The highs and lows of lifting loads: SPM analysis of multi-segmental spine angles in healthy adults during manual handling with increased load.

Introduction: Manual handling personnel and those performing manual handling tasks in non-traditional manual handling industries continue to suffer debilitating and costly workplace injuries. Smart assistive devices are one solution to reducing musculoskeletal back injuries. Devices that provide targeted assistance need to be able to predict when and where to provide augmentation via predictive algorithms trained on functional datasets. The aim of this study was to describe how an increase in load impacts spine kinematics during a ground-to-platform manual handling task. Methods: Twenty-nine participants performed ground-to-platform lifts for six standardised loading conditions (50%, 60%, 70%, 80%, 90%, and 100% of maximum lift capacity). Six thoracic and lumbar spine segments were measured using inertial measurement units that were processed using an attitude-heading-reference filter and normalised to the duration of the lift. The lift was divided into four phases weight-acceptance, standing, lift-to-height and place-on-platform. Statistical significance of sagittal angles from the six spine segments were identified through statistical parametric mapping one-way analysis of variance with repeated measures and post hoc paired t-tests. Results: Two regions of interest were identified during a period of peak flexion and a period of peak extension. There was a significant increase in spine range of motion and peak extension angle for all spine segments when the load conditions were increased (p < 0.001). There was a decrease in spine angles (more flexion) during the weight acceptance to standing phase at the upper thoracic to upper lumbar spine segments for some condition comparisons. A significant increase in spine angles (more extension) during the place-on-platform phase was seen in all spine segments when comparing heavy loads (>80% maximum lift capacity, inclusive) to light loads (<80% maximum lift capacity) (p < 0.001). Discussion: The 50%-70% maximum lift capacity conditions being significantly different from heavier load conditions is representative that the kinematics of a lift do change consistently when a participant's load is increased. The understanding of how changes in loading are reflected in spine angles could inform the design of targeted assistance devices that can predict where and when in a task assistance may be needed, possibly reducing instances of back injuries in manual handling personnel.

Exoskeleton Application to Military Manual Handling Tasks.

OBJECTIVE: The aim of this review was to determine how exoskeletons could assist Australian Defence Force personnel with manual handling tasks. BACKGROUND: Musculoskeletal injuries due to manual handling are physically damaging to personnel and financially costly to the Australian Defence Force. Exoskeletons may minimize injury risk by supporting, augmenting, and/or amplifying the user's physical abilities. Exoskeletons are therefore of interest in determining how they could support the unique needs of military manual handling personnel. METHOD: Industrial and military exoskeleton studies from 1990 to 2019 were identified in the literature. This included 67 unique exoskeletons, for which Information about their current state of development was tabulated. RESULTS: Exoskeleton support of manual handling tasks is largely through squat/deadlift (lower limb) systems (64%), with the proposed use case for these being load carrying (42%) and 78% of exoskeletons being active. Human-exoskeleton analysis was the most prevalent form of evaluation (68%) with reported reductions in back muscle activation of 15%-54%. CONCLUSION: The high frequency of citations of exoskeletons targeting load carrying reflects the need for devices that can support manual handling workers. Exoskeleton evaluation procedures varied across studies making comparisons difficult. The unique considerations for military applications, such as heavy external loads and load asymmetry, suggest that a significant adaptation to current technology or customized military-specific devices would be required for the introduction of exoskeletons into a military setting. APPLICATION: Exoskeletons in the literature and their potential to be adapted for application to military manual handling tasks are presented.

The need for a paradigm shift in the development of military exoskeletons.

An exoskeleton is a body-worn mechanical device designed to work in concert with the user to enhance human capabilities. For the dismounted close combatant, an exoskeleton could be worn whilst performing a variety of complex tasks and duties. As such, there is a requirement for the human and the exoskeleton to readily adapt to different movements in different contexts. There have been many attempts to design an exoskeleton to improve the performance of the complex adaptive human system with limited success. Despite a vast investment in time and resources, exoskeletons have not yet been adopted for operational use by military leadership for use by the dismounted close combatant as they are yet to demonstrate substantive augmentation to individual warfighter and collective team capability. We argue that a major limitation of current exoskeleton systems is their inability to concurrently adapt to the user, task and environment. Unless a device can meet this requirement, it is unlikely to offer a comparative benefit to the dismounted close combatant. This paper will present the state of the art of current exoskeleton technology, and recommend future research necessary to reach an acceptable standard of augmentation and thereby lead to widespread adoption.

Prediction of gait trajectories based on the Long Short Term Memory neural networks.

The forecasting of lower limb trajectories can improve the operation of assistive devices and minimise the risk of tripping and balance loss. The aim of this work was to examine four Long Short Term Memory (LSTM) neural network architectures (Vanilla, Stacked, Bidirectional and Autoencoders) in predicting the future trajectories of lower limb kinematics, i.e. Angular Velocity (AV) and Linear Acceleration (LA). Kinematics data of foot, shank and thigh (LA and AV) were collected from 13 male and 3 female participants (28 ± 4 years old, 1.72 ± 0.07 m in height, 66 ± 10 kg in mass) who walked for 10 minutes at preferred walking speed (4.34 ± 0.43 km.h-1) and at an imposed speed (5km.h-1, 15.4% ± 7.6% faster) on a 0% gradient treadmill. The sliding window technique was adopted for training and testing the LSTM models with total kinematics time-series data of 10,500 strides. Results based on leave-one-out cross validation, suggested that the LSTM autoencoders is the top predictor of the lower limb kinematics trajectories (i.e. up to 0.1s). The normalised mean squared error was evaluated on trajectory predictions at each time-step and it obtained 2.82-5.31% for the LSTM autoencoders. The ability to predict future lower limb motions may have a wide range of applications including the design and control of bionics allowing improved human-machine interface and mitigating the risk of falls and balance loss.

Lower Limb Kinematics Trajectory Prediction Using Long Short-Term Memory Neural Networks.

This study determined whether the kinematics of lower limb trajectories during walking could be extrapolated using long short-term memory (LSTM) neural networks. It was hypothesised that LSTM auto encoders could reliably forecast multiple time-step trajectories of the lower limb kinematics, specifically linear acceleration (LA) and angular velocity (AV). Using 3D motion capture, lower limb position-time coordinates were sampled (100 Hz) from six male participants (age 22 ± 2 years, height 1.77 ± 0.02 m, body mass 82 ± 4 kg) who walked for 10 min at 5 km/h on a 0% gradient motor-driven treadmill. These data were fed into an LSTM model with a sliding window of four kinematic variables with 25 samples or time steps: LA and AV for thigh and shank. The LSTM was tested to forecast five samples (i.e., time steps) of the four kinematic input variables. To attain generalisation, the model was trained on a dataset of 2,665 strides from five participants and evaluated on a test set of 1 stride from a sixth participant. The LSTM model learned the lower limb kinematic trajectories using the training samples and tested for generalisation across participants. The forecasting horizon suggested higher model reliability in predicting earlier future trajectories. The mean absolute error (MAE) was evaluated on each variable across the single tested stride, and for the five-sample forecast, it obtained 0.047 m/s2 thigh LA, 0.047 m/s2 shank LA, 0.028 deg/s thigh AV and 0.024 deg/s shank AV. All predicted trajectories were highly correlated with the measured trajectories, with correlation coefficients greater than 0.98. The motion prediction model may have a wide range of applications, such as mitigating the risk of falls or balance loss and improving the human-machine interface for wearable assistive devices.

Medial Gastrocnemius Muscle Activity during Single-Leg Hopping to Exhaustion.

This study described changes in leg muscle activation characteristics during exhaustive single-leg hopping. Twenty-seven healthy men performed trials (132 hops/min) to exhaustion, without a target height, to a target height with visual feedback and target height with tactile feedback. Mean muscle activation amplitude of the medial gastrocnemius (MG) decreased during the anticipatory period while duration of MG activity was maintained when hopping to a target height and contrasted the changes during hopping without a target height. Changes to MG activity were specific to whether the hopping height had been maintained or not. Changes during the anticipatory period of MG activity, indicative of adaptation in descending motor pathways, implicate utility of a motor learning strategy to allow completion of an exhaustive task.

Consensus paper on testing and evaluation of military exoskeletons for the dismounted combatant.

Enhancing the capabilities of the dismounted combatant has been an enduring goal of international military research communities. Emerging developments in exoskeleton technology offers the potential to augment the dismounted combatant's capabilities. However, the ability to determine the value proposition of an exoskeleton in a military context is difficult due to the variety of methods and metrics used to evaluate previous devices. The aim of this paper was to present a standard framework for the evaluation and assessment of exoskeletons for use in the military. A structured and systematic methodology was developed from the end-user perspective and progresses from controlled laboratory conditions (Stage A), to simulated movements specific to the dismounted combatant (Stage B), and real-world military specific tasks (Stage C). A standard set of objective and subjective metrics were described to ensure a holistic assessment on the human response to wearing the exoskeleton and the device's mechanical performance during each stage. A standardised methodology will ensure further advancement of exoskeleton technology and support improved international collaboration across research and industry groups. In doing so, this better enables international military groups to evaluate a system's potential, with the hope of accelerating the maturity and ultimately the fielding of devices to augment the dismounted close combatant and small team capability.

Acute attenuation of fatigue after sodium bicarbonate supplementation does not manifest into greater training adaptations after 10-weeks of resistance training exercise.

PURPOSE: In two concurrent studies, we aimed to a) confirm the acute effect of 0.3 g·kg-1 body weight (BW) sodium bicarbonate (NaHCO3) supplementation on central and peripheral mechanisms associated with explosive power (Study 1) and b) determine whether chronic NaHCO3 supplementation would improve the adaptive response of the neuromuscular system during a 10-week resistance training program (Study 2). METHODS: Eight resistance trained participants volunteered after providing written consent. The experimental design consisted of a week of baseline testing, followed by ten weeks of training with progress measures performed in Week 5. Study 1 involved neuromuscular measurements before and after the leg extension portion of a power based training session performed in Week 1. Changes in maximal torque (MVT) and rates of torque development (RTD), along with other variables derived from femoral nerve stimulation (e.g. voluntary activation, neural recruitment) were analysed to determine the extent of fatigue under NaHCO3 or placebo conditions. Changes in these same variables, coupled with functional 1-repetition maximum leg extension strength, were measured in Study 2 from baseline (Week 0) to Week 5, and again at Week 10. RESULTS AND CONCLUSION: In Study 1, we observed a decline after the leg extension task in both MVT (~ 30%) and rates of torque production (RTD) irrespective of acid-base status, however the decline in maximal RTD (RTDMAX) was nearly 20% less in the NaHCO3 condition when compared to placebo (mean difference of 294.8 ± 133.4 Nm·s-1 (95% CI -583.1 to -6.5 Nm, p < 0.05)). The primary finding in Study 2, however, suggests that introducing NaHCO3 repeatedly during a 10-week RT program does not confer any additional benefit to the mechanisms (and subsequent adaptive processes) related to explosive power production.

Can Video Self-Modeling Improve Affected Limb Reach and Grasp Ability in Stroke Patients?

The authors examined whether feedforward video self-modeling (FF VSM) would improve control over the affected limb, movement self-confidence, movement self-consciousness, and well-being in 18 stroke survivors. Participants completed a cup transport task and 2 questionnaires related to psychological processes pre- and postintervention. Pretest video footage of the unaffected limb performing the task was edited to create a best-of or mirror-reversed training DVD, creating the illusion that patients were performing proficiently with the affected limb. The training yielded significant improvements for the forward movement of the affected limb compared to the unaffected limb. Significant improvements were also seen in movement self-confidence, movement self-consciousness, and well-being. FF VSM appears to be a viable way to improve motor ability in populations with movement disorders.

A Comparison of Vertical Stiffness Values Calculated from Different Measures of Center of Mass Displacement in Single-Leg Hopping.

This study assessed the agreement between Kvert calculated from 4 different methods of estimating vertical displacement of the center of mass (COM) during single-leg hopping. Healthy participants (N = 38) completed a 10-s single-leg hopping effort on a force plate, with 3D motion of the lower limb, pelvis, and trunk captured. Derived variables were calculated for a total of 753 hop cycles using 4 methods, including: double integration of the vertical ground reaction force, law of falling bodies, a marker cluster on the sacrum, and a segmental analysis method. Bland-Altman plots demonstrated that Kvert calculated using segmental analysis and double integration methods have a relatively small bias (0.93 kN⋅m-1) and 95% limits of agreement (-1.89 to 3.75 kN⋅m-1). In contrast, a greater bias was revealed between sacral marker cluster and segmental analysis (-2.32 kN⋅m-1), sacral marker cluster and double integration (-3.25 kN⋅m-1), and the law of falling bodies compared with all methods (17.26-20.52 kN⋅m-1). These findings suggest the segmental analysis and double integration methods can be used interchangeably for the calculation of Kvert during single-leg hopping. The authors propose the segmental analysis method to be considered the gold standard for the calculation of Kvert during single-leg, on-the-spot hopping.

The influence of sodium bicarbonate on maximal force and rates of force development in the triceps surae and brachii during fatiguing exercise.

NEW FINDINGS: What is the central question of this study? Does metabolic alkalosis in humans, induced by sodium bicarbonate, affect rates of skeletal muscle fatigue differentially in muscle groups composed predominately of slow- and fast-twitch fibres? What is the main finding and its importance? Sodium bicarbonate exhibited no effect on the fatigue profile observed between triceps surae and brachii muscle groups during and after 2 min of tetanic stimulation. For the first time in exercising humans, we have profiled the effect of sodium bicarbonate on the voluntary and involuntary contractile characteristics of muscle groups representative of predominately slow- and fast-twitch fibres. The effect of metabolic alkalosis on fibre-specific maximal force production and rates of force development (RFD) has been investigated previously in animal models, with evidence suggesting an improved capacity to develop force rapidly in fast- compared with slow-twitch muscle. We have attempted to model in vivo the fatigue profile of voluntary and involuntary maximal force and RFD in the triceps surae and brachii after sodium bicarbonate (NaHCO3 ) ingestion. In a double-blind, three-way repeated-measures design, participants (n = 10) ingested either 0.3 g kg-1 NaHCO3 (ALK) or equivalent calcium carbonate (PLA) prior to 2 min of continuous (1 Hz) supramaximal stimulation (300 ms at 40 Hz) of the triceps surae or brachii, with maximal voluntary efforts (maximal voluntary torque) coupled with direct muscle stimulation also measured at baseline, 1 and 2 min. Metabolic alkalosis was achieved in both ALK trials but was not different between muscle groups. Regardless of the conditions, involuntary torque declined nearly 60% in the triceps brachii (P < 0.001) and ∼30% in the triceps surae (P < 0.001). In all trials, there was a significant decline in normalized involuntary RFD (P < 0.05). Maximal voluntary torque declined nearly 28% but was not different between conditions (P < 0.01), and although declining nearly 21% in voluntary RFD (P < 0.05) there was no difference between PLA and ALK in either muscle group (P = 0.93). Sodium bicarbonate exhibited no effect on the fatigue observed between representative fibre-type muscle groups on maximal voluntary and involuntary torque or rates of torque development during and after 2 min of tetanic stimulation.

Adaptation of lower limb movement patterns when maintaining performance in the presence of muscle fatigue.

Adaptations in lower limb movement patterns were examined when performance was maintained during a fatiguing repetitive loading task. Forty recreationally active male and female participants performed single-leg hopping to volitional exhaustion at 2.2Hz to a submaximal height. Spatio-temporal characteristics, mechanical characteristics and variability of the knee-ankle and hip-knee joint couplings were determined at 20% increments during the duration of the hopping task. Variability of the knee-ankle and hip-knee couplings in the flexion/extension axis significantly increased during the loading and propulsion phases during the hopping task (p<0.05). Performance (vertical stiffness, hopping frequency and height) did not change significantly during the task (p>0.05), however foot contact time increased progressively during this task (p<0.05) and maximum hop height significantly decreased after the task (p<0.05). The observed increase in variability between adjoining lower limb segments demonstrated the ability of the neuromotor system to adapt and maintain performance even with the onset of fatigue. This finding highlights that during the performance of a rapid and repetitive loading activity, performance can be preserved when there is variability in the neuromotor system.

Does providing real-time augmented feedback affect the performance of repeated lower limb loading to exhaustion?

INTRODUCTION: This study aimed to determine whether real-time augmented feedback influenced performance of single-leg hopping to volitional exhaustion. METHODS: Twenty-seven healthy, male participants performed single-leg hopping (2.2 Hz) with (visual and tactile feedback for a target hop height) or without feedback on a force plate. Repeated measures ANOVA were used to determine differences in vertical stiffness (k), duration of flight (tf) and loading (tl) and vertical height displacement during flight (zf) and loading (zl). A Friedman 2-way ANOVA was performed to compare the percentage of trials between conditions that were maintained at 2.2 Hz ± 5%. Correlations were performed to determine if the effects were similar when providing tactile or visual feedback synchronously with the audible cue. RESULTS: Augmented feedback resulted in maintenance of the tf, zf and zl between the start and end of the trials compared to hopping with no feedback (p<0.01). With or without feedback there was no change in tl and k from start to end. Without feedback, 21 of 27 participants maintained >70% of total hops at 2.2 ± 5% Hz and this was significantly lower (p=0.01) with tactile (13/27) and visual (15/27) feedback. There was a strong correlation between tactile and visual feedback for duration of hopping cycle (Spearman's r=0.74, p ≤ 0.01). CONCLUSION: Feedback was detrimental to being able to maintain hopping cadence in some participants while other participants were able to achieve the cadence and target hop height. This indicates variability in the ability to use real-time augmented feedback effectively.

The reliability of determining the onset of medial gastrocnemius muscle activity during a stretch-shorten-cycle action.

The instant at which a muscle increases its level of activity from baseline represents the onset of muscle activity. Accurate identification of muscle onset allows determination of temporal and amplitude characteristics of the surface electromyography (sEMG) signal. This investigation determined the intra- and inter-tester reliability for determining the onset of medial gastrocnemius (MG) activity using visual and automated methods. One hundred hop cycles, performed at 2.2Hz, were selected from sEMG recordings (bandpass filtered 50-500Hz and full wave rectified) of ten participants who performed three trials of single-leg hopping. The onset of MG muscle activity was identified by 3 separate investigators on two separate occasions and an automated method (10% of the peak activation amplitude). The duration of the anticipatory period, from muscle onset to initial ground contact, was then determined. Intra-tester (ICC from 0.72 to 0.95) and inter-tester reliability (ICC from 0.70 to 0.88) were high as was comparison to the automated method (ICC=0.90). These findings indicate that visual onset detection was highly reproducible between testing sessions, independent investigators and comparable to an automated method. These methods may be used reliably to determine the onset of MG muscle activity during a stretch-shorten-cycle muscle action.