Effects of the Computer Desk Level on the Musculoskeletal Discomfort of Neck and Upper Extremities and EMG Activities in Patients with Spinal Cord Injuries

Background

Computers are used as a means of social communication, for work and other purposes. However, patients with spinal cord injuries may have a higher risk than normal individuals with musculoskeletal problems when using computers owing to their inability to control respective postures due to problems in motor and sensory functioning.

Objectives

This study is aimed at identifying the effect of computer desk heights on musculoskeletal discomforts of the neck and upper extremities and EMG activities in patients with spinal cord (C6) and upper thoracic spinal cord injuries.

Methods

Participants of the present study were the patients diagnosed with ASIA A or B. The patients were divided into two groups according to their spinal cord injuries: C6 group and T2-T6 group. The level of the desk was set at 5 cm below the elbow, at the elbow level, and 5 cm above the elbow level. Electromyography was used to measure the duration of typing task EMG(%RVC) of the cervical erector spinae, upper trapezius, anterior deltoid, and wrist extensor. Subjective musculoskeletal discomfort (Borg-RPE) was measured at the end of the experiment.

Results

The two groups showed differences in terms of RPE corresponding to each level of the computer desk (p < .05). Postanalysis revealed the C6 group had decreased RPE as the level of computer desk increased, whereas the subjects in the T2-T6 group had decreased RPE values in accordance with the decreasing level of computer desk (p < .05). In EMG, both groups had no significant differences (p > .05). However, in terms of the interaction between the muscles and the level of computer desk in both groups, the differences in the interactions of the upper trapezius and wrist extensor with each level of the desk were found (p < .05).

Conclusion

This study is meaningful in that it confirms computer work posture and preference of spinal cord-injured individuals.

Employee Perceived Stress

Repetitive strain injuries (RSIs), specifically carpal tunnel syndrome, are the fastest growing type of occupational injury. Research about precipitating factors and prevention has been controversial and inconclusive. Preventive measures typically have addressed ergonomic changes. The purpose of this research article is to describe the effects of several variables on the perceived development of RSI symptoms, particularly those of carpal tunnel syndrome. Emphasis was placed on the role of perceived stress. The study design was a descriptive survey using a nonprobability sampling method. The study focused on four variables related to perceptions of symptoms: 1) perceptions of level of knowledge related to the prevention of RSIs; 2) taking a specific action to make one's workstation more ergonomically correct; 3) perceptions of having ergonomically correct workstations; and 4) perceptions of being stressed. Study results indicated that perceived stress was significantly associated with perceived RSI symptoms. Workers who use a computer 4 or more hours per day reported significantly more symptoms than those who did not. At risk computer users who perceive an ergonomically correct workstation reported fewer symptoms. To prevent RSIs, occupational health nurses must address ergonomics, stress levels, and knowledge levels.

Musculoskeletal Symptomnatology and Repetitive Strain Injuries in Diagnostic Medical Sonographers

Repetitive strain injuries are beginning to be widely recognized as a serious occupational risk for sonographers. The goal of this study was to establish the incidence of musculoskeletal symptomatology and repetitive strain injuries in sonographers from Washington state and Oregon and to correlate certain physical attributes, work load, and work habits with the reporting rates of musculoskeletal symptomatology and repetitive strain injuries. The data for this study were gathered through a comprehensive questionnaire. Eighteen percent of respondents suffered no symptoms; 66% suffered symptoms without repetitive strain injury, and 15% were diagnosed with repetitive strain injury. The analysis revealed that a positive correlation exists between certain ergonomically unsound work habits and increased symptomatology. The proportion of repetitive strain injury-diagnosed sonographers tended to increase with more years in the profession. The reporting rate of musculoskeletal symptomatology and repetitive strain injuries also appeared to be influenced by other variables, such as gender, work load, and stress in the workplace.

A high prevalence of cumulative trauma disorders in Iranian instrumentalists

Background

Cumulative trauma disorders (CTDs) are common in musicians and their prevalence has been the subject of a number of studies in most western countries. Such studies are scarce in developing countries despite the possibility that CTDs may have a different prevalence in these countries, especially when considering traditional musical instruments and different methods of playing. Although not formally studied before, according to our experience the prevalence of CTDs seemed to be high among Iranian instrumentalists.

We proposed this study to determine the prevalence of CTDs in amateur music students playing one of the two traditional Iranian instruments: Daf and Setar.

Methods

In a prospective cross sectional study, we interviewed and examined the students of three music training centers in Iran. Seventy eight instrumentalists, who were playing Daf or Setar and twelve students who had not started playing yet were regarded as case and control groups respectively. Some of them also underwent electrodiagnostic studies.

Results

Forty-seven percent (17 of 36) of the Setar players and 57% (24 of 42) of the Daf players and fifty-three percent (41 of 78) of the instrumentalists as a whole had CTDs. None of them had carpal tunnel syndrome.

Conclusions

Our study revealed that the prevalence of CTDs in Iranian instrumentalists was unusually high. In addition to age, other variables may be contributory. This needs to be further studied.

Presentation and response of patients with upper extremity repetitive use syndrome to a multidisciplinary rehabilitation program: a retrospective review of 24 cases

OBJECTIVE

To analyze retrospectively a group of patients presenting to an outpatient hand rehabilitation clinic with complaints related to repetitive tasks of the upper extremity.

DESIGN

Retrospective case study reviewing 24 consecutive cases for presenting symptoms and response of patients to a multidisciplinary rehabilitation approach.

SETTING

An outpatient hand rehabilitation clinic in a tertiary referral center offering simultaneous medical, psychological, and occupational evaluations.

PATIENTS

Twenty-four patients with upper extremity symptoms related to repetitive use, who had all failed various prior therapeutic interventions. Fifty percent of the patients were receiving medical disability compensation because of their symptoms. Sixty-two percent had filed a worker's compensation claim.

INTERVENTIONS

Treatment consisted of medical management with pharmacologic interventions, occupational therapy with workplace simulation and job-site evaluations, and psychological treatment with pain management and biofeedback training. Treatments were individualized to meet each patient's needs.

OUTCOME MEASURES

Reduction in symptom intensity or frequency, increase in work and performance of activities of daily living, and termination of medical disability with return to work.

RESULTS

Most cases (83%) were found to be related to occupational computer keyboard use. Bilateral hand and forearm pain were the major symptoms. A unique physical finding was diffuse tendon tenderness and tightness of the long flexor and extensor muscles of the forearm. Carpal tunnel syndrome was found in only one patient. Twenty-five percent of patients achieved resolution of most symptoms, although on a modified and often reduced activity level; 54% had moderate improvement; and 13% had only minimal or no improvement. Of the patients receiving medical disability compensation, 58% returned to their previous jobs.

CONCLUSIONS

Patients with upper extremity symptoms related to repetitive use often have unique physical findings, distinct from those of carpal tunnel syndrome. Resulting work disability is high. Patients who have not responded to conventional interventions within a reasonable time may benefit from a multidisciplinary treatment approach. Most patients improve with this treatment but do not fully recover.

Ergonomic risk exposure and upper-extremity cumulative trauma disorders in a maquiladora medical devices manufacturing plant

Workers at a Nogales, Mexico, maquiladora plant that assembles medical devices were studied to determine the prevalence of upper-extremity cumulative trauma disorders (CTD). Subjects included production workers employed 6 months or longer; of the 148 eligible workers, 145 (98%) participated. Subjects had a mean age of 24.6 years (SD = 5.2; range, 17 to 45) and the mean length of employment was 3.5 years (SD = 2.5; range, 0.5 to 14). Job tasks were videotaped and analyzed for ergonomic risk factors, using pre-defined criteria. All jobs performed by study subjects were found to involve one or more ergonomic risk factors associated with the development of CTD. A CTD questionnaire and screening physical examination format, similar to that used by the National Institute of Occupational Safety and Health (NIOSH) in a chicken processing plant study, were administered. Period prevalence of CTD within the previous year, as reported on the questionnaire, was 28%. Prevalence of CTD was 17%, using data from the screening physical examination. Point prevalence (current pain data from the questionnaire plus positive symptoms on the screening physical examination) was 15%. CTD was reported more frequently in women than men (46% and 25%, respectively; P < 0.05) and in subjects who had worked at the plant less than one year (50%; P < 0.05). Workforce turnover (3% monthly) may have resulted in those affected by CTD leaving employment, reducing the apparent CTD rate in experienced workers.

Pain management programs in hand therapy: a literature review and appraisal

This article analyzes literature on pain management programs in hand therapy. Philosophical and practical issues that may influence the approach to pain are reviewed. Possible explanations for the relative lack of interdisciplinary/comprehensive approaches to pain are put forth. Conditions under which more comprehensive treatment should be considered are discussed.