Biomechanical Effects of Using a Passive Exoskeleton for the Upper Limb in Industrial Manufacturing Activities: A Pilot Study.

This study investigates the biomechanical impact of a passive Arm-Support Exoskeleton (ASE) on workers in wool textile processing. Eight workers, equipped with surface electrodes for electromyography (EMG) recording, performed three industrial tasks, with and without the exoskeleton. All tasks were performed in an upright stance involving repetitive upper limbs actions and overhead work, each presenting different physical demands in terms of cycle duration, load handling and percentage of cycle time with shoulder flexion over 80°. The use of ASE consistently lowered muscle activity in the anterior and medial deltoid compared to the free condition (reduction in signal Root Mean Square (RMS) -21.6% and -13.6%, respectively), while no difference was found for the Erector Spinae Longissimus (ESL) muscle. All workers reported complete satisfaction with the ASE effectiveness as rated on Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), and 62% of the subjects rated the usability score as very high (>80 System Usability Scale (SUS)). The reduction in shoulder flexor muscle activity during the performance of industrial tasks is not correlated to the level of ergonomic risk involved. This preliminary study affirms the potential adoption of ASE as support for repetitive activities in wool textile processing, emphasizing its efficacy in reducing shoulder muscle activity. Positive worker acceptance and intention to use ASE supports its broader adoption as a preventive tool in the occupational sector.

Wearable Sensors and Artificial Intelligence for Physical Ergonomics: A Systematic Review of Literature.

Physical ergonomics has established itself as a valid strategy for monitoring potential disorders related, for example, to working activities. Recently, in the field of physical ergonomics, several studies have also shown potential for improvement in experimental methods of ergonomic analysis, through the combined use of artificial intelligence, and wearable sensors. In this regard, this review intends to provide a first account of the investigations carried out using these combined methods, considering the period up to 2021. The method that combines the information obtained on the worker through physical sensors (IMU, accelerometer, gyroscope, etc.) or biopotential sensors (EMG, EEG, EKG/ECG), with the analysis through artificial intelligence systems (machine learning or deep learning), offers interesting perspectives from both diagnostic, prognostic, and preventive points of view. In particular, the signals, obtained from wearable sensors for the recognition and categorization of the postural and biomechanical load of the worker, can be processed to formulate interesting algorithms for applications in the preventive field (especially with respect to musculoskeletal disorders), and with high statistical power. For Ergonomics, but also for Occupational Medicine, these applications improve the knowledge of the limits of the human organism, helping in the definition of sustainability thresholds, and in the ergonomic design of environments, tools, and work organization. The growth prospects for this research area are the refinement of the procedures for the detection and processing of signals; the expansion of the study to assisted working methods (assistive robots, exoskeletons), and to categories of workers suffering from pathologies or disabilities; as well as the development of risk assessment systems that exceed those currently used in ergonomics in precision and agility.

Exergame for the functional rehabilitation of adults over 55 with neurological diseases.

SUMMARY: Rehabilitation based on Exergame is showing a rapid evolution, with interesting applications for the recovery of mobility, balance, postural control, coordination and fine motor skills, and including home-based training. At present, there are no precise indications for Exergamebased rehabilitation of people over 55 affected by stroke, Parkinson's disease, or multiple sclerosis. This review examines the proposed modalities and the effectiveness of Exergame-based rehabilitation interventions for adults over 55 with stroke, Parkinson's disease or multiple sclerosis, highlighting the limitations, advantages, controversies and impact of this approach. We examined randomized controlled trials published between 2016-2020, with search in the databases of PubMed, Scopus, Cochrane Library, RehabData, selecting 24 studies. The study of patients with chronic or subacute stroke in outpatient treatment, and with small sample sizes, prevails. Wide variability characterizes the rehabilitation methods, the technological platforms used, the type and dose of exercise administered, the outcome measures. The adequacy and efficacy of Exergames remains uncertain in the neurological elderly, and the functional improvement in the neurological adult patient is not yet attested using this type of approach.

A Logistic Regression Model for Biomechanical Risk Classification in Lifting Tasks.

Lifting is one of the most potentially harmful activities for work-related musculoskeletal disorders (WMSDs), due to exposure to biomechanical risk. Risk assessment for work activities that involve lifting loads can be performed through the NIOSH (National Institute of Occupational Safety and Health) method, and specifically the Revised NIOSH Lifting Equation (RNLE). Aim of this work is to explore the feasibility of a logistic regression model fed with time and frequency domains features extracted from signals acquired through one inertial measurement unit (IMU) to classify risk classes associated with lifting activities according to the RNLE. Furthermore, an attempt was made to evaluate which are the most discriminating features relating to the risk classes, and to understand which inertial signals and which axis were the most representative. In a simplified scenario, where only two RNLE variables were altered during lifting tasks performed by 14 healthy adults, inertial signals (linear acceleration and angular velocity) acquired using one IMU placed on the subject's sternum during repeated rhythmic lifting tasks were automatically segmented to extract several features in the time and frequency domains. The logistic regression model fed with significant features showed good results to discriminate "risk" and "no risk" NIOSH classes with an accuracy, sensitivity and specificity equal to 82.8%, 84.8% and 80.9%, respectively. This preliminary work indicated that a logistic regression model-fed with specific inertial features extracted by signals acquired using a single IMU sensor placed on the sternum-is able to discriminate risk classes according to the RNLE in a simplified context, and therefore could be a valid tool to assess the biomechanical risk in an automatic way also in more complex conditions (e.g., real working scenarios).

Participatory ergonomics for the reduction of musculoskeletal exposure of maintenance workers.

Exposure to musculoskeletal disorders (MSDs) is a prevalent risk among those working in the maintenance of machinery and equipment for industry. Participatory ergonomics (PE) in the workplace embodies a solid strategy for the implementation of MSD prevention programs. This practical case describes a PE project implemented to improve MSD prevention strategies for the safety of maintenance workers. Experienced workers and maintenance workers employed in an Italian company for the industrial processing of wool have been actively involved in the risk assessment, in the proposal of improvement interventions and in the proposal of new preventive strategies. Ergonomic training and guidance helped the workers to have a proactive role in the prevention process. PE can help in the preventive management of critical activities of maintenance, through the empowerment of workers, the identification of targeted and feasible solutions and by using ergonomics as a basis for improving health and safety at work.

Artificial Neural Network Analyzing Wearable Device Gait Data for Identifying Patients With Stroke Unable to Return to Work.

A potential dramatic effect of long-term disability due to stroke is the inability to return to work. An accurate prognosis and the identification of the parameters inflating the possibility of return to work after neurorehabilitation are crucial. Many factors may influence it, such as mobility and, in particular, walking ability. In this pilot study, two emerging technologies have been combined with the aim of developing a prognostic tool for identifying patients able to return to work: a wearable inertial measurement unit for gait analysis and an artificial neural network (ANN). Compared with more conventional statistics, the ANN showed a higher accuracy in identifying patients with respect to healthy subjects (90.9 vs. 75.8%) and also in identifying the subjects unable to return to work (93.9 vs. 81.8%). In this last analysis, the duration of double support phase resulted the most important input of the ANN. The potentiality of the ANN, developed also in other fields such as marketing on social networks, could allow a powerful support for clinicians that today should manage a large amount of instrumentally recorded parameters in patients with stroke.

Work-Related Risk Assessment According to the Revised NIOSH Lifting Equation: A Preliminary Study Using a Wearable Inertial Sensor and Machine Learning.

Many activities may elicit a biomechanical overload. Among these, lifting loads can cause work-related musculoskeletal disorders. Aspiring to improve risk prevention, the National Institute for Occupational Safety and Health (NIOSH) established a methodology for assessing lifting actions by means of a quantitative method based on intensity, duration, frequency and other geometrical characteristics of lifting. In this paper, we explored the machine learning (ML) feasibility to classify biomechanical risk according to the revised NIOSH lifting equation. Acceleration and angular velocity signals were collected using a wearable sensor during lifting tasks performed by seven subjects and further segmented to extract time-domain features: root mean square, minimum, maximum and standard deviation. The features were fed to several ML algorithms. Interesting results were obtained in terms of evaluation metrics for a binary risk/no-risk classification; specifically, the tree-based algorithms reached accuracies greater than 90% and Area under the Receiver operating curve characteristics curves greater than 0.9. In conclusion, this study indicates the proposed combination of features and algorithms represents a valuable approach to automatically classify work activities in two NIOSH risk groups. These data confirm the potential of this methodology to assess the biomechanical risk to which subjects are exposed during their work activity.

A multiple linear regression approach to extimate lifted load from features extracted from inertial data.

SUMMARY: Work-related musculoskeletal disorders are among the main occupational health problems. Substantial evidence has shown that work-related physical risk factors are the main source of low back complaints, particularly affecting heavy and repetitive manual lifting activities. The aim of the study is, during load lifting tasks, to explore the correlation between the time domain features extracted from the acceleration and angular velocity signals of the performing subject and the load lifted, and to explore the feasibility of a multiple linear regression model to predict the lifted load. The acceleration and angular velocity signals were acquired along the three directions of space by means of an inertial sensor placed on the subject's chest, during lifting activities with load gradually increased by 1 kg from 0 kg to 18 kg. Successively three time-domain features (Root Mean Square, Standard Deviation and MinMax value) were extracted from the acquired signals. First a correlation analysis was carried out between each individual feature and the load lifted (calculating r); then the time-domain features that proved most representative (strong correlation) were used to create a multiple linear regression model (calculating R-square). The statistical analysis was carried out by means of the Pearson correlation and multiple linear regression model was fed with the most informative time-domain features according to the correlation analysis. The correlation analysis showed a strong correlation (r > 0,7) between six features (three extracted from z-axes acceleration and three extracted from y-axes angular velocity) and the lifted load. The predictive multiple linear regression model, fed with these six features achieved a Rsquare greater than 0,9.The study demonstrated that the proposed combination of kinematic features and a multiple regression model represents a valid approach to automatically calculate the load lifted based on raw signals obtained by means of an inertial sensor placed on the chest. The results confirm the potential application of this methodology to indirectly monitor the load lifted by workers during their activity.

Job preservation by an office worker with idiopathic cervical dystonia: case report.

BACKGROUND: Work preservation is a main goal in the rehabilitation of chronic disabling diseases. We describe the application of an interdisciplinary protocol, involving the occupational physician, the occupational therapist and the ergonomist, in the case of a 50 year-old office worker with idiopathic cervical dystonia, a movement disorder that can seriously impair work capability. CASE REPORT: The disease was diagnosed at age 25, and subsequently worsened. The man presented postural difficulties and pain. The symptomatology worsened during working shifts, preventing him from doing his job properly. Functional evaluation and ergonomic inspection of the office environment led to the correction of evident critical inadequacies. This allowed the patient to continue working in correct conditions, resulting in improvement of his global health status. CONCLUSIONS: The interdisciplinary rehabilitative approach here described may allow subjects with idiopathic cervical dystonia to keep their jobs by adapting the workplace to the changed physical capabilities.

Design and Validation of an E-Textile-Based Wearable Sock for Remote Gait and Postural Assessment.

This paper presents a new wearable e-textile based system, named SWEET Sock, for biomedical signals remote monitoring. The system includes a textile sensing sock, an electronic unit for data transmission, a custom-made Android application for real-time signal visualization, and a software desktop for advanced digital signal processing. The device allows the acquisition of angular velocities of the lower limbs and plantar pressure signals, which are postprocessed to have a complete and schematic overview of patient's clinical status, regarding gait and postural assessment. In this work, device performances are validated by evaluating the agreement between the prototype and an optoelectronic system for gait analysis on a set of free walk acquisitions. Results show good agreement between the systems in the assessment of gait cycle time and cadence, while the presence of systematic and proportional errors are pointed out for swing and stance time parameters. Worse results were obtained in the comparison of spatial metrics. The "wearability" of the system and its comfortable use make it suitable to be used in domestic environment for the continuous remote health monitoring of de-hospitalized patients but also in the ergonomic assessment of health workers, thanks to its low invasiveness.

Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation.

Cerebrovascular diseases, including stroke, are historically considered diseases of old adults so only in a few studies has "return to work" (RTW) been considered as an index of rehabilitative outcome. At the moment, data on RTW in patients with stroke are highly variable: four different reviews reported the following ranges: 11-85%, 19-73%, 22-53%, and 40-45%. The absence of re-integration to work after a stroke is shown to be associated with an increase of cardiac disorders and depression, with a higher level of mortality, with social isolation and with insufficient adaptive skills. The aim of this study was to verify the effectiveness of technological treatment, performed with optic (SonicHand) and wearable (Riablo™) systems providing auditory and visual biofeedback, on RTW in patients with stroke. RTW was found to be associated with a higher independence in the activities of daily living (assessed by the Modified Barthel Index). No significant differences were found between technological versus conventional rehabilitation in terms of RTW, despite the former showing a higher odds ratio than the latter (OR = 9 vs. 6). Assistive devices were mainly used in patients who had not returned to work. Finally, quality of life was found higher in those patients who returned to work with the same conditions (work duties and time) as before stroke.

[The ICD-ICF outpatient pathway in occupational therapy]. / Il percorso ambulatoriale ICD-ICF in terapia occupazionale.

SUMMARY: The Complex Ambulatory Macroactivity (MAC, Macroattività Ambulatoriale Complessa) has recently been included among the therapeutic and diagnostic Specialized Rehabilitation services issued by the Lombardy Region health institutes. Within Maugeri Scientific Clinical Institutes, our Occupational Physiatrics and Ergonomics Service is actively involved in the organic redefinition of rehabilitative pathways in the light of functional and patient-centered interpretation, typical of ICF (International Classification of Functioning). The article describes the assumptions, criteria and procedures that support the MAC system, proposing a modeling that can be inserted into the modern and complex system of health services.

[Active population aging, ICD-ICF clinical model and Occupational and Rehabilitation Medicine]. / Invecchiamento della popolazione attiva, modello clinico ICD-ICF e Medicina del lavoro e della Riabilitazione.

SUMMARY: The aging of the active population is more and more increasing in advanced western societies. This phenomenon also implies a constant increase in the average age of workers in various productive sectors, not least that of health. In this, in fact, alongside the known occupational risks, more and more frequently we are witnessing the emergence of chronic-degenerative pathologies connected with aging, even with symptoms that do not determine an unsuitability for work. In fact, within a scientific landscape accounting little evidence on the effectiveness of complex rehabilitation programs, the use of the ICD / ICF system in therapeutic programming should produce an important turning point, providing health professionals with a conceptual paradigm that supports both the functional assessment and the rational planning of therapeutic interventions, also contributing to the advancement of specialist knowledge. The present work shows how an effective collaboration between occupational physicians and rehabilitation specialists can effectively participate in the evaluation of the patient / worker even in the elderly, with particular regard to the return to work, taking full advantage of the classification and diagnostic tools implemented in the ICD and ICF systems.

[Physical activity, tool for the prevention and management of chronic diseases]. / Attività fisica, strumento di prevenzione e gestione delle malattie croniche.

OBJECTIVES: Physical activity is a key element in the prevention, treatment and rehabilitation of many diseases. METHODS: In the context of an adequate lifestyle, its practice amplifies the health benefits and increases the fitness, and furthermore counteracts the development and progression of chronic non-communicable diseases, modulating many risk factors. Its function is important in all life cycles and helps to keep the functional capabilities and independence even with aging. RESULTS: While inadequate physical activity (due to a sedentary lifestyle) is currently the fourth leading cause of mortality in developed countries, being one of the main public health issues, strong scientific evidences show that a regular and sufficient dose of physical activity reduces by about 30% the risk of premature death, cardiovascular disease and stroke, type II diabetes, colon and breast cancer, depression. CONCLUSIONS: Several guidelines and recommendations define the type, intensity, frequency and duration of physical activity, and many lifestyle preventative interventions prove its effectiveness and sustainability. Although so far a minority of the population actually adheres to the recommendations, the epidemiological strenght of lifestyle-oriented programs is considerable: quitting sedentariness, even low doses of physical activity are protective for health and reduce by about 22 % the risk of premature death. Physical activity is also an important therapeutic tool for patients with cardiovascular diseases, hypertension, diabetes II, cancer, chronic obstructive pulmonary diseases; an appropriate dosage reduces the risk of recurrence and disease progression, improves the control of clinical parameters and increases the patient's quality of life.

Active music therapy approach for stroke patients in the post-acute rehabilitation.

Guidelines in stroke rehabilitation recommend the use of a multidisciplinary approach. Different approaches and techniques with music are used in the stroke rehabilitation to improve motor and cognitive functions but also psychological outcomes. In this randomized controlled pilot trial, relational active music therapy approaches were tested in the post-acute phase of disease. Thirty-eight hospitalized patients with ischemic and hemorrhagic stroke were recruited and allocated in two groups. The experimental group underwent the standard of care (physiotherapy and occupational therapy daily sessions) and relational active music therapy treatments. The control group underwent the standard of care only. Motor functions and psychological aspects were assessed before and after treatments. Music therapy process was also evaluated using a specific rating scale. All groups showed a positive trend in quality of life, functional and disability levels, and gross mobility. The experimental group showed a decrease of anxiety and, in particular, of depression (p = 0.016). In addition, the strength of non-dominant hand (grip) significantly increased in the experimental group (p = 0.041). Music therapy assessment showed a significant improvement over time of non-verbal and sonorous-music relationships. Future studies, including a greater number of patients and follow-up evaluations, are needed to confirm promising results of this study.

Spinal load in nurses during emergency lifting of obese patients: preliminary results.

BACKGROUND: Nurses are exposed to the risk of injury while handling patients. This is particularly true for obese patients. OBJECTIVE: The goal of this paper is to estimate the spinal loads and the related risk of injury to nurses while lifting obese patients from the floor with a bariatric sheet during a hospital emergency. METHODS: Six male nurses participated in this study. The biomechanical analysis focused on the lifting strategy. Thirty obese in-patients were enrolled to take part in the experimental study and divided into three groups according to their Body Mass Index (BMI). Three-dimensional motion analysis was conducted using an optoelectronic system. The trunk kinematics and the loading on the spines of the operating nurses were computed. RESULTS: Our data showed that when the nurse was operating from the central handle, his trunk was more flexed at the end of the lift with a reduced range of motion. The values were higher when the nurse lifted patients with higher BMIs. All kinetic parameters and tension in the lumbar muscles at the end of the movement were characterised by lower values for the nurse placed beside the patient's head or feet if compared to the operator positioned beside the central handle in all patient groups. CONCLUSIONS: Our preliminary data suggest that only the reaction load on the spine of the nurse holding the central handle, closest to the patient's centre of mass, seems to exceed the recommended safety limits.

[Not Available]. / Il rischio posturale lavorativo e i disturbi agli arti inferiori.

The working posture is part of the risk factors for the development of muscle-skeletal disorders. Compared to postural problems of the trunk and upper limbs, those related to the lower limbs have been so far undervalued in the context of preventive medicine and ergonomics. The risk assessment tools for the lower limbs posture are inhomogeneous and incomplete. The classification of postures, the quantification of the risk, the correlation with organizational and individual aspects, and interventions for the prevention and management of the risk are aspects yet to be explored.

[Criteria of the OCRA method in evaluating the structural assembly of aircrafts: preliminary data]. / Criteri applicativi del metodo OCRA nella valutazione dell'assemblaggio strutturale degli aeromobili: dati preliminari.

In the aircraft productive sector, the risk assessment of repetitive occupational activities through the OCRA method presents some major obstacles: - high number of different tasks (more than 20) carried out during the work shift. - definite identification of the number of technical actions per cycle. Risk assessment through the traditional OCRA method provides in this sector a index which varies according to the sampling of the occupational tasks, rather than reflecting the effective risk level. The study raises an OCRA-based method which is applicable in the aircraft production sector and defines the overall ergonomic load for homogeneous groups of exposed workers, based on production data specified for each aircraft model.

[Role of occupational rehabilitation therapy in returning to work: experimental experience]. / Ruolo della terapia riabilitativa occupazionale nel reinserimento al lavoro: esperienze sperimentali.

The experimental experience is the result of combining cultural, clinical and scientific interest in rehabilitative, occupational and forensic mnedicine and in ergonomics. It deals with the rehabilitation and return at work of patients with physical disabilities caused by occupational trauma or disease. The programme described starts with a selection by INAIL and involves with an outpatient surgery inclusion. It is composed of: preliminary physical examination, functional assessment, the formulation of a rehabilitation plan and its successive implementation. At the end of the evaluation plan, there is a final assessment to identify outcome indicators and residual functional and work capacity.