RU2378979C1 - Method of evaluation and prediction of functional state of transport profession workers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medical diagnostics and allows to evaluate person's functional psyco-physiological state, obtain conclusion about worker's state, about necessity of next examination or rehabilitation procedures. Registration in dynamics of three groups of indices is carried out: physiological, reflecting state of cardio-vascular system, psyco-physiological, reflecting state of nervous-analysing system, and psychological, characterising level of anxiety and psychic adaptation of organism. They are evaluated by population standards in accordance with four gradations: 1 - bad condition, 2 - low; 3 - satisfactory, 4 - good. Mean evaluations for said groups of indices, mean evaluation for all indices - general evaluation of functional state, are determined, rounded and evaluated in accordance with said four gradations. Basing on results of evaluations of current values of separate indices, mean evaluations of group indices and general evaluation of functional state, as well as on the results of their comparison with data of previous examinations, prediction about character and expression of changes of separate indices, groups of indices and general functional state are made; recommendations are grounded: absence of changes - in case of presence of index change within one gradation: improvement of functional state by said index - in case index value moves on one higher gradation; considerable improvement of functional state by said index - in case value moves on two or more higher gradations; aggravation of functional state by said index - in case index values move on one lower gradation; considerable aggravation of functional state by said index - in case index values move on two and more lower gradations; necessity of extraordinary extended psyco-physiological examination of worker - in case mean evaluation of one of index groups reduces on one gradation or evaluation of one of separate indices on two gradations or evaluation of two or more separate indices on one gradation; necessity to elaborate and administer professionally oriented complex of preventive, correcting, restoring and rehabilitating measures - if general evaluation of functional state reduces on one gradation, or mean evaluation of one of the index groups reduces on two gradations, or mean evaluation of two or more index groups reduces on one gradation.

EFFECT: invention allows to obtain complex evaluation of current functional state of transport profession workers during short period of time (30-35 minutes), give prediction about its changing, determine necessity to administer advanced psyco-physiological examination, carrying out rehabilitation procedures, to evaluate their efficiency.

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Description

The invention relates to the field of medical diagnosis and allows to evaluate the functional psychophysiological state of a person. The method is suitable for conducting an automated psychophysiological examination of workers in transport professions.

The functional state of a person can be judged by the totality of psychophysiological indicators. A known method of evaluating the indicator of activity of regulatory systems, calculated by the spectral and mathematical-statistical characteristics of the heart rhythm (Baevsky P.M. Prediction of conditions on the verge of normal and pathology. - M., 1979). The development of this method is RF patent No. 2028078, IPC АВВ 5/04 “Device for monitoring and correction of a person’s functional state”, which allows one to present physiological parameters and an integral point assessment of a person’s condition to both the researcher and the subject for express control and self-control. The method allows to evaluate the integral indicator of the cardiovascular system PARS. Its drawback is the assessment of only one of the components of a person’s functional state - the state of the cardiovascular system.

The well-known "Method for assessing the functional state of the central nervous system of a person" according to the patent of the Russian Federation No. 2289297, IPC AB 5/00, including the measurement of selected physiological parameters. The method is applicable for pre-trip or pre-shift monitoring of operational personnel of specialized services and is not intended for long-term assessment and prediction of the condition.

For workers in transport professions, both pre-trip control of the physiological state and an assessment of maladaptive disorders of the functional state of workers, a forecast of their performance and health level are necessary. Timely detection of functional disorders and their subsequent correction are necessary to maintain professional performance, increase professional reliability and preserve the health of workers.

Currently, it is generally accepted that the transition from a state of professional fitness to a state of unsatisfactory professional performance is an abrupt process of an inevitable decrease in a person's ability to adapt to the effective implementation of professional production activities.

With this approach, two levels of professional suitability are considered: a person is fit or unfit to perform work by profession.

A different approach to the assessment and forecast of professional suitability, which is based on the following theoretical principles, is proposed.

The level of professionally important qualities is largely due to the innate properties of the individual’s nervous system, but can vary significantly - improve or worsen with the maturation or aging of the body, the use of special exercises, or due to past illnesses.

In the dynamics of indicators of professionally important qualities and individual indicators of the functional state of the neuro-analyzer system, a pronounced correlation dependence is observed.

Significant changes in indicators of professionally important qualities are preceded by significant changes in indicators of a functional state.

The transition to a state of unsatisfactory professional performance goes through a series of stages at which the body tries to adapt to its new conditions of existence by changing the level of functioning and tension of regulatory mechanisms.

It is known that the successful functioning of professionally important qualities is based on the effective functioning of production-important body systems. In turn, a high level of professionally important qualities, ceteris paribus, provides the necessary professional performance and, which is especially important for the employer, professional reliability. The forecast of the dynamics of the functional state of the employee’s body makes it possible for medical and psychophysiological support specialists to build a forecast for the employer’s professional workability and reliability of the driver, take timely measures to prevent negative developments.

It is these approaches that were used to assess and forecast the professionally important qualities of railway workers on the basis of dynamic control of the functional state.

The problem to which this invention is directed is to create a method for assessing and predicting the functional state of workers in transport professions. For this, in the process of dynamic monitoring of a functional state in a person, the current values of physiological, psychophysiological and psychological indicators are determined, followed by comparison with population norms for assessing the current functional state, as well as with the results of previous studies to predict the functional state.

This method is implemented in the hardware-software complex "EXPROM" - the examination and forecast of the driver, which has the following distinctive features:

the complex allows you to receive information of different levels of detail, which allows it to be used by specialists of different degrees of training and qualifications (paramedic, psychologist, doctor);

according to the research results, an assessment and forecast is made of both the general level of the functional state of the human body, and its somatic, psychosomatic and mental components;

during the assessment of individual indicators, the determination of body systems with a reduced level of functioning is carried out;

an assessment of the level of functioning is given on the basis of the definition of three groups of indicators: physiological, reflecting the state of the cardiovascular system; psychophysiological, reflecting the state of the nervous-analytic system, and psychological, characterizing the level of anxiety and mental adaptation of the body;

a detailed analysis of individual indicators of body systems reveals those of them whose values indicate deviations from population norms and the results of previous studies;

when comparing the current values of both individual indicators with population norms, and a group of indicators and average values of all indicators (general functional state) with established average values, each of them is evaluated;

when comparing the current values of both individual indicators and the average values of a group of indicators and the general functional state with the results of previous studies, a forecast is given for each of them;

depending on the nature and severity of the change in both individual indicators and the average values of the group of indicators and the overall assessment of the functional state, an extraordinary extended psychophysiological examination is prescribed or a professionally oriented complex of preventive, correctional, rehabilitation and rehabilitation measures is developed with a subsequent assessment of their effectiveness.

The proposed method for assessing and predicting a person’s functional state, implemented in the EXPROM hardware and software complex — expert examination of a condition and a driver’s forecast can be used as a means of diagnosing a functional state and predicting professional performance during a prolonged psychophysiological professional selection in the railway transport profession, primarily related to the safety of train traffic, as well as in medical and preventive and sanatorium health centers for the diagnosis of the severity of functional disorders, evaluating the effectiveness of preventive, correctional, rehabilitation and rehabilitation measures.

In the developed hardware and software complex "EXPROM" the following methods and tests are implemented (table).

Physiological indicators:

resting heart rate;

Baevsky heart rate index;

Ruthier-Dickson index.

Psychophysiological indicators:

tapping test;

simple visual motor reaction time;

time of complex visual-motor reaction;

Wexler symbol-digital test.

Psychological indicators:

Goldberg general health;

personal anxiety according to Taylor;

situational anxiety according to Spielberger-Khanin;

coefficient of the vegetative balance according to the color test of Lusher-Shipos;

subjective minute according to Halberger-Moiseeva.

Measured indicators are evaluated according to the following criteria:

Tab. one Heart rate Values (bpm) Level condition Rating from 60 to 70 Optimal Good four from 70 to 80 Normal Satisfactory 3 50 to 60 and 80 to 90 Mild bradycardia and tachycardia Lowered 2 less than 50 and more than 90 Severe bradycardia and tachycardia Bad one

Tab. 2 Heart Rate Index Values (conventional units) Level condition Rating up to 270 Low Good four from 270 to 385 Average Satisfactory 3 from 385 to 500 Elevated Lowered 2 500 and more Tall Bad one Tab. 3 Ruthier-Dixon Index Values (conventional units) Health level condition Rating up to 40 Tall Good four from 40 to 60 Average Satisfactory 3 from 60 to 80 Insufficient Lowered 2 80 and more Low Bad one

Tab. four Tapping test Health Change Pattern Type of change condition Rating Pace buildup at minimum 70 bpm Positive Good four Slight fluctuations from the midline or a decrease in pace at the minimum values of 60-70 beats / cycle Stable Satisfactory 3 Pronounced oscillatory nature with minimum values of 50-60 beats / cycle Risk group Lowered 2 Steady decrease in results at minimum values up to 50 bpm Negative Bad one

Tab. 5 Simple hand-eye reaction Values (ms) Run level condition Rating up to 210 Tall Good four from 210 to 250 Average Satisfactory 3 from 250 to 290 Below the average Lowered 2 290 and more Low Bad one

Tab. 6 Complicated hand-eye reaction Values (ms) Run level condition Rating up to 400 Tall Good four from 400 to 470 Average Satisfactory 3 from 470 to 530 Below the average Lowered 2 530 and more Low Bad one

Tab. 7 Wexler Alphanumeric Test Number of recoded characters Health level condition Rating 37 and more Tall Good four 26-36 Average Satisfactory 3 21-25 Below the average Lowered 2 20 and less Low Bad one

Tab. 8 Goldberg General Health Number of points condition Rating S <= 30 Good four 30 <S <= 45 Satisfactory 3 45 <S <= 60 Lowered 2 > 60 Bad one

Tab. 9 Taylor Personal Anxiety Number of points Anxiety level condition Rating up to 5 Low Good four 6-15 Average Satisfactory 3 16-25 Tall Lowered 2 26 and more Elevated Bad one

Tab. 10 Spilberger-Hanin Situational Anxiety Number of points Anxiety level condition Rating up to 30 Low Good four 31-35 Average Satisfactory 3 36-45 Tall Lowered 2 46 and more Tall Bad one

Tab. eleven Vegetative balance ratio Number of points Functioning level condition Rating 3.0-5.0 Ergotropy Good four 1.0-2.0 Ergotropy Satisfactory 3 0.5-0.9 Trophotropy Lowered 2 0.2-0.4 Trophotropy Bad one

Tab. 12 The subjective minute of Halberg-Moiseeva Assessment Time (sec) Adaptation level condition Rating from 60 to 70 Tall Good four 50 to 60 or more 70 Average Satisfactory 3 from 40 to 50 Below the average Lowered 2 40 and less Low Bad one

The assessment of individual indicators, a group of indicators and the general functional state is carried out in accordance with table 13:

Tab. 13 Indicators Condition assessment Bad Will satisfy. Lowered. Good Physiological indicators Heart rate one 2 3 four Voltage index one 2 3 four Ruthier-Dixon Index one 2 3 four Sum of ratings 3 6 9 12 Assessment of physiological parameters 3-4 5-7 8-10 11-12 Average value 1.00-1.33 1.66-2.33 2.66-3.33 3.66-4.00 Rating one 2 3 four Psychophysiological indicators Tapping test one 2 3 four Simple reaction one 2 3 four Difficult reaction one 2 3 four Wexler Test one 2 3 four Sum of ratings four 8 12 16 Assessment of psychophysiological indicators 4-6 7-10 11-14 15-16 Average value 1.00-1.50 1.75-2.50 2.75-3.50 3.37-4.00 Rating one 2 3 four Psychological indicators Overall health assessment one 2 3 four Personal anxiety one 2 3 four Situational anxiety one 2 3 four Vegetative balance ratio one 2 3 four Subjective minute one 2 3 four Sum of ratings 5 10 fifteen twenty Assessment of psychological indicators 5-7 8-12 13-17 18-20 Average value 1.00-1.40 1.6-2.40 2.60-3.50 3.60-4.00 Rating one 2 3 four The sum of the ratings of all indicators 12 24 36 48 General assessment of functional status 12-16 17-30 31-42 43-48 Average value 1.00-1.33 1.41-2.50 2.58-3.50 3.58-4.00 Rating one 2 3 four

According to the population norms of individual indicators, individual groups of indicators and the general functional state, 4 gradations of states are distinguished, which have an increase in a significant property with assignment of the following ratings: 1 - poor condition, 2 - low, 3 - satisfactory and 4 - good.

By comparing the current values of individual indicators with population norms, as well as a group of indicators and the general functional state with established average values, each of them is given one of the selected estimates.

Registration of all indicators is carried out in dynamics, which allows, by comparing the results of current and previous measurements, to determine the nature and severity of changes for each indicator, for a group of indicators, for all indicators, thereby forecasting the development of the employee’s functional state, and developing recommendations for preventing negative development of the process .

Based on the results of dynamic observation and estimates of the values of both individual and group indicators, the computer program gives the following conclusion:

if there are changes in the indicator within the same gradation - the absence of changes;

upon transition of the indicator value to one higher gradation - improvement of the functional state according to this indicator;

upon transition of the indicator value to two or higher gradations - a significant improvement in the functional state of this indicator;

upon transition of the indicator values to one lower gradation - deterioration of the functional state according to this indicator;

with the transition of the indicator values to two or lower gradations - a significant deterioration in the functional state of this indicator.

The decision on the appointment of an extraordinary extended psychophysiological examination of the employee is made when the assessment of one of the groups of indicators is reduced by one gradation, or the assessment of one indicator by two gradations, or the assessment of two or more separate indicators by one gradation.

The decision on the need to develop and prescribe a professionally oriented set of preventive, correctional, rehabilitation and rehabilitation measures is taken when the overall functional state assessment is reduced by one gradation, or one of the groups of indicators is assessed by two gradations, or two or three groups of indicators are assessed by one gradation.

Example. SURVEY PROTOCOL on the EXPROM instrument complex

Name Ivanov Ivan Ivanovich Position - IMPS driver Age (full years) - 49 Work experience by profession (years) - 17 Date of examination - 02.03.09 Survey results FS indicators present value Individual rate condition Dynamics Physiological indicators State of emergency 72 67 sat. without changes ON WEDNESDAY 96 87 good improvement RD Index 74 44 lowered worsening average rating sat. without changes Psychophysiological indicators Tapping test 331 318 sat. without changes PZMR 208 220 good without changes SZMR 378 364 good without changes Wexler Test eleven 36 dissatisfied. without changes average rating sat. without changes Psychological indicators POPs 43 25 sat. without changes LT 22 23 lowered without changes ST 56 59 lowered without changes KVB 83 135 lowered without changes Test minute 49 66 lowered worsening average rating lowered without changes Average rating of all indicators sat. without changes Recommendations: given the average assessment of psychological indicators - "lowered", a specialist psychologist needs to conduct a conversation in order to find out the reasons for this condition Note:

Claims (1)

A method for assessing and predicting the functional state of workers in transport professions, which consists in registering the dynamics of the values of 3 groups of indicators: physiological, reflecting the state of the cardiovascular system, psychophysiological, reflecting the state of the nervous-analytic system, and psychological, characterizing the level of anxiety and mental adaptation of the body , their assessment according to population standards in accordance with four grades: 1 - poor condition, 2 - low, 3 - satisfactory, 4 - good, define and average ratings for selected groups of indicators, determining the average rating for all indicators - a general assessment of the functional state, their rounding and assessment in accordance with the same 4 grades, characterized in that according to the results of assessments of the current values of individual indicators, average estimates of group indicators and the total assessment of the functional state, as well as the results of their comparison with the data of previous studies, a forecast is given on the nature and severity of changes in individual indicators, groups of indicators and general its functional state, recommendations are justified: no changes - if there are changes in the indicator within the same gradation; Improving the functional state of this indicator - when the indicator changes to one higher gradation; a significant improvement in the functional state of this indicator - with the transition of the indicator to two or higher gradations; deterioration of the functional state for this indicator - when the indicator values go to one lower gradation; a significant deterioration in the functional state of this indicator - with the transition of the indicator to two or lower gradations; the need for an extraordinary extended psychophysiological examination of the employee - with a decrease in the average score of one of the groups of indicators for one gradation or the assessment of one of the individual indicators for two gradations, or the assessment of two or more separate indicators for one gradation; the need to develop and prescribe a professionally oriented set of preventive, correctional, rehabilitation and rehabilitation measures - with a decrease in the overall assessment of the functional state by one gradation or an average assessment of one of the groups of indicators by two gradations, or a decrease in the average score of two or more groups of indicators by one gradation.