Effects of common working postures on balance control during the stabilisation phase of transitioning to standing

Ability of Wearable Accelerometers-Based Measures to Assess the Stability of Working Postures

With the rapid development and widespread application of wearable inertial sensors in the field of human motion capture, the low-cost and non-invasive accelerometer (ACC) based measures have been widely used for working postural stability assessment. This study systematically investigated the abilities of ACC-based measures to assess the stability of working postures in terms of the ability to detect the effects of work-related factors and the ability to classify stable and unstable working postures. Thirty young males participated in this study and performed twenty-four load-holding tasks (six working postures × two standing surfaces × two holding loads), and forty-three ACC-based measures were derived from the ACC data obtained by using a 17 inertial sensors-based motion capture system. ANOVAs, t-tests and machine learning (ML) methods were adopted to study the factors’ effects detection ability and the postural stability classification ability. The results show that almost all forty-three ACC-based measures could (p < 0.05) detect the main effects of Working Posture and Load Carriage, and their interaction effects. However, most of them failed in (p ≥ 0.05) detecting Standing Surface’s main or interaction effects. Five measures could detect both main and interaction effects of all the three factors, which are recommended for working postural stability assessment. The performance in postural stability classification based on ML was also good, and the feature set exerted a greater influence on the classification accuracy than sensor configuration (i.e., sensor placement locations). The results show that the pelvis and lower legs are recommended locations overall, in which the pelvis is the first choice. The findings of this study have proved that wearable ACC-based measures could assess the stability of working postures, including the work-related factors’ effects detection ability and stable-unstable working postures classification ability. However, researchers should pay more attention to the measure selection, sensors placement, feature selection and extraction in practical applications.

Effects of working posture, lifting load, and standing surface on postural instability during simulated lifting tasks in construction

Postural instability is a major contributor to fatal and nonfatal falls in the construction industry. This study investigated the effects of working posture, lifting load and standing surface on perceived postural instability. Thirty young males performed simulated lifting tasks in construction using six different postures under four experimental conditions (2 loads × 2 surfaces). Results showed working postures with bending at the waist and overhead carrying were associated with high postural instability. With lifting load and inclined standing surface both significantly increased postural instability for all working postures except the full squatting. Full squatting with lifting load was more stable than without load for the flat surface, but opposite for the inclined surface. These findings indicate three investigated factors had not only significant main effects, but also complicated interaction effects on postural instability, implying that all three factors should be considered simultaneously for the real practice on fall prevention in construction. Practitioner summary: The leading causes of worker deaths in the construction industry were falls. This study showed that working postures with waist bending and overhead carrying were associated with high postural instability. With lifting load and inclined standing surface both significantly increased postural instability for all working postures except the full squatting.

Effect of a Cardiopulmonary Resuscitation Coach on Workload During Pediatric Cardiopulmonary Arrest: A Multicenter, Simulation-Based Study

OBJECTIVES

Optimal cardiopulmonary resuscitation can improve pediatric outcomes but rarely is cardiopulmonary resuscitation performed perfectly despite numerous iterations of Basic and Pediatric Advanced Life Support. Cardiac arrests resuscitation events are complex, often chaotic environments with significant mental and physical workload for team members, especially team leaders. Our primary objective was to determine the impact of a cardiopulmonary resuscitation coach on cardiopulmonary resuscitation provider workload during simulated pediatric cardiac arrest.

DESIGN

Multicenter observational study.

SETTING

Four pediatric simulation centers.

SUBJECTS

Team leaders, cardiopulmonary resuscitation coach, and team members during an 18-minute pediatric resuscitation scenario.

INTERVENTIONS

National Aeronautics and Space Administration-Task Load Index.

MEASUREMENTS AND MAIN RESULTS

Forty-one teams (205 participants) were recruited with one team (five participants) excluded from analysis due to protocol violation. Demographic data revealed no significant differences between the groups in regard to age, experience, distribution of training (nurse, physician, and respiratory therapist). For most workload subscales, there were no significant differences between groups. However, cardiopulmonary resuscitation providers had a higher physical workload (89.3 vs 77.9; mean difference, -11.4; 95% CI, -17.6 to -5.1; p = 0.001) and a lower mental demand (40.6 vs 55.0; mean difference, 14.5; 95% CI, 4.0-24.9; p = 0.007) with a coach (intervention) than without (control). Both the team leader and coach had similarly high mental demand in the intervention group (75.0 vs 73.9; mean difference, 0.10; 95% CI, -0.88 to 1.09; p = 0.827). When comparing the cardiopulmonary resuscitation quality of providers with high workload (average score > 60) and low to medium workload (average score < 60), we found no significant difference between the two groups in percentage of guideline compliant cardiopulmonary resuscitation (42.5% vs 52.7%; mean difference, -10.2; 95% CI, -23.1 to 2.7; p = 0.118).

CONCLUSIONS

The addition of a cardiopulmonary resuscitation coach increases physical workload and decreases mental workload of cardiopulmonary resuscitation providers. There was no change in team leader workload.

Accuracy of Base of Support Using an Inertial Sensor Based Motion Capture System

The potential of miniature inertial sensors for human balance and gait analysis appears promising. Base of support (BOS), together with its interaction with center of mass, is a critical indicator in above mentioned research fields. This study aims to evaluate the accuracy of Xsens MVN BIOMECH, a commercial widely used inertial sensor-based motion capture system, for measuring static BOS and examine the effect of different task complexity on the accuracy. Eleven young males participated in this study and went through eleven different experimental tasks. Results showed there were considerable errors in estimating BOS area (error ranged from −12.6% to +64.6%) from Xsens MVN and a large error in foot separation distance when there was knee flexion. The estimated BOS area from MVN was smaller than the ground truth from footprint when there was no knee flexion, and larger when there was knee flexion, and it increased monotonically along with the knee flexion angles. Wrongly estimated foot separations, mainly caused by knee flexion, and the initial system estimation error on BOS, were two major reasons for error and instability of BOS estimation. The findings suggested that caution should be taken when using Xsens MVN BIOMECH to estimate BOS and foot position-related measurements, especially for postures/motions with knee flexion.

Stabilisation times after transitions to standing from different working postures

Transitioning to standing after maintaining working postures may result in imbalance and could elicit a fall. The objective of this study was to quantify the magnitude of imbalance using a stabilisation time metric. Forty-five male participants completed three replications of conditions created by one of four working postures (bent at waist, squat, forward kneel, reclined kneel) and three durations within posture. Participants transitioned to quiet standing at a self-selected pace. Stabilisation time, based on changes in centre of pressure velocity, was used to indicate the initiation of steady state while standing. Stabilisation time was significantly affected by static postures but not duration within posture. The largest stabilisation times resulted from transitions initiated from a bent at waist posture. The smallest were associated with the kneeling postures, which were not significantly different from each other. Findings may lead to recommendations for redesign of tasks, particularly in high-risk environments such as construction. Statement of Relevance: Task performance on the jobsite often requires individuals to maintain non-erect postures. This study suggests that working posture affects stabilisation during transition to a standing position. Bending at the waist and squatting resulted in longer stabilisation times, whereas both kneeling postures evaluated resulted in greater imbalance but for a shorter duration.

Age-related differences in movement strategies and postural control during stooping and crouching tasks

While epidemiologic data suggests that one in four older adults have difficulty performing stooping and crouching (SC) tasks, little is known about how aging affects SC performance. This study investigated differences between young and older adults in lower limb kinematics and underfoot center of pressure (COP) measures when performing a series of SC tasks. Twelve healthy younger and twelve healthy older participants performed object-retrieval tasks varying in: (1) initial lift height, (2) precision demand, and (3) duration. Whole-body center of mass (COM), underfoot COP, and hip and knee angular kinematics (maximum angles and velocities) were analyzed. Compared to younger, older participants moved slower when transitioning into and out of pick-up postures that were characterized by less hip and knee flexion. Older participants also showed a diminished ability to adapt to the changing postural demands of each set of tasks. This was especially evident during longer tasks, whereby older individuals avoided high knee flexion crouching postures that were commonly used by younger participants. Older adults also tended to exhibit faster and more frequent COP trajectory adjustments in the anterior-posterior direction. It is likely that limitations in physical characteristics such as lower limb strength and range of motion contributed to these differences.

Methodological considerations of existing techniques for determining stabilization times following a multi-planar transition

Postural stabilization is required following perturbations or after transitioning to standing. The current research evaluated two available algorithms that utilize within-trial data to quantify standing following multi-planar transitions. Forty-five participants began each trial by assuming a static forward kneeling posture that ended with an auditory signal prompting transition to standing. Data from two force plates was collected at 100Hz for 20s starting with the transition. With one algorithm, using windows of various lengths, stabilization time was defined as when mean center of pressure (CoP) velocity of the current window was less than that for the mean of all subsequent windows. This algorithm produced significantly different stabilization times (1.3-6.9s) depending on the window length. In a second algorithm, a negative exponential mathematical model was fit to data within each trial (R(2)=0.93). This approach was easily implemented and produced results (mean=2.1s) with lower variability (SD=0.9s). Though approaches exist that adequately determine stabilization times in well-constrained uni-planar movements, there are limitations to generalizability. The negative exponential mathematical model evaluated in this study provides a promising method for systematically determining stabilization times for multi-planar movements.