Samuel D. Moon

Use of surface electromyography to estimate neck muscle activity

This paper reviews the literature concerning the use of surface electromyography (sEMG) for the study of the neck musculature in response to work and workplace design during light work and semi-static tasks. The paper also draws upon basic research and biomechanical modeling in order to provide methodological recommendations for the use of surface electromyography in this region of the body and to identify areas which require further investigation. The paper includes review and discussion of electrode site location, methods of normalization, data reliability, and factors that can affect sEMG signals from this region, including noise, physiologic artifact, stress, visual deficiencies, and pain. General guidance for maximum exertions with the neck musculature, for sEMG normalization or other purposes, is also included.

A Multidimensional Integrative Medicine Intervention to Improve Cardiovascular Risk

AbstractBACKGROUND: Integrative medicine is an individualized, patient-centered approach to health, combining a whole-person model with evidence-based medicine. Interventions based in integrative medicine theory have not been tested as cardiovascular risk-reduction strategies. Our objective was to determine whether personalized health planning (PHP), an intervention based on the theories and principles underlying integrative medicine, reduces 10-year risk of coronary heart disease (CHD). METHODS: We conducted a randomized, controlled trial among 154 outpatients age 45 or over, with 1 or more known cardiovascular risk factors. Subjects were enrolled from primary care practices near an academic medical center, and the intervention was delivered at a university Center for Integrative Medicine. Following a health risk assessment, each subject in the intervention arm worked with a health coach and a medical provider to construct a personalized health plan. The plan identified specific health behaviors important for each subject to modify; the choice of behaviors was driven both by cardiovascular risk reduction and the interests of each individual subject. The coach then assisted each subject in implementing her/his health plan. Techniques used in implementation included mindfulness meditation, relaxation training, stress management, motivational techniques, and health education and coaching. Subjects randomized to the comparison group received usual care (UC) without access to the intervention. Our primary outcome measure was 10-year risk of CHD, as measured by a standard Framingham risk score, and assessed at baseline, 5, and 10 months. Differences between arms were assessed by linear mixed effects modeling, with time and study arm as independent variables. RESULTS: Baseline 10-year risk of CHD was 11.1% for subjects randomized to UC (n=77), and 9.3% for subjects randomized to PHP (n=77). Over 10 months of the intervention, CHD risk decreased to 9.8% for UC subjects and 7.8% for intervention subjects. Based on a linear mixed-effects model, there was a statistically significant difference in the rate of risk improvement between the 2 arms (P=.04). In secondary analyses, subjects in the PHP arm were found to have increased days of exercise per week compared with UC (3.7 vs 2.4, P=.002), and subjects who were overweight on entry into the study had greater weight loss in the PHP arm compared with UC (P=.06). CONCLUSIONS: A multidimensional intervention based on integrative medicine principles reduced risk of CHD, possibly by increasing exercise and improving weight loss.

A field evaluation of monitor placement effects in VDT users

Appropriate visual display terminal (VDT) location is a subject of ongoing debate. Generally, visual strain is associated with higher placement, and musculoskeletal strain is associated with lower placement. Seeking resolution of the debate, this paper provides a comparison of results from previous lab-based monitor placement studies to recommendations and outcomes from viewing preference and neutral posture studies. The paper then presents results from a field study that addressed two outstanding issues: Does monitor placement in a workplace elicit postures and discomfort responses similar to those seen in laboratory settings? Results showed placements in the workplace elicited postures similar to those in lab studies. Additionally, preferred VDT location generally corresponded to the location in which less neck discomfort was reported, though that trend requires further investigation. Overall, there seems to be consistent evidence to support mid-level or somewhat higher placement, as a rule-of-thumb, considering preferred gaze angle and musculoskeletal concerns. However, optimal placement may be lower for some individuals or tasks.

Measures of Physical and Cognitive Function and Work Status Among Individuals with Multiple Sclerosis: A Review of the Literature

The purpose of this review was to critically evaluate the multiple sclerosis (MS) literature that has examined physical and cognitive function in relation to ability to work. Although numerous factors may be considered when determining work ability, physical and/or cognitive functional limitations associated with MS are presumably the primary determinants of work capacity. An exhaustive search of the literature produced 20 research articles that described 18 studies. Findings from these studies support that limitations in physical or cognitive function can hinder one’s ability to work; however, ability to work could not be based solely on these measures of function. Work ability among individuals extended beyond measures of impairment to include level of education, job characteristics, and disease symptoms such as fatigue. In summary, measures of physical and cognitive function can guide physicians when clinically evaluating an individual with MS, but are poor indicators for precluding an individual from working.

The Effects of VDT Location on User Posture and Comfort: A Field Study

A month-long field study was conducted to determine effects of large-screen VDT placement on user posture, comfort, and preference and to assess recommendations from a laboratory study. Viewing angles of 0 deg and -17.5 deg to center of screen were tested. Results showed effects of monitor placement on head tilt, but not on trunk postures. Total discomfort was greater at 0 deg. At the conclusion of the study, 8 participants elected to work with their monitors in the 0 deg location, 5 chose −17.5 deg, and one preferred a location midway between. For most subjects, these selections did not coincide with total reported discomfort. Together, findings from the laboratory and field studies suggest that computer users, whose primary focus is the monitor, be provided the flexibility to place the VDT in locations of their own choosing, within a viewing angle envelope of 0 to −17.5 deg.

Evaluation of the North Country on the Job Network: a model of facilitated care for injured workers in rural upstate New York

We describe the evaluation of a community-based program designed to facilitate access to care and return to work for injured workers in a rural, medically underserved area in upstate New York. Providers are recruited to provide easily accessible care and are oriented to concepts of transitional duty and rapid return to work as medically appropriate; companies are recruited with the agreement to provide transitional work for injured employees. Registered nurses, hired by the local hospital, serve as case coordinators to facilitate care and coordinate communications among all parties. Over 3000 injured workers received care through the program in the first 56 months, with a decline in the number of transitional days over time. The number of days that the cases remain open has steadily declined, and the number of return-to-work cases has increased. The success of this initiative provides an excellent background for continued improvement in delivery of care to injured workers and proactive efforts at improving workplace safety and health in a rural area.

The Physician/Patient Encounter from a Cognitive Behavioral Therapy Perspective

Cognitive-behavioral therapy (CBT) offers benefit in rehabilitation, particularly with pain problems. Its conceptual basis and certain of its techniques fit well with the type of occupational rehabilitation that encourages patient involvement and comprehensive attention to impediments to reaching functional goals. The physician-patient encounter remains a pivotal force from the onset of illness or injury through rehabilitation and resolution. Communications within these encounters have been studied and linked to patient attitudes, perceptions, and health- related outcomes. There appears to be potentially useful conjunction between CBT principles and parameters of interest in the physician-patient encounter. Scientific attention to this conjunction is largely lacking. However, suggestions are offered that may enable physicians and other health care providers to apply CBT early in the course of illness, interact more effectively in a multi disciplinary team using CBT, or make more fruitful referrals to CBT practitioners.