Evaluating a prototype device designed to alleviate night vision goggle induced neck strain among military personnel.

The purpose of this study was verify the design of a novel Helmet System Support Device (HSSD) that can be used by military aircrew to help intervene on and reduce the high prevalence of neck trouble. Twelve healthy participants repeated simulated helicopter aircrew tasks on 3 separate days. On each day they wore a different helmet configuration, where measures of performance, perceived demand/preference and muscular demand were recorded. The results showed that vigilance tasks were performed over 10% faster with the HSSD configuration compared to wearing the normal helmet configuration. Participants were able to maintain static (endurance) postures for 28% longer, and use of the HSSD helped to prevent neck muscle fatigue in the most demanding task. The results of this design verification study indicate that the HSSD may be a realistic, feasible near-term solution to intervene on the high prevalence of neck trouble among rotary-wing aircrew. Practitioner Summary: This paper verifies the effectiveness of the Helmet System Support Device (HSSD) as an on-body personal protective device to help control exposures associated with aircrew neck trouble. The HSSD reduced perceived demand, reduced cumulative muscle activity in select muscles and provided improved fatigue resistance, meeting its desired design objectives.

A dynamical systems analysis of assisted and unassisted anterior and posterior hand-held load carriage.

Load carriage is recognised as a primary occupational factor leading to slip and fall injuries, and therefore assessing balance maintenance during such tasks is critical in assessing injury risk. Ten males completed 55 strides under five carriage conditions: (1) unassisted anterior, (2) unassisted posterior, (3) assisted anterior, (4) assisted posterior and (5) unloaded gait (UG). Kinematic data were recorded from markers affixed to landmarks on the right side of each participant, in order to calculate segment angles for the foot, shank, thigh and pelvis. Continuous relative phase (CRP) variability was calculated for each segment pair and local dynamic stability was calculated for each segment in all three movement planes. In general, irrespective of the assistive device or movement plane, anterior load carriage was most stable (lower CRP variability and maximum finite-time Lyapunov exponents). Moreover, load carriage was less dynamically stable than UG, displaying the importance of objectively investigating safe load carriage practices. PRACTITIONER SUMMARY: Dynamical systems analyses were used to comprehensively evaluate the stability of various handheld load carriage methods. In general, anterior load carriage was significantly more stable than posterior load carriage,Mover's assistive device had small but beneficial effects on stability, and load carriage was less stable than UG.

Ascertaining maximal voluntary effort production during isokinetic knee strength testing of anterior cruciate ligament-reconstructed patients.

OBJECTIVE: The aim of this study was to assess the performance of prediction rules meant for declaration of efforts as being maximal or not during isokinetic strength testing in a cohort that underwent anterior cruciate ligament reconstruction. DESIGN: Thirty-six individuals performed four sets of six reciprocal concentric knee extension/flexion repetitions at a testing speed of 60 degrees per second through a 60-degree range of motion. The sets consisted of a maximal voluntary effort, two nonmaximal sincere efforts at 50% and 75% of self-perceived maximum, and a set attempting to feign or exaggerate thigh muscle strength deficiencies. Strength curve derived set internal consistency measures, namely, cross-correlation and percent root mean square difference scores, were inputted into the prediction rules, whose performance is reported as specificity and sensitivity percentages. RESULTS: Dependent on the prediction rule used and when expressed on an individual participant basis, the corresponding specificity and sensitivity values ranged from 66.6% to 97.2% and 97.2% to 94.4%, respectively. CONCLUSIONS: Using the prediction rules presented in this investigation, clinicians may be able to ascertain maximal effort production during isokinetic testing in those who have undergone surgical reconstruction of their anterior cruciate ligament.

Principal component modeling of isokinetic moment curves for discriminating between the injured and healthy knees of unilateral ACL deficient patients.

Bilateral knee strength evaluations of unilateral anterior cruciate ligament (ACL) deficient patients using isokinetic dynamometry are commonly performed in rehabilitation settings. The most frequently-used outcome measure is the peak moment value attained by the knee extensor and flexor muscle groups. However, other strength curve features may also be of clinical interest and utility. The purpose of this investigation was to identify, using Principal Component Analysis (PCA), strength curve features that explain the majority of variation between the injured and uninjured knee, and to assess the capabilities of these features to detect the presence of injury. A mixed gender cohort of 43 unilateral ACL deficient patients performed 6 continuous concentric knee extension and flexion repetitions bilaterally at 60°s(-1) and 180°s(-1) within a 90° range of motion. Moment waveforms were analyzed using PCA, and binary logistic regression was used to develop a discriminatory decision rule. For all directions and speeds, a statistically significant overall reduction in strength was noted for the involved knee in comparison to the uninvolved knee. The discriminatory decision rule yielded a specificity and sensitivity of 60.5% and 60.5%, respectively, corresponding to an accuracy of ∼62%. As such, the curve features extracted using PCA enabled only limited clinical usefulness in discerning between the ACL deficient and contra lateral, healthy knee. Improvement in discrimination capabilities may perhaps be achieved by consideration of different testing speeds and contraction modes, as well as utilization of other data analysis techniques.

Looking forward by looking back: Helping to reduce work-related musculoskeletal disorders.

Over my career I have been involved in research covering three different strategies to reduce workplace injuries, namely: (a) developing bona fide occupational requirements for physically demanding jobs, (b) conducting training programs and a case-control study of low back pain in industry, and (c) developing ergonomically-designed equipment and tools. The purpose of this paper is to identify some areas where I believe research is needed to reduce the risks of musculoskeletal disorders. Hopefully, new researchers will pick up the torch on some of these topics and continue to enhance the impact of occupational biomechanics and ergonomics on improving jobs for workers.

Subjective and objective analysis of three water pump systems carried by forest firefighters.

BACKGROUND: The Mark 3 (M3) water power pump is an integral piece of wildfire fighting equipment. However, it is provided to fire stations without a carrying harness. The currently-used carrying harness is very uncomfortable, especially when carrying the pumps considerable distance in a forest to reach a water source. OBJECTIVE: The purpose of this study was to advise the Ontario Ministry of Natural Resources on the selection of a new M3 load carriage system. PARTICIPANTS: Twenty Fire Rangers wore the three systems (Original, Prototype, and Modified) through a circuit of tasks representative of their working environment. METHODS: Subjective and objective approaches were combined to assess and rank the M3 carriage systems. Subjective visual analogue scale ratings were obtained for ease of loading/unloading, comfort, system stability, and overall performance. Tri-axial accelerometers were mounted on each pump and at the sternum of each participant to determine relative pump-carrier accelerations. RESULTS: Overall, the Prototype was ranked as the best system; it resulted in the lowest relative pump-carrier accelerations on 10 out of 15 objective measures, and also received a first place ranking on all subjective measures. CONCLUSION: It was recommended that the Prototype be implemented as the M3 carriage system for fire suppression teams.

Interpreting principal components in biomechanics: representative extremes and single component reconstruction.

Principal component analysis is a powerful tool in biomechanics for reducing complex multivariate datasets to a subset of important parameters. However, interpreting the biomechanical meaning of these parameters can be a subjective process. Biomechanical interpretations that are based on visual inspection of extreme 5th and 95th percentile waveforms may be confounded when extreme waveforms express more than one biomechanical feature. This study compares interpretation of principal components using representative extremes with a recently developed method, called single component reconstruction, which provides an uncontaminated visualization of each individual biomechanical feature. Example datasets from knee joint moments, lateral gastrocnemius EMG, and lumbar spine kinematics are used to demonstrate that the representative extremes method and single component reconstruction can yield equivalent interpretations of principal components. However, single component reconstruction interpretation cannot be contaminated by other components, which may enhance the use and understanding of principal component analysis within the biomechanics community.

The effect of an on-body assistive device on transverse plane trunk coordination during a load carriage task.

Load carriage is a physically demanding task that is often required of employees in many different occupations. The Mover's Assistive Device (MAD) is an on-body ergonomic assistive device designed to help professional movers transfer boxes during two techniques of hand-held load carriage: anterior carriage and posterior carriage. The purpose of this study was to examine the intersegment coordination between the trunk and pelvis as well as the trunk and box, since coordination may be a mechanism to reduce the amount of stress exerted on the back during load carriage. Thirteen males completed a hand-held load carriage task in a laboratory setting using two popular techniques employed by professional movers (anterior/posterior), with and without the assistance of the Mover's Assistive Device (MAD); resulting in a total of four conditions. Triads of retro-reflective markers tracked the angular positions of the trunk, pelvis and the load being carried. Intersegment coordination between the trunk-pelvis and the box-trunk were measured using continuous relative phase angles in the transverse plane of motion. No trunk coordination differences were observed across carrying techniques (anterior/posterior); however, under all conditions users walked with a near in-phase coordination pattern, which is believed to help reduce the risk of injury. MAD use resulted in decreased perceived discomfort and more in-phase coordination between the trunk-pelvis, which may help reduce injury risk when carrying loads either anteriorly or posteriorly.

Interjoint coordination and the personal lift-assist device.

It has been suggested that interjoint coordination may serve to reduce joint stress and muscular demand and to maintain balance during dynamic lifting tasks, thus having implications for safe lifting practices. Before recommending the use of an on-body ergonomic aid, the Personal Lift-Assist Device (PLAD), it is important to determine any effects this device may have on interjoint coordination. Principal component analyses were applied to relative phase angle waveforms, defining the hip-knee and lumbar spine-hip coordination of 15 males and 15 females during a repetitive lifting task. When wearing the PLAD, users lifted with more synchronous hip-knee and lumbar spine-hip coordination patterns (P < .01). Furthermore, increases in load caused less synchronized interjoint coordination at both the hip-knee and lumbar spine-hip during the up and down phases of the lift (P < .01) for all conditions. No significant main effects of sex or significant interactions were observed on any of the outcome variables.

Reproducibility of isokinetic knee eccentric and concentric strength indices in asymptomatic young adults.

OBJECTIVE: To assess the reproducibility of isokinetic eccentric and concentric knee extension and flexion strength indices obtained at two different angular velocities. DESIGN: Cohort study. SETTING: University human performance laboratory. PARTICIPANTS: 45 healthy physically active young adults (25 males). MAIN OUTCOME MEASURES: A non reciprocal protocol of concentric and eccentric contractions of the knee extensors and flexors was performed at 30 and 120°/s. Strength indices evaluated included peak moment; dynamic control ratios; and the difference between eccentric and concentric ratio at the two angular velocities. RESULTS: No evidence for inter-test bias in any of the strength indices was noted. Measurement precision for peak moment, as quantified using ratio limits of agreement, suggest that scores may be expected to vary up to 15% for the knee extensors in both eccentric and concentric contraction modes. An error of up to 19% was calculated for the peak moment scores of the knee flexors. Intraclass correlation coefficients revealed fairly robust preservation of participants' rank order for the majority of strength indices (>0.85). CONCLUSION: Isokinetic-related indices of knee muscles performance enable an acceptable level of detection of expected changes in muscular strength parameters as a result of planned interventions.

The effect of perspiration on the sEMG amplitude and power spectrum.

Sweat accumulation underneath surface EMG (sEMG) electrodes is a common problem in workplace studies which compromises electrode adherence to the skin as well as signal fidelity. In this study, the effect of sweat accumulation on signal amplitude and mean frequency (MF) was examined to determine if the sEMG signal becomes altered through the sweat layer and whether this effect can be avoided by interrupting the pool of sweat using a thin strip of medical adhesive between the electrode snaps. Nine males performed a maximum, isometric contraction of their right quadriceps as sEMG was collected. Skin conditions under the electrode were dry and wet in incremental layers of 0.02 mm of artificial sweat. The results demonstrated that sweat accumulation under sEMG electrodes dampens the amplitude of the EMG signal in a predictable way (r = .88 and .97 for double and single snap electrodes, respectively) with almost 2% and 3% deterioration for every 0.02 mm of sweat depending on the type of electrode used. The medical adhesive proved to be highly effective at preventing amplitude deterioration indicating that signal shunting can be prevented. MF was not influenced by sweat accumulation even under the extreme wet condition.

Comparison of three strategies of trunk support during asymmetric two-handed reach in standing.

No trunk support (NTS) was compared to a lower trunk support (LTS) of leaning against a worktable and a dynamic upper trunk support (UTS) using postural kinematics, trunk extensor muscle activity and subjective rating of both comfort and effort. Ten females completed 3 repetitions where they lifted 0 and 5 kg load from a symmetrical position at hip-height to a 45° asymmetric position at: i) hip-height and ii) shoulder-height. Human motion capture showed trunk flexion decreased by 12° ± 10 with trunk support with hip-height reach. The table blocked axial rotation of the pelvis which was compensated by an additional 8° ± 6 rotation of the thoracic segment. Surface EMG of the lumbar erector spinae, contralateral to reach, showed the UTS to be almost twice as effective as the LTS with shoulder-height reach with a 30% ± 18 reduction. With hip-height reach, UTS resulted in a smaller reduction equal to 23% ± 27 while the LTS had no effect. Further investigation is needed to determine optimal performance parameters for trunk support with complex, dynamic trunk postures and whether altered kinematics arising from LTS have higher risk of upper back discomfort.

Local dynamic stability of trunk movements during the repetitive lifting of loads.

The local dynamic stability of trunk movements was assessed during repetitive lifting using nonlinear Lyapunov analyses. The goal was to assess how varying the load-in-hands affects the neuromuscular control of lumbar spinal stability. Thirty healthy participants (15M, 15F) performed repetitive lifting at 10 cycles per minute for three minutes under two load conditions: zero load and 10% of each participant's maximum back strength. Short- and long-term maximum finite-time Lyapunov exponents (λ(max-s) and λ(max-l)), describing responses to infinitesimally small perturbations, were calculated from the measured trunk kinematics to estimate the local dynamic stability of the system. Kinematic variability was also assessed using mean standard deviations (MeanSD) across cycles. The results of a mixed-design repeated-measures ANOVA showed that increasing the load lifted significantly reduced λ(max-s) (µ(0%-LOAD)=0.379, µ(10%-LOAD)=0.335, p<.001), but not λ(max-l) (µ(0%-LOAD)=0.46E-03, µ(10%-LOAD)=2.41E-03, p=.055) or MeanSD (µ(0%-LOAD)=2.57, µ(10%-LOAD)=2.89, p=.164). There were no between-subject effects of sex, or significant interactions (α<.05). The present findings indicated improved dynamic spinal stability when lifting the heavier load; meaning that as muscular and moment demands increased, so too did participants' abilities to respond to local perturbations. These results support the notion of greater spinal instability during movement with low loads due to decreased muscular demand and trunk stiffness, and should aid in understanding how lifting various loads contributes to occupational low back pain.

Discriminating between maximal and feigned isokinetic knee musculature performance using waveform similarity measures.

BACKGROUND: Muscle strength test outcomes may aid in determination of impairment or disability rating following injury. In such settings, verification of participant effort during testing is imperative. This investigation explored the utilization of within-set moment waveform similarity measures, namely cross correlation and percent root mean square difference scores, to develop decision rules for discriminating between maximal and feigned efforts during isokinetic testing of the knee joint musculature. METHODS: A mixed-gender sample of 46 participants performed non-reciprocal sets of maximal or feigned knee extension and flexion concentric and eccentric efforts at testing velocities of 30°s(-1) and 120°s(-1). Logistic regression and Monte Carlo simulations were used to derive decision rules for differentiating between the two effort types. FINDINGS: Employing cutoff scores corresponding to 100% specificity; sensitivities of the knee extensor's velocity-specific decision rules were 92.4% and 84.8%, respectively. The velocity-specific knee flexor's test sensitivities were 56.5% and 46.7%. INTERPRETATION: Utilizing the proposed decision rules, substantiating maximal effort performance of the knee extensors may be possible using this specific testing protocol. However, the proposed methods are limited in their ability to verify performance of maximal knee flexor efforts.

Differentiating between types and levels of isokinetic knee musculature efforts.

This investigation assessed whether a measure of moment curve shape similarity, and a measure quantifying curve magnitude differences, enables differentiation between types (sincere vs. feigned) and levels (maximal vs. submaximal) of effort exerted during isokinetic testing of the knee. Healthy participants (n=37) performed four sets of six concentric knee extension-flexion repetitions on two occasions. The sets consisted of: (1) maximal effort; (2) self-perceived 75% of maximal effort; (3) self-perceived 50% of maximal effort; and (4) a set attempting to feign injury. Average cross-correlation and percent root mean square difference values were computed between moment curves in each direction. Logistic regression was used to derive decision rules for differentiating between maximal and submaximal effort levels; and between sincere and feigned effort types. Using a cutoff criteria corresponding to 100% specificity, maximal effort production could be ascertained with 96% sensitivity within the sample. Feigned efforts, however, could be ascertained with only 31% sensitivity due to overlap with sincere submaximal effort. Using the proposed models, clinicians may be able to ascertain whether maximal efforts were produced during isokinetic knee musculature testing. Additionally, evidence regarding participant's intentions with regard to influencing test results may be gauged, although to a lesser extent.

Local dynamic stability of the lifting kinematic chain.

While a stable trunk and centre of mass (CoM) trajectory are required during lifting, it is unclear how stability is controlled. Thirty healthy participants (15M, 15F) performed repetitive, symmetric lifting at 10 cycles per minute for 3 min with a load-in-hands equivalent to 10% of their maximum back strength. Short- and long-term maximum finite-time Lyapunov exponents (λ(max-s) and λ(max-l)), describing responses to small (local) perturbations, estimated the local dynamic stability of the foot, shank, thigh, pelvis, lower back, and upper back segments. Instability (λ(max-s)) significantly increased when moving up the kinematic chain (p<0.001). Therefore, to maintain trunk equilibrium and accurately regulate CoM trajectory during lifting, stability of the distal (fixed) lower limb segments is prioritized. This is contrary to previous results observed during gait, indicating that trunk control via kinematic chain stability is accomplished differently for walking and lifting.

The personal lift-assist device and lifting technique: a principal component analysis.

The personal lift-assist device (PLAD) is a non-motorised, on-body device that acts as an external force generator using the concept of stored elastic energy. In this study, the effect of the PLAD on the lifting kinematics of male and female lifters was investigated using principal component analysis. Joint kinematic data of 15 males and 15 females were collected using an opto-electronic system during a freestyle, symmetrical-lifting protocol with and without wearing the PLAD. Of the 31 Principal Components (PCs) retained in the models, eight scores were significantly different between the PLAD and no-PLAD conditions. There were no main effects for gender and no significant interactions. Results indicated that the PLAD similarly affected the lifting kinematics of males and females; demonstrating significantly less lumbar and thoracic flexion and significantly greater hip and ankle flexion when wearing the PLAD. These findings add to the body of work that suggest the PLAD may be a safe and effective ergonomic aid. STATEMENT OF RELEVANCE: The PLAD is an ergonomic aid that has been shown to be effective at reducing low back demands during manual materials handling tasks. This body of work establishes that the PLAD encourages safe lifting practices without adversely affecting lifting technique.

Does the personal lift-assist device affect the local dynamic stability of the spine during lifting?

The personal lift-assist device (PLAD) is an on-body ergonomic aid that reduces low back physical demands through the restorative moment of an external spring element, which possesses a mechanical advantage over the erector spinae. Although the PLAD has proven effective at reducing low back muscular demand, spinal moments, and localized muscular fatigue during laboratory and industrial tasks, the effects of the device on the neuromuscular control of spinal stability during lifting have yet to be assessed. Thirty healthy subjects (15M, 15F) performed repetitive lifting for three minutes, at a rate of 10 lifts per minute, with and without the PLAD. Maximum finite-time Lyapunov exponents, representing short-term (λ(max-s)) and long-term (λ(max-l)) divergence were calculated from the measured trunk kinematics to estimate the local dynamic stability of the lumbar spine. Using a mixed-design repeated-measures ANOVA, it was determined that wearing the PLAD did not significantly change λ(max-s) (µ(NP)=0.335, µ(P)=0.321, p=0.225), but did significantly reduce λ(max-l) (µ(NP)=0.0024, µ(P)=-0.0011, p=0.014, η(2)=0.197). There were no between-subject effects of sex, or significant interactions (p>0.720). The present results indicated that λ(max-s) was not statistically different between the device conditions, but that the PLAD significantly reduced λ(max-l) to a negative (stable) value. This shows that subjects' neuromuscular systems were able to respond to local perturbations more effectively when wearing the device, reflecting a more stable control of spinal movements. These findings are important when recommending the PLAD for long-term industrial or clinical use.

Case study: a novel biomechanical approach for evaluating extended body armor systems.

To combat the devastating effects of improvised explosive devices (IEDs), body armor that provides extended coverage has been developed. However, this extended coverage increases the armor's weight and may restrict movement. Throughout this case study, a novel technique to assess several armor systems was investigated. Four soldiers performed shoulder and trunk movements while wearing each of the six different armor inserts. Electromyography (EMG) was used to quantify muscular activity and inertial motion sensors were used to determine joint range of motion (ROM). Outcome measures included maximum ROM, integrated EMG, and the soldiers' subjective rankings. For the shoulder tasks, objective ROM and EMG measures were related to each other as well as to subjective rankings and armor material properties. Conversely, little agreement was found between measures for the trunk tasks. Results of this preliminary investigation indicate that combining shoulder ROM and EMG measures has the potential to provide an objective assessment of body armor systems.

Retest reliability of force-time variables of neck muscles under isometric conditions.

CONTEXT: Proper conditioning of the neck muscles may play a role in reducing the risk of neck injury and, possibly, concussions in contact sports. However, the ability to reliably measure the force-time-based variables that might be relevant for this purpose has not been addressed. OBJECTIVE: To assess the between-days reliability of discrete force-time-based variables of neck muscles during maximal voluntary isometric contractions in 5 directions. DESIGN: Cohort study. SETTING: University research center. PATIENTS OR OTHER PARTICIPANTS: Twenty-six highly physically active men (age  =  21.6 ± 2.1 years, height  =  1.85 ± 0.09 m, mass  =  81.6 ± 9.9 kg, head circumference  =  0.58 ± 0.01 m, neck circumference  =  0.39 ± 0.02 m). INTERVENTION(S): We used a custom-built testing apparatus to measure maximal voluntary isometric contractions of the neck muscles in 5 directions (extension, flexion, protraction, left lateral bending, and right lateral bending) on 2 separate occasions separated by 7 to 8 days. MAIN OUTCOME MEASURE(S): Variables measured were peak force (PF), rate of force development (RFD), and time to 50% of PF (T(50)PF). Reliability indices calculated for each variable comprised the difference in scores between the testing sessions, with corresponding 95% confidence intervals, the coefficient of variation of the typical error of measurement (CV(TE)), and intraclass correlation coefficients (ICC [3,3]). RESULTS: No evidence of systematic bias was detected for the dependent measures across any movement direction; retest differences in measurements were between 1.8% and 2.7%, with corresponding 95% confidence interval ranges of less than 10% and overlapping zero. The CV(TE) was lowest for PF (range, 2.4%-6.3%) across all testing directions, followed by RFD (range, 4.8%-9.0%) and T(50)PF (range, 7.1%-9.3%). The ICC score range for all dependent measures was 0.90 to 0.99. CONCLUSIONS: Discrete variables representative of the force-generating capacity of neck muscles under isometric conditions can be measured with an acceptable degree of reliability. This finding has possible applications for investigating the role of neck muscle strength-training programs in reducing the risk of injuries in sport settings.