Evaluation of a passive exoskeleton for static upper limb activities.

The aim of this study was to evaluate the effect of a passive upper body exoskeleton on muscle activity, perceived musculoskeletal effort, local perceived pressure and subjective usability for a static overhead task. Eight participants (4 male, 4 female) held a load (0 kg and 2 kg) three times overhead for a duration of 30 s each, both with and without the exoskeleton. Muscle activity was significantly reduced for the Biceps Brachii (49%) and Medial Deltoid (62%) by the device for the 2 kg load. Perceived effort of the arms was significantly lower with the device for the 2 kg load (41%). The device did not have a significant effect on trunk or leg muscle activity (for the 2 kg load) or perceived effort. Local perceived pressure was rated below 2 (low pressure levels) for all contact areas assessed. Half of the participants rated the device usability as acceptable. The exoskeleton reduced muscle activity and perceived effort by the arms, and had no significant negative effect on the trunk and lower body with regards to muscle activity, perceived effort and localised discomfort.

Assessment of an active industrial exoskeleton to aid dynamic lifting and lowering manual handling tasks.

The aim of this study was to evaluate the effect of an industrial exoskeleton on muscle activity, perceived musculoskeletal effort, measured and perceived contact pressure at the trunk, thighs and shoulders, and subjective usability for simple sagittal plane lifting and lowering conditions. Twelve male participants lifted and lowered a box of 7.5 kg and 15 kg, respectively, from mid-shin height to waist height, five times, both with and without the exoskeleton. The device significantly reduced muscle activity of the Erector Spinae (12%-15%) and Biceps Femoris (5%). Ratings of perceived musculoskeletal effort in the trunk region were significantly less with the device (9.5%-11.4%). The measured contact pressure was highest on the trunk (91.7 kPa-93.8 kPa) and least on shoulders (47.6 kPa-51.7 kPa), whereas pressure was perceived highest on the thighs (35-44% of Max LPP). Six of the users rated the device usability as acceptable. The exoskeleton reduced musculoskeletal loading on the lower back and assisted with hip extensor torque during lifting and lowering. Contact pressures fell below the Pain Pressure Threshold. Perceived pressure was not exceptionally high, but sufficiently high to cause discomfort if used for long durations.

Influence of Work Pace on Upper Extremity Kinematics and Muscle Activity in a Short-Cycle Repetitive Pick-and-Place Task.

OBJECTIVES: This study investigated the extent to which controlled changes in work pace in a cyclic pick-and-place task influence upper extremity kinematics and muscle activity, and whether an effect depends on working height. METHODS: Thirteen participants performed the task for 4 min at each of five work paces ranging from 8 to 12 cycles·min-1 in each of two experimental conditions where the hand was moved horizontally with an average upper arm elevation of 30° and 50°, respectively. For each work cycle, we calculated the average and standard deviation of the upper arm elevation angle and the activity of the trapezius and deltoid muscles, as well as the angular peak velocity. We summarized these seven variables by calculating averages across cycles and cycle-to-cycle variabilities. RESULTS: At 30° arm elevation, pace significantly influenced within-cycle angle variation, cycle-to-cycle variability of the average angle, angular peak velocity, and cycle-to-cycle variability of peak velocity. However, only angular peak velocity increased monotonically across all paces from 8 to 12 cycles·min-1). Average activity in the trapezius and the deltoid were the only muscle activity variables to increase consistently with pace. These effects of work pace did not change with working height. CONCLUSION: The present study did not find any consistent work pace effect on upper extremity kinematics and muscle activity, in spite of a comprehensive empirical basis compared to previous literature. While our results suggest that work pace may not be of critical concern in an occupational health context, we encourage further studies verifying or disproving this notion.

Is rotating between static and dynamic work beneficial for our fatigue state?

Shoulder disorders comprise a large part of work-related musculoskeletal disorders. Risk factors, such as repetitiveness and monotony, may cause muscle fatigue and be attenuated by task rotation. We investigated rotation between a dynamic box-lifting task and a relatively static pick-and-place task and aimed to determine whether (1) a high rotation frequency leads to less fatigue development than a low rotation frequency, and (2) a self-selected rotation frequency leads to less fatigue development than imposed rotation frequencies. Ten participants performed four one-hour rotation schedules: two low frequency rotation schedules rotating at 30min, one high frequency rotation schedule rotating every sixth minute, and a self-selected rotation schedule. Borg, SOFI and electromyography of Trapezius and Deltoid subparts served as fatigue indicators. We found significant signs of fatigue for most schedules regarding the Borg and SOFI ratings and the M. Trapezius pars Descendens. Task rotation frequency had no significant effect on any of the outcome parameters, whereas the self-selected rotation schedule clearly resulted in less development of perceived fatigue than imposed schedules. In conclusion, we think that freedom of rotation has the greatest potential to attenuate potential development of musculoskeletal disorders and we require due caution with the use and interpretation of EMG indicators of fatigue.

The effects of a passive exoskeleton on muscle activity, discomfort and endurance time in forward bending work.

Exoskeletons may form a new strategy to reduce the risk of developing low back pain in stressful jobs. In the present study we examined the potential of a so-called passive exoskeleton on muscle activity, discomfort and endurance time in prolonged forward-bended working postures. Eighteen subjects performed two tasks: a simulated assembly task with the trunk in a forward-bended position and static holding of the same trunk position without further activity. We measured the electromyography for muscles in the back, abdomen and legs. We also measured the perceived local discomfort. In the static holding task we determined the endurance, defined as the time that people could continue without passing a specified discomfort threshold. In the assembly task we found lower muscle activity (by 35-38%) and lower discomfort in the low back when wearing the exoskeleton. Additionally, the hip extensor activity was reduced. The exoskeleton led to more discomfort in the chest region. In the task of static holding, we observed that exoskeleton use led to an increase in endurance time from 3.2 to 9.7 min, on average. The results illustrate the good potential of this passive exoskeleton to reduce the internal muscle forces and (reactive) spinal forces in the lumbar region. However, the adoption of an over-extended knee position might be, among others, one of the concerns when using the exoskeleton.

Towards exposure limits for working postures and musculoskeletal symptoms - a prospective cohort study.

Occupational postures are considered to be an important group of risk factors for musculoskeletal pain. However, the exposure-outcome association is not clear yet. Therefore, we aimed to determine the exposure-outcome association of working postures and musculoskeletal symptoms. Also, we aimed to establish exposure limits for working postures. In a prospective cohort study among 789 workers, intensity, frequency and duration of postures were assessed at baseline using observations. Musculoskeletal pain was assessed cross-sectionally and longitudinally and associations of postures and pain were addressed using logistic regression analyses. Cut-off points were estimated based on ROC-curve analyses. Associations were found for kneeling/crouching and low-back pain, neck flexion and rotation and neck pain, trunk flexion and low-back pain, and arm elevation and neck and shoulder pain. The results provide insight into exposure-outcome relations between working postures and musculoskeletal symptoms as well as evidence-based working posture exposure limits that can be used in future guidelines and risk assessment tools. Practitioner Summary: Our study gives insight into exposure-outcome associations of working postures and musculoskeletal symptoms (kneeling/crouching and low-back pain, neck flexion/rotation and neck pain, trunk flexion and low-back pain, and arm elevation and neck and shoulder pain). Results furthermore deliver evidence-based postural exposure limits that can be used in guidelines and risk assessments.

Exoskeletons for industrial application and their potential effects on physical work load.

The aim of this review was to provide an overview of assistive exoskeletons that have specifically been developed for industrial purposes and to assess the potential effect of these exoskeletons on reduction of physical loading on the body. The search resulted in 40 papers describing 26 different industrial exoskeletons, of which 19 were active (actuated) and 7 were passive (non-actuated). For 13 exoskeletons, the effect on physical loading has been evaluated, mainly in terms of muscle activity. All passive exoskeletons retrieved were aimed to support the low back. Ten-forty per cent reductions in back muscle activity during dynamic lifting and static holding have been reported. Both lower body, trunk and upper body regions could benefit from active exoskeletons. Muscle activity reductions up to 80% have been reported as an effect of active exoskeletons. Exoskeletons have the potential to considerably reduce the underlying factors associated with work-related musculoskeletal injury. Practitioner Summary: Worldwide, a significant interest in industrial exoskeletons does exist, but a lack of specific safety standards and several technical issues hinder mainstay practical use of exoskeletons in industry. Specific issues include discomfort (for passive and active exoskeletons), weight of device, alignment with human anatomy and kinematics, and detection of human intention to enable smooth movement (for active exoskeletons).

Task variation during simulated, repetitive, low-intensity work--influence on manifestation of shoulder muscle fatigue, perceived discomfort and upper-body postures.

Work-related musculoskeletal disorders are increasing due to industrialisation of work processes. Task variation has been suggested as potential intervention. The objectives of this study were to investigate, first, the influence of task variation on electromyographic (EMG) manifestations of shoulder muscle fatigue and discomfort; second, noticeable postural shoulder changes over time; third, if the association between task variation and EMG might be biased by postural changes. Outcome parameters were recorded using multichannel EMG, Optotrak and the Borg scale. Fourteen participants performed a one-hour repetitive Pegboard task in one continuous and two interrupted conditions with rest and a pick-and-place task, respectively. Manifestations of shoulder muscle fatigue and discomfort feelings were observed throughout the conditions but these were not significantly influenced by task variation. After correction for joint angles, the relation between task variation and EMG was significantly biased but significant effects of task variation remained absent. PRACTITIONER SUMMARY: Comparing a one-hour continuous, repetitive Pegboard task with two interrupted conditions revealed no significant influences of task variation. We did observe that the relation between task variation and EMG was biased by posture and therefore advise taking account for posture when investigating manifestations of muscle fatigue in assembly tasks.

Validity and inter-observer reliability of subjective hand-arm vibration assessments.

Exposure to mechanical vibrations at work (e.g., due to handling powered tools) is a potential occupational risk as it may cause upper extremity complaints. However, reliable and valid assessment methods for vibration exposure at work are lacking. Measuring hand-arm vibration objectively is often difficult and expensive, while often used information provided by manufacturers lacks detail. Therefore, a subjective hand-arm vibration assessment method was tested on validity and inter-observer reliability. In an experimental protocol, sixteen tasks handling powered tools were executed by two workers. Hand-arm vibration was assessed subjectively by 16 observers according to the proposed subjective assessment method. As a gold standard reference, hand-arm vibration was measured objectively using a vibration measurement device. Weighted κ's were calculated to assess validity, intra-class-correlation coefficients (ICCs) were calculated to assess inter-observer reliability. Inter-observer reliability of the subjective assessments depicting the agreement among observers can be expressed by an ICC of 0.708 (0.511-0.873). The validity of the subjective assessments as compared to the gold-standard reference can be expressed by a weighted κ of 0.535 (0.285-0.785). Besides, the percentage of exact agreement of the subjective assessment compared to the objective measurement was relatively low (i.e., 52% of all tasks). This study shows that subjectively assessed hand-arm vibrations are fairly reliable among observers and moderately valid. This assessment method is a first attempt to use subjective risk assessments of hand-arm vibration. Although, this assessment method can benefit from some future improvement, it can be of use in future studies and in field-based ergonomic assessments.

The influence of task variation on manifestation of fatigue is ambiguous - a literature review.

Task variation has been proposed to reduce shoulder fatigue resulting from repetitive hand-arm tasks. This review analyses the effect of task variation, both 'temporal (i.e. change of work-rest ratio)' and 'activity (i.e. job rotation)' variation, on physiological responses, endurance time (ET) and subjective feelings. Pubmed was searched and complemented with references from selected articles, resulting in 17 articles. Temporal variation had some positive effects on the objective parameters, as blood pressure decreased and ET increased, and on the subjective feelings, as perceived discomfort decreased. The observed findings of activity variation showed both positive and negative effects of increased activity variation, while hardly any effects were found on electromyography manifestations of fatigue. In conclusion, the evidence for positive effects of increasing the level of variation is scarce. The number of studies on variation is limited, while in most studies the findings were not controlled for the amount or intensity of work.

Movement strategy and performance in a high-volume order picking workstation.

The design of a work station generally prescribes a global movement pattern of the operator, but also leaving some degrees of freedom regarding movement strategy. For a specific order picking work station, we studied the movement strategies, the underlying factors and its impact on performance. Eight subjects performed a task comprising, the picking and placing of an object and pressing a button in eight conditions varying in product weight, movement direction (left vs. right), and placing distance. Movements were analyzed and cycle times were obtained from video-recordings. We observed various types of strategy regarding hand use and global placing mode (reaching vs. placing). The different strategies did not show clear relationships with performance (in contrast to the various work place factors). Ergonomically spoken, the fact that the workstation allows movement variation without loss of performance, is favorable.

Manifestations of shoulder fatigue in prolonged activities involving low-force contractions.

Shoulder fatigue has been suggested to be a useful risk indicator for shoulder disorders in repetitive, low-force work tasks. In contrast to high-force or purely isometric tasks, it is unclear whether measurable fatigue develops in realistic low-force work. The question addressed in this review was: 'Is there evidence of objective signs of fatigue in the shoulder region in realistic, low-force work tasks?' Studies on objective measures of fatigue applied in realistic low-force work tasks were systematically reviewed, using a task duration of more than 1 h and an intensity level of less than 20% maximum voluntary contraction (MVC) for the median trapezius activation level as inclusion criteria. Thirteen studies were found to fulfil the criteria. All these studies addressed fatigue-related changes in the electromyographic signal in the descending part of the trapezius muscle. Seven did find a combination of frequency decrease and amplitude increase over time, which is generally considered as an objective manifestation of fatigue. Thus, there is evidence of objective signs of fatigue in some of the realistic, low-force tasks. The intensity level appeared to be a main determinant here. In the studies demonstrating signs of fatigue an intensity level of 15%MVC or more was used, while the intensity level in the studies with a negative result was generally lower.

Ergonomics and safety of manual bag sealing.

A variety of seals is used to close bags. Each seal has advantages and disadvantages. For shop assistants sealing bags could be a repetitive physically demanding action. Opening and closing the bags again can cause some discomfort or annoyance for consumers. Besides, it is an activity which can endanger safety, i.e., knives being used in opening, children swallowing the systems of sealing. To prevent these problems a new sealing system was developed. In this paper the opinion of shop assistants, consumers and experts on several bag sealing systems was studied. It appeared that for sealing plastic bags, adhesive tape with paper is the best out of 4 systems, closely followed by adhesive tape. It is discussed that for the elderly, there is still room for improvement in opening bag seals.

Foot positioning instruction, initial vertical load position and lifting technique: effects on low back loading.

This study investigated the effects of initial load height and foot placement instruction in four lifting techniques: free, stoop (bending the back), squat (bending the knees) and a modified squat technique (bending the knees and rotating them outward). A 2D dynamic linked segment model was combined with an EMG assisted trunk muscle model to quantify kinematics and low back loading in 10 subjects performing 19 different lifting movements, using 10.5 kg boxes without handles. When lifting from a 0.05 m height with the feet behind the box, squat lifting resulted in 19.9% (SD 8.7%) higher net moments (p < 0.001) and 17.0% (SD 13.2%) higher compression forces (p < 0.01) than stoop lifting. This effect was reduced to 12.8% (SD 10.7%) for moments and a non-significant 7.4% (SD 16.0%) for compression forces when lifting with the feet beside the box and it disappeared when lifting from 0.5 m height. Differences between squat and stoop lifts, as well as the interaction with lifting height, could to a large extent be explained by changes in the horizontal L5/S1 intervertebral joint position relative to the load, the upper body acceleration, and lumbar flexion. Rotating the knees outward during squat lifts resulted in moments and compression forces that were smaller than in squat lifting but larger than in stoop lifting. Shear forces were small ( < 300 N) at the L4/L5 joint and substantial (1100 - 1400 N) but unaffected by lifting technique at the L5/S1 joint. The present results show that the effects of lifting technique on low back loading depend on the task context.