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Применение принципов функционального биоуправления в профилактической медицине Skip to content Известия Южного федерального университета. Технические науки 2000 ВАК Область наук
на тему «Применение принципов функционального биоуправления в профилактической медицине»
ПРИМЕНЕНИЕ ПРИНЦИПОВ ФУНКЦИОНАЛЬНОГО БИОУПРАВЛЕНИЯ В ПРОФИЛАКТИЧЕСКОЙ МЕДИЦИНЕ
А.В. Адамчук, А. А. Скоморохов
Научно-производственно-конструкторская фирма «Медиком МТД»
347900, г. Таганрог, Ростовская обл., ул. Ленина, 99, т.(863-44) 2-63-84, 2-34-68, ф.2-74-26, E-mail: office@medicom-mtd.com; http://www. medicom-mtd.com;
Цели профилактической медицины могут остаться благими пожеланиями, если не предпринять специальных усилий по обеспечению мотивации каждого конкретного индивида на сохранение и укрепление здоровья тогда, когда еще нет явных признаков его нарушения. Формирование мотивации — комплексная задача, охватывающая уровни воспитания, образования, культуры, образа жизни, а также частные методы и средства оценки и мобилизации психофизиологических резервов организма. Последние и являются предметом дальнейшего рассмотрения.
С точки зрения теории функциональных систем Анохина П. К. деятельность живого организма организуется иерархическими функциональными системами (ФС) с целью получения полезного для организма результата. Поэтому применение методов ФБУ в реабилитации явно нарушенных функций, когда контролируемый параметр непосредственно связан с полезным для организма результатом, базируется на уже сформированной функциональной системе, в которую дополнительно привносится еще один усиливающий контур обратной афферентации на сознательном уровне.
На стадии, когда еще нет клинических проявлений заболевания и сопутствующих ему беспокоящих симптомов, но резервы организма сдвинуты в сторону истощения (т.н. донозологическое состояние, предболезнь), отсутствуют условия для возникновения ФС, корректирующей функционирование организма на поведенческом уровне. И только тогда, когда её проявления препятствуют или ощутимо затрудняют удовлетворение доминирующих потребностей различного уровня, формируется ФС, направленная на преодоление патологии — изменение образа жизни, самолечение, обращение к врачу и т.д.
Одним из возможных подходов к разрешению противоречия в рамках этого общего положения представляется совместное применение принципов ФБУ и теории ФС. Суть этой интеграции заключается в том, что в одну из имеющихся в памяти данного субъекта ФС высокого уровня, актуализированную на некотором интервале времени, искусственно вовлекается дополнительная ФС более низкого уровня, включающая проблемную систему организма (например, систему регуляции дыхания, позы, артериального давления, вегетативных компонентов поведения и т. д.). При этом результат функционирования большой ФС зависит от функционирования и взаимоотношения входящих в неё элементарных ФС различного уровня, и в тоже время функционирование каждого элемента системы оказывается подчиненным достижению результата большой ФС. Поэтому, если наличный уровень функционирования проблемной ФС не обеспечивает достижения цели большой ФС, то начинается поисковая активность, направленная на получение требуемого результата в новых условиях. Естественно, этот процесс должен быть организован так, чтобы достижение глобальной цели обеспечивалось только при изменении уровня функционирования проблемной системы в требуемом направлении.
Практическая реализация предлагаемого подхода заключается в введении в целесообразную деятельность субъекта некоторого дополнительного элемента, затрудняющего удовлетворение его доминирующей потребности и получение полезного (по критериям большой ФС) результата. Степень затруднения
Известия ТРТУ
Тематический выпуск
деятельности при этом ставится в зависимость от степени отклонения некоторой контролируемой функции организма от его желаемого индивидуального уровня. Таким образом, осуществляется лишь частичная модификация естественной ФС с сохранением всех ранее сформированных её компонентов — афферентный синтез, мотивация, акцептор результата и т.д., а корригируемая функция оказывается непосредственно связанной с теперь уже вдвойне полезным для пациента результатом действия.
Важное методологическое следствие — степень осознания процесса биоуправления, уровень интеллекта, воля и, по-видимому, другие высшие психические функции пациента, значимость которых отмечается многими авторами, перестают играть ограничивающую роль в сфере использования ФБУ, что существенно расширяет возрастной диапазон пациентов, спектр их патологий и состояний.
Принципиально внедрение дополнительного элемента может быть осуществлено в любую ФС, однако требования эффективности практической реализации обусловливают необходимость выполнения критериев универсальности и простоты. Критерию универсальности, безусловно, отвечают те ФС, которые удовлетворяют естественные базовые потребности организма (пища, воздух, микроклимат, секс, отдых, безопасность и т.п.) и, с некоторыми оговорками, те ФС, которые удовлетворяют социальные потребности (достижения, престиж, статус, эстетические, информационные и т. п.). Первые являются наиболее мощными, способными вовлечь в себя и перестроить функционирование практически любой системы организма, в том числе и психики, даже при отсутствии требуемой или наличии противоположной мотивации. Вторые технически проще реализовать, но они менее универсальны и требуют учета индивидуальных особенностей пациента, в частности, его мотивационной сферы. Например, расширяющееся применение игрового подхода к построению процедур ФБУ безусловно является шагом в направлении повышения их эффективности и субъективной привлекательности, однако, по крайней мере для пациентов с дефицитом внимания (около 10% населения) и формирующимися психопатоподобными чертами личности, игровая активность не способна удерживать их внимание необходимое время. Кроме того, далеко не каждому здоровому человеку свойственен игровой темперамент и азарт, тем более это относится к потенциальным пациентам, у которых, независимо от специфики патологии, деформируется психическая сфера в направлении, не способствующем повышению привлекательности игры (низкая самооценка, снижение волевых качеств, установка на получение помощи извне, тревога, депрессия).
Второй критерий продиктован очевидными экономическими соображениями. Отражением методологии предлагаемого подхода в средствах для его реализации является использование некоторой существующей технической системы, предназначенной для удовлетворения той или иной доминирующей потребности, в которую добавляется подсистема ФБУ. Это позволяет придать системе эффект двойной полезности, позволяя использовать ее не только при проведении процедур, но и по основному назначению.
В качестве иллюстрации рассмотрим несколько возможных вариантов процедуры ФБУ для нормализации пограничных функций. Первый ориентирован на использование естественных потребностей в отдыхе и комфортном микроклимате (отдых — это важнейший вид деятельности, направленный на восстановление ресурсов организма). Используется оборудование для управления микроклиматом рабочей зоны помещения — сплит-система с возможностью управления температурой, влажностью, скоростью движения воздуха. Вначале сеанса пациент самостоятельно подбирает субъективно наиболее комфортные параметры микроклимата, которые принимаются в качестве его индивидуальных эталонных и
формируют акцептор результата деятельности. После их установления в течение нескольких минут производится оценка текущих значений параметров контролируемых функций организма и степени их отклонения от желаемых. Затем параметры микроклимата изменяются в соответствие с выявленным отклонением параметров контролируемых функций, а задачей пациента становится получение максимального удовольствия от отдыха путем восстановления эталонных параметров комфорта за счет изменения контролируемых параметров внутреннего состояния. Такой подход к построению процедур ФБУ представляется весьма перспективным, поскольку способствует перераспределению вегетативного баланса в сторону усиления трофотропных процессов на фоне которых адаптационные перестройки протекают более эффективно. Напротив, любая активность, в том числе и управление параметрами состояния по сигналам БОС, сопровождается нарастанием напряженности и активизирует эрготропные процессы, объективно сужающие диапазон возможных перестроек контролируемой системы организма. К тому же, само по себе пребывание пациента в комфортных условиях приводит к существенным физиологическим перестройкам в сторону снятия психического напряжения.
Второй вариант базируется на удовлетворении социальной потребности. Выявляется имеющаяся у индивидуума или актуализируется некоторая типовая доминирующая потребность, например, эстетическая — просмотр репродукций картин, фотографий, фильмов, прослушивание музыки в соответствии с его вкусами. Предъявляется фрагмент соответствующего материала в зрительной и/или слуховой модальности с субъективно наилучшим качеством для формирования акцептора результата действия и одновременно оценивается текущее значение параметров контролируемой функции организма. Вводятся факторы (помехи), мешающие процессу получения эстетического удовольствия, причем выраженность помех пропорциональна степени отклонения контролируемых параметров от требуемых. Цель поисковой деятельности пациента — максимизировать эстетическое удовольствие за счет смещения параметров контролируемого процесса в требуемом направлении. Этот вариант реализуется в изготавливаемом НПКФ «Медиком МТД» комплексе «Реакор».
Анализ доступных отечественных и иностранных источников позволяет утверждать, что предложенный подход к организации процесса ФБУ отличается от известных в настоящее время и позволяет создать новый класс современных средств функциональной коррекции систем организма. Его основные особенности — существенное расширение круга потенциальных пациентов и повышение привлекательности процедур за счет включения их в контекст осмысленной целенаправленной деятельности субъекта, базирующейся на активности естественной ФС.
КОРРЕКЦИЯ НЕБЛАГОПРИЯТНЫХ СОСТОЯНИЙ В СИСТЕМЕ ПСИХОФИЗИОЛОГИЧЕСКОГО МОНИТОРИНГА
О.М. Исмайлова
ГВКГ им. Бурденко, г. Москва
Результаты экспериментальных исследований, проводившихся в последние годы на различных предприятиях электроэнергетики, среди военнослужащих, учащихся школ показывают, что процент психосоматических заболеваний среди всех категорий граждан достаточно высок. Их проявления различны – гипертонические состояния, язвенная болезнь и т.д. Еще больше выявляется лиц с отклонениями в функциональном состоянии. Это, прежде всего, повышенная тревожность, снижение
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