Wearable Motion Capture Devices for the Prevention of Work-Related Musculoskeletal Disorders in Ergonomics-An Overview of Current Applications, Challenges, and Future Opportunities.

Work-related musculoskeletal disorders (WMSDs) are a major contributor to disability worldwide and substantial societal costs. The use of wearable motion capture instruments has a role in preventing WMSDs by contributing to improvements in exposure and risk assessment and potentially improved effectiveness in work technique training. Given the versatile potential for wearables, this article aims to provide an overview of their application related to the prevention of WMSDs of the trunk and upper limbs and discusses challenges for the technology to support prevention measures and future opportunities, including future research needs. The relevant literature was identified from a screening of recent systematic literature reviews and overviews, and more recent studies were identified by a literature search using the Web of Science platform. Wearable technology enables continuous measurements of multiple body segments of superior accuracy and precision compared to observational tools. The technology also enables real-time visualization of exposures, automatic analyses, and real-time feedback to the user. While miniaturization and improved usability and wearability can expand the use also to more occupational settings and increase use among occupational safety and health practitioners, several fundamental challenges remain to be resolved. The future opportunities of increased usage of wearable motion capture devices for the prevention of work-related musculoskeletal disorders may require more international collaborations for creating common standards for measurements, analyses, and exposure metrics, which can be related to epidemiologically based risk categories for work-related musculoskeletal disorders.

Effectiveness and usability of real-time vibrotactile feedback training to reduce postural exposure in real manual sorting work.

Vibrotactile feedback training may be used as a complementary strategy to reduce time in demanding postures in manual handling. This study evaluated the short- and medium-term effects of concurrent posture-correction vibrotactile feedback training on trunk inclination exposure in real manual sorting work. Fifteen warehouse workers completed the training and the follow-up sessions. Trunk inclination angles were recorded using the ambulatory Smart Workwear System. Questionnaires were used for assessing system usability, perceived physical exertion, and work ability. The results showed reduced time in trunk inclination >30°, >45°, and >60°, and reductions in the 90th, 95th, and 99th percentile trunk inclination angles, when receiving feedback and immediately after feedback withdrawal. No significant reduction was retained after one and three weeks. The wearer's comfort was scored high, and the feedback did not increase the perceived cognitive demands. No significant effects attributed to changed trunk inclination exposure were observed for perceived physical exertion or work ability. The training program has the potential of contributing to reduced trunk inclination exposure in the short term. Future studies are needed to evaluate if improvements in the feedback training can transfer the short-term results to retained median- and long-term effects.Practitioner summary: A two-day training program with concurrent posture-correction vibrotactile feedback can contribute to reduced exposure of trunk inclination in real manual sorting work in the short term. More research is needed on how to design the feedback training programs in order to be effective in the long term.

Optimizing inhalation therapy in the aspect of peak inhalation flow rate in patients with chronic obstructive pulmonary disease or asthma.

BACKGROUND: Pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs) are commonly used drug-delivering devices for patients with chronic airway diseases. Appropriate peak inhalation flow rate (PIFR) and inhaler technique is essential for effective therapy. We aimed at optimizing inhalation therapy through the analysis of PIFRs in patients with chronic obstructive pulmonary disease (COPD) or asthma as well as the effect of technique training using In-Check DIAL® to help patients to achieve their optimal inspiratory flow rates. METHODS: The study continuously enrolled patients who were diagnosed as COPD or asthma from respiratory clinics. PIFRs were described and analyzed between the newly-diagnosed and follow-up patients, and the stable and acute exacerbation patients, respectively. Every participant was trained inhaler technique using In-Check DIAL®. PIFRs before and after training was compared by self-control analysis. RESULTS: Among a total of 209 patients, the average age was 56.9 years. For DPIs users, 10.8% patients had a PIFR < 30 L/min and 44.1% patients had a PIFR ≥ 60 L/min before technique training. After technique training, scarcely patient (1.5%) had a PIFR < 30 L/min, and 60.5% patients had a PIFR ≥ 60 L/min. The patient's average PIFR increased by 5.6L/min after training. The increase in PIFR before and after training was significant (p < 0.001) for most patients, but no significant variation was found in patients with acute exacerbation (p = 0.822). CONCLUSIONS: A considerable number of patients with COPD or asthma were not able to achieve the minimum or optimal PIFR for DPIs. Inhaler training can increase patients' PIFRs and improve their ability to use DPIs. Trail registration The study has registered in chictr.org.cn (ChiCTR1900024707) and been approved by the Ethics Committee of Zhongshan Hospital of Fudan University (B2019-142).

Retention of Sterile Compounding Knowledge Among Pharmacy Technicians.

Background: Patient safety is in jeopardy due to a rise in the preparation of adulterated parenteral products with poor technique identified as a significant contributing factor. Pharmacy technicians perform an overwhelming majority of aseptic compounding practices; however, this group's progressive loss of aseptic technique knowledge has not been documented. Objective: The purpose of this correlational research study was to investigate the association between sterile compounding knowledge and years in the field controlling for formal training in sterile compounding techniques. Methods: An assessment tool of fundamental sterile compounding content was electronically distributed to sterile compounding technician members of pharmacy organizations in the southeastern United States. A multiple regression was conducted to predict sterile compounding knowledge from number of years in the field and prior years of formal compounding training. Results: Sixty-eight assessments were returned complete. The overall model was significant (P < .0005), explaining 22% of the variance in knowledge retention. Years in the field was the only significant predictor (P < .001). Each additional year of work experience was associated with a 0.18 drop in the assessment score. Conclusions: The longer pharmacy technicians remain in the field, the more aseptic technique knowledge they will lose. Modeling of poor sterile compounding techniques in the workplace may promote loss of competency of the skill. As a result, a plan to address continuing education for pharmacy technician sterile compounders is necessary to ensure patient safety.

A Wearable Sensor System for Physical Ergonomics Interventions Using Haptic Feedback.

Work-related musculoskeletal disorders are a major concern globally affecting societies, companies, and individuals. To address this, a new sensor-based system is presented: the Smart Workwear System, aimed at facilitating preventive measures by supporting risk assessments, work design, and work technique training. The system has a module-based platform that enables flexibility of sensor-type utilization, depending on the specific application. A module of the Smart Workwear System that utilizes haptic feedback for work technique training is further presented and evaluated in simulated mail sorting on sixteen novice participants for its potential to reduce adverse arm movements and postures in repetitive manual handling. Upper-arm postures were recorded, using an inertial measurement unit (IMU), perceived pain/discomfort with the Borg CR10-scale, and user experience with a semi-structured interview. This study shows that the use of haptic feedback for work technique training has the potential to significantly reduce the time in adverse upper-arm postures after short periods of training. The haptic feedback was experienced positive and usable by the participants and was effective in supporting learning of how to improve postures and movements. It is concluded that this type of sensorized system, using haptic feedback training, is promising for the future, especially when organizations are introducing newly employed staff, when teaching ergonomics to employees in physically demanding jobs, and when performing ergonomics interventions.

Examining the effects of different teaching strategies on metacognition and academic performance.

The purpose of this study was to evaluate the effect of different metacognitive interventions on knowledge and regulation of cognition, as well as academic performance (i.e., exam and final grades) in three sections of an undergraduate human anatomy and physiology course. All targeted classes were randomly assigned to one of three groups (reflection practice, passive acquisition of knowledge, and collaborative learning), and the interventions were implemented after exam 1. A pre- and posttest survey was administered during the semester (during week 2 and after exam 2), and exam and final course grades were collected at the end of the semester. The final sample included 129 students. A significant interaction of group and time was observed for knowledge of cognition: it increased in the reflection practice group, did not change in the collaborative learning group, and it decreased in the passive acquisition of knowledge. The interventions did not produce any significant interactions or main effects on regulation of cognition, exam scores, or final grades. Along with more research on metacognition in physiology education contexts, it is recommended to further examine the ways in which such data can be collected, as self-report measures only tell part of the story.

Authors' response to the letter to the editor: "Effects of acoustic feedback training in elite-standard Para-Rowing" by Schaffert and Mattes (2015).

Our article in the Journal of Sports Sciences was designed to examine effects of auditory feedback on mean boat speed during on-water training of visually impaired athletes in elite-standard Para-Rowing. This aim is stated explicitly in the title, abstract, introduction and discussion section. The effects were analysed on the basis of a conservative approach to using inferential statistics by emphasising measures that communicate meaningful differences and effect sizes to help interpret the data's practical importance for sport competition. Biomechanical measurements have been combined with standardised questionnaires to assess the athletes' perceived experience during rowing with acoustic feedback. An application for high-performance rowing has already been used to successfully investigate the effects of acoustic feedback on the time structure of the rowing cycle during the recovery phase. In this response, we provide our comments to the concerns presented in the 'Letter to the Editor' along with a brief description of the issues that relate to research in high-performance sport.

Effects of acoustic feedback training in elite-standard Para-Rowing.

Assessment and feedback devices have been regularly used in technique training in high-performance sports. Biomechanical analysis is mainly visually based and so can exclude athletes with visual impairments. The aim of this study was to examine the effects of auditory feedback on mean boat speed during on-water training of visually impaired athletes. The German National Para-Rowing team (six athletes, mean ± s, age 34.8 ± 10.6 years, body mass 76.5 ± 13.5 kg, stature 179.3 ± 8.6 cm) participated in the study. Kinematics included boat acceleration and distance travelled, collected with Sofirow at two intensities of training. The boat acceleration-time traces were converted online into acoustic feedback and presented via speakers during rowing (sections with and without alternately). Repeated-measures within-participant factorial ANOVA showed greater boat speed with acoustic feedback than baseline (0.08 ± 0.01 m·s(-1)). The time structure of rowing cycles was improved (extended time of positive acceleration). Questioning of athletes showed acoustic feedback to be a supportive training aid as it provided important functional information about the boat motion independent of vision. It gave access for visually impaired athletes to biomechanical analysis via auditory information. The concept for adaptive athletes has been successfully integrated into the preparation for the Para-Rowing World Championships and Paralympics.

Determining whether biomechanical variables that describe common 'safe lifting' cues are associated with low back loads.

Lift technique training programs have been implemented to help reduce injury risk, but the underlying content validity of cues used within these programs is not clear. The objective of this study was to determine whether biomechanical variables, that commonly used lifting cues aim to elicit, are associated with resultant low back extensor moment exposures. A sample of 72 participants were recruited to perform 10 repetitions of a floor-to-waist height barbell lift while whole-body kinematics and ground reaction forces were collected. Kinematic, kinetic, and energetic variables representative of characteristics commonly targeted by lifting cues were calculated as predictor variables, while peak and cumulative low back moments were calculated as dependent measures. Multiple regression revealed that 56.6-59.2% of variance in low back moments was explained by predictor variables. From these regression models, generating motion with the legs (both greater hip and knee work), minimizing the horizontal distance of the body to the load, maintaining a stable body position, and minimizing lift time were associated with lower magnitudes of low back moments. These data support that using cues targeting these identified variables may be more effective at reducing peak low back moment exposures via lift training.

A comparison of augmented feedback and didactic training approaches to reduce spine motion during occupational lifting tasks.

Manual handling training may be improved if it relied on the provision of individualized, augmented feedback about key movement features. The purpose of this study was to compare the reduction in sagittal spine motion during manual lifting tasks following two training approaches: didactic (DID) and augmented feedback (AUG). Untrained participants (n = 26) completed lifting tests (box, medication bag, and paramedic backboard) and a randomly-assigned intervention involving 50 practice box lifts. Lifting tests were performed immediately before and after training, and one-week after interventions. Both groups exhibited reductions in spine motions immediately and one-week after the interventions. However, the AUG intervention group elicited significantly greater reductions in 5 of 12 between-group comparisons (3 tasks × 4 spine motion variables). The results of the current study support the use of augmented feedback-based approaches to manual handling training over education-based approaches.

A Mathematical Model for the Take-Off in Platform Diving.

In platform diving the take-off phase is of outstanding importance in order to achieve both a high level of performing quality and a high degree of difficulty. The diver has to produce the right forces and direction of the center of mass (COM) in order to attain the required angular momentum and dive height. To support the development of an optimum take-off technique, the Institute for Applied Training Science designed a dryland measuring and feedback system. Using the example of the dive back 1» somersault tucked in preparation for the dive back 3½ somersault tucked (207 C) from the 10-m-platform, kinematic and kinetic reference values for key positions were determined. Therefore, we developed a mathematical model using a multi-step examination plan with the following parts: (1) variables defined using nonparametric correlation analyses rs of the motion parameters, (2) statistical modelling to predict values of the parameters, (3) stochastic modelling. The model is based on a selection of 18 dives from 10 different elite divers of the German Swimming Federation (DSV). The approach presented provides helpful insights into the mechanisms of an optimal take-off, enables a target-performance comparison with objective motion parameters and therefore, enables individualized feedback to guide the training process more efficiently.

Reducing postural load in order picking through a smart workwear system using real-time vibrotactile feedback.

Vibrotactile feedback training may be one possible method for interventions that target at learning better work techniques and improving postures in manual handling. This study aimed to evaluate the short term effect of real-time vibrotactile feedback on postural exposure using a smart workwear system for work postures intervention in simulated industrial order picking. Fifteen workers at an industrial manufacturing plant performed order-picking tasks, in which the vibrotactile feedback was used for postural training at work. The system recorded the trunk and upper arm postures. Questionnaires and semi-structured interviews were conducted about the users' experience of the system. The results showed reduced time in trunk inclination ≥20°, ≥30° and ≥45° and dominant upper arm elevation ≥30° and ≥45° when the workers received feedback, and for trunk inclination ≥20°, ≥30° and ≥45° and dominant upper arm elevation ≥30°, after feedback withdrawal. The workers perceived the system as useable, comfortable, and supportive for learning. The system has the potential of contributing to improved postures in order picking through an automated short-term training program.

New low-cost magnifying device for temporal bone laboratory.

Temporal bone dissection has important role in educating and training oto and skull base surgeons. Mounting of a temporal bone laboratory is expensive. A dedicated magnifying system, such as a surgical microscope or an endoscopic equipment, represents one of the most significant costs. The aim of this study is to test and demonstrate the utility of a commercial USB as a low-cost solution to equip the laboratory with a good magnifying system and illumination.

Using verbal instructions to influence lifting mechanics - Does the directive "lift with your legs, not your back" attenuate spinal flexion?

"Use your legs" is commonly perceived as sound advice to prevent lifting-related low-back pain and injuries, but there is limited evidence that this directive attenuates the concomitant biomechanical risk factors. Body segment kinematic data were collected from 12 men and 12 women who performed a laboratory lifting/lowering task after being provided with different verbal instructions. The main finding was that instructing participants to lift "without rounding your lower back" had a greater effect on the amount of spine flexion they exhibited when lifting/lowering than instructing them to lift "with your legs instead of your back" and "bend your knees and hips". It was concluded that if using verbal instructions to discourage spine flexion when lifting, the instructions should be spine- rather than leg-focused.

Comparison of faculty and student self-assessment scores of aseptic technique skills and the impact of video review on self-awareness for second-year pharmacy students.

BACKGROUND AND PURPOSE: Educating students about aseptic technique presents many challenges. Students at Drake University have limited exposure to this skill outside of the classroom setting, and students have previously shown a lack of awareness related to their own aseptic technique skills. One approach to developing self-awareness in this area may be the incorporation of activities involving video viewing and self-reflection. EDUCATIONAL ACTIVITY AND SETTING: Second-year pharmacy students in the Intermediate Pharmacy Skills and Applications 2 course completed four total aseptic technique activities, each of which was assessed by faculty using a standardized assessment tool. Each student was video-recorded during one of these aseptic technique activities. Students were asked to self-reflect on their performance immediately after the activity and again after viewing the video recording of their performance (using the same criteria included in a standardized faculty assessment tool). Student self-reflection scores before and after video viewing were then compared to faculty scores. FINDINGS: One-hundred six students participated in the video recording and self-reflection activity. Compared to faculty assessment scores, there was no significant difference between the self-reflections before or after video viewing (p = 0.571). DISCUSSION: Video self-reflection had no significant impact on the ability to accurately self-assess aseptic technique skills, but this study did reveal several other opportunities for future teaching and research. SUMMARY: Future efforts to impact student self-awareness should include additional self-reflection instruction, repeated self-reflection activities conducted over the course of a semester, and improved video recording technology.

Isokinetic muscle strength testing and technology of training in sports medicine / Teste isocinético de força muscular e tecnologia de treinamento na medicina esportiva / Pruebas isocinéticas de fuerza muscular y tecnología de entrenamiento en medicina deportiva

ABSTRACT Introduction Current research in sports medicine on muscles adjacent to joints in patients with joint instability focuses on functional instability. However, few studies on muscle strength in the muscles adjacent to the joints in typical patients. Objective This study tests the changes in isokinetic muscle strength in flexion-extension muscle groups in common subjects' knees and elbows. Methods Randomly selected ordinary citizens to perform isokinetic muscle strength testing with grip strength, explosive pedaling force, and elbow and knee joint movement speeds of 60°/s. Results The single work of the normal knee flexors and extensors decreases with test speed at different movement speeds. Conclusion The grip strength test and isokinetic pedaling test can be used as simple muscle strength tests for fitness monitoring. Evidence Level II; Therapeutic Studies - Investigating the result.

RESUMO Introdução Pesquisas atuais na medicina esportiva sobre os músculos adjacentes às articulações em pacientes com instabilidade articular concentram-se na instabilidade funcional. Entretanto há poucos estudos sobre a força muscular nos músculos ao redor das articulações em pacientes comuns. Objetivo Este estudo testa as alterações na força muscular isocinética nos grupos musculares de flexo-extensão em joelhos e cotovelos de indivíduos comuns. Métodos Selecionamos aleatoriamente cidadãos comuns para realizar testes isocinéticos de força muscular com força de aderência, força explosiva de pedalar e velocidades de movimento da articulação do cotovelo e joelho de 60°/s. Resultados O trabalho único dos flexores e extensores normais do joelho diminui com a velocidade de teste em diferentes velocidades de movimento. Conclusão O teste de força de aderência e teste isocinético de pedalar podem ser usados como testes de força muscular simples para o monitoramento do condicionamento físico. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción La investigación actual en medicina deportiva sobre los músculos adyacentes a las articulaciones en pacientes con inestabilidad articular se centra en la inestabilidad funcional. Sin embargo, hay pocos estudios sobre la fuerza muscular en los músculos que rodean las articulaciones en pacientes comunes. Objetivo Este estudio comprueba los cambios en la fuerza muscular isocinética en grupos musculares de flexión-extensión en rodillas y codos de sujetos comunes. Métodos Seleccionamos al azar a ciudadanos normales para realizar pruebas isocinéticas de fuerza muscular con fuerza de agarre, fuerza explosiva de pedaleo y velocidades de movimiento de la articulación del codo y la rodilla de 60°/s. Resultados El trabajo individual de los flexores y extensores normales de la rodilla disminuye con la velocidad de la prueba a diferentes velocidades de movimiento. Conclusión La prueba de fuerza de agarre y la prueba de pedaleo isocinético pueden utilizarse como pruebas sencillas de fuerza muscular para el control de la condición física. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.