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PubMed2004

Handle with care: The American Nurses Association's Campaign to address work-related musculoskeletal disorders.

In response to the significant number and severity of work-related back injuries and other musculoskeletal disorders among nurses, the American Nurses Association (ANA) has launched the Handle With Care campaign. The campaign seeks to build a health care industry-wide effort to prevent back and other musculoskeletal injuries. This is being done through developing partnerships and coalitions, education and training, increasing use of assistive equipment and patient-handling devices, reshaping nursing education to incorporate safe patient handling, and pursuing federal and state ergonomics policy by highlighting technology-oriented safe-patient handling benefits for patients and nurses. In the absence of ergonomics regulations at national or state levels that protect health care workers, ANA has taken on alternative approaches to encourage a movement to control ergonomic hazards in the health care workplace and prevent back injuries among the nation's nursing workforce.

American Nurses' Association↗
PubMed2005

Functional Independence Score in Haemophilia: a new performance-based instrument to measure disability.

Morbidity in haemophilia has been described predominantly in terms of musculoskeletal dysfunction and assessed by the clinical and radiological joint scores. These scores document changes in a particular joint, but do not reflect the impact of these changes on the individual in terms of his overall musculoskeletal function. Several self-assessment instruments have been used to measure musculoskeletal function but none have been specifically validated for use in haemophilia. In order to objectively assess musculoskeletal function of patients with haemophilia, we developed Functional Independence Score in Hemophilia (FISH), a performance-based instrument. FISH measures the patient's independence in performing seven activities under three categories: self-care (grooming and eating, bathing and dressing), transfers (chair and floor) and mobility (walking and step climbing). Each function is graded from 1 to 4 depending on the amount of assistance needed in performing the function. We evaluated 35 patients who were over 10 years old and had had at least three major bleeds per year. All subjects were scored for clinical (World Federation of Hemophilia, WFH score) and radiological changes (Pettersson's score). Functional independence of the patient was assessed using the Stanford Health Assessment Questionnaire (HAQ) and the FISH. Correlation of the FISH score was modest with both the WFH clinical score (r = -0.68) and the radiological score (r = -0.44). While there was good correlation between FISH and HAQ (r = -0.90), FISH had better internal consistency than HAQ (Cronbach's alpha 0.83 vs. 0.66). FISH appears to be a promising disease-specific instrument for assessing overall musculoskeletal function in haemophilia. It requires evaluation in different patient populations.

Activities of Daily Living↗
PubMed1991

Musculoskeletal syndromes associated with acne.

The acne conglobata (AC)-, acne fulminans (AF)-, and isotretinoin-associated musculoskeletal syndromes are three distinct clinical entities. The AC-associated musculoskeletal syndrome occurs primarily in black men over the age of 22, who develop sacroilitis with or without a peripheral arthropathy. In contrast, the AF-associated musculoskeletal syndrome is found almost exclusively in white male teenagers. Fever, weight loss, and arthralgias are prominent components of this syndrome. A unique feature of the AF-associated musculoskeletal syndrome is osteolytic lesions that occur most frequently in the clavicle, sternum, long bones, and ilium. The isotretinoin-associated musculoskeletal syndrome occurs with equal frequency in male and female acne patients. Mild, transient myalgias and arthralgias are very common and do not require discontinuation of isotretinoin therapy. Asymptomatic, small, hyperostotic lesions of the spine occur in approximately 10% of acne patients with the isotretinoin-associated musculoskeletal syndrome.

Acne Vulgaris↗
PubMed2005

Myofascial trigger point development from visual and postural stressors during computer work.

The mechanism of musculoskeletal pain underlying low level static exertions, such as those experienced during computer work, is poorly understood. It was hypothesized that static postural and visual stress experienced during computer work might contribute to trigger point development in the trapezius muscles, resulting in myofascial pain. A study was conducted to observe the development of myofascial trigger points while 16 female subjects used a computer under conditions of high and low postural and visual stress. Trigger point development was monitored via expert opinion, subject self-report, and electromyographic activity. Only the high visual stress conditions resulted in greater trigger point sensitivity as reported by subjects and the myofascial specialist. Cyclic trends in median frequency of the EMG signal were assessed for the trapezius muscle. When high visual stress was combined with low postural stress condition there were significantly fewer cycles (1.6 cycles) as compared to the condition of low visual and low postural stress (2.8 cycles), and the condition of high visual and high postural stress (3.5 cycles). These significant differences between conditions were found for the right trapezius but not for the left. The findings suggest that high visual stress may be involved in the development of the myofascial pain response.

Adult↗
PubMed2001

Movement and stability dysfunction--contemporary developments.

A good understanding of the control processes used to maintain stability in functional movements is essential for clinicians who attempt to treat or manage musculoskeletal pain problems. There is evidence of muscle dysfunction related to the control of the movement system. There is a clear link between reduced proprioceptive input, altered slow motor unit recruitment and the development of chronic pain states. Dysfunction in the global and local muscle systems is presented to support the development of a system of classification of muscle function and development of dysfunction related to musculoskeletal pain. The global muscles control range of movement and alignment, and evidence of dysfunction is presented in terms of imbalance in recruitment and length between the global stability muscles and the global mobility muscles. Direction related restriction and compensation to maintain function is identified and related to pathology. The local stability muscles demonstrate evidence of failure of adequate segmental control in terms of allowing excessive uncontrolled translation or specific loss of cross-sectional area at the site of pathology. Motor recruitment deficits present as altered timing and patterns of recruitment. The evidence of local and global dysfunction allows the development of an integrated model of movement dysfunction.

Chronic Disease↗
PubMed1981

Design and evaluation of a pilot community program for musculoskeletal disability.

A pilot community program for arthritis disability was developed for three census tracts in Jamaica Plain. An inexpensive case-finding phone and mail survey carried out by community volunteers identified persons with arthritis disability at a unit cost of $8.46. Persons identified had a variety of problems: undiagnosed and treatable arthritic conditions such as psoriatic arthritis and tophaceous gout. Some were ignorant about the risks and benefits of joint replacement surgery, about rehabilitation intervention, or about existing community resources such as transportation services. Persons with impaired function from arthritis were assessed by a rehabilitation team and were given specific management recommendations. A trained ombudsman assisted the clients in getting health care or community services. An experimental design was used to evaluate the advocacy program in improving function and to document patterns of utilization. The results suggest that persons who received the intervention were more likely to have improved their function status, but the numbers are too small to permit definite conclusions.

Arthritis↗
PubMed2005

[Translation and psychometric testing of the Rotator Cuff Quality-of-Life Measure (RC-QOL) for use in German-speaking regions].

The evaluation of quality of life is an established criterion for evaluation of therapeutic measures. Starting from the English-speaking area a great number of different patient-based outcomes measures were developed to specifically question disorders of the musculoskeletal system and the results of treatment. Because of the lack of a German measurement tool for patients with rotator cuff disease the translation and the psychometric testing following international guidelines of the 34-item, multidimensional, English Rotator Cuff Quality-of-Life Measure (RC-QOL) was undertaken. Reliability (test-retest reliability, internal consistency), validity, practicability and acceptance of the German version of the RC-QOL were tested by 102 patients with an impingement syndrome after translation and cross-culture adaptation of the English original questionnaire. In addition, the SF-36, the Constant and UCLA scores were evaluated. Between the evaluations there was no significant difference; the Pearson correlation coefficient was 0.89 for the test-retest reliability. The internal consistency showed a high homogeneity with a Cronbach Alpha-coefficient of 0.98. A Pearson correlation coefficient between 0.67-0.76 registered a high correlation with the physical subscales of the SF-36, the Constant and the UCLA scores. The mean time required for completing the RC-QOL was 12 minutes; mean time required for evaluation was 10 minutes. The questionnaire was incompletely answered by 16 patients (15.6%). A total of 120 items (3.5%) were left unanswered. After successful translation and psychometric testing of the German version of the Rotator Cuff Quality-of-Life Measure (RC-QOL) a multidimensional measurement tool for evaluating the quality of life of German-speaking patients with pathology of the rotator cuff is available.

Female↗
PubMed2001

Rotational moment arms of the medial hamstrings and adductors vary with femoral geometry and limb position: implications for the treatment of internally rotated gait.

Persons with cerebral palsy frequently walk with a crouched, internally rotated gait. Spastic medial hamstrings or adductors are presumed to contribute to excessive hip internal rotation in some patients; however, the capacity of these muscles to produce internal rotation has not been adequately investigated. The purpose of this study was to determine the hip rotation moment arms of the medial hamstrings and adductors in persons with femoral anteversion deformities who walk with a crouched, internally rotated gait. A musculoskeletal model with a "deformable" femur was developed. This model was used, in conjunction with kinematic data obtained from gait analysis, to calculate the muscle moment arms for combinations of joint angles and anteversion deformities exhibited by 21 subjects with cerebral palsy and excessive hip internal rotation. We found that the semimembranosus, semitendinosus, and gracilis muscles in our model had negligible or external rotation moment arms when the hip was internally rotated or the knee was flexed -- the body positions assumed by the subjects during walking. When the femur was excessively anteverted, the rotational moment arms of the adductor brevis, adductor longus, pectineus, and proximal compartments of the adductor magnus in our model shifted toward external rotation. These results suggest that neither the medial hamstrings nor the adductors are likely to contribute substantially to excessive internal rotation of the hip and that other causes of internal rotation should be considered when planning treatments for these patients.

Adolescent↗
PubMed1998

Passive regulation of impact forces in heel-toe running.

OBJECTIVE: the purpose of this study was to determine whether passive mechanisms can account for impact force regulation with changing shoe hardness. DESIGN: A three-dimensional musculoskeletal model of the lower extremity was developed to simulate impact in running with two different shoe hardnesses. BACKGROUND: Considerable research has focused on developing shoe cushioning to reduce impact forces. However, only minimal changes in peak external impact force have been observed with changes in shoe hardness. It is hypothesized that passive mechanisms can regulate impact forces with changing shoe hardness, without changing muscle activities. METHODS: Initial kinematic inputs for the simulations were measured from nine male subjects performing heel-toe running. Simulations were performed with initial conditions and muscle stimulation patterns held constant while shoe hardness was varied between a hard and a soft condition. RESULTS: There was no significant difference between the soft and hard shoe peak impact forces. Peak rates of loading were greater for the hard shoe than the soft shoe. Muscle forces changed with shoe conditions. For some muscles (including the tibialis anterior) the forces were greater for the hard shoe, whereas for other muscles (including the peroneus) forces were greater for the soft shoe condition. CONCLUSIONS: Peak impact forces with changing shoe conditions can be regulated by passive mechanical changes without changing muscle activities or kinematics before touchdown. RELEVANCE: Potential injury causing loads on internal structures (e.g. muscles, tendons, etc.) during the impact phase of running can depend upon shoe hardness, but are not reflected in changes in external ground reaction force.

Journal Article↗
PubMed2003

Issues of exploration: human health and wellbeing during a mission to Mars.

Today, the tools are in our hands to enable us to travel away from our home planet and become citizens of the solar system. Even now, we are seriously beginning to develop the robust infrastructure that will make the 21st century the Century of Space Travel. But this bold step must be taken with due concern for the health, safety and wellbeing of future space explorers. Our long experience with space biomedical research convinces us that, if we are to deal effectively with the medical and biomedical issues of exploration, then dramatic and bold steps are also necessary in this field. We can no longer treat the human body as if it were composed of muscles, bones, heart and brain acting independently. Instead, we must lead the effort to develop a fully integrated view of the body, with all parts connected and fully interacting in a realistic way. This paper will present the status of current (2000) plans by the National Space Biomedical Research Institute to initiate research in this area of integrative physiology and medicine. Specifically, three example projects are discussed as potential stepping stones towards the ultimate goal of producing a digital human. These projects relate to developing a functional model of the human musculoskeletal system and the heart.

Adaptation, Physiological↗
PubMed1998

Differential effects of a six-day immobilization on newborn rat soleus muscles at two developmental stages.

Our objective was to determine the effects of a six-day immobilization on the musculoskeletal system of the rat during postnatal development at two key periods when the states of innervation are known to be different. This work was undertaken on the soleus muscle since it is well known that postural slow muscles show marked changes after a period of disuse. Thus, the soleus muscle was immobilized in a shortened position either when the innervation was polyneuronal or monosynaptic, respectively from 6 to 12 and from 17 to 23 days. The muscle modifications were followed by ATPase staining and myosin heavy chain (MyHC) isoform identification using monoclonal antibodies and SDS-PAGE. The functional properties of skinned fibre bundles were established by calcium/strontium (Ca/Sr) activation characteristics. In control muscles the maturation was characterized by a progressive increase of adult MyHCs (I and IIA) concomitant with a decrease in both the MyHC neo and the Ca affinity. Between 6 to 12 days, immobilization of the limb induced an increase in histochemical type IIC fibres. Using antibodies we identified new fibre types, classified as a function of their MyHC isoform co-expression. We observed an increase in expression of both MyHC neo and Ca affinity. From 17 to 23 days, the immobilization induced an increase in Ca affinity and marked changes in the MyHC isoform composition: disappearance of MyHC neo and expression of the fast MyHC IIB isoform, which in normal conditions is never expressed in the soleus muscle. We conclude that an immobilization imposed during polyneuronal innervation delays the postnatal maturation of the soleus muscle, whereas when the immobilization is performed under monosynaptic innervation the muscle evolves towards a fast phenotype using a default pathway for MyHC expression.

Adenosine Triphosphatases↗
PubMed1999

The effectiveness of commonly used lifting assessment methods to identify industrial jobs associated with elevated risk of low-back disorders.

Low-back disorders (LBD) continue to be the most costly and common musculoskeletal problem facing society today. Investigators have developed tools or measures that are intended to identify jobs that will probably be associated with an elevated risk of low-back disorders. However, an important and not widely discussed issue associated with these tools and procedures has been that of the validity or effectiveness of the tools. Therefore the objective of this study was to evaluate the validity and effectiveness of two commonly used types of LBD assessment methods in terms of their ability to correctly associate jobs with LBD risk. The 1981 NIOSH Work Practices Guide for Manual Lifting and the 1991 NIOSH revised lifting equation, along with psychophysical measures were assessed for their ability to correctly identify high-, medium-, and low-risk (of LBD) jobs. Risk was defined according to a database of 353 industrial jobs representing over 21 million person-hours of exposure. The results indicated that both NIOSH measures were predictive and resulted in odds ratios between 3.1 and 4.6. Higher odds ratios were found when the maximum horizontal distance was used to assess a job compared to the average horizontal distance. Further analyses indicated that the two NIOSH assessment methods classified risk in very different ways. The 1981 NIOSH Guide demonstrated good specificity (91%) in that it identified low-risk jobs well but it also displayed low sensitivity by only correctly identifying 10% of the high-risk jobs. The 1993 NIOSH revised lifting equation, on the other hand, had better sensitivity. It correctly identified 73% of the high-risk jobs but did not identify low- and medium-risk jobs well. Using psychophysical criteria it was observed that 60% of the high-risk jobs would be judged to be acceptable, whereas, 64% and 91% of the medium- and low-risk jobs, respectively, would be judged to be acceptable. This study indicates that the different measures have various strengths and weaknesses. When controlling for occupational LBD it should be recognized that a variety of measures exist and that the measure that most appropriately assesses risk depends upon the characteristics of the job.

Databases, Factual↗
PubMed1999

Chronic brucellosis in workers in a meat-packing plant.

We report an outbreak of brucellosis among 9 patients in a meat-packing plant. All patients developed chronic brucellosis characterized by severe chronic musculoskeletal pains, diffuse arthralgia, myalgia and recurrent bouts of fever, which we suggest may be related to a delay in antibiotic treatment. All the patients had a prolonged recovery requiring rehabilitation therapy.

Adult↗
PubMed1998

A Device for Preventing Occupational Diseases of Lower Legs.

Physiological processes characteristic of the fatigue of legs mainly appear when the worker's activity requires standing. If the processes are intensive and regular, various diseases of legs, such as varicose veins and musculoskeletal disorders of legs and feet, can develop. Therefore, methods of reducing the fatigue of legs are important in occupational health protection. Air jet massage technology was developed and an appropriate massage device was built by the authors. The massage head turning around the lower leg and moving up and down gradually covers the leg's surface. To determine the efficiency of the massage, fatigue processes were studied. These studies showed that jet massage effectively reduces both the subjective and objective fatigue symptoms. The device is convenient for use in industry, services, and at home.

Journal Article↗
PubMed2005

Upper limb load as a function of repetitive task parameters: part 1--a model of upper limb load.

The aim of the study was to develop a theoretical indicator of upper limb musculoskeletal load based on repetitive task parameters. As such the dimensionless parameter, Integrated Cycle Load (ICL) was accepted. It expresses upper limb load which occurs during 1 cycle. The indicator is based on a model of a repetitive task, which consists of a model of the upper limb, a model of basic types of upper limb forces and a model of parameters of a repetitive task such as length of the cycle, length of periods of the cycle and external force exerted during each of the periods of the cycle. Calculations of the ICL parameter were performed for 12 different variants of external load characterised by different values of repetitive task parameters. A comparison of ICL, which expresses external load with a physiological indicator of upper limb load, is presented in Part 2 of the paper.

Arm↗
PubMed1983

Working posture and musculoskeletal problems of video display terminal operators--review and reappraisal.

In order to minimize the stresses on the musculoskeletal system, attempts have been made to develop design guidelines for video display terminal workstations. Evaluations of VDT workstations reveal that many of the health problems experienced by operators might be attributed to awkward postures caused by lack of consideration of these guidelines. In other cases, it may be a matter of specific individuals not fitting "average" workstations. This has led to an increasing emphasis on designing adjustable workstations which can be adapted to the individual worker's needs. Even when guidelines are followed and workstations are adjusted to fit individuals, a variety of postural complaints may arise. One of the most important contributing factors is the constraint which is typically placed on the posture of the VDT operator. Many tasks lead to prolonged static positioning of the back, neck, arms and legs; producing rapid fatigue and increasing the risk of chronic problems. Another factor which must be considered is the effect of repetitive motion patterns which could lead to disorders in the muscles, tendons, nerves and joints. Finally, the effects of job pressures must not be overlooked as a potential contributing factor in postural complaints.

Bone Diseases↗
PubMedDate not supplied

Handle with Care: the American Nurses Association's campaign to address work-related musculoskeletal disorders.

In response to the significant number and severity of work-related back injuries and other musculoskeletal disorders among nurses, the American Nurses Association (ANA) has launched the Handle With Care(R) campaign. The campaign seeks to build a health care industry-wide effort to prevent back and other musculoskeletal injuries. This is being done through developing partnerships and coalitions, education and training, increasing use of assistive equipment and patient-handling devices, reshaping nursing education to incorporate safe patient handling, and pursuing federal and state ergonomics policy by highlighting technology-oriented safe-patient handling benefits for patients and nurses. In the absence of ergonomics regulations at national or state levels that protect health care workers, ANA has taken on alternative approaches to encourage a movement to control ergonomic hazards in the health care workplace and prevent back injuries among the nation's nursing workforce.

Comment↗