Effects of Two Passive Back-Support Exoskeletons on Muscle Activity, Energy Expenditure, and Subjective Assessments During Repetitive Lifting.

OBJECTIVE: The aim of this study was to explore the efficacy of two different passive back-support exoskeleton (BSE) designs during repetitive lifting in different postures. BACKGROUND: Although BSEs have been proposed as a potential intervention for reducing physical demands, limited information is available about the impacts of different exoskeleton designs in diverse work scenarios. METHOD: Eighteen participants (gender-balanced) performed lab-based simulations of repetitive lifting tasks. These tasks were performed in 12 different conditions, involving two BSEs and a control condition, two levels of lifting symmetry (symmetric and asymmetric), and two postures (standing and kneeling). Outcome measures described muscle activity and energy expenditure, along with perceived discomfort, balance, and usability. RESULTS: Using both BSEs significantly reduced peak activity of the trunk extensor muscles (by ~10%-28%) and energy expenditure (by ~4%-13%) in all conditions tested. Such reductions, though, were task dependent and differed between the two BSEs. In most of the tested conditions, using BSEs positively affected subjective responses regarding perceived exertion and usability. CONCLUSION: Our results suggest that the beneficial effects of a BSE are task specific and depend on the specific BSE design approach. More work is needed, though, to better characterize this task specificity and to determine the generalizability of BSE effects on objective and subjective outcomes for a wider range of conditions and users. APPLICATION: Our results provide new evidence to guide the selection and application of passive BSE designs in diverse lifting tasks.

Inter-individual variability in load carriage economy and comparisons between different load conditions.

Equivocal findings exist for the economy associated with load carried close to the body's centre of mass. Individual variation could explain some of the equivocal findings. This research aimed to examine the extent of individual variation in loaded walking economy. Eighteen females carried load on the back, head and split between the front and back. Individual variation in relative load carriage economy (ELI) was primarily assessed using standard deviation, coefficients of variation (CV) and intraclass correlation coefficients (ICC). There was large inter-individual variation in ELI values with highest mean CV's of 16%, 12% and 10% for head-, back- and combined front and back-loading. Mean ELI values were not significantly different between methods. The large amount of individual variation found here suggests future load carriage research should account for individual variation, particularly when considering sample size and when making inferences on the economy associated with different types of load carriage using group mean data.

Development of a Wireless Health Monitoring System for Measuring Core Body Temperature from the Back of the Body.

In this paper, a user-friendly and low-cost wireless health monitoring system that measures skin temperature from the back of the body for monitoring the core body temperature is proposed. To measure skin temperature accurately, a semiconductor-based microtemperature sensor with a maximum accuracy of ±0.3°C was chosen and controlled by a high-performance/low-power consumption Acorn-Reduced Instruction Set Computing Machine (ARM) architecture microcontroller to build the temperature measuring device. Relying on a 2.4 GHz multichannel Gaussian frequency shift keying (GFSK) RF communication technology, up to 100 proposed temperature measuring devices can transmit the data to one receiver at the same time. The shell of the proposed wireless temperature-measuring device was manufactured via a 3D printer, and the device was assembled to conduct the performance tests and in vivo experiments. The performance test was conducted with a K-type temperature sensor in a temperature chamber to observe temperature measurement performance. The results showed an error value between two devices was less than 0.1°C from 25 to 40°C. For the in vivo experiments, the device was attached on the back of 10 younger male subjects to measure skin temperature to investigate the relationship with ear temperature. According to the experimental results, an algorithm based on the curve-fitting method was implemented in the proposed device to estimate the core body temperature by the measured skin temperature value. The algorithm was established as a linear model and set as a quadratic formula with an interpolant and with each coefficient for the equation set with 95% confidence bounds. For evaluating the goodness of fit, the sum of squares due to error (SSE), R-square, adjusted R-square, and root mean square error (RMSE) values were 33.0874, 0.0212, 0.0117, and 0.3998, respectively. As the experimental results have shown, the mean value for an error between ear temperature and estimated core body temperature is about ±0.19°C, and the mean bias is 0.05 ± 0.14°C when the subjects are in steady status.

Gait Symmetry Assessment with a Low Back 3D Accelerometer in Post-Stroke Patients.

Gait asymmetry is an important marker of mobility impairment post stroke. This study proposes a new gait symmetry index (GSI) to quantify gait symmetry with one 3D accelerometer at L3 (GSIL3). GSIL3 was evaluated with 16 post stroke patients and nine healthy controls in the Six-Minute-Walk-Test (6-MWT). Discriminative power was evaluated with Wilcoxon test and the effect size (ES) was computed with Cliff's Delta. GSIL3 estimated during the entire 6-MWT and during a short segment straight walk (GSIL3straight) have comparable effect size to one another (ES = 0.89, p < 0.001) and to the symmetry indices derived from feet sensors (|ES| = [0.22, 0.89]). Furthermore, while none of the indices derived from feet sensors showed significant differences between post stroke patients walking with a cane compared to those able to walk without, GSIL3 was able to discriminate between these two groups with a significantly lower value in the group using a cane (ES = 0.70, p = 0.02). In addition, GSIL3 was strongly associated with several symmetry indices measured by feet sensors during the straight walking cycles (Spearman correlation: |ρ| = [0.82, 0.88], p < 0.05). The proposed index can be a reliable and cost-efficient post stroke gait symmetry assessment with implications for research and clinical practice.

A comparison of economy and sagittal plane trunk movements among back-, back/front- and head-loading.

It has been suggested that freedom of movement in the trunk could influence load carriage economy. This study aimed to compare the economy and sagittal plane trunk movements associated with three load carriage methods that constrain posture differently. Eighteen females walked at 3 km.h-1 with loads of 0, 3, 6, 9, 12, 15 and 20 kg carried on the back, back/front and head. Load carriage economy was assessed using the Extra Load Index (ELI). Change in sagittal plane trunk forward lean and trunk angle excursion from unloaded to loaded walking were assessed. Results show no difference in economy between methods (p = .483), despite differences in the change in trunk forward lean (p = .001) and trunk angle excursion (p = .021) from unloaded to loaded walking. We conclude that economy is not different among the three methods of load carriage, despite significant differences in sagittal plane trunk movements. Practitioner summary: This article shows, based on mean data, that there is no difference in economy among back, back/front and head-loading, despite differences in trunk movement. It is possible a combination of factors align to influence individual economy, rather than a single set of factors, applicable to all individuals for each method.

Vibrotactile perception assessment for a haptic interface on an antigravity suit.

Haptic technology is used in various fields to transmit information to the user with or without visual and auditory cues. This study aimed to provide preliminary data for use in developing a haptic interface for an antigravity (anti-G) suit. With the structural characteristics of the anti-G suit in mind, we determined five areas on the body (lower back, outer thighs, inner thighs, outer calves, and inner calves) on which to install ten bar-type eccentric rotating mass (ERM) motors as vibration actuators. To determine the design factors of the haptic anti-G suit, we conducted three experiments to find the absolute threshold, moderate intensity, and subjective assessments of vibrotactile stimuli. Twenty-six fighter pilots participated in the experiments, which were conducted in a fixed-based flight simulator. From the results of our study, we recommend 1) absolute thresholds of ∼11.98-15.84 Hz and 102.01-104.06 dB, 2) moderate intensities of 74.36 Hz and 126.98 dB for the lower back and 58.65 Hz and 122.37 dB for either side of the thighs and calves, and 3) subjective assessments of vibrotactile stimuli (displeasure, easy to perceive, and level of comfort). The results of this study will be useful for the design of a haptic anti-G suit.

Validity of a small low-cost triaxial accelerometer with integrated logger for uncomplicated measurements of postures and movements of head, upper back and upper arms.

Repetitive work and work in constrained postures are risk factors for developing musculoskeletal disorders. Low-cost, user-friendly technical methods to quantify these risks are needed. The aims were to validate inclination angles and velocities of one model of the new generation of accelerometers with integrated data loggers against a previously validated one, and to compare meaurements when using a plain reference posture with that of a standardized one. All mean (n = 12 subjects) angular RMS-differences in 4 work tasks and 4 body parts were <2.5° and all mean median angular velocity differences <5.0 °/s. The mean correlation between the inclination signal-pairs was 0.996. This model of the new generation of triaxial accelerometers proved to be comparable to the validated accelerometer using a data logger. This makes it well-suited, for both researchers and practitioners, to measure postures and movements during work. Further work is needed for validation of the plain reference posture for upper arms.

Evaluation of four sensor locations for physical activity assessment.

Direct measurements of physical activity (PA) obtained with inertial measurement units (IMUs) secured to the upper arms and trunk of 36 registered nurses working a full shift were compared to measurements obtained with a commercially-available PA monitor (ActiGraph wGT3X-BT) worn at the waist. Raw accelerations from each device were summarized into PA counts/min and metabolic equivalent (METs) categories using standard definitions. Differences between measurements were examined using repeated measures one-way analyses of variance (ANOVA) and agreement was assessed using Bland-Altman plots. Statistically significant differences were observed between all sensor locations for all PA summary metrics except for between the left and right arm for percentages of work time in the light and moderate counts/min categories. Bland-Altman plots suggested limited agreement between measurements obtained with the IMUs and measurements obtained with the wGT3X-BT waist-worn PA monitor. Results indicate that PA measurements vary substantially based on sensor location.

A smartphone-centric system for the range of motion assessment in stroke patients.

The range of motion (ROM) in stroke patients is often severely affected. Poststroke rehabilitation is guided through the use of clinical assessment scales for the rROM. Unfortunately, these scales are not widely utilized in clinical practice as they are excessively time-consuming. Although commercial motion-capture systems are capable of providing the information required for the assessments, most systems are either too costly or lack the convenience required for assessments to be conducted on a daily basis. This paper presents the design and implementation of a smartphone-based system for automated motor assessment using low-cost off-the-shelf inertial sensors. The system was used to automate a portion of the upper-extremity Fugl-Meyer assessment (FMA), which is widely used to quantify motor deficits in stroke survivors. Twelve out of 33 items were selected, focusing mainly on joint angle measurements of the upper body. The system has the ability to automatically identify the assessment item being conducted, and calculate the maximum respective joint angle achieved. Preliminary results show the ability of this system to achieve comparable results to goniometer measurements, while significantly reducing the time required to conduct the assessments. The portability and ease-of-use of the system would simplify the task of conducting range-of-motion assessments.

A system for predicting musculoskeletal disorders among dental students.

OBJECTIVE: This study aimed to develop a system for predicting work-related musculoskeletal disorders (WMSD) among dental students. MATERIALS AND METHODS: The system comprised 2 accelerometer sensors to register neck and upper back postures and movements, and software developed to collect and process the data. Hidden Markov models (HMMs) were used to predict the likelihood of WMSD in dental students by comparing their neck and upper back movement patterns with WMSD and non-WMSD HMMs learned from previous data. To evaluate the performance of the system, 16 participants were randomly assigned into a 2 × 2 crossover trial scheduled for each sequence of working: receiving feedback or no-feedback from the system. The primary outcome measure was the extension of the neck and upper back, before (pre-test) and after (posttest) receiving feedback or no-feedback from the system. The secondary outcome measure was the log likelihood of classifying the movements as WMSD. RESULTS AND DISCUSSION: The results showed that in the group that received feedback, the extension of the neck in the y axis and of the upper back in the y axis decreased significantly (t test, p < .05) on the post-test. CONCLUSION: The system for predicting and preventing WMSD aids the correction of the extension of the neck and upper back in the y axis.

Assessment of balance in unsupported standing with elderly inpatients by force plate and accelerometers.

BACKGROUND AND AIMS: Unsupported standing is one of the most important functional tasks involving balance control. Unlike younger people, who have been shown to counteract imbalance preferably with an ankle strategy, older people tend to do so with a hip strategy. These strategies can be described by matching balance measures at floor and hip level, a good match representing an ankle-dominant strategy and a low one a hip-dominant strategy. The aim of this study was to show possible change in the association between force platform measurement at floor level and accelerometry at hip level in elderly inpatients standing unsupported during rehabilitation. METHODS: Forty four elderly inpatients (mean age 82.5 yrs) after hip fracture or stroke were recruited for the study. Balance was assessed after admission and 2 weeks later on a force platform at floor level and simultaneously by a tri-axial accelerometer at hip level. RESULTS: The correlation between the 2 measures was initially poor to fair (r=0.04 to r=0.51), but increased after 2 weeks of rehabilitation (r=0.30 to r=0.66). CONCLUSIONS: A change in the association between measures obtained at lower back level and floor level may indicate a change from a hip- to an ankle-dominant strategy, to counteract imbalance during unsupported standing.

Postural assessment of school children: an input for the design of furniture.

During the last decades of the previous century, school desks with a tilt top have disappeared. The chairs have been designed for sitting upright, with the hip, knees and ankles all at right angles. However, the erect posture cannot be maintained for more than one or two minutes, after which it will result in fatigue, discomfort or poor posture. The main aim of project is to identify the type of furniture that most effectively contribute to adequate neck and back postures of the school children, by carrying out a postural analysis of a sample of school pupils when using three different types of furniture. The postures adopted by school pupils were monitored by video during several activities, such as reading, writing and painting tasks, copying from a blackboard and listening the teacher. Additionally, the characteristics of the adopted postures were assessed by registering the head tilt, flexion of the neck, trunk and hips position. All these aspects were classified and the results were recorded for future analysis. The obtained results seem to point out that the use of a school desk with a tilted table surface resulted in a reduction in trunk and neck flexion, preserving the natural lordosis in the lumbar and cervical regions. Accordingly, it can be concluded that there are alternatives to consider in the furniture design in order to eliminate tensions and, consequently, to improve children's wellbeing.

Inertial sensors for assessment of back movement in horses during locomotion over ground.

REASONS FOR PERFORMING STUDY: Assessing back movement is an important part of clinical examination in the horse and objective assessment tools allow for evaluating success of treatment. OBJECTIVES: Accuracy and consistency of inertial sensor measurements for quantification of back movement and movement symmetry during over ground locomotion were assessed; sensor measurements were compared to optical motion capture (mocap) and consistency of measurements focusing on movement symmetry was measured. METHODS: Six nonlame horses were trotted in hand with synchronised mocap and inertial sensor data collection (landmarks: T6, T10, T13, L1 and S3). Inertial sensor data were processed using published methods and symmetry of dorsoventral displacement was assessed based on energy ratio, a Fourier based symmetry measure. Limits of agreement were calculated and visualised to compare mocap and sensor data. Consistency of sensor measurements was assessed using Pearson correlation coefficients and linear regression to investigate the effect of speed on movement symmetry. RESULTS: Dorsoventral and mediolateral sensor displacement was observed to lie within ± 4-5 mm (± 2 s.d., 9-28% of movement amplitude) and energy ratio to lie within ± 0.03 of mocap data. High levels of correlation were found between strides and trials (0.86-1.0) for each horse and each sensor and variability of symmetry was lowest for T13 followed by T10, T6, L1 and S3 with no significant effect of speed at T6, T10 and T13. CONCLUSIONS: Inertial sensor displacement and symmetry data showed acceptable accuracy and good levels of consistency for back movement. The small mediolateral movement amplitude means that changes of <25% in mediolateral amplitude (also unlikely to be detected by visual assessment) may go undetected. New sensor generations with improved sensor sensitivity and ease of use of equipment indicate good potential for use in a field situation.

A novel system for the dynamic assessment of back shape.

Low back pain can be exacerbated by poor posture, particularly over extended stationary periods such as when sitting or standing. The repetitive determination of back shape could allow an ongoing assessment of subject specific posture to better understand the mechanisms of back pain. The portable measurement system SpineDMS(©) allows the dynamic, extended assessment of back shape in six segments of the lumbar and lower thoracic spine. The objective of this study was to assess the accuracy and repeatability of the system to determine its applicability for assessing back shape in patients. To assess the accuracy and repeatability of angle measurements, six SpineDMS(©) sensor strips (three systems) were repeatedly bent taut over a range of defined arcs. Measurements of spinal curvature were additionally conducted in 10 volunteers who performed flexion and extension exercises, with all results compared against reference marker data. The measurement sensors had a high accuracy and excellent repeatability (mean intraclass correlation coefficient (ICC) >0.98), with test-retest reliability ICCs of >0.98. Measurements in volunteers showed that SpineDMS(©) was capable of detecting the shape and movement of the human back. This study showed that SpineDMS(©) could be deployed as a reliable diagnostic tool for back posture, as well as movements in the sagittal plane.

Magnetic resonance imaging (MRI) for assessment of differences in geometrical parameters in muscles stabilizing vertebral column in young and older persons. Case study.

Today non-traumatic low back pain (LBP) is a social disease being attributed to weakening the function of abdominal and back muscles. Condition of deep muscles, inaccessible to non-invasive examinations, can be assessed by means of magnetic resonance imaging (MRI). The method allows for the assessment of cross-sections, muscle girths, as well as their intensity (brightness). The aim of the investigations was to determine the opportunities to employ MRI technique for assessing the geometry of muscles which stabilize spinal column. The study covered 4 women without LBP symptoms. The cross-sectional area, thickness and brightness of abdominal and back muscles were measured at the level of L3-L4. Measurement of geometrical parameters in the positions studied was aimed at setting such measurement conditions that would force higher isometric contraction in the muscles examined. As a result of measurements it can be inferred that other conditions of the experiment affect neither an increase in cross-sectional surface area nor the thickness of the muscles examined. The differences observed in geometrical parameters of the muscles testify to different coordination of muscle activation in the positions studied, both in young and older subjects, and to the purposefulness of continuing this type of measurements.

Assessment of the validity of the Biering-Sørensen test for measuring back muscle fatigue based on EMG median frequency characteristics of back and hip muscles.

The aims of the present study were (1) to investigate the differences in median frequency characteristics between back and hip muscles of healthy subjects during a Biering-Sørensen test, (2) to determine if the Biering-Sørensen test is a valid test for measuring back muscle fatigue, and (3) to standardise the Biering-Sørensen test by using objective movement analysis when defining endurance time, and compare this to the original method based on tactile feedback. Twenty healthy subjects participated in this experiment. The electromyographic activity of eight back and hip muscles was bilaterally measured. In addition three-dimensional data of the lumbar region were collected with an ultrasound movement analysis system. Median frequencies were computed from the EMG power spectra. Two methods of determining the endurance time of the Biering-Sørensen test yielded highly correlated but significantly different normalized median frequency slope values (NMF(slope)). Significant differences in NMF(slope) values between several back and hip muscles could be demonstrated. Low to moderate correlation coefficients were shown between NMF(slope) values and endurance time. Multiple stepwise linear regression analyses revealed that only NMF(slope) of the thoracic part of the iliocostalis lumborum muscle could significantly predict the test endurance time. The findings of the present study support the validity of the Biering-Sørensen test for measuring back muscle fatigue.

The assessment of back muscle capacity using intermittent static contractions. Part I - Validity and reliability of electromyographic indices of fatigue.

INTRODUCTION: Back muscle capacity is impaired in chronic low back pain patients but no motivation-free test exists to measure it. The aims of this study were to assess the reliability and criterion validity of electromyographic indices of muscle fatigue during an intermittent absolute endurance test. METHODS: Healthy subjects (44 males and 29 females; age: 20-55 yrs) performed three maximal voluntary contractions (MVC) and a fatigue test while standing in a static dynamometer. Surface EMG signals were collected from four pairs of back muscles (multifidus at the L5 level, iliocostalis lumborum at L3, and longissimus at L1 and T10). The fatigue test, assessing absolute endurance (90-Nm torque), consisted in performing an intermittent extension task to exhaustion. Strength was defined as the peak MVC whereas our endurance criterion was defined as the time to reach exhaustion (Tend) during the fatigue test. From the first five min (females) or ten min (males) of EMG data, frequency and time-frequency domain analyses were applied to compute various spectral indices of muscle fatigue. RESULTS: The EMG indices were more reliable when computed from the time-frequency domain than when computed from the frequency domain, but showed comparable correlation results (criterion validity) with Tend and Strength. Some EMG indices reached moderate to good correlation (range: 0.64-0.69) with Tend, lower correlations (range: 0.39-0.55) with Strength, and good to excellent between-day test-retest reliability results (intra-class correlation range: 0.75-0.83). The quantification of the spectral content more locally in different frequency bands of the power spectrum was less valid and reliable than the indices computed from the entire power spectrum. Differences observed among muscles were interpreted in light of specific neuromuscular activation levels that were observed during the endurance test. These findings supported the use of an intermittent and time-limited (5-10min) absolute endurance test, that is a practical way to assess the back capacity of chronic low back pain subjects, to assess absolute endurance as well as strength with the use of electromyographic indices of muscle fatigue.

Assessment of fall-risk by means of a neural network based on parameters assessed by a wearable device during posturography.

We have investigated the use of an Artificial Neural Network (ANN) for the assessment of fall-risk (FR) in patients with different neural pathologies. The assessment integrates a clinical tool based on a wearable device (WD) with accelerometers (ACCs) and rate gyroscopes (GYROs) properly suited to identify trunk kinematic parameters that can be measured during a posturography test with different constraints. Our ANN--a Multi Layer Perceptron Neural Network with four layers and 272 neurones--shows to be able to classify patients in three well-known fall-risk levels. The training of the neural network was carried on three groups of 30 subjects with different Fall-Risk Tinetti scores. The validation of our neural network was carried out on three groups of 100 subjects with different Fall-Risk Tinetti scores and this validation demonstrated that the neural network had high specificity (> or =0.88); sensitivity (> or =0.87); area under Receiver-Operator Characteristic Curves (>0.854).

An in vivo assessment of the low back response to prolonged flexion: Interplay between active and passive tissues.

BACKGROUND: Full flexion lumbar postures maintained over a prolonged period of time have been shown to lead to changes in the supporting passive structures of the spine and it has been hypothesized that this may lead to low back pain/disorders. However, the specific biomechanics and physiology of this link have not been fully developed. Of particular interest is the interplay between the active and passive extensor mechanisms and the role of rest break in this response. METHODS: Ten healthy participants performed a regimen of a 10-min full lumbar flexion followed by a 10-min upright standing, with a slow speed isokinetic lift every 2.5min. Changes in the full lumbar flexion angle (system creep) and the electromyographic activity of back extensors in the isokinetic lifts were evaluated. FINDINGS: Results showed significant increases in the full flexion angle and increased activity of the extensor muscles in the prolonged flexion to compensate for the reduced extension moment producing capability of the passive tissues. A 30-s rest break in the middle of the flexion moderated these viscoelastic responses. INTERPRETATION: The results suggest that prolonged lumbar flexion results in the systematic transfer of an extension moment from passive tissues to active muscles. Heavy lifting or high force exertion of back muscles immediately after prolonged flexion could be a risk factor for low back disorders when the muscles lose their force generating capacity due to passive stretching. This study also indicated the importance of sufficient rest between consecutive full flexion tasks in reducing the risk.

Determination of worker physiological cost in workspace reach envelopes.

Oxygen uptake (VO2), heart rate (HR) and myoelectric activity (EMG) were measured while performing a repetitive task in the normal, maximum and extreme workspace reach envelopes. The VO2 and HR increased significantly from the normal to the maximum to the extreme workspace reach envelope. The average increases in VO2 when compared to the normal workspace were 19 and 52%, respectively. The corresponding average increases in HR were 6 and 14%, respectively. The increase in EMG for anterior deltoid, upper trapezious and erector spinae showed a significant increase from normal to maximum and from maximum to extreme workspaces. The average increases in EMG for anterior deltoid, upper trapezious and erector spinae, compared to the normal workspace were 96, 37 and 48% respectively for the maximum workspace and 193, 95 and 106% for the extreme workspace, respectively. The research indicated for the first time that during task performance, worker physiological cost would increase significantly with the increase in workspace reach levels.