A chair for patients with burns of the back.
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Back Injuries↗
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Reducing back stress through an ergonomic approach: weighing a patient.
Back problems are prevalent in nursing personnel. Nursing assistants in a nursing home stated weighing dependent patients was a very stressful task; they manually lifted patients up onto a chair scale. The task was redesigned in two ways: the use of a ramp scale and use of a hoist with a digital scale. With the new methods, perceived physical stress to shoulder, back and body was reduced, compressive force to L5S1 and shear force were reduced (wheelchair scale method), and "patient" feelings of comfort and security were increased.
Adult↗
Salvage of extensively burned upper limbs by a pedicled latissimus dorsi flap.
Very deep burns of the arm and elbow lead to soft tissue necrosis and infection with exposure of important structures. Aggressive debridement should be performed as early as possible to cut the vicious circle, and the defect, which may be extensive, should be covered by well-vascularized tissues. The reliability and versatility of the pedicled latissimus dorsi muscle or musculocutaneous flap make it our first choice in the management of this problem. A retrospective study of three patients for whom salvage of the upper limb has been achieved by the use of a pedicled latissimus dorsi flap is presented, illustrating the advantages of this technique.
Adult↗
Determination of firing distance and firing angle by neutron activation analysis in a case involving gunshot wounds.
This paper reports the determination of the firing distance and a method for the evaluation of the firing angle in a fatal incident caused by two gunshots. Neutron Activation Analysis (NAA) was used to determine the Sb pattern around the bullet entrance holes on a garment of the victim, and around bullet holes produced by different shots on test targets from the gun and ammunition under investigation. The calibration curves obtained at various distances and firing angles enabled the determination of the firing distances and angles of the crime shots with a standard deviation of +/- 2 cm and +/- 5 degrees, respectively.
Axilla↗
The FAST scan: beyond free fluid.
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Adult↗
Evaluation in industry of a draft code of practice for manual handling.
This paper reports findings from a study which evaluated the draft New Zealand Code of Practice for Manual Handling. The evaluation assessed the ease of use, applicability and validity of the Code and in particular the associated manual handling hazard assessment tools, within New Zealand industry. The Code was studied in a sample of eight companies from four sectors of industry. Subjective feedback and objective findings indicated that the Code was useful, applicable and informative. The manual handling hazard assessment tools incorporated in the Code could be adequately applied by most users, with risk assessment outcomes largely consistent with the findings of researchers using more specific ergonomics methodologies. However, some changes were recommended to the risk assessment tools to improve usability and validity. The evaluation concluded that both the Code and the tools within it would benefit from simplification, improved typography and layout, and industry-specific information on manual handling hazards.
Back Injuries↗
Validation of an instrument for patient handling assessment.
Nursing personnel are at high risk from work-related musculoskeletal disorders, especially back symptoms. Handling patients has been established as one of the factors playing an important role in the etiology of occupational low back pain. The aim of this study was to develop an instrument for patient handling assessment and to determine its validity and reliability. Instrument validity was established based on content and construct validity. Reliability was estimated through homogeneity, stability (test-retest) and equivalence (interrater) tests. Reliability estimated by internal consistency reached a Cronbach's Alpha coefficient of 0.81. Pearson's correlation coefficient for test-retest reliability was r = 0.92. There was an excellent agreement between observers, according to the k values (Kappa = 0.92). Interobserver (interrater) reliability was assessed by Pearson's correlation coefficient, reaching an r value of 0.84. The agreement between both observers was also fairly good (Kappa = 0.84). The results of the current study show that the instrument seems to be reliable and valid for patient handling assessment.
Back Injuries↗
An ergonomic intervention to reduce back strain among apple harvest workers in New York State.
The impact of modifications to the apple picking bucket on common picking postures, self-reported comfort, ease of use, and speed of harvest were measured. Fourteen apple pickers wore an intervention hip belt, were interviewed and measured using posture-activities-tools-handling methodology. The use of hip belt did not significantly alter time spent in various postures. 78.6% of interviewed workers preferred the modified bag, 71.4% noted a difference in the back, neck, or shoulder, while 64.3% said regular use of modified bag would slow their work. Major themes in worker comments are discussed. The hip belt modification to apple harvest bag seems generally acceptable to workers, but needs further development to overcome unintended effects. Although work sampling demonstrates that the bag does not affect work practices, workers appear somewhat concerned that productivity will be negatively impacted. Further training of workers in the use and potential benefits of bag are needed.
Agricultural Workers' Diseases↗
Designing ergonomic interventions for EMS workers, Part I: transporting patients down the stairs.
The objective of the current work was to test ergonomic interventions aimed at reducing the magnitude of trunk muscle exertions in firefighters/paramedics (FFPs) providing emergency medical services (EMS) when transporting patients down the stairs. The interventions, developed using focus groups, were a footstrap to prevent the patient from sliding down on the backboard, a change in the handle configuration on the stairchair, and 2 devices, the "backboard wheeler" and a tank tread-like device (descent control system, DCS) for a stretcher, that change the backboard and stretcher carrying tasks into rolling and sliding tasks. Eleven two-person teams transported a 75 kg dummy with each intervention and its corresponding control condition down a flight of steps. Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant. Results showed that the backboard footstrap reduced the erector spinae (ERS) activity for the FFP in the "leader" role by 15 percent, on average. The change in handle configuration on the stairchair had no effect on the variables measured. The backboard wheeler reduced the ERS activity bilaterally in the FFP in the leader role and unilaterally for the FFP in the "follower" role, by 28 and 24 percent, respectively. The DCS reduced the 90th percentile ERS activity for both FFPs from 26 to 16 percent MVC, but increased the latissimus dorsi activity in the follower from 11 to 15 percent MVC. The DCS was the only intervention tested that resulted in a reduced rating of perceived exertion relative to the corresponding control condition. In summary, the hypotheses that the proposed interventions could reduce trunk muscle loading were supported for 3 of the 4 transport interventions tested.
Adult↗
Comparing the results of five lifting analysis tools.
The objective of this study was to compare the results of the NIOSH, ACGIH TLV, Snook, 3DSSPP and WA L&I lifting assessment instruments when applied to a uniform task (lifting and lowering milk cases with capacities of 15 and 23l). To enable comparisons between the various lifting assessment instruments, the outputs of each method were converted to an exposure index similar to the NIOSH Lifting Index. All instruments showed higher exposures associated with lifting the 23l cases versus the 15l cases. The NIOSH, ACGIH TLV and Snook methods were similar in their results with respect to the pattern of exposure over various height levels and the differences in exposures associated with lifting 15 and 23l cases. However, the WA L&I and 3DSSPP predicted substantially lower exposures. The reasons for instrument differences are presented so that practitioners can better select the methods they need and interpret the results appropriately.
Back Injuries↗
Designing ergonomic interventions for emergency medical services workers--part III: Bed to stairchair transfers.
The objective of the current work was to test interventions aimed at reducing the low-back musculoskeletal loads experienced by firefighters/paramedics (FFPs) providing emergency medical services (EMS) that involve transferring a patient between a bed and a stairchair. The interventions, developed or selected using focus groups, were a prototype Drew People Movertrade mark, and a Transfer Sling. These interventions changed the coupling between the EMS worker and the patient. They were compared with an under-axilla lift. Eleven FFP teams transferred a 75kg dummy between a bed and a stairchair. Both interventions were tested using two-person transfers. In addition, the Transfer Sling was tested using a one-person transfer. Surface electromyographic (EMG) data were collected from 8 trunk muscles from each participant along with spine kinematic data. Additionally, ground reaction force data obtained from two forceplates were acquired for one member of each FFP team that was used to estimate directional spine moments using a 3D linked-segment model. In the two-person transfers, there was 19 degrees less trunk flexion (p=0.002) for the FFP on the patient's left side and a trend towards less motion for the FFP on the patient's right side (p=0.079) when using the interventions. Both FFPs showed reductions in the ipsilateral Erector Spinae activity using the Drew People Mover and the Transfer Sling that averaged approximately 9% MVC, which corresponds to a 21% decrease in the muscle activation levels. While the overall EMG was greater when performing a single-FFP transfer, the Transfer Sling reduced the bilateral Erector Spinae activity by approximately 20%. During the two-person transfers, the FFP on the forceplate to the right side of the patient showed a reduction in the forward bending moment using the Drew People Mover relative to the Sling and under-axilla conditions. During the single-person transfers, only the twisting moment was significantly reduced through use of the Transfer Sling. These objective measures, when combined with the subjective ratings of perceived exertion and the verbal feedback lead us to recommend the use of these interventions for bed to stairchair transfers.
Adult↗
An evaluation of backpack harness systems in non-neutral torso postures.
Much of the research on backpack design has been focused on spinal loading/biomechanics while the wearer is in a neutral/upright trunk posture, such as those employed by outdoor enthusiasts and schoolchildren. This research has led to some important harness design improvements that reduce trunk muscle exertions, fatigue and improve overall comfort. There are number of occupations, however, wherein workers wear back-mounted packs/devices (e.g. air tanks) while working in non-neutral trunk postures. The objective of the current study was to evaluate the effects of these non-neutral postures on biomechanical loading and then reconsider the backpack system design recommendations. Fifteen participants were asked to support a 18.2 kg load on their back while assuming static forward flexed postures of the torso (15 degrees , 30 degrees , 45 degrees , and 60 degrees of sagittal bend). The mass on the back was attached to the participant through two different harness mechanisms: a basic harness design (as seen on college student backpacks) and a more advanced design containing lateral stiffness rods and a weight-bearing hip belt (as seen on backpacks for hikers). While performing these static, posture maintenance tasks, the activation levels of the bilateral trapezius, erector spinae, and rectus abdominis were collected. Participants also provided subjective ratings of comfort. The results showed that there was a significant interaction between harness type and forward flexion angle for the trapezius and the erector spinae muscles. The normalized EMG for the trapezius muscles showed a 14% and 11% reduction in muscle activity at 15 degrees and 30 degrees , respectively, with the advanced design but these positive effects of the advanced design were not found at the greater flexion angles. Likewise the erector spinae muscles showed a 24% and 14% reduction in muscle activity at 15 degrees and 30 degrees , respectively, with the advanced design harness but these effects of the advanced design were not found at the greater forward flexion angles. The level of forward flexion angle affected the rectus abdominis muscle activity, but neither the harness type main effect nor the interaction of harness type and forward flexion angle was significant. The subjective survey results agreed with the EMG results and showed the advanced design harness was generally more comfortable with respect to the shoulder and low back areas. Collectively, the subjective and objective results show a significant improvement with the advanced harness system but also note an interesting interaction with degree of sagittal flexion, indicating a diminished effectiveness of the design improvements at forward flexed postures. Design criteria for harness systems in these forward flexed postures are discussed.
Adult↗
Risk assessment of patient handling with ambulance stretcher systems (ramp/(winch), easi-loader, tail-lift) using biomechanical failure criteria.
The research aims to carry out a detailed analysis of the loads applied by the ambulance workers when loading/unloading ambulance stretchers. The forces required of the ambulance workers for each system are measured using a load cell in a force handle arrangement. The process of loading and unloading is video recorded for all the systems to register the posture of the ambulance workers in different stages of the process. The postures and forces exerted by the ambulance workers are analyzed using biomechanical assessment software to examine if the work loads at any stage of the process are harmful. Kinetic analysis of each stretcher loading system is performed. Comparison of the kinetic analysis and measurements shows very close agreement for most of the cases. The force analysis results are evaluated against derived failure criteria. The evaluation is extended to a biomechanical failure analysis of the ambulance worker's lower back using 3DSSPP software developed at the Centre for Ergonomics at the University of Michigan. The critical tasks of each ambulance worker during the loading and unloading operations for each system are identified. Design recommendations are made to reduce the forces exerted based on loading requirements from the kinetic analysis.
Allied Health Personnel↗
The role of quadratus lumborum asymmetry in the occurrence of lesions in the lumbar vertebrae of cricket fast bowlers.
In cricket fast bowlers an increased incidence of stress fractures or lesions in the L4 pars interarticularis is observed, which shows a strong statistical correlation with the presence of hypertrophy in the contralateral Quadratus Lumborum (QL) muscle. This study aims to find a physical explanation for this correlation. A mathematical model was used to estimate the forces and moments on the L3 and L4 vertebrae in six postures attained during fast bowling. These forces and moments were used in finite element models to estimate the stresses in the pars interarticularis. Two scenarios were examined per posture: symmetric QL muscles, and right QL muscle volume 30% enlarged. Influence of muscle activation was also investigated. QL asymmetry only correlates with significant stress increases when stress levels are relatively low. When stress levels are high, due to extreme posture or muscle activation, asymmetry only causes small stress changes, suggesting that asymmetry is not the cause of stress fractures in the pars. There are even indications that asymmetry might help to reduce stresses, but more detailed knowledge of the size and activation of the lumbar muscles is needed to confirm this.
Athletic Injuries↗
Changes in spine loading patterns throughout the workday as a function of experience, lift frequency, and personality.
BACKGROUND CONTEXT: Psychosocial stressors have been associated with low back pain reporting. However, response to psychosocial risk factors may be dependent on the individual's personality type that, in turn, can affect muscle recruitment and spine loading. This study explores how personality might be associated with spine loading during repetitive lifting performed throughout an entire work shift. PURPOSE: Assess spine loading as a function of an individual's personality type during repetitive, long-term exposure to a materials handling tasks. STUDY DESIGN: Laboratory experiment where experienced and inexperienced participants performed repetitive, asymmetric lifts at various load and lift frequency levels throughout a series of 8-hour exposure periods. Spine loads were monitored throughout the work period. PATIENT SAMPLE: Twelve novice and 12 experienced materials handlers who were asymptomatic for back pain. OUTCOME MEASURES: Spine compression, anterior-posterior (A/P) shear, and lateral shear at the L5-S1 level. METHODS: Participants were categorized into personality types based upon the Myers-Briggs personality type indicator. An electromyography-assisted biomechanical model was used to assess spine compression, A/P shear, and lateral shear throughout the exposure period. RESULTS: The results indicate that intuitors had higher shear spinal loading regardless of moment exposure, lift frequency, and time through the work period, compared with the sensor personality type. In addition, higher spine compressive and shear forces occurred in the perceiver personality compared with the judgers' personality trait, regardless of moment and, often, lift frequency. Novice lifters typically experienced greater spine loading. CONCLUSIONS: The results suggest that when there exists a personality-job environment mismatch, spinal loading increases via an increase in antagonistic co-contraction. The trends suggest that inherent personality characteristics may play a role in one's motor control strategies when performing a repetitive lifting task.
Adult↗
Saddle pressure measuring: validity, reliability and power to discriminate between different saddle-fits.
Saddle-fit is recognised as an important factor in the pathogenesis of back problems in horses and is empirically being evaluated by pressure measurements in clinical practice, although not much is known about the validity, reliability and usability of these devices in the equine field. This study was conducted to assess critically a pressure measurement system marketed for evaluating saddle fit. Validity was tested by calculating the correlation coefficient between total measured pressure and the weight of 28 different riders. Reliability and discriminative power with respect to different saddle fitting methods were evaluated in a highly standardised, paired measurement set-up in which saddle-fit was quantified by air-pressure values inside the panels of the saddle. Total pressures under the saddle correlated well with riders' weight. A large increase in over-day sensor variation was found. Within trial intra-class correlation coefficients (ICCs) were excellent, but the between trial ICCs varied from poor to excellent and the variation in total pressure was high. In saddles in which the fit was adjusted to individual asymmetries of the horse, the pressure measurement device was able to detect correctly air-pressure differences between the two panels in the back area of the saddle, but not in the front area. The device yielded valid results, but was only reliable in highly standardised conditions. The results question the indiscriminate use of current saddle pressure measurement devices for the quantitative assessment of saddle-fit under practical conditions and suggest that further technical improvement may be necessary.
Animal Husbandry↗
Ergonomics in the workplace.
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Back Injuries↗