severe disturbance of behaviour. A decision from GC will be necessary in nearly all cases, even if there is a legal authority given proxy for the patient, because the common lack of knowledge about psychopathological syndromes will not increase to such an extent, that could make it possible to anticipate the situation of clinical treatment after such cerebral disorders.