The Sensor-Based Biomechanical Risk Assessment at the Base of the Need for Revising of Standards for Human Ergonomics.

Due to the epochal changes introduced by "Industry 4.0", it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human-robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative "direct instrumental evaluations" and "rating of standard methods", allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers' awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities.

Global Muscle Coactivation of the Sound Limb in Gait of People with Transfemoral and Transtibial Amputation.

The aim of this study was to analyze the effect of the level of amputation and various prosthetic devices on the muscle activation of the sound limb in people with unilateral transfemoral and transtibial amputation. We calculated the global coactivation of 12 muscles using the time-varying multimuscle coactivation function method in 37 subjects with unilateral transfemoral amputation (10, 16, and 11 with mechanical, electronic, and bionic prostheses, respectively), 11 subjects with transtibial amputation, and 22 healthy subjects representing the control group. The results highlighted that people with amputation had a global coactivation temporal profile similar to that of healthy subjects. However, amputation increased the level of the simultaneous activation of many muscles during the loading response and push-off phases of the gait cycle and decreased it in the midstance and swing subphases. This increased coactivation probably plays a role in prosthetic gait asymmetry and energy consumption. Furthermore, people with amputation and wearing electronic prosthesis showed lower global coactivation when compared with people wearing mechanical and bionic prostheses. These findings suggest that the global lower limb coactivation behavior can be a useful tool to analyze the motor control strategies adopted and the ability to adapt to the prosthetic device.

Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components.

The present study's aim was to identify the kinematic and kinetic gait patterns and to measure the energy consumption in people with amputation according to both the anatomical level of amputation and the type of prosthetic components in comparison with a control group matched for the gait speed. Fifteen subjects with unilateral transtibial amputation (TTA), forty with unilateral transfemoral amputation (TFA) (9 with mechanical, 17 with CLeg and 14 with Genium prosthesis) and forty healthy subjects were recruited. We computed the time-distance gait parameters; the range of angular motion (RoM) at hip, knee and ankle joints, and at the trunk and pelvis; the values of the 2 peaks of vertical force curve; the full width at half maximum (FWHM) and center of activity (CoA) of vertical force; the mechanical behavior in terms of energy recovery (R-step) and energy consumption. The main results were: i) both TTA and TFA show a common gait pattern characterized by a symmetric increase of step length, step width, double support duration, pelvic obliquity, trunk lateral bending and trunk rotation RoMs compared to control groups. They show also an asymmetric increase of stance duration and of Peak1 in non-amputated side and a decrease of ankle RoM in amputated side; ii) only TFA show a specific gait pattern, depending on the level of amputation, characterized by a symmetric reduction of R-step and an asymmetric decrease of stance duration, CoA and FWHM and an increase of Peak1 in the amputated side and of hip and knee RoM, CoA and FWHM in the non-amputated side; iii) people with amputation with Genium prosthesis show a longer step length and increased hip and knee RoMs compared to people with amputation with mechanical prosthesis who conversely show an increased pelvic obliquity: these are specific gait patterns depending of the type of prosthesis. In conclusion, we identified both common and specific gait patterns in people with amputation, either regardless of, or according to their level of amputation and the type of prosthetic component.

Erratum: Alberto, R. et al., Wearable Monitoring Devices for Biomechanical Risk Assessment at Work: Current Status and Future Challenges-A Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 2001.

Due to an error during production, the first author's name of the published paper [...].

Wearable Monitoring Devices for Biomechanical Risk Assessment at Work: Current Status and Future Challenges-A Systematic Review.

Background: In order to reduce the risk of work-related musculoskeletal disorders (WMSDs) several methods have been developed, accepted by the international literature and used in the workplace. The purpose of this systematic review was to describe recent implementations of wearable sensors for quantitative instrumental-based biomechanical risk assessments in prevention of WMSDs. Methods: Articles written until 7 May 2018 were selected from PubMed, Scopus, Google Scholar and Web of Science using specific keywords. Results: Instrumental approaches based on inertial measurement units and sEMG sensors have been used for direct evaluations to classify lifting tasks into low and high risk categories. Wearable sensors have also been used for direct instrumental evaluations in handling of low loads at high frequency activities by using the local myoelectric manifestation of muscle fatigue estimation. In the field of the rating of standard methods, on-body wireless sensors network-based approaches for real-time ergonomic assessment in industrial manufacturing have been proposed. Conclusions: Few studies foresee the use of wearable technologies for biomechanical risk assessment although the requirement to obtain increasingly quantitative evaluations, the recent miniaturization process and the need to follow a constantly evolving manual handling scenario is prompting their use.

Myoelectric manifestation of muscle fatigue in repetitive work detected by means of miniaturized sEMG sensors.

Upper limb work-related musculoskeletal disorders have a 12-month prevalence ranging from 12 to 41% worldwide and can be partly caused by handling low loads at high frequency. The association between the myoelectric manifestation of elbow flexor muscle fatigue and occupational physical demand has never been investigated. It was hypothesized that an elbow flexor muscle fatigue index could be a valid risk indicator in handling low loads at high frequency. This study aims to measure the myoelectric manifestation of muscle fatigue of the three elbow flexor muscles during the execution of the work tasks in different risk conditions. Fifteen right-handed healthy adults were screened using a movement analysis laboratory consisting of optoelectronic, dynamometer and surface electromyographic systems. The main result indicates that the fatigue index calculated from the brachioradialis is sensitive to the interaction among risk classes, session and gender, and above all it is sensitive to the risk classes.

Mechanical lifting energy consumption in work activities designed by means of the "revised NIOSH lifting equation".

The aims of the present work were: to calculate lifting energy consumption (LEC) in work activities designed to have a growing lifting index (LI) by means of revised NIOSH lifting equation; to evaluate the relationship between LEC and forces at the L5-S1 joint. The kinematic and kinetic data of 20 workers were recorded during the execution of lifting tasks in three conditions. We computed kinetic, potential and mechanical energy and the corresponding LEC by considering three different centers of mass of: 1) the load (CoML); 2) the multi-segment upper body model and load together (CoMUpp+L); 3) the whole body and load together (CoMTot). We also estimated compression and shear forces. Results shows that LEC calculated for CoMUpp+L and CoMTot grew significantly with the LI and that all the lifting condition pairs are discriminated. The correlation analysis highlighted a relationship between LEC and forces that determine injuries at the L5-S1 joint.

A new muscle co-activation index for biomechanical load evaluation in work activities.

Low-back disorders (LBDs) are the most common and costly musculoskeletal problem. Muscle co-activation, a mechanism that stabilises the spine, is adopted by the central nervous system to provide added protection and avoid LBDs. However, during high-risk lifting tasks, the compressive load on the spine grows owing to increased co-activation. The aim of this study was to develop a method for the sample-by-sample monitoring of the co-activation of more than two muscles, and to compare this method with agonist-antagonist methods. We propose a time-varying multi-muscle co-activation function that considers electromyographic (EMG) signals as input. EMG data of 10 healthy subjects were recorded while they manually lifted loads at three progressively heavier conditions. The repeated measures ANOVA revealed a significant effect of lifting condition on our co-activation index. Heavier conditions resulted in higher muscle co-activation values. Significant correlations were found between the time-varying multi-muscle co-activation index and other agonist-antagonist methods. Practitioner Summary: We have developed a method to quantify muscle co-activation during the execution of a lifting task. To do this we used surface electromyography. Our algorithm provides a measure of time-varying co-activation between more than two muscles.

Kinematic and electromyographic assessment of manual handling on a supermarket green- grocery shelf.

BACKGROUND: There are few epidemiological data regarding musculoskeletal disorders (MSDs) in retail industry. Biomechanical risk assessment in ergonomics is commonly performed in retail sector using standardized protocols. However, such protocols have numerous limitations, such as the lack of objectivity or applicability and restrictive conditions. OBJECTIVE: The aim of this study was to analyze one of the most commonly used shelves in vegetable and fruit departments in order to investigate the effect of different shelf levels (i.e. with variations in height and horizontal distance) and load weights on the workers' biomechanical load. METHODS: We investigated trunk, shoulder, elbow, hip, knee and ankle joint ROMs, as well as the mean and peak EMG values of the upper limb, trunk and lower limb muscles. RESULTS: We found that shelf level has a significant effect on most of the parameters examined, whereas within this limited range of 6 and 8 kg, weight does not affect the biomechanical load. We also identified the shelf levels that place the least and most strain on the musculoskeletal system. CONCLUSIONS: We therefore recommend that the height and horizontal distance be carefully considered when shelves are being designed. Kinematic and EMG approach may help to objectively assess shelf-related risks. Our findings are in agreement with RNLE LI values and therefore support RNLE.

[The role of coactivation of the trunk musculature in evaluating biomechanical risk]. / Ruolo della coattivazione della muscolatura del tronco nella valutazione del rischio biomeccanico.

One of the mechanisms adopted by the central nervous system to stabilize the joints or the spine is muscle co-activation. Nevertheless during lifting tasks muscle co-activation increases spinal load. For co-activation assessment during 3 lifting tasks at increasing load levels we utilized a time-varying co-activation algorithm proposed by Rudolph in 2000. We found that Rudolph co-activation index grew with lifting index. The time-varying co-activation index gave a continuous measure of low back compression. A time-varying co-activation index could be of great interest in all conditions in which NIOSH equation is not applicable.

Lower-limb joint coordination pattern in obese subjects.

The coordinative pattern is an important feature of locomotion that has been studied in a number of pathologies. It has been observed that adaptive changes in coordination patterns are due to both external and internal constraints. Obesity is characterized by the presence of excess mass at pelvis and lower-limb areas, causing mechanical constraints that central nervous system could manage modifying the physiological interjoint coupling relationships. Since an altered coordination pattern may induce joint diseases and falls risk, the aim of this study was to analyze whether and how coordination during walking is affected by obesity. We evaluated interjoint coordination during walking in 25 obese subjects as well as in a control group. The time-distance parameters and joint kinematics were also measured. When compared with the control group, obese people displayed a substantial similarity in joint kinematic parameters and some differences in the time-distance and in the coupling parameters. Obese subjects revealed higher values in stride-to-stride intrasubjects variability in interjoint coupling parameters, whereas the coordinative mean pattern was unaltered. The increased variability in the coupling parameters is associated with an increased risk of falls and thus should be taken into account when designing treatments aimed at restoring a normal locomotion pattern.

Biomechanical evaluation of supermarket cashiers before and after a redesign of the checkout counter.

An experiment was carried out on supermarket cashiers to evaluate the time, kinematic and electromyographic changes, in both sitting and standing positions, following the redesign of a checkout counter. The novelty of the prototype checkout counter is a disk wheel placed in the bagging area, which is designed to avoid the cashier having to manually push products along the bagging area. The kinematic evaluation was based on the upper limb and trunk range of motions (RoM). The electromyographic parameters assessed were mean and maximum muscular activations. Three factors were taken into account: design (before and after redesign), posture (standing or sitting) and bagging area (anterior or posterior). The results show that the RoM values are lowest after the intervention and in the standing position. Mean and maximum muscular activation patterns are similar. Differences related to the bagging area in which the goods were released also emerged. The disk wheel represents a valid aid for reducing biomechanical overload in cashiers; the standing position is biomechanically more advantageous. Practitioner Summary: EMG and optoelectronic motion analysis systems are useful for the quantitative assessment of the effects of the redesign of the workplace biomechanical risk. Our results suggest that a disk wheel positioned in the bagging area reduces the biomechanical risk for cashiers and increases time spent resting.

Kinematic analysis of post office employees' workstations.

This study analyzed a post office clerk's tasks, comparing two workstation models. The clerk was facing the client in one, and seated at 45 degrees to the counter in the other. We analyzed the most frequent tasks and those presenting the most critical points: 1) payment of a postal order; 2) accepting a registered letter, breaking them down into subtasks. We used an optoelectronic system for kinematic analysis, and calculated the range of motion of the trunk and arms in the three spatial planes. The 45( position required less torsion of the trunk and head when using the printer, placed to the left of the employee. A larger worktop improved the workstation, leaving more room for equipment and allowing the worker to sit frontally to the monitor. However, this solution involved a shorter distance between the worker and the client with longer extension of the shoulder and elbow and less trunk flexion. These findings suggested a modification in the layout that shortens the distance between the worker and client.