Exoskeleton Usability Questionnaire: a preliminary evaluation questionnaire for the lower limb industrial exoskeletons.

Exoskeleton robots are a promising solution to reduce musculoskeletal disorders (MSDs) in different work environments, but a specific usability scale for evaluating them is lacking. This study aimed to develop and verify a preliminary Exoskeleton Usability Questionnaire (EUQ) for the lower limb exoskeletons by creating a draft survey questionnaire from existing questions in prior studies. An experiment was conducted with 20 participants who performed a specific task while wearing three lower limb robots and provided subjective feedback using the developed questionnaire. Data were analysed using exploratory and confirmatory factor analysis (CFA), resulting in a usability evaluation questionnaire for exoskeleton robots clustered into four main factors: mobility, adjustability, handling and safety. This study's findings are expected to be useful in evaluating the usability of the lower limb exoskeletons in both general production sites and agricultural work, which can aid in reducing the prevalence of lower limb MSDs.Practitioner Summary: This study developed a preliminary subjective usability evaluation questionnaire for exoskeleton robots. The questionnaire is clustered into four main factors: mobility, adjustability, handling and safety. These findings provide a valuable tool for assessing exoskeleton usability, potentially reducing musculoskeletal disorders (MSDs) in various work environments.

The relationship between hand anthropometrics, total grip strength and individual finger force for various handle shapes.

The design and shape of hand tool handles are critical factors for preventing musculoskeletal disorders (MSDs) caused by the use of hand tools. We explored how these factors are related to total force and individual finger force in males and females with various hand anthropometrics. Using the MFFM system, we assessed four indices of anthropometry, and measured total force and individual finger force on various handle designs and shapes. Both total force and individual finger force were significant according to gender and handle shape. Total grip strength to the handle shape indicated the greatest strength with D shape and the least with A shape. From the regression analysis of hand anthropometric indices, the value of R was respectably high at 0.608-0.696. The current study examined the gender and handle shape factors affecting grip strength based on the force measurements from various handle types, in terms of influence on different hand anthropometric indices.

Evaluation of total grip strength and individual finger forces on opposing (A-type) handles among Koreans.

The present study evaluated the effect of grip span on finger forces and defined the best grip span for maximising total grip strength based on the finger forces and subjective discomfort in a static exertion. Five grip spans (45, 50, 55, 60 and 65 mm) of the opposing (A-type) handle shape were tested in this study to measure total grip strength and individual finger force among Korean population. A total of 30 males who participated in this study were asked to exert a maximum grip force with two repetitions, and to report the subjective discomfort experienced between exertions using the Borg's CR-10 scale. The highest grip strength was obtained at 45 mm and 50 mm grip spans. Results also showed that forces of all fingers, except for the middle finger force, significantly differed over the grip spans. The lowest subjective discomfort was observed in the 50 mm grip span. The results might be used as development guidelines for ergonomic opposing (A-type) hand tools for Korean population.

The effects of co-ordinating postures with shoulder and elbow flexion angles on maximum grip strength and upper-limb muscle activity in standing and sitting postures.

Eighteen co-ordination postures with shoulder flexion angles (0°, 45° and 90°) and elbow flexion angles (0°, 45° and 90°) in standing and sitting positions were evaluated to identify the effects of co-ordination postures on maximum grip strength and muscle activities of the upper limb in this study. Thirty-nine subjects were recruited and their maximum grip strengths were measured. According to the analysis of grip strength, grip strength was shown to be stronger in a standing posture (297.4 N) than in a sitting posture (274.6 N). In addition, grip strength (293.8 N) at 90° shoulder flexion angle was significantly higher than that at 0° and 45° shoulder angles. There was no statistically significant difference in grip strength from the effects of elbow angles in this study. The results of muscle activities for all muscle groups showed a similar trend with the results of grip strength associated with shoulder angles.

Evaluation of the Efficacy of a Lift-Assist Device Regarding Caregiver Posture and Muscle Load for Transferring Tasks.

The aim of this study was to confirm the effect of a lift-assist device when performing a patient-lifting task. Ten working caregivers participated in this experiment, and lifting patients from bed to wheelchair (B2C) and wheelchair to bed (C2B) was performed for manual care (MC) and lift-assist device (robot) care (RC). EMG sensors and IMU motion sensors were attached as indicators of the assistive device's effectiveness. EMG was attached to the right side of eight muscles (UT, MD, TB, BB, ES, RF, VA, and TA), and flexion/extension angles of the neck, shoulder, back, and knee were collected using motion sensors. As a result of the analysis, both B2C and C2B showed higher muscle activities in MC than RC. When using a lift-assist device to lift patients, the RC method showed reductions in muscle activities compared to MC. As a result of the work-posture analysis, both the task type and the task phase exhibited pronounced reductions in shoulder, back, and knee ROM (range of motion) compared to those of MC. Therefore, based on the findings of this study, a lift-assist device is recommended for reducing the physical workloads of caregivers while performing patient-lifting tasks.

Comparison of the Physical Care Burden on Formal Caregivers between Manual Human Care Using a Paper Diaper and Robot-Aided Care in Excretion Care.

Although the older population has been rapidly growing, the availability of formal caregivers remains limited. Assistance provided by care robots has helped lower this burden; however, whether using a care robot while providing excretion care (EC) is quantitatively increasing or decreasing caregivers' physical care burden has not been extensively studied. This study aimed to quantitatively compare the physical burden experienced by caregivers while providing manual excretion care (MC) using a paper diaper versus robot-aided care (RC). Ten formal caregivers voluntarily participated in the experiment. MC and RC tasks were structuralized according to phases and classified by characteristics. The experiment was conducted in a smart care space. The physical load of formal caregivers was estimated by muscular activity and subjective rating of perceived physical discomfort. The results demonstrated that although the physical load on the lower back and upper extremities during the preparation and post-care phases were greater in RC than MC, RC markedly alleviated caregivers' physical load when performing front tasks. In the preparation-care phases, the physical loads on the lower back and upper extremities were approximately 40.2 and 39.6% higher in the case of RC than MC, respectively. Similar to the preparation-care phases, the physical loads on the lower back and upper extremities during post-care phases were approximately 39.5 and 61.7% greater in the case of RC than MC, respectively. On the other hand, in the front-care phases, the physical loads on the lower back and upper extremities were approximately 25.6 and 34.9% lower in the case of RC than MC, respectively. These findings can quantitatively explain the effectiveness and features of a care robot to stakeholders and provide foundational research data for the development of EC robots. This study emphasizes the implementation and promotion of the dissemination, popularization, and development of care robots to fulfill formal caregiving needs.

Efficacy of passive upper-limb exoskeletons in reducing musculoskeletal load associated with overhead tasks.

Overhead work can pose substantial musculoskeletal stress in many industrial settings. This study aimed to evaluate the efficacy of passive upper-limb exoskeletons in reducing muscular activity and subjective discomfort ratings. In a repeated-measures laboratory experiment, 20 healthy male participants performed 10-min drilling tasks with and without two passive upper-limb exoskeletons (VEX and Airframe). During the tasks, muscle activity in eight muscles (upper limb - upper trapezius, middle deltoid, biceps brachii, triceps brachii; low back - erector spinae; lower limb - rectus femoris, biceps femoris, tibialis anterior) was collected using electromyography as a physical exertion measure. Subjective discomfort rating in six body parts was measured using the Borg's CR-10 scale. The results showed that muscle activity (especially in the upper-limb muscles) was significantly decreased by 29.3-58.1% with both exoskeletons compared to no exoskeleton condition. The subjective discomfort ratings showed limited differences between the conditions. These findings indicate that passive upper-limb exoskeletons may have potential as an effective intervention to reduce muscular loading and physical exertion during overhead work.

A passive upper-limb exoskeleton reduced muscular loading during augmented reality interactions.

The aim of this study was to evaluate a passive upper-limb exoskeleton as an ergonomic control to reduce the musculoskeletal load in the shoulders associated with augmented reality (AR) interactions. In a repeated-measures laboratory study, each of the 20 participants performed a series of AR tasks with and without a commercially-available upper-limb exoskeleton. During the AR tasks, muscle activity (anterior, middle, posterior deltoid, and upper trapezius), shoulder joint postures/moment, and self-reported discomfort were collected. The results showed that the exoskeleton significantly reduced muscle activity in the upper trapezius and deltoid muscle groups and self-reported discomfort. However, the shoulder postures and task performance measures were not affected by the exoskeleton during the AR interactions. Given the significant decrease in muscle activity and discomfort without compromising task performance, a passive exoskeleton can be an effective ergonomic control measure to reduce the risks of developing musculoskeletal discomfort or injuries in the shoulder regions.

Postural evaluation in a poultry farm for broiler chickens.

The goal of this study was to evaluate working postures in 9 operations of poultry farming for broiler chickens for 14 body segments with 4 categories, and for fingers with 14 categories. Overall, the farmers commonly bent almost all their body segments and used power grips. The operations of cleaning with water wand and inspecting chickens seemed light work because the farmers walked around most of their working time. The operations of detaching base from hanging feeder and attaching base to hanging feeder had the farmers continue squatting to handle the feeders close to the floor. The farmers also repeatedly bent their trunks in shoveling feces, unloading a box of chicks, and releasing chicks. A power grip was frequently observed due to using tools with round handles. Workplace design to raise working height would be necessary for a better working environment for broiler farmers.

Quantification of physical stress experienced by obstetrics and gynecology sonographers: A comparative study of two ultrasound devices.

This study aims to quantify the stresses of sonographers using two different ultrasound devices, one of conventional and one of ergonomic design. A total of 20 obstetricians and gynecologists participated in this study, and two types of tasks (scanning and positioning) were evaluated while using the two different devices. To quantify workload, four dependent variables (muscle activity, estimated grip force, subjective comfort rating, and task time) were measured. The muscular activity required while using the conventional device was 14.4% MVC (Maximum voluntary contraction) for the scanning task, which was significantly higher than that of the ergonomic device. The subjective comfort rating for the conventional design was lower than that of the ergonomic design. For the positioning task, the ergonomic device (33.2% MVC) resulted in significantly higher muscle activity in the extensor digitorum (ED) and flexor digitorum superficialis (FDS) than the conventional design (22.2% MVC), whereas the deltoid muscle showed significantly lower activity than in users of conventional design (4.5% MVC). Ergonomically-designed ultrasound devices improve ease of moving and the probe's supporters, reduce physical load and increase ease of use for sonographers. Our results may be used as guidelines for usability testing of ultrasound devices.

Ergonomic Assessment of a Lower-Limb Exoskeleton through Electromyography and Anybody Modeling System.

The aim of this study was to determine the muscle load reduction of the upper extremities and lower extremities associated with wearing an exoskeleton, based on analyses of muscle activity (electromyography: EMG) and the AnyBody Modeling System (AMS). Twenty healthy males in their twenties participated in this study, performing bolting tasks at two working heights (60 and 85 cm). The muscle activities of the upper trapezius (UT), middle deltoid (MD), triceps brachii (TB), biceps brachii (BB), erector spinae (ES), biceps femoris (BF), rectus femoris (RF), and tibialis anterior (TA) were measured by EMG and estimated by AMS, respectively. When working at the 60 cm height with the exoskeleton, the lower extremity muscle (BF, RF, TA) activities of EMG and AMS decreased. When working at the 85 cm height, the lower extremity muscle activity of EMG decreased except for TA, and those of AMS decreased except for RF. The muscle activities analyzed by the two methods showed similar patterns, in that wearing the exoskeleton reduced loads of the lower extremity muscles. Therefore, wearing an exoskeleton can be recommended to prevent an injury. As the results of the two methods show a similar tendency, the AMS can be used.

The effects of age, viewing distance, display type, font type, colour contrast and number of syllables on the legibility of Korean characters.

This study evaluated the effects of age (20s and 60s), viewing distance (50 cm, 200 cm), display type (paper, monitor), font type (Gothic, Ming), colour contrast (black letters on white background, white letters on black background) and number of syllables (one, two) on the legibility of Korean characters by using the four legibility measures (minimum letter size for 100% correctness, maximum letter size for 0% correctness, minimum letter size for the least discomfort and maximum letter size for the most discomfort). Ten subjects in each age group read the four letters presented on a slide (letter size varied from 80 pt to 2 pt). Subjects also subjectively rated the reading discomfort of the letters on a 4-point scale (1 = no discomfort, 4 = most discomfort). According to the ANOVA procedure, age, viewing distance and font type significantly affected the four dependent variables (p < 0.05), while the main effect of colour contrast was not statistically significant for any measures. Two-syllable letters had smaller letters than one-syllable letters in the two correctness measures. The younger group could see letter sizes two times smaller than the old group could and the viewing distance of 50 cm showed letters about three times smaller than those at a 200 cm viewing distance. The Gothic fonts were smaller than the Ming fonts. Monitors were smaller than paper for correctness and maximum letter size for the most discomfort. From a comparison of the results for correctness and discomfort, people generally preferred larger letter sizes to those that they could read. The findings of this study may provide basic information for setting a global standard of letter size or font type to improve the legibility of characters written in Korean. STATEMENT OF RELEVANCE: Results obtained in this study will provide basic information and guidelines for setting standards of letter size and font type to improve the legibility of characters written in Korean. Also, the results might offer useful information for people who are working on design of visual displays.

Evaluation of upper-limb body postures based on the effects of back and shoulder flexion angles on subjective discomfort ratings, heart rates and muscle activities.

A possible limitation of many ergonomics checklists that evaluate postures is an independent evaluation of each body segment without considering the coordination between body segments and resulting in the under-/over-estimation of body postures. A total of 20 men were selected to evaluate the effects of shoulder and back flexion angles on the upper-limb muscle activities, subjective discomforts and heart rates. Interesting findings were obtained from the coordination between back flexion angles and shoulder flexion angles. At a back flexion angle of 45°, the discomfort and heart rates were the least at a shoulder flexion angle of 45°. The %MVC also showed a similar trend. It could be inferred that the 0° shoulder flexion angle would be a natural posture, when the back flexion angle is 0°, whereas 45° shoulder flexion might be a more natural posture when the back flexion angle is 45°. STATEMENT OF RELEVANCE: This study evaluated the effects of back and shoulder flexion angles on subjective as well as objective measures. The findings of this study considered the coordination between two body flexion angles and could be used to improve the accuracy of existing ergonomics evaluation methods for body postures.

Individual finger contribution in submaximal voluntary contraction of gripping.

The objective of this study was to evaluate individual finger force and contribution to a gripping force, the difference between actual and expected finger forces and subjective discomfort rating at 10 different submaximal voluntary contraction (%MVC) levels (10-100% in 10 increments). Seventy-two participants randomly exerted gripping force with a multi-finger force measurement system. The individual finger force, gripping force and discomfort increased as %MVC levels increased. The middle and ring fingers exerted more force and contributed to a gripping force more than the index and little fingers due to their larger mass fractions of the digit flexor muscles. It was apparent at <50% MVC; however, the index finger increased its contribution and exerted even more force than expected at more than 50% MVC. Subjective discomfort supported the results of the objective measures. This could explain the conflicting findings between index and ring fingers in previous finger contribution studies. STATEMENT OF RELEVANCE: Hand tool design is of special interest in ergonomics due to its association with musculoskeletal disorders in the hand. This study reveals a different contribution pattern of the fingers in submaximal voluntary contraction of gripping exertion.

Guidelines for Working Heights of the Lower-Limb Exoskeleton (CEX) Based on Ergonomic Evaluations.

The aim of this study was to evaluate the muscle activities and subjective discomfort according to the heights of tasks and the lower-limb exoskeleton CEX (Chairless EXoskeleton), which is a chair-type passive exoskeleton. Twenty healthy subjects (thirteen males and seven females) participated in this experiment. The independent variables were wearing of the exoskeleton (w/ CEX, w/o CEX), working height (6 levels: 40, 60, 80, 100, 120, and 140 cm), and muscle type (8 levels: upper trapezius (UT), erector spinae (ES), middle deltoid (MD), triceps brachii (TB), biceps brachii (BB), biceps femoris (BF), rectus femoris (RF), and tibialis anterior (TA)). The dependent variables were EMG activity (% MVC) and subjective discomfort rating. When wearing the CEX, the UT, ES, RF, and TA showed lower muscle activities at low working heights (40-80 cm) than not wearing the CEX, whereas those muscles showed higher muscle activities at high working heights (100-140 cm). Use of the CEX had a positive effect on subjective discomfort rating at lower working heights. Generally, lower discomfort was reported at working heights below 100 cm when using the CEX. At working heights of 100-140 cm, the muscle activity when wearing the CEX tended to be greater than when not wearing it. Thus, considering the results of this study, the use of the lower-limb exoskeleton (CEX) at a working height of 40-100 cm might reduce the muscle activity and discomfort of whole body and decrease the risk of related disorders.

Application of AULA Risk Assessment Tool by Comparison with Other Ergonomic Risk Assessment Tools.

Agricultural upper limb assessment (AULA), which was developed for evaluating upper limb body postures, was compared with the existing assessment tools such as rapid upper limb assessment (RULA), rapid entire body assessment (REBA), and ovako working posture analysis system (OWAS) based on the results of experts' assessments of 196 farm tasks in this study. The expert group consisted of ergonomists, industrial medicine experts, and agricultural experts. As a result of the hit rate analysis, the hit rate (average: 48.6%) of AULA was significantly higher than those of the other assessment tools (RULA: 33.3%, REBA: 30.1%, and OWAS: 34.4%). The quadratic weighted kappa analysis also showed that the kappa value (0.718) of AULA was significantly higher than those of the other assessment tools (0.599, 0.578, and 0.538 for RULA, REBA, and OWAS, respectively). Based on the results, AULA showed a better agreement with expert evaluation results than other evaluation tools. In general, other assessment tools tended to underestimate the risk of upper limb posture in this study. AULA would be an appropriate evaluation tool to assess the risk of various upper limb postures.

A Comparison Study of Posture and Fatigue of Neck According to Monitor Types (Moving and Fixed Monitor) by Using Flexion Relaxation Phenomenon (FRP) and Craniovertebral Angle (CVA).

This study quantified the neck posture and fatigue using the flexion relaxation phenomenon (FRP) and craniovertebral angle (CVA); further, it compared the difference between the level of fatigue and neck posture induced by two types of monitors (regular fixed monitor and moving monitor). Twenty-three male participants were classified into two groups-the low-flexion relaxation ratio (FRR) group and the normal-FRR group, depending on the FRR value. All participants performed a document task for 50 min using both types of monitors. It was found that the FRR values significantly decreased after the documentation task. The CVA analysis showed that the moving monitor's frequency of forward head posture (FHP) was lower than that for the fixed monitor. Overall, the moving monitor worked better than the fixed monitor; this can be interpreted as proof that such monitors can reduce neck fatigue.

Evaluation of subjective perceived rating for grip strength depending on handedness for various target force levels.

BACKGROUND: Measurement of hand exertion is very important to quantify the risk of Work-related Musculoskeletal Disorders (WMSDs) in manufacturing fields. Although a direct measurement is the most accurate way to quantify physical load, it is expensive and time consuming. To solve this limitation, a subjective self-report method has been proposed as a possible alternative. OBJECTIVE: The purpose of this study was to analyze the accuracy of subjective perception for grip force exertions associated with handedness (dominant and non-dominant hands). METHODS: A total of nine healthy adults participated in this study. All participants were asked to exert hand grip forces for randomly selected target force levels without any information about the actual target force levels. Then, participants were also asked to rate the subjective perception of their exertion level using % Maximum Voluntary Contraction (MVC) after each hand grip force exertion. RESULTS: The trend of subjective perception for various target force levels was different according to the handedness. In the case of the dominant hand, participants tend to rate less MVC levels (under-estimation) than the actual target force levels at lower than 50% MVC, whereas they tend to rate more MVC levels (over-estimation) than the actual target force levels at higher than 50% MVC, respectively. In case of non-dominant hand, generally participants showed over-estimate for all levels of MVCs in this study. CONCLUSIONS: According to the results of this study, subjective perception of exertion showed different patterns on the handedness (S-shape for dominant hand vs. over-estimation for non-dominant hand) for various target force levels. Therefore, it would be necessary to apply different criteria for each hand to evaluate subjective perception of hand grip exertion tasks.

Evaluation of handle shapes for screwdriving.

This study investigated the effects of screwdriver handle shape, surface, and workpiece orientation on subjective discomfort, number of screw-tightening rotations, screw-insertion time, axial screwdriving force, and finger contact forces in a screwdriving task. Handles with three longitudinal cross-sectional shapes (circular, hexagonal, triangular), four lateral shapes (cylindrical, double frustum, reversed double frustum, cone), and two surface materials (plastic, rubber coated) were tested. Individual phalangeal segment force distributions indicated how fingers and phalangeal segments were involved in the creation of total finger force (15.0%, 34.6%, 34.5%, and 15.9% for the index, middle, ring, and little fingers; and 45.7%, 22.4%, 12.9%, and 19.0% for the distal, middle, proximal, and metacarpal phalanges, respectively). From this finding, the index and little fingers appeared to contribute mainly in the guiding and balancing of the screwdriver handles, whereas middle and ring fingers played a more prominent role in gripping and turning. Participants preferred circular and hexagonal longitudinal-shaped and double frustum and cone lateral-shaped handles over the triangular longitudinal-shaped handles, and cylindrical and reversed double frustum lateral-shaped handles. Circular, cylindrical, and double frustum handles exhibited the least total finger force associated with screw insertion. In terms of combinations of longitudinal and lateral shapes, circular with double frustum handles were associated with less discomfort and total finger force.

Comparisons of ergonomic evaluation tools (ALLA, RULA, REBA and OWAS) for farm work.

INTRODUCTION: The purpose of this study was to validate the agricultural lower limb assessment (ALLA) ergonomic checklist, which was developed for various agricultural tasks in Korea. METHODS: One hundred and ninety-six working postures were selected from the real agricultural tasks to verify ALLA, a lower limb body posture assessment tool, and then evaluated by 16 ergonomic experts. Hit rate, quadratic weighted κ, one-way analysis of variance and t-test analyses were applied to compare ALLA with other assessment tools. RESULTS: ALLA analysis had a superior hit rate with ergonomic expert assessment compared with other assessment tools. Quadratic weighted κ analysis also showed that ALLA provided superior estimates of risk levels for farm working postures. DISCUSSION: ALLA would be an appropriate assessment tool to estimate risk factors for various lower limb body postures which frequently occur in agricultural tasks in Korea. ALLA is a simple and accurate risk assessment tool that could be usefully applied to identify and mitigate risk factors and work-related musculoskeletal disorders in agricultural tasks, and also to evaluate the effects of control and intervention for working conditions.