This article was downloaded by: [HINARI] On: 10 November 2011, At: 05:47 Publisher: Taylor & Francis

Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Ergonomics
Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/terg20

Balance control during lateral load transfers over a slippery surface

Robert D. Catena , Angela DiDomenico , Jacob J. Banks & Jack T. Dennerlein
a b a b b c d

Department of Physical Therapy, University of Evansville, Evansville, IN, USA

Center for Physical Ergonomics, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA
c d

Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA

Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Available online: 25 Oct 2011

To cite this article: Robert D. Catena, Angela DiDomenico, Jacob J. Banks & Jack T. Dennerlein (2011): Balance control during lateral load transfers over a slippery surface, Ergonomics, 54:11, 1060-1071 To link to this article: http://dx.doi.org/10.1080/00140139.2011.618229

PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae, and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand, or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

Ergonomics Vol. 54, No. 11, November 2011, 10601071

Balance control during lateral load transfers over a slippery surface

Robert D. Catenaa, Angela DiDomenicob*, Jacob J. Banksb and Jack T. Dennerleinc,d
Department of Physical Therapy, University of Evansville, Evansville, IN, USA; bCenter for Physical Ergonomics, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA; cDepartment of Environmental Health, Harvard School of Public Health, Boston, MA, USA; dDepartment of Orthopaedic Surgery, Brigham and Womens Hospital and Harvard Medical School, Boston, MA, USA (Received 5 November 2010; nal version received 23 August 2011) Few studies have measured balance control during manual material handling, and even fewer with environmental cofactors. This study examined the eect of dierent surface frictions during a stationary manual material handling task. Thirty-six healthy participants completed 1808 lateral transfer tasks of a load over high- and low-friction surfaces (m 0.86 and m 0.16, respectively). Balance measures, stance kinematics and lower extremity muscle activities were measured. Success during the novel slippery surface dichotomised our population, allowing us to investigate benecial techniques to lateral load transfers over the slippery surface. Stance width reduction by 8 cm and 158 of additional external foot rotation towards the load were used to counter the imbalance created by the slippery surface. There was no clear alteration to lower extremity muscular control to adapt to a slippery surface. Changes in stance seemed to be used successfully to counter a slippery surface during lateral load transfers. Statement of Relevance: Industries requiring manual material handling where slippery conditions are potentially present have a noticeable increase in injuries. This study suggests stance conguration, more so than any other measure of balance control, dierentiates vulnerability to imbalance during material handling over a slippery surface. Keywords: falls; balance control; manual materials handling; slips; friction
a

Downloaded by [HINARI] at 05:47 10 November 2011

Introduction According to the US Bureau of Labor Statistics (BLS 2009), there is a particularly high rate of falls in industries requiring manual material handling, such as delivery personnel and transportation cargo handlers. Fall incidence rates are about 100% higher in ground freight transportation compared with ground passenger transportation occupations. Activities within manual material handling industries require a variety of movements and manoeuvres with a load. Balance and fall related research has primarily addressed biomechanical aspects of walking during load-carrying situations (Holbein-Jenny et al. 2007, Birrell and Haslam 2009, Gillette et al. 2010). Load transfer manoeuvres have not been examined extensively as a challenge to balance control and we are not aware of any detailed epidemiological data to indicate the risk of dierent load transfer manoeuvres. The previous balance control studies that have examined load transfers have emphasised sagittal plane reaching (Kozak et al. 2003, Row and Cavanagh 2007, Liao and Lin 2008) and lifting (Commissaris and Toussaint 1997, Toussaint et al. 1998, Kollmitzer et al. 2002), where the centre of gravity (COG) is not expected to

excessively deviate towards the lateral directions (Kollmitzer et al. 2002). Our research group has recently endeavoured to examine the lateral load transfer manoeuvre. This task requires the acquisition, movement and placement of a load from one side of the body to the other. This is similar to tasks performed by air and truck cargo handlers and deliverers. The body COG is required to travel closer to the sides of the base of support (BOS) as load distance is increased during such a manoeuvre. Relocation of the COG near the edges of the BOS may be an important cause of imbalance during manual material handling (Streepey and AnguloKinzler 2002). Our rst examination (Catena et al. 2010) focussed on the eects of weight during the lateral load transfer. We found that increased weight led to greater vulnerability to a loss of balance. Individuals in turn constricted movement about the ankle joints by stiening the joints through co-contraction of antagonist shank musculature. Stiening the bodys posture is a commonly used conservative adaptation to environmental perturbations (Santello and McDonagh 1998, Lark et al. 2003, Nielsen et al. 2004).

*Corresponding author. Email: angela.didomenico@libertymutual.com

ISSN 0014-0139 print/ISSN 1366-5847 online 2011 Taylor & Francis http://dx.doi.org/10.1080/00140139.2011.618229 http://www.tandfonline.com

Ergonomics Besides highlighting the importance of co-contraction to control balance, these previous studies highlight the need to examine the eects of a variety of environmental factors (e.g. icy surface, unstable loads or distracting attention) in balance control, as not all factors are countered with the same control mechanisms. This remains true for occupational tasks such as the lateral load transfer, where there has been limited research involving environmental factors such as reduced friction. Load transferring in slippery conditions has focussed more on basic tasks such as walking (Myung and Smith 1997) and simple grasping tasks (Cooper et al. 2005), as opposed to lateral movements with the load. One study (Holbein and Redfern 1997) suggests that holding loads to the side in more slippery conditions probably leads to choosing a more conservative posture, by reducing the travel area of the COG within the BOS. The more dynamic task of walking with a load in slippery conditions has been shown to result in imbalance (Myung and Smith 1997, Cham and Redfern 2002). While imbalance is certainly more prevalent in walking, since the COG has greater motion and is more prevalently located outside of the BOS, a fall during walking is commonly in the anterior or posterior (A/P) direction (Bakken et al. 2006). A fall in the A/ P direction has easily employed countermeasures such as stepping manoeuvres, joint exions and bracing by a leg and arms (Bakken et al. 2006). Imbalance in a medial or lateral direction does not permit the same countermeasures (Lo and Ashton-Miller 2008). Stepping manoeuvres to counter a fall to same side as the loaded leg are blocked by the loaded leg requiring rotation of the entire body around it. Lower extremity lateral joint movements are limited to hip and ankle abductions and bracing for impact after a fall is limited to the arm on the side of the lateral fall. A fall in the A/ P direction can, however, be more easily countered during lateral movements of the body. Stepping manoeuvres could be accomplished with either foot (depending on the distribution of the body weight over

1061

Downloaded by [HINARI] at 05:47 10 November 2011

each foot). During this stepping manoeuvre, all lower extremity joints are available to help decelerate the body. If the step does not succeed in preventing a fall, then both arms are available to help brace for impact with the ground. Occupational tasks that require lateral motions of the whole body must be examined more closely if we hope to get a full understanding of falls in the workplace. In this study, we evaluated how balance control during lateral load transfers was aected by the friction of the standing surface. The rst attempt on a novel slippery surface was of particular interest. Based upon our previous analyses of weight during the lateral load transfer, we hypothesised that rather than demographic characteristics or kinematic factors, inappropriate muscular control would be the predominant factor in loss of balance. Secondly, we sought to describe how individuals adapt to a slippery surface given enough practice. We hypothesised that muscular activity in the lower extremities might be altered to control imbalance suciently. Findings from this research will demonstrate how a slippery surface can be negotiated safely when a lateral load transfer is required and how individuals might alter normal lateral load transfer performance when a slippery surface is not necessarily expected, but occasionally present. Methods Participants Thirty-six healthy working age (2066 years of age) adults without material handling experience participated in this study (Table 1). Informed consent was approved by the Institutional Review Boards of both Harvard School of Public Health and Liberty Mutual Research Institute for Safety. The informed consent was read and signed by each participant prior to data collection. Participants wore a tank top, shorts, below-ankle socks and below-ankle hiking shoes (Nike Bandolier

Table 1. Demographic variables across the two groups: those who successfully completed LCOF-1 (SL-1) and those who were unsuccessful (UL-1). Variable Gender: female, male Age (years): mean (SD) Height (m): mean (SD) Weight (kg): mean (SD) BMI (kg/m2): mean (SD) Arm length (% body height): mean (SD) Pelvis width (% body height): mean (SD) Hand dominance: right, left Foot dominance: right, left SL-1 8, 15 44.6 (14.8) 1.70 (0.10) 77.6 (17.7) 26.6 (4.0) 34.9 (1.1) 15.4 (1.6) 18, 5 20, 3 UL-1 6, 7 43.0 (15.9) 1.68 (0.08) 70.6 (11.0) 25.0 (3.4) 35.3 (1.2) 15.2 (1.4) 11, 2 10, 3 p-value 0.501 0.871 0.598 0.150 0.202 0.353 0.654 0.644 0.438

1062

R.D. Catena et al. low coecient of friction surface (LCOF). The two surfaces were the same colour and had a similar gloss so that they were nearly indistinguishable. The surface and shoe modication was performed in such a way as to not alert the participants about the change. The task required the participants to transfer the box from one pedestal to the other, whose heights were adjusted such that the boxs handles were at the participants standing elbow height. The pedestals top surfaces were 11.5 cm wider and longer than the box and covered with perforated rubber matting, which encouraged the participants to lift rather than slide the box o the surface. Prior to data collection, each participant was given the opportunity to practice the lateral load transfer over the high friction surface. Participants were instructed to perform the transfer at a self-selected pace. The purpose of this practice session was to familiarise them with the process and instructions. At the same time, we asked that they determine their self-imposed maximum transfer distance that could be completed safely while still adhering to our instructions. For consistency, specic instructions on how to complete the task were provided to all participants.

II) for instrumentation purposes. All shoes were purchased at the beginning of this study and were only worn for this study; therefore, the tread was that of brand new hiking shoes. A harness connected to an overhead fall arrest system was worn during box transfer tasks for safety purposes. The harness was adjusted to allow for unobstructed side-to-side motion. Slack in the harness cable was adjusted to provide resistance only when needed to catch the person from falling (Figure 1). Procedure Each participant completed 1808 lateral transfers of a 41.5 (width) cm 6 41.5 (depth) cm 6 32.5 (height) cm box loaded to 5% (+ 0.01 kg) of their body weight with semi-oval, reinforced cut-out handles. Two dierent ooring surfaces were presented to the participants. A high friction surface (m 0.86) was created between the rubber shoe soles and plywood ooring painted with a granular white paint high coecient of friction surface (HCOF). A low friction surface (m 0.16) was created between Teon tape adhered to the bottom of the shoes and Teon ooring

Downloaded by [HINARI] at 05:47 10 November 2011

Figure 1. The start position for a HCOF trial. The objective is for the participant to transfer the box from its pedestal to the opposing pedestal without walking. A researcher monitors the feet from behind during the trial. Lasers on the oor mark the starting stance conguration. This gure has been adopted from Catena et al. (2010) with written consent from the authors and publisher.

Ergonomics These were: (1) you are not allowed to lift a foot completely o of the ground, drag your feet or slide your lead foot, but you are allowed to pivot on your feet. (2) When lifting the box, make sure you have your little ngers in the handles before lifting, dont drag the box, dont rest your weight on it, and dont push yourself up by pushing into it. (3) When placing the box, make sure that the box is completely on the pedestal and again dont push against the box to push yourself up. The nal purpose of the practice sessions was for the participants to determine their preferred starting stance conguration. The starting stance conguration was marked. After each collected transfer trial, the participant would be instructed to return to the starting stance conguration. Data collection started with six successful trials performed at the participants practiced maximum distance over a HCOF. While the participants were sequestered away from the testing area, researchers modied the ooring surface to the Teon surface. When the participants returned to the testing area they put on the modied shoes, which were not slippery unless in contact with the Teon surface. The second test condition required a single transfer of the box at the same distance and starting stance conguration over the new and unidentied LCOF-1. There were no practice trials for this condition. The third condition started after adequate familiarisation and practice with the modied surface. This practice session included modications to the transfer distance and starting stance conguration as deemed necessary by the participant. Once the modications and practice were completed, the new start stance conguration was marked and the participants completed six successful transfer trials LCOF-2. The conditions were not randomised because the novelty of the rst low friction condition and adaptation to the slippery surface were of particular interest. Measurements and parameters All COFs were measured with a Brungraber Mark II tribometer (Chang et al. 2003). Testing for the high friction condition involved a cut section of a shoe sole against the plywood oor surface. Testing for the low friction condition involved a cut section of a shoe sole with Teon taped to the bottom against the Teon oor surface. A load cell (Scaime C9418) was located underneath the top of each pedestal and sampled at 1000 Hz to capture the timing of the box transfer. The gradual acquisition and release of the box (per cent of box weight on pedestal) was measured from these data, allowing for calculations of the total time to complete the box transfer and inclusion of the box weight into

1063

the body centre of mass (COM). The distance the box was transferred was calculated from the displacement of the box COM as measured by the motion analysis system described below, and normalised to the stature of the participant. Three-dimensional marker data were collected by a 12-camera motion capture system (MotionAnalysis, Santa Rosa, CA). Thirty-four markers were placed on the body to identify 13 individual body segments, similar to previous marker sets used for measuring balance control (Hahn and Chou 2004, Catena et al. 2009, Catena et al. 2010). Eight markers (four for each foot) attached to the shoes at the most anterior, posterior, medial and lateral projections of the sole allowed us to measure elevation of each part of the foot o of the ground. These same markers were used for BOS measurements. Marker data were collected at 100 Hz for a time sucient for the participant to complete the task and ltered with a zero-lag forth order low pass Butterworth lter at 8 Hz. Thirteen body segment COMs were calculated based on anthropometric data of segment COM locations and weights from previous research using the appropriate age, gender and body mass index information for each participant (Plagenhoef et al. 1983, Winter 1990, de Leva 1996, Pavol et al. 2002, Durkin and Dowling 2003). The weighted sum of segment COMs, harness and electromyography (EMG) transmitter determined the whole body COM at each time frame for the entire trial. The weight of the box was proportionally accounted for in the COM calculation as load cell measures in each pedestal changed. The BOS was calculated from the four markers on each foot. As a portion of a foot was raised, BOS sides connected to the corresponding marker were disregarded. If a foot was raised entirely o the ground then that trial was excluded from our analyses. Stance kinematics was measured through calculations of displacement of the ankle joint centres in the lateral direction (stance width) and the external rotation of the support and contralateral feet with respect to pelvis rotation (combination of foot and hip external rotation). The minimum distance of the COG to each of the six edges (front, back and lateral forefoot and rear foot of the right and left feet) of the BOS (E1: where x2, y2 and x1, y1 are coordinates of adjacent BOS markers and x0, y0 are coordinates for the COG at a single point in time) was used to indicate balance control. Variability in balance control was determined by measuring the total area of COG path (estimated as an oval using the most A/P and M/L points) normalised to the area of the BOS and the COM path distance during the transfer normalised by the displacement of the box during the transfer.

Downloaded by [HINARI] at 05:47 10 November 2011

1064 d x2 x1 y1 y0 x1 x0 y2 y1 q : x2 x1 2 y2 y1 2

R.D. Catena et al. E1 novel low friction (LCOF-1), and practiced low friction (LCOF-2)]. However, our balance control variables were unobtainable for LCOF-1 in a group of 13 individuals who were unable to successfully complete the rst slippery trial. Therefore, we dichotomised groups by successful (SL-1) vs. unsuccessful (UL-1) completion of LCOF-1. Four analyses were performed: (1) group comparison, (2) between-group comparison during HCOF, (3) withingroup comparison of LCOF-1 and HCOF in the SL-1 group and (4) a group-by-task comparison with the two groups and HCOF and LCOF-2 tasks. All assumptions for analysis of variance (ANOVA) were considered appropriate except for muscle activity variables and age, which displayed non-parametric distribution. Muscle activity was examined using the KruskalWallis test for group comparisons, Savage one-way analyses for task comparison main eects and Wilcoxon two-sample tests for task pair-wise comparisons in SAS (Cary, NC). Age was analysed with a MannWhitney test in SPSS 12.0 (Chicago, IL). Parametrically distributed stance and balance variables were examined using the Proc MIXED function of SAS with age as a covariate to t ANCOVA models with subject as a random eect. Pair-wise comparisons with Bonferroni adjustments were performed when statistical signicance was calculated from main eects. Analyses performed on group demographics and the rst slippery trials were analysed with chi-squared analyses and t-tests, when respectively appropriate, in SPSS 12.0. Alpha levels for all statistical analyses were set a priori at 0.05.

Bilateral activity of the biceps femoris, vastus medialis, gastrocnemius and tibialis anterior were measured by a telemetry electromyography system (Noraxon, Scottsdale, AZ). All electrode placements were in accordance with those described in the literature (Hermens et al. 1999) and conrmed via palpation and observing the EMG signal during isometric contractions. The skin was prepared beforehand by treatment with alcohol and gentle abrasion. One author was responsible for all skin preparation and electrode placement for all participants during this study. Data from maximum voluntary contractions (MVCs) were collected to normalise the amplitude of the EMG signal. A MVC for 5 s was collected while the lower limb was manually restrained by a researcher at a specic joint angle (08 ankle plantar exion for gastrocnemius and tibialis anterior; 308 knee exion for biceps femoris; 158 knee exion for vastus medialis). This was performed three times for each muscle with 1 min breaks in between. All EMG signals were pre-amplied, band passed ltered (10500 Hz), sampled at 1000 Hz and synchronised with motion capture data. EMG signals were rectied and smoothed using a 100-ms moving window about each frame. The signals collected during the lateral transfers were normalised by the maximum signal amplitude measured during the MVC protocols. The eight muscle activities were grouped into four agonistantagonist pairs: the support and contralateral shank (gastrocnemius and tibialis anterior) and the support and contralateral thigh (biceps femoris and vastus medialis). The support leg was dened as the leg on the ipsilateral side of the load at a particular time and the contralateral leg was opposite of the support leg. For each pair, we calculated the average intensity (average muscle activity of the segment muscles) and co-contraction percentage (lesser muscle activity as a percent of greater muscle activity) of agonistantagonist muscle pairs for 800 ms time windows around acquisition and release of the box to determine support leg muscle activity and muscle activity of the contralateral leg. We previously used this method to measure co-contraction activity and percentage separately (Catena et al. 2010). Our separate equations are derived from the single encompassing equation proposed by Winter (1990). Statistical analyses This study initially had one independent variable (task), which had three levels [high friction (HCOF),

Downloaded by [HINARI] at 05:47 10 November 2011

Results First slippery trial analyses Group comparisons By analysing performance during the rst slippery trial, we hoped to determine how balance is aected by lateral load transfer over a novel slippery surface. Of the 36 participants, 13 of them were unable to successfully complete the rst slippery trial. Two individuals fell (fall arrested by harness) during their rst trial with the slippery surface (Figure 2). Six individuals took a step to maintain balance during their rst trial with the slippery surface. The ve remaining individuals did not lose balance in any way, but chose to stop the trial after rst attempting it, stating that they believed they would be unable to complete the task given the instructions described previously without falling. This group of 13 individuals made up the unsuccessful during rst low friction trial (UL-1) group. We found no signicant dierences between genders, hand dominance, foot dominance,

Ergonomics age, height, weight, body mass index (BMI), pelvis width normalised by height or arm length normalised by height for the two groups (Table 1). Between-group comparison during HCOF Our next attempt to determine what dierentiated group success examined initial performance of

1065

Downloaded by [HINARI] at 05:47 10 November 2011

Figure 2. Example raw data of a LCOF-1 trial for an UL-1 individual transferring a box from right to left. Top view of the COG movement throughout the trial within the BOS. The BOS shown is specic to the instance of pickup. The symbol shows the COG location at pickup. Notice how the COG quickly trails straight backwards at the end of the trial. This individual failed due to a loss of balance backward at the end of the trial that resulted in a fall into the harness.

individuals in the HCOF trials. By doing this, we hoped to learn what tactics each group was initially employing and would supposedly continue to employ if unaware of work environment changes. Independent sample t-test results indicated that there were no dierences between groups in how far the box was transferred or the transfer time for HCOF trials. The UL-1 group started with an 8.3-cm wider stance than SL-1 (p 5 0.001). Stance width remained statistically wider for the UL-1 group throughout the load transfer (Figure 3). Table 2 shows the results only for start and load acquisition times, but results were similar at load release and the end of the trial. While the two groups did not dier signicantly in the amount of foot external rotation that they initially started with, the UL-1 group used 138 less external rotation when they manoeuvred to acquire the box compared with the SL-1 group (p 5 0.001). During this manoeuvre, the load side foot rotates out about the hip and then the pelvis rotates about the longitudinal body axis, and often past that of the externally rotated foot, but does even more so in the UL-1 group as this group keeps the foot in a relatively static position compared with SL-1 individuals. The UL-1 group did not contract agonistantagonist muscles as uniformly across lower extremity joints (co-contraction) as the SL-1 group (Table 3); however,

Figure 3. The average BOS transition from start (A) to pickup (B) of the box between SL-1 (black) and UL-1 (grey) for the HCOF trials. Stance width for the two groups is indicated in the middle of the feet and the dierence between lead foot rotation angles is indicated between the dashed lines.

1066
Table 2. Variable Stance width at start (cm) Stance width at load acquisition (cm) External foot rotation* of lead foot at start (degree)

R.D. Catena et al.

Stance kinematic variables across the three conditions. Group SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 HCOF 54.4 62.7 60.4 65.7 15.94 18.49 716.84 729.89 LCOF-1 (10.4) (8.5)X (10.8) (14.2)X LCOF-2 51.6 54.9 63.3 62.8 16.78 19.34 72.58 712.15 (13.7) (17.7)Y (10.8)X (15.8) (9.83) (14.4) (13.6)X (16.6)X

External foot rotation* of lead foot at load acquisition (degree)

55.5 (9.9)B (17.1)A X (8.1)B Y 63.0 (16.0)A (9.03) 14.86 (15.0) (22.3)A Y 75.90 (23.6)B

Notes: *Relative to perpendicular position of pelvis ASIS; A group 4 B group during the specied task (p 5 0.05); X task 4 Y task in the specied group (p 5 0.05). Signicant pairwise comparison results are presented with superscript letters and shaded. Values are given as mean (SD.)

Table 3. Agonistantagonist muscle pair co-contraction parameters over the 800 ms window for the support leg and contralateral leg. Variable Group SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 HCOF 53.7 49.5 26.5 29.5 50.2 44.4 21.0 24.2 32.1 17.3 9.8 17.1 37.4 35.3 9.4 11.0 (24.7)A (23.5)B (13.0) (24.9) (24.8)A (22.8)B (13.2)B Y (13.1)A Y (26.5)A X (18.7)B (6.5)B (10.3)A (26.9) (23.7) (7.2)B (9.1)A LCOF-1 55.1 (24.4) 28.7 (13.2) 54.7 (25.0) 24.1 (14.2) 21.4 (17.7) 10.6 (7.9) 40.3 (26.8) 10.3 (8.3) LCOF-2 52.3 49.3 25.8 35.6 50.2 47.2 23.6 27.1 23.7 18.9 8.8 16.5 38.4 38.1 9.7 11.2 (24.7)A (26.8)B (12.2) (33.5) (22.8)A (26.3)B (13.2)B X (17.2)A X (22.3)A Y (20.7)B (7.7)B (17.1)A (24.8) (26.4) (7.9)B (11.4)A

Downloaded by [HINARI] at 05:47 10 November 2011

Support shank co-contraction intensity{ Support shank average intensity{ Support thigh co-contraction intensity Support thigh average intensity{ Contralateral shank co-contraction intensity{ Contralateral shank average intensity{ Contralateral thigh co-contraction intensity Contralateral thigh average intensity{
{ {

Notes: A group 4 B group during the specied task (p 5 0.05); X task 4 Y task in the specied group (p 5 0.05); {% of the larger muscle activity; {% MVC. Signicant pairwise comparison results are presented with superscript letters and shaded. Values are given as mean (SD).

the UL-1 group did use more agonistantagonist muscular intensity at the support thigh (p 0.006), contralateral thigh (p 5 0.001) and contralateral shank (p 0.046). Ultimately, only a few outcome balance measures proved to be dierent between the two resultant groups in the HCOF condition (Table 4). We did nd that the COG of the UL-1 group travelled 1.4 cm closer to the edge of their lateral-rear foot side of the BOS during box acquisition compared with the SL-1 group (p 0.037). On the other hand, the UL-1 group stayed 1.2 cm further away from the front boundary of their BOS compared with the SL-1 group (p 0.024). Within-group comparison of LCOF-1 and HCOF in the SL-1 group Our nal attempt to determine what dierentiated group success examined initial performance of

successful individuals in the HCOF trials compared with their performance during LCOF-1. By doing this, we hoped to learn whether initial tactics used by this group either continued to be used with success or were abandoned in favour of more appropriate tactics specically for the slippery surface. Box transfer distance and start stance properties did not change from HCOF to LCOF-1 because they were held constant between tasks to emulate unawareness to a change in the work environment. While there were no dierences in start stance, there was a change in stance almost immediately as the individuals manoeuvred to pick the load up (Table 2). There was over a 2-cm increase in stance width at load acquisition in LCOF-1 compared to HCOF (p 5 0.001), which became a 5-cm increase by the end of the trial in LCOF-1 (p 0.037). During LCOF1, the SL-1 group also rotated their feet more with the pelvis as it rotated towards the direction of the pedestal

Ergonomics
Table 4. Variable Total area of COG (% of start BOS area) COM path distance during transfer (% of box displacement) Minimum distance between COG and front of BOS (cm) Minimum distance between COG and back of BOS (cm) Practice trials prior to the given task Average number of foot lifts (trials excluded during analysis of other variables) Balance control variables across the three conditions. Group SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 SL-1 UL-1 HCOF 25.0 24.6 28.5 29.7 7.18 8.38 7.88 7.83 13.83 13.69 0.74 0.69 (9.8)Y (9.0)Y (4.4)Y (4.9) (3.8)A X (3.4)B X (2.4)X (2.2)X (5.8)X (5.9)X (1.1) (1.0) LCOF-1 27.7 (9.8) 30.0 (4.3)X 5.19 (3.2)Y 7.13 (2.2)Y

1067

LCOF-2 28.8 29.8 30.0 29.3 4.52 6.22 5.67 6.66 7.09 7.38 0.39 1.15 (9.5)X (9.8)X (4.6)X (4.4) (3.0)Y (3.0)Y (2.4)Y (2.0)Y (1.5)Y (2.3)Y (0.8)B (1.1)A

Notes: A group 4 B group during the specied task (p 5 0.05); X task 4 Y task in the specied group (p 5 0.05). Signicant pairwise comparison results are presented with superscript letters and shaded. Values are given as mean (SD).

Downloaded by [HINARI] at 05:47 10 November 2011

to either pick up or drop o the box (p 5 0.001). There were no statistical dierences between lower extremity muscle involvements in each task for the SL-1 group (Table 3). The outcome balance measures of individuals after introduction of a slippery surface changed signicantly from a high friction surface for the successful group (Table 4). The SL-1 group took 22% longer (more than half a second longer) to complete the box transfer in LCOF-1 compared with the HCOF condition (p 0.010). During this time, there was an increase in COM travel distance (p 0.003). The COG of the SL-1 group stayed 1.6 cm further from the edge of their lateral-fore foot side of the BOS during box acquisition with the slippery surface (p 5 0.001). On the other hand, the COG travelled closer to the anterior and posterior sides of the BOS during the task with a slippery surface (p 5 0.001 and p 0.017, respectively). Group-by-task comparison with HCOF and LCOF-2 tasks By analysing performance during the HCOF and LCOF-2, we hoped to determine how the two groups adapted to a slippery surface to accomplish the lateral load transfer. This in turn provided some additional information of what dierentiated success in the rst slippery trial. Eventually, all individuals from the UL-1 group made sucient modications to accomplish the lateral load transfer over the slippery surface. This occurred after several practice trials during which the pedestal distance was initially shortened, and then increased as a new transfer technique was employed successfully. By the end of the practice trials, there were no statistical dierences in transfer distance between the two groups or between surface conditions. For both groups, the maximum transfer distance for

LCOF-2 was determined with half as many practice trials as for HCOF (p 5 0.001), but there was no group dierence in the number of practice trials used (p 0.815). While the UL-1 group had a signicantly wider start stance than SL-1 in the high friction condition (as documented in a previous section), the group dierence was not present in the adapted low friction condition (Table 2). The UL-1 group had decreased their start stance width by 7.8 cm during LCOF-2 compared to HCOF (p 0.002), while there was no signicant change in the SL-1 group. As previously mentioned, the SL-1 group had more external rotation of the foot towards the box just before picking it up during HCOF compared to the UL-1 group. This remained true during LCOF-2 (p 0.027), but both groups increased external rotation of the pickup foot even more so during this task (p 5 0.001). Likewise, when individuals turned to drop the box o on the opposing pedestal, both groups increased the external rotation of the foot on that side by more than 158 (p 5 0.001). The two groups modied muscular control going from HCOF to LCOF-2 similarly and group dierence remained similar between the two tasks. The one dierence between the two groups was that the SL-1 group decreased contralateral shank co-contraction during LCOF-2 (p 0.008), while the UL-1 group did not (Table 3). Occasional imbalances still occurred after adaptation to the slippery surface. There was no dierence in the number of unsuccessful trials between the two groups during HCOF (Table 4), but the UL-1 group had signicantly more unsuccessful trials during LCOF-2 than the SL-1 group (p 0.026). We found an increase in the area of the BOS covered by the COG for both groups during LCOF-2 compared to HCOF (p 5 0.001). The COG of all individuals travelled closer to the back (p 5 0.001) and front

1068

R.D. Catena et al. scientic literature describing balance with a very wide stance (450 cm), but when stance width is increased to such a degree muscle pathways and lengths across the hip, knee and ankle are drastically altered. Some muscles such as the gluteals and the tibialis anterior are shortened when stance is wide, while hamstrings and peroneal muscles are lengthened. The lengthtension relationship then dictates that these muscles will have reduced force production (Nordin and Frankel 2001). We suspect muscle tensions played a role in anterior/posterior imbalance seen. When individuals stood with a 45-cm stance width, there were no deleterious eects on balance (Kirby et al. 1987). However, when individuals rotate their pelvis towards the box to pick it up, they are now actually standing with less mediolateral stance width and more A/P foot displacement. When individuals stood with 30 cm of A/P foot separation, there were signicant increases in mediolateral deviation of the centre of pressure (Kirby et al. 1987), similar to A/P measures in our study because our measures are based on a global reference. Since anterior and posterior COG movement increased in the slippery surface conditions, it seems apparent that movements in these directions are important to examine as a direct cause of loss of balance during lateral load transfers. Something about the SL-1 group allowed them to explore these areas of the BOS, similar to the UL-1 group, without the same detrimental balance eects that the UL-1 groups faced. Stance kinematics One possible area to analyse group dierence in imbalance in the A/P direction is kinematics of the lateral load transfer manoeuvre. There was clear evidence of group dierences in transfer manoeuvres. The UL-1 group chose a wider BOS to transfer this box over a high friction surface. A wider BOS may indicate even further reductions in force production of lower extremity muscles. When used during the slippery surface condition, this wider BOS may not be as easily controlled as a narrower BOS when friction is not supplying a lateral stopping force against the sole of the foot and hip adductor muscles are solely responsible for maintaining the stance width. This is similar to hip adductor use to decelerate the foot in push o during skating (Chang et al. 2009). One of the adaptive techniques that the UL-1 group chose to employ was a narrowed stance width in LCOF-2. The hypothesis that stance width determines success then leads to questions about strength as a contributing factor. A narrower stance width would require more low-back extensor activity to reach a load because of a need for increased torso exion. Greater hip adductor

(p 5 0.001) of the BOS during LCOF-2 compared to HCOF. Discussion The purpose of this study was to evaluate balance control during lateral load transfers to determine (1) characteristics of individuals able to maintain balance on a novel slippery surface and (2) to see how individuals adapted to a slippery surface, particularly when at rst they were unable to maintain balance. We had originally hypothesised that the key to maintaining balance during the lateral load transfer over a slippery surface was increased joint stiness as scientic literature and our own past research had suggested. We found that this was not the case for a slippery surface. The most benecial technique to maintaining balance was to increase intended movement towards and with the box, as evident in the success individuals had after allowing greater foot rotations with stance width adjustments. These ndings suggest that individuals already incorporating increased body motion towards the direction of interest will be less likely to succumb to a loss of balance on the occasional low friction surface experienced during a lateral material handling task. Balance control Balance control was measured several ways in this study, the most direct being a loss of balance. A complete loss of balance was rare. Foot lifts to quickly readjust the BOS to encompass the body COG were much more prevalent. All individuals at some point in testing or practice trials used such a strategy. However, the UL-1 group had a signicant increase in these needed BOS adjustments during the required completion of six successful low COF trials. This indicated that adaptation to the slippery surface did not completely eliminate imbalance and that the UL-1 individuals may face an increased chance of a loss of balance. In fact, we never observed UL-1 performance completely equivalent to SL-1 performance. Future studies might examine performance over more trials to determine if there is ever complete convergence of the two groups. By examining balance through measures of the COM, we were able to identify how balance was possibly lost in many of these situations. While the lateral load transfer task has large movements from side-to-side, the BOS is appropriately widened for this movement. However, by widening the BOS to such a degree, anterior and posterior control is possibly reduced through a signicant alteration in normal muscle functioning. We were unable to nd any

Downloaded by [HINARI] at 05:47 10 November 2011

Ergonomics strength would allow individuals to maintain a slightly wider BOS over a slippery surface to avoid torso exion. Another important kinematic change was the external foot rotation towards the load. In the high friction conditions, the SL-1 group rotated the ipsilateral foot more towards the load than the UL-1 group. External rotation was even greater during the rst slippery trial. UL-1 individuals similarly increased the amount of ipsilateral foot rotation to the load in the adaptive low friction trials. One possible reason this may be benecial is that this manoeuvre positions the lower extremities in such a way that exion at the ankle, knee and hip is towards the load rather than only having a hip abduction moment available to control movement in the direction of interest as would be the case if the body remained directed forward with the load still by the side. This hypothesis emphasises the importance of muscles that were unfortunately not measured in our study (e.g. gluteus medius and tensor fascia latae) so we can only speculate that the rotation manoeuvre decreased the reliance on less eective hip abductors. A second reason external rotation might be signicant is not that it just signies what is specically needed for better performance in this particular task, but it might also be an indicator that the groups beneted from a strategy that utilised body movement to their advantage. Foot rotations may be just one indicator of a surfer movement over slippery surfaces; a motion altered to glide with body momentum over the slippery surface, rather than ghting against the motion unreduced by a lack of surface friction (Marigold and Patla 2002). This alteration reduces the need for shear forces applied to the surface for movement. To completely analyse this hypothesis, future studies will look at whole body kinematics. The unfavourable eect of rotating feet towards to the load is that the body is put into a more tandem-like stance conguration. This form of stance has been demonstrated to be more unstable than side-by-side stance (Winter 1995). We believe that this contributed to the increased motion towards the forward and backward directions of the BOS. Doing this would require increased activation of lateral balance control musculature that was unfortunately not measured in our testing. Muscular control Initial and continued group dierences in lower extremity muscle activity would seem to indicate that the UL-1 group stiened lower extremity joints in an apparent conservative strategy to avoid falling. This is similar to previous literature that shows that many dierent populations regard joint stiening as a way to Limitations

1069

Downloaded by [HINARI] at 05:47 10 November 2011

avoid falls (Santello and McDonagh 1998, Lark et al. 2003, Nielsen et al. 2004). However, muscular control that we measured had no apparent eect on success in the lateral load transfer over the slippery surface. If anything, it was benecial to loosen the joints with less lower-extremity muscle activity. Their continued slight increase in joint stiness may be an explanation as to why the UL-1 group required more step manoeuvres to avoid falling even after adaptation to the slippery surface. This was contradictory to our hypothesis and to our previous ndings that indicated stiening of the ankle joint to counter increased load weight during the lateral load transfer (Catena et al. 2010). This was also contradictory to others interpretation of the benet of ankle stiness. However, some researchers have found that while joint stiening is employed, it is not always successful in maintaining postural control (Reeves et al. 2006, Cenciarini et al. 2010, Reynolds 2010), which indicates task dependency, or that success may depend on the joint and task being examined (Cham and Redfern 2001). Future studies of the lateral load transfers should include measurements of muscles involved in coronal and transverse plane movements to complete the analysis of muscular control. Demographic characteristics We found no indication that simple demographic factors determined successful performance in lateral load transfer over a low friction surface. Among the examined factors, age (Winter 1995) and BMI (Hue et al. 2007, Teasdale et al. 2007) have been touted as correlating factors to balance control. Our sample of individuals contained a range of BMIs (17.734.2 kg/ m2) that we think was adequate to assess it as a nonfactor in balance during the lateral load transfer for most of the working population performing such tasks. We had a normal distribution of BMIs that made up our sample. Unfortunately, we do not believe our sample of age (2066 years) was completely adequate to state for sure that it is a non-factor in balance during the lateral load transfer. Rather than a normal distribution, ours was a uniform distribution of age. It also failed to include enough individuals of a balanceeected age, older than 50 (Winter 1995). We do believe that age will certainly be a factor past 60, but our ndings do show that the gradual age increase was not a factor in the working age population.

(1) A list of instructions were given to the participants and specied in the Procedure section. These instructions were meant to limit

1070

R.D. Catena et al. Conclusions This study has shown that a slippery surface has adverse eects on individuals using a wide stance and constricted movement to perform a lateral load transfer. Even though the task is mostly side-to-side movement, the balance control results suggest that loss of balance will likely occur in the A/P directions. The often employed strategy of maintaining balance through increased joint stiness was not used successfully to maintain balance in the slippery condition, was not increased any further in adaptation to the slippery condition, and in some cases was even decreased during the slippery condition. Only stance kinematic performance was able to distinguish success in the slippery conditions. Whole body kinematics will be analysed in future studies to determine the extent that body kinematics plays in successful completion of the lateral load transfer over a slippery surface. Having shown that simple modications to stance kinematics can determine balance control over a slippery surface during lateral material handling, further research strategies could be taught to individuals having to occasionally perform such an occupational task. It might also be the case that a decreased reliance on muscle control might be benecial for such a task. However, we caution any immediate use of the techniques described in this article without further analysis on whole body joint kinematics to detect any additional modications to the lateral manoeuvre that might be needed accompaniments. Acknowledgements
This research was supported by the Liberty MutualHarvard School of Public Health Postdoctoral Program, as a postdoctoral fellowship was awarded to Dr. Catena. The authors also thank Simon Matz for his help with statistical analyses.

the variability between individuals. While this process allows us to specically analyse the variables of interest (low friction and balance), we risked missing the natural or desired manoeuvres individuals might use if not constrained. Specically, not allowing stepping would be highly unlikely to occur in a natural setting, especially for such a transfer distance. Our requirement that the maximum box transfer distance be attempted was also meant to reduce the variability between individuals. This requirement meant that individuals attempted lateral load transfer much further than they would normally. Observed compensations for this unnatural distance were a wider stance in the UL-1 group and more trunk exion in the SL-1 group. An interesting future study might use information from this study to compare with natural performance of the same task without said restrictions. (2) There are a couple of limitations to using the study cohort. We have no reason to believe that our cohort is anthropometrically characteristic of the manual material handling population. Application of our results should consider this. Also, we did not attempt to control was athletic ability. We had one individual in our study that was a collegiate athlete, and several others that would be considered athletic. These individuals were able to complete the rst slippery trial successfully, but since there were very few of them we could not analyse them in a statistical analysis. Athletes have been previously shown to recover from imbalance situations better than nonathletes (Brauer et al. 2008). Increased strength and coordination of an athlete would imaginably have some benecial eect on performance of the lateral load transfer. (3) Muscle activity was a key factor in our previous study of lateral load transfers (Catena et al. 2010). Specically, exor/extensor co-contractions were found to be a factor in performance. Our current study continued with these measures but was not able to draw any signicant conclusions from them. Since we did not anticipate transverse and coronal plane kinematics as being important, we made no measurements of major contributors to movement in these planes. The result was a lack of information that would possibly be benecial to our analysis. Likewise, no measure of strength was recorded, which would be helpful in making more concrete conclusions about the consequences of stance width adjustments.

Downloaded by [HINARI] at 05:47 10 November 2011

References
Bureau of Labor Statistics (BLS), 2009. Survey of occupational injuries and illnesses in cooperation with participating state agencies [online]. US Department of Labor. Available from: http://www.bls.gov/ [Accessed 26 September 2011]. Bakken, G.M., et al., 2006. Slips, trips, missteps and their consequences. Tucson, AZ: Lawyers and Judges Publishing. Birrell, S.A. and Haslam, R.A., 2009. The eect of military load carriage on 3-D lower limb kinematics and spatiotemporal parameters. Ergonomics, 52, 12981304. Brauer, S.G., Neros, C., and Woollacott, M., 2008. Balance control in the elderly: do Masters athletes show more ecient balance responses than healthy older adults? Aging Clinical and Experimental Research, 20, 406411. Catena, R.D., et al., 2010. The eect of load weight on balance control during lateral box transfers. Ergonomics, 53, 13591367.

Ergonomics
Catena, R.D., van Donkelaar, P., and Chou, L.S., 2009. Dierent gait tasks distinguish immediate vs. long-term eects of concussion on balance control. Journal of Neuroengineering and Rehabilitation, 6, 25. Cenciarini, M., et al., 2010. Stiness and damping in postural control increase with age. IEEE Transactions on Biomedical Engineering, 57, 267275. Cham, R. and Redfern, M.S., 2001. Lower extremity corrective reactions to slip events. Journal of Biomechanics, 34, 14391445. Cham, R. and Redfern, M.S., 2002. Changes in gait when anticipating slippery oors. Gait Posture, 15, 159171. Chang, R., Turcotte, R., and Pearsall, D., 2009. Hip adductor muscle function in forward skating. Sports Biomechanics, 8, 212222. Chang, W.-R., Cotnam, J.P., and Matz, S., 2003. Field evaluation of two commonly used slipmeters. Applied Ergonomics, 34, 5160. Commissaris, D.A. and Toussaint, H.M., 1997. Load knowledge aects low-back loading and control of balance in lifting tasks. Ergonomics, 40, 559575. Cooper, S.A., et al., 2005. Reducing stability of support structure for a target does not alter reach kinematics among younger adults. Perceptual & Motor Skills, 100, 831838. de Leva, P., 1996. Adjustments to Zatsiorsky-Seluyanovs segment inertia parameters. Journal of Biomechanics, 29, 12231230. Durkin, J.L. and Dowling, J.J., 2003. Analysis of body segment parameter dierences between four human populations and the estimation errors of four popular mathematical models. Journal of Biomechanical Engineering, 125, 515522. Gillette, J.C., et al., 2010. The eects of age and type of carrying task on lower extremity kinematics. Ergonomics, 53, 355364. Hahn, M.E. and Chou, L.-S., 2004. Age-related reduction in sagittal plane center of mass motion during obstacle crossing. Journal of Biomechanics, 37, 837844. Hermens, H.J., et al., 1999. European recommendations for surface electromyography, deliverable of the SENIAM project. The Netherlands: Roessingh Research and Development. Holbein, M.A. and Redfern, M.S., 1997. Functional stability limits while holding loads in various positions. International Journal of Industrial Ergonomics, 19, 387395. Holbein-Jenny, M.A., et al., 2007. Kinematics of heelstrike during walking and carrying: implications for slip resistance testing. Ergonomics, 50, 352363. Hue, O., et al., 2007. Body weight is a strong predictor of postural stability. Gait Posture, 26, 3238. Kirby, R.L., Price, N.A., and MacLeod, D.A., 1987. The inuence of foot position on standing balance. Journal of Biomechanics, 20, 423427. Kollmitzer, J., et al., 2002. Postural control during lifting. Journal of Biomechanics, 35, 585594. Kozak, K., Ashton-Miller, J.A., and Alexander, N.B., 2003. The eect of age and movement speed on maximum forward reach from an elevated surface: a study in healthy women. Clinical Biomechanics, 18, 190196.

1071

Lark, S.D., et al., 2003. Joint torques and dynamic joint stiness in elderly and young men during stepping down. Clinical Biomechanics, 18, 848855. Liao, C.F. and Lin, S.I., 2008. Eects of dierent movement strategies on forward reach distance. Gait Posture, 28, 1623. Lo, J. and Ashton-Miller, J.A., 2008. Eect of pre-impact movement strategies on the impact forces resulting from a lateral fall. Journal of Biomechanics, 41, 19691977. Marigold, D.S. and Patla, A.E., 2002. Strategies for dynamic stability during locomotion on a slippery surface: eects of prior experience and knowledge. Journal of Neurophysiology, 88, 339353. Myung, R. and Smith, J.L., 1997. The eect of load carrying and oor contaminants on slip and fall parameters. Ergonomics, 40, 235246. Nielsen, J.F., Andersen, H., and Sinkjaer, T., 2004. Decreased stiness at the ankle joint in patients with long-term Type 1 diabetes. Diabetic Medicine, 21, 539 544. Nordin, M. and Frankel, V.H., 2001. Basic biomechanics of the musculoskeletal System. Philadelphia: Lippincott Williams & Wilkins. Pavol, M.J., Owings, T.M., and Grabiner, M.D., 2002. Body segment inertial parameter estimation for the general population of older adults. Journal of Biomechanics, 35, 707712. Plagenhoef, S., Evans, F.G., and Abdelnour, T., 1983. Anatomical data for analyzing human motion. Research Quarterly for Exercise and Sport, 54, 169178. Reeves, N.P., et al., 2006. The eects of trunk stiness on postural control during unstable seated balance. Experimental Brain Research, 174, 694700. Reynolds, R.F., 2010. The ability to voluntarily control sway reects the diculty of the standing task. Gait Posture, 31, 7881. Row, B.S. and Cavanagh, P.R., 2007. Reaching upward is more challenging to dynamic balance than reaching forward. Clinical Biomechanics, 22, 155164. Santello, M. and McDonagh, M.J., 1998. The control of timing and amplitude of EMG activity in landing movements in humans. Experimental Physiology, 83, 857874. Streepey, J.W. and Angulo-Kinzler, R.M., 2002. The role of task diculty in the control of dynamic balance in children and adults. Human Movement Science, 21, 423 438. Teasdale, N., et al., 2007. Reducing weight increases postural stability in obese and morbid obese men. International Journal of Obesity (London), 31, 153160. Toussaint, H.M., et al., 1998. Scaling anticipatory postural adjustments dependent on condence of load estimation in a bi-manual whole-body lifting task. Experimental Brain Research, 120, 8594. Winter, D.A., 1990. Biomechanics and motor control of human movement. New York, NY: Wiley-Interscience. Winter, D.A., 1995. A.B.C. (Anatomy Biomechanics and Control) of balance during standing and walking. Waterloo, ON: University of Waterloo.

Downloaded by [HINARI] at 05:47 10 November 2011