Knee flexion and base of support in asymmetrical handling: effects on the worker's dynamic stability and the moments of the L(5)/S(1) and knee joints

Age affects the dynamic interaction between kinematics and gait stability

Introduction: It is crucial to comprehend the interplay between the center of mass (CoM) and base of support (BoS) in elderly individuals' body movements, as it could have implications for fall prevention. Methods: The purpose of this study is to characterize age-related differences using the instantaneous location of the CoM and CoM velocity vector in relation to the dynamically changing BoS during walking. Thirty subjects participated in the experiments. Derivation formulas of feasible stability region and age-related statistical analyses were proposed. Results: The stability margin and distance to centroid for elderly group were found to be significantly different from the young group (p < 0.05). At heel strike, while the CoMv distance was similar for age-based groups (p > 0.05), older individuals demonstrated a greater CoMv distance to the border than the younger at right limb, which suggesting age-related differences in momentum control. In addition, Bland-Altman analysis indicated that the validity was substantial, making it feasible to capture stride-to-stride variability. Discussion: The CoM trajectories and feasible stability region could provide a better understanding of human momentum control, underlying mechanisms of body instability and gait imbalance.

A machine-learning method for classifying and analyzing foot placement: Application to manual material handling

Foot placement strategy is an essential aspect in the study of movement involving full body displacement. To get beyond a qualitative analysis, this paper provides a foot placement classification and analysis method that can be used in sports, rehabilitation or ergonomics. The method is based on machine learning using a weighted k-nearest neighbors algorithm. The learning phase is performed by an observer who classifies a set of trials. The algorithm then automatically reproduces this classification on subsequent sets. The method also provides detailed analysis of foot placement strategy, such as estimating the average foot placements for each class or visualizing the variability of strategies. An example of applying the method to a manual material handling task demonstrates its usefulness. During the lifting phase, the foot placements were classified into four groups: front, contralateral foot behind, ipsilateral foot behind, and parallel. The accuracy of the classification, assessed with a holdout method, is about 97%. In this example, the classification method makes it possible to observe and analyze the handler's foot placement strategies with regards to the performed task.

Influence of a passive lower-limb exoskeleton during simulated industrial work tasks on physical load, upper body posture, postural control and discomfort

This study investigated the effect of wearing a passive lower-limb exoskeleton on physical load, kinematics, postural control, and discomfort. 45 healthy males participated and were exposed to three 21-min simulations, including screwing, cable-mounting, and clip-fitting. Each exposure comprised one of three exoskeleton statuses (standing, high and low sitting on exoskeleton) and three working distances (optimal, far, very far). The order of exoskeleton status and working distance were randomized across subjects. A force platform was used to calculate the mean center of pressure (COP) and absolute (SS_ABS) and relative static postural stability (SS_REL) as measures of postural control as well as the weight transferred to the exoskeleton supports as indicator of physical load. Neck and back angles were recorded together with electrical activity of four bilateral muscles (trapezius, erector, vastus, gastrocnemius). Discomfort was recorded before and after each exposure on an 11-point numeric rating scale. Physical load decreased due to the exoskeleton carrying up to 64% of the subject's body mass. The COP remained within the base of support with the lowest values of static postural stability for high sitting (27%). During sitting, vastus activity increased (∼95-135%) while gastrocnemius activity decreased (∼25%) compared to standing. Trapezius and erector activity levels showed only minor differences between exposures. Larger working distances resulted in a more anterior COP and increased erector activity. Standing without exoskeleton was related to less discomfort (0.5) than sitting on the exoskeleton (∼1.3). Working postures and distances changed SS_REL and activity levels of the vastus, gastrocnemius, and erector, but not SS_ABS. However, postural stability did not approach a critical state in our simulations without external perturbations. Therefore, investigating exoskeletons in the field will provide useful information about their effectiveness and usability in dynamic working situations where external forces could occur.

Dynamic stability margin using a marker based system and Tekscan: a comparison of four gait conditions

Stability during gait is maintained through control of the center of mass (CoM) position and velocity in relation to the base of support (BoS). The dynamic stability margin, or the interaction of the extrapolated center of mass with the closest boundary of the BoS, can reveal possible control errors during gait. The purpose of this study was to investigate a marker based method for defining the BoS, and compare the dynamic stability margin throughout gait in comparison to a BoS defined from foot pressure sensors. The root mean squared difference between these two methodologies ranged from 0.9 cm to 3.5 cm, when walking under four conditions: plantigrade, equinus, everted, and inverted. As the stability margin approaches -35 cm prior to contralateral heel strike, there was approximately 90% agreement between the two systems at this time point. Underestimation of the marker based dynamic stability margin or overestimation of the pressure based dynamic stability margin was due to inaccuracies in defining the medial boundary of the BoS. Overall, care must be taken to ensure similar definitions of the BoS are utilized when comparing the dynamic stability margin between participants and gait conditions.

Lifting strategies of expert and novice workers during a repetitive palletizing task

Thirty manual material handlers (15 experts and 15 novices) were invited to perform series of box transfers under conditions similar to those of large distribution centers. The objective of the present study was to verify whether multiple box transfers leading to fatigue would also lead to differences between expert and novice workers in joint motions and in back loading variables (L5/S1 moments). The task consisted in transferring 24 15-kg boxes from one pallet to another (4 layers of boxes; 6 boxes/layer: 3 in the front row, 3 in the back) at a self-determined pace and then at an imposed pace of 9 lifts/min for a total of 240 lifts. The underlying idea was to set a challenging task that would force the experts to use their skills. Full-body 3D kinematic data were collected as well as external foot forces. A dynamic 3D linked segment model was used to estimate the net moments at L5/S1. The results clearly show that the experts bent their lumbar spine less (10° less) and were closer (4 cm) to the box than novice workers. Knee flexions were similar in both groups except when the box was lifted from ground level (expert ≈ 71°, novice ≈ 48°). The peak resultant moment was not statistically different (expert = 168 Nm, novice = 184 Nm) although experts had lower values on average than novices when lifting heights (and deposit heights) of the boxes increased. Therefore, experts differed from novice workers mostly in the posture-related variables. These differences are especially important to consider when the box is located on the ground, as the back posture and back loading are then at their greatest magnitude and could have a major impact on the distribution of internal forces on the spine.

Assessing the stability of human locomotion: a review of current measures

Falling poses a major threat to the steadily growing population of the elderly in modern-day society. A major challenge in the prevention of falls is the identification of individuals who are at risk of falling owing to an unstable gait. At present, several methods are available for estimating gait stability, each with its own advantages and disadvantages. In this paper, we review the currently available measures: the maximum Lyapunov exponent (λS and λL), the maximum Floquet multiplier, variability measures, long-range correlations, extrapolated centre of mass, stabilizing and destabilizing forces, foot placement estimator, gait sensitivity norm and maximum allowable perturbation. We explain what these measures represent and how they are calculated, and we assess their validity, divided up into construct validity, predictive validity in simple models, convergent validity in experimental studies, and predictive validity in observational studies. We conclude that (i) the validity of variability measures and λS is best supported across all levels, (ii) the maximum Floquet multiplier and λL have good construct validity, but negative predictive validity in models, negative convergent validity and (for λL) negative predictive validity in observational studies, (iii) long-range correlations lack construct validity and predictive validity in models and have negative convergent validity, and (iv) measures derived from perturbation experiments have good construct validity, but data are lacking on convergent validity in experimental studies and predictive validity in observational studies. In closing, directions for future research on dynamic gait stability are discussed.

Relative importance of expertise, lifting height and weight lifted on posture and lumbar external loading during a transfer task in manual material handling

The objective of this study was to measure the effect size of three important factors in manual material handling, namely expertise, lifting height and weight lifted. The effect of expertise was evaluated by contrasting 15 expert and 15 novice handlers, the effect of the weight lifted with a 15-kg box and a 23-kg box and the effect of lifting height with two different box heights: ground level and a 32 cm height. The task consisted of transferring a series of boxes from a conveyor to a hand trolley. Lifting height and weight lifted had more effect size than expertise on external back loading variables (moments) while expertise had low impact. On the other hand, expertise showed a significant effect of posture variables on the lumbar spine and knees. All three factors are important, but for a reduction of external back loading, the focus should be on the lifting height and weight lifted.

PRACTITIONER SUMMARY

The objective was to measure the effect size of three important factors in a transfer of boxes from a conveyor to a hand trolley. Lifting height and weight lifted had more effect size than expertise on external back loading variables but expertise was a major determinant in back posture.

Center of mass and base of support interaction during gait

During gait the body is in a continuous state of imbalance, with each subsequent step preventing a fall. Gait balance is maintained by regulating the interactions between the center of mass (CoM) and base of support (BoS). The purpose of this study was to investigate the interaction of the CoM position and velocity (CoMv) in relation to the dynamically changing BoS throughout gait. This was quantified using: (1) The shortest distance from the CoM to the boundary of the BoS; (2) The distance from the CoM to the centroid of the BoS; and (3) The distance from the CoM to the BoS along the direction of the CoMv. These interactions were investigated in healthy young adults, healthy older adults, and elderly fallers, who performed level walking at a self-selected speed. Elderly fallers demonstrated a conservative CoM-BoS separation at toe off and reduced balance control ability, specifically a decreased time to contact, when compared to healthy young adults at heel strike. Decreased time available in responding to perturbations might result in a greater number of falls. Understanding foot position and CoM trajectories might allow for appropriate rehabilitation practices.

The development of a model to predict the effects of worker and task factors on foot placements in manual material handling tasks

Accurate prediction of foot placements in relation to hand locations during manual materials handling tasks is critical for prospective biomechanical analysis. To address this need, the effects of lifting task conditions and anthropometric variables on foot placements were studied in a laboratory experiment. In total, 20 men and women performed two-handed object transfers that required them to walk to a shelf, lift an object from the shelf at waist height and carry the object to a variety of locations. Five different changes in the direction of progression following the object pickup were used, ranging from 45° to 180° relative to the approach direction. Object weights of 1.0 kg, 4.5 kg, 13.6 kg were used. Whole-body motions were recorded using a 3-D optical retro-reflective marker-based camera system. A new parametric system for describing foot placements, the Quantitative Transition Classification System, was developed to facilitate the parameterisation of foot placement data. Foot placements chosen by the subjects during the transfer tasks appeared to facilitate a change in the whole-body direction of progression, in addition to aiding in performing the lift. Further analysis revealed that five different stepping behaviours accounted for 71% of the stepping patterns observed. More specifically, the most frequently observed behaviour revealed that the orientation of the lead foot during the actual lifting task was primarily affected by the amount of turn angle required after the lift (R(2) = 0.53). One surprising result was that the object mass (scaled by participant body mass) was not found to significantly affect any of the individual step placement parameters. Regression models were developed to predict the most prevalent step placements and are included in this paper to facilitate more accurate human motion simulations and ergonomics analyses of manual material lifting tasks. STATEMENT OF RELEVANCE: This study proposes a method for parameterising the steps (foot placements) associated with manual material handling tasks. The influence of task conditions and subject anthropometry on the foot placements of the most frequently observed stepping pattern during a laboratory study is discussed. For prospective postural analyses conducted using digital human models, accurate prediction of the foot placements is critical to realistic postural analyses and improved biomechanical job evaluations.

Biomechanical differences between expert and novice workers in a manual material handling task

The objective was to verify whether the methods were safer and more efficient when used by expert handlers than by novice handlers. Altogether, 15 expert and 15 novice handlers were recruited. Their task was to transfer four boxes from a conveyor to a hand trolley. Different characteristics of the load and lifting heights were modified to achieve a larger variety of methods by the participants. The results show that the net moments at the L5/S1 joint were not significantly different (p > 0.05) for the two groups. However, compared with the novices, the experts bent their lumbar region less (experts 54° (SD 11°); novices 66° (SD 15°)) but bent their knees more (experts approx. 72° (SD approx. 30°); novices approx. 53° (SD approx. 33°), which brought them closer to the box. The handler's posture therefore seems to be a major aspect that should be paid specific attention, mainly when there is maximum back loading. STATEMENT OF RELEVANCE: The findings of this research will be useful for improving manual material handling training programmes. Most biomechanical research is based on novice workers and adding information about the approach used by expert handlers in performing their tasks will help provide new avenues for reducing the risk of injury caused by this demanding physical task.

Foot motions in manual material handling transfer tasks: a taxonomy and data from an automotive assembly plant

Ergonomic job analysis commonly applies static postural and biomechanical analysis tools to particular postures observed during manual material handling (MMH) tasks, usually focusing on the most extreme postures or those involving the highest loads. When these analyses are conducted prospectively using digital human models, accurate prediction of the foot placements is critical to realistic postural analyses. In automotive assembly jobs, workers frequently take several steps between task elements, for example, picking up a part at one location and moving to another location to place it on the vehicle. A detailed understanding of the influence of task type and task sequence on the stepping pattern is necessary to accurately predict the foot placements associated with MMH tasks. The current study examined the patterns of foot motions observed during automotive assembly tasks. Video data for 529 pickup and delivery tasks from 32 automotive assembly jobs were analysed. A minimum of five cycles was analysed for each task. The approach angle, departure angle, hand(s) used, manipulation height and patterns of footsteps were coded from the video. Object mass was identified from the job information sheet provided by the assembly plant. Three independent raters coded each video and demonstrated an intraclass correlation coefficient of 0.54 for identification of the configuration of the lower extremities during terminal stance. Based on an analysis of the distribution of stepping behaviours during object transitions (pickups or deliveries), a transition classification system (TRACS) was developed. TRACS uses a compact notation to quantify the sequence of steps associated with a MMH transition. Five TRACS behaviour groups accounted for over 90% of the transition stepping behaviours observed in the assembly plant. Approximately two-thirds (68.4%) of the object transfers observed were performed with only one foot in contact with the ground during the terminal posture. The results from this paper suggest that a predictive model for choosing a transition stepping behaviour, coupled with a model to scale the selected foot behaviours, is needed to facilitate accurate prospective ergonomic analyses. This study proposes a method for categorising the stepping patterns associated with MMH tasks. The influence of task type and task sequence on the stepping patterns observed during several automotive assembly tasks is discussed. For prospective postural analyses conducted using digital human models, accurate prediction of the foot placements is critical to realistic postural analyses.

Destabilizing and stabilizing forces to assess equilibrium during everyday activities

Postural stability is essential to functional activities. This paper presents a new model of dynamic stability which takes into account both the equilibrium associated with the body position over the base of support (destabilizing force) and the effort the subject needs to produce to keep his/her centre of mass inside the base of support (stabilizing force). The ratio between these two forces (destabilizing over stabilizing) is calculated to provide an overall index of stability for an individual. Preliminary results from data collected during walking at preferred and maximal safe speed in four older adults (aged from 64 to 84yr) showed that both forces are lower for subjects with reduced maximal gait speed. In addition, the stabilizing force increases by 2-3 times from preferred to maximal speed, while the destabilizing force barely changes with gait speed. Overall, the model through the index of stability attributes lower dynamic stability to subjects with lower maximal gait speed. These preliminary results call for larger-scale studies to pursue the development and validation of the model and its application to different functional tasks.

Perception and biomechanics data in a manual handling task: a comparative study

This paper explores the use of subjective perception tasks and its correlations with biomechanical data in the evaluation of manual material handling. Three main dimensions were considered for perception: physical regroups sensations issued from a specific body area; operative regroups feelings related to the execution of the task; and performance regroups feelings that involve a judgement on the execution or reflect overall sensations. The following questions were then explored. To what extent are perception data related to biomechanics data? Do both approaches lead to similar conclusions or interpretations when effect of practice, format and off-centre were tested? How can they complement one another? The task consisted of transferring 50 series of three 15 kg loads in order to verify the impact of free practice, format (box/cylinder) and load centre of gravity position. Eleven subjects rated perception on a CR-10 scale (Borg 1982) after each series. The session was completed with an interview on perception. The net resulting moment was systematically found to be the best correlated with data perception. While all physical and performance items corresponded in various ways to biomechanics data, perceptions associated with operative dimension appeared to be less related with biomechanical data. As regards the impact of practice, format and off-centre, both approaches would lead to the same conclusions, except for the effect of the off-centre. Verbal data add rational information about how or why perception can or cannot be reflected in biomechanics data. How both approaches can be matched more closely in manual handling is discussed.

Estimating three-dimensional spinal repositioning error: the impact of range, posture, and number of trials

STUDY DESIGN

Spinal repositioning sense was tested in normal subjects using a balanced within-subject study design.

OBJECTIVES

The study had three objectives: first, to document the number of trials required to derive a representative value of accuracy and precision in spinal repositioning; second, to document the effects of range on spinal repositioning sense; and finally, to document the effect of different lower limb postures on the repositioning performance.

SUMMARY OF BACKGROUND DATA

Joint position sense and kinesthesia play an important role in the control of normal movement of the spine. This has important implications for the diagnosis and assessments of specific movement disorders in individuals with spinal pain syndromes. The literature is varied in methods and results in assessing spinal repositioning sense. For some studies, the inability to determine effects for range or differences between patients with low back pain and normal control subjects may be related to the fact that too few trials were performed to detect a statistical difference.

METHODS

Twenty-three subjects were tested in standing on a repositioning task for spinal position sense. After a familiarization period, each subject performed 10 matching trials in three ranges (20%, 50%, and 80% of available range) during spinal flexion. The flexion task was performed with knees fully extended, with knees partly flexed, and with the pelvis rotated at 45 degrees to incorporate an asymmetric flexion rotation movement pattern. The three-dimensional coordinates of the repositioning tasks were used to determine accuracy (mean and median of trials) and precision (variable error-standard deviation of trials). The coefficient of variation and statistical power analysis using variables derived from progressively larger numbers of trials were examined. Analysis of variance was used to detect differences for the three ranges and three postures.

RESULTS

After the familiarization period, no learning effect was demonstrated across trials. The coefficient of variation and statistical power for the accuracy and precision tended to stabilize after six trials. Using derived variables from six trials, there was a statistically significant range effect. Accuracy in the inner range was worse than that in the outer range (P < 0.05). There was little evidence of a range effect for precision. Posture had little overall impact. Trunk flexion with the knees flexed improved three-dimensional accuracy in the middle range compared with accuracy with the knees extended and during the flexion rotation task.

CONCLUSIONS

It was concluded that increasing the number of trials increases the statistical power and stability of the derived variables. In normal subjects, the accuracy of trunk flexion repositioning improves as one moves further into range.