U.S. patent number 3,675,640 [Application Number 05/026,817] was granted by the patent office on 1972-07-11 for method and apparatus for dynamic health testing evaluation and treatment.
Invention is credited to James D. Gatts.
United States Patent |
3,675,640 |
Gatts |
July 11, 1972 |
METHOD AND APPARATUS FOR DYNAMIC HEALTH TESTING EVALUATION AND
TREATMENT
Abstract
Method and apparatus for a dynamic health testing, evaluation
and treatment comprising the recordation of test data from large
numbers of individuals to establish dynamic physical performance
norms for patients of many varied types. Historical data is taken
from a patient which, in conjunction with a physical examination,
is used to establish a specific theoretical dynamic physical
performance norm for that particular patient and the recommended
loading for the dynamic health testing machine. The patient is
placed on the exercise machine which is under a programmed load
based upon the basic data and numerous parameters of the patient's
state of health are monitored under dynamic conditions. The
monitored information is continuously fed back to correct the
programmed load to protect the patient against overstress. The
patient's performance is then compared with his own theoretical
norm and treatment is recommended consistent with the patient's age
and health which would lead toward the achievement of the dynamic
physical performance norm.
Inventors: |
Gatts; James D. (Denver,
CO) |
Family
ID: |
21833936 |
Appl.
No.: |
05/026,817 |
Filed: |
April 9, 1970 |
Current U.S.
Class: |
600/484; D24/167;
482/4 |
Current CPC
Class: |
A61B
5/316 (20210101); A61B 5/083 (20130101); A61B
5/0205 (20130101); A61B 5/222 (20130101) |
Current International
Class: |
A61B
5/04 (20060101); A61B 5/0205 (20060101); A61B
5/083 (20060101); A61B 5/08 (20060101); A61B
5/22 (20060101); A61b 005/02 () |
Field of
Search: |
;128/2.6R,2.6F,2.5R,2.1R,2R ;272/69 ;73/379 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Amer. Journ. of Med. Electronics, 1964, Jan.-March, pp. 41-46.
.
Surgery, Dec., 1968, pp. 1057-1070..
|
Primary Examiner: Howell; Kyle L.
Claims
What is claimed is:
1. Apparatus for use in dynamic health testing, evaluation and
treatment of a medical patient, said apparatus comprising:
an exerciser means programmable to provide a selected load to cause
a patient to exercise a predetermined amount;
sensing means connectable to the patient to sense at least one body
function parameter of the patient while exercising for providing
first output signals as a function of the amount of exercise
undertaken by the patient;
an information storage means for providing second output signals
from information stored therein indicative of the same body
function parameters of at least one healthy human body when
undergoing the same exercise;
comparison means for comparing said first and second output signals
and providing an output indicative of any variation
therebetween;
means for programming said exerciser in response to said second
output signals; and
means for modifying said exerciser program in response to said
first output signals.
2. Apparatus, as claimed in claim 1, wherein said sensing means
senses a plurality of body function parameters and said information
storage means includes means for providing second output signals
indicative of a corresponding plurality of body function parameters
derived from a composite of healthy human bodies when undergoing
the same exercise, said information storage means further
comprising:
means for storing data from said sensing means;
first means responsive to the information stored on healthy human
bodies to provide output signals for generating individual
performance curves for each body function parameter being measured
and for generating a summary curve of all body function parameters
being measured for the patient if he were in a normal state of
health;
second means responsive to the data stored from the sensing means
to provide output signals for generating individual performance
curves for each actual body function parameter of the patient being
measured and for generating a summary curve of all actual body
function parameters being measured; and
third means responsive to output signals from said first and second
responsive means to provide output signals for generating curves
representative of the variance between the individual curves
generated by the output of said first responsive means and the
individual curves generated by the output of said second responsive
means and representative of the variance between the summary curve
generated by the output of said first responsive means and the
summary curve generated by said second responsive means,
respectively;
said comparison means further including:
plotting means for plotting said curves in response to said outputs
of said first, second and third responsive means respectively.
3. Apparatus, as claimed in claim 1, further including:
means for updating the information in said information storage
device as more data is developed.
4. A dynamic testing, evaluation and treatment method for
determining the state of health of the body of a medical patient,
said method comprising the steps of:
exercising the patient using an automatic processor controlled
exercising means;
measuring at least one of the significant health parameters of the
patient's body while it is being exercised;
obtaining at least one of the same significant health parameters
from a human body of the same characteristics while doing the same
exercise and known to be in a good state of health;
feeding the above measured and obtained parameters to automatic
processor means to compare the measured health parameters with the
same parameters of the healthy human body; and
automatically compiling data in said processor means representative
of any variation of the measured health parameters of the patient
from the same parameters obtained from a human body of the same
characteristics and known to be in a good state of health.
5. The method, as claimed in claim 4, including the further step
of:
developing a therapy program for the patient based on the data
representative of any variation which program is designed to
rehabilitate the body of the patient under test to a more optimum
state of health.
6. The method, as claimed in claim 4, including the further step
of:
compiling data representative of the maximum rate of change of each
measured parameter which the body under test may be subjected
without physical danger from the significant health parameters of
the human body of the same characteristics and known to be in a
good state of health; and
modifying the patient's exercise rate in response to any measured
significant parameters undergoing a rate of change greater than the
predetermined rate of change during the testing.
7. The method, as claimed in claim 4, wherein:
said measuring step, said obtaining step and said comparing step
include measuring, obtaining and comparing a plurality of
significant health parameters.
8. A dynamic testing, evaluation, and treatment method for the
purpose of determining the state of health of a human body of a
medical patient, said method comprising the steps of:
exercising the patient using an automatic processor controlled
exercising means;
measuring the rate of change of at least one of the significant
health parameters of the patient's body while it is being
exercised;
obtaining at least one of the same significant health parameters
from a human body of the same characteristics while doing the same
exercise and known to be in a good state of health;
feeding the above measured and obtained parameters to automatic
processor means to compare the rate of change of the measured
health parameters with the rate of change of the same parameters of
the healthy human body; and
automatically compiling data in said processor means representative
of any variation of the rate of change of the measured health
parameters from the rate of change of the same parameters obtained
from a human body of the same characteristics and known to be in a
good state of health.
9. The method, as claimed in claim 8, including the further step
of:
developing a therapy program for the patient based on the data
representative of any variation of the rate of change designed to
rehabilitate the body of the patient under test of a more optimum
state of health.
10. The method, as claimed in claim 8, further including the steps
of:
compiling data representative of the maximum rate of change of each
measured parameter which the body under test may be submitted
without physical danger from the significant health parameters of
the human body of the same characteristics and known to be in a
good state of health; and
modifying the patient's exercise rate in response to any measured
significant parameters undergoing a rate of change greater than the
predetermined rate of change during the testing.
11. The method, as claimed in claim 8, wherein:
said measuring step, said obtaining step and said comparing step
include measuring, obtaining and comparing a plurality of
significant health parameters.
Description
This invention is directed to a method and apparatus for carrying
out the method for establishing an accurate, standardized, dynamic,
and repeatable health evaluation system which will diagnose,
evaluate, and systematically program an individual from a condition
of minimal to optimal physical performance reserve, excluding, of
course, certain non-reversible cardiopulmonary pathologies.
At the present time there is nothing known to be available in the
prior art in the form of either a standardized, dynamic health
evaluation; dynamic physical performance rehabilitation program; or
combination evaluation, reconditioning and post conditioning
maintenance system. Static cardiac tests (EKG) have been shown to
be essentially valueless for prognostic or corrective tests.
Heart disease is the number one medical problem as it is the
leading cause of death in the United States with 54.3 percent of
all deaths resulting from heart disease. Above the age of 45 years,
heart disease claims lives by a two to one ratio over the next
leading cause of death.
The primary object of the present invention is to provide a new and
improved method and apparatus adapted to test for and establish
levels of reversible cardiovascular and cardiopulmonary disease or
cardiovascular deconditioning in various population segments and to
develop and prescribe an optimum therapy program leading to a state
of normal health.
A further important object of the invention is to provide a new and
improved method and apparatus adapted to establish a unique and
standardized nationwide source of dynamic physical performance data
for cardiovascular and cardiopulmonary research.
In accordance with the invention there is provided a novel method
and means for carrying out the method, which method comprises the
steps of establishing and recording basic patient data in the form
of the significant parameters of cardiac, pulmonary, and physical
characteristics for differing categories of patients and
establishing a physical, cardiac, and pulmonary norm for each
category; further, establishing and recording the significant
cardiac, pulmonary and physical characteristics of a specific
patient; comparing the significant cardiac, pulmonary, and physical
characteristics of the patient with the norm for the category into
which he fits to establish the amount of deviation from the norm;
establishing a dynamic treatment program in accordance with such
deviation, and modifying the dynamic treatment in accordance with
the monitored data to provide an optimized level of reconditioning
therapy to lead the patient to a normal state of health.
For a better understanding of the present invention, together with
other and further objects thereof, reference is made to the
following description taken in connection with the accompanying
drawing and its scope will be pointed out in the appended
claims.
In the drawings:
FIG. 1 is a perspective view of the apparatus according to the
present invention in operation;
FIG. 2 is a block diagram of a computer program for carrying out
the method of this invention; and
FIG. 3 is a block diagram of the complete dynamic health evaluation
system according to the present invention.
The method and apparatus of this invention which shall be termed
the dynamic health evaluation system 10 and as preferred embodiment
thereof disclosed in FIG. 1 involves the unique combination of
several different systems. These are the static data input systems
12, the exercise systems 14, the body parameter measurement or
sensor system 15, the central processor system 16, and the data
output systems 18. The static data input system 12 comprises a
typewriter, reader, and paper tape input device which are standard
peripheral equipment of the PDP-12 computer, more fully described
below, and which receives patient data and physical examination
data for input to the central processor. The exercise system 14
comprises a load device such as a treadmill, bicycle ergometer, or
crank ergometer and provides a controlled and programmed load to
the patient during the time the sensor data is being obtained. A
suitable treadmill is known as model P-2000, manufactured by Warren
E. Collins, Inc., 220 Wood Road, Raintree, Mass. The body parameter
measurement system 15 obtains the dynamic body functions through
sensors and pickups digital for input to the central processor
system. The central processor or computer system 16 which may be a
model PDP-12 computer from Digital Equipment Corp., 146 Main
Street, Maynard, Mass. includes analog to digital input converters,
programmable output discretes, historical data storage, and the
central processor. This system receives the static patient data,
the dynamic body measurement data, population research data and the
exercise load data, and computes, compares, and programs output
data to the output data systems 18 which include the plotter,
printout reader, exercise load setting device, and magnetic tape
memory storage. A suitable plotter is manufactured by Houston
Complot, Houston Instruments Division of Bausch & Lomb in
Bellair, Texas. The printout reader, exercise load setting device
and magnetic tape memory storage are standard peripheral equipment
of the PDP-12 computer, referred to above.
In carrying out the method of this invention, the physiological
monitoring parameters of primary importance to be measured by the
body parameter measurement system 15 are believed to be heart rate
and rhythm, blood pressure, ST segment of the electrocardiogram,
oxygen consumption, CO.sub.2 production, and respiratory volume and
rate. The system 15 may comprise an electrocardiograph such as
model 337 available from the Birtcher Corporation, 4371 Valley
Blvd., Los Angeles, Calif. for taking an EKG and which supplies a
signal to a heart rate meter such as model 760-20-121 manufactured
by the Sanborn Division of Hewlett Packard Co., 175 Wyman Street,
Wotham, Mass. Oxygen consumption may be measured by a model 778
Oxygen Process Analyzer from Beckman Instruments, Inc., 2500 Harbor
Blvd., Fullerton, Calif. and CO.sub.2 production may be measured by
a model 315 Infra Red CO.sub.2 analyzer from the same company.
Blood pressure may be measured by a model 1900 London Pressurometer
from the Avionics Research Products Corp., 6901 West Imperial Hwy,
Los Angeles, Calif. and the respiratory rate by a model 760-20-130
meter from the Sanborn Division of Hewlett Packard Co., 175 Wayman
Street, Wotham, Mass. These measurement parameters are chosen
because they are believed by leading cardiologists across the
nation to be the best current indexes to cardiopulmonary function,
and because they can be used with considerable reliability and
without surgical insult to the patient. The measurements made are
concerned with dynamic conditions, that is, it is the rate of
change per unit time under dynamic patient conditions in each of
the parameters stated that is considered significant.
The present invention takes all of these measurements and
correlates, weighs and evaluates them and brings them into the
determination at the best possible time. For example, the change in
heart rate may be the most important at the very beginning of the
exercise program. The change in oxygen consumption may be more
significant when it reaches the steady state after several minutes.
Blood pressure is usually most important at the end of the test or
during the recovery phase, and, of course, the ST segment
depression of the EKG wave varies, but it generally increases in
intensity as the exertional period continues in time or as it
becomes more strenuous. When these curves are computed for their
most significant values, that is, weighted and individually
modified in accordance with the formulation during the respective
significant portions of the exertional workout, a composite curve
is produced, at the end of the test, which can be the most
meaningful in evaluating the person's performance.
Preferably the exercise equipment comprises both a bicycle
ergometer, a treadmill, and a crank ergometer so that essentially
all people can be evaluated for cardiopulmonary conditioning
regardless of any handicaps; thus if a man cannot walk on a
treadmill, he can stand and turn a crank or he can ride an
ergometer. The input loading to the various exercise devices is a
weighted and regulated workload regardless of which device is being
used.
The processor of the system comprises a computer which is
programmed to compare a given individual using the dynamic testing
device, against a preestablished norm for a person of that type.
The device establishes approximately how a specific individual
should perform if he were in good physical and cardiopulmonary
health. This performance curve is accomplished by a comparison of
the individual's data with clinical data stored in a memory bank
that considers such important parameters as physical handicaps,
known cardiac disease, age, weight, existing pathology of
non-cardiac origin, and the like. The dynamic health evaluation
(DHE) system establishes that if the pertinent information
concerning a specific person is recorded and evaluated against
sufficient known clinical dynamic performance data, it will show
what that specific person's physical performance capacity should
be. Subsequently, when the same patient goes through the actual
dynamic testing process, he prints out his own personal curve of
performance in the readout system. Simultaneously, the computer
prints out a proposed curve of performance for that same individual
as if he were in a normal state of health. The personal performance
curve would be first of all, a series of curves representing
approximately five or six specifically weighted physiological
parameters such as, but not limited to heart rate and rhythm, blood
pressure, ST segment of the EKG wave, oxygen consumption, carbon
dioxide production, respiratory volume and rate. The computer
would, in addition, combine this information into a single weighted
performance summary curve for that patient. The purpose is to
provide the dynamic health evaluation clinic physician or other
physicians reviewing the patient's condition complete information
on what the person's performance was in each parameter. The
individual himself would receive a copy of the summary curve of
performance, so that he could compare himself against, not
necessarily an olympic athlete, but rather a person just like
himself, in a good state of health.
An additional function of the computer of the DHE clinic is to
compare the two curves, that is the curve of the individual's own
performance and the theoretical curve of a similar individual in
optimum physical condition, and produce a recommended
reconditioning level designed in terms of intensity, frequency, and
duration to systematically program this patient to an optimum state
of physical capacity that is consistent with his age and general
health.
A simplified description of the computer operation follows. There
are four separate inputs or signals to the computer. These are: (1)
basic patient statistics, (2) normal population coefficients, (3)
no-go limits and, (4) patient dynamic measurement parameters. The
outputs or signals from the DHE system include: (1) point by point
plot of each dynamic measurement parameter of the patient, (2)
point by point plot of each dynamic measurement parameter corrected
to provide a curve of the patient as if he were in normal cardiac
health, (3) summary plot or curve combining all patient dynamic
measurement parameters into a single curve utilizing previously
established weighting factors, (4) summary plot or curve for
patient in normal cardiopulmonary health, (5) plot of difference
between patient summary curve (3 above) and ideal summary curve (4
above), (6) programmed load for a load device such as a treadmill,
and (7) printout of optimum reconditioning level and schedule to
minimize variation in (5).
Reference is now made to FIG. 2 which shows a simplified block
diagram of the intelligence flow of the system. The basic patient
statistics are collected and data introduced as at 20. These
include the significant history and physical examination data.
Based upon this actual patient historical and physical examination
data, normal curves which are generally representative of this
patient for each significant parameter such as heart rate; oxygen
consumption; blood pressure; and the like are withdrawn from
research data as at 22. These normal curves are derived from past
research test data which is used to generate an equation of the
curve. The equation for these parameters in terms of height above a
coordinate axis and time can be expressed by the following
equation:
B = .alpha..sub.1 t.sup.1 + .alpha..sub.2 t.sup.2 + .alpha..sub.3
t.sup.3 + . . . ..alpha..sub.n t.sup.n (1)
Where:
B = functions of the significant patient parameters
.alpha. = coefficients which are a function of the basic patient
statistics and research statistics
n = indication of the complexity of the curve
t = elapsed time from start of the test
The alphas are developed from research data and are continually
updated as more data is accumulated.
In addition, dynamic physical data will be obtained from the
patient during the test for each significant parameter such as
heart rate; oxygen consumption; blood pressure; and the like as at
28 and will generate a curve of actual values versus time. This
results in two curves as at 34 for each of the significant
parameters; one curve the patient has exhibited during the test and
one nominal curve from research data. These curves are constructed
on the same time base and are plotted during the test for
comparison purposes.
All of the significant parameters can be combined into one
performance summary curve. The value of performance at a particular
time in the test is determined by equation of the form of equation
2. The usage of equation 2 is similar in that two curves are
constructed from its results; one curve based on the data exhibited
by the patient during the test and one nominal curve:
Y = B.sub.1 C.sub.1 + B.sub.2 C.sub.2 + B.sub.3 C.sub.3 + . . . .
B.sub.n C.sub.n (2)
Where:
Y = performance summary value
B = functions of the significant patient parameters from equation 1
or actual patient test data
C = weighting factors based on the relative importance of the betas
with time
The weighting factors C are determined from accumulated research
data and stored as at 22 to solve equation 2 as at 32.
The initial treadmill setting is determined from basic patient
statistics and research data as at 24.
As the test is started, values for all of the significant patient
parameters are obtained from the sensors as at 26 and fed to 28 as
the first data point. This first data is associated with a time
such as the time of start of the test. The time of all other data
points is measured from this point. This point is used in equation
1 to obtain the ideal value for the patient parameter as at 30.
This process is simultaneously repeated for all of the significant
patient parameters. All of these ideal values for patient
parameters are used along with their associated time in equation 2
to obtain a point on the normal ideal summary curve as at 32. All
of the actual readings of the patient parameters obtained from the
treadmill and sensors are used in equation 2 to obtain a summary
dynamic patient curve as at 34. The ideal composite curve and the
dynamic patient curve are compared as at 32 and a difference output
obtained and plotted at 34. This difference is an indication of how
far the patient deviates from the ideal value. It is recorded as at
36 and may be used to revise the treadmill setting as at 38.
At the end of this process, for each data point, the following
parameters may be plotted on the plotter versus time as at 34:
results of test data for patient parameters; results of equation 1
for ideal parameters; results of equation 2 for patient parameters;
results of or for ideal parameters; and differential values. The
differential values are also plotted versus time and can be used to
prescribe treatment for the patient, since it is an indication of
the patient's deviation from the ideal which represents that
necessary to bring the patient to an optimal state of health
attainable for him. The patient data value, its associated time and
the treadmill setting are compared to a memory as at 29 for each
data point. The current treadmill setting may be altered as at 38
as the data points are produced whenever the patient's data value
from the treadmill and sensors exceeds or approximates a value
stored in the memory which would be dangerous for the health of the
particular patient. The next data point is obtained from the
sensors and the loop is repeated from the point at which the data
point is associated with a time value. Thus at any time during the
dynamic test, if a demand is made upon the patient which is in
excess or approaching an excessive demand, the data from the
sensors by comparison with a value stored in the memory, will
reprogram the treadmill to a less severe program to protect the
patient.
The system of this invention may be used as a research tool,
whereby data from many many patients would be made available
through a computer system to do various research projects on the
development and progression of cardiovascular disease. Thus, the
dynamic health evaluation system concept would establish a
standardized dynamic testing and evaluating system which could be
used throughout the nation.
The specific parameters measured by the system may vary with
experience but would appear at the present time to include:
Heart Rate: The rate of change of heart rate per unit time and
intensity of physical exertion is a sensitive and fundamental
indicator of cardiac function. It is also currently one of the most
dependable and convenient method of limiting physical overstress
potential in normally functioning hearts; thus to say an individual
will work or exert himself up to a given heart rate level is a
recognized and quite standard limit establishing approach. There
are acceptable maximum heart rate levels established and there is a
considerable amount of work available on heart rate as an index to
cardiac performance.
Blood Pressure: The rate of change of blood pressure per unit time
and intensity of physical exertion may be used as an indirect
indicator of compliance of the cardiovascular system; the systolic
pressure curve may furnish information on the force and time of
ventricular contraction. Blood pressure is important because it
gives information relating to the circulatory systems general
capacity to adapt to an increased movement or pressure of blood. If
the diastolic blood pressure elevates with exercise, the patient
may be in the hypertensive or the pre-hypertensive category. If the
blood pressure goes down or stays the same, the individuals blood
pressure response is probably normal. The blood pressure pulse wave
may offer information on the general cardiovascular condition
relative to the development of atherosclerosis.
ST segment of the electrocardiagram: A bipolar transthoracic lead
EKG offers an option to monitor changes in the ST segment of the
EKG wave. This segment follows the ventricular contraction or the
QRS complex and is considered to be the ventricular repolarization
or recovery wave. A good deal of research on this subject has shown
that the ST segment is probably associated with cardiac ischemia or
a lack of proper oxygenation due to compromised coronary
circulation. Some physicians believe that the level of depression
of ST segment with exercise even indicates in a quantitative manner
the amount of circulatory embarrassment or diminution of perfusion
of the cardiac muscle with exercise. It also is an important
diagnostic factor in that it gives a good indication of what the
patient is experiencing at any time he may complain of chest pain
or other discomfort related to cardiopulmonary function. In
addition, the EKG wave will furnish cardiac rhythm or evidence of
abnormal contractions and rhythms.
O.sub.2 Consumption: Changes in the rate of O.sub.2 consumption are
an indirect measurement of changes in the rate of metabolism.
Maximum O.sub.2 consumption may be used as an indication of
physiological performance capacity, or aerobic energy output.
Oxygen is consumed in metabolism, and if the person's skeletal
muscle mass is known, the oxygen uptake may give an idea of how
efficiently the muscle mass is functioning. When large muscle
groups are involved, oxygen consumption becomes a valid index to a
person's ability to perform physically or his aerobic motor power.
There may be a necessity for a correction for pulmonary function in
that a person may have sufficient metabolic capacity but have
deficient pulmonary or ventilatory capacity.
CO.sub.2 Production: CO.sub.2 production is an additional indirect
indicator of metabolism. The CO.sub.2 produced is a waste product.
A measure of the performance of an engine can be made by the amount
of air it takes in, or by the amount and type of air or exhaust
that it puts out. One can calculate a respiratory coefficient or an
exchange ratio of the amount of CO.sub.2 produced related to the
amount of oxygen taken in. This measurement offers an index to the
efficiency of the skeletal muscle and its output capacity. It is
also a good index to the condition of the cardiopulmonary complex,
that is, the capacity of the blood to circulate oxygen and the
respiratory membrane to exchange oxygen and carbon dioxide.
Respiratory Volume/Min: The mechanical capacity of the pulmonary
system to furnish O.sub.2 can be the limiting factor in
establishing physical capacity. Its evaluation adds to the
performance profile. This measurement is used mainly in combination
with the others to establish the mechanical capacity of the chest,
lungs, trachea, the air distribution system to the respiratory
membrane. That is, how well is the person getting air or oxygen to
the respiratory membrane and how well is he moving away carbon
dioxide.
The dynamic health evaluation system is designed in such a manner
that the physical monitoring parameters can be changed or modified
as additional research data becomes available. For example cardiac
output, oxygen saturation in mixed venous blood, systolic ejection
time, and others could be included or replace existing parameters
as technical progress allows more efficient and reliable sensing
devices.
Typical Operational Procedure of Dynamic Health Evaluation System:
To further clarify the function of the DHE, an imaginary patient
will be taken through the system as illustrated by FIG. 3. As the
patient enters the clinic at an appointed time, he will first go
through the pre-test history to develop the static data as at 40 to
be inserted into the central processor or computer 44. The
patient's health history is obtained by a technician and an
automated electronic questioning system as at 41. The questions
would be related to five main categories. The first would be
cardiovascular disease. The intention would be to establish any
existing disease or part disease that could limit or affect current
dynamic cardiovascular performance capacity. It would also
eliminate past diseases that are not pertinent to current
performance capacity and help to establish a safe exertional
limitation. The second category would be the pulmonary disease
area. Here again, the intention would be to establish any existing
or past disease which would compromise the pulmonary system and
therefore compromise the capacity of the individual for physical
work. In this area, physical activity, diet, weight, geographical
location, a smoking or air pollution history, etc., could be
considered in conjunction with cardiopulmonary conditions as
parameters in a variety of research programs. The third category is
physical impairment. Such things as arthritis, old leg or back
injuries could alter a person's ability to perform and thus
influence his physical output capacity. This category of the
history would attempt to establish existing and past disease, or
injury that might effect the individual performance. The other
thing it would do is to establish the best type of exercise system
for a particular patient such as a bicycle ergometer, treadmill or
a crank ergometer. The fourth category of the history would be
physical activity. This would allow the computer to know the type
and intensity of exercise to which the individual is normally
accustomed.
Such information would help to determine the most appropriate
exercising device and also provide data for the level of testing
intensity to employ. The last category would be general health
area. This again would attempt to establish past or present
disease, conditions of metabolism, circulation, CNS (central
nervous system) function, etc., which might currently limit the
person's exertional capacity.
The questions are asked and the answers provided in a coded form so
that a digital type output can be placed into the central processor
or computer 44 which will in part preprogram the level and type of
exercise to be used. The patient next experiences the physical
examination as at 42. This is at least a partially automated system
which measures the person's body weight, his height, etc., which
goes into a digitized form to be used directly by the computer 44.
The body type such as endomorph, mesomorph, ectomorph; the per cent
overweight or underweight; body temperature; the resting blood
pressure; resting pulse rate rhythm from resting EKG derived from
the pretest resting state are also programmed in. Secondarily,
there would be included some pulmonary measurements such as vital
capacity, expiration time, maximum breathing capacity, and a
further point is to physically examine any areas of real or
suspected physical conditions relative to exertional capacity which
were uncovered during the history taking session. At this point,
the individual steps into the exercising area or room. He then has
the various dynamic body sensors 46 applied, such as transthoracic
cardiac electrodes placed on his chest, a blood pressure cuff or
other blood pressure device attached, the oxygen consumption and
CO.sub.2 production mask (or tube) put in place, and respiratory
volume rate sensors activated. There is first a pretest resting
state (see above), the individual simply sitting or standing, then
he is subjected to a pre-programmed exertional or exercise test on
the exercise machine 48. This test will vary widely, depending on
the history and physical examination data fed into the computer 44.
The computer 44 then supplies updated data to the storage 50 of the
clinic records relative to this particular patient and this data is
also accumulated in the storage 52 of the research program which
generates a normal population storage 54. The data from the normal
population storage is fed back into the computer 44 to continuously
normalize the comparative data. The data from the patient is
compared with the normalized data by the computer and performance
curves are plotted for the normal patient and the actual patient by
plotter 56. These curves are compared by computer 44 and the curves
as well as the differences are presented by plotter 56 and printer
60. As is necessary, the exercise test will run from 6 to 10
minutes programmed at different levels of intensity, resting
periods, and so on. At the end of the test, there is a cool-off or
recovery period during which parametric information would continue
into the computer. With its preload of history and physical
information, the computer writes out for this individual a
theoretical optimum cardiac performance curve, that is, a cardiac
performance curve based on testing thousands of people and knowing
what the level should be for a person just like the individual
being tested in an optimal state of health. The computer figures
all of the patient's handicaps, and of course, his non-handicaps
and establishes how he should perform. At the same time, he is
writing an actual performance curve from his own exertional output.
It will be noted that there is a feedback from the computer 44
directly to the exercise machine 48 via 47 by which the exercise
machine is adapted to be reprogrammed to a different level of
stress at any time the sensors 46 detect a condition being
approached which the computer recognizes as being detrimental to
the health of the patient being exercised. The computer compares
the exertional output in terms of individual parameters and also in
terms of a summary cardiac curve. At the end of the dynamic
performance test, the system prints the readouts as at 60 which are
then available to the physician. The readouts include separate
written curves, summary curves, and also an optimum reconditioning
program with which the physician may counsel the patient for
implementation and return visits.
The dynamic health evaluation system of this invention is believed
to be the only such system available that can safely and accurately
establish a patient's level of dynamic performance capacity or
cardiopulmonary health and evaluate changes in functional capacity.
It is further believed the performance levels will become
accurately prognostic in the event of unaltered progress of trends
in dynamic cardiopulmonary performance curves. The computer will
also supply performance information to a paper punched tape writer
62. This information is thus available for feeding into computer 44
on a return visit of the patient and is also fed to readout 60 to
be available for comparison with newly developed data. Thus it is
seen that all of the objects of the invention are accomplished.
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