Biomechanical Effects of Using a Passive Exoskeleton for the Upper Limb in Industrial Manufacturing Activities: A Pilot Study.

This study investigates the biomechanical impact of a passive Arm-Support Exoskeleton (ASE) on workers in wool textile processing. Eight workers, equipped with surface electrodes for electromyography (EMG) recording, performed three industrial tasks, with and without the exoskeleton. All tasks were performed in an upright stance involving repetitive upper limbs actions and overhead work, each presenting different physical demands in terms of cycle duration, load handling and percentage of cycle time with shoulder flexion over 80°. The use of ASE consistently lowered muscle activity in the anterior and medial deltoid compared to the free condition (reduction in signal Root Mean Square (RMS) -21.6% and -13.6%, respectively), while no difference was found for the Erector Spinae Longissimus (ESL) muscle. All workers reported complete satisfaction with the ASE effectiveness as rated on Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), and 62% of the subjects rated the usability score as very high (>80 System Usability Scale (SUS)). The reduction in shoulder flexor muscle activity during the performance of industrial tasks is not correlated to the level of ergonomic risk involved. This preliminary study affirms the potential adoption of ASE as support for repetitive activities in wool textile processing, emphasizing its efficacy in reducing shoulder muscle activity. Positive worker acceptance and intention to use ASE supports its broader adoption as a preventive tool in the occupational sector.

Exergame for the functional rehabilitation of adults over 55 with neurological diseases.

SUMMARY: Rehabilitation based on Exergame is showing a rapid evolution, with interesting applications for the recovery of mobility, balance, postural control, coordination and fine motor skills, and including home-based training. At present, there are no precise indications for Exergamebased rehabilitation of people over 55 affected by stroke, Parkinson's disease, or multiple sclerosis. This review examines the proposed modalities and the effectiveness of Exergame-based rehabilitation interventions for adults over 55 with stroke, Parkinson's disease or multiple sclerosis, highlighting the limitations, advantages, controversies and impact of this approach. We examined randomized controlled trials published between 2016-2020, with search in the databases of PubMed, Scopus, Cochrane Library, RehabData, selecting 24 studies. The study of patients with chronic or subacute stroke in outpatient treatment, and with small sample sizes, prevails. Wide variability characterizes the rehabilitation methods, the technological platforms used, the type and dose of exercise administered, the outcome measures. The adequacy and efficacy of Exergames remains uncertain in the neurological elderly, and the functional improvement in the neurological adult patient is not yet attested using this type of approach.

Participatory ergonomics for the reduction of musculoskeletal exposure of maintenance workers.

Exposure to musculoskeletal disorders (MSDs) is a prevalent risk among those working in the maintenance of machinery and equipment for industry. Participatory ergonomics (PE) in the workplace embodies a solid strategy for the implementation of MSD prevention programs. This practical case describes a PE project implemented to improve MSD prevention strategies for the safety of maintenance workers. Experienced workers and maintenance workers employed in an Italian company for the industrial processing of wool have been actively involved in the risk assessment, in the proposal of improvement interventions and in the proposal of new preventive strategies. Ergonomic training and guidance helped the workers to have a proactive role in the prevention process. PE can help in the preventive management of critical activities of maintenance, through the empowerment of workers, the identification of targeted and feasible solutions and by using ergonomics as a basis for improving health and safety at work.

Work-Related Risk Assessment According to the Revised NIOSH Lifting Equation: A Preliminary Study Using a Wearable Inertial Sensor and Machine Learning.

Many activities may elicit a biomechanical overload. Among these, lifting loads can cause work-related musculoskeletal disorders. Aspiring to improve risk prevention, the National Institute for Occupational Safety and Health (NIOSH) established a methodology for assessing lifting actions by means of a quantitative method based on intensity, duration, frequency and other geometrical characteristics of lifting. In this paper, we explored the machine learning (ML) feasibility to classify biomechanical risk according to the revised NIOSH lifting equation. Acceleration and angular velocity signals were collected using a wearable sensor during lifting tasks performed by seven subjects and further segmented to extract time-domain features: root mean square, minimum, maximum and standard deviation. The features were fed to several ML algorithms. Interesting results were obtained in terms of evaluation metrics for a binary risk/no-risk classification; specifically, the tree-based algorithms reached accuracies greater than 90% and Area under the Receiver operating curve characteristics curves greater than 0.9. In conclusion, this study indicates the proposed combination of features and algorithms represents a valuable approach to automatically classify work activities in two NIOSH risk groups. These data confirm the potential of this methodology to assess the biomechanical risk to which subjects are exposed during their work activity.

A multiple linear regression approach to extimate lifted load from features extracted from inertial data.

SUMMARY: Work-related musculoskeletal disorders are among the main occupational health problems. Substantial evidence has shown that work-related physical risk factors are the main source of low back complaints, particularly affecting heavy and repetitive manual lifting activities. The aim of the study is, during load lifting tasks, to explore the correlation between the time domain features extracted from the acceleration and angular velocity signals of the performing subject and the load lifted, and to explore the feasibility of a multiple linear regression model to predict the lifted load. The acceleration and angular velocity signals were acquired along the three directions of space by means of an inertial sensor placed on the subject's chest, during lifting activities with load gradually increased by 1 kg from 0 kg to 18 kg. Successively three time-domain features (Root Mean Square, Standard Deviation and MinMax value) were extracted from the acquired signals. First a correlation analysis was carried out between each individual feature and the load lifted (calculating r); then the time-domain features that proved most representative (strong correlation) were used to create a multiple linear regression model (calculating R-square). The statistical analysis was carried out by means of the Pearson correlation and multiple linear regression model was fed with the most informative time-domain features according to the correlation analysis. The correlation analysis showed a strong correlation (r > 0,7) between six features (three extracted from z-axes acceleration and three extracted from y-axes angular velocity) and the lifted load. The predictive multiple linear regression model, fed with these six features achieved a Rsquare greater than 0,9.The study demonstrated that the proposed combination of kinematic features and a multiple regression model represents a valid approach to automatically calculate the load lifted based on raw signals obtained by means of an inertial sensor placed on the chest. The results confirm the potential application of this methodology to indirectly monitor the load lifted by workers during their activity.

Job preservation by an office worker with idiopathic cervical dystonia: case report.

BACKGROUND: Work preservation is a main goal in the rehabilitation of chronic disabling diseases. We describe the application of an interdisciplinary protocol, involving the occupational physician, the occupational therapist and the ergonomist, in the case of a 50 year-old office worker with idiopathic cervical dystonia, a movement disorder that can seriously impair work capability. CASE REPORT: The disease was diagnosed at age 25, and subsequently worsened. The man presented postural difficulties and pain. The symptomatology worsened during working shifts, preventing him from doing his job properly. Functional evaluation and ergonomic inspection of the office environment led to the correction of evident critical inadequacies. This allowed the patient to continue working in correct conditions, resulting in improvement of his global health status. CONCLUSIONS: The interdisciplinary rehabilitative approach here described may allow subjects with idiopathic cervical dystonia to keep their jobs by adapting the workplace to the changed physical capabilities.

Design and Validation of an E-Textile-Based Wearable Sock for Remote Gait and Postural Assessment.

This paper presents a new wearable e-textile based system, named SWEET Sock, for biomedical signals remote monitoring. The system includes a textile sensing sock, an electronic unit for data transmission, a custom-made Android application for real-time signal visualization, and a software desktop for advanced digital signal processing. The device allows the acquisition of angular velocities of the lower limbs and plantar pressure signals, which are postprocessed to have a complete and schematic overview of patient's clinical status, regarding gait and postural assessment. In this work, device performances are validated by evaluating the agreement between the prototype and an optoelectronic system for gait analysis on a set of free walk acquisitions. Results show good agreement between the systems in the assessment of gait cycle time and cadence, while the presence of systematic and proportional errors are pointed out for swing and stance time parameters. Worse results were obtained in the comparison of spatial metrics. The "wearability" of the system and its comfortable use make it suitable to be used in domestic environment for the continuous remote health monitoring of de-hospitalized patients but also in the ergonomic assessment of health workers, thanks to its low invasiveness.

[The ICD-ICF outpatient pathway in occupational therapy]. / Il percorso ambulatoriale ICD-ICF in terapia occupazionale.

SUMMARY: The Complex Ambulatory Macroactivity (MAC, Macroattività Ambulatoriale Complessa) has recently been included among the therapeutic and diagnostic Specialized Rehabilitation services issued by the Lombardy Region health institutes. Within Maugeri Scientific Clinical Institutes, our Occupational Physiatrics and Ergonomics Service is actively involved in the organic redefinition of rehabilitative pathways in the light of functional and patient-centered interpretation, typical of ICF (International Classification of Functioning). The article describes the assumptions, criteria and procedures that support the MAC system, proposing a modeling that can be inserted into the modern and complex system of health services.

[Active population aging, ICD-ICF clinical model and Occupational and Rehabilitation Medicine]. / Invecchiamento della popolazione attiva, modello clinico ICD-ICF e Medicina del lavoro e della Riabilitazione.

SUMMARY: The aging of the active population is more and more increasing in advanced western societies. This phenomenon also implies a constant increase in the average age of workers in various productive sectors, not least that of health. In this, in fact, alongside the known occupational risks, more and more frequently we are witnessing the emergence of chronic-degenerative pathologies connected with aging, even with symptoms that do not determine an unsuitability for work. In fact, within a scientific landscape accounting little evidence on the effectiveness of complex rehabilitation programs, the use of the ICD / ICF system in therapeutic programming should produce an important turning point, providing health professionals with a conceptual paradigm that supports both the functional assessment and the rational planning of therapeutic interventions, also contributing to the advancement of specialist knowledge. The present work shows how an effective collaboration between occupational physicians and rehabilitation specialists can effectively participate in the evaluation of the patient / worker even in the elderly, with particular regard to the return to work, taking full advantage of the classification and diagnostic tools implemented in the ICD and ICF systems.

[Physical activity, tool for the prevention and management of chronic diseases]. / Attività fisica, strumento di prevenzione e gestione delle malattie croniche.

OBJECTIVES: Physical activity is a key element in the prevention, treatment and rehabilitation of many diseases. METHODS: In the context of an adequate lifestyle, its practice amplifies the health benefits and increases the fitness, and furthermore counteracts the development and progression of chronic non-communicable diseases, modulating many risk factors. Its function is important in all life cycles and helps to keep the functional capabilities and independence even with aging. RESULTS: While inadequate physical activity (due to a sedentary lifestyle) is currently the fourth leading cause of mortality in developed countries, being one of the main public health issues, strong scientific evidences show that a regular and sufficient dose of physical activity reduces by about 30% the risk of premature death, cardiovascular disease and stroke, type II diabetes, colon and breast cancer, depression. CONCLUSIONS: Several guidelines and recommendations define the type, intensity, frequency and duration of physical activity, and many lifestyle preventative interventions prove its effectiveness and sustainability. Although so far a minority of the population actually adheres to the recommendations, the epidemiological strenght of lifestyle-oriented programs is considerable: quitting sedentariness, even low doses of physical activity are protective for health and reduce by about 22 % the risk of premature death. Physical activity is also an important therapeutic tool for patients with cardiovascular diseases, hypertension, diabetes II, cancer, chronic obstructive pulmonary diseases; an appropriate dosage reduces the risk of recurrence and disease progression, improves the control of clinical parameters and increases the patient's quality of life.

[Not Available]. / Il rischio posturale lavorativo e i disturbi agli arti inferiori.

The working posture is part of the risk factors for the development of muscle-skeletal disorders. Compared to postural problems of the trunk and upper limbs, those related to the lower limbs have been so far undervalued in the context of preventive medicine and ergonomics. The risk assessment tools for the lower limbs posture are inhomogeneous and incomplete. The classification of postures, the quantification of the risk, the correlation with organizational and individual aspects, and interventions for the prevention and management of the risk are aspects yet to be explored.

[Criteria of the OCRA method in evaluating the structural assembly of aircrafts: preliminary data]. / Criteri applicativi del metodo OCRA nella valutazione dell'assemblaggio strutturale degli aeromobili: dati preliminari.

In the aircraft productive sector, the risk assessment of repetitive occupational activities through the OCRA method presents some major obstacles: - high number of different tasks (more than 20) carried out during the work shift. - definite identification of the number of technical actions per cycle. Risk assessment through the traditional OCRA method provides in this sector a index which varies according to the sampling of the occupational tasks, rather than reflecting the effective risk level. The study raises an OCRA-based method which is applicable in the aircraft production sector and defines the overall ergonomic load for homogeneous groups of exposed workers, based on production data specified for each aircraft model.

[Role of occupational rehabilitation therapy in returning to work: experimental experience]. / Ruolo della terapia riabilitativa occupazionale nel reinserimento al lavoro: esperienze sperimentali.

The experimental experience is the result of combining cultural, clinical and scientific interest in rehabilitative, occupational and forensic mnedicine and in ergonomics. It deals with the rehabilitation and return at work of patients with physical disabilities caused by occupational trauma or disease. The programme described starts with a selection by INAIL and involves with an outpatient surgery inclusion. It is composed of: preliminary physical examination, functional assessment, the formulation of a rehabilitation plan and its successive implementation. At the end of the evaluation plan, there is a final assessment to identify outcome indicators and residual functional and work capacity.

Electric versus hydraulic hospital beds: differences in use during basic nursing tasks.

Biomechanical, postural and ergonomic aspects during real patient-assisting tasks performed by nurses using an electric versus a hydraulic hospital bed were observed. While there were no differences in the flexed postures the nurses adopted, longer performance times were recorded when electric beds were used. Subjective effort, force exertion and lumbar shear forces exceeding safety limits proved electric beds were superior. Patients' dependency level seemed to influence the type of nurses' intervention (duration and force actions), irrespective of the bed used. The nurses greatly appreciated the electric bed. Its use seemed to reduce the level of effort perceived during care giving and the postural load during critical subtasks. Ergonomics and organizational problems related to adopting electric beds in hospital wards should be addressed further to make their use more efficient.

[The shoe industry and the musculoskeletal system]. / Attività calzaturiera ed apparato muscoloscheletrico.

Shoes factory workers are engaged in ripetitive tasks, often performed in constrained postures and in concomitance of force applied, which result in increased risk of musculoskeletal disorders. Risk assessment and ergonomic interventions are part of the on-site prevention program, which should pertain also to gender and age differences. Health and safety issues can be adequately faced by an active epidemiological surveillance complemented by ergonomics.

[Obesity and work: an emerging problem]. / Obesità e lavoro: un problema emergente.

In Italy, 42.5% of adult males is overweight and 10.5% obese, while 26.6% of the women is overweight and 9.1% obese. The economical consequences of a growing number of obese workers are relevant: obesity is associated to reduced participation to productive life, increased absenteeism, disability and need for health care, lower salaries, negative impact on productivity. The obese worker is characterized by reduced tolerance to effort, limited range of motion at spinal and joints level, reduced muscle strength normalized per body weight, lower tolerance to prolonged postures, reduced balance and overall reduced work capacity linear to the increase of body mass index. The present article reviews the most evident relationships between work factors (stress, musculoskeletal disorders, etc.) and obesity and speculates about possible interventions to prevent occupational issues for obese workers.

Functional limitations and occupational issues in obesity: a review.

Four hundred million adults are obese. Such a pandemic involves people of working age. Excess weight imposes abnormal mechanics on body movements, which could account for the high incidence of musculoskeletal disorders in these subjects. This article reviews the physiological and biomechanical causes of the reduced work capacity in obese workers and speculates on the relationships between occupational exposure and obesity. The reduction in work capacity appears to be due to the following factors: reduced spine flexibility, decay in endurance, limited range of movement of the major joints, reduced muscle strength and capacity to hold prolonged fixed postures, impaired respiratory capacity and visual control. Work capacity in morbidly obese workers should always be evaluated to match specific job demands. Due to the relationship between obesity, musculoskeletal disorders, disability and health costs, prevention of obesity and ergonomic interventions on-site are a priority in the work place.

[Risk reduction in handling obese patients]. / La riduzione del rischio nella movimentazione del paziente obeso.

BACKGROUND: Hospital staff are exposed to significant risk in the manual handling and care of obese patients. OBJECTIVES: to illustrate how risk reduction can be achieved by means of integrated measures, particularly aimed at developing specific know-how among the operators, and the use of safety guidelines and technical aids for transferring obese patients in various situations. METHODS: on the basis of the recent literature, the present article reviews the technological aids and the preventive procedures that ensure safe transfer and health care of obese patients. RESULTS: Many devices are available in the USA for the handling and assisting the obese patient; however, much remains to be done for the development of specific equipment. In Italy, along with knowledge of the devices, specific competence needs to be promoted among the operators dealing with obese patients. Organizational and structural issues arise from this new specialty. CONCLUSIONS: An integrated approach, requiring suitable environments, ergonomic devices, standard procedures and personnel competence needs to be adopted in order to reduce the risk in health-care workers dealing with obese patient.

Long-term strength training for community-dwelling people over 75: impact on muscle function, functional ability and life style.

The objective was to determine the impact of a 1-year mixed strength-training programme on muscle function, functional ability, physical activity and life style. Twice-a-week hospital-based exercise classes and a once-a-week home session were conducted. Nineteen healthy community-dwelling training (T) men (76.6 +/- 3.1 years), 19 women (77.5 +/- 4.0 years) and 20 matched controls (C) participated in this study. Training was given with a two multi-gym machines for the lower limbs (Sitting calf and Leg press, TECHNOGYM, Italy) at 60% of the repetition maximum (1 RM) and at home it was with elastic bands. The following were the measurements made: muscle function-maximum isometric strength of the knee extensors (KE) and ankle plantar flexors (PF) measured with a Cybex Norm dynamometer, leg extensor power (LEP) with the Nottingham Power Rig; functional abilities-functional reach, chair rise, bed rise, 6-min walking test, stair climbing, get up and go, one-leg standing; physical activity-aerobic activities over 3 MET intensity (AA3), intensity classes; life-style-mean daily energy expenditure (MDEE). Significant gains in muscle function and functional abilities in both training females and males were observed, but females improved significantly more than males. Males (T + C) showed higher AA3 times than females (T + C) (P = 0.02), with females significantly more involved in light-intensity activities. We observed a 60% increase (t = 2.45) in AA3 time in T, but no increase in C. Trained males increased Class 2 physical activity time by 146% (t = 2.82) and trained females by 16% (t = 2.23). MDEE increased by 10% (t=2.62) in trained males. Our long-term mixed programme can improve muscle function and functional abilities in elderly females and functional abilities in males. It can positively affect the amount of habitual physical activity and the life-style of males and females over 75.

A test to assess the mechanical power sustainable during everyday activities in older people.

OBJECTIVE: to define with a simple test the power sustainable by older people during everyday occupations. METHODS: nine healthy subjects (65-71 years) performed two series of 5-6 trials on bicycle and arm ergometers at constant power. Throughout the exercise they reported their evaluation of the effort, referred either to perceived whole body exertion or to the working muscles, using Borg's category-ratio, CR10, scale. The exercise was interrupted when CR7 was attained. From a linear regression of the individual data of the work done from the start of each trial to the transition from CR4 to CR5, corresponding to 'somewhat heavy' and 'heavy', and the corresponding duration it was possible to calculate the slope of the work/time relationship. This was considered as the value of power sustainable for leg or arm muscles. RESULTS: on average the sustainable power for the work done on the bicycle ergometer represented 55% of the maximal mechanical power. During the control trial on the bicycle ergometer at a power corresponding to their sustainable power the subjects were able to exercise for 30 min without symptoms of fatigue or discomfort, with an average CR of 3. The average heart rate was 114 bpm and the blood lactate concentration at the end of the exercise was always lower than 4 mmol/l. Sustainable power calculated for the arm muscles was about one quarter that of the leg muscles, but all subjects reported the evaluation of the effort as more difficult. CONCLUSION: the determination of power sustainable for the leg muscles with this simple test appears reliable and accurate.