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.

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.

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.

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.