Muscular and kinematic adaptations to fatiguing repetitive upper extremity work

Evaluation of a passive arm-support exoskeleton for surgical team members: Results from live surgeries

BACKGROUND

Musculoskeletal symptoms and injuries adversely impact the health of surgical team members and their performance in the operating room (OR). Though ergonomic risks in surgery are well-recognized, mitigating these risks is especially difficult. In this study, we aimed to assess the impacts of an exoskeleton when used by OR team members during live surgeries.

METHODS

A commercial passive arm-support exoskeleton was used. One surgical nurse, one attending surgeon, and five surgical trainees participated. Twenty-seven surgeries were completed, 12 with and 15 without the exoskeleton. Upper-body postures and muscle activation levels were measured during the surgeries using inertial measurement units and electromyography sensors, respectively. Postures, muscle activation levels, and self-report metrics were compared between the baseline and exoskeleton conditions using non-parametric tests.

RESULTS

Using the exoskeleton significantly decreased the percentage of time in demanding postures (>45° shoulder elevation) for the right shoulder by 7% and decreased peak muscle activation of the left trapezius, right deltoid, and right lumbar erector spinae muscles, by 7%, 8%, and 12%, respectively. No differences were found in perceived effort, and overall scores on usability ranged from "OK" to "excellent."

CONCLUSIONS

Arm-support exoskeletons have the potential to assist OR team members in reducing musculoskeletal pain and fatigue indicators. To further increase usability in the OR, however, better methods are needed to identify the surgical tasks for which an exoskeleton is effective.

The effect of a task-specific training on upper limb performance and kinematics while performing a reaching task in a fatigued state

BACKGROUND

Fatigue impacts motor performance and upper limb kinematics. It is of interest to study whether it is possible to minimize the potentially detrimental effects of fatigue with prevention programs.

OBJECTIVE

To determine the effect of task-specific training on upper limb kinematics and motor performance when reaching in a fatigued state.

METHODS

Thirty healthy participants were recruited (Training group n = 15; Control group n = 15). Both groups took part in two evaluation sessions (Day 1 and Day 5) during which they performed a reaching task (as quickly and accurately as possible) in two conditions (rested and fatigued). During the reaching task, joint kinematics and motor performance (accuracy and speed) were evaluated. The Training group participated in three task-specific training sessions between Day 1 and Day 5; they trained once a day, for three days. The Control group did not perform any training. A three-way non-parametric ANOVA for repeated measures (Nonparametric Analysis of Longitudinal Data; NparLD) was used to assess the impact of the training (Condition [within subject]: rested, fatigued; Day [within subject]: Day 1 vs. Day 5 and Group [between subjects]: Training vs. Control).

RESULTS

After the training period, the Training group significantly improved their reaching speed compared to the Control group (Day x Group p < .01; Time effect: Training group = p < .01, Control group p = .20). No between-group difference was observed with respect to accuracy. The Training group showed a reduction in contralateral trunk rotation and lateral trunk flexion in Day 2 under the fatigue condition (Group x Day p < .04; Time effect: Training group = p < .01, Control group = p < .59).

CONCLUSION

After the 3-day training, participants demonstrated improved speed and reduced reliance on trunk compensations to complete the task under fatigue conditions. Task-specific training could help minimizing some effects of fatigue.

Multisensory Evaluation of Muscle Activity and Human Manipulability during Upper Limb Motor Tasks

In this work, we evaluate the relationship between human manipulability indices obtained from motion sensing cameras and a variety of muscular factors extracted from surface electromyography (sEMG) signals from the upper limb during specific movements that include the shoulder, elbow and wrist joints. The results show specific links between upper limb movements and manipulability, revealing that extreme poses show less manipulability, i.e., when the arms are fully extended or fully flexed. However, there is not a clear correlation between the sEMG signals' average activity and manipulability factors, which suggests that muscular activity is, at least, only indirectly related to human pose singularities. A possible means to infer these correlations, if any, would be the use of advanced deep learning techniques. We also analyze a set of EMG metrics that give insights into how muscular effort is distributed during the exercises. This set of metrics could be used to obtain good indicators for the quantitative evaluation of sequences of movements according to the milestones of a rehabilitation therapy or to plan more ergonomic and bearable movement phases in a working task.

Upper-Limb Kinematic Behavior and Performance Fatigability of Elderly Participants Performing an Isometric Task: A Quasi-Experimental Study

Upper-limb position-sustained tasks (ULPSIT) are involved in several activities of daily living and are associated with high metabolic and ventilatory demand and fatigue. In older people, this can be critical to the performance of daily living activities, even in the absence of a disability.

OBJECTIVES

To understand the ULPSIT effects on upper-limb (UL) kinetics and performance fatigability in the elderly.

METHODS

Thirty-one (31) elderly participants (72.61 ± 5.23 years) performed an ULPSIT. The UL average acceleration (AA) and performance fatigability were measured using an inertial measurement unit (IMU) and time-to-task failure (TTF).

RESULTS

The findings showed significant changes in AA in the X- and Z-axes (p < 0.05). AA differences in women started earlier in the baseline cutoff in the X-axis, and in men, started earlier between cutoffs in the Z-axis. TTF was positively related to AA in men until 60% TTF.

CONCLUSIONS

ULPSIT produced changes in AA behavior, indicative of movement of the UL in the sagittal plane. AA behavior is sex related and suggests higher performance fatigability in women. Performance fatigability was positively related to AA only in men, where movement adjustments occurred in an early phase, though with increased activity time.

Biomechanical Assessments of the Upper Limb for Determining Fatigue, Strain and Effort from the Laboratory to the Industrial Working Place: A Systematic Review

Recent human-centered developments in the industrial field (Industry 5.0) lead companies and stakeholders to ensure the wellbeing of their workers with assessments of upper limb performance in the workplace, with the aim of reducing work-related diseases and improving awareness of the physical status of workers, by assessing motor performance, fatigue, strain and effort. Such approaches are usually developed in laboratories and only at times they are translated to on-field applications; few studies summarized common practices for the assessments. Therefore, our aim is to review the current state-of-the-art approaches used for the assessment of fatigue, strain and effort in working scenarios and to analyze in detail the differences between studies that take place in the laboratory and in the workplace, in order to give insights on future trends and directions. A systematic review of the studies aimed at evaluating the motor performance, fatigue, strain and effort of the upper limb targeting working scenarios is presented. A total of 1375 articles were found in scientific databases and 288 were analyzed. About half of the scientific articles are focused on laboratory pilot studies investigating effort and fatigue in laboratories, while the other half are set in working places. Our results showed that assessing upper limb biomechanics is quite common in the field, but it is mostly performed with instrumental assessments in laboratory studies, while questionnaires and scales are preferred in working places. Future directions may be oriented towards multi-domain approaches able to exploit the potential of combined analyses, exploitation of instrumental approaches in workplace, targeting a wider range of people and implementing more structured trials to translate pilot studies to real practice.

Uncontrolled Manifold Analysis of the Effects of Different Fatigue Locations on Kinematic Coordination During a Repetitive Upper-Limb Task

Fatigue at individual joints is known to affect interjoint coordination during repetitive multijoint tasks. However, how these coordination adjustments affect overall task stability is unknown. Twelve participants completed a repetitive pointing task at rest and after fatigue of the shoulder, elbow, and trunk. Upper-limb and trunk kinematics were collected. Uncontrolled manifold framework was applied to a kinematic model to link elemental variables to endpoint fingertip position. Mixed and one-way analysis of variances determined effects (phase and fatigue location) on variance components and synergy index, respectively. The shoulder fatigue condition had the greatest impact in causing increases in variance components and a decreased synergy index in the late phase of movement, suggesting more destabilization of the interjoint task caused by shoulder fatigue.

Effect of Expertise on Shoulder and Upper Limb Kinematics, Electromyography, and Estimated Muscle Forces During a Lifting Task

OBJECTIVE

To highlight the working strategies used by expert manual handlers compared with novice manual handlers, based on recordings of shoulder and upper limb kinematics, electromyography (EMG), and estimated muscle forces during a lifting task.

BACKGROUND

Novice workers involved in assembly, manual handling, and personal assistance tasks are at a higher risk of upper limb musculoskeletal disorders (MSDs). However, few studies have investigated the effect of expertise on upper limb exposure during workplace tasks.

METHOD

Sixteen experts in manual handling and sixteen novices were equipped with 10 electromyographic electrodes to record shoulder muscle activity during a manual handling task consisting of lifting a box (8 or 12 kg), instrumented with three six-axis force sensors, from hip to eye level. Three-dimensional trunk and upper limb kinematics, hand-to-box contact forces, and EMG were recorded. Then, joint contributions, activation levels, and muscle forces were calculated and compared between groups.

RESULTS

Sternoclavicular-acromioclavicular joint contributions were higher in experts at the beginning of the movement, and in novices at the end, whereas the opposite was observed for the glenohumeral joint. EMG activation levels were 37% higher for novices but predicted muscle forces were higher in experts.

CONCLUSION

This study highlights significant differences between experts and novices in shoulder kinematics, EMG, and muscle forces; hence, providing effective work guidelines to ensure the development of a safe handling strategy is important.

APPLICATION

Shoulder kinematics, EMG, and muscle forces could be used as ergonomic tools to identify inappropriate techniques that could increase the prevalence of shoulder injuries.

Impact of fatigue at the shoulder on the contralateral upper limb kinematics and performance

Background

Altered movement patterns have been proposed as an etiological factor for the development of musculoskeletal pain. Fatigue influences upper limb kinematics and movement performance which could extend to the contralateral limb and potentially increasing risk of injury. The aim of this study was to investigate the impact of fatigue at the dominant arm on the contralateral upper limb movement.

Methods

Forty participants were randomly assigned to one of two groups: Control or Fatigue Group. All participants completed a reaching task at the baseline and post-experimental phase, during which they reached four targets with their non-dominant arm in a virtual reality environment. Following the baseline phase, the Fatigue Group completed a shoulder fatigue protocol with their dominant arm only, while the Control Group took a 10-minute break. Thereafter, the reaching task was repeated. Upper limb and trunk kinematics (joint angles and excursions), spatiotemporal (speed and accuracy) and surface electromyographic (sEMG) activity (sEMG signal mean epoch amplitude and median frequency of the EMG power spectrum) were collected. Two-way repeated-measures ANOVA were performed to determine the effects of Time, Group and of the interaction between these factors.

Results

There was a significant Time x Group interaction for sternoclavicular elevation range of motion (p = 0.040), movement speed (p = 0.043) and accuracy (p = 0.033). The Fatigue group showed higher contralateral sternoclavicular elevation and increased movement error while experiencing fatigue in the dominant arm. Moreover, the Control group increased their speed during the Post-experimental phase compared to baseline (p = 0.043), while the Fatigue group did not show any speed improvement. There was no EMG sign of fatigue in any of the muscles evaluated.

Conclusion

This study showed that fatigue at the dominant shoulder impacts movement at the contralateral upper limb. Such changes may be a risk factor for the development of shoulder pain in both the fatigued and non-fatigued limbs.

Motion envelopes: unfolding longitudinal rotation data from walking stick-figures

This work presents Motion Envelopes (ME), a simple method to estimate the missing longitudinal rotations of minimal stick figures, which is based on the spatial-temporal surface traced by line segments that connect contiguous pairs of joints. We validate ME by analyzing the gait patterns of 6 healthy subjects, comprising a total of 18 gait cycles. A strong correlation between experimental and estimated data was obtained for lower limbs and upper arms, indicating that ME can predict their longitudinal orientation in normal gait, hence, ME can be used to complement the kinematic information of stick figures whenever it is incomplete.

Interaction between hand span and different sizes of keyboards on EMG activity in pianists: An observational study

The availability of keyboards with reduced key width has been recently promoted as an ergonomic aid for small-handed pianists to overcome any potential physical disadvantages that may restrict their piano repertoire. However, a lack of biomechanical data exists to support whether reduced piano key size is effective in achieving this outcome. This research investigates the effect of playing on three different key width size pianos (5.5-inch octave, 6.0-inch octave and conventional size with 6.5-inch octave) on hand, arm and shoulder muscle activity levels according to the hand size of the pianists. Results indicate that piano key size affects the muscle activity levels of selected muscles. Furthermore, this effect of different key sizes changed according to the players' hand spans. Small-handed pianists may benefit from using smaller-sized keyboards to reduce muscular exertion during performance. This investigation provides preliminary EMG data supporting the use of different size keyboards to improve the ergonomic fit according to the dimensions of individual pianists.

Continuous, integrated sensors for predicting fatigue during non-repetitive work: demonstration of technique in the operating room

Surface electromyography (sEMG) can monitor muscle activity and potentially predict fatigue in the workplace. However, objectively measuring fatigue is challenging in complex work with unpredictable work cycles where sEMG may be influenced by the dynamically changing posture demands. This study proposes a multi-modal approach integrating sEMG with motion sensors and demonstrates the approach in the live surgical work environment. Seventy-two exposures from twelve participants were collected, including self-reported musculoskeletal discomfort, sEMG, and postures. Posture sensors were used to identify time windows where the surgeon was static and in non-demanding positions, and mean power frequencies (MPF) were then calculated during those time windows. In 57 out of 72 exposures (80%), participants experienced an increase in musculoskeletal discomfort. Integrated (multi-modality) measurements showed better performance than single-modality (sEMG) measurements in detecting decreases in MPF, a predictor of fatigue. Based on self-reported musculoskeletal discomfort, sensor-based thresholds for identifying fatigue are proposed for the trapezius and deltoid muscle groups. Practitioner summary Work-related fatigue is one of the intermediate risk factors to musculoskeletal disorders. This article presents an objective integrated approach to identify musculoskeletal fatigue using wearable sensors. The presented approach could be implemented by ergonomists to identify musculoskeletal fatigue more accurately and in a variety of workplaces. Abbreviations: sEMG: surface electromyography; IMU: inertia measurement unit; MPF: mean power frequency; ACGIH: American Conference of Governmental Industrial Hygienists; SAGES: Society of American Gastrointestinal and Endoscopic Surgeons; LD: left deltoid; LT: left trapezius; RD: right deltoid; RT: right trapezius.

The impact of experimental pain on shoulder movement during an arm elevated reaching task in a virtual reality environment

BACKGROUND

People with chronic shoulder pain have been shown to present with motor adaptations during arm movements. These adaptations may create abnormal physical stress on shoulder tendons and muscles. However, how and why these adaptations develop from the acute stage of pain is still not well-understood.

OBJECTIVE

To investigate motor adaptations following acute experimental shoulder pain during upper limb reaching.

METHODS

Forty participants were assigned to the Control or Pain group. They completed a task consisting of reaching targets in a virtual reality environment at three time points: (1) baseline (both groups pain-free), (2) experimental phase (Pain group experiencing acute shoulder pain induced by injecting hypertonic saline into subacromial space), and (3) Post experimental phase (both groups pain-free). Electromyographic (EMG) activity, kinematics, and performance data were collected.

RESULTS

The Pain group showed altered movement planning and execution as shown by a significant increased delay to reach muscles EMG peak and a loss of accuracy, compared to controls that have decreased their mean delay to reach muscles peak and improved their movement speed through the phases. The Pain group also showed protective kinematic adaptations using less shoulder elevation and elbow flexion, which persisted when they no longer felt the experimental pain.

CONCLUSION

Acute experimental pain altered movement planning and execution, which affected task performance. Kinematic data also suggest that such adaptations may persist over time, which could explain those observed in chronic pain populations.

Investigating the Effects of Mental Fatigue on Resistance Exercise Performance

Mental fatigue can impart negative effects on subsequent physical performance, although the mechanisms underlying these effects are not well understood. This study examined whether mental fatigue confers negative carryover effects on the performance of a set of biceps curls, while also investigating physiological and psychological mechanisms proposed to explain the predicted effect. A randomized, cross-over design was employed. On visit 1, participants (N = 10) performed a barbell biceps curl one-repetition maximum (1RM) test. On visits 2-3, participants performed 20 biceps curls at 50% of their 1RM, followed by their respective 10 min experimental manipulation (high vs. low cognitive exertion) and then a second set of biceps curls to exhaustion. Ratings of perceived exertion and electromyography of the biceps brachii, triceps brachii, upper trapezius, thoracic erector spinae and lumbar erector spinae were recorded during the physical task. The total number of repetitions completed was similar across the conditions. Results also failed to show between-condition differences for muscle activation and perceptions of exertion. Future research is needed to build an adequate knowledge base to determine whether there is an effect of mental fatigue on dynamic resistance-based task performance and, if so, identify the mechanisms explaining how and why.

Infrared thermal imaging monitoring on hands when performing repetitive tasks: An experimental study

The monitoring of infrared thermal images is reported to analyze changes in skin temperature in the hand fingers when repetitive work is performed to know which finger has a greater risk of injury, besides, the recovery time is analyzed regarding the initial temperature and its relationship with age, sex, weight, height if practice sports, and Body Mass Index (BMI) per individual. For the above, an experimental test was carried out for 10 minutes on a repetitive operation that takes place in the telecommunications industry and 39 subjects participated in which an infrared thermal image of the dorsal and palmar part of both hands was taken in periods of 5 minutes after the 10-minute test has elapsed. The results show that none of the participants recovered their initial temperature after 10 minutes of the experimental test. In addition, it was found that there is a relationship between skin temperature and sex, and that age influences the recovery of temperature. On the other hand, the thumb, index, and middle fingers have a higher risk of injury in the analyzed task. It is concluded that performing repetitive work with all the fingers of the hand does not show that all they have the same risk of injury, besides that, not all the variables studied affect the recovery of temperature and its behavior.

Fatigue, induced via repetitive upper-limb motor tasks, influences trunk and shoulder kinematics during an upper limb reaching task in a virtual reality environment

Background

Efficient shoulder movement depends on the ability of central nervous system to integrate sensory information and to create an appropriate motor command. Various daily encountered factors can potentially compromise the execution of the command, such as fatigue. This study explored how fatigue influences shoulder movements during upper limb reaching.

Methods

Forty healthy participants were randomly assigned to one of two groups: Control or Fatigue Group. All participants completed an upper limb reaching task at baseline and post-experimental, during which they reached four targets located at 90° of shoulder abduction, 90° external rotation at 90° abduction, 120° scaption, and 120° flexion in a virtual reality environment. Following the baseline phase, the Fatigue Group completed a shoulder fatigue protocol, while Controls took a 10-minute break. Thereafter, the reaching task was repeated. Upper limb kinematic (joint angles and excursions) and spatiotemporal (speed and accuracy) data were collected during the reaching task. Electromyographic activity of the anterior and middle deltoids were also collected to characterize fatigue. Two-way repeated-measures ANOVA were performed to determine the effects of Time, Group and of the interaction between these factors.

Results

The Fatigue group showed decreased mean median power frequency and increased electromyographic amplitudes of the anterior deltoid (p < 0.05) following the fatigue protocol. Less glenohumeral elevation, increased trunk flexion and rotation and sternoclavicular elevation were also observed in the Fatigue group (Group x Time interaction, p < 0.05). The Control group improved their movement speed and accuracy in post-experimental phase, while the Fatigue group showed a decrease of movement speed and no accuracy improvement (Group x Time interaction, p < 0.05).

Conclusion

In a fatigued state, changes in movement strategy were observed during the reaching task, including increased trunk and sternoclavicular movements and less glenohumeral movement. Performance was altered as shown by the lack of accuracy improvement over time and a decrease in movement speed in the Fatigue group.

Which subject-related variables contribute to movement variability during a simulated repetitive and standardised occupational task? Recurrence quantification analysis of surface electromyographic signals

Movement variability is a component of human movement. This study applied recurrence quantification analysis (RQA) on electromyographic signals to determine the effects of two types of variables on movement variability during a short, simulated repetitive and standardised occupational clip-fitting task. The electrical activity of six muscles in the dominant upper limb was recorded in 21 participants. Variables related to the task performance (insertion force and movements performed when fitting clips) affected RQA measures: recurrence rate (RR), percentage of determinism (DET) and diagonal line length entropy (ENT). Variables related to participant's characteristics (sex, age, and BMI) affected only DET and ENT. A constrasting variability was observed such as a high-DET value combined with a high-ENT value and inversely. Variables affected mainly the recurrences organisation of the more distal muscles. Even if movement variability is complex, it should be considered by ergonomists and work place designers to better understanding of operators' movements. Practitioner summary: It is essential to consider the complexity of operators' movement variability to understand their activities. Based on intrinsic movement variability knowledge, ergonomists and work place designers will be able to modulate the movement variability by acting on workstation designs and occupational organisation with the aim of preserving operators' health. Abbreviations: RR: recurrence rate; DET: percentage of determinism; ENT: diagonal line length entropy; BMI: body mass index; FDS: flexor digitorum superficialis; EXT: extensor digitorum communis; BIC: biceps brachii; TRI: triceps brachii; DEL: deltoideus anterior; TRA: trapezius pars descendens; F: female; M: male; S: supinated; P: pronated; CM: continuous movement; DM: discontinuous movement.

Is sex a proxy for mechanical variables during an upper limb repetitive movement task? An investigation of the effects of sex and of anthropometric load on muscle fatigue

BACKGROUND

Women report more work-related pain and neck/shoulder musculoskeletal disorders than men. For the same absolute workload, due to lower strength, females generally work at a higher relative intensity, which could induce more fatigue. However, the arm's anthropometric load (AL) of men is higher. Therefore, simply lifting their arm could be more fatiguing. Sex as a variable is formed of many constructs, and analyses can become muddied by their differing responses to fatigue. No studies have considered AL, when comparing how fatigue affects men and women. The purpose was to determine if including the arm's AL in the statistical analysis would impact findings of sex-specific effects of shoulder fatigue on muscle EMG.

METHODS

Fifty-five (29m/26f) participants completed a repetitive pointing task (RPT) at shoulder height until they reported fatigue of 8+ on the BORG CR-10 scale. Muscle activities were measured using surface electrodes placed over the anterior deltoid (AD) and upper trapezius (UT) muscles. Muscle activity amplitude was quantified using root mean square (RMS). First- and last-minute data were used to assess change from no-fatigue (NF) to fatigue-terminal (FT) conditions. AL was calculated using sex-specific body parameter equations. General estimating equations (GEE) were used to determine the effects of sex and fatigue on RMS values, while including AL in the GEE.

RESULTS

There was no sex difference in time to reach fatigue. A significant main effect of sex on RMS was observed (χ²(1) = 4.17, p = 0.04) when including AL as a covariate. Females displayed a significantly higher percentage change in AD RMS from NF to FT, compared to males (p = 0.03), when AL was included in the GEE. No sex differences in UT were observed.

CONCLUSIONS

This sex difference emerged when AL was included as a covariate, suggesting that sex-associated anthropometric differences may contribute to sex differences in the fatigue response. Differences in the impact of AL on AD compared to UT could be explained by differences in their respective mechanical roles or muscle fiber content. Anthropometrics may be useful to include as covariates in future research to separate individual anthropometric differences from sex differences.

Effects of Thrower's Ten exercises on upper extremity performance: A randomized controlled study

OBJECTIVES

The Thrower's Ten Exercise program is an exercise program especially designed to improve the strength, power and endurance of the shoulder complex. The aim of this study was to investigate the effects of the Thrower's Ten exercises on the upper extremity performance in healthy sedentary individuals.

METHODS

36 healthy sedentary individuals completed this study conducted with a randomized controlled design. The subjects were divided into 2 groups: exercise and control. The exercise group received a training of the Thrower's Ten exercises of 50-minute sessions 3 times a week for a duration of 8 weeks. Before and after the study, the subjects were tested for dynamic balance on the upper extremity with the Upper Limp Y balance test and for explosive power with the medicine ball throw test. Moreover, the strength of the shoulder internal and external rotator muscles was measured with an isokinetic dynamometer at a speed of 60°/second. The study was registered on the Clinical Trials website by the number NCT04162886.

RESULTS

A comparison between the groups showed significant differences in terms of dynamic balance and explosive power (P < .05), but not in terms of isokinetic muscle strength and body composition (P > .05). On the other hand, comparisons of the dynamic equilibrium, explosive power and isokinetic muscle strength parameters within the exercise group returned statistically different results (P < .05).

CONCLUSIONS

The Thrower's Ten exercises represent an effective method to improve the balance on the upper extremity, explosive power and isokinetic strength in healthy sedentary individuals.

Joint moment trade-offs across the upper extremity and trunk during repetitive work

Individuals can coordinate small kinematic changes at several degrees of freedom simultaneously in the presence of fatigue, leaving it unclear how overall biomechanical demands at each joint are altered. The purpose of this study was to evaluate trade-offs in joint moments between the trunk, shoulder, and elbow during repetitive upper extremity work. Participants performed four simulated workplace tasks cyclically until meeting fatigue termination criteria. Emergent fatigue-induced adaptations to repetitive work resulted in task-dependent trade-offs in joint moments. In general, reduced shoulder moments were compensated for by increased elbow and trunk joint moment contributions. Although mean joint moment changes were modest (range: 1-3 Nm) across participants, a wide distribution of responses was observed, with standard deviations exceeding 10 Nm. Re-distributing biomechanical demands across joints may alleviate constant tissue loads and facilitate continued task performance with fatigue but may be at the expense of increasing demands at adjacent joints.

Forearm muscular strength and performance fatigability in orthopaedic surgeons when performing bone screw fixations

This study investigated the muscle strength and performance fatigability of the forearms in eight male orthopaedic surgeons when performing bone screw fixations. Each surgeon performed an eight-bone screws operations in a porcine femur model to simulate fractural fixation using plating technique. The pre- and post-fatigue maximum isometric forces and corresponding electromyography responses were measured to assess the forearm muscle strength loss and fatigue due to screwing. Results showed that after eight bone screws were inserted, the maximal grip force, maximal driving torque and maximal push force losses were approximately 29%, 20% and 23%, respectively. While the grip force and/or driving torque acting, both the brachioradialis and extensor carpi ulnaris had a higher percentage change of EMG than the biceps brachii. The driving forces decreased with the number of screw insertions; however, the insertion time increased parabolically with the number of screws and significantly decreased the insertion rate of the screws, indicating that forearm muscle fatigue may occur in surgeons who treat fracture fixation using more than eight bone screws.

Computational musculoskeletal modeling of compensatory movements in the upper limb

It is well documented that most upper limb amputees utilize compensatory movement strategies to accomplish everyday tasks when using a prosthetic device and that musculoskeletal complaints (MSCs) are more common in this population. However, little information is available on how the loss of distal degrees of freedom (DOFs) in the arm impact muscle force, thereby limiting our understanding of the mechanism by which these MSCs are manifesting. Knowledge of how a loss of DOFs may lead to MSCs can enable clinicians to provide more targeted guidance on how best to restore functional ability while addressing pain, and may serve as a tool for prescriptive decision-making when determining the impact of device selection on long-term clinical needs. 3D motion capture data were collected from 12 right-handed subjects with no upper limb disability using an 8-camera Vicon™ motion analysis system as they performed the targeted Box and Blocks test under normal and braced conditions to simulate a loss of DOFs in the wrist and fingers. Muscle force data were calculated using AnyBody Modeling Software™ for four different muscles: erector spinae, infraspinatus, deltoid, and trapezius. Linear mixed effects models were generated using the peak force data and mean force data for a given muscle fascicle. The fixed effect coefficient and 95% confidence intervals were reported for each muscle fascicle. Overall, a strong effect of condition on muscle force was seen for most muscles in the right side of the body (specifically deltoid and infraspinatus), with greater forces generated during the braced condition.

Sex differences in postures of the upper body during a simulated work task performed above shoulder level

The aim of this study was to evaluate if there are sex differences in postures of upper arm, upper back, head and neck after muscle fatigue induced by a simulated work task, requiring upper arm movements performed above shoulder level. Nineteen females and 18 males were evaluated. Upper arm elevation, upper back, head and neck forward flexion postures were recorded using digital inclinometers. The first and the last cycles of the task were considered as pre- and post-fatigue periods, respectively. For both periods, Amplitude Probability Distribution Function (APDF) was calculated for 10th, 50th and 90th percentiles, as well as the angular ranges between the 5th and 95th percentiles (APDF_5-95 range). The APDF_5-95 range for upper arm elevation was higher with fatigue, but with a higher increase for males. After fatigue, there was also a decrease in the upper arm elevation, with a larger decrease in males for the 10th and 50th percentiles. For head and neck, females showed higher APDF_5-95 ranges than males, regardless of the task period evaluated. After muscle fatigue, males adopted more neutral postures of the upper arm than females. Furthermore, females showed more non-neutral postures for head and neck. These findings suggest that the kinematic strategies adopted by females and males during a simulated work task are different and may predispose females to a higher risk of developing work-related musculoskeletal disorders of the neck.

Identifying an Optimal Sampling Method to Estimate Postural Risk in a Dynamic Work Task

INTRODUCTION

The Rapid Upper Limb Assessment (RULA) is an ergonomic assessment tool used to screen for risk of musculoskeletal injury due to working posture. The RULA is traditionally applied once during a work task to approximate overall risk. No method exists for estimating a RULA score for work requiring frequent shifts in posture across an extended period of time.

PURPOSE

The goal of this study was to identify an optimal sampling method for applying the RULA across a long time-period that accurately represents overall risk.

METHODS

Four right-handed female dental hygiene students were video recorded from three angles while performing hand scaling during patient clinic visits (88.97 minutes on average). RULA was continuously scored across the entire session, updating the score when a significant postural shift lasting for more than 15 seconds occurred. A time-weighted average (TWA) RULA score was calculated. Three sampling methods were evaluated: equivalent interval samples, random samples, and random samples selection weighted within "clock positions." Each method was compared to the TWA using a paired samples t-test and percent difference.

RESULTS

TWA RULA across the four students ranged from 3.4 to 4.3. Preliminary sampling averages using 10 samples were all within 0.2 of the TWA. Further iterations evaluating various sample sizes is ongoing.

DISCUSSION

Preliminary results suggest that all three sampling methods provide a reasonably accurate approximation of the TWA score at the sampling rate tested. Future iterations of this analysis will be continued to identify the minimum required sampling rate to meet our TWA criterion.