Gert-Åke Hansson

Validity and reliability of triaxial accelerometers for inclinometry in posture analysis

There is a need for objective and quantitative methods for measuring posture and movement, so that, for instance, exposure-response relationships for work-related musculoskeletal disorders can be established. Inclinometry data have been obtained from triaxial accelerometers based on uniaxial solid-state accelerometers used in conjunction with a computer program to perform co-ordinate transformations. The transducer can be mounted in an arbitrary orientation on a body segment, since if two reference positions are recorded, the co-ordinate system of the transducer can be transformed to that of the body segment. The angular error of the system is small (1.3°), the reproducibility is high (0.2°), and the inherent angular noise is small (0.04°) and independent of the orientation of the device. Under quasi-static conditions, the angular velocities can be derived from the inclinometry data. The angular and the angular-velocity errors can be approximated using the relative deviation of the acceleration magnitude from gravitation. For applications involving a high degree of movement, the accelerometer data are still valid, although they cannot be interpreted as inclination. Used in combination with the computer program, the transducer can be used to measure posture and movement under static and quasi-static conditions, which occur in most areas of occupational work. It is shown that spherical co-ordinates can be used to present the inclinometry data.

Goniometer measurement and computer analysis of wrist angles and movements applied to occupational repetitive work

In epidemiological studies of occupational musculoskeletal disorders there is a need for quantitative exposure measurements of the physical work load. In studies of neck and upper limb disorders the so-called cumulative trauma disorders (CTDs), in particular the carpal tunnel syndrome, the positions and movements of the wrist are of special interest. A biaxial flexible electrogoniometer was used to measure continuously, with a sampling rate of 20 Hz, wrist flexion/extension and abduction/adduction angles up to 27 min. Evaluation of the influence of rotation on the goniometer showed some inherent crosstalk, which, however, did not invalidate the results. For occupational repetitive work, 99.5% of the signal power was contained in the 0-5 Hz band. Two-dimensional angle distributions and power spectra gave comprehensive information about wrist postures and movements. Measures reflecting both static and dynamic properties were derived from time and frequency domains. These measures give quantitative information on different potential risk factors and are therefore useful in epidemiological studies. Mean power frequency (MPF) is suggested as a generalized measure of repetitiveness. The method was applied in field studies of fish processing industry workers with highly repetitive work and risk of CTD.

Disorders of the neck and upper limbs in women in the fish processing industry

OBJECTIVE--The aim was to study the association between personal factors and physical and psychosocial work environment factors and disorders of the neck or upper limbs among women in the fish processing industry. METHODS--A cross sectional study was performed on 206 women in the fish processing industry and 208 control women. Several physical and psychosocial work environment factors were evaluated. Subjective complaints about the neck or upper limbs were assessed by questionnaire and by a clinical examination. RESULTS--The study showed a high prevalence (35%) of diagnoses in the neck or shoulders of the exposed women. All prevalence odds ratios (PORs) were substantially higher in young women. There was a pronounced dose-response relation between disorders of the neck or shoulders and duration of employment for women < 45 years old. When studying 322 former workers, the proportion who claimed musculoskeletal complaints as the reason for leaving was highest among the older women. Muscular tension, stress or worry, work strain, and the largest fraction of the work time spent with highly repetitive work tasks were clearly associated with disorders of the neck or shoulders. The measurements of the wrist movements also showed that the work was performed almost without any pauses and that the median flexion and extension velocity was high (41 degree/s). The results of observation showed good agreement with the measurements of wrist motion. CONCLUSION--Work in the fish processing industry is a risk factor for disorders of the neck and upper limbs. Due to the homogenity of the physical work load in the exposed group, we could not show any associations between the objective measurements and disorders. In cross sectional studies the risk may be underestimated due to a healthy worker effect.

Influence of the subcutaneous fat layer, as measured by ultrasound, skinfold calipers and BMI, on the EMG amplitude

Surface electromyography (sEMG) is an important tool to estimate muscular activity at work. There is, however, a great inter-individual variation, even in carefully standardized work tasks. The sEMG signal is attenuated in the subcutaneous tissues, differently for each subject, which requires normalization. This is commonly made in relation to a reference contraction, which by itself, however, introduces a variance. A normalization method that is independent of individual motivation, motor control and pain inhibition would be desirable. The aim of the study was to explore the influence of the subcutaneous tissue thickness on sEMG amplitude. Ultrasound measurements of the muscle to skin surface distance were made bilaterally over the trapezius muscle in 12 females. Skinfold caliper measurements from these sites, as well as from four other sites, were made, body mass index (BMI) was recorded, and sEMG was recorded at maximal and submaximal contractions. The muscle–electrode distance, as measured by ultrasound, explained 33% and 31% (on the dominant and non-dominant sides respectively) of the variance of the sEMG activity at a standardized submaximal contraction (average between the sides, 46%); for maximal contractions the explained variance was 21%. Trapezius skinfold measurements showed poor correlations with sEMG. Instead, the mean of skinfold measurements from other sites explained as much as 68% (submaximal contraction). The corresponding figure for BMI was 67%. In conclusion, skinfold thickness explains a major part of the inter-individual variance in sEMG amplitude, and normalization to this measure is a possibility worth further evaluation.

Sensitivity of trapezius electromyography to differences between work tasks — influence of gap definition and normalisation methods

Surface electromyography (EMG) has been used extensively to estimate muscular load in studies of work related musculoskeletal disorders, especially for the trapezius muscle. The occurrences of periods of EMG silence (gaps), the time below a predetermined threshold level (muscular rest) and various percentiles of the amplitude distribution (APDF) are commonly used summary measures. However, the effects of the criteria used to calculate these measures (e.g., gap duration, threshold level, normalisation method) on the sensitivity of these measures to accurately differentiate work loads is not well known. Bilateral trapezius EMG was recorded, for a full workday, for 58 subjects following both maximal (MVE) and submaximal (RVE) reference contractions. Gap frequency, muscular rest, and percentiles were derived for eight fundamental work tasks. The calculations were performed using different gap duration criteria, threshold levels and normalisation methods.A gap duration of less than 1/2 s, and threshold level approximately 0.3% MVE for gap frequency, and approximately 0.5% MVE for muscular rest, were the criteria that optimised sensitivity to task differences. Minimal sensitivity to tasks and a high sensitivity to individuals was obtained using gap frequency with a threshold level of approximately 1% MVE. Normalisation to RVE, rather than MVE, improved sensitivity to differences between tasks, and reduced undesirable variability. Muscular rest was more sensitive to task differences than APDF percentiles.

Muscular rest and gap frequency as EMG measures of physical exposure : the impact of work tasks and individual related factors

Owing to an orderly recruitment of motor units, low threshold type I fibres are presumed to be vulnerable in contractions of long duration. To study load on these fibres muscular rest was registered as the time fraction of electromyographic (EMG) activity below a threshold. Moreover, the frequency of periods with muscular rest, EMG gaps, was derived, since a low gap frequency has been shown to be a risk factor for musculoskeletal disorders. Trapezius EMG was registered in 24 female hospital cleaners, 21 female office workers and 13 male office workers during one working day. Cleaners have a high risk of neck/shoulder pain and had much less muscular rest than office workers measured as a percentage of total registered time (median value= 1.5%, range= 0.2-13% vs. median value= 12%, range= 0.0-32%, respectively). Gap frequency showed no difference between the two occupational groups. Both measures displayed a wide inter-individual variation. For the cleaners, some of the variance was explained by body mass index (BMI) and age, with lower values of muscular rest for older subjects with a high BMI. Among the office workers, low values of muscular rest and a high gap frequency were registered in subjects with a low subjective muscular tension tendency. Gender, strength, smoking, job strain, employment time and musculoskeletal symptoms had no impact on either EMG measure.

Impact of physical exposure on neck and upper limb disorders in female workers

Physical workload [muscular load of the trapezius and infraspinatus muscles using electromyography (EMG), wrist positions and movements by electrogoniometers] and neck and upper limb disorders (from, for example, a physical examination) were studied in women with repetitive industrial work (n = 95) and referents (n = 74). The repetitive work displayed higher ratings for wrist movements, but not for EMG. The prevalences of neck, shoulder and wrist/hand disorders were elevated for women with repetitive work [age-adjusted prevalence odds ratios (PORs) 2.0-7.5]. For the left hand, high frequency of wrist movements (mean power frequency 0.53 Hz) was associated with a high prevalence of disorders (56%), as compared to low (0.28 Hz and 26%; POR 3.5). We found no consistent and significant effect of muscular load, on either neck or shoulder disorders. However, selection and other bias may have diminished our possibility to observe such effects. Psychosocial work environment factors were not confounding the results. Measurements of wrist movements may be used for identification of high-risk work tasks.

Assessment of work postures and movements using a video-based observation method and direct technical measurements.

The aim was to study postures and movements during repetitive work using video-based observations and direct technical measurements (inclinometers and goniometers). A total of 21 healthy women from a poultry processing plant volunteered. Neck flexion > 20 degrees was registered during 92% of the recorded time with the observation method, while the corresponding value measured with the inclinometer was 65%. Different reference positions and different measured variables apparently contributed to the differences between the methods. Mean wrist position was measured to be 0 degrees in flexion-extension and 19 degrees in ulnar deviation. Differences between the methods in the registered hand positions were small. The number of repetitive movements/minute and mean power frequency (MPF) of the electrogoniometer data was significantly related, showing both variables to be relevant measures of repetitiveness. In conclusion, the observation method and the technical measurements supplemented each other well. A reduction in class categories was suggested for future observation methods.

Risk of musculoskeletal disorders among females and males in repetitive/constrained work

This paper combines epidemiological data on musculoskeletal morbidity in 40 female and 15 male occupational groups (questionnaire data 3720 females, 1241 males, physical examination data 1762 females, 915 males) in order to calculate risk for neck and upper limb disorders in repetitive/constrained vs. varied/mobile work and further to compare prevalence among office, industrial and non-office/non-industrial settings, as well as among jobs within these. Further, the paper aims to compare the risk of musculoskeletal disorders from repetitive/constrained work between females and males. Prevalence ratios (PR) for repetitive/constrained vs. varied/mobile work were in neck/shoulders: 12-month complaints females 1.2, males 1.1, diagnoses at the physical examination 2.3 and 2.3. In elbows/hands PRs for complaints were 1.7 and 1.6, for diagnoses 3.0 and 3.4. Tension neck syndrome, cervicalgia, shoulder tendonitis, acromioclavicular syndrome, medial epicondylitis and carpal tunnel syndrome showed PRs > 2. In neck/shoulders PRs were similar across office, industrial and non-office/non-industrial settings, in elbows/hands, especially among males, somewhat higher in industrial work. There was a heterogeneity within the different settings (estimated by bootstrapping), indicating higher PRs for some groups. As in most studies, musculoskeletal disorders were more prevalent among females than among males. Interestingly, though, the PRs for repetitive/constrained work vs. varied/mobile were for most measures approximately the same for both genders. In conclusion, repetitive/constrained work showed elevated risks when compared to varied/mobile work in all settings. Females and males showed similar risk elevations. This article enables comparison of risk of musculoskeletal disorders among many different occupations in industrial, office and other settings, when using standardised case definitions. It confirms that repetitive/constrained work is harmful not only in industrial but also in office and non-office/non-industrial settings. The reported data can be used for comparison with future studies.

Wrist positions and movements as possible risk factors during machine milking.

High prevalence of hand and wrist symptoms has been found in females working with machine milking. Therefore the aim of this study was to quantify the positions and movements of the wrist during machine milking, and to compare tethering and loose-housing systems with respect to this. Biaxial electrogoniometers and data loggers were used for recording flexion and deviation angles of both the right and left wrists in 11 healthy milkers. For each individual 25 min of representative work was recorded in each system. High values of dorsiflexion and radial deviation were found, which might induce an increased risk of carpal tunnel syndrome. Moreover, the velocity and repetitiveness were close to those values described in repetitive work with a high risk of elbow and hand disorders in the fish-processing industry and giro-form data entry work. According to our findings, the load on the upper extremities has increased with respect to dorsiflexed hand position and repetitiveness when milking in the modern loose-housing milking system. This is probably due to the change of the working position and/or the higher productivity (number of cows that milked per time unit) in the loose-housing system as compared to the old-fashioned tethering system. These negative effects on wrist positions and movements should be considered when building new milking systems.