The effect of a structured personalized ergonomic intervention program for hospital nurses with reported musculoskeletal pain: An assigned randomized control trial.

BACKGROUND: Intervention programs for hospital nurses with musculoskeletal pain present a challenge for the health professions. OBJECTIVE: To examine the effect of a structured personalized ergonomic intervention program for hospital nurses with musculoskeletal pain. METHODS: In a randomised controlled trial, 31 nurses from one central hospital with musculoskeletal pain were observed at work. A multi-stage study that included the Nordic Musculoskeletal Questionnaire, Karasek's questionnaire, The Rapid Entire Body Assessment, and an intervention program was completed with 14 nurses, while the remaining 17 were assigned to a control group. The intervention program was carried out by one physiotherapist and included four meetings over three months. The control group received only instruction sheets. Data on body posture and frequency and intensity of pain were collected before and at three months after the termination of the intervention program. RESULTS: Compared with the control group, the intervention group showed an improvement in REBA scores and in posture that is considered risk factor for work-related musculoskeletal discomfort disorders [p < 0.001], but there were no significant differences in the number of body parts in pain or in the level of musculoskeletal pain. CONCLUSIONS: The intervention was shown to be effective in reducing risk factors for work-related musculoskeletal disorders over a short follow-up period. A long-term study is required to determine if this effect is preserved over a longer period and to determine whether the intervention can reduce musculoskeletal symptoms.

Perceived environmental restrictions for the participation of children with mild developmental disabilities.

AIM: In light of the International Classification of Functioning, and Health (ICF) model, to assess whether parents of children with mild developmental disabilities perceived various environmental factors as barriers to their child's participation, and whether these factors have a unique contribution to the total explained variance of participation, beyond personal factors. METHODS: Seventy-nine kindergarten children (mean age 5.20 ± 0.52 years old) with mild developmental disabilities and their parents participated in the study. Three questionnaires measuring the child's participation, performance skills and environmental factors were completed by the parents. RESULTS: Parents perceived environmental factors as slightly restricting to their child's participation. Associations were found between home and education factors and the dimensions of child participation - independence, enjoyment and parental satisfaction. Although parents perceived human environmental factors as more restricting than physical factors at home, regression analysis revealed that the latter was found to affect the child participation dimension of independence beyond the contribution of personal factors. INTERPRETATION: These findings are the first, to our knowledge, to support the contribution of environmental factors to the participation of young children with mild developmental disabilities. The results show that environmental factors have significant slight contribution to child's independence in participation beyond other predictors (i.e. personal factors). Therefore, it is recommended to include environmental restrictions measurement in the child evaluation process to facilitate effective intervention programs.

Personal and environmental pathways to participation in young children with and without mild motor disabilities.

OBJECTIVE: Participation in everyday activities has a positive influence upon health and well-being and is considered as an outcome measure. According to recent models child participation is the product of the dynamic interaction between health states and both individual and environmental factors. Children with mild developmental disabilities often present decreased participation in everyday activities. The purpose of this study was to explore the extent to which individual and environmental factors explain the participation of young children, with and without mild motor disabilities. METHODS: The study population included 58 kindergarten children together with their parents (29 children with mild motor disabilities who were referred to occupational therapy and 29 children without motor disabilities). Both groups of children were matched for: age; gender; age of parents; and socio-economic status (SES). We assessed participation using the Child Participation Questionnaire (intensity, diversity, independence, child enjoyment and parental satisfaction) and we assessed children's self-efficacy and motor abilities for individual factors. Parental self-efficacy and SES were collected by questionnaires. RESULTS: Participation diversity (number of activities) was predicted by child and mother self-efficacy and by SES. Child independence and enjoyment as well as parental satisfaction were predicted by child motor ability but mainly by maternal self-efficacy. Results suggest that the total explained variance is more than double when the environmental variables (parental self-efficacy and SES) are inserted to the participation model. CONCLUSIONS: Maternal self-efficacy and SES serve as facilitators to increased participation and well-being of children with mild motor disabilities.

Correlation between risk factors and musculoskeletal disorders among classical musicians.

BACKGROUND: Musculoskeletal disorders in humans may originate from biomechanical, environmental, psychosocial and personal risk factors encountered in the working environment. These disorders in musicians are designated as playing related musculoskeletal disorders (PRMD). AIMS: To investigate the correlation between biomechanical, environmental, psychosocial and personal risk factors and potential incidence of PRMD arising in professional classical musicians. METHODS: Fifty-nine orchestral classical musicians were observed: They also filled out questionnaires providing information regarding musculoskeletal symptoms, psychosocial factors and demography. RESULTS: Clinical observation using the Rapid Upper Limb Assessment (RULA) showed significantly higher scores in string musicians compared with woodwind and brass players (right RULA score F = 4.77, P < 0.05; left RULA score, F = 3.90, P < 0.05). A multivariate regression model showed statistical significance for five of the six dependent variables regarding prevalence of painful joints, severity of musculoskeletal symptoms and functional limitation. The regression analysis revealed that biomechanical risk factors, perceived physical environment risk factors, instrument weight and average playing hours per week, were the main predictors of PRMD. CONCLUSIONS: The biomechanical risk factors that predict PRMD are mainly associated with the upper limbs. A high association between PRMD and clinical observation emphasizes the need for further investigation of these risk factors and to study possible implementations in order to define 'prevention strategies' for musical routines and patterns, as used by classical musicians.

Are young adults with special needs ready for the physical work demands?

Youth and Adolescents with Special Needs (YASN) face many challenges during transition into employment. Although most of their physical challenges are secondary, yet they call for attention since most of them are hired for blue collar jobs. Functional Capacity Evaluation (FCE) should be adapted to prepare them addressing the physical job-demands, and maintain their jobs effectively and safely. The current pilot study aims to demonstrate the use of standard (FCE) in order to assess performance of basic generic physical activities conducted by YASN, as part of transition to work program. Specifically, it compared subtests of the Physical Work Performance Evaluation of YASN (N = 13) with matched control group (YA) (N = 13). Results revealed slower and reduced performance among YASNs than YA, in basic job demands, like dynamic strength, hand strength, and fine motor skills. Implications and recommendations for research and transition to work practice in the educational setting are discussed.

Can personal and environmental factors explain dimensions of child participation?

OBJECTIVE: One of the main goals of paediatric occupational therapists and other health professionals is to enhance child participation in age-related activities within their communities. According to theoretical models, the act of participation has numerous dimensions, affected by personal and environmental factors. However, there have been relatively few studies undertaken to validate this theory. The purpose of this study was to explore the extent to which personal and environmental factors explain each of five distinct dimensions of child participation, which are: diversity, intensity, independence, enjoyment and subsequent parental satisfaction. METHOD: A convenient sample of 70 kindergarten children without developmental disabilities together with their parents participated in the study. Data were collected using standardized assessments for personal factors and questionnaires for environmental factors. RESULTS: The findings confirmed our hypothesis and revealed that with typical children, motor and cognitive abilities affect participation diversity. Moreover, performance skills and self-perceptions of competence affect their independence levels, while environmental factors contribute to frequency of participation and parental satisfaction. However, these factors on their own do not fully explain the degree of enjoyment experienced by children. CONCLUSIONS: The findings highlight the importance of measuring the full range of participation dimensions, and provide empirical evidence about the nature of child participation. Further studies are warranted to validate this approach for children with developmental difficulties.

Efficiency of the home parental programme in visual-motor home activity among first-grade children.

BACKGROUND: The objectives of this study were to assess the efficacy of the home parental programme (HPP) in improving children's visual-motor skills, and to assess parent satisfaction with the programme. METHODS: Forty-five children and their parents participated in the study: 23 children and their parents in the study group (children receiving consultation in the classroom and whose parents participated in the HPP) and 22 children and their parents in the control group (children receiving consultation in the classroom only). All children were recruited based on their scores on the Visual Motor Integration test or upon teacher referral. The Developmental Test of Visual Perception-2 administered before and after intervention served as an outcome measure. HPP lasted approximately 12 weeks and included relevant visual-motor activities carried out at home by the parents with their children. RESULTS: The study failed to prove that HPP improved children's visual-motor skills beyond the other service delivery methods used in the present study. CONCLUSIONS: Parent satisfaction was significantly higher among those who participated in the HPP. Parents showed high compliance with the friendly programme despite their low socio-economic status.

The presence of musculoskeletal disorders among amateur bowlers.

BACKGROUND: With increasing numbers of adults taking part in amateur athletic activity during leisure hours there have been indications that amateur athletic activity may have negative effects on musculoskeletal disease. A literature review focusing on musculoskeletal injuries among bowlers provided only limited references. STUDY OBJECTIVES: Studying the characteristic of bowlers complaining of musculoskeletal disorders in general and of upper extremity cumulative trauma disorders specifically, and locating the factors that statistically predict musculoskeletal disorders among Israeli bowlers. METHODS: The research population includes 98 amateur bowlers who attended two bowling clubs (cluster sampling). Musculoskeletal disorders of the research population were assessed by subjective report using the Standardized Nordic Questionnaires. Further use was made of questionnaires concerning bio-demographic data, work assessment, and the characteristics of the bowling game. RESULTS: Sixty two percent of bowlers reported the presence of musculoskeletal symptoms in one or more of their body joints during the preceding year. Regression analysis with the number of painful joints in the upper extremities as a dependent variable revealed one main predictor: the number of leagues in which the bowler participated (beta = 0.22, p < 0.03). When the dependent variable was the number of painful joints in the entire body, the statistical predictor was the average achievement of the bowlers (beta = 0.40, p < 0.001). CONCLUSIONS: Research findings shed light on the unique musculoskeletal disorders of bowlers. Bowlers should be instructed with regard to what are the safe limits of their leisure activities.

School-age children born to diabetic mothers and to mothers with gestational diabetes exhibit a high rate of inattention and fine and gross motor impairment.

OBJECTIVES: To study the neurobehavioral effects that pregestational and gestational diabetes might have on offspring at school age. STUDY DESIGN: We studied neurobehavioral function at school age of 57 children born to 48, well controlled, diabetic mothers and of 32 children born to 32 women with gestational diabetes. Their development was compared with 57 control children matched by age, birth order and parental socio-economic status, using a number of cognitive, behavioral, sensory and motor neurological tests. RESULTS: The IQ scores on the WISC-R and Bender tests of the children born to diabetic mothers were similar to those of control children, but the Bender scores of the children born to mothers with gestational diabetes were slightly lower. No differences were found between the study groups in various sensory-motor functions in comparison to controls. However, both study group children performed less well than controls in fine and gross motor functions as observed on the Bruininks-Oseretzki test of motor proficiency. The scores of children born to the mothers with pregestational diabetes were higher than controls on the Touwen & Prechtl neurological examination (worse function). The children from both research groups also performed worse on the Pollack taper test that is designed to detect inattention and hyperactivity. The children of the two study groups also had slightly higher scores on the Conners abbreviated parents-teachers questionnaire measuring hyperactivity and inattention, but the differences from controls were not statistically significant. We found a negative correlation between the performance of the children born to mothers with pregestational diabetes on various neurodevelopmental and behavioral tests and the severity of maternal hyperglycemia as assessed by blood glycosylated hemoglobin levels and acetonuria. CONCLUSIONS: Pregestational or gestational diabetes was found to adversely affect attention span and motor functions of offspring at school age, but not their cognitive ability. These effects were negatively correlated with the degree of maternal glycemic control, and were more pronounced in younger children.

Effect of exposure to lead on postural control in workers.

OBJECTIVES: To examine the effect of lead on postural control of workers who have been exposed to lead. METHODS: 63 Male, lead battery workers mean (SD) age 41.0 (7.4) were compared with 48 age matched male controls after excluding those with acute or chronic diseases. Exposed workers had mean (SD) past blood lead concentrations of 37.5 (9.2) micrograms/dl and 11.2 (5.7) years of employment. Postural control was measured with a computerised postural sway measurement system which measured both sway and total movements. RESULTS: Workers standing straight with eyes open on the bare plates had sway and total movements which were not notably different from controls. On the other hand increased movements were needed in the exposed workers to maintain stability (the general stability quotient 18.2 (5.4) v 15.4 (4.4) in controls, p < 0.01) when standing directly on the foot-plates with closed eyes,, and with the head tilted (15.0 (3.8) v 11.5 (3.0) in controls, p < 0.001). Exposed workers also had a trend for less ability to synchronize anterior posterior and lateral sway in the stress positions (0.0625) than had non-exposed workers. Significant but low correlations were found between the estimate of the chronic internal dose of lead and three of 10 of the postural control measurements, and present lead blood concentrations and only one of the 10 measurements and (r values ranged from 0.21 to 0.31, p < or = 0.03). CONCLUSIONS: These findings suggest that lead affects postural control in asymptomatic workers. Further studies are warranted to find whether workers with decreased postural control are at increased risk of accidents and the relation, if any, of these measurements with subsequent morbidity.

From hand twister to mind twister: computer-aided treatment in traumatic wrist fracture.

OBJECTIVE: The use of computers as a treatment modality in the occupational therapy hand clinic is, as yet, not common practice. A computer interface for wrist movements was developed, and a study to justify the application of such a device is presented. METHOD: Forty-seven patients in a day hand clinic who had traumatic fracture of one hand with limitation of wrist mobility participated in the study. Participants were divided into two treatment groups: computer-aided treatment (high technology) and traditional brush machine treatment (low technology). A device was developed based on the brush machine in which the brush machine's mechanism was converted into a medial-lateral joystick. Right-to-left movements were digitally transformed for the use of a computer game. Participants were treated for 5 weeks, and outcome measures included range of motion (ROM), grip strength, edema, and level of interest. RESULTS: Results showed significant improvement in ROM, grip strength, and edema across 5 weeks for all participants. Although no significant differences were found between the two groups in ROM, grip strength, and edema, the computer-aided group showed significantly more interest in treatment than did the brush machine group. Finally, the interaction between treatment group and the attitude toward computers was not significant. CONCLUSIONS: These results indicate the potential for more interesting motor treatment and rehabilitation of the wrist through the use of computer games. The efficacy of using computers in occupational therapy clinics needs further investigation.

Comparison of the motor development of school-age children born to mothers with and without diabetes mellitus.

The objectives of this study were to examine the effects of diabetes during pregnancy on the long-term motor development of the offspring and to study possible correlations between glycemic control and motor development. We compared the motor development of 57 children, 5- to 12-years-of-age, born to 48 mothers with well-controlled diabetes, to the motor development of 57 control children matched by age, birth order, and parental socio-economic status. Children born to mothers with diabetes performed less well than controls in fine and gross motor functions on the Bruininks-Oseretsky Test of Motor Proficiency. A negative correlation existed between the test scores of the children whose mothers had diabetes and the severity of hyperglycemia as assessed by blood glycosylated hemoglobin levels and acetonuria. Motor ability of the children of mothers with diabetes had a high correlation with biological and environmental variables. These results suggest that diabetes during pregnancy may affect the developing brain, inducing long-term mild motor deficiency. The effects seem to result from the adverse effects of diabetic metabolic factors, and the effects correlate with the degree of diabetes control. The combination of metabolic functioning of women with diabetes and home environment may affect the motor development of their children.

Neurodevelopmental outcome at early school age of children born to mothers with gestational diabetes.

AIMS: To study the metabolic derangements in the second half of pregnancy caused by gestational diabetes, on the long term development of children. METHODS: The neuropsychological function of 32 school age children born to 32 mothers with well controlled gestational diabetes and 57 control children matched by age, birth order, and parental socioeconomic status was studied. RESULTS: There were no differences in head circumference and height, but the children born to diabetic mothers were heavier. The verbal IQ scores of index children below the age of 9 years were lower than those of control children. No differences were found between the groups in various sensory and motor functions and in the Touwen and Prechtl neurological test. The young index group children performed less well than controls in fine and gross motor functions, as observed on the Bruininks-Oseretzky test of motor proficiency. The scores of young children born to mothers with gestational diabetes were also lower than controls on the Pollack tapper test, and there were more index group children who scored abnormally on the parents' Conners questionnaire. No correlation was found between the performance of the index group children on various neurodevelopmental tests and the severity of perinatal complications. The differences tended to disappear with age. CONCLUSIONS: Gestational diabetes, as a result of the metabolic abnormalities in the second half of pregnancy, induces long term minor neurological deficits which are more pronounced in younger children. There does not seem to be any direct relation between the appearance of congenital anomalies and neurodevelopmental outcome.

Neurobehaviour of school age children born to diabetic mothers.

AIM: To study the neurobehavioural effects that diabetes during pregnancy might have on children by school age. METHODS: The neurobehavioural function of 57 school age children born to 48, well controlled diabetic mothers was compared with 57 control children matched for age, birth order, and parental socioeconomic status, using several cognitive, behavioural, sensory and motor neurological tests. RESULTS: The IQ scores of the index group children were similar to those of control children (117.7 +/- 13.4 vs 118.5 +/- 10.1). There were no differences between the groups in various sensory motor functions. However, the index group children performed less well than the controls on indices of fine and gross motor functions, as observed on the Bruininks-Oseretzky test of motor proficiency. The scores of children born to diabetic mothers were higher than controls on the Touwen and Prechtl neurological examination. They also performed worse in the Pollack tapper test which is designed to detect minor neurological deficits, inattention, and hyperactivity. The index children had higher scores on the Conners abbreviated parent-teacher questionnaire which measures hyperactivity and inattention. There was a negative correlation between the performance of the index group children on various neurodevelopmental and behavioural tests and the severity of hyperglycaemia, as assessed by blood glycosylated haemoglobin and acetonuria. CONCLUSIONS: Diabetes during pregnancy adversely affects some fine neurological functions in children at school age, but not their cognitive scores. These effects are not correlated with the degree of glycaemic control.

Part I: the effect of long-term exposure to organic solvents on memory: a cross sectional study.

This study focuses on a wide range of different aspects of memory functions trying to ascertain a possible profile of memory changes, which take place following long-term exposure to organic solvents. The research design was cross-sectional. Study population included 31 industrial painters who were exposed at work to organic solvents and 31 unexposed workers. Workers after long-term exposure to organic solvents showed significant decline in memory as indicated in all three standard memory tests (i.e. Wechsler Memory Scale - Revised, Benton Revised Visual Retention Test, and Rey Auditory Verbal Learning Test). The results of Rey Auditory Verbal Learning Test showed a negative correlation with exposure index indicating that the more intensive and longer the time of exposure was, the more impaired is the verbal memory. It was also found that the affect of age on memory was stronger among workers after long-term exposure to organic solvents compared to the unexposed workers.

Reported level of pain of upper extremities related to multi-factorial workloads among office workers during and after work hours.

OBJECTIVES: This research compared the level of reported pain between women workers with high workload (main work involved typing) and women workers with low workload (various office work where typing was not the main task). The research examined the relationship between reported pain of upper extremities (UE) and the following variables: physical strain exerted during typing on a computer keyboard, extra-work strain on UE, bio-demographic variables, psychosocial variables, and ergonomic variables. STUDY DESIGN: Participants were 60 women who worked in offices, divided into two groups. The index group included women whose main work involved typing (high workload: M=6.16 h of typing per day), and the control group did various office work where typing was not the main task (low workload: M=3.23 h of typing per day). The level of pain, physical strain, and data concerning bio-demographic variables, psychosocial variables and ergonomic variables was assessed by a self-reported questionnaire. RESULTS: The results suggested that there was a significant difference between workers with high and low typing workloads. Workers with higher typing load reported higher levels of pain. There was a significant positive correlation between level of reports of pain and levels of physical overload at work, and extra-work strain on UE both among workers with high and low workloads. It was also found that levels of pain correlated significantly with bio-demographic variables (age and number of children) and psychosocial variables (managerial responsibilities) among low workload workers only. CONCLUSIONS: The research on pain of UE indicates that pain may be affected by a multi-factorial nature of a work-related environment which includes physical strain exerted during typing on a computer keyboard, extra-work strain on UE, bio-demographic variables and psychosocial variables.