Menoni O

Muscular effort and musculo-skeletal disorders in piano students: electromyographic, clinical and preventive aspects

An investigation was made on the relationship between music practice and musculo-skeletal disorders among piano students, with the main aim of developing health education programmes that would improve the performance and health of the students. The investigation covered three areas: (a) Analysis of study organization and main musculo-skeletal complaints achieved by a questionnaire distributed to all piano students at the Milan Conservatory. (b) Vocational electromyographic analysis of the effort exerted by the various muscle groups of the trunk, of the shoulder and shoulder blade girdle, and of the arm during performance of a standard set of piano exercises, an unseen passage and a passage of maximum difficulty. This analysis was made on a sample of six subjects. (c) A series of preventive measures was developed on the basis of a critical assessment of the results (38% of the students practised for excessively long periods without breaks; 62% had from 1 to 5 complaints, the most affected sites being the spine and the trapezius muscles). These consisted largely of a health education programme aimed at helping the students to suitably organize practice and rest periods and in instructing them in appropriate exercises for relaxation and stretching of overused muscle groups and strengthening the supporting muscle groups. Changes in lifestyle were also suggested.

MAPO index for risk assessment of patient manual handling in hospital wards: A validation study

Manual handling of disabled patients – as regards movement – is one of the major factors affecting acute low back pain of exposed nursing staff. In the absence of quantitative methods assessing this kind of risk, the Research Unit Ergonomics of Posture and Movement of Milan developed in 1997 a risk assessment method called Movement and Assistance of Hospital Patients (MAPO), which is applicable in hospital wards. A first study conducted in 1999 allowed the identification of three levels of MAPO index corresponding with increasing probabilities of being affected by acute low back pain. In accordance with the well-known traffic light model, for MAPO index values between 0 and 1.5 the risk is considered to be absent or negligible. For values between 1.51 and 5.00 the risk is considered to be moderate. For values exceeding 5.00 the risk is considered to be high. In view of the limitations of the previous study, the results needed confirmation and so, in 2000–2001, another cross-sectional study was carried out, which included 191 hospital wards for acute and chronic patients and 2603 exposed subjects. This paper presents the analytical results of the association between the MAPO index and acute low back pain in this new data sample. The agreement between results of the two studies indicates that the MAPO index can be used as a risk index, although with some caution, as detailed in the paper. It can assess the risk exposure level of patient manual handling in wards and can be a useful tool for planning effective preventive actions to reduce the risk of work-related musculoskeletal disorders in health-care workers looking after disabled patients.

Clinical trials among worker populations: a model for an anamnestic survey of upper limb pathologies and its practical application methods

Following a brief review of the principal clinical characteristics of musculoskeletal disorders of the upper limbs, the authors propose a protocol for a structured anamnestic examination featuring a series of set questions. The anamnestic model is based on a detailed listing of the symptoms to be analysed, which are divided into four categories: pain, paraesthesia, symptoms attributable to hyposthenia, and neurovegetative disorders. Regarding pain and paraesthesia, the authors list the localization, pattern of onset, duration and number of episodes, irradiation and treatment. The patients can thus be classified as anamnestic cases based on the following criteria: presence of pain or paraesthesia during the last 12 months, with episodes lasting for at least 1 week or occurring at least once a month, with no previous acute trauma. For hyposthenia, the authors report on the conditions under which the disorder may develop. The neurovegetative disorders considered are modifications in colour of the fingers and reaction to exposure to low temperatures. The structure of the proposed anamnestic chart permits all findings to be easily encoded for subsequent storage in a dedicated database. The appendix contains an annotated facsimile of the anamnestic chart.

Investigation on Risk and Damages of Muscoloscheletal Apparatus of Health Care Workers: A Case Study on 3800 Nurses

An investigation was carried out by teams from various centres coordinated by the EPM (Ergonomics of Posture and Movement) Research Unit on 54 different hospitals in various regions of northern and central Italy. The teams examined a total of 3800 health workers whose job involved manual handling of patients. Numerous meetings were held to ensure that the methods of assessing the exposure indexes and spinal impairment were identical in the various teams. The final data were processed centrally at the EPM Research Unit. Physical examination revealed that 8.4% of the workers had had at least one episode of acute low back pain in the previous 12 months: i.e., 4 times the values of the reference groups. The best association between index of exposure to manual patient handling and consequent injury was the association evaluated via the incidence rates of episodes of total low back pain.

Hoists: Selection Criteria and Standards

A fundamental part of the prevention strategies aimed at reducing risk due to manual handling of patients is the use of appropriate aids. This paper defines the basic types of aids for hospital wards and also proposes a procedure for choice of the type of aid. The procedure uses a specific protocol and also analyses work organisation and the environmental features of the ward. The proposed criteria for choice concern at first place the fundamental requirements of the equipment: safety for operator and patient, simplicity of use and comfort for the patient. Secondly the basic determinants for the choice of the type of aid are the kind of disabled patient usually present in the ward, and the analysis of the movements done during patients handling.

A Longitudinal Study of Workers with Work-Related Musculoskeletal Disease after Relocation to Redesigned work Stations

This paper presents a longitudinal study on the return to the workforce of employers with WMSDs of the upper limbs and their reallocation to jobs with “low exposure”. The study started 5 years ago with 100 workers affected by WMSDs and includes now 180 affected workers operating in the same factory. The trial involved: definition of criteria for characterising jobs for affected workers; classifying WMSDs workers according to the type and severity of the disorders. The results, 5 years after the start of the trial, are encouraging and show that when the affected workers return in jobs that full meet the defined criteria, a significant prevalence of improvements are reported.

Methods of Exposure Assessement of Patient Handling Tasks: A New Risk Index (MAPO)

The authors describe and propose a model for identifying the main risk factors in this type of occupational exposure: presence of disabled patients, staff engaged on manual handling of patients, working environment, aids for moving patients, training of workers. For each factor a procedure for assessment is proposed that is easily applicable in practice. The authors also propose a formula for the calculation of a exposure index (MAPO Index), which brings together the various factors. From a practical point of view, in the present state of knowledge, it can be stated that for MAPO Index values between 0 and 1.5, risk is deemed negligible, average for values between 1.51 and 5, and high for values exceeding 5.