Work 34 (2009) 133148 DOI 10.

3233/WOR-2009-0912 IOS Press

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FAST ERGO X A tool for ergonomic auditing and work-related musculoskeletal disorders prevention
Isabel L. Nunes
Universidade Nova Lisboa, Faculdade de Ciencias e Tecnologia, Departamento de Engenharia Mecanica e Industrial; and Centro de Tecnologia e Sistemas, UNINOVA; Campus de Caparica, 2829-516 Caparica, Portugal Tel.: +351 212 948 567; E-mail: imn@fct.unl.pt

Received 21 February 2008 Accepted 7 May 2009

Abstract. Work-related musculoskeletal disorders associated with repetitive and strenuous working conditions continue to represent one of the biggest occupational problems in companies. Despite the variety of efforts to control them, including engineering design changes, organizational modications and working methods training programs, work-related musculoskeletal disorders account for a huge amount of human suffering and economic costs to companies and to healthcare systems. This paper presents an ergonomic analysis tool, FAST ERGO X, designed to support ergonomic auditing activities related with work-related musculoskeletal disorders. This tool can be used to analyze workplaces regarding potential ergonomic risk factors. The FAST ERGO X is a fuzzy expert system designed to help the identication, assessment and control of the risk factors present in the work system, due to lack of adequate ergonomics. Based on objective and subjective data, the system evaluates the risk factors that can lead to the development of work-related musculoskeletal disorders, and presents the ndings resulting from such evaluation. The system also presents recommendations to eliminate or at least reduce the risk factors present in the work situation under analysis. Keywords: Ergonomic workstation analysis, prevention of ergonomic risk factors, expert systems, fuzzy logics

1. Introduction Work-related musculoskeletal disorders (WRMD) are impairments of bodily structures such as muscles, joints, tendons, ligaments, nerves, bones and the localized blood circulation system, caused or aggravated primarily by work itself or by the environment in which work is implemented. The WRMD are a central concern in Europe, given the increasingly large number of workers affected. WRMD are the main occupational disease category suffered by European workers and they are widespread in all activity sectors. According to the European Foundation for the Improvement of Living and Working Conditions more than one third of the European workers suffer from WRMD [5]. Other factors contributing to the relevance of the subject are the heavy economic

consequences resulting from the high WRMD prevalence and the suffering they cause, often leading to permanent, partial or total disability of the worker. Data from the Nordic countries and the Netherlands, estimate the costs related to WRMD at between 0.5 and 2% of Gross Domestic Product. According to the same data, the WRMD affect women more than men because of the type of work they perform [1]. The recognition that the work may adversely affect health is not new. Almost 300 years ago (in 1717) the Italian physician Bernardino Ramazzini, father of occupational medicine, acknowledged the relationship between work and certain disorders of the musculoskeletal system due to the performance of sudden and irregular movements and the adoption of awkward postures. In old medical records is also possible to nd references to a variety of injuries related to the execution

1051-9815/09/$17.00 2009 IOS Press and the authors. All rights reserved

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of certain work. Such disorders assumed names related with the professions where they mainly occurred (for instance carpenters elbow, seamstress wrist or bricklayers shoulder) [28]. Over the years much has been written about these disorders, their incidence and risk factors. See for instance [24,6,810,1416,28,29,33,3537]. The strong correlation between the incidence of WRMD and the exertions resulting from the working conditions is well known, particularly considering the physical risk factors associated with jobs (e.g., awkward postures, high repetition, excessive force, static work, cold or vibration). Work intensication and stress seem also to be factors that increasingly contribute to the onset of those disorders [5]. The Fourth European Working Conditions Survey data revealed that organisational features such as job rotation and team working are associated with the incidence of WRMD [26]. On the other hand, the same survey states that a good level of job autonomy and control over work, support from colleagues and superiors, opportunities to learn new things and worker participation result in lower levels of exposure to WRMD. Along the years different ergonomic tools for assessing workstations in order to identify WRMD risk factors have been developed by individuals and organizations. Some examples are, for instance, OWAS [7] (and the associated software WinOWAS [31]), RULA [11], Strain Index [12], NIOSH [13,34] or OCRA [24,25]. Despite all the available knowledge there remains some uncertainty about the precise level of exposure to risk factors that triggers WRMD. In addition there is signicant variability of individual response to the risk factors exposure. Aware that there was yet room for use of alternative approaches and the development of new features, and recognizing the adequacy of applying fuzzy expert systems for dealing with the uncertainty and imprecision inherent in the factors considered in an ergonomic analysis, the author developed a fuzzy expert system model for workstation ergonomic analysis, named ERGO X, a rst prototype [18,23] and then the FAST ERGO X. The ERGO X method of workstation ergonomic analysis was subject to a Portuguese patent application [21]. FAST ERGO X is a fuzzy expert system designed to identify, evaluate and control the risk factors due to ergonomic inadequacies existing in the work system. Based on objective and subjective data, the system evaluates the risk factors present in workplaces that can lead to the development of WRMD, and presents the ndings of the evaluation. The system also presents

recommendations that users can follow to eliminate or at least reduce the risk factors present in the work situation. This paper contains 5 sections. Section 1 is this introduction, Section 2 introduces some basic concepts about Fuzzy Logics and Expert Systems, Section 3 presents FAST ERGO X features, Section 4 demonstrates the use of the system on the analysis of a workstation; and Section 5 presents the Conclusions.

2. Fuzzy logic and expert systems The development of ergonomic workstation analysis tools is conditioned by the complexity, imprecision and subjectivity that often characterizes the knowledge and data used in the ergonomic analysis process. Fuzzy Logic (Fuzzy Set Theory) provides appropriate logicalmathematical tools to deal with problems with such characteristics [39]. On the other hand, Expert Systems offer support to experts and non-experts in dealing with complex and ill structured problems, such as humancentered systems [32]. 2.1. Fuzzy Logic Fuzzy Logic (FL) foundations were laid, in 1965, by Lot Zadeh with the formulation of Fuzzy Set Theory [39]. FL provides a mathematical framework for the systematic treatment of vagueness and imprecision. The subjective nature of human classication processes renders classical (dichotomous) approaches almost useless to deal with imprecise systems. So FL facilitates the elicitation and encoding of uncertain knowledge. It provides a representation mechanism that improves the exibility for dealing with imprecise data. The result is more robust tools that perform better for a wider variety of conditions and users. From an encoding point of view, fuzzy sets support the representation of knowledge and its uncertainty as a unique entity. The resulting representation is very exible, since it can be easily coupled with non-fuzzy forms of knowledge representation, and it can be manipulated by a variety of evaluation methods [30]. A fuzzy set presents a boundary with a gradual contour (see Fig. 1), by contrast with classical sets, which present a discrete border. Let U be the universe of discourse and u a generic element of U, then U = {u}. A fuzzy set A, dened in U, is one set of the dual pairs: A = {(u, A (u))|u U }

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1
Membership Deg Degree
very near

near not near

very, quite, more or less)] and connectives (and, or). Each modier has a mathematical function associated to it. For instance, considering the primary term near, the following terms can be generated: very near = near2 A (u)2 not near = 1 near 1 A (u) Illustrative membership functions of the three terms (near, very near, not near) are depicted in Fig. 1. Naturally the distance scale will depend on the context, for instance, if one considers to walk to the school, the distance corresponding the point where near fuzzy set membership degree reaches 0 can be something like 1 km; however if one considers that the travel is done using car or public transportations, then the distance can be something like 10 km. In the example depicted in Fig. 1 it was assumed that the concept of near is totally true for a distance smaller than 200 m (membership degree of 1) and is false for a distance greater than 1 km (membership degree of 0). Distances in between 200 m and 1 km will be relatively near, but the adherence to the near concept will decrease as the distance increases, i.e., the membership degree will tend to 0. Looking at the 3 concepts represented, it is possible to observe that as the distance increases the very near set becomes false faster than the near set, and on the other hand the not near set becomes true. FL allows the formalization of the human ability to perform approximate reasoning, i.e., reasoning and judging under uncertainty conditions. FL extends Classical Logic to include a continuum of truth degrees (partially true states) between the true and the false values. Basically, FL has two principal components. The rst is, in effect, a translation system for representing the meaning of propositions and other semantic entities. The second component is an inferential system for obtaining answers to questions that relate to information resident in a knowledge base using, for instance, IF THEN rules [38]. Both components are used in the FAST ERGO X. 2.2. Expert Systems Expert Systems (ES) or Knowledge Based Systems are computer programs that aim to achieve the same level of accuracy as human experts when dealing with complex and ill-structured specic domain problems (like the ergonomic analysis), so that they can be used by non-experts to obtain answers, solve problems or get decision support in the domain [32]. The strength

0 0

distance

1 km

Fig. 1. Representation of 3 fuzzy sets related to the linguistic variable distance.

where A (u) is designated as membership function or membership grade (also designated as degree of compatibility or degree of truth) of u in A [39]. The membership function associates to each element u, of U, a real number A (u), in the interval [0,1]. Further, the membership function of a fuzzy set can be seen as a predicate, since A (u1 ) indicates the degree to which u1 has the property (feature) represented by the fuzzy set A. In this case a 0 (zero) membership degree to a fuzzy set A means that it is totally false that u 1 belongs to A (or adheres to the concept represented by A), a membership of 1 (one) to a fuzzy set means that it is totally true that u1 belongs to A, and intermediate membership values represent partial belonging to A, i.e., its more or less true that u 1 belongs to A. Fuzzy sets admit a set of basic operations such as union, intersection, complement, product, cartesian product, concentration and dilation [41]. Linguistic variables are an important concept in FL used for the approximate characterization of phenomena which are too complex or too ill-dened to be susceptible of description in precise terms. Linguistic variables admit as values words or sentences of natural language, which can be represented as fuzzy sets. In human discourse, variables values are, normally, expressed by words, not by numbers. Thus, one advantage of using linguistic variables is that one can deal directly with semantic concepts of imprecise nature, with a consistent mathematical formulation [4043]. Consider an example regarding the distance of a place. When one states The school is near, the word near is a linguistic value of the variable distance, i.e., is the label of the fuzzy set near. The set of terms of a linguistic variable is the collection of primary terms (e.g., near, far) and the ones obtained by using modiers [negation (not), qualiers and quantiers (few,

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Fig. 2. Typical architecture of an expert system.

of these systems lies in its ability to put expert knowledge to practical use when an expert is not available. ES make knowledge more widely available and help overcome the problem of translating knowledge into practical useful results. ES architecture contains four basic components (a) a specialized knowledge base that stores the relevant knowledge about the expertise domain, (b) an inference engine, used to reason about some specic problems, for instance using production rules or multiple attribute decision making models, (c) a working memory, which records facts about real world, and (d) an interface that ensures user-system interaction [32] (see Fig. 2). A Fuzzy Expert System is an ES that uses Fuzzy Logic into its reasoning/ inference process and/or knowledge representation scheme.

3. FAST ERGO X FAST ERGO Xs aim is to support and advise occupational safety and health professionals in the ergonomic analysis of workstations. It also supports, through advice, the decision on the corrective or preventive actions to implement in order to minimize the risk factors responsible for the ergonomic inadequacies, helping to promote improvement of the overall ergonomic quality of workplaces analyzed. As stated before, FAST ERGO X is based on ERGO Xs model [20]. In broad terms, FAST ERGO X is a fuzzy expert system with architecture identical to the one shown on Fig. 2. The working memory records, among other,

the collected objective and subjective data to evaluate. The knowledge base is organized in two domain modules: posture and work-related musculoskeletal disorders. The knowledge about those expertise domains was obtained using a knowledge elicitation process involving the available literature (17 references were considered in this process) and subject matter experts opinion, namely Occupational Physicians. The aim and length of this paper is not compatible with a more thorough discussion about the knowledge elicitation process, namely the identication of the risk factors contributing to WRMD, and the denition of their weight for the evaluation process, however a detailed discussion about this process can be found in [19]. The inference engine performs the ergonomic workstation analysis based on the model depicted in Fig. 3. This model involves two processes, the evaluation process and the advisory process. The rst, based on a fuzzy multiple attribute decision-making methodology, evaluates the combined effect of the risk factors present on the workstation and provides the results in the form of conclusions, and the corresponding explanations. The second selects the recommendations, which provide guidelines, leading to the identication of corrective measures in order to minimize the risk factors identied on the analyzed workstation. For more information about the model refer to [18,22]. As discussed by Nunes in [17], the use of an ergonomic analysis method based on Fuzzy Logic presents some advantages over the classical ergonomic analysis methods commonly used (based on discrete assessment criteria). Some of the benets associated

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Fig. 3. FAST ERGO Xs inference model. Objective data (measurements) collected in Record Sheets (recs) are converted, using inadequacy membership function (mfunc), in objective attribute inadequacy degrees (inato) and then aggregated into objective risk factor inadequacy degrees (inrfo). Similarly, subjective data (opinions) collected in Questionnaires (quest) are converted in subjective risk factor inadequacy degrees (inrfs), using linguistic variables (vling). The next step is to combine objective and subjective risk factor inadequacy degrees in risk factor inadequacy degrees (inrf). This risk factor inadequacy degrees are aggregated using weighting factors to evaluate cases inadequacy, which are converted in conclusions using qualication linguistic variables (vling(qual)). Associated to conclusions are explanations about the results, and recommendations.

with the use of fuzzy concepts are: (1) the use of continuous membership functions, which are more realistic than discrete classications, (2) enabling the aggregation and processing of objective and subjective data in a consistent way, (3) the complexity of a fuzzy rules system is approximately constant regardless of the number of factors considered as criteria, (4) complex fuzzy knowledge bases can be built easily and evaluation of the data can use an extended variety of fuzzy operators, allowing the analysis of complex situations, (5) regardless if the results are presented in nu-

merical or linguistic format, the processing using fuzzy methods is numerical, allowing the combination of different types of data in the classication and sorting of different situations under analysis. FAST ERGO X evaluates the risk factors present in the workplace based on objective and subjective data. The subjective data result from replies to questionnaires that collect workers opinions about the perceived adequacy of the risk factors. The opinions are captured using discrete classications based on terms of linguistic variables. On the other hand the evaluation of each

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Fig. 4. Fuzzy set for assessing the elbow exion posture inadequacy. The graph illustrates the assessment of the inadequacy of an elbow exion angle of 115 , which is 0.25 i.e., the inadequacy is low, meaning that there is no signicant risk associated with this posture.

risk factor based on objective data is done considering a subset of relevant attributes that characterizes the work activity. For instance, when considering the risk factor posture regarding a wrist joint, some of the attributes to consider are the angles of wrist exion/extension, and radial/ulnar deviations. The attribute evaluation can be done based on estimations or measurements performed either directly (e.g., using goniometers) or indirectly, using the FAST ERGO X virtual goniometer associated with the video analysis tool. The objective attributes inadequacy evaluation is performed based on fuzzy sets. These fuzzy sets, characterized by continuous membership functions, create the correspondence between numerical values (e.g., posture angles) and membership degrees in the interval [0, 1]. The denition of these membership functions was based on the available literature and Occupational Physicians opinion [19]. Consider, for instance, the evaluation of the elbow posture inadequacy, which is performed based on a value reecting the elbow exion angle that the worker assumes during the working activity. If the angle is 115 and the adopted elbow exion posture inadequacy fuzzy set is the one presented in Fig. 4, the resulting membership degree (i.e. the inadequacy degree concerning such posture) is 0.25. A low inadequacy degree (close to 0) means that posture is adequate while a high value (close to 1) means that posture is inadequate. For the analysis of dynamic activities the objective data can be collected using a time sampling of the task. This allows capturing the motions performed by the operators along their working cycles. The time sampled data is processed using the Equivalent Mean Value (VME) function that computes an angle value whose inadequacy degree is equivalent to the cumulative effect of the different postures observed [22]. The VME of the data sets collected for each body joint can be used as an input in a specic record sheet to be processed by the evaluation process shown in Fig. 3.

The system is modular. Currently two modules are under use, the Posture module and the WRMD module. The rst allows the analysis of workers posture, and the second, the evaluation of the possibility of occurrence of musculoskeletal disorders in a given working situation. The analysis is performed by body joint. The Posture module restricts the analysis to posture data. This module is used to produce an expeditious indicator of the ergonomic quality of a job setup for a given employee. Posture analysis is also useful since posture is one of the most important risk factors for the development of WRMD. The WRMD module considers a more complete set of risk factors. The analysis is more time consuming but the results are more reliable since, besides posture, there are other relevant factors (e.g., force, repetition, vibration) that contribute to the development of occupational diseases. Table 1 lists some of the risk factors that the FAST ERGO X assesses in the WRMD evaluation process. The FAST ERGO X software has the following features: supports the user to collect data directing the collection and the lling of the data, according to the settings of analysis dened by the user and characteristics of the workstations and tasks under analysis; performs the assessment of risk factors present on the workplace synthesises the elements of analysis and presents the conclusions using different graphical or text formats; provides explanations about the results obtained in the ergonomics analysis allowing an easy identication of individual risk factors that contributed to the result displayed; advises corrective or preventive measures to apply to the work situations the knowledge base includes a set of recommendations in HTML format,

I.L. Nunes / FAST ERGO X a tool for ergonomic auditing and WRMD prevention Table 1 WRMD assessed Risk Factors Physical Posture Repetition Force Direct pressure Vibration Cold Risk Factors Psychosocial Work pace Autonomy Monotony Work/rest cycle Task demands Personnel inter relations with management Peer personnel inter relations Job uncertainty Individual Age Sex Professional Activities Sport Activities Recreation Activities Domestic Activities Alcohol/Tobacco Previous WRMD (same joint)

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with hyperlinks that enable the navigation to a set of relevant topics related to the issues addressed (for example, risk factors, potential consequences, preventive measures or good practice references). The use of FAST ERGO X comprehends three main phases: analysis conguration, data collection and data analysis. These phases are depicted in Fig. 5. The data collection phase requires the performance of other related activities, like obtaining workers opinions using questionnaires or measuring work-related features (e.g., durations, postural angles, number of repetitions). The acquisition of such measurements can be supported by video recordings and by equipment or software that assists the analysis. FAST ERGO X provides the Video Analysis Tool, which is one component that allows the visualization of two synchronized videos and the extraction, for instance, of multiple postural angles. Another characteristic of the FAST ERGO X is the portability of the system. The software can be used in laptops offering the possibility of making in situ analyses, from the data collection phase until the presentation of the conclusions about the working situation under analysis and the discussion of the applicable recommendations. The evaluation model used by FAST ERGO X was applied on the analysis of several working situations, from different activity sectors (e.g. industry and services) for validation and evaluation purposes. Thus FAST ERGO X results were compared with the results produced by other ergonomic analysis methods, with available occupational health records and with the assessment of experts. General agreement or correlation between FAST ERGO X and other methods results was veried. Where discrepancies were found it was possible to justify them based on the evaluation methods differences. The results regarding WRMD were compared with medical records data, in order to verify whether there was correlation between the fore-

seen disorders and those diagnosed. Based on these comparisons it was found that all disorders diagnosed by physicians were considered relevant by the expert system model. For further details about the validation process refer to [20]. The data collection is performed by worker and by task. Thus, results of the data analysis can reect a global evaluation of all data available or be selected to address just a particular worker or a particular task. The development of the FAST ERGO X software was a project funded by the Portuguese Institute for Safety, Hygiene and Health at Work (currently Work Conditions Authority). The current available version of the software is in Portuguese, and the English version is on the nal stage of development. The screens presented in this paper were captured from the English version of FAST ERGO X. On the next section a case study is presented demonstrating the main features of the FAST ERGO X.

4. Example of FAST ERGO X use 4.1. Characterization of the study The present case study addresses the ergonomic analysis of checkouts in a large supermarket. The supermarket has a checkout line with 80 terminals. Each terminal includes one optical bar-code reader placed on a frontal position by the side of a keyboard that includes the credit cards reader and a printer. The top cover of the values drawer is the desktop of the checkout terminal. The checkout has two side conveyor belts, one to feed the terminal and the other to move the articles away to the packing zone. The terminals are paired in sets of two using a layout where the operators are working back to back. This way, half the terminals are right side fed while the other half are left side fed. The number of checkout operators is around 250, which is approximately 30% of the supermarket work

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Fig. 5. Activities performed on the analysis of a work situation.

force. The number of weekly working hours per operator varies between 40 hours, for full-time workers, and 14 to 30 hours, for part-time workers. The majority of the checkout operators (67.1%) work 30 or more hours per week (45.7%30 h and 21.4%40 h). The average working time is 28.3 hours and the standard deviation is 8.1. The age distribution is mainly concentrated in the range 2029 years (79%). The average age is 23.3 years (minimum = 18 years; maximum = 43; standard deviation = 4.1). The majority (84%) of operators are females. Considering the operators time on job according to the number of years of service, the majority of the workers (78.2%) worked less than three years in the company. Despite the youth of workers and the reduced time performing the task, the Occupational Physician frequently receives complaints about wrist, shoulder and back pain on the checkout sector. Based on the occupational health records about 15% of the checkout op-

erators were affected by WRMD, mostly on the shoulder (Shoulder Tendonitis) and wrist (Carpal Tunnel Syndrome and De Quervain Disease), but also on the neck (Tension Neck Syndrome), back (Low Back Pain) and elbow (Epicondylitis). The information about the workers complaints and the existence of already diagnosed WRMD were the trigger for action. The evaluation was performed using the FAST ERGO X system, based on objective and subjective data. The objective data was gathered by means of video recordings and the subjective data was obtained from the workers replies to the FAST ERGO X questionnaire. The videos were used, for instance, to evaluate postural angles, number of repetitions and cycle times. Due to operational reasons, the recordings were taken on one single checkout, but were repeated on different days and involved several workers. Two cameras were used to record different views of the same activity. Surveillance videos from the supermarket security recording system were also used in order to have access to the top view of the checkout workstation.

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Fig. 6. User interface for the conguration of a new analysis session.

4.2. Performing the analysis using FAST ERGO X Using FAST ERGO X a new analysis session was congured by introducing data about Company, workplaces, tasks and workers involved on the study. It was also selected the type of analysis to perform. In the current study both postural and WRMD analyses were activated. Figure 6 presents a view of the conguration environment interface where the analysis type and the body joints to assess are selected. After analysis conguration the next step was to collect the data. Postural data sets were collected from the videos using the Video Analysis Tool. The user interface shown in Fig. 7 allows the analysis of video frames and the collection of multiple postural data using a virtual goniometer. The dual video mode illustrated in the gure allows the analysis of synchronized videos, making possible, for instance, the collection of data from opposite side body parts in one single step. The objective data used for the checkout analysis was imported from the video analysis tool (the VME values that synthesized the data sets) or inputted manually. Figure 8 illustrates the objective data collection and edition interface. This interface lists the complete set of attributes to ll according to the conguration of the analysis. It is possible to observe that software

immediately offers a preliminary evaluation of the data of the selected risk factor (e.g., posture, repetition) for the different body joints. Such assessment is presented as colour coded areas over the joints of the mannequin. Subjective data was collected from the operators replies to the Questionnaires produced by the FAST ERGO X according to the analysis conguration. The replies are inserted on the system using a user interface equivalent to the one shown in Fig. 8. Once the input of data is nished the system is ready to start the evaluation and to present results. These results can assume different formats, like lists or graphs. On the other hand it is possible to select if the evaluation is global (considering the data from all tasks and workers analysed on the workstation) or if is focused on a specic task or worker. As shown on Fig. 9, one of the conclusions outputs is a list of Conclusions in the form of sentences like The possibility for development of a WRMD on the Right Wrist is extreme (0,92). Extreme is a linguistic qualier for the computed inadequacy degree that is shown inside the parenthesis. The fuzzy inadequacy scale is the interval [0,1] where 0 means no inadequacy (i.e., absence of risk) and 1 means an extremely high possibility of occurrence of WRMD on the body joint under consideration (if the conclusions refer to the WR-

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Fig. 7. FAST ERGO X Analysis Video Tool user interface. The tool allows the independent or synchronised analysis of up to two videos. The dots connected by dotted lines over the left movie are used to capture the joint posture angles.

Fig. 8. User interface for objective data collection. The input data are the objective attributes (measurements), which are organized by Risk Factor. Using a colour code on the mannequin a preliminary evaluation of the selected risk factor data is presented for the different body joints.

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Fig. 9. Presentation of the conclusions and their explanations in a text style.

MD Module). Considering the Posture module Conclusions an inadequacy evaluation of 0 means a neutral posture, while 1 means an extremely bad posture. The Conclusions can be explained by presenting the computed risk factors inadequacy degrees that contributed to the overall result. As for the Conclusions the Explanations are presented as sentences like The weighted inadequacy of the number of Repetitions performed by the Right Wrist is very high. Very high is the linguistic qualier for the computed inadequacy degree regarding the repetition risk factor. Both Conclusions and Explanations have associated a colour coded bar, on the left, that highlights the severity of the situation. Note that the fuzzy aggregation operators used on the evaluation process reect the synergistic effect observed when several risk factors are combined. This is the reason why most of the conclusions present a level of inadequacy higher than the individual risk factors that have been aggregated. Another way of presenting the results is as a horizontal bar graph. The same colour codes referred to before are used here to code the level of possibility for development of WRMD. Figure 10 shows this type of information output.

Finally, the results can be presented as a bar graph, but this time depicting the risk factors inadequacy degrees for each upper body joint (i.e., the Explanation of a Conclusion). The different graphs can be selected by clicking on the mannequin at the left side of the graph. As for the other graphical representations, colour codes are used. In this case the colours reect the inadequacy degree of the individual risk factors. Figure 11 illustrates this type of output. From the list of Conclusions it is possible to invoke the Recommendations regarding specic risk factors. This will open a browser like interface where the user can look for further information on the issue and for advice on typical preventive and corrective actions and best practice references. Figure 12 shows the interface used in this feature. The FAST ERGO X also produces reports and other type of outputs that include, for instance, different types of graphs. For instance, postural data collected with the Video Analysis Tool can be presented as joint angle vs. time graphs. Figure 13 shows the interface used to present such graphs. On the mannequin, at the right side, the user selects a joint and the corresponding graph is depicted, at the left side. The graph can then be saved as a picture for future use.

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Fig. 10. Presentation of the conclusions in a graphical format.

Fig. 11. Presentation of the explanation of a conclusion in a graphical style.

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Fig. 12. Recommendations presented in a browser like environment.

Fig. 13. Left elbow exion angle vs. time.

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I.L. Nunes / FAST ERGO X a tool for ergonomic auditing and WRMD prevention Table 2 FAST ERGO X results vs. reported WRMD Results Joint Neck Trunk Global assessment Very high (0.74) Very high (0.72) Very high (0.71) High (0.62) Very high (0.68) Very high (0.70) Extreme (0.92) Very high (0.86) Main Risk Factors Posture Repetition Force Contact pressure High (0.66) High (0.56) Medium (0.21) High (0.61) High (0.63) Medium (0.23) High (0.61) High (0.47) Medium (0.23) High (0.59) High (0.47) Medium (0.28) High (0.61) Medium (0.31) High (0.50) Medium (0.28) High (0.61) Medium (0.31) High (0.50) Medium (0.46) Very High (0.88) Medium (0.56) Medium (0.17) Medium (0.28) Very High (0.81) High (0.47) Medium (0.25) Reported WRMD Tension Neck Syndrome Low Back Pain Shoulder Tendonitis Lateral and Medial Epicondylitis Carpal Tunnel Syndrome & De Quervain Disease

Right Left Right Elbow Left Right Wrist/Hand Left Shoulder

4.3. Results discussion As shown above, FAST ERGO X evaluation produced results regarding the degree of possibility of development of WRMD on the upper body joints and about the main contributing risk factors. These results are compiled in Table 2. The results are presented both quantitatively (as membership degrees to inadequacy fuzzy set, dened in the interval [0, 1]) and qualitatively (as terms of a linguistic variable intensity). The table also species the WRMD already identied in the Occupational Health records. It is possible to verify that the results produced by FAST ERGO X are consistent with the Occupational Health records. According to the companys Department of Occupational Medicine estimation, about 15% of the approximately 250 checkout operators are affected by musculoskeletal disorders at some point of their activity. The most frequent injuries, which occur in equal proportion, are the shoulder (Shoulder Tendonitis) and wrist (Carpal Tunnel Syndrome and De Quervain Disease). With lower incidence, and sorted by decreasing number of occurrences, there are cases of Tension Neck Syndrome (neck), Low Back Pain (trunk) and Lateral and Medial Epicondylitis (elbow). They are also in line with the ergonomic experts observations, regarding the occupational risks present on the checkout workstations. The data presented in Table 2 demonstrate that the expert system positively identied the body parts that have potential to develop disorders. In fact FAST ERGO X concluded there was an extreme to very high degree of possibility of development of WRMD on all the body joints where there is already some history of existence of occupational disorders. The activity has a high level of repetition, and the joint movements are combined with forceful exertions, since the checkout operators have to lift the products and slide or suspend them over the scanner. This material handling imposes high solicitations to the hands,

mainly the one that is on the incoming conveyor side, since the operators perform very frequent grip and grasp movements. The effort to handle the loads is also propagated to the shoulders and trunk, which are also subject to frequent motions, since the operators have to reach the products and pass them to the opposite conveyor. The neck is exed most of the time causing discomfort and ultimately tension and disorders. The operators alternate the work between terminals that are right side fed and left side fed. This organizational measure reduces the incidence of injuries on one specic body side. Probably this also is why there is no signicant difference on the results obtained for each side of the operators upper limbs. It is not demonstrated in this paper but, as was mentioned, FAST ERGO X can collect data per worker and per task. In this specic case study 3 workers were analyzed, representing the distribution of characteristics of the checkout operators population, in terms of age, time on activity, gender, and anthropometric characteristics. All were young individuals (aged around 23 years), working for about 2 years on the job; 2 were female and 1 was male. The workers were selected also considering their body size, so that they were distributed among different percentiles (one woman was small, the other had an average size, and the man was taller than normal). The data presented above reects the global analysis. However, considering the analysis of the data performed regarding individual workers it is possible to conrm that the system is sensitive to the variation of workers characteristics, and working postures and habits of the operators. For instance, the taller operator presented more severe possibilities of developing WRMD on low back and neck, which can be explained by the fact that he works with the trunk and the neck more exed that the other workers analyzed. On the hand the smaller worker had higher possibility of developing WRMD on shoulders, which can be explained by the fact that she works with the arms more raised than the other workers.

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The experience of using FAST ERGO X shows that the systems signals the possibility of occurrence of disorders on body joints where there is yet no history of identied disorders. This is normal because WRMD have different latency times, meaning that the time required for occupational diseases to reveal their symptoms varies. The results presented by the FAST ERGO X suggest that, if the operators work under the same conditions for a signicant period of time, some WRMD may appear. This was already conrmed by subsequent queries to occupational health departments regarding workplaces that were evaluated using FAST ERGO X but where no ergonomic intervention was performed. Notice that, in fact, this forecast capability is one of the main merits of the evaluation model, since it allows the system to evaluate workstations in an early phase prior to the development of WRMD. This capability is very important for WRMD prevention, since it creates the opportunity to act on the identied risk factors in a workstation, avoiding the WRMD associated costs and suffering.

The forecast capability of the evaluation model allows the use of the system as a WRMD prevention tool creating the opportunity to act on identied risk factors, avoiding the WRMD associated costs and pains. Finally, FAST ERGO X can also be used as a tool to promote participatory ergonomics. For instance, the software and the media used for the analysis of the work situations (e.g., video recordings) can be used to support the training of workers in the eld of Occupational Safety and Health. This can be achieved either by using the knowledge repository compiled on the knowledge base, by discussing the results of analyses carried out, or by proceeding to critical reviews of the videos collected for the analysis of work situations. Workers awareness is a key success factor for the reduction of potentially risky behaviors, the identication of inadequate situations, and the development of solutions that help the prevention of WRMD.

Acknowledgments The FAST ERGO X was developed at the Ergonomics Laboratory, Faculty of Science and Technology of the New University of Lisbon, within a Project funded by the Portuguese Institute for Safety, Hygiene and Health at Work, currently Work Conditions Authority.

5. Conclusions FAST ERGO X is a fuzzy expert system whose aim is to assist Occupational Health and Safety professionals in the identication, assessment and control of ergonomic risks related with the development of WRMD. FAST ERGO X application was based on the ERGO X model. This model was developed by the author using Fuzzy Logics. This is an innovative approach that uses Articial Intelligence concepts. This approach presents some advantages over the classical methods commonly used. This paper presents the use of the FAST ERGO X on the process of ergonomic analysis of checkouts. The main features and characteristics of the software were introduced while the required analysis steps were described. In the discussion it was shown that the results produced by the system were valid and consistent with the existent Occupational Health records regarding WRMD and with experts analysis. The use of the software is very exible. On one hand, because it allows the use of objective and subjective data, separately or combined; on the other hand because it can be used on portable computers, which makes its utilization possible in situ either to collect data, to present the results and to support any decision-making that may be required, for instance due to the need of corrective interventions.

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Copyright of Work is the property of IOS Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Copyright of Work is the property of IOS Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.