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PubMed2001

Employer attitudes, training, and return-to-work outcomes: a pilot study.

This work was concerned with investigating and changing employer attitudes and practices that impede return to work and rehabilitation for injured workers. Prior studies have shown that employer responses to workers reporting work-related musculoskeletal discomfort have significant and independent effects on disability outcomes. Based on these findings, a pilot training program was developed by occupational rehabilitation specialists to improve the response of supervisors to employees reporting work-related injuries. The training was delivered to 108 supervisors at seven southeastern New Hampshire companies that volunteered to participate. A survey was developed and pilot-tested, then administered before the training. Survey participants were employees who had work-related injuries in the past year. The survey asked about types and onset of injury, specific supervisor responses, and overall impression of supervisor interaction at the time of injury. Employee responses before the intervention were compared with those collected from workers who reported injuries after the training. The postintervention results demonstrated significant decreases in supervisors (1) blaming employees for the injury, (2) not taking the condition seriously, and (3) discouraging the worker from filing a claim. Positive trends in confidentiality of discussions, access to medical care, and accommodation and work modifications were also noted. Although anecdotal reports from the companies indicated a consistent decrease in work-related lost time after the intervention, actual verification was not possible, and other components of the intervention may have accounted for this outcome. Small numbers of cases and possible lack of comparability of cases before and after the intervention are significant limitations. However, rehabilitation professionals may be able to improve disability management practices and accommodations through employer education, especially when training is directed toward front-line supervisors.

Attitude↗
PubMed2002

Results of an OSHA ergonomic intervention program in New Hampshire.

A number of articles have been written about the value of OSHA inspections, and to a lesser extent, OSHA targeting. However, there have been few, if any, that quantify the effectiveness of an injury specific targeting program. This study examines the change in the incidence of carpal tunnel syndrome (CTS) in a group of employers following the implementation of an OSHA Local Emphasis Program (LEP) for ergonomics by an area office of the Occupational Safety and Health Administration (OSHA). The OSHA program consisted of inspections initiated between 1992 and 1995 in New Hampshire at work sites with a history of CTS and tendinitis workers' compensation claims. Workers' compensation data for 14 employers were examined and the annual incidence for that group were compared with the experience of all other New Hampshire employers. New Hampshire employers who had one or more of their work sites experienced a decline in carpal tunnel syndrome greater than in other New Hampshire employers. The annual incidence of CTS of inspected employers fell from 38/10,000 in 1992 to 3.8/10,000 in 1997. New Hampshire employers not receiving an inspection focused on upper extremity cumulative trauma hazards fell from 6.6/10,000 to 3.4/10,000 during that same period. The LEP group of employers was responsible for 17 percent of all workers' compensation CTS cases in New Hampshire in 1992. By 1997 their contribution had dropped to less than 5 percent.

Adult↗
PubMed1996

Neuroarthropathy: an overuse injury of the shoulder in quadriplegia.

The shoulder joint of the spinal cord injured patient is the primary joint used for transfer and wheelchair propulsion. In addition to ordinary use, the shoulder is subject to overuse injury with resultant functional impairment. Frequent overuse injuries of the shoulder include subdeltoid bursitis, bicipital tendonitis, rotator cuff tear and secondary degenerative arthritis. Neuroarthropathy of the shoulder, an overuse injury of an insensate shoulder girdle, has been rarely described in the literature. The case presented is that of an active 47 year old, right hand dominant, C7 complete quadriplegic male with a one week history of painless right shoulder girdle swelling. Radiologic evaluation documented right proximal humerus destruction. Magnetic Resonance Imaging (MRI) confirmed syringomyelia. The pathophysiology of neuroarthropathy is presented here and limited treatment options are discussed.

Arthropathy, Neurogenic↗
PubMed2006

Effusion of the hips in a patient with tetraplegia.

BACKGROUND: Patients with spinal cord injury are at risk for knee effusion, most likely as a result of repetitive microtrauma. Patients with paralysis are susceptible to effusions of the hip similar to those seen in documented cases regarding the knee. The etiology is likely similar and is related to repetitive microtrauma, such as that experienced when aggressive range of motion exercises are applied. DESIGN: Case report. SETTING: Acute rehabilitation department of a spinal cord injury center. FINDINGS: A 19-year-old man with a complete cervical spinal cord injury presented to acute rehabilitation on postinjury day 25 with a C6 American Spinal Injury Association classification A injury, complete. He was found to have bilateral hip effusions. Joint aspiration yielded a right sterile hydroarthrosis and a left sterile hemarthrosis. During his rehabilitation stay, the patient developed one mildly elevated alkaline phosphatase level, but he showed no radiographic evidence of heterotopic ossification and maintained full passive range of motion of the hips. CONCLUSION: This case indicates that hip effusion may be a similar, less-common occurrence than knee effusion in patients with spinal cord injury. In this case, bilateral aseptic hip effusion was not associated with heterotopic ossification. More research is needed to determine the etiology and sequelae of this condition.

Adult↗
PubMed1995

Repetitive Strain in Nonrepetitive Work: A Case Study.

In a Québec factory, a woman in a nontraditional job suffered from epicondylitis whereas her male coworkers were unaffected. A study was undertaken in order to enumerate the operations at risk for epicondylitis. Workers were interviewed in order to identify difficult operations and systematic observations were done over 4 work days. Although tasks were extremely varied, certain movements at risk for epicondylitis were repeated many times. Fifty-three valves were turned against resistance as part of this job, and one valve requiring a particularly difficult movement was turned 20 times in one day. There were at least 61 operations at risk for epicondylitis per day over a 4-day period. Strain on the elbow joint was particularly intense for the woman worker because the design of the workplace gave an advantage to taller workers with larger hands. Although this case study does not permit us to conclude that the worker's epicondylitis was due to her job, it enables us to suggest that it would be wise to adapt the dimensions of relevant equipment and worksites to a wider range of potential worker sizes. We also raise some questions about the definition of repetitive strain in epidemiological studies. We suggest that it may be necessary to consider not only the cycle time but also the total of forces exerted on a joint in order to study workplace injuries to the musculoskeletal system.

case study↗
PubMed1998

Evaluation of Grip Force Using Electromyograms in Isometric Isotonic Conditions.

The purpose of this study was to develop a relationship to evaluate the grip force (forcerel) using the electromyogram (EMGrel) of the flexor digitorum superficialis (FDS) and of the extensor digitorum (ED) according to the flexion-extension wrist angle (θf.e) and to the pronation-supination forearm angle (θp-s). Fifteen participants had to exert 3 levels of grip forces in 4 positions of the wrist combined with 3 positions of the forearm. The relationship is: forcerel = 0.0045· θf-e· EMGrel(FDS) + 0.48· EMGrel(FDS)-0.0014 · θf-e · EMGrel(ED) -0.0016 · θp.s · EMGrel(ED) + 0.4· EMGrel(ED) This relationship can be used to estimate grip force for levels of strength lower than 50% of the maximal voluntary contraction.

biomechanical stresses↗
PubMed2003

Ergonomic study on the manual component insertion lines for occupational health and safety improvements.

The study aimed at reducing the occupational health and safety problems faced by the manual component insertion operators. Subjective and objective assessments, and direct observations were made in the printed circuit assembly factory. Simple and low-cost ergonomic interventions were implemented, that is, repairing chairs, reducing high workloads, assigning operators to a maximum of 2 workstations, confining machines that emitted bad smell and much noise, and providing finger work aids. The results of the interventions were reductions in operators' work discomforts, that is, chair discomfort (by 90%), high work stress, and discomfort due to profound change in their workstations. Their health hazards were also eliminated, that is, inhalation of toxic fumes, exposure to too much noise, and pain due to pressing sharp components.

Air Pollutants, Occupational↗
PubMed2003

Relevance of the EMG/grip relationship in isometric anisotonic conditions.

The aim of the present study was to develop a relationship to evaluate grip force using the electromyogram (EMG) in isometric anisotonic conditions. The EMGs of the flexor digitorum superficialis (FDS) and the extensor digitorum (ED) were recorded in 3 flexion-extension positions of the wrist (30 degrees flexion, 30 degrees extension, and 60 degrees extension) associated with 3 positions of the forearm (70 degrees pronation, prono-supination, and 70 degrees supination). For each position, the participants had to follow linear ramp targets (2 rates of increase and decrease) displayed on an oscilloscope. The results show the best fit is a quadratic type force-EMG relationship. Some aspects such as the rate of force variation and the forearm and wrist positions are then discussed along with the limitations of the relationship.

Cumulative Trauma Disorders↗
PubMed2003

A new approach to the mouse arm syndrome.

OBJECTIVES: The study validates a new computer mouse concept. The tested device is a small mouse with a pivoting pen-shaped handle. The hypothesis behind the design is the assumptions that the pen grip requires less static tension than the normal mouse grip and that fine-motor, high precision tasks normally are done with finger movements with forearm at rest. METHODS: Four muscles were monitored with electromyography (EMG) during work with a new mouse and with a traditional mouse. RESULTS: EMG activity was significant lower, in M. pronator teres--46%, M. extensor digitorum--46%, M. trapezius--69%, and M. levator scapulae--82%, during work with the new mouse as compared to the traditional mouse. CONCLUSION: Altering the design of the computer mouse can significantly reduce muscular tension.

Carpal Tunnel Syndrome↗
PubMed2004

Major health risk factors in Iranian hand-woven carpet industry.

This paper reviews the role and importance of small-scale industries together with the issue of occupational health problems and their causes in Iranian hand-woven carpet industry as a typical informal small-scale industry in an industrially developing country. The objective of this paper is to review health risk factors and related occupational health and ergonomic problems in the carpet industry. Since the overwhelming majority of weavers' health problems originate from ergonomic risk factors, it is concluded that any improvement program in this industry should focus on ergonomic aspects. To assess ergonomic conditions in weaving workshops, a checklist has been developed and an ergonomics index indicating the ergonomic conditions of the workshop has been proposed. To test and verify the checklist, 50 weaving workshops were visited and their ergonomic conditions were assessed. Based on the results some modifications were made and the checklist was shown to be an effective tool.

Cumulative Trauma Disorders↗
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↗
PubMed2005

Upper limb load as a function of repetitive task parameters: part 2--an experimental study.

The aim of the study was to compare the theoretical indicator of upper limb load with the physiological indicator of musculoskeletal load, which is present while performing a repetitive task (a normalized electromyography [EMG] amplitude recorded from the muscles of the upper limb involved in the performed task). In an experimental study of a repetitive task, the EMG signal from 5 main muscles of the shoulder girdle, arm and forearm was registered: extensor carpi radialis longus, flexor carpi ulnaris, deltoideus anterior, biceps brachii caput breve and trapezius descendent. The results of the study showed a strong correlation between the theoretical indicator (Integrated Cycle Load) and the physiological indicator (root mean square of a normalized EMG amplitude from the 5 muscles). This proves that the developed theoretical indicator can be accepted as an indicator of upper limb musculoskeletal load during a work task.

Adult↗
PubMed2002

Effect of type 3 (oversize) tennis ball on serve performance and upper extremity muscle activity.

This study investigated the effect of the larger diameter (Type 3) tennis ball on performance and muscle activation in the serve. Sixteen male advanced tennis players performed serves using regular size and Type 3 tennis balls. Ball speed, surface electromyography, and serve accuracy were measured. There were no significant differences in mean initial serve speeds between balls, but accuracy was significantly greater (19.3%) with the Type 3 ball than with the regular ball. A consistent temporal sequence of muscle activation and significant differences in mean activation of different muscles were observed. However, ball type had no effect on mean arm muscle activation. These data, combined with a previous study, suggest that play with the larger ball is not likely to increase the risk of overuse injury, but serving accuracy may increase compared to play with the regular ball.

Acceleration↗
PubMedDate not supplied

Antecedent factors and disabling occupational morbidity--insights from the new BLS data.

Since 1992 the United States Bureau of Labor Statistics' (BLS) annual survey of occupational injuries and illnesses (SOII) has collected data on occupational injuries and illnesses involving 1 or more days away from work (DAW). However, to date, the BLS has not published a comprehensive set of cross-tabulated part of body (BP), nature of injury or illness (NOI), and exposure/event (EE) data. To improve the understanding of the causes of disabling occupational morbidity in the United States, the present study used a special data call and data reduction strategy to identify the leading BP-NOI-EE combinations for DAW cases by frequency, incidence rate, and severity (median DAW) for 1996. The results indicated that the majority of injury and illness morbidity reported by the BLS was related to musculoskeletal conditions of either gradual or sudden onset and traumatic injuries of sudden onset. In particular, traumatic injuries from sudden events such as falls resulted in the most disabling cases. The results indicate that the occupational morbidity identified in the SOII requires interventions focused on overexertion and falls, as well as more traditional injury prevention approaches. The BLS can improve the utility of the system by adding provisions for a second event code to the coding structure and by improving direct access to these data for occupational health and safety professionals.

Absenteeism↗
PubMedDate not supplied

Efficient one-day sampling of mechanical job exposure data--a study based on upper trapezius activity in cleaners and office workers.

This ergonomics exposure assessment study compared the efficiency of eight 1-day-only strategies, that is, the relationship between the number of data collected per subject and the precision of the resulting mean exposure estimate. Whole-day electromyographic recordings from the right upper trapezius muscle in 24 cleaners and 23 office workers were processed to give minute-by-minute values of gap time and jerk time-parameters representing the level and frequency dimensions of muscle activation, respectively. On-site observations provided data on time spent in each of eight exhaustive task categories in the job, seven of which were associated with activities during work, and the last comprising breaks. On average, sampling at fixed intervals without regard to tasks doubled efficiency as compared with random sampling, which in turn was several times as efficient as consecutive sampling. Stratified sampling according to the two broad categories, work and breaks, increased efficiency for random and fixed-interval sampling, but the gain was distinct only among cleaners (about 20%). The commonly used strategy in ergonomic studies of sampling consecutively for short periods within tasks was highly inefficient. Further classification of work into the seven subcategories resulted in marginal additional increases in efficiency; on average less than 2%. A decision algorithm is given for determining appropriate sampling strategies in different types of jobs.

Adult↗