These Temporary criteria for determining the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases were developed in pursuance of the Government Resolution Russian Federation dated October 16, 2000 N 789 “On approval of the Rules for determining the degree of loss of professional ability to work as a result of accidents at work and occupational diseases” for use by medical and social examination institutions in determining the degree of loss of professional ability to work by persons who suffered health damage as a result of accidents at work production or occupational diseases (hereinafter referred to as victims), their need for measures of medical, professional and social rehabilitation.
These criteria are temporary for the period of studying their application in practice and making possible adjustments.
I. General principles determining the extent of loss
professional work capacity as a percentage
1. The degree of loss of professional ability to work is determined based on the consequences of health damage due to an industrial accident, taking into account the victim’s professional abilities, psychophysiological capabilities and professionally significant qualities that allow him to continue to perform professional activity, preceding an industrial accident and occupational disease, of the same content and in the same volume, or taking into account a reduction in qualifications, a reduction in the volume of work performed and the severity of work in ordinary, specially created production or other conditions; expressed as a percentage and set between 10 and 100 percent.
2. The main methodological principle of examining the professional working capacity of the victim is a cumulative analysis of the following criteria:
clinical and functional;
the nature of professional activity (qualifications, quality and volume of work, ability to perform it);
3. Clinical and functional criteria include:
nature and severity of injury, occupational disease;
features of the course of the pathological process caused by an accident at work or occupational disease;
nature (type) of dysfunctions of the body;
degree of dysfunction of the body (significantly expressed, pronounced, moderate, insignificant);
clinical and rehabilitation prognosis;
psychophysiological abilities;
clinical and labor prognosis.
4. When determining the degree of loss of professional ability to work, the severity of dysfunction of the victim’s body, leading to limited ability to work, and other categories of life activity are taken into account. Characteristic of traumatic injuries and occupational diseases is the diversity clinical manifestations, varying both in nature and severity of dysfunction. Polymorphism clinical picture in victims may be due to the presence of both direct consequences of injuries, occupational diseases, and their complications. In this regard, the method of expert examination of this category of victims requires a comprehensive clinical and physiological study using modern methods diagnostics and retrospective analysis of post-traumatic and previous periods of development of an occupational disease, careful study of anamnestic information, data from medical institutions, medical, expert documentation, etc. Analysis of a set of indicators of a clinical and physiological nature helps to clarify the main medical and biological factors (nature, degree of dysfunction , course of the disease, etc.), which are the basis of clinical and functional criteria for determining the degree of loss of professional ability to work.
II. Criteria for assessing ability
to professional activities
5. When determining the degree of loss of professional ability to work, it is necessary to take into account the professional factor, in particular, the ability of the victim after an accident at work or the occurrence of an occupational disease to perform work in full in his previous profession (before the accident or occupational disease) in ordinary or specially created production facilities or other working conditions.
(as amended by Order of the Ministry of Health and Social Development of the Russian Federation dated April 18, 2007 N 280)
6. Professional activity in full involves a full working day, a full working week, and fulfillment of production standards by at least 100 percent.
7. The criteria for assessing the possibility of performing professional activities are related to the difference in tariff and qualification categories within the relevant profession.
8. The frequency of reduction in qualifications is determined taking into account the established tariff categories, classes, categories for a given professional activity.
9. The ranking of work by degree of complexity (and therefore by skill level) is based on labor complexity factors:
technological - the complexity of managing (maintaining, using) tools; complexity of technological (working) processes;
organizational - the breadth of the complex of operations (work) performed and the degree of independence of the employee in the process of performing work;
responsibility - material and responsibility for life and health;
specific - special requirements for work, for example, work in unusual, close to extreme conditions of production activity.
10. Assessment of the level of complexity of work is carried out differentially for work that differs in the degree of mechanization: manual, machine-manual, machine, automated, hardware.
11. When determining the tariff and qualification category, the employee’s qualifications are taken into account as a set of knowledge, skills and work habits, as well as the time spent on preparation (study). Qualification requirements for knowledge increase from initial information to the extent of incomplete high school(1 - 2 categories) to knowledge of individual disciplines in the amount of a full course of secondary specialized educational institutions(6th category).
12. The tariff and qualification system for assessing work and professions of workers is characterized by a pattern of increasing complexity of work for each of the factors taken as the basis for determining the category. For example, according to the technological factor: when moving from 1 category to the next, the complexity, power, and dimensions of a unit of serviced equipment for a similar purpose increase. According to the organizational factor of complexity, the degree of independence in performing work increases and the functions of managing workers of lower skill levels are included.
13. Professions of skilled manual workers are classified into six tariff and qualification categories. The tariff-qualification category indicates the compliance of the worker’s qualifications with the complexity of the work performed, as well as the level of his knowledge, skills and work habits.
Skilled worker professions can have a different range of ranks (1 - 6, 4 - 6, 3 - 5, etc.).
14. If the victim cannot perform work of the same complexity (qualification), then the question arises of transferring him to work of less complexity (qualification) in accordance with the types of work provided for by the Unified Tariff and Qualification Directory of Work and Professions of Workers (UTKS), with optimal ( 1st class of working conditions) or acceptable (2nd class of working conditions) physical, neuro-emotional load, which does not contain contraindicated production factors and corresponds to the psychophysiological capabilities of the victim to perform it.
15. In this case, the degree of loss of professional ability to work is established depending on the level of reduction in qualifications, taking into account the reduction in the coefficient of complexity of work. For example, transferring a 6th grade worker to 2nd grade leads to a decrease in qualifications with the loss of four grades and a decrease (by 60 percent) in the work complexity coefficient.
16. The degree of loss of professional working capacity of a worker of unskilled physical labor is established depending on his psychophysiological state, physical ability to perform simple physical labor and is associated with the assessment of classes of working conditions based on the severity of labor.
The loss of professional working capacity for a given contingent of workers is determined taking into account the degree of reduction in the category (class) of the severity of work, for example, when transferring a worker of heavy physical labor of the 4th category of severity (lifting and carrying a load weighing more than 35 kg) to the shown work of the 1st category of severity with light physical stress (one-time lifting of a load weighing no more than 2 kg) with a pronounced reduction in the category (class) of the severity of the labor process.
17. When determining the degree of loss of professional ability to work, it is necessary to take into account the classes of working conditions in terms of the harmfulness and danger of factors in the working environment, the severity and intensity of the labor process.
18. A set of indicators reflecting production factors is the basis for resolving the issue of the need to change the profession, qualifications of an employee, and the volume of his production activity in connection with an injury or occupational disease.
19. Loss of professional working capacity of employees (engineers, managers at various levels, people in creative professions, etc.), to whose activities labor standards are applicable, is determined taking into account the reduction in the volume of work performed, its complexity and intensity, and job responsibilities.
III. Determining the degree of professional loss
working capacity as a percentage
20. In cases where, as a result of an industrial accident or occupational disease with significant impairment of body functions, the victim has a complete loss of ability to perform professional activities, including in specially created production or other working conditions, 100 percent loss of professional ability is established.
(as amended by the Resolution
21. Examples of clinical and functional criteria for establishing 100 percent loss of professional ability to work, which determine the complete loss of professional ability to work, are significantly pronounced violations of the static-dynamic function:
a) lower paraplegia; significantly pronounced tetraparesis, triparesis, paraparesis with increased muscle tone of a spastic type or hypotension, with a minimum volume (5.0 - 6.0 degrees) of active movements in all joints lower limbs, a significant decrease in muscle strength (up to 1 point), with the inability to move independently; Type III EMG - frequent fluctuations in potential, distortion of the normal structure of the electromyogram "in bursts of frequent oscillations" (significantly pronounced paresis); IV type EMG - complete bioelectrical silence during functional loads (paralysis of the limbs);
b) significantly pronounced paresis of both upper limbs with a minimum range of active movements in all joints (shoulder - 5.5 - 10 degrees, elbow - 4.3 - 7.7 degrees, wrist - 5.5 - 8.5 degrees); significant limitation of opposition thumb(the distal phalanx of the latter reaches the base of the second finger), bending the fingers into a fist (the distal phalanges of the fingers do not reach the palm at a distance of 5 - 8 cm); decrease in muscle strength of the upper limbs (up to 1 point); violation of the main function of the upper limb: grasping and holding large and small objects is not possible, only the auxiliary function is preserved - maintaining and pressing objects;
c) vestibular-cerebellar disorders: significantly pronounced static, dynamic ataxia; hyperreflexia of vestibular excitability with a duration of grade III post-rotational nystagmus of more than 120 seconds, grade III caloric nystagmus of more than 130 seconds;
d) amputation stumps of both lower extremities (non-prosthetic) in combination with the stump of the upper extremity, starting with the absence of all fingers;
d) respiratory failure III degree, circulatory disorder stage III (shortness of breath at rest, respiratory rate of 30 or more per minute, increased respiratory rate by 10 - 15 per minute after minor physical stress without restoration of the original level, significantly pronounced cyanosis, participation of auxiliary respiratory muscles at rest, severe tachycardia - 130 or more beats per minute, epigastric pulsation, liver enlargement, peripheral edema, decrease in vital capacity of the lungs to 50% of the proper value, maximum ventilation of the lungs - up to 50 percent, increase in minute respiratory volume up to 180 percent, decrease in the Tiffno index of less than 40 percent and oxygen utilization rate up to 20 percent, decreased contractility of the right ventricular myocardium in combination with impaired pulmonary hemodynamics);
e) significantly expressed sensory impairments (practical or absolute blindness of the only or better seeing eye: visual acuity with correction - 0.04 - 0, field of vision equal to - 0 - 10 degrees (peripheral boundaries along the meridian from the point of fixation and/or central or paracentral confluent scotomas); visual performance - significantly reduced or absent, EFI indicators - thresholds E-U more than 300 μA or not detectable, lability less than 20 Hz or absent, CFSM less than 20 p/sec. or absent - if there are contraindications to performing any work);
g) significantly pronounced dysfunctions of the pelvic organs (urinary and fecal incontinence).
22. In the case where the victim, due to severe impairment of body functions, can perform professional labor (work) only in specially created production conditions, the degree of loss of professional ability to work is established from 70 to 90 percent.
In this case, the degree of loss of professional ability for victims with severe impairments of body functions is established depending on the level of reduction in qualifications and the possibility of using professional knowledge and skills when performing work in specially created production conditions:
a) has become invalid. - Order of the Ministry of Health and Social Development of the Russian Federation dated September 24, 2007 N 620;
b) in cases where the victim can perform lower-skilled work in specially created production conditions, taking into account professional knowledge and skills, 80 percent of the loss of professional ability to work is established;
c) in cases where the victim can perform work in a profession that preceded an industrial accident or occupational disease in specially created production conditions, 70 percent of the loss of professional ability to work is established.
23. Examples of clinical and functional criteria for establishing 70 - 90 percent loss of professional ability for victims with the consequences of industrial injuries and occupational diseases, with the possibility of professional activity in specially created conditions, are pronounced violations of the static-dynamic function:
(as amended by Resolution of the Ministry of Labor of the Russian Federation dated April 26, 2004 N 61)
a) pronounced paresis of both lower extremities, tetraparesis, triparesis, hemiparesis with a pronounced increase in muscle tone of the spastic type or muscle hypotonia, with a pronounced limitation of the amplitude of active movements in all joints of the lower extremities - hip (up to 20 degrees), knee (up to 10 degrees) , ankle (up to 6 - 7 degrees); with a pronounced decrease in muscle strength (up to 2 points) of the lower extremities, pronounced varus, equinovarus deformity of the feet; spastic, paretic, peroneal gait with pronounced foot drop; moving with additional support (crutches);
b) a pronounced violation of the biomechanics of walking - an increase in the number of steps when walking 100 meters to 204 - 226 (normally 80 - 120 steps), an increase in the duration of a double step to 2.6 - 3.6 seconds (normally 1.0 - 1, 3 seconds), reducing the walking pace to 29 - 46 steps per minute (normally 80 - 100 steps), reducing the walking rhythm coefficient to 0.52 - 0.58 (normally 0.94 - 1.00), reducing movement speed up to 1.0 km per hour (normally 4 - 5 km/h); Type II EMG with a pronounced disturbance of the bioelectrical activity of muscles - low-frequency potentials of the “fasciculations” type with a clear rhythm at rest and during functional loads;
c) severe paresis of both upper extremities, contractures of the joints of the upper extremities with a range of active movements within 10 - 20 degrees, with a pronounced limitation in flexing the fingers into a fist (the distal phalanges of the fingers do not reach the palm at a distance of 3 - 4 cm), with a violation of the basic function of the upper limbs: it is not possible to grasp small objects, to hold large objects for a long time and firmly, EMG - type II;
d) pronounced vestibular-cerebellar disorders (dizziness at rest, severe and frequent attacks of dizziness - 4 or more times a month), spontaneous nystagmus of II - III degrees, pronounced disturbances in statics and coordination of movements, movement with the help of aids(cane, crutches), hyperreflexia of vestibular excitability with the duration of post-rotational nystagmus II - III degree 85 - 120 seconds, caloric nystagmus II - III degree 110 - 130 seconds;
e) amputation stumps of the thighs or legs at different levels, false joints of both leg bones with a defective position of the lower limb, with a functionally disadvantageous position of the knee joint with flexion contracture with the inability to extend more than 140 degrees, defective installation of the lower limb in a functionally disadvantageous position of the hip joint with limitation extension up to 150 degrees or abduction of the leg over 165 degrees with a pronounced distortion of the pelvis and functional shortening of the limb by 10 cm, severe contracture with a range of motion of no more than 30 degrees or ankylosis of the joints in a functionally disadvantageous position;
f) respiratory failure stage II, circulatory disorder stage II (respiratory rate at rest 21 - 29 per minute, increased respiratory rate by 12 - 16 per minute after physical activity, pronounced cyanosis, participation of auxiliary respiratory muscles in the act of breathing during slight physical activity, heart rate 100 - 129 beats per minute, slight peripheral edema, decrease in vital capacity of the lungs to 50 - 55% of the proper one, maximum ventilation of the lungs - up to 51 - 54 %, an increase in minute volume of respiration up to 150%, a decrease in the Tiffno index to 54 - 40%, oxygen utilization rate up to 28%, a decrease in the contractility of the right ventricular myocardium in combination with impaired pulmonary hemodynamics);
g) pronounced sensory impairment: high degree of low vision in the only or better seeing eye, corrected visual acuity is equal to or less than 0.1 - 0.05, field of vision - peripheral boundaries are equal to or less than 20 degrees, but wider than 10 degrees and (or) single central scotomas, visual performance - a pronounced decrease, EFI indicators - E-U thresholds - 200 - 300 μA, lability - 20 - 35 Hz, CFSM - 20 - 35 p/sec.;
pronounced hearing loss: perception of spoken speech up to 0.5 - 1.5 meters, hearing threshold - 61 - 80 dB, speech intelligibility threshold - 80 - 90 dB;
h) severe dysfunction of the pelvic organs, absence of the urge to urinate and the feeling of urine passing through the urethra; with cystometry, the capacity of the bladder with detrusor hypotension is 500 - 600 ml, residual urine - up to 400 ml, with detrusor hypertension the capacity is 20 - 30 ml; long delay defecation - up to 5 days; anal reflex, sphincter tone and pressure during monometry are reduced - in the anal canal of the external sphincter - 10 - 15 mm Hg. Art., internal sphincter - 16 - 25 mm Hg. Art. (norm 35 - 62 mm Hg).
24. In cases where the victim can, under normal production conditions, perform professional work with a pronounced decrease in qualifications or with a decrease in the volume of work performed, or if he has lost the ability to continue professional activities due to a moderate impairment of body functions, but can, under normal production conditions, continue professional activities of a lower level qualifications, it is established from 40 to 60 percent of loss of professional ability to work.
(as amended by Resolution of the Ministry of Labor of the Russian Federation dated April 26, 2004 N 61)
25. In this case, the degree of loss of professional ability for victims with moderate impairments of body functions is established depending on the level of reduction in qualifications, the volume of production activity or the category of labor severity:
a) 60 percent loss of professional ability to work is established in the following cases:
if the victim can perform work in the profession, but with a reduction in qualifications by four tariff categories;
if the victim can perform work using professional knowledge, skills and abilities, but with a reduction in qualifications by four tariff categories;
the paragraph is no longer valid. - Order of the Ministry of Health and Social Development of the Russian Federation dated May 13, 2005 N 329;
if the victim can perform unskilled physical labor with a reduction in the level of work by four categories of severity;
(paragraph "a" as amended by Resolution of the Ministry of Labor of the Russian Federation dated April 26, 2004 N 61)
b) 50 percent loss of professional ability to work is established in the following cases:
if the victim can perform work in a profession with a reduction in qualifications by three tariff categories;
if the victim can perform work in his profession with a decrease in the volume of production activity (by 0.5 times the rate);
if the victim can perform unskilled physical labor with a reduction in the level of work by three categories of severity;
c) 40 percent loss of professional ability to work is established in the following cases:
if the victim can perform work in his profession with a decrease in the volume of production activities;
if the victim can perform work using professional knowledge, skills and abilities, but with a reduction in qualifications by two tariff categories;
(as amended by Resolution of the Ministry of Labor of the Russian Federation dated April 26, 2004 N 61)
if the victim can perform work in a profession with a reduction in qualifications by two tariff categories;
if the victim can perform unskilled physical labor with a reduction in the category of work by two categories of severity.
26. Examples of clinical and functional criteria for establishing 40 - 60 percent loss of professional ability for victims with the consequences of industrial injuries and occupational diseases, when it is possible to perform professional activities in normal production conditions, are moderate violations of the static-dynamic function:
(as amended by Resolution of the Ministry of Labor of the Russian Federation dated April 26, 2004 N 61)
a) moderate paresis of both lower extremities, tetraparesis, triparesis, hemiparesis, monoparesis with muscle wasting of the thigh by 5 - 7 cm, lower leg - by 4 - 5 cm, increased muscle tone of a spastic type or muscle hypotonia, with a moderate limitation of the amplitude of active movements during all joints of the lower extremities - hip (up to 15 - 20 degrees), knee - (up to 16 - 20 degrees), ankle - (up to 14 - 18 degrees); moderate decrease in muscle strength (up to 3 points), spastic, paretic, peroneal gait with slight or moderate foot drop; movement sometimes with the use of additional support (cane);
b) moderate violation of the biomechanics of walking - an increase in the number of steps when walking 100 meters to 170 - 190, an increase in the duration of a double step to 2.0 - 3.0 seconds, a decrease in the walking pace to 50 - 60 steps per minute, a decrease in the walking rhythm coefficient to 0.82 - 0.75, moderate reduction in movement speed to 2.0 km per hour;
c) moderate disturbance of bioelectrical activity - ACBA within more than 25 percent, but less than 70 percent of the norm;
d) moderate paresis of the upper limb: hemiparesis with limited range of active movements in the shoulder joint (35 - 40 degrees), elbow (30 - 45 degrees), wrist (30 - 40 degrees), moderate decrease in muscle strength of the upper limb (3 points) , limited opposition of the thumb to the hand (the distal phalanx of the thumb reaches the base of the 4th finger), limited flexion of the fingers into a fist (the distal phalanges of the fingers do not reach the palm at a distance of 1 - 2 cm), with difficulty grasping small objects; on EMG - a moderate decrease in the amplitude of bioelectrical activity of the muscles of the upper extremities within 25 - 75 percent of normal;
e) contracture of the shoulder joint with a range of motion within 30 - 90 degrees, elbow joint - 80 - 130 degrees, wrist joint - 120 - 130 degrees (flexion contracture and extension contracture - 200 - 220 degrees); ankylosis of joints in a functionally advantageous position; absence of three fingers, excluding the first finger, with difficulty grasping small objects;
f) moderate vestibular-cerebellar disorders: dizziness with sudden changes in the position of the head, body, driving; spontaneous nystagmus I or I - II degree; moderate static-dynamic disturbances (staggering in the Romberg position, when walking, missing the mark during the heel-knee test); hyperreflexia of vestibular excitability with a duration of post-rotational nystagmus of 50 - 80 seconds, caloric nystagmus - 90 - 110 seconds;
g) amputation stumps of a limb (thigh, lower leg, both feet at the level of the Chopart, Lisfranc joint), moderate flexion or extension contracture of the hip joint, knee joint; flexion contracture of the ankle joint (foot equinus); shortening of the lower limb by 5 - 7 cm; ankylosis of the joints in a functionally advantageous position - flexion angle at hip joint within 160 - 170 degrees, in knee joint- 170 - 180 degrees, at the ankle - 95 - 100 degrees;
h) respiratory failure of the I - II degree, circulatory disorders of the I - II stage (shortness of breath with moderate physical exertion, increased cyanosis after moderate physical activity, respiratory rate at rest up to 20 per minute, increased respiratory rate by 12 - 16 per minute after physical exercise load with restoration to the initial level within 5 minutes, slight tachycardia (90 - 99 beats per minute), moderate decrease in vital capacity of the lungs to 56 - 69 percent of the proper, maximum ventilation of the lungs - up to 55 - 58 percent, increase in minute respiratory volume to 142 - 148 percent, reduction in the Tiffno index to 74 - 55 percent, oxygen utilization rate to 36 - 44 percent, oxygen absorption per minute - 277 - 287 ml, signs of a moderate decrease in the contractility of the right ventricular myocardium in combination with impaired pulmonary hemodynamics);
i) moderate sensory impairment: functional impairment visual analyzer - average degree low vision: decreased visual acuity of the single or better seeing eye with correction equal to or more than 0.1, visual field - peripheral boundaries less than 40 degrees, but wider than 20 degrees, visual performance is moderately reduced, EPI indicators - E-U thresholds - 100 - 150 μA , lability from 30 - 35 to 40 - 43 Hz, frequency frequency from 30 - 35 to 40 - 43 p/sec.; moderate hearing loss - perception of spoken speech up to 2 - 3 meters, whispered speech - up to 0.5 - 0 meters, average hearing threshold - 41 - 60 dB, speech intelligibility threshold - 50 - 70 dB;
j) moderate dysfunction of the pelvic organs: lack of sensation of bladder filling, with cystometry, the capacity of the bladder with detrusor hypotonia is 500 - 400 ml, residual urine - more than 100 ml with detrusor hypertension, the capacity is 20 - 125 ml; long delay in defecation - up to 3 - 4 days; sphincter insufficiency - incontinence of gases, the anal reflex is reduced, the tone and volitional contractions of the sphincter are weakened, manometry reveals a moderate decrease in the pressure of the external sphincter - 16 - 25 mm Hg. Art., internal sphincter - 26 - 40 mm Hg. Art.
27. In cases where the victim can, under normal production conditions, perform professional work with a moderate or slight reduction in qualifications, or with a decrease in the volume of work performed, or when working conditions change, leading to a decrease in the victim’s earnings, or if the performance of his professional activities requires more stress, than before, 10 to 30 percent of loss of professional ability is established.
28. In this case, the degree of loss of professional ability for victims who have minor impairments in body functions due to industrial injuries or occupational diseases is determined depending on the level of reduction in qualifications, the volume of production activity or the category of labor severity:
a) 30 percent loss of professional ability to work is established in the following cases:
if the victim can perform work in a profession with a reduction in qualifications by one tariff category,
if the victim can perform unskilled physical labor with a reduction in the level of work by one category of severity,
if the victim can perform work in his profession with a slight decrease in the volume of professional activity (reduction in the production rate by 1/3 of the previous load);
(as amended by Resolution of the Ministry of Labor of the Russian Federation dated April 26, 2004 N 61)
b) 20 percent loss of professional ability to work is established if the victim can perform work with a reduction in the volume of professional activity by 1/5 of the previous load;
c) 10 percent loss of professional ability to work is established if the victim can perform work in his profession with a reduction in the volume of professional activity by 1/10 of the previous workload.
29. Examples of clinical and functional criteria for establishing 10 - 30 percent loss of professional ability for victims with the consequences of industrial injuries and occupational diseases, with the possibility of performing professional activities in normal production conditions with a slight reduction in qualifications, category of labor severity or a decrease in the volume of production activities are minor violations of the statistic -dynamic function:
(as amended by Resolution of the Ministry of Labor of the Russian Federation dated April 26, 2004 N 61)
a) slight paraparesis, tetraparesis, hemiparesis, monoparesis of the lower limb with hypotrophy of the muscles of the thigh and lower leg by 1.5 - 2.0 cm (flaccid paresis), a decrease in muscle strength (up to 4 points) with a full range of motion in all joints, with a slight violation of the biomechanics of walking - increasing the number of steps when walking 100 meters to 150 - 160, increasing the duration of a double step to 1.5 - 1.7 seconds, reducing the walking pace to 64 - 70 steps per minute, reducing the walking rhythm coefficient to 0.85 - 0.90, reduction in movement speed to 3.0 km per hour; with a slight decrease in the EMG amplitude of fluctuations in bioelectrical activity to 25 percent of normal;
b) minor paresis of one or both upper extremities with muscle wasting of the shoulder and forearm by 1.5 - 2.0 cm (flaccid paresis), a decrease in muscle strength in all parts of one or both upper extremities up to 4 points, with preservation of active movements in the joints in full and the main function of the hand - grasping and holding objects; on EMG - a slight decrease in the amplitude of bioelectrical activity of the muscles of the upper extremities to 25 percent of normal;
c) minor contracture of the shoulder, elbow or wrist joints; absence of one or two fingers, excluding the first finger, with preservation of the main function of the hand;
d) minor vestibular-cerebellar disorders: dizziness that occurs occasionally; sometimes spontaneous nystagmus of the first degree;
e) minor stato-dynamic disturbances (instability in the Romberg, Sarbo position), hyperreflexia of vestibular excitability with a duration of post-rotational nystagmus of 50 - 80 seconds, caloric nystagmus of 80 - 90 seconds;
f) minor contracture of the joints of the lower extremities: in the ankle joint, extension to an angle of 100 degrees with the equinus position of the foot (flexion contracture), flexion to an angle of 80 degrees - heel foot (extension contracture);
g) respiratory failure of the first degree, circulatory disorders of the first stage (shortness of breath with significant physical exertion, fast walking, respiratory rate at rest within the normal range of 16 - 20 per minute, increased respiratory rate by 10 - 12 per minute after physical activity - 10 squats or bending the body forward with restoration to the initial level within 3 minutes, a slight increase in cyanosis after physical activity, a slight decrease in the vital capacity of the lungs to 80 - 90 percent of the proper one, maximum ventilation of the lungs - up to 60 - 74 percent, an increase in minute respiratory volume to 130 - 140 percent, oxygen absorption per minute - up to 260 - 270 ml, signs of compensatory hyperfunction of the right ventricular myocardium);
h) minor sensory impairments: dysfunction of the visual analyzer - a small degree of low vision in the only or better seeing eye, visual acuity with correction of more than 0.3, visual fields - peripheral boundaries are normal or the fields are narrowed to 40 degrees, visual performance is normal, EFI indicators - E-U thresholds from 80 to 100 µA, lab. over 40 to 43 - 45 Hz, KFSM over 40 to 43 - 45 p/sec.; hearing impairment - perception of spoken speech up to 3 - 5 meters, whispered speech - up to 1.5 - 2.0 meters, average hearing threshold 20 - 40 dB, speech intelligibility threshold - 30 - 40 dB;
i) minor dysfunctions of the pelvic organs: a weak feeling of the urge to urinate, with cystometry the bladder capacity is 200 - 250 ml, residual urine - up to 50 ml; defecation delay - for 2 - 3 days; gas incontinence, anal reflex is reduced, sphincter tone is reduced, monometry reveals a decrease in external sphincter pressure - 22 - 33 mm Hg. Art., internal sphincter - 41 - 58 mm Hg. Art.
30 - 31. Lost power. - Resolution of the Ministry of Labor of the Russian Federation dated December 30, 2003 N 92.
32. The degree of loss of professional ability to work in the event of repeated industrial accidents or newly emerging occupational diseases is established for the victim for each of them separately, depending on the impact of their consequences on his ability to perform professional activities preceding the repeated accident, taking into account the results of implementation individual program rehabilitation of the victim to restore professional ability to work in the previous profession (preceding the previous accident) and in total cannot exceed 100 percent.
33. The degree of loss of professional ability to work during the next re-examination is established taking into account the results of the victim’s rehabilitation.
Decreased performance is a condition that has many different causes. If such a symptom is present, one can think of both a rather serious illness and chronic fatigue syndrome, so in in this case everything is strictly individual.
Why is this happening
First of all, the reasons are chronic diseases, which are based on damage to the central nervous system. Symptoms such as drowsiness, laziness, clumsiness, and absent-mindedness are present here. At the same time, it seems that everything is literally falling out of hand.
At the same time, chronic fatigue begins to slowly develop. This has a negative impact on performance
The second reason for decreased performance is stress, depression and other phenomena that suppress the functioning of the central nervous system. In addition to depression, overexcitation, for example, strong emotions, also affects performance. This may also include taking certain medications, as well as excessive consumption of coffee or tea.
Third, no less common reason- overwork. Most often, factors such as overwork, lack of sleep and improper daily routine play a role here. And the lack of vacation and the need to work even on weekends only aggravates the process. Therefore, it is important to promptly identify and be sure to eliminate all these factors. Otherwise, overwork may further develop into chronic fatigue syndrome.
The fifth is the psychological factor. It happens that work is very annoying, while a person does not receive satisfaction from his work, and also does not receive financial satisfaction from it. In this case, the work is done haphazardly, which greatly affects performance.
The fifth common reason is incorrect work schedule. This should also include incorrectly set priorities when choosing primary and secondary tasks.
And finally, the cause of decreased performance may be the consumption of large quantity sugar and carbohydrates.
How to fix
To improve your performance, you need to follow some important rules. The first thing you need to do is visit a doctor and find out if there are any serious health problems, and these could be disorders of the endocrine, nervous and other systems. This condition is often present oncological diseases, so visiting an oncologist should also be mandatory. It is also necessary to try to transfer all existing chronic diseases into remission.
It is important not to lie down in the morning and wake up at the same time every day. This helps activate neurons that are responsible for performance. In this case, you can easily get rid of laziness. The most important thing is to force yourself to get out of bed.
If necessary, you can do something more radical and change unloved job or quit from a place where there are unloved bosses. As a rule, this saves from decreased performance in most cases. After all, work should bring not only money, but also pleasure and self-satisfaction.
If a decrease in desire to engage in a particular activity is associated with psychological factor, then you should definitely contact a psychologist who will advise what to do in a given situation. As a rule, such sessions almost always help to restore the joy of life.
Be sure to play sports and preferably fresh air. This is one of the best ways in order to overcome depression. Also know when to work in moderation and try not to stay at the enterprise after the end of the working day.
And, of course, don’t forget about time management, which can be incredibly useful, because not everyone can manage their time wisely.
Concerning preventive measures, it is recommended to conduct here healthy image life, regularly visit other countries on vacation, and on weekends you need to relax, and not finish the work that is left over from the working week.
There are several probable causes decrease in human performance, and they can be divided into two groups: psychological reasons And physiological reasons. They often coexist with each other and act together, exerting a complex effect on human performance. However, this different reasons, and should be discussed separately. Psychological causes are those that lead to a decrease in performance due to the action of one of the following factors:
- 1) lack of proper motivation for activity, a person’s interest in the type of activity in which performance decreases,
- 2) a person’s sufficiently strong preoccupation with something that distracts him from his main work,
- 3) an unfavorable emotional state of a person at a given moment in time, for example, frustration, apathy, boredom, indifference, etc.,
- 4) lack of faith in the success of the business, associated with one of the following circumstances: a person’s lack of self-confidence, lack of hope for the success of the business in given specific conditions.
The following reasons for decreased performance are called physiological:
- 5) illness,
- 6) fatigue, weakness of the nervous system, increased fatigue, general physical weakness of the body.
Let's consider how to determine which of the named reasons or groups of reasons is actually effective, what recommendations in each such case can be offered to the employee.
The first of these reasons - lack of motivation - can be defined as follows.
It can be identified by talking directly to the employee and determining whether he or she has an interest in engaging in the relevant activity. If, in response to a question directly asked of him, an employee quite definitely answers “no,” then this clearly indicates that the employee really does not have such an interest, with the exception, of course, of an extremely rare case in the practice of psychological counseling when the employee is simply not in the mood , tell the consultant the truth about yourself.
If the employee says “yes,” this does not always mean that this is actually the case. The employee may think that he really has such an interest, although in fact he may not. In addition, the employee often unwittingly says “yes”, not wanting the consultation to end if the answer is “no”.
In the latter case, there really is no point in continuing it, since the client’s actual lack of interest in the case cannot be compensated for by other measures.
The lack of proper motivation for an employee’s work can also be determined indirectly by asking the employee and receiving answers from him to the following questions:
- 1. What do you find interesting for yourself in the work during which you notice that your performance is decreasing?
- 2. What can and should be done to make the relevant work more attractive and interesting for you?
- 3. What will change in your life if you completely stop doing this work?
- 4. Can this work be replaced by any other for you?
After conducting the study (Appendix, Table 2.), three employees answered the first question definitely and without much thought, naming a lot of things that attract him to work, we can conclude that the employee is quite strongly motivated to engage in the relevant type of activity. This also gives grounds for the conclusion that the reason for the client’s decreased performance is not a lack of interest in work (lack of motivation), but something completely different.
But the rest of the employees gave a vague answer to this question, accompanied, moreover, by long thoughts, but in this case the hypothesis of a lack of motivation cannot be completely rejected.
When answering the second question, the employees found it difficult to answer; in this case, it can be assumed that the reason for the decrease in their performance is the lack of positive motivation for work. If workers gave a confident answer to this question, this hypothesis, on the contrary, would be questioned.
Answering the third question, four workers list mainly only the possible negative consequences of stopping work, and this gives reason to assume that his motivation to engage in the relevant type of activity is quite strong.
But, on the part of one employee, positive consequences of stopping this type of activity were named and it can be assumed that the client’s motivation is not strong enough, but one employee did not decide on the answer.
Finally, four employees answered “yes” to the fourth question; we can conclude that this type of activity in itself is of little interest to the client. And for the rest of the employees the answer was “no,” but the conclusion that the activity was “uninteresting” cannot be clearly drawn.
Having found out the reality of the first of the above reasons, or rather the presence of positive motivation for activity, we can then move on to find out the second reason - distraction or the presence of competing motivation.
The effectiveness of this possible cause is determined in the following way. Employees are asked if at this moment in time, in the current period of his life, they have any other problems that do not allow him to fully concentrate on the task, in connection with which he complains of decreased performance. (adj., table 3.).After the survey, it turns out that there are such problems, but not everyone has them; this will mean that these problems are a possible reason for the decrease in the client’s performance. If employees do not have other problems, such an assumption is unlikely.
Unfavorable emotional states: frustration, apathy and others - identified as possible reason decrease in performance as follows.
First of all, these emotional states can be identified simply by carefully observing the employee's behavior during the consultation. If during a conversation an employee is constantly in a state of increased emotional arousal and psychological stress, then it is quite possible to assume that he is in the same state during the work in which his performance decreases.
Such questions could be, for example, the following:
“What emotions do you usually experience while working: positive or negative?”
“Do you worry about anything when you work? If so, what exactly?”
Lack of confidence in one's success as a possible cause of decreased performance or the presence of negative expectations (expectations of failure) associated with the work performed is identified by a number of signs. First of all, based on the employee’s answers to questions like:
“Is your work going well?”
“Do you believe that you will ultimately succeed?”
Self-doubt as a cause of decreased performance can be identified by the client’s behavior and his answers to relevant questions.
If an employee behaves confidently enough, if he answers questions asked to him with the same confidence, then this is the basis for the assumption that such confidence is characteristic of him at work.
If the employee does not behave confidently enough and also does not quite confidently answer the questions asked to him, then we can conclude that lack of self-confidence is probably characteristic of him at work.
However, in the latter case, the employee’s uncertainty, as a hypothesis,
requires additional verification and independent confirmation. This confirmation can be provided by the employee’s answers to the following questions:
“Do you always feel confident enough when you do your work?”
“Do you believe that you can succeed in this job?”
If the client answers “yes” to these questions, then the hypothesis of uncertainty as a character trait should probably be rejected. If the client’s answers to them are “no,” then such a hypothesis will be quite probable.
If the reason for the decrease in performance is purely
physiological nature, unfavorable state of the body, then the employee should still be given some recommendations of a psychological nature, since a certain impact on physical state psychological factors influence a person.
First of all, here we must keep in mind that positive emotions increase, and negative emotions decrease, a person’s performance. Therefore, it is necessary to strive to ensure that the work evokes predominantly positive emotions in a person and, as far as possible, excludes negative emotional experiences.
It should also be remembered that fatigue is easier to prevent than to eliminate once it has already occurred.
For this reason, to maintain performance for enough time high level It is important to take care of creating an optimal operating mode. This regime consists of preventing the occurrence of a pronounced state of physical fatigue by taking frequent, short rest breaks during work, designed to quickly restore strength.
Another important rule on this matter it says: people usually get more tired not from the work that they have already completed, but from the work that they should have done, but for one reason or another did not manage to do it on time. Consequently, when planning your work for the day or planning to complete a certain amount of work over a period of time, it is necessary to include in it only what will definitely and under all circumstances be completed by the given deadline.
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In the process of production activities in the “man-machine-environment” system, the most vulnerable element is the person. The artificial environment, the chemical composition of the air, acceleration, noise and vibration - all this negatively affects a person’s well-being, causing him both latent fatigue and overwork. Injuries at enterprises are a cause for particular concern. Injuries occur as a result of repetitive movements and overexertion, causing occupational occipito-cervical and musculoskeletal disorders. Injuries often become epidemic, putting up to 15-20% of workers at risk. The US National Institute for Occupational Safety and Health lists work-related injuries as one of the top 10 hazards facing people at work. Inconvenient workplaces and tools are the main culprits of work-related injuries and occupational diseases.
For physical and mental state people at work are also affected by stressful situations that arise when a number of components are combined.
We list the factors influencing the creation of a stressful situation:
Environment (social and physical environment at work and in free time);
Organizational factors (leadership style);
Individual factors (personal qualities).
Ergonomics faces the problem of designing systems focused on the user, his experience, knowledge, and qualifications. Among the main issues that should be taken into account are the organization of working conditions depending on gender (“ergonomics” women's work"), highlighting ergonomic design for the elderly and disabled (in the workplace and in the environment).
In ergonomics, performance is considered as a person’s potential ability to perform work activities within a given time and with a given efficiency.
The concept of working capacity is psychophysiological; it differs from the concept of working capacity, which reflects the physical state of health.
If the ability to work is already limited, then it is necessary to establish the degree of loss of working ability (20%, 50%, etc.). The composition of the group of people with limited ability to work is very heterogeneous in terms of age, type and degree of damage, social status and so on. Thus, a decrease in working capacity by 50-100% occurs in 18.8% of the group, by 30-50% in 3.2%, while working capacity does not decrease in 37%. This is expressed in levels of social activity - from zero to relative activity, when a person strives to continue an accessible work or social form of activity and leads an active lifestyle.
The manifestations of performance include:
General level: human potential;
Current state: the actual level of performance, varying depending on the phases of its dynamics, as well as various external and internal factors.
When characterizing general level performance The standard is usually taken as the average statistical data of adult healthy men with normal health and well-being in a favorable phase of performance dynamics - 2-3 hours after the start of the shift, on days 2-3 of the weekly cycle.
There are five groups of factors influencing performance:
1st group- due to the characteristics of a growing organism, acceleration problems; functional resources lag behind morphological ones, therefore the level of performance of adolescents and young men is lower than that of adults;
2nd group- due to age characteristics old people; age-related decline in the body's functional abilities begins after 45 years;
3rd group- associated with anatomical and physiological characteristics female body, causing a decrease in the level of performance of women compared to the standard (especially during physical labor);
4th group- associated with individual characteristics body (constitutional features, fitness). It refers to the state physiological norm and therefore the reduction in labor capabilities in this case is moderate and does not lead to loss of working capacity;
5th group- pathological changes in the body - both chronic (permanent decrease in performance) and acute (temporary impairment of performance).
When developing ergonomic principles for organizing the work of disabled people, it is necessary to rely on the qualification of the defect and the associated psychophysiological characteristics of this category of persons. It is advisable to consider defectological changes at several interrelated levels:
Corrective means provide for increasing the capabilities of a weakened function through special measures (vision - with lenses, hearing correction - using a hearing aid, etc.). These tools are universal, but are not related to the characteristics of a specific activity. For many other types of disorders, special means are used - various kinds of devices in the workplace that correct one or another weakened function. Special means of correcting impaired vision include changing the lighting and color scheme in the workplace, the brightness of light sources, the color of the room, etc. Such a corrective direction does not require significant transformations of the means of labor, making the labor process accessible to humans even without its radical restructuring.
Another direction is associated with a radical restructuring of the labor process itself and with a projective ergonomic approach to organizing the activity itself for persons with disabilities. Projective approach involves restructuring the entire labor process, preserving only its purpose and results of activity.
Thus, manual control of a car for a disabled person entails a radical restructuring of the controls and their layout.
The main direction in organizing the work of disabled people is the design of new technical means of compensation for various defects based on the replacement of lost functions while relying on preserved functions. In addition to designing such tools, it is necessary to organize a training system for people with disabilities in their use (Fig. 84).
