The object of the current study was to determine whether static contraction of proximal musculatu... more The object of the current study was to determine whether static contraction of proximal musculature has an effect on the blood flow more distally in the upper extremity. Static contractions of muscles in the neck shoulder region at three levels (relaxed, shoulders elevated and shoulders elevated loaded with 4.95 kg each) were combined with intermittent pinch forces at 0, 10 and 25% of the maximum voluntary contraction (MVC). Blood flow to the forearm was measured with Doppler ultrasound. Myoelectric activity of the forearm and neck-shoulder muscles was recorded to check for the workload levels. Across all levels of shoulder load, blood flow increased significantly with increasing pinch force (21% at 10% MVC and by 44% at 25% MVC). Blood flow was significantly affected by shoulder load, with the lowest blood flow at the highest shoulder load. Interactions of pinch force and shoulder load were not significant. The myoelectric activity of forearm muscles increased with increasing pinch force. The activation of the trapezius muscle decreased with increasing pinch force and increased with increasing shoulder load. The precise mechanisms accounting for the influence of shoulder load remains unclear. The results of this study indicate that shoulder load might influence blood flow to the forearm.
Http Dx Doi Org 10 1080 00140130310001617967, Feb 20, 2007
The objective of the present study was to gain insight into the effects of precision demands and ... more The objective of the present study was to gain insight into the effects of precision demands and mental pressure on the load of the upper extremity. Two computer mouse tasks were used: an aiming and a tracking task. Upper extremity loading was operationalized as the myo-electric activity of the wrist flexor and extensor and of the trapezius descendens muscles and the applied grip-and click-forces on the computer mouse. Performance measures, reflecting the accuracy in both tasks and the clicking rate in the aiming task, indicated that the levels of the independent variables resulted in distinguishable levels of accuracy and work pace. Precision demands had a small effect on upper extremity loading with a significant increase in the EMG-amplitudes (21%) of the wrist flexors during the aiming tasks. Precision had large effects on performance. Mental pressure had substantial effects on EMG-amplitudes with an increase of 22% in the trapezius when tracking and increases of 41% in the trapezius and 45% and 140% in the wrist extensors and flexors, respectively, when aiming. During aiming, grip-and click-forces increased by 51% and 40% respectively. Mental pressure had small effects on accuracy but large effects on tempo during aiming. Precision demands and mental pressure in aiming and tracking tasks with a computer mouse were found to coincide with increased muscle activity in some upper extremity muscles and increased force exertion on the computer mouse. Mental pressure caused significant effects on these parameters more often than precision demands. Precision and mental pressure were found to have effects on performance, with precision effects being significant for all performance measures studied and mental pressure effects for some of them. The results of this study suggest that precision demands and mental pressure increase upper extremity load, with mental pressure effects being larger than precision effects. The possible role of precision demands as an indirect mental stressor in working conditions is discussed.
The effect of the number of two-wheeled containers at a gathering point on the energetic workload... more The effect of the number of two-wheeled containers at a gathering point on the energetic workload and the work efficiency in refuse collecting was studied in order to design an optimal gathering point for two-wheeled containers. Three sizes of gathering points were investigated, i.e. with 2, 16 and 32 two-wheeled containers at a gathering point. The collecting of two-wheeled containers was simulated in a test circuit. The energetic workload was quantified by the parameters oxygen uptake (1 min(-1)), heart rate (beats min(-1)) and perceived exertion. The work efficiency was quantified as the time it took to collect 32 two-wheeled containers per time period. The maximum acceptable amount of two-wheeled containers collected during an 8-h working day was estimated using the energetic criterion of a maximum oxygen uptake of 30% VO2max. The size of the gathering point had no effect on the oxygen uptake, heart rate or perceived exertion. However, the number of two-wheeled containers per collecting period (work efficiency) and the maximum acceptable amount during an 8-h working day were higher in the conditions with 16 and 32 two-wheeled containers at a gathering point compared to the condition with the 2 two-wheeled containers at a gathering point.
Http Dx Doi Org 10 1080 0014013031000065619, Mar 12, 2014
The objective of this study was to compare the mechanical and perceived workload when working wit... more The objective of this study was to compare the mechanical and perceived workload when working with a redesigned two-wheeled container and working with a standard two-wheeled container for refuse collecting. The three changes in the design of the container were a displacement of the position of the centre of mass in the direction of the axis of the wheels, a slight increase in the height of the handle and a slight increase in the horizontal distance between the handle and the wheel-axis, and an increase in the diameter of the wheels. The volume of the container remained 0.240 m 3 . Nine refuse collectors performed some of their most frequent daily activities with both types of containers in the laboratory. Kinematics and exerted hand forces were assessed as input for detailed 3D biomechanical models of the low back and shoulder to estimate net moments at the low back and shoulders, compressive forces at the low back and contact forces at the glenohumeral joint. Also, the refuse collectors rated the ease of handling the two-wheeled containers on a five point scale. The use of the redesigned container resulted in a decrease of the exerted hand forces of 27%, decreases in the net moments at the low back and shoulders of 8% and 20%, respectively, and a decrease of 32% of the contact force at the glenohumeral joint when compared to the standard container. However, pulling an empty redesigned container on to the pavement resulted in an increase of the shoulder moment of more than 100%. No differences between container types were found for the compressive forces at the low back. Pushing and pulling with the redesigned container was rated as easier than pushing and pulling with the standard container. No differences in subjective ratings were found for the tasks of turning the container or pulling an
The effect of job rotation on the physical workload was investigated for male employees working a... more The effect of job rotation on the physical workload was investigated for male employees working at a refuse collecting department. Before the introduction of job rotation, an employee worked as a street sweeper, as a refuse collector or as a driver. After the introduction of job rotation, every employee was allowed to alternate between two of the three possible jobs during the day, i.e. refuse collecting/street sweeping, refuse collecting/driving or street sweeping/driving. Two non-rotation groups (i.e. refuse collectors and street sweepers) and two rotation groups (i.e. refuse collectors/street sweepers and street sweepers/drivers) were mutually compared. The physical workload was determined by measuring the perceived load, energetic load and postural load during a full working day. Job rotation resulted in a significant decrease of the perceived load and energetic load and a slight decrease of the postural load. The results indicate that the total amount of work performed by means of job rotation resulted in an overall reduced physical workload of the employees of the refuse collecting department.
In the present study the validity of EMG based methods to estimate the net moment working at the ... more In the present study the validity of EMG based methods to estimate the net moment working at the lumbar spine was investigated. Eight subjects performed a series of static and dynamic tasks. EMG was recorded from 8 locations over the back muscles. At the same time force platform and kinematic data for a linked segment analysis were collected. The net moment at the lumbar spine was calculated from the latter data and compared to EMG based estimates of the same moment. These estimates were derived from a linear regression between the EMG amplitudes and the net moments obtained during static ramp calibrations. It appeared that calibration in several postures, covering the range occurring in the tasks studied, and in a posture in the middle of this range, yielded estimates of the group averaged 10th, 50th, and 90th percentile of the net moments which were within 10% of the real value. The explained variance obtained in the calibration procedure proved not to be a good indicator of the validity of the procedure.
A review of the literature on the pathophysiology of upper extremity muscle disorders (UEMDs) was... more A review of the literature on the pathophysiology of upper extremity muscle disorders (UEMDs) was performed. An overview is given of clinical findings and hypotheses on the pathogenesis of UEMDs. The literature indicates that disorders of muscle cells and limitations of the local circulation underlie UEMDs. However, these disorders identified do not necessarily lead to symptoms. The following mechanisms have been proposed in the literature: (1) selective recruitment and overloading of type I (Cinderella) motor units; (2) intra-cellular Ca 2+ accumulation; (3) impaired blood flow; (3b) reperfusion injury; (3.3c) blood vessel-nociceptor interaction; (4a) myofascial force transmission; (4b) intramuscular shear forces; (5) trigger points; (6) impaired heat shock response. The results of the review indicate that there are multiple possible mechanisms, but none of the hypotheses forms a complete explanation and is sufficiently supported by empirical data. Overall, the literature indicates that: (1) sustained muscle activity, especially of type I motor units, may be a primary cause of UEMDs; (2) in UEMDs skeletal muscle may show changes in morphology, blood flow, and muscle activity; (3) accumulation of Ca 2+ in the sarcoplasm may be the cause of muscle cell damage; (4) it seems plausible that suboptimal blood flow plays a role in pathogenesis of UEMDs; (5) since the presence of fiber disorders is not a sufficient condition for the development of UEMSDs additional mechanisms, such as sensitization, are assumed to play a role.
We aimed to determine the role of the wrist, elbow and shoulder joints to single-finger tapping. ... more We aimed to determine the role of the wrist, elbow and shoulder joints to single-finger tapping. Six human subjects tapped with their index finger at a rate of 3 taps/s on a keyswitch across five conditions, one freestyle (FS) and four instructed tapping strategies. The four instructed conditions were to tap on a keyswitch using the finger joint only (FO), the wrist joint only (WO), the elbow joint only (EO), and the shoulder joint only (SO). A single-axis force plate measured the fingertip force. An infra-red active-marker three-dimensional motion analysis system measured the movement of the fingertip, hand, forearm, upper arm and trunk. Inverse dynamics estimated joint torques for the metacarpal-phalangeal (MCP), wrist, elbow, and shoulder joints. For FS tapping 27%, 56%, and 18% of the vertical fingertip movement were a result of flexion of the MCP joint and wrist joint and extension of the elbow joint, respectively. During the FS movements the net joint powers between the MCP, wrist and elbow were positively correlated (correlation coefficients between 0.46 and 0.76) suggesting synergistic efforts. For the instructed tapping strategies (FO, WO, EO, and SO), correlations decreased to values below 0.35 suggesting relatively independent control of the different joints. For FS tapping, the kinematic and kinetic data indicate that the wrist and elbow contribute significantly, working in synergy with the finger joints to create the fingertip tapping task.
International Journal of Industrial Ergonomics, 2000
City officials from Haarlem, a Dutch city in which one of the first scientific studies on the wor... more City officials from Haarlem, a Dutch city in which one of the first scientific studies on the workload of refuse collectors was performed, wanted to compare the work situation and physical workload in 1997 with the results of a study performed in Haarlem in 1985 and with the results of a national study conducted in 1993. Depending on the results, they wanted to implement effective preventive measures. The present study consisted of a field study, a simulation experiment in the laboratory, and a questionnaire concerning work characteristics and health effects among 18 refuse collectors. The work situation and the energetic workload were not more favourable in Haarlem in 1997 compared to Haarlem of 1985 or the national study conducted in 1993. On several important parameters, such as the time carrying plastic bags or pushing containers, amount of refuse collected and percentage VO 2max during a working day, the results in the present study did not differ from those in earlier studies. However, the working postures and the perceived exertion of the refuse collectors in Haarlem in 1997 were more favourable when compared to the refuse collectors in the national study. The results have convinced the management to plan an intervention study of potentially effective measures to improve the work situation and to reduce the physical workload. Planned measures are the introduction of job rotation, an effective work2rest schedule and the redesign of two-wheeled containers.
International Archives of Occupational and Environmental Health, 2011
Objective Physicians are exposed to a range of workrelated risk factors that may result in occupa... more Objective Physicians are exposed to a range of workrelated risk factors that may result in occupational diseases. This systematic review aims at shedding light on the prevalence and incidence of musculoskeletal complaints among hospital physicians. Methods A systematic literature search was performed in Pubmed and EMBASE (1990EMBASE ( -2010, and methodological quality criteria were applied. A search was done for musculoskeletal complaints. Results Five medium-quality studies and three highquality studies were included in this review. The definitions and assessment used in the studies for musculoskeletal complaints were different. In short, the frequently reported prevalence for hand and wrist pain was 8-33 and 0%, 17% for shoulder pain, and 9-28% for neck pain. Moreover, the annual prevalence of low back pain was between 33 and 68%. Interpretation The limited number of studies makes it difficult to draw conclusions, and the results should be intepreted with care. In conclusion, musculoskeletal complaints may be work-related complaints in hospital physicians, which need future attention.
The object of the current study was to determine whether static contraction of proximal musculatu... more The object of the current study was to determine whether static contraction of proximal musculature has an effect on the blood flow more distally in the upper extremity. Static contractions of muscles in the neck shoulder region at three levels (relaxed, shoulders elevated and shoulders elevated loaded with 4.95 kg each) were combined with intermittent pinch forces at 0, 10 and 25% of the maximum voluntary contraction (MVC). Blood flow to the forearm was measured with Doppler ultrasound. Myoelectric activity of the forearm and neck-shoulder muscles was recorded to check for the workload levels. Across all levels of shoulder load, blood flow increased significantly with increasing pinch force (21% at 10% MVC and by 44% at 25% MVC). Blood flow was significantly affected by shoulder load, with the lowest blood flow at the highest shoulder load. Interactions of pinch force and shoulder load were not significant. The myoelectric activity of forearm muscles increased with increasing pinch force. The activation of the trapezius muscle decreased with increasing pinch force and increased with increasing shoulder load. The precise mechanisms accounting for the influence of shoulder load remains unclear. The results of this study indicate that shoulder load might influence blood flow to the forearm.
Http Dx Doi Org 10 1080 00140130310001617967, Feb 20, 2007
The objective of the present study was to gain insight into the effects of precision demands and ... more The objective of the present study was to gain insight into the effects of precision demands and mental pressure on the load of the upper extremity. Two computer mouse tasks were used: an aiming and a tracking task. Upper extremity loading was operationalized as the myo-electric activity of the wrist flexor and extensor and of the trapezius descendens muscles and the applied grip-and click-forces on the computer mouse. Performance measures, reflecting the accuracy in both tasks and the clicking rate in the aiming task, indicated that the levels of the independent variables resulted in distinguishable levels of accuracy and work pace. Precision demands had a small effect on upper extremity loading with a significant increase in the EMG-amplitudes (21%) of the wrist flexors during the aiming tasks. Precision had large effects on performance. Mental pressure had substantial effects on EMG-amplitudes with an increase of 22% in the trapezius when tracking and increases of 41% in the trapezius and 45% and 140% in the wrist extensors and flexors, respectively, when aiming. During aiming, grip-and click-forces increased by 51% and 40% respectively. Mental pressure had small effects on accuracy but large effects on tempo during aiming. Precision demands and mental pressure in aiming and tracking tasks with a computer mouse were found to coincide with increased muscle activity in some upper extremity muscles and increased force exertion on the computer mouse. Mental pressure caused significant effects on these parameters more often than precision demands. Precision and mental pressure were found to have effects on performance, with precision effects being significant for all performance measures studied and mental pressure effects for some of them. The results of this study suggest that precision demands and mental pressure increase upper extremity load, with mental pressure effects being larger than precision effects. The possible role of precision demands as an indirect mental stressor in working conditions is discussed.
The effect of the number of two-wheeled containers at a gathering point on the energetic workload... more The effect of the number of two-wheeled containers at a gathering point on the energetic workload and the work efficiency in refuse collecting was studied in order to design an optimal gathering point for two-wheeled containers. Three sizes of gathering points were investigated, i.e. with 2, 16 and 32 two-wheeled containers at a gathering point. The collecting of two-wheeled containers was simulated in a test circuit. The energetic workload was quantified by the parameters oxygen uptake (1 min(-1)), heart rate (beats min(-1)) and perceived exertion. The work efficiency was quantified as the time it took to collect 32 two-wheeled containers per time period. The maximum acceptable amount of two-wheeled containers collected during an 8-h working day was estimated using the energetic criterion of a maximum oxygen uptake of 30% VO2max. The size of the gathering point had no effect on the oxygen uptake, heart rate or perceived exertion. However, the number of two-wheeled containers per collecting period (work efficiency) and the maximum acceptable amount during an 8-h working day were higher in the conditions with 16 and 32 two-wheeled containers at a gathering point compared to the condition with the 2 two-wheeled containers at a gathering point.
Http Dx Doi Org 10 1080 0014013031000065619, Mar 12, 2014
The objective of this study was to compare the mechanical and perceived workload when working wit... more The objective of this study was to compare the mechanical and perceived workload when working with a redesigned two-wheeled container and working with a standard two-wheeled container for refuse collecting. The three changes in the design of the container were a displacement of the position of the centre of mass in the direction of the axis of the wheels, a slight increase in the height of the handle and a slight increase in the horizontal distance between the handle and the wheel-axis, and an increase in the diameter of the wheels. The volume of the container remained 0.240 m 3 . Nine refuse collectors performed some of their most frequent daily activities with both types of containers in the laboratory. Kinematics and exerted hand forces were assessed as input for detailed 3D biomechanical models of the low back and shoulder to estimate net moments at the low back and shoulders, compressive forces at the low back and contact forces at the glenohumeral joint. Also, the refuse collectors rated the ease of handling the two-wheeled containers on a five point scale. The use of the redesigned container resulted in a decrease of the exerted hand forces of 27%, decreases in the net moments at the low back and shoulders of 8% and 20%, respectively, and a decrease of 32% of the contact force at the glenohumeral joint when compared to the standard container. However, pulling an empty redesigned container on to the pavement resulted in an increase of the shoulder moment of more than 100%. No differences between container types were found for the compressive forces at the low back. Pushing and pulling with the redesigned container was rated as easier than pushing and pulling with the standard container. No differences in subjective ratings were found for the tasks of turning the container or pulling an
The effect of job rotation on the physical workload was investigated for male employees working a... more The effect of job rotation on the physical workload was investigated for male employees working at a refuse collecting department. Before the introduction of job rotation, an employee worked as a street sweeper, as a refuse collector or as a driver. After the introduction of job rotation, every employee was allowed to alternate between two of the three possible jobs during the day, i.e. refuse collecting/street sweeping, refuse collecting/driving or street sweeping/driving. Two non-rotation groups (i.e. refuse collectors and street sweepers) and two rotation groups (i.e. refuse collectors/street sweepers and street sweepers/drivers) were mutually compared. The physical workload was determined by measuring the perceived load, energetic load and postural load during a full working day. Job rotation resulted in a significant decrease of the perceived load and energetic load and a slight decrease of the postural load. The results indicate that the total amount of work performed by means of job rotation resulted in an overall reduced physical workload of the employees of the refuse collecting department.
In the present study the validity of EMG based methods to estimate the net moment working at the ... more In the present study the validity of EMG based methods to estimate the net moment working at the lumbar spine was investigated. Eight subjects performed a series of static and dynamic tasks. EMG was recorded from 8 locations over the back muscles. At the same time force platform and kinematic data for a linked segment analysis were collected. The net moment at the lumbar spine was calculated from the latter data and compared to EMG based estimates of the same moment. These estimates were derived from a linear regression between the EMG amplitudes and the net moments obtained during static ramp calibrations. It appeared that calibration in several postures, covering the range occurring in the tasks studied, and in a posture in the middle of this range, yielded estimates of the group averaged 10th, 50th, and 90th percentile of the net moments which were within 10% of the real value. The explained variance obtained in the calibration procedure proved not to be a good indicator of the validity of the procedure.
A review of the literature on the pathophysiology of upper extremity muscle disorders (UEMDs) was... more A review of the literature on the pathophysiology of upper extremity muscle disorders (UEMDs) was performed. An overview is given of clinical findings and hypotheses on the pathogenesis of UEMDs. The literature indicates that disorders of muscle cells and limitations of the local circulation underlie UEMDs. However, these disorders identified do not necessarily lead to symptoms. The following mechanisms have been proposed in the literature: (1) selective recruitment and overloading of type I (Cinderella) motor units; (2) intra-cellular Ca 2+ accumulation; (3) impaired blood flow; (3b) reperfusion injury; (3.3c) blood vessel-nociceptor interaction; (4a) myofascial force transmission; (4b) intramuscular shear forces; (5) trigger points; (6) impaired heat shock response. The results of the review indicate that there are multiple possible mechanisms, but none of the hypotheses forms a complete explanation and is sufficiently supported by empirical data. Overall, the literature indicates that: (1) sustained muscle activity, especially of type I motor units, may be a primary cause of UEMDs; (2) in UEMDs skeletal muscle may show changes in morphology, blood flow, and muscle activity; (3) accumulation of Ca 2+ in the sarcoplasm may be the cause of muscle cell damage; (4) it seems plausible that suboptimal blood flow plays a role in pathogenesis of UEMDs; (5) since the presence of fiber disorders is not a sufficient condition for the development of UEMSDs additional mechanisms, such as sensitization, are assumed to play a role.
We aimed to determine the role of the wrist, elbow and shoulder joints to single-finger tapping. ... more We aimed to determine the role of the wrist, elbow and shoulder joints to single-finger tapping. Six human subjects tapped with their index finger at a rate of 3 taps/s on a keyswitch across five conditions, one freestyle (FS) and four instructed tapping strategies. The four instructed conditions were to tap on a keyswitch using the finger joint only (FO), the wrist joint only (WO), the elbow joint only (EO), and the shoulder joint only (SO). A single-axis force plate measured the fingertip force. An infra-red active-marker three-dimensional motion analysis system measured the movement of the fingertip, hand, forearm, upper arm and trunk. Inverse dynamics estimated joint torques for the metacarpal-phalangeal (MCP), wrist, elbow, and shoulder joints. For FS tapping 27%, 56%, and 18% of the vertical fingertip movement were a result of flexion of the MCP joint and wrist joint and extension of the elbow joint, respectively. During the FS movements the net joint powers between the MCP, wrist and elbow were positively correlated (correlation coefficients between 0.46 and 0.76) suggesting synergistic efforts. For the instructed tapping strategies (FO, WO, EO, and SO), correlations decreased to values below 0.35 suggesting relatively independent control of the different joints. For FS tapping, the kinematic and kinetic data indicate that the wrist and elbow contribute significantly, working in synergy with the finger joints to create the fingertip tapping task.
International Journal of Industrial Ergonomics, 2000
City officials from Haarlem, a Dutch city in which one of the first scientific studies on the wor... more City officials from Haarlem, a Dutch city in which one of the first scientific studies on the workload of refuse collectors was performed, wanted to compare the work situation and physical workload in 1997 with the results of a study performed in Haarlem in 1985 and with the results of a national study conducted in 1993. Depending on the results, they wanted to implement effective preventive measures. The present study consisted of a field study, a simulation experiment in the laboratory, and a questionnaire concerning work characteristics and health effects among 18 refuse collectors. The work situation and the energetic workload were not more favourable in Haarlem in 1997 compared to Haarlem of 1985 or the national study conducted in 1993. On several important parameters, such as the time carrying plastic bags or pushing containers, amount of refuse collected and percentage VO 2max during a working day, the results in the present study did not differ from those in earlier studies. However, the working postures and the perceived exertion of the refuse collectors in Haarlem in 1997 were more favourable when compared to the refuse collectors in the national study. The results have convinced the management to plan an intervention study of potentially effective measures to improve the work situation and to reduce the physical workload. Planned measures are the introduction of job rotation, an effective work2rest schedule and the redesign of two-wheeled containers.
International Archives of Occupational and Environmental Health, 2011
Objective Physicians are exposed to a range of workrelated risk factors that may result in occupa... more Objective Physicians are exposed to a range of workrelated risk factors that may result in occupational diseases. This systematic review aims at shedding light on the prevalence and incidence of musculoskeletal complaints among hospital physicians. Methods A systematic literature search was performed in Pubmed and EMBASE (1990EMBASE ( -2010, and methodological quality criteria were applied. A search was done for musculoskeletal complaints. Results Five medium-quality studies and three highquality studies were included in this review. The definitions and assessment used in the studies for musculoskeletal complaints were different. In short, the frequently reported prevalence for hand and wrist pain was 8-33 and 0%, 17% for shoulder pain, and 9-28% for neck pain. Moreover, the annual prevalence of low back pain was between 33 and 68%. Interpretation The limited number of studies makes it difficult to draw conclusions, and the results should be intepreted with care. In conclusion, musculoskeletal complaints may be work-related complaints in hospital physicians, which need future attention.
Uploads
Papers by Bart Visser