A systematic review of work related musculoskeletal disorders among physical therapists and physiotherapists.

Physical therapists and physiotherapists (PPTs) perform and repeat physical tasks that can lead to work-related musculoskeletal disorders (WMSD). The aim was to study the main research concerning this problem, i.e. the risk factors, activities that exacerbate WMSD symptoms, alterations in work habits and the proposed responses, and to estimate mean value (±standard deviation, STD) for the most studied parameters. This review was conducted according to the PRISMA guideline. Five databases (Pubmed, ScienceDirect, Google Scholar, Medeley and Science.gov) were scanned to identify works investigating the different aspects of WMSD among PPTs. Two reviewers independently selected relevant studies using inclusion/exclusion criteria, critically appraised, and extracted data. To homogenize the data, prevalence were reported to the total sample studied when necessary. Among the 9846 articles identified, 19 articles were included. The WMSD prevalence was over 50 %. The areas most affected were the lower back, neck and thumb. An exhaustive list of parameters were constructed for job risk factors (n = 19), activities that exacerbating symptoms (n = 13), altered work habits (n = 15), responses and treatments (n = 26). The mean prevalence (±STD) was calculated for the major parameters. Nine main job risk factors were extracted with an average prevalence of about 30 % and a relatively high variability. Seven activities exacerbating WMSD symptoms and five altered work habits were identified with a homogeneous rate (5-20 %). Three main responses and treatments were found with heterogeneous prevalence. This review provides useful results for the development of future protocols to prevent the occurrence of WMSD among PPTs and meta-analyses.

Work-Related Musculoskeletal Disorders Risk Assessment during Manual Lymphatic Drainage with Compressive Bands among Physiotherapists.

BACKGROUND: Complete decongestive therapy is the standard treatment for lymphedema. Manual lymphatic drainage and short-stretch multilayer compression bandaging are two daily stages of complete decongestive therapy during which physiotherapists work with patients. OBJECTIVE: The aim of this study was to assess the risks of musculoskeletal disorders to which physiotherapists are exposed during these two phases. METHOD: Five physiotherapists performed five 20 min manual lymphatic drainages, followed by the compression bandaging phase. From the video recordings, 8477 postures defined by 13 joint angles were grouped into clusters using hierarchical cluster analysis. The risk of musculoskeletal disorders in physiotherapists' postures was assessed using ergonomic tools. RESULTS: Seven clusters, called generic postures (GP), were identified and defined throughout the mean joint angle values and standard deviation. Four seated GPs were found for the drainage phase, and three standing GPs were identified for the bandaging phase. This phase corresponded to a quarter of the total duration. The GP's ergonomic scores ranged from 4.51 to 5.63 and from 5.08 to 7.12, respectively, for the Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA). GP1, GP3, and GP4 presented the highest ergonomic scores (RULA scores: 5.27 to 5.63; REBA scores: 6.25 to 7.12). The most affected areas were the neck (flexion > 20° for all GPs), trunk (flexion between 25 and 30° for GP2, and GP7 during the bandaging phase and GP4 during the drainage phase), and shoulder (flexion and abduction >20° for all GPs except GP5). CONCLUSIONS: These results highlighted that the two complete decongestive therapy phases could be described as a combination of GP. Ergonomic assessment showed that compression bandaging as well as drainage phases expose physiotherapists to moderate musculoskeletal disorder risks that require "further investigation and change soon".

Postural prevalence, time of day and spent time activities during smartphone weekday use among students: A survey to prevent musculoskeletal disorders.

The long time spent on smartphones in awkward postures exposes young users to the risk of developing musculoskeletal disorders (MSDs). This study aimed to investigate 1) how the duration of smartphone use varies by the time of day and activities and 2) the risks of MSDs based on an analysis of the postures used when interacting with smartphones. A cross-sectional survey was conducted among 263 university students. The duration of smartphone use during a typical weekday was investigated over four times of the day and seven activities. After checking for normality, a nonparametric Friedman test was used to study the differences in the time spent using a smartphone according to the time of day and activity. Postural prevalence during weekdays was analyzed using a taxonomy called SmarTaxo, consisting of 41 postures. The Rapid Upper Limb Assessment (RULA) ergonomic score was chosen to assess the MSD risks associated with each posture. Smartphone use was the highest in the evening (301.1 min; 95 % confidence interval [CI]: 277.4-324.8 min, p < 0.05). Texting (170.8 min; 95 % CI: 152.0-189.6 min) and watching videos (163.6 min; 95 % CI: 146.3-180.9 min) were the most common activities. Three sitting and two walking postures were primarily used in the morning (29.3-36.9 %), afternoon (27.0-44.4 %), and evening (28.9%-38.9 %). Standing postures were preferred in the morning and afternoon (36.9 % and 42.2 %, respectively), while one lying posture was widely reported in the evening (39.2 %). The RULA scores for these postures ranged from 3 to 4. However, four lying postures, often observed during the evening (frequency between 20.5 % and 37.6 % of the time), had RULA scores of 6. In conclusion, the study identified an existing MSD risk among smartphone users, especially with long durations of daily use. Special emphasis should be placed on addressing the reclining postures adopted during evening smartphone use, as they subject students to a significantly elevated risk of MSDs.

Effect of day time on smartphone use posture and related musculoskeletal disorders risk: a survey among university students.

BACKGROUND: Musculoskeletal disorders (MSDs) are one of the most important problems among young smartphone users worldwide. Portability leads to a wide variety of postures during the different activities of the day. The objective evaluation of these postures coupled with ergonomic tools allows evaluating the level of MSD risk to which users are exposed. METHODS: The purpose was to investigate the effect of the time of day on the posture adopted during smartphone use among university students. The study was conducted through a cross-sectional survey of 263 university sports students. Four time of day, i.e. morning, afternoon, evening and night, and a taxonomy of 41 postures called SmarTaxo were considered. SmarTaxo included 18 sitting, 11 standing, 10 lying and 2 walking postures and their ergonomic score. After checking the normality of the data, a non-parametric Kruskal-Wallis test was used to study the effect of the time of day on the use duration of the different postures. RESULTS: The total mean duration use per typical weekday was 5.39 ± 2.19 h for males and 5.15 ± 1.60 h for females with maximal duration during evening. The average smartphone use durations were statistically longer in afternoon and evening for all sitting (9.44 and 9.22 min respectively, p < 0.05) and calling (3.38 and 3.33 min respectively, p < 0.05) postures. The longest duration for standing postures was recorded for afternoon (8.91 min, p < 0.05). The lying postures were significantly more present in evening (19.36 min). Some postures were more used during a time of day. The side-lying posture was used more in evening and has an ergonomic score of 6, i.e. a high MSD risk. CONCLUSIONS: The survey showed that users are exposed to MSDs regardless of posture and time of day. Sitting postures are used more in the morning and afternoon while lying postures are used more in the evening. As long as the rate of use is so high (> 5 h per day), young people will remain highly exposed to MSDs.

Three-month work-related musculoskeletal disorders assessment during manual lymphatic drainage in physiotherapists using Generic Postures notion.

OBJECTIVES: The aim of this work was to quantify the postures and to assess the musculoskeletal disorders (MSDs) risk in physiotherapists repeating a manual lymphatic drainage (MLD) over a three-month period. The underlying hypothesis was that there would be Generic Postures (GP) that would be repeated and could be used to more simply describe repetitive and long-duration complex activities. METHODS: The posture of five physiotherapists performing five 20-min MLD at their workplace was captured by two cameras. From the recordings, the adopted postures were extracted every 5 s and quantified through 13 joint angles, that is, 6594 analyzed postures. Rapid Upper Limb (RULA) and Rapid Entire Body Assessment (REBA) were used to assess MSDs risks. A hierarchical analysis was used to define GP. RESULTS: Seven GP were identified through mean values and standard deviation. GP ergonomic assessment showed a low to moderate MSD risk (RULA between 3 and 6 and REBA between 2 and 7). High neck (>20°) and trunk (>15°) flexion were observed for all GP. High shoulder abduction and flexion (>40°) were evidenced for GP3 to GP5. GP1 was the most used (34%) and presented the lowest ergonomic scores (RULA: 4.46 ± 0.84; REBA: 5.06 ± 1.75). GP3 to GP6 had frequency of between 10 and 20%. GP5, GP6, and GP7 obtained the highest ergonomic scores (RULA>5; REBA>7). All physiotherapists use different GP combinations to perform MLD. CONCLUSION: MLD could be described as a combination of GP. Ergonomic analysis showed that MLD exposes physiotherapists to low at moderate MSD risks.

Effect of Assisted Surgery on Work-Related Musculoskeletal Disorder Prevalence by Body Area among Surgeons: Systematic Review and Meta-Analysis.

Surgeons are highly exposed to work-related musculoskeletal disorders (WMSDs). The objective of this review was to summarize the WMSD prevalence by body area with and without assistive devices. The underlying question was whether there is an effect of assistive device use (robot, video, or other) during surgery on WMSD prevalence by body area among surgeons, regardless of their specialty. The systematic review was conducted according to the PRISMA guidelines. The Google Scholar, Pubmed/Medline, and ScienceDirect databases were scanned to identify relevant studies. The article selection, review, critical appraisal, and data extraction were performed by two authors independently. Among the 34,854 unique identified records, 77 studies were included. They were divided into two groups: 35 focused on robotic- and video-assisted surgery (RVAS) and 48 concerning surgery without video/robotic assistance (WAS) (6 studies evaluated the prevalence for both groups). WMSD prevalence was reported for 13 body areas: the neck, back, upper back, mid-back, lower back, shoulders, elbows, wrists, fingers, thumbs, hips, knees, and ankles. The results showed that WMSD prevalence was significantly higher (unpaired t-test, p < 0.05) for RVAS in the shoulders (WAS: 28.3% vs. RVAS: 41.9%), wrists (WAS: 20.9% vs. RVAS: 31.5%), and thumbs (WAS: 9.9% vs. RVAS: 21.8%). A meta-analysis was performed for 10 body areas (with 4 areas including more than 25 studies). No sufficient data were available for the mid-back, thumbs, or hips. A high heterogeneity (Cochran's Q test and I2 statistic) was observed. A random-effects model revealed that the highest worldwide prevalence was in the neck (WAS: 41% and RVAS: 45.3%), back (WAS: 37.7% and RVAS: 49.9%), lower back (WAS: 40.0% and RVAS: 37.8%), and shoulders (WAS: 27.3% and RVAS: 41.4%). Future work could focus on work environment design, particularly the positioning and adjustment of equipment, and on postural analysis to reduce the appearance of WMSDs. Recommendations are proposed for future reviews and meta-analyses.

Global prevalence of musculoskeletal disorders among physiotherapists: a systematic review and meta-analysis.

BACKGROUND: Musculoskeletal disorders (MSD) are one of the most important problems among physiotherapists worldwide. However, there is no meta-analysis of the MSD prevalence in all body areas among physiotherapists. OBJECTIVES: The purpose was to investigate and estimate the worldwide prevalence of MSD among physiotherapists using a systematic review-, meta-analysis and meta-regression. METHODS: The systematic review, meta-analysis and meta-regression were performed in 2022 using the PRISMA guidelines. DATA SOURCES: The search was performed on PubMed/Medline, ScienceDirect, Google Scholar, Medeley and Science.gov databases. STUDY APPRAISAL: The quality appraisal of the included articles was assessed using the critical appraisal tool for cross-sectional studies AXIS. RESULTS: A total of 722 articles were found. After screening and comparison with the inclusion criteria, 26 studies were retained. Based on the random-effects model, the worldwide MSD prevalence in neck, upper back, mid back, lower back, shoulders, elbows, wrists/hands, thumb, hips/thighs, knees/legs, and ankles/feet was 26.4% (CI 95%: 21.0-31.9%), 17.7% (CI 95%: 13.2-22.2%), 14.9% (CI 95%: 7.7-22.1%), 40.1% (CI 95%: 32.2-48.0%), 20.8% (CI 95%: 16.5-25.1), 7.0% (CI 95%: 5.2-8.9), 18.1% (CI 95%: 14.7-21.5%), 35.4% (CI 95%: 23.0-47.8), 7.0% (CI 95%: 5.2-8.8), 13.0% (CI 95%: 10.3-15.8), and 5% (CI 95%: 4.0-6.9) respectively. The neck and shoulder prevalence of four continents were close to the world prevalence. No effect of continent was found on MSD prevalence. The heterogeneity of the results obtained in the meta-analysis and meta-regression was discussed. CONCLUSIONS: Based on the random effects model, the results of the worldwide meta-analysis showed that lower back pain, thumb, neck and shoulder were the area most at risk for MSD and were therefore those to be monitored as a priority. Recommendations were proposed for future reviews and meta-analyses.

A New Approach to Quantifying Muscular Fatigue Using Wearable EMG Sensors during Surgery: An Ergonomic Case Study.

(1) Background: Surgeons are exposed to musculoskeletal loads that are comparable to those of industrial workers. These stresses are harmful for the joints and muscles and can lead to musculoskeletal disorders (MSD) and working incapacity for surgeons. In this paper, we propose a novel ergonomic and visualization approach to assess muscular fatigue during surgical procedures. (2) Methods: The activity of eight muscles from the shoulder girdle and the cervical/lumbar spines were evaluated using position and electromyographic wearable sensors while a surgeon performed an arthroscopic rotator-cuff surgery on a patient. The time and frequency-domain variables of the root-mean-square amplitude and mean power frequency, respectively, were calculated from an electromyographic signal. (3) Results: The entire surgical procedure lasted 73 min and was divided into 10 sub-phases associated with specific level of muscular activity and fatigue. Most of the muscles showed activity above 60%, while the middle trapezius muscles were almost constantly activated (>20%) throughout the surgical procedure. (4) Conclusion: Wearable sensors can be used during surgical procedure to assess fatigue. Periods of low-to-high activity and fatigue can be evaluated and visualized during surgery. Micro-breaks throughout surgical procedures are suggested to avoid fatigue and to prevent the risk of developing MSD.

Ergonomic risk assessment during massage among physiotherapists: Introduction of generic postures notion.

BACKGROUND: Musculoskeletal disorders are prevalent among physiotherapists. They perform many repetitive tasks in awkward postures that require a high muscle load. This issue was often addressed through subjective analysis (questionnaire) but rarely using postural evaluation combined with an ergonomic assessment. OBJECTIVE: The aim of this article was to decompose draining lymphatic massage performed by physiotherapists in generic postures (GP) to quickly assess the musculoskeletal disorder risk. METHODS: Based on numeric video recorded in frontal and sagittal planes, 3360 postures were defined from 20-minutes lymphatic drainage massage performed by 7 physiotherapists over a period of 6 months. A hierarchical cluster analysis was applied to define the GP. RESULTS: Seven GP were identified, which were described by their average joint angles, variability and relative frequency. GP6, GP4 and GP2 had the highest frequencies (17.6%, 16.9% and 16.8% respectively). Trunk and neck were essentially flexed (neck: 17.0±10.0° for GP1; trunk: 20.4±8.7° for GP4). Shoulder flexion and abduction ranged from 15° (GP7) to 60° (GP4). Mean and variability of RULA score completed the analysis. The highest scores were computed for GP2 and GP3 (respectively 5.5±1.3 and 5.8±1.2, p < 0.05). GP4 had the lowest (4.0±1.1, p < 0.05). The results suggest that massages have to be monitored. Attention should be paid to the postures used to prevent the occurrence of MSDs. CONCLUSION: The massages could be described as a combination of generic posture for a rapid ergonomic assessment.

Prevalence of Body Area Work-Related Musculoskeletal Disorders among Healthcare Professionals: A Systematic Review.

Healthcare professionals perform daily activities that can lead to musculoskeletal disorders (MSDs). The objective of this review was to summarize these MSDs by body areas in relation to healthcare professions. The underlying question is, worldwide, whether there are areas that are more exposed depending on the occupation or whether there are common areas that are highly exposed to MSDs. This issue has been extended to risk factors and responses to reduce MSDs. The review was conducted according to the PRISMA guidelines between February and May 2022. Google scholar and Science Direct databases were scanned to identify relevant studies. Two authors independently reviewed, critically appraised, and extracted data from these studies. Overall and body area prevalence, risk factors, and responses to MSDs were synthetized by occupational activity. Among the 21,766 records identified, 36 covering six healthcare professions were included. The lower back, neck, shoulder and hand/wrist were the most exposed areas for all healthcare professionals. Surgeons and dentists presented the highest prevalence of lower back (>60%), shoulder and upper extremity (35-55%) MSDs. The highest prevalence of MSDs in the lower limbs was found for nurses (>25%). The main causes reported for all healthcare professionals were maintenance and repetition of awkward postures, and the main responses were to modify these postures. Trends by continent seem to emerge regarding the prevalence of MSDs by healthcare profession. Africa and Europe showed prevalence three times higher than Asia and America for lower back MSDs among physiotherapists. African and Asian nurses presented rates three times higher for elbow MSDs than Oceanians. It becomes necessary to objectively evaluate postures and their level of risk using ergonomic tools, as well as to adapt the work environment to reduce exposure to MSDs with regard to the specificities of each profession.

A predictive model to quantify joint torques and support reaction forces when using a smartphone while standing with support.

The present study had a dual objective: (1) to present and validate a predictive model of standing posture in the sagittal plane, joint torques and support forces for a smartphone user built from biomechanical principles; (2) propose risk scales for joint torques and reaction forces based on simulations in order to use them into the musculoskeletal disorders prevention. Comparison of the modelled data with experimental measurements (400 tested postures with sample size verification) for calling and texting tasks highlights the model's ability to correctly estimate posture and reaction forces on the ground. The model was able to provide estimates of the range of variation of each parameter for a wide range of environmental conditions as a function of the user body mass index (setting between 12.5 and 50). Joint torques risk scales have been constructed, especially for shoulder and elbow, to characterise the risks incurred by the users. Practitioner summary: The proposed model enables the postures, joint torques and reaction forces to be estimated from subject's body mass index and environmental configuration without resorting to experimentation, which is relevant in industry. This approach allows the proposition of new scales based on joint torques to reinforce the recommendations for MSDs prevention. Abbreviations: BMI: body mass index; LUBA: postural loading on the upper body assessment; MSDs: musculoskeletal disorders; RULA: rapid upper limb assessment; WHO: World Health Organization.

Identification of generic drilling task phases and height effect: Coupling of kinematic and kinetic data.

BACKGROUND: The prevention of work-related musculoskeletal disorders (MSDs) is an important issue for the health of operators, especially when the workload is heavy, such as in drilling activities. RESEARCH QUESTION: This study aimed to propose an objective identification and description of the different phases that comprise a drilling task as well as a biomechanical and ergonomic evaluation of the subjects' overall posture during its effective part. METHODS: Fourteen healthy subjects performed three successive drillings at two different heights, 130 (H130) and 170 cm (H170) from the ground, of a 3 mm thick steel plate. Kinematic and kinetic data were simultaneously acquired using a Qualisys motion capture system and a force platform. The speed profiles of each body segments and the evolution of the force exerted were analysed to identify the different phases. Then, the average joint angles of the whole body were calculated during the drilling phase for the two heights considered and compared. Finally, the measured postures were qualified through the Rapid Upper Limb Assessment (RULA) score in order to assess the risk of developing MSDs for each condition. RESULTS: The drilling task could be divided into five phases whatever the condition: transport, aiming, repositioning, drilling, and return. The increase in height has doubled the duration of the drilling phase while reducing the force exerted by about 30 %. Similarly, height variation significantly influenced the subjects' posture, mainly in the head, trunk and upper limbs, and the RULA scores obtained for conditions H130 and H170 were 6 and 7 respectively. SIGNIFICANCE: The results indicate, on the one hand, the relevance of coupling kinematic and kinetic data in order to analyse the drilling task and, on the other hand, that operators are exposed to considerable risk of developing MSDs, even at intermediate heights, which increase as the height increases.

Comparison between joystick- and gaze-controlled electric wheelchair during narrow doorway crossing: Feasibility study and movement analysis.

Due to motor deficiencies inducing low force capabilities or tremor, many persons have great difficulties to use joystick-operated wheelchairs. To alleviate such difficulties, alternative interfaces using vocal, gaze, or brain signals are now becoming available. While promising, these systems still need to be evaluated thoroughly. In this framework, the aims of this study are to analyze and evaluate the behavior of 11 able-bodied subjects during a navigation task executed with gaze or joystick-operated electric wheelchair involving a door crossing. An electric wheelchair was equipped with retroreflective markers, and their movements were recorded with an optoelectronic system. The gaze commands were detected using an eye tracking device. Apart from classical, forward, backward, stop, left and right commands, the chosen screen-based interface integrated forward-right and forward-left commands. The global success rate with the gaze-based control was 80.3%. The path optimally ratio was 0.97 and the subject adopted similar trajectories with both systems. The results for gaze control are promising and highlight the important utilization of the forward-left and forward-right commands (25% of all issued commands) that may explain the similarity between the trajectories using both interfaces.

Effects of environmental illumination and screen brightness settings on upper limb and axial skeleton parameters: how do users adapt postures?

79% of smartphone users carry their phone 22 hours a day. In this context, the main task worldwide, texting, is performed under a wide range of light and position conditions. The aim of this study was to test the effects of environmental illumination and screen brightness settings on upper limb and axial skeleton parameters. Twelve subjects performed three trials of texting under three experimental positions, two screen luminance settings and three environmental light conditions. 3 D axial skeleton and upper limb angles, smartphone orientation and face-to-smartphone distance were used as dependent variables. High environmental illumination and/or low screen brightness resulted in an increase in interaction time and a reduction in the face-to-smartphone distance by approximately 10%. Subjects attempted to compensate for the unfavourable effects of such light conditions by adopting postures rated 5 in the Rapid Upper Limb Assessment, indicating an increased risk of developing musculoskeletal disorders. Practitioner's summary: The purpose of the study was to quantify the joint angles of the upper body in experimental conditions that represent daily life. Postures were influenced by ambient illumination and display brightness. The most harmful postures were observed when the display brightness was minimum, and the ambient light was similar to a sunny day. Abbreviations: ST: seated with table; SWT: seated without any support; STA: standing; 0L: in the dark, no light; AL: ambient light; SL: strong light; BrightMin: minimum display brightness; BrightMax: maximum display brightness (BrightMax); ISB: International Society of Biomechanics; RULA: rapid upper limb assessment; MSDs: musculoskeletal disorders.

Maximal isometric force exertion predicted by the force feasible set formalism: application to handbraking.

The aim of this study was to test the capacity of the force feasible set formalism to predict maximal force exertion during isometric handbraking. Maximal force exertion and upper-limb posture were measured with a force sensor embedded in a handbrake and an optoelectronic system, respectively. Eleven subjects participated in the experiment which consisted of exerting the maximal force in isometric conditions considering five hand brake positions relative to the seat H-point. Then, maximal force was predicted by the force feasible set obtained from an upper-limb musculoskeletal model. The root-mean-square (RMS) of the angle between measured and predicted forces was 8.4° while the RMS error (RMSE) for amplitude prediction was 95.4 N. However, predicted, and measured force amplitudes were highly correlated (r = 0.88, p < 0.05, slope = 0.97, intercept = 73.3N) attesting the capacity of the model to predict force exertion according to the subject's posture. The implications in the framework of ergonomics are then discussed. Practitioner summary: Maximal force exertion is of paramount importance in digital human modelling. We used the force feasible set formalism to predict maximal force exertion during handbraking from posture and anthropometric data. The predicted and measured force orientation showed a RMS of 8.4° while amplitude presented a RMSE of 95.4 N with a strong correlation (r = 0.88, p < 0.05, slope 0.97, intercept 77.3 N).

Force feasible set prediction with artificial neural network and musculoskeletal model.

Developing tools to predict the force capabilities of the human limbs through the Force Feasible Set (FFS) may be of great interest for robotic assisted rehabilitation and digital human modelling for ergonomics. Indeed, it could help to refine rehabilitation programs for active participation during exercise therapy and to prevent musculoskeletal disorders. In this framework, the purpose of this study is to use artificial neural networks (ANN) to predict the FFS of the upper-limb based on joint centre Cartesian positions and anthropometric data. Seventeen right upper-limb musculoskeletal models based on individual anthropometric data are created. For each musculoskeletal model, the FFS is computed for 8428 different postures. For any combination of force direction and joint positions, ANNs can predict the FFS with high values of coefficient of determination (R2 > 0.89) between the true and predicted data.

Wheelchair propulsion: Force orientation and amplitude prediction with Recurrent Neural Network.

The aim of this study was to use Recurrent Neural Network (RNN) to predict the orientation and amplitude of the applied force during the push phase of manual wheelchair propulsion. Trunk and the right-upper limb kinematics data were assessed with an optoeletronic device (Qualisys) and the force applied on the handrim was recorded with an instrumented wheel (SMARTWheel®). Data acquisitions were performed at 60/80/10/120/140% of the freely chosen frequency at submaximal and maximal conditions. The final database consisted of d = 5708 push phases. The input data were the trunk and right upper-limb kinematics (joint angle, angular velocity and acceleration) and anthropometric data (height, weight, segment length) and the output data were the applied forces orientation and amplitude. A ratio of 70/15/15 was used to train, validate and test the RNN (dtrain = 3996, dvalidation = 856 and dtest = 856). The angle and amplitude errors between the measured and predicted force was assessed from dtest. Results showed that for most of the push phase (∼70%), the force direction prediction errors were less than 12°. The mean absolute amplitude errors were less than 8 N and the mean absolute amplitude percentage errors were less than 20% for most of the push phase (∼80%).

The impact of Nordic walking training on the gait of the elderly.

The purpose of the current study was to define the impact of regular practice of Nordic walking on the gait of the elderly. Thereby, we aimed to determine whether the gait characteristics of active elderly persons practicing Nordic walking are more similar to healthy adults than that of the sedentary elderly. Comparison was made based on parameters computed from three inertial sensors during walking at a freely chosen velocity. Results showed differences in gait pattern in terms of the amplitude computed from acceleration and angular velocity at the lumbar region (root mean square), the distribution (Skewness) quantified from the vertical and Euclidean norm of the lumbar acceleration, the complexity (Sample Entropy) of the mediolateral component of lumbar angular velocity and the Euclidean norm of the shank acceleration and angular velocity, the regularity of the lower limbs, the spatiotemporal parameters and the variability (standard deviation) of stance and stride durations. These findings reveal that the pattern of active elderly differs significantly from sedentary elderly of the same age while similarity was observed between the active elderly and healthy adults. These results advance that regular physical activity such as Nordic walking may counteract the deterioration of gait quality that occurs with aging.

Evaluation and validation of musculoskeletal force feasible set indices: Application to manual wheelchair propulsion.

The aim of this work was to assess handrim wheelchair propulsion effectiveness, related to the applied forces on the handrim, through the force feasible set. For a given posture of the upper-limb, it represents the set of isometric forces that can be applied on the handrim in any direction. The force feasible set was predicted from a musculoskeletal model of the upper-limb and trunk (10 degrees of freedom and 56 muscles). The aim of the first part of the study was to compare the force feasible set prediction and the force currently applied on the handrim. The second part proposes the creation of a new index called "Musculoskeletal Postural Performance Index" (MPPI) derived from the force feasible set and its comparison with the Mechanical Efficiency Force (MEF). These comparisons were conducted at 60, 80, 100, 120 and 140% of the Freely Chosen Frequency at submaximal and maximal conditions on 5 different phases of the push phase. The values of the MPPI were significantly correlated with those of the MEF. During the course of the push phase, the orientation of the force feasible set main axis approached that of the measured force and the force effectiveness evaluated through the MPPI increased.

Contribution of interaction torques during dart throwing: Differences between novices and experts.

We examined if experts and novices show different utilization of the torque components impulses during dart throwing. Participants threw darts continuously at a dartboard aiming for the centre (target bull's eye). The upper-limb joint torque impulses were obtained through inverse dynamics with anthropometric and motion capture data as input. Depending on the joint degree of freedom (DOF) and movement phase (acceleration and follow-through), three main strategies of net torque (NET) impulse generation through joint muscle (MUS) and interaction (INT) torque impulses were highlighted. Firstly, our results showed that the elbow flexion-extension DOF leads the movement according to the joint leading hypothesis. Then, considering the acceleration phase, the analysis revealed differences in torque impulse decomposition between expert and novices. For the glenohumeral (GH) joint abduction-adduction and for wrist flexion, the INT torque impulse contributed positively to NET joint torque impulse in the group of experts unlike novices. This allowed to lower the necessary MUS torque impulse at these DOFs. Also, GH axial rotation was actively controlled by muscle torque impulse in the group of experts. During the follow-through, the experts used the INT torque impulse more proficiently than novices to break the elbow extension. The comparison between experts and novices through inverse dynamics document the link between the exploitation of interaction torques impulses and expertise in dart throwing for which the main objective is precision rather than velocity.