The effect of forearm support on children’s head, neck and upper limb posture and muscle activity during computer use

Use of computers by children has increased rapidly, however few studies have addressed factors which may reduce musculoskeletal stress during computer use by children. This study quantified the postural and muscle activity effects of providing forearm support when children used computers. Twelve male and 12 female children (10–12 years) who regularly used computers were recruited. Activities were completed using a computer with two workstation configurations, one of which provided for forearm support on the desk surface. 3D posture was analysed using an infra-red motion analysis system. Surface EMG was collected from five muscle groups in the neck/shoulder region and right upper limb. Providing a support surface resulted in more elevated and flexed upper limbs. The use of forearm or wrist support was associated with reduced muscle activity for most muscle groups. Muscle activity reductions with support were of sufficient magnitude to be clinically meaningful. The provision of a supporting surface for the arm is therefore likely to be useful for reducing musculoskeletal stresses associated with computing tasks for children.     

The impact of computer display height and desk design on muscle activity during information technology work by young adults.

Computer display height and desk design are believed to be important workstation features and are included in international standards and guidelines. However, the evidence base for these guidelines is lacking a comparison of neck/shoulder muscle activity during computer and paper tasks and whether forearm support can be provided by desk design. This study measured the spinal and upper limb muscle activity in 36 young adults whilst they worked in different computer display, book and desk conditions. Display height affected spinal muscle activity with paper tasks resulting in greater mean spinal and upper limb muscle activity. A curved desk resulted in increased proximal muscle activity. There was no substantial interaction between display and desk.     

A model-based study of passive joint properties on muscle effort during static stance

This study examined the impact of lower extremity joint stiffnesses and simulated joint contractures on the muscle effort required to maintain static standing postures after a spinal cord injury (SCI). Static inverse computer simulations were performed with a three-dimensional 15 degree of freedom musculoskeletal model placed in 1600 different standing postures. The required lower extremity muscle forces were calculated through an optimization routine that minimized the sum of the muscle stresses squared, which was used as an index of the muscle effort required for each standing posture. Joint stiffnesses were increased and decreased by 100 percent of their nominal values, and contractures were simulated to determine their effects on the muscle effort for each posture. Nominal muscle and passive properties for an individual with a SCI determined the baseline muscle effort for comparisons. Stiffness changes for the ankle plantar flexion/dorsiflexion, hip flexion/extension, and hip abduction/adduction directions had the largest effect on reducing muscle effort by more than 5 percent, while changes in ankle inversion/eversion and knee flexion/extension had the least effect. For erect standing, muscle effort was reduced by more than 5 percent when stiffness was decreased at the ankle plantar flexion/dorsiflexion joint or hip flexion/extension joint. With simulated joint contractures, the postural workspace area decreased and muscle effort was not reduced by more than 5 percent for any posture. Using this knowledge, methods can be developed through the use of orthoses, physical therapy, surgery or other means to appropriately augment or diminish these passive moments during standing with a neuroprosthesis.     

The effect of postural correction on muscle activation amplitudes recorded from the cervicobrachial region

In clinical practice, postural correction is a common treatment approach for individuals with neck and shoulder pain. As chronic static muscle use is thought to be associated with the onset of some neck and shoulder pain syndromes, it is important to understand the impact a postural correction program might have on muscle activation amplitudes in the neck and shoulder regions. Normalized surface electromyographic data were recorded from the levator scapulae, upper trapezius, supraspinatus, posterior deltoid, masseter, rhomboid major, cervical erector spinae, and sternocleidomastoid muscles of the dominant side of each of eighteen healthy subjects. Subjects performed five repetitions of each of four seated typing postures (habitual, corrected, head-forward and slouched) and four standing postures (habitual, corrected, and head-forward and slouched). Repeated-measures analysis of variance models (α = 0.05) revealed that in sitting postural correction tended to decreased the level of muscle activation required in all muscles studied during seated computer work, however this finding was not statistically significant. Corrected posture in sitting did, however produce a statistically significant reduction in muscle activity compared to forward head posture. Corrected posture in standing required more muscle activity than habitual or forward head posture in the majority of cervicobrachial and jaw muscles, suggesting that a graduated approach to postural correction exercises might be required in order to train the muscles to appropriately withstand the requirements of the task. A surprising finding was that muscle activity levels and postural changes had the largest impact on the masseter muscle, which demonstrated activation levels in the order of 20% maximum voluntary electrical activation.     

Simulation of the effects of different pilot helmets on neck loading during air combat

New generation pilot helmets with mounted devices enhance the capabilities of pilots substantially. However, the additional equipment increases the helmet weight and shifts its center of mass forward. Two helmets with different mass properties were modeled to simulate their effects on the pilot's neck. A musculoskeletal computer model was used, with the methods of inverse dynamics and static optimization, to compute the muscle activations and joint reaction forces for a given range of quasi-static postures at various accelerations experienced during air combat. Head postures which induce much higher loads on the cervical spine than encountered in a neutral position could be identified. The increased weight and the forward shift of the center of mass of a new generation helmet lead to higher muscle activations and higher joint reaction loads over a wide range of head and neck movements. The muscle activations required to balance the head and neck in extreme postures increased the compressive force at the T1-C7 level substantially, while in a neutral posture the muscle activations remained low. The lateral neck muscles can reach activations of 100% and cause compressive joint forces up to 1100N during extensive rotations and extensions at high 'vertical' accelerations (Gz). The calculated values have to be interpreted with care as the model has not been validated. Nevertheless, this systematic analysis could separate the effects of head posture, acceleration and helmet mass on neck loading. More reliable data about mass properties and muscle morphometry with a more detailed motion analysis would help to refine the existing model.     

Analytic and rule-based decision support tool for VDT workstation adjustment and computer accessories arrangement

One important factor that leads to the development of musculoskeletal disorders (MSD) and cumulative trauma disorders (CTD) among visual display terminal (VDT) users is their work posture. While operating a VDT, a user's body posture is strongly influenced by the task, VDT workstation settings, and layout of computer accessories. This paper presents an analytic and rule-based decision support tool called EQ-DeX (an ergonomics and quantitative design expert system) that is developed to provide valid and practical recommendations regarding the adjustment of a VDT workstation and the arrangement of computer accessories. The paper explains the structure and components of EQ-DeX, input data, rules, and adjustment and arrangement algorithms. From input information such as gender, age, body height, task, etc., EQ-DeX uses analytic and rule-based algorithms to estimate quantitative settings of a computer table and a chair, as well as locations of computer accessories such as monitor, document holder, keyboard, and mouse. With the input and output screens that are designed using the concept of usability, the interactions between the user and EQ-DeX are convenient. Examples are also presented to demonstrate the recommendations generated by EQ-DeX.     

Thumb postures and physical loads during mobile phone use – A comparison of young adults with and without musculoskeletal symptoms

The aim of this study was to evaluate thumb postures, thumb movements and muscle activity when using mobile phones for SMS messaging and to determine whether there were differences in these exposures (a) across various mobile phone tasks, (b) between gender and (c) between subjects with and without musculoskeletal symptoms in shoulders and upper extremities. Fifty-six young adults (15 healthy and 41 with musculoskeletal symptoms) performed a series of distinct tasks on a mobile phone. Muscular load in four forearm/hand muscles in the right arm and the right and left trapezius muscles were measured using electromyography (EMG). Thumb movements were registered using an electrogoniometer. The results showed that postures (sitting or standing) and the type of mobile phone task (holding the phone versus texting) affected muscle activity and thumb positions. Females compared to males had higher muscle activity in the extensor digitorum and the abductor pollicis longus when entering SMS messages and tended to have greater thumb abduction, higher thumb movement velocities and fewer pauses in the thumb movements. Subjects with symptoms had lower muscle activity levels in the abductor pollicis longus and tended to have higher thumb movement velocities and fewer pauses in the thumb movements compared to those without symptoms.     

Posture-dependent trunk extensor EMG activity during maximum isometrics exertions in normal male and female subjects.

Posture-dependent trunk function data are important for appropriate normalization of submaximal trunk exertions, and is also necessary to define a more precise and specific use for strength testing in the prevention and diagnosis of spinal disorders. The aim of the current study was to quantify maximal effort trunk muscle extensor activity and trunk isometric extension torque over a functional range of sagittal standing postures. Twenty healthy, young adult male and female subjects performed isometric extension tasks over a sagittal posture range of -20 degrees extension to +50 degrees flexion, in 10 degrees increments. Erector spinae muscle activity was recorded bilaterally at the level of L3 using surface EMG electrodes. Isometric trunk extension torque was measured using a trunk dynamometer. EMG and trunk torque differed significantly between genders, but there were no differences between male and female subjects when the data were normalized with respect to the upright posture. For the combined male and female population, upright posture normalized L3 EMG activity (EMGn) and trunk extension torque (Tn) increased 1.7-fold and 3.5-fold, respectively, over the 70 degrees range of sagittal postures examined. The ratio (Tn/EMGn) increased two-fold (0.83 to 1.67) from -20 degrees extension to +50 degrees flexion, indicating that the neuromuscular efficiency increases with flexion. Trunk extension torque normalized with respect to the upright posture was linearly and positively correlated (r = 0.59, P < 0.001) to similarly normalized L3 EMG activity. This relatively weak correlation suggests that trunk muscle synergism and/or intrinsic muscle length-tension relationships are also modulated by posture. This study provides data that can be used to estimate trunk extensor muscle function over a broad range of sagittal postures. Our findings indicate that appropriate postural normalization of trunk extensor EMG activity is necessary for studies where submaximal trunk exertions are performed over a range of upright postures.     

Upper extremity biomechanics in computer tasks differ by gender

ObjectivesThis laboratory study examined gender differences in upper extremity postures, applied forces, and muscle activity when a computer workstation was adjusted to individual anthropometry according to current guidelines.MethodsFifteen men and 15 women completed five standardized computer tasks: touch-typing, completing a form, editing text, sorting and resizing graphical objects and navigating intranet pages. Subjects worked at a height-adjustable workstation with the keyboard on top of the work surface and the mouse to the right. Subjects repeated the text editing task with the mouse in two other locations: a “high” mouse position, which simulated using a keyboard drawer with the mouse on the primary work surface, and “center” mouse position with the mouse between the keyboard and the body, centered with the body’s center line. Surface electromyography measured muscle activity; electrogoniometric and magnetic motion analysis system measured wrist, forearm and upper arm postures; load-cells measured typing forces; and a force-sensing mouse measured applied forces.ResultsRelative forces applied to the keyboard, normalized muscle activity of two forearm muscles, range of motion for the wrist and shoulder joints and external rotation of the shoulder were higher for women (p < 0.05). When subjects were dichotomized instead by anthropometry (either large/small shoulder width or arm length), the differences in forces, muscle activity of the shoulder and wrist posture and shoulder posture became more pronounced with smaller subjects having higher values. Postural differences between the genders increased in the high mouse position and decreased in the center mouse location.ConclusionsWhen a workstation is adjusted per current guidelines differences in upper extremity force, muscle activity and postural factors still exist between genders. However, these were often stronger when subjects were grouped by anthropometry suggesting that perhaps the computer input devices themselves should be scaled to be more in proportion with the anthropometry and strength of the user.     

Effects of a posture-sensing air seat device (PSASD) on kinematics and trunk muscle activity during continuous computer work

The prevalence and incidence of musculoskeletal disorders is high with computer workers, and poor sitting posture can be considered a factor contributing to low back discomfort. In the clinical literature, maintaining a neutral spinal curvature has been considered an optimal sitting posture. This study investigated the flexion and lateral flexion of trunk movements and trunk muscle activity during computer work with and without a posture-sensing air seat device (PSASD). By sensing a certain amount of increased pressure over the baseline, posture-related visual feedback was given to participants through the PSASD. Eleven regular computer workers participated in this study. PSASD had the function of alerting the subject to their poor posture by using visual feedback. Subjects performed 20 min of computer work with and without a PSASD. Surface electromyography was used to measure the activity of the erector spine and internal abdominal oblique. Kinematic data were obtained using an electrogoniometer. The results showed that the mean of trunk flexion and lateral flexion was significantly reduced with PSASD. The activity of the erector spine and internal oblique was significantly higher with the PSASD than without. Our findings indicated that the PSASD helps to prevent habitual poor posture by maintaining an erect sitting posture during prolonged computer work.     

Regional activation of supraspinatus and infraspinatus sub-regions during dynamic tasks performed with free weights

Growing evidence supports the existence of distinct anatomical sub-regions within supraspinatus and infraspinatus, but only recently has attention turned to exploring their potential functional differences. Using indwelling fine-wire electromyography, muscle activity was investigated from these sub-regions in 15 participants (mean 34 yr, 170 cm, 71.9 kg) during dynamic external rotation (ER), abduction, flexion, and scaption tasks with and without free weights corresponding to 50% and 75% of the participant’s five repetition maximum. Electromyography data were normalized to isometric and isokinetic maximal voluntary contractions and activation ratios for each sub-region compared.Differences in mean regional activation ratios for supraspinatus and infraspinatus varied by arm posture, but were not influenced by load. Relative activation of posterior supraspinatus was greater during an ER task performed in side lying compared to an ER task performed with 90° of humeral elevation in seated and prone postures. Relative activation of superior infraspinatus was greater during an ER task in prone and side lying postures compared to flexion and scaption. Similar results were found when comparing regional muscle activation ratios for infraspinatus between tasks regardless of normalization method employed. These findings may impact exercise selection in the non-operative management of rotator cuff tears.     

Accessory muscle activity contributes to the variation in time to task failure for different arm postures and loads.

Time to failure and electromyogram activity were measured during two types of sustained submaximal contractions with the elbow flexors that required each subject to exert the same net muscle torque with the forearm in two different postures. Twenty men performed the tasks, either by maintaining a constant force while pushing against a force transducer (force task), or by supporting an equivalent load while maintaining a constant elbow angle (position task). The time to failure for the position task with the elbow flexed at 1.57 rad and the forearm horizontal was less than that for the force task (5.2 +/- 2.6 and 8.8 +/- 3.6 min, P = 0.003), whereas it was similar when the forearm was vertical (7.9 +/- 4.1 and 7.8 +/- 4.5 min, P = 0.995). The activity of the rotator cuff muscles was greater during the position tasks (25.1 +/- 10.1% maximal voluntary contraction) compared with the force tasks (15.2 +/- 5.4% maximal voluntary contraction, P < 0.001) in both forearm postures. However, the rates of increase in electromyogram of the accessory muscles and mean arterial pressure were greater for the position task only when the forearm was horizontal (P < 0.05), whereas it was similar for the elbow flexors. These findings indicate that forearm posture influences the difference in the time to failure for the two fatiguing contractions. When there was a difference between the two tasks, the task with the briefer time to failure involved greater rates of increase in accessory muscle activity and mean arterial pressure.     

Neurovascular responses to mental stress in the supine and upright postures.

The purpose of this study was to determine neurovascular responses to mental stress (MS) in the supine and upright postures. MS was elicited in 23 subjects (26 +/- 1 yr) by 5 min of mental arithmetic. In study 1 (n = 9), Doppler ultrasound was used to measure mean blood flow velocity in the renal (RBFV) and superior mesenteric arteries (SMBFV), and venous occlusion plethysmography was used to measure forearm blood flow (FBF). In study 2 (n = 14), leg blood flow (LBF; n = 9) was measured by Doppler ultrasound, and muscle sympathetic nerve activity (MSNA; n = 5) was measured by microneurography. At rest, upright posture increased heart rate and MSNA and decreased LBF, FBF, RBFV, and SMBFV and their respective conductances. MS elicited similar increases in mean arterial blood pressure ( approximately 12 mmHg) and heart rate ( approximately 17 beats/min), regardless of posture. MS in both postures elicited a decrease in RBFV, SMBFV, and their conductances and an increase in LBF, FBF, and their conductances. Changes in blood flow were blunted in the upright posture in all vascular beds examined, but the pattern of the vascular response was the same as the supine posture. MS did not change MSNA in either posture (change: approximately 1 +/- 3 and approximately 3 +/- 3 bursts/min, respectively). In conclusion, the augmented sympathetic activity of the upright posture does not alter heart rate, mean arterial blood pressure, or MSNA responses to MS. MS elicits divergent vascular responses in the visceral and peripheral vasculature. These results indicate that, although the upright posture attenuates vascular responses to MS, the pattern of neurovascular responses does not differ between postures.     

Effect of load position on muscle forces, internal loads and stability of the human spine in upright postures

A novel kinematics-based approach coupled with a non-linear finite element model was used to investigate the effect of changes in the load position and posture on muscle activity, internal loads and stability margin of the human spine in upright standing postures. In addition to 397 N gravity, external loads of 195 and 380 N were considered at different lever arms and heights. Muscle forces, internal loads and stability margin substantially increased as loads displaced anteriorly away from the body. Under same load magnitude and location, adopting a kyphotic posture as compared with a lordotic one increased muscle forces, internal loads and stability margin. An increase in the height of a load held at a fixed lever arm substantially diminished system stability thus requiring additional muscle activations to maintain the same margin of stability. Results suggest the importance of the load position and lumbar posture in spinal biomechanics during various manual material handling operations.     

Crouched postures reduce the capacity of muscles to extend the hip and knee during the single-limb stance phase of gait

Many children with cerebral palsy walk in a crouch gait that progressively worsens over time, decreasing walking efficiency and leading to joint degeneration. This study examined the effect of crouched postures on the capacity of muscles to extend the hip and knee joints and the joint flexions induced by gravity during the single-limb stance phase of gait. We first characterized representative mild, moderate, and severe crouch gait kinematics based on a large group of subjects with cerebral palsy (N=316). We then used a three-dimensional model of the musculoskeletal system and its associated equations of motion to determine the effect of these crouched gait postures on (1) the capacity of individual muscles to extend the hip and knee joints, which we defined as the angular accelerations of the joints, towards extension, that resulted from applying a 1N muscle force to the model, and (2) the angular acceleration of the joints induced by gravity. Our analysis showed that the capacities of almost all the major hip and knee extensors were markedly reduced in a crouched gait posture, with the exception of the hamstrings muscle group, whose extension capacity was maintained in a crouched posture. Crouch gait also increased the flexion accelerations induced by gravity at the hip and knee throughout single-limb stance. These findings help explain the increased energy requirements and progressive nature of crouch gait in patients with cerebral palsy.     

Effect of load position on muscle forces,internal loads and stability of the human spine in upright postures

A novel kinematics-based approach coupled with a non-linear finite element model was used to investigate the effect of changes in the load position and posture on muscle activity, internal loads and stability margin of the human spine in upright standing postures. In addition to 397 N gravity, external loads of 195 and 380 N were considered at different lever arms and heights. Muscle forces, internal loads and stability margin substantially increased as loads displaced anteriorly away from the body. Under same load magnitude and location, adopting a kyphotic posture as compared with a lordotic one increased muscle forces, internal loads and stability margin. An increase in the height of a load held at a fixed lever arm substantially diminished system stability thus requiring additional muscle activations to maintain the same margin of stability. Results suggest the importance of the load position and lumbar posture in spinal biomechanics during various manual material handling operations.     

Pre-impact lower extremity posture and brake pedal force predict foot and ankle forces during an automobile collision

BACKGROUND: The purpose of this study was to determine how a driver's foot and ankle forces during a frontal vehicle collision depend on initial lower extremity posture and brake pedal force. METHOD OF APPROACH: A 2D musculoskeletal model with seven segments and six right-side muscle groups was used. A simulation of a three-second braking task found 3647 sets of muscle activation levels that resulted in stable braking postures with realistic pedal force. These activation patterns were then used in impact simulations where vehicle deceleration was applied and driver movements and foot and ankle forces were simulated. Peak rearfoot ground reaction force (F(RF)), peak Achilles tendon force (FAT), peak calcaneal force (F(CF)) and peak ankle joint force (F(AJ)) were calculated. RESULTS: Peak forces during the impact simulation were 476 +/- 687 N (F(RF)), 2934 +/- 944 N (F(CF)) and 2449 +/- 918 N (F(AJ)). Many simulations resulted in force levels that could cause fractures. Multivariate quadratic regression determined that the pre-impact brake pedal force (PF), knee angle (KA) and heel distance (HD) explained 72% of the variance in peak FRF, 62% in peak F(CF) and 73% in peak F(AJ). CONCLUSIONS: Foot and ankle forces during a collision depend on initial posture and pedal force. Braking postures with increased knee flexion, while keeping the seat position fixed, are associated with higher foot and ankle forces during a collision.     

Evaluating protocols for normalizing forearm electromyograms during power grip

Many studies use a reference task of an isometric maximum voluntary power grip task in a mid-pronated forearm posture to normalize their forearm electromyographic (EMG) signal amplitude. Currently there are no recommended protocols to do this. In order to provide guidance on the topic, we examined the EMG amplitude of six forearm muscles (three flexors and three extensors) during twenty different maximal voluntary efforts that included various gripping postures, force and moment exertions and compared them to a frequently used normalization task of exerting a maximum grip force, termed the reference task. 16 participants (8 male and 8 female, aged 18–26) were recruited for this study. Overall, maximal muscle activity was produced during the resisted moment tasks. When contrasted with the reference task, the resisted moment tasks produced EMG activity that was up to 2.8 times higher (p < 0.05). Although there was no one task that produced greater EMG values than the reference task for all forearm muscles, the resisted flexor and extensor moment tasks produced similar, if not higher EMG activity than the reference task for the three flexors and three extensor muscles, respectively. This suggests that researchers wishing to normalize forearm EMG activity during power gripping prehensile tasks should use resisted flexor and extensor moment tasks to obtain better estimates of the forearm muscles’ maximum electrical activation magnitudes.     

Posture shifting after spinal cord injury using functional neuromuscular stimulation--a computer simulation study

The ability for individuals with spinal cord injury (SCI) to affect changes in standing posture with functional neuromuscular stimulation (FNS) was explored using an anatomically inspired musculoskeletal model of the trunk, pelvis and lower extremities (LE). The model tracked trajectories for anteriorly and laterally shifting movements away from erect stance. Forces were applied to both shoulders to represent upper extremity (UE) interaction with an assistive device (e.g., a walker). The muscle excitations required to execute shifting maneuvers with UE forces <10% body-weight (BW) were determined via dynamic optimization. Nine muscle sets were examined to maximize control of shifting posture. Inclusion of the Psoas and External Obliques bilaterally resulted in the least relative UE effort (0.119, mean UE effort = 45.3N ≡ 5.4% BW) for anterior shifting. For lateral shifting, the set including the Psoas and Latissimus Dorsi bilaterally yielded the best performance (0.025, mean UE effort = 27.8 N ≡ 3.3% BW). However, adding the Psoas alone bilaterally competed favorably in overall best performance across both maneuvers. This study suggests suitable activation to specific muscles of the trunk and LE can enable individuals with SCI to alter their standing postures with minimal upper-body effort and subsequently increase reach and standing work volume.