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Exoskeletons have shown significant impact at reducing the biomechanical demand on muscles during repetitive lifting and overhead tasks in non-healthcare industries. However, the benefits of exoskeletons are yet to be realized in the operating room, particularly as work-related musculoskeletal disorders continue to be a concern for surgeons. This study quantified the effect of using neck, arm, and trunk exoskeletons on muscle activity while assuming typical postures held in the operating room. Fourteen participants were recruited to participate in this study. In this two-part experiment participants were asked to 1) hold a series of neck flexion, arm abduction and trunk flexion postures seen in surgical procedures, and 2) perform a simulated surgical task requiring five different trunk flexion posture levels. Participants were required to complete these tasks with and without passive exoskeleton(s). This study showed that even for postures held short time periods, exoskeletons are beneficial at reducing the demand on muscles; however, the reduction in muscle demand depends on body segment and postural angle, as intended with these passive exoskeletons. Furthermore, for the simulated surgical task with awkward trunk flexion postures (10-65°), the trunk exoskeletons showed a significant reduction in the rate of rise in back muscle sEMG (+1.365%MVC/min vs. +0.769%MVC/min for non-dominant lumbar extensor muscles, p = 0.0108; +1.377%MVC/min vs. +0.770%MVC/min for the dominant lumbar extensor muscles, p = 0.0196) over 25 min, consequently resulting in improved trunk subjective discomfort scores (7.34 vs. 4.30, p < 0.05), with no impact on the neck and shoulder biomechanical demand. The results from this study indicate that exoskeletons may be a potential intervention to reduce biomechanical loading during surgery., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Interventional radiologists are at increased risk for musculoskeletal discomfort/disorders and this has been linked to the use of radiation personal protective equipment (rPPE). This study examined the effects of rPPE on the development of fatigue of the erector spinae and trapezius muscles. Surface electromyography (EMG) was used to capture muscle activity, and both time domain (average rectified value) and frequency domain (median frequency) measures were considered in the assessment of localized muscle fatigue. Sixteen participants performed a simulated surgical procedure requiring intermittent 30° flexed static trunk posture with and without rPPE on separate days. The results showed that the rPPE condition demonstrated significantly greater (p < 0.05) downward shift in median frequency in the left lumbar erector spinae and left lower thoracic erector spinae consistent with task-induced localized muscle fatigue. Ergonomic intervention strategies are discussed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Previous literature has documented the alterations in the flexion-relaxation response of the lumbar extensor musculature to passive tissue elongation (PTE) and muscle fatigue (MF). There is no study, however, that has explored this response as a function of the combined effect of both PTE and MF, which is often seen in occupational settings. Twelve participants performed three experimental protocols on three different days to achieve (1) PTE, (2) MF and (3) PTE&MF (combined). Trunk kinematics and muscle activities were monitored to assess the effects of these protocols on the peak lumbar flexion angle and the lumbar angle of the flexion-relaxation of the trunk extensor muscles. Results showed responses to the uni-dimensional stresses (PTE and MF) consistent with those seen in the previous literature, while the combined protocol elicited responses that more closely matched the PTE protocol., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Leaning against a stationary barrier during manual materials handling tasks is observed in many industrial environments, but the effects of this kinematic constraint on low back mechanics are unknown. Thirteen participants performed two-handed lifting tasks using both a leaning posture and no leaning posture while trunk kinematics, muscle activity and ground reaction force were monitored. Results revealed that lifting with the leaning posture required significantly less activity in erector spinae (26% vs. 36% MVC) and latissimus dorsi (8% vs. 14% MVC), and less passive tissue moment compared with the no leaning posture. Peak sagittal accelerations were lower when leaning, but the leaning posture also had significantly higher slip potential as measured by required coefficient of friction (0.05 vs. 0.36). The results suggested that the leaning lifting strategy provides reduced low back stress, but does so at the cost of increased slip potential., (Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

The objective of this study was to quantify the effects of ground surface motion on the biomechanical responses of a person performing a lifting task. A boat motion simulator (BMS) was built to provide a sinusoidal ground motion (simultaneous vertical linear translation and a roll angular displacement) that simulates the deck motion on a small fishing boat. Sixteen participants performed lifting, lowering and static holding tasks under conditions of two levels of mass (5 and 10 kg) and five ground moving conditions. Each ground moving condition was specified by its ground angular displacement and instantaneous vertical acceleration: A): +6°, -0.54 m/s(2); B): +3°, -0.27 m/s(2); C): 0°, 0m/s(2); D): -3°, 0.27 m/s(2); and E): -6°, 0.54 m/s(2). As they performed these tasks, trunk kinematics were captured using the lumbar motion monitor and trunk muscle activities were evaluated through surface electromyography. The results showed that peak sagittal plane angular acceleration was significantly higher in Condition A than in Conditions C, D and E (698°/s(2) vs. 612-617°/s(2)) while peak sagittal plane angular deceleration during lowering was significantly higher in moving conditions (conditions A and E) than in the stationary condition C (538-542°/s(2) vs. 487°/s(2)). The EMG results indicate that the boat motions tend to amplify the effects of the slant of the lifting surface and the external oblique musculature plays an important role in stabilizing the torso during these dynamic lifting tasks., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

A review of the scientific literature reveals little research on the ergonomics of handsaws and no literature on the specific challenges of arborist saws (saws for cutting and pruning living trees). This study was designed to provide some insight into the effects of saw design and height of sawing activity on the biomechanical response of the upper extremity. Eighteen participants performed a simple sawing task at three different heights using six different arborist handsaws. As they performed this task, the electromyographic activity of several muscle groups of the forearm (flexor and extensor digitorum), arm (biceps brachii long and short heads) and shoulder girdle (posterior deltoid, infraspinatus and latissimus dorsi) were sampled. Also gathered were the wrist postures in the radial/ulnar plane at the beginning and ending of the sawing stroke, the time to complete the sawing task and a subjective ranking of the six different saws. The results show an interesting mix of biomechanical and subjective responses that provide insight into handsaw design. First, there were tradeoffs among muscle groups as a function of work height. As work height increased the biceps muscles increased their activation levels (approximately 19%) while the posterior deltoid activity decreased (approximately 17%) with the higher location. The results also showed the benefits of a bent handle design (average 21% reduction in ulnar deviation). The subjective responses of the participants generally supported the productivity data, with the saws demonstrating the shortest task completion time also being the ones most highly ranked. RELEVANCE TO INDUSTRY: Understanding the stresses placed on the upper extremity during sawing activities, and design features that can reduce these stresses, may help saw designers to create products that reduce the risk of injury in workers who use handsaws.

Obesity in the workforce is a growing problem worldwide. While the implications of this trend for biomechanical loading of the musculoskeletal system seem fairly straightforward, the evidence of a clear link between low back pain (LBP) and body mass index (BMI) (calculated as whole body mass in kilograms divided by the square of stature in meters) has not been shown in the epidemiology literature addressing this topic. The approach pursued in the current study was to evaluate the lifting kinematics and ground reaction forces of a group of 12 subjects -- six with a BMI of less than 25 kg/m(2) (normal weight) and six with a BMI of greater than 30 kg/m(2) (obese). These subjects performed a series of free dynamic lifting tasks with varied levels of load (10% and 25% of capacity) and symmetry (sagittally symmetric and 45 degrees asymmetric). The results showed that BMI had a significant effect (p<0.05) on trunk kinematics with the high BMI group exhibiting higher peak transverse plane (twisting) velocity (59% higher) and acceleration (57% higher), and exhibiting higher peak sagittal plane velocity (30% higher) and acceleration (51% higher). When normalized to body weight, there were no significant differences in the ground reaction forces between the two groups. This study provides quantitative data describing lifting task performance differences between people of differing BMI levels and may help to explain why there is no conclusive epidemiological evidence of a relationship between BMI and LBP.

One of the challenges facing ergonomists in the implementation of an ergonomic solution is addressing the concerns related to their impact on productivity. The focus of the current study was to (1) apply standard learning curve analysis to the learning that takes place as an individual works with a patient handling device and (2) compare the effects of two different training protocols on measures of learning. Eighteen subjects completed 11 replications of a patient transfer task after participating in either an "interactive" training protocol or "see-one-do-one" training protocol. The results show that the learning rate for this task was 83% with no difference as a function of training protocol. The results do indicate that the effect of Training Method was significant (p<0.05) for time to complete the first patient lift task (370s for the interactive training vs. 475s for see-one-do-one training). The results of the analysis of the survey data supported the objective results in that the only measure that was responsive to training type (p<0.05) was related to comfort level in performing the patient lift task for the first time. The results emphasize the importance in considering learning when introducing an intervention in the workplace, and showed that in this instance, training type had an immediate impact on productivity, but that this effect diminished over time.

Much of the research on backpack design has been focused on spinal loading/biomechanics while the wearer is in a neutral/upright trunk posture, such as those employed by outdoor enthusiasts and schoolchildren. This research has led to some important harness design improvements that reduce trunk muscle exertions, fatigue and improve overall comfort. There are number of occupations, however, wherein workers wear back-mounted packs/devices (e.g. air tanks) while working in non-neutral trunk postures. The objective of the current study was to evaluate the effects of these non-neutral postures on biomechanical loading and then reconsider the backpack system design recommendations. Fifteen participants were asked to support a 18.2 kg load on their back while assuming static forward flexed postures of the torso (15 degrees , 30 degrees , 45 degrees , and 60 degrees of sagittal bend). The mass on the back was attached to the participant through two different harness mechanisms: a basic harness design (as seen on college student backpacks) and a more advanced design containing lateral stiffness rods and a weight-bearing hip belt (as seen on backpacks for hikers). While performing these static, posture maintenance tasks, the activation levels of the bilateral trapezius, erector spinae, and rectus abdominis were collected. Participants also provided subjective ratings of comfort. The results showed that there was a significant interaction between harness type and forward flexion angle for the trapezius and the erector spinae muscles. The normalized EMG for the trapezius muscles showed a 14% and 11% reduction in muscle activity at 15 degrees and 30 degrees , respectively, with the advanced design but these positive effects of the advanced design were not found at the greater flexion angles. Likewise the erector spinae muscles showed a 24% and 14% reduction in muscle activity at 15 degrees and 30 degrees , respectively, with the advanced design harness but these effects of the advanced design were not found at the greater forward flexion angles. The level of forward flexion angle affected the rectus abdominis muscle activity, but neither the harness type main effect nor the interaction of harness type and forward flexion angle was significant. The subjective survey results agreed with the EMG results and showed the advanced design harness was generally more comfortable with respect to the shoulder and low back areas. Collectively, the subjective and objective results show a significant improvement with the advanced harness system but also note an interesting interaction with degree of sagittal flexion, indicating a diminished effectiveness of the design improvements at forward flexed postures. Design criteria for harness systems in these forward flexed postures are discussed.

Industry-specific ergonomics guidelines are an important component in the four-pronged approach to workplace ergonomics currently pursued by the United States Occupational Safety and Health Administration. The American Furniture Manufacturers Association has taken the initiative of developing such a guideline for its members. The result of this effort is the "AFMA Voluntary Ergonomics Guideline for the Furniture Manufacturing Industry", a document that includes basic information about ergonomics program components as well as a compilation of work-proven, ergonomics best practices as submitted by members of the furniture manufacturing community. This guideline was developed through an industry-research-government partnership and made strategic use of the unique attributes that each sector brought to this effort. Outlined in this paper are some of the characteristics of this partnership including, the roles played by each, the different motivations for pursuing the guideline, the challenges faced during the development of the document, the successes experienced in this process, as well as a proposed outline for measuring the effectiveness of this effort. The hope is that this summary, and some of the lessons learned contained herein, would be helpful to others considering the prospect of developing such a guideline for their industry.

Commercial fishing is a job characterized by long hours in an unpredictable, dynamic natural environment and variable demands placed on the musculoskeletal system, requiring strength, coordination, and endurance. The focus of this project was in the quantification of the biomechanical stresses placed on the lumbar spine during the work activities of commercial crab fishermen. The continuous assessment of back stress (CABS) methodology was used to develop distributions describing the amount of time that each of the crew members on a two- or three-man crabbing crew spend at various levels of low back stress. The results of this analysis, expressed in terms of time-weighted histograms, show significant inter and intra-crewmember variability in the stress measures during regular daily work activities. For the three man crew, the captain has relatively low stress levels throughout the work day, while the mate performs high force (up to 30 kg), dynamic exertions while pulling the crab pots from the water up into the boat and high loads (20-40 kg) during the loading and unloading of the boat in the morning and evening, respectively. The third man of the crew experiences static awkward postures (forward flexed postures held for up to 5 min at a time) as he sorts and packs the crabs. For the two-man crew, the results show a more even distribution of the high stress activities between the crewmembers. The application of the results of this analysis for prioritization of work tasks for ergonomic intervention is discussed.

Alternative methods for viewing teeth while performing simulated dental procedures were investigated. The methods allowed participants to assume postures requiring less neck flexion than the standard direct view. One alternative used a video camera and monitor to view the mouth, the other incorporated 90 degrees prism glasses. The study was conducted in two parts: (1) novice participants performing a targeting task; (2) dental hygienists performing a scaling task on a mouth model. Posture and subjective perceptions were assessed in Parts 1 and 2. Muscle activity and performance were also assessed in Part 1. The alternative methods significantly reduced muscle activity, neck flexion, and discomfort, compared to the direct view. Preferences were a function of criteria (general, comfort, productivity, or accuracy). Previously, recommendations for reducing ergonomic risk factor exposure of dental professionals emphasized reducing time spent performing dental procedures. This study shows ergonomic interventions offer alternative means of risk exposure reduction.

Appropriate visual display terminal (VDT) location is a subject of ongoing debate. Generally, visual strain is associated with higher placement, and musculoskeletal strain is associated with lower placement. Seeking resolution of the debate, this paper provides a comparison of results from previous lab-based monitor placement studies to recommendations and outcomes from viewing preference and neutral posture studies. The paper then presents results from a field study that addressed two outstanding issues: Does monitor placement in a workplace elicit postures and discomfort responses similar to those seen in laboratory settings? Results showed placements in the workplace elicited postures similar to those in lab studies. Additionally, preferred VDT location generally corresponded to the location in which less neck discomfort was reported, though that trend requires further investigation. Overall, there seems to be consistent evidence to support mid-level or somewhat higher placement, as a rule-of-thumb, considering preferred gaze angle and musculoskeletal concerns. However, optimal placement may be lower for some individuals or tasks.

For many years, arch-support orthotics have been prescribed for individuals with discomfort and/or abnormal skeletal alignments in the structures of the lower extremity. Recently there has been an increased interest in promoting semi-rigid orthotics as an ergonomic aid for asymptomatic workers who must stand all day at their workplace. A laboratory study was performed to assess the biomechanical impact of prefabricated semi-rigid orthotics on asymptomatic individuals. Ten subjects wore semi-rigid arch-support orthotics (experimental condition) for two months and flexible polyurethane/Sorbothane shoe inserts (control condition) for two months. Throughout this 18-week testing period, the subjects returned to the lab to perform a battery of assessment tests at regularly scheduled intervals. These tests examined subject strength, standing posture, stability, fatigue effects, and body part discomfort. The results of this study showed no significant changes in the strength, posture, or stability as a function of insert type. The subjects reported a reduction in low-back discomfort along with an increase in foot discomfort during a fatiguing exertion task while wearing the semi-rigid orthotics as compared to the control condition.

Prolonged use of video display terminals (VDTs) has been shown to be a risk factor for musculoskeletal and visual discomfort. A standard workplace design recommendation is to position the centre of the VDT 15 degrees below horizontal eye level. Recently a viewing angle of 40 degrees below horizontal has been suggested based on studies that have indicated that this is the preferred viewing angle for visually intensive tasks. The goal of this study was to investigate the effects of these two VDT positions on muscular activity, muscular fatigue, head/neck posture, visual acuity, operator performance (productivity and quality), heart rate and operator subjective assessment. The experimental task consisted of reading text from a computer screen and answering reading comprehension questions using a mouse and a keyboard. Each experimental session lasted 2 h. The 40 degree VDT position showed significantly greater head tilt angles and higher muscle activity levels for six of the 10 neck, shoulder and back muscles sampled. No significant differences in visual acuity, operator performance or heart rate were detected as a result of monitor location. Seven of the 12 subjects preferred the 15 degree monitor position.