Maury A. Nussbaum

Reliability of COP-based postural sway measures and age-related differences

The objectives of this study were to assess the within-day and between-day reliability of several center of pressure (COP)-based measures of postural sway and identify whether there were age-related differences in reliability. Thirty-two healthy individuals (16 younger and 16 older) participated. COP was recorded during quiet upright stance on 4 different days, and a variety of measures determined: mean velocity, median power frequency, RMS distance, sway area, and two fractal measures derived from Hurst rescaled range analysis (HR/S) and detrended fluctuation analysis (DFA). Intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were used to quantify reliability. Mean velocity was the most reliable measure. DFA exponents had relatively better reliability than HR/S exponents. In general, within-day reliability was better than between-day. In comparison with younger participants, older participants exhibited better relative reliability (ICC) for all COP measures and comparable absolute reliability (SEM) except for mean velocity and sway area. These results may be useful in guiding the future selection and interpretation of COP-based measures.

Fatigue, performance and the work environment: a survey of registered nurses

AIMS This paper is a report of a study of perceived levels of mental, physical and total fatigue, and also acute and chronic fatigue states, among registered nurses. Relationships between dimensions of fatigue and performance were investigated, as were differences in fatigue across levels of several demographic and work environment variables. BACKGROUND Fatigue is a factor that has been linked to performance decrements in healthcare workers. As a result of the nature of their work, nurses may be particularly susceptible to multiple dimensions of fatigue, and their performance is closely linked to patient safety. METHODS An online survey was used to measure mental, physical, and total fatigue dimensions, acute and chronic fatigue states, and performance. Participants were recruited via convenience sampling in cooperation with professional nursing organizations; 745 registered nurses completed the survey between February 2008 and April 2009. RESULTS Reported mental fatigue levels were higher than physical fatigue levels, and acute fatigue levels were higher than chronic fatigue levels. All fatigue dimensions and states were negatively correlated with perceived performance. Longer shift lengths and hours worked per week were associated with increases in physical and total fatigue levels. Mental, physical and total fatigue levels also differed with shift schedule. CONCLUSIONS Fatigue levels were negatively correlated with performance, further supporting the role of fatigue in nurse performance. Work environment variables were strongly associated with differences in perceived levels of fatigue. By altering the work environment, it may thus be possible to reduce fatigue levels and the rates of medical errors.

Static and dynamic myoelectric measures of shoulder muscle fatigue during intermittent dynamic exertions of low to moderate intensity.

Abstract. Despite extensive research on muscular fatigue during prolonged static efforts, there have been relatively few studies of more complex tasks (dynamic and intermittent). A laboratory study of overhead work tasks was conducted to investigate whether electromyographic (EMG) measures can potentially serve as indicators of fatigue, particularly for ergonomic tasks analysis. Sixteen participants performed the tasks until they either developed substantial discomfort or reached a 3-h limit. EMG signals were obtained at intervals throughout the experiment from four shoulder muscles, both statically (during fixed-level test contractions) and dynamically (during task performance). Both EMG root mean square (RMS) amplitude and spectral content (mean and median power frequencies) were examined and compared in terms of their variability and sensitivity. In addition, a new fatigue index was developed to allow for the estimation of substantial fatigue onset. Variability was found to differ significantly between muscles and EMG measures, and was generally lowest for mean power frequencies obtained during static test contractions. Sensitivity was typically greatest for RMS versus spectral measures, and slightly higher for median than mean power frequencies. The results suggest that fatigue during dynamic tasks, while a complex phenomenon, can be monitored and quantified using EMG.

Fatigue and Endurance Limits During Intermittent Overhead Work

Shoulder problems are prevalent in industrial work, particularly when tasks require the hands to be used at or above shoulder level. Although extensive research has been conducted on prolonged static exertions, and several guidelines for such efforts exist, there is insufficient information for ergonomic evaluation of tasks that are intermittent and/or dynamic. A laboratory simulation was conducted of overhead assembly work that was both intermittent and dynamic, and which varied the duty cycle (work/rest ratio), arm reach, and hand orientation of a tapping task. Results consisted of endurance times and also the times of fatigue onset as indicated by perceived discomfort and declines in muscle strength. Females exhibited longer (22%) endurance times, delayed reports of discomfort, and slower declines in strength. Significant influences of duty cycle were found on both endurance and fatigue times, yet arm reach and hand orientation did not have consistent effects. Distributions of endurance and fatigue times are presented as criteria for preliminary evaluation of overhead work. Endurance times could be predicted with only moderate accuracy from earlier indicators of fatigue onset. Existing guidelines, albeit developed for static tasks, appeared unsuitable for the simulated overhead assembly efforts examined. Furthermore, such guidelines may fail to capture the substantial interindividual variability observed in this experiment.

Influence of fatigue time and level on increases in postural sway

The purpose of this study was to investigate the influence of fatigue time and fatigue level on the increases in postural sway during quiet standing. Centre of pressure-based measures of postural sway were collected both before and after fatiguing participants using three different fatigue levels and two different fatigue times. Results showed increasing fatigue time increased sway velocity and sway area, and increasing fatigue level increased sway velocity. Fatigue time effects are important to consider when applying laboratory-based findings to the field given that the fatigue time can differ substantially between the two. Fatigue level effects imply a dose – response relationship between localized muscle fatigue and risk of falling that can have important implications in work/rest cycle scheduling for occupations at risk of injurious falls.

Development and evaluation of a scalable and deformable geometric model of the human torso

A model is developed to provide a geometric representation of the human spine including thoracic and lumbar motion segments, lumbar muscles, ribs, sternum, sacrum, and pelvis. An existing model was modified in order to allow for scaling using standard anthropometric measures, deformation to specific 3-dimensional postures using surface markers, and incorporation of muscle length-tension and motion segment passive bending properties. Experiments were performed to evaluate the accuracy of model postural predictions. Analysis of surface marker displacements demonstrated that the thoracic spine deforms only minimally over a range of flexion, extension, and lateral bending torso postures, suggesting that it can be treated as essentially rigid during low-weight lifting over the range of passive flexibility. Locations of bony landmarks were accurately reproduced (mean errors 2.9-6.8 mm) as were several body dimensions (mean differences 2.6-15.4 mm). It is concluded that linear scaling to subject-specific anthropometry and the use of specific surface markers provides an accurate and direct technique for describing spinal geometry. Predicted passive spinal moments were found to be comparable to those required to support body weight in different extreme postures. It is recommended that data obtained from this type of model be incorporated in future investigations of spinal loading.

Fatigue during prolonged intermittent overhead work: reliability of measures and effects of working height

Shoulder pain is prevalent among industrial workers and existing evidence supports that overhead work is an important specific risk factor. Existing guidelines are limited, with overhead work typically recommended to be avoided, and research on overhead work has been mixed in terms of the effects of increasing arm reach. A laboratory-based simulation of overhead work was conducted, at three working heights, in order to facilitate improved guidelines and to identify potential non-linear effects of overhead work height. Several indicators of shoulder fatigue served as outcome measures and a preliminary study was performed to assess the reliability of several of these measures. Fatigue measures based on electromyography (EMG) generally had low reliability, whereas excellent reliability was exhibited for ratings of perceived discomfort (RPD). Consistent with this, no effects of overhead work height were found on EMG-based measures, yet clear non-linear effects were found on RPD and task performance. The source of the effects of work height appeared to be related to a combination of muscle activation levels and demands on precision/control at the highest location. These results support the utility of subjective measures for relatively low-level intermittent exertions and demonstrate increasingly detrimental fatigue and performance effects at extremes in reach during overhead work.

The influence of age on isometric endurance and fatigue is muscle dependent: a study of shoulder abduction and torso extension

The present study examined differences in isometric muscle capacity between older (55–65 years) and younger (18 – 25 years) individuals. A total of 24 younger and 24 older participants (gender balanced within each group) performed sustained shoulder abductions and torso extensions to exhaustion at 30%, 50% and 70% of individual maximal voluntary contraction (MVC). Along with endurance time, manifestations of localized fatigue were determined based on changes in surface electromyographic signals obtained from the shoulder (middle deltoid) and the torso (multifidus and longissimus thoracis) muscles. Strength recovery was monitored using post-fatigue MVCs over a 15-min period. Compared to the younger group, older individuals exhibited lower muscular strength, longer endurance time and slower development of local fatigue. Age effects on fatigue were typically moderated by effort level, while effects of gender appeared to be marginal. Non-linear relationships between target joint torque and endurance time were observed, with effects of age differing between shoulder abduction and torso extension. Overall, the effects of age on endurance and fatigue were more substantial and more consistent for the shoulder muscle than for the torso muscles and were likely related to differences in muscle fibre type composition. For strength recovery rates, no significant age or gender effects were found in either experiment. In summary, this study suggests that differences in isometric work capacity do exist between older and younger individuals, but that this effect is influenced by effort level and the muscle tested.

Systematic evaluation methodology for cell phone user interfaces

As cell phones have expanded their functionality with enhanced mobile technology, use of cell phones has become complex. Although usability of cell phones has been improved by featuring hierarchical menu systems, designing comprehensible navigation in the menu hierarchy is still a major challenge to cell phone user interface (UI) developers as more diverse users are adopting cell phones. To develop an easy-to-use cell phone UI, an effective usability evaluation method (UE) is essential. While various usability evaluation methods (UEM) have been developed, laboratory-based usability testing produces high-quality usability data from actual users. Yet, the effectiveness of such testing can vary dramatically depending on what data is collected and how the data are analyzed. To provide a practical guidance for the effective laboratory testing, we developed a systematic evaluation methodology for cell phone user interfaces (SEM-CPU). SEM-CPU is specifically designed to integrate five empirical methods (scenario-based task performance, questionnaires, post-task interview, user observation, and retrospective think aloud) into a laboratory-based test in order to evaluate cell phone UIs. By following SEM-CPU, usability engineers should be able to (1) conduct laboratory-based testing with multiple empirical methods in an efficient way, (2) collect diverse but useful data to measure necessary usability attributes, (3) identify determinants of usability problems, and (4) integrate all usability data to generate proper solutions for the problems. Detailed descriptions of SEM-CPU are presented along with a case study where SEM-CPU was applied to a comparative cell phone usability test.

Muscle fatigue and endurance during repetitive intermittent static efforts: development of prediction models

Localized muscle fatigue has received growing attention as a potential design variable and exposure metric in research towards prevention of musculoskeletal disorders in the workplace. While fatigue during sustained static work has been investigated extensively, effects during tasks comprising work–rest cycles are less clear. Work–rest models for static intermittent work have been presented in several reports, but the applicability is often limited to specific conditions. A study was conducted that facilitated a description of the relationships between static intermittent efforts and muscle endurance and fatigue. Exercises consisted of 1 h (maximum) of repetitive static arm abductions, involving a range of muscle contraction levels (10–30% maximum voluntary exertion), duty cycles (0.2–0.8) and cycle times (20–180 s). A between-subject central composite experimental design was used and 15 different exercise conditions were examined with six participants (three females and three males) for each. Along with endurance times, temporal changes related to fatigue were monitored using muscle strength, ratings of discomfort and electromyography (EMG) obtained from the middle-deltoid muscle during the contraction phase of the work cycles. The results of this study showed the influence of contraction level and duty cycle on the majority of fatigue measures used, while cycle time tended to affect EMG spectral measures. Using a response surface methodology, several fatigue prediction models and contour plots were developed that can be employed as an aid for design and evaluation of light repetitive static tasks. Good correspondence was generally found between discomfort rating and other measures of fatigue, suggesting the usefulness of this measure for rapid assessments of local fatigue in the workplace.