An experimental approach for the characterization of prolonged sitting postures using pressure sensitive mats

The adoption of prolonged sitting posture,which is a condition commonly encountered in several working tasks,is known to induce a wide range of negative effects,including discomfort,which has been recognized as an early predictor for musculoskeletal disorders (particularly low back pain).In this regard,the continuous monitoring of worker’s psychophysical state while sitting for long periods of time, may result useful in to preventing and managing potentially risky situations and to promote ergonomics and macroergonomics interventions,aimed to better organize work shifts and workplaces.The aim of this dissertation is to provide and test the reliability of a set of monitoring parameters,based on the use of quantitative information derived from body-seat contact pressure sensors.In particular, he study was focused on the assessment of trunk postural sway (the small oscillations resulting from the stabilization control system) and the number of In Chair Movements (ICM) or postural shifts performed while sitting, proven as a reliable tool for discomfort prediction. This thesis is articulated into four experimental campaigns.The first is a pilot study which aimed to define the most reliable algorithm and the set of parameters useful to assess the performed postural shifts or In chair Movements (ICM), which result useful to characterize postural strategies in the long term-monitoring. In this regard, a pilot study was conducted in which two different algorithms for the ICM computing were tested, based on different parameters and having different thresholds. The chosen algorithm was used, together with trunk sway parameters, to evaluate postural strategies in the other three experiments of this thesis. The second and the third studies evaluated sitting postural strategies among bus drivers during regular, long-term work shifts performed on urban and extra-urban routes. The results, in this case, showed that, all drivers reported a constant increase in perceived discomfort levels and a correspondent increase in trunk sway and overall number of ICM performed. This may indicate the adoption of specific strategies in order to cope with discomfort onset, a fatigue-induced alteration of postural features, or both simultaneously. However, it was interesting to observe differences in ICM vs trunk sway trend considering the single point-to-point route in the case of urban drivers. This difference between may indicate that these parameters refer to different aspects of sitting postural strategies: ICM may be more related to discomfort while sway may be more representative of task-induced fatigue. Trunk sway monitoring, as well as the count of ICM performed by bus drivers may thus be a useful tool in detecting postural behaviors potentially associated with deteriorating performance and onset of discomfort. Finally, the last experiment aimed to characterize modifications in sitting behavior, in terms of trunk sway and ICM among office workers during actual shifts. Surprisingly, results showed a decreasing trend in trunk sway parameters and ICM performed over time, with significant modifications in sitting posture in terms of trunk flexion-extension. Subjects were also stratified basing on their working behavior (staying seated or making short breaks during the trial) and significant differences were identified among these two groups in terms of postural sway and perceived discomfort. This may indicate that the adoption of specific working strategies can significantly influence sitting behavior and discomfort onset. In conclusion, the trunk sway monitoring and the ICM assessment in actual working environments may represent a useful tool to detect specific postural behaviors potentially associated with deteriorating performance and onset of discomfort, both among professional drivers and office workers.They might effectively support the evaluation of specific working strategies,as well as the set-up of macroergonomics interventions

Movement Behavior and Health Outcomes among Sedentary Adults: A Cross-Sectional Study

Background: Sedentary behavior, which is highly prevalent among office workers, is associated with multiple health disorders, including those of the musculoskeletal and cardiometabolic systems. Although prior studies looked at postures or physical activity during work or leisure time, few analyzed both posture and movement throughout the entire day. Objective: This cross-sectional pilot study examined the movement behavior of sedentary office workers during both work and leisure time to explore its association with musculoskeletal discomfort (MSD) and cardiometabolic health indicators. Methods: Twenty-six participants completed a survey and wore a thigh-based inertial measuring unit (IMU) to quantify the time spent in different postures, the number of transitions between postures, and the step count during work and leisure time. A heart rate monitor and ambulatory blood pressure cuff were worn to quantify cardiometabolic measures. The associations between movement behavior, MSD, and cardiometabolic health indicators were evaluated. Results: The number of transitions differed significantly between those with and without MSD. Correlations were found between MSD, time spent sitting, and posture transitions. Posture transitions had negative correlations with body mass index and heart rate. Conclusions: Although no single behavior was highly correlated with health outcomes, these correlations suggest that a combination of increasing standing time, walking time, and the number of transitions between postures during both work and leisure time was associated with positive musculoskeletal and cardiometabolic health indicators among sedentary office workers and should be considered in future research

Robot-assisted rehabilitation of people with breast cancer developing upper limb lymphedema: protocol of a randomized controlled trial with a 6-month follow‐up

Upper limb lymphedema (ULLy) is an external (and/or internal) manifestation of lymphatic system insufficiency and deranged lymph transport for more than 3 months and frequently affects people as a consequence of breast cancer (BC). ULLy is often underestimated despite diminished motor skills, mood, and cognitive-behavioral complaints negatively condition the health-related quality of life (HRQoL) of persons. BC can also metastasize to the jawbone, further impacting on the HRQoL. In time, the implementation of robot-assisted rehabilitation (RR) for neurological diseases has grown to improve HRQoL and pain. This study aims to evaluate the effectiveness of a RR program in the treatment of individuals who develop an ULLy; as a further analysis, the study will assess the effectiveness of the same program in people with jawbone metastases from BC who will also develop ULLy. A randomized, parallel-group superiority-controlled trial will be conducted. 44 participants will be randomly allocated to either the experimental (receiving a RR program) or the control group (regular rehabilitation). Both groups will follow individual-based programs three times a week for 10 weeks. The main outcome measure will be the Lymphedema Quality of Life Questionnaire. Secondary outcomes will be a pain intensity numerical rating scale and the Cranio-Facial Pain Disability Inventory. Evaluations are before and after training and 6 months later. Findings may provide evidence on the effectiveness of a RR program on inducing improvements in the HRQoL and pain of individuals with ULLy due to BC. People with ULLy and jawbone metastases from BC are expected for similar or higher improvements as per the same comparisons above. This trial might contribute towards defining guidelines for good clinical rehabilitation routines and might be used as a basis for health authorities' endorsements.Trial registration OSF REGISTRIES, osf-registrations-jz7ax-v1 . Registered on 26 June 2023

An experimental analysis on driving behaviour for professional bus drivers

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Lower Limb Kinematics in Individuals with Hip Osteoarthritis during Gait: A Focus on Adaptative Strategies and Interlimb Symmetry

Among the functional limitations associated with hip osteoarthritis (OA), the alteration of gait capabilities represents one of the most invalidating as it may seriously compromise the quality of life of the affected individual. The use of quantitative techniques for human movement analysis has been found valuable in providing accurate and objective measures of kinematics and kinetics of gait in individuals with hip OA, but few studies have reported in-depth analyses of lower limb joint kinematics during gait and, in particular, there is a scarcity of data on interlimb symmetry. Such aspects were investigated in the present study which tested 11 individuals with hip OA (mean age 68.3 years) and 11 healthy controls age- and sex-matched, using 3D computerized gait analysis to perform point-by-point comparisons of the joint angle trends of hip, knee, and ankle. Angle-angle diagrams (cyclograms) were also built to compute several parameters (i.e., cyclogram area and orientation and Trend Symmetry) from which to assess the degree of interlimb symmetry. The results show that individuals with hip OA exhibit peculiar gait patterns characterized by severe modifications of the physiologic trend at hip level even in the unaffected limb (especially during the stance phase), as well as minor (although significant) alterations at knee and ankle level. The symmetry analysis also revealed that the effect of the disease in terms of interlimb coordination is present at knee joint as well as hip, while the ankle joint appears relatively preserved from specific negative effects from this point of view. The availability of data on such kinematic adaptations may be useful in supporting the design of specific rehabilitative strategies during both preoperative and postoperative periods

Motor and cognitive skills implicated in the Motor Observation Questionnaire for Teachers (MOQ-T): A multidisciplinary approach

This study was designed to determine the relationship between an observational measure of motor skills for teachers (i.e., MOQ-T), age, and some objectively assessed cognitive and motor indices. Two further goals were to examine which motor and cognitive factors predicted MOQ-T scores and to explore whether pupils with very low motor skills identified through MOQ-T also exhibited lower scores on objectively assessed motor and visuo-spatial tasks. A sample of 156 pupils aged 8.4 years–11.3 years and attending Italian primary school completed a battery of tests assessing writing speed, visuo-spatial abstract reasoning, fluency, and static balance abilities objectively assessed by measuring postural sway. Small to medium associations were found be- tween MOQ-T scores and age, motor, and cognitive parameters, respectively. Moreover, approximately 26% of the variance in MOQ-T was predicted by sway area in the eyes-open condition, visuo-spatial fluency, and writing speed. Finally, pupils at risk of developmental co- ordination disorder exhibited poorer writing speed, and motor and higher-order visuo-spatial deficits. In conclusion, the synergistic use of objective measures of motor and cognitive func- tioning and observational screening questionnaires such as MOQ-T should be encouraged at school to identify pupils at risk of developmental coordination disorder

Effects of exercise on balance in patients with non-specific low back pain: a systematic review and meta-analysis

Introduction: Non-specific low back pain (NS-LBP) is one of the most common musculoskeletal conditions related to medical expenses and disability. Evidence suggests that changes in motion patterns could induce trunk instability and impaired postural control. Therefore, this systematic review investigated the effects of exercise on balance in patients with NS-LBP. Evidence acquisition: A systematic review and meta-analysis were conducted. Findings were reported following the 2020 PRISMA statement and the main databases were searched for RCTs. Studies were independently screened through a standardized form and their internal validity assessed by using the Cochrane risk of bias (RoB) tool. Pooled effects were calculated at post-treatment and quality of evidence was assessed through the GRADE framework. Evidence synthesis: Twelve articles were included in the review, eight in the meta-analysis. None of the studies were judged at low RoB. There is very low quality evidence that exercise is effective in reducing Centre of Pressure (CoP) displacement [-16.99 (-27.29, -6.68); p=0.001] and in improving single-leg stance test performance [-28.7 (-48.84, -8.67); p=0.005] and dynamic balance [-4.74 (-8.02, -1.46); p=0.005]. Conversely, no significant results were observed in "ellipse area" and in "limits of stability" indexes. Other results were summarized in a qualitative synthesis. Conclusions: Exercise could be effective in improving both static and dynamic balance in patients with NS-LBP over a short-term period. However, quality of evidence was estimated as very low, hence further double-blinded, high-quality RCTs are needed to address clinical practice and research

An Immersive Virtual Kitchen Training System for People with Multiple Sclerosis: A Development and Validation Study

Rehabilitation via virtual reality (VR) training tools allows repetitive, intensive, and task-specific practice in a controlled and safe environment. Our goal was to develop and validate a novel immersive VR system based on the practice of real-life activities in a kitchen environment in people with multiple sclerosis (pwMS) with upper-limb dysfunction. The novel immersive VR kitchen application includes several tasks, i.e., tidying up the kitchen, preparing a hamburger and soup meal, and dish washing. Following the development phase, the system was tested for an 8-week intervention period on a small sample of pwMS suffering from upper-limb dysfunction. The Suitability Evaluation Questionnaire for VR systems served as the primary outcome. The scores for enjoyment, sense of comfort with the system, feelings of success and control, realism, easy-to-understand instructions, assists in rehabilitation therapy, were between 4.0 and 4.6, indicating a high satisfaction. The scores for eye discomfort, dizziness, nausea, and disorientation during practice were between 2.8 and 1.3, indicating a low-to-moderate interference of the system. The virtual kitchen training system is feasible and safe for upper-limb training in pwMS and paves the way for future RCTs to examine the benefits of the system compared with standard care, thus improving the functionality of the upper limbs in pwMS

Cybersickness in People with Multiple Sclerosis Exposed to Immersive Virtual Reality

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0–6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild–moderate disability (i.e., EDSS in the range of 2.5–6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0–2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild–moderate disability) and COP path length relating to the use of VR (pwMS with mild–moderate disability and unaffected individuals), thus suggesting a sort of “balance training effect”. Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants

Postural Strategies of Bus Drivers During a Regular Work Shift in Urban Area: A Pilot Study

Bus drivers are forced to adopt constrained postures for a long time on a daily basis. This may cause discomfort and, in the long term, represent a co-factor for the onset of musculoskeletal disorders (MSDs), particularly in the low back. Objective measurements of biomechanical variables associated to sitting posture may be useful to better estimate the risk of MSD and, in this context, in recent times in chair movements (ICM) have been shown to represent a reliable tool to characterize sitting postural strategies. This study aimed to evaluate postural strategies of bus drivers during actual long-term driving session in urban area, through the analysis of ICM trend with shift time. Seven professional drivers were tested during regular 6- hours work-shift divided in 50 min point-to-point routes, interspersed by 10 minutes breaks at each last stop. Body-seat interface pressures were collected using a pressure sensitive mat and subjective discomfort rating was evaluated using a 2-parts questionnaire. The results show that, during the whole shift, most drivers report a constant increase in perceived discomfort and a correspondent increase in the overall number of ICM. However, it was interesting to observe that considering a single point-to-point route (i.e. the maximum amount of time in which the drivers must remain seated continuously) the number of ICM increase at the beginning of the period but then decrease significantly, probably when the optimal position to minimize discomfort is reached