Effects of a Passive Back-Support Exosuit on Erector Spinae and Abdominal Muscle Activity During Short-Duration,Asymmetric Trunk Posture Maintenance Tasks
Restricted accessResearch articleFirst published online July, 2024
Effects of a Passive Back-Support Exosuit on Erector Spinae and Abdominal Muscle Activity During Short-Duration,Asymmetric Trunk Posture Maintenance Tasks
To examine the effects of asymmetry and lower extremity mobility restrictions on the effectiveness of a passive back-support exosuit in short-duration, static trunk flexion postures.
Background
The effectiveness of trunk exoskeletons/suits for sagittally symmetric trunk posture maintenance has been investigated, but there has been limited study of the effects of asymmetric trunk postures or lower extremity motion restriction.
Method
Sixteen participants held trunk flexion postures involving trunk flexion (20°, 40°, 60°), asymmetry (0°, 30°), and lower extremity mobility (Free, Restricted) for 3 s. Participants held these postures with and without an exosuit while erector spinae and abdominal muscle activities were collected.
Results
There were no significant interactions between exosuit and asymmetry or exosuit and lower extremity motion restrictions, indicating no significant effects of these factors on the effectiveness of the exosuit at reducing trunk muscle activity. The exosuit was found to be effective at reducing erector spinae muscle activity regardless of asymmetry of posture or lower extremity restrictions (average 21%, from 11.2% MVC to 8.8% MVC). The magnitude of the erector spinae activity at 60° of trunk flexion with the exosuit was similar to that seen at 20° without the exosuit.
Conclusion
The exosuit consistently provided biomechanical benefit through reduced activation of the erector spinae muscles and neither asymmetry of trunk posture nor lower extremity restriction influenced this effectiveness.
Application
Trunk exoskeletons/suits can reduce trunk muscle activation and understanding how characteristics of the trunk postures assumed impact these responses may help target tasks wherein these devices may be effective.
Abdoli-EM.AgnewM. J.StevensonJ. M. (2006). An on-body personal lift augmentation device (PLAD) reduces EMG amplitude of erector spinae during lifting tasks. Clinical Biomechanics, 21(5), 456–465. https://doi.org/10.1016/j.clinbiomech.2005.12.021
2.
Abdoli-EM.StevensonJ. M. (2008). The effect of on-body lift assistive device on the lumbar 3D dynamic moments and EMG during asymmetric freestyle lifting. Clinical Biomechanics, 23(3), 372–380. https://doi.org/10.1016/j.clinbiomech.2007.10.012
3.
AlemiM. M.GeissingerJ.SimonA. A.ChangS. E.AsbeckA. T. (2019). A passive exoskeleton reduces peak and mean EMG during symmetric and asymmetric lifting. Journal of Electromyography and Kinesiology: official journal of the International Society of Electrophysiological Kinesiology, 47, 25–34. https://doi.org/10.1016/j.jelekin.2019.05.003
4.
AlemiM. M.MadineiS.KimS.SrinivasanD.NussbaumM. A. (2020). Effects of two passive back-support exoskeletons on muscle activity, energy expenditure, and subjective assessments during repetitive lifting. Human Factors, 62(3), 458–474. https://doi.org/10.1177/0018720819897669
AnderssonG. B. J. (1991). The epidemiology of spinal disorders. In FrymoyerJ. W. (Ed.), The adult spine: Principles and Practice-+. Raven Press. Ch 8.
7.
BergmarkA. (1989). Stability of the lumbar spine: A study in mechanical engineering. Acta orthopaedica Scandinavica. Supplementum, 230, 2301–2354. https://doi.org/10.3109/17453678909154177
8.
BoschT.van EckJ.KnitelK.de LoozeM. (2016). The effects of a passive exoskeleton on muscle activity, discomfort and endurance time in forward bending work. Applied Ergonomics, 54, 212–217. https://doi.org/10.1016/j.apergo.2015.12.003
9.
ChaJ. S.MonfaredS.StefanidisD.NussbaumM. A.YuD. (2020). Supporting surgical teams: Identifying needs and barriers for exoskeleton implementation in the operating room. Human Factors, 62(3), 377–390. https://doi.org/10.1177/0018720819879271
10.
ColemanD. M.MoneyS. R.MeltzerA. J.WohlauerM.DrudiL. M.FreischlagJ. A.HallbeckS.HalloranB.HuberT. S.ShanafeltT.SheahanM. G.SVS Wellness Task Force (2021). Vascular surgeon wellness and burnout: A report from the society for vascular surgery wellness task force. Journal of Vascular Surgery, 73(6), 1841–1850. https://doi.org/10.1016/j.jvs.2020.10.065
11.
DanneelsL. A.VanderstraetenG. G.CambierD. C.WitvrouwE. E.StevensV. K.De CuyperH. J. (2001). A functional subdivision of hip, abdominal, and back muscles during asymmetric lifting. Spine, 26(6), 114–121. https://doi.org/10.1097/00007632-200103150-00003
12.
DavilaV. J.MeltzerA. J.HallbeckM. S.StoneW. M.MoneyS. R. (2019). Physical discomfort, professional satisfaction, and burnout in vascular surgeons. Journal of Vascular Surgery, 70(3), 913–920. https://doi.org/10.1016/j.jvs.2018.11.026
13.
DavisK. G.ReidC. R.RempelD. D.TreasterD. (2020). Introduction to the human factors special issue on user-centered design for exoskeleton. Human Factors, 62(3), 333–336. https://doi.org/10.1177/0018720820914312
14.
FloydW. F.SilverP. H. S. (1955). The function of the erectores spinae muscles in certain movements and postures in man. The Journal of physiology, 129(1), 184–203. https://doi.org/10.1113/jphysiol.1955.sp005347
15.
GoršičM.SongY.DaiB.NovakD. (2021). Evaluation of the HeroWear Apex back-assist exosuit during multiple brief tasks. Journal of Biomechanics, 126, 110620. https://doi.org/10.1016/j.jbiomech.2021.110620
16.
GoršičM.SongY.DaiB.NovakD. (2022). Short-term effects of the Auxivo LiftSuit during lifting and static leaning. Applied Ergonomics, 102, 103765. https://doi.org/10.1016/j.apergo.2022.103765
17.
HwangJ.Kumar YerriboinaV. N.AriH.KimJ. H. (2021). Effects of passive back-support exoskeletons on physical demands and usability during patient transfer tasks. Applied Ergonomics, 93, 103373. https://doi.org/10.1016/j.apergo.2021.103373
18.
JinS.MirkaG. A. (2015a). A systems-level perspective of the biomechanics of the trunk flexion-extension movement: Part I – normal low back condition. International Journal of Industrial Ergonomics, 46, 7–11. https://doi.org/10.1016/j.ergon.2015.01.008
19.
JinS.MirkaG. A. (2015b). A systems-level perspective of the biomechanics of the trunk flexion-extension movement: Part II – Fatigued low back conditions. International Journal of Industrial Ergonomics, 46, 1–6. https://doi.org/10.1016/j.ergon.2015.01.007
20.
KangS. H.MirkaG. A. (2023). Effect of trunk flexion angle and time on lumbar and abdominal muscle activity while wearing a passive back-support exosuit device during simple posture-maintenance tasks. Ergonomics, 1–11. https://doi.org/10.1080/00140139.2023.2191908
21.
KelseyJ. L.GithensP. B.WhiteA. A.HolfordT. R.WalterS. D.O’ConnorT.OstfeldA. M.WeilU.SouthwickW. O.CalogeroJ. A. (1984). An epidemiologic study of lifting and twisting on the job and risk for acute prolapsed lumbar intervertebral disc. Journal of Orthopaedic Research: official publication of the Orthopaedic Research Society, 2(1), 61–66. https://doi.org/10.1002/jor.1100020110
22.
KoopmanA. S.KingmaI.de LoozeM. P.van DieënJ. H. (2020a). Effects of a passive back exoskeleton on the mechanical loading of the low-back during symmetric lifting. Journal of Biomechanics, 102, 109486. https://doi.org/10.1016/j.jbiomech.2019.10948
23.
KoopmanA. S.KingmaI.FaberG. S.de LoozeM. P.van DieënJ. H. (2019a). Effects of a passive exoskeleton on the mechanical loading of the low back in static holding tasks. Journal of Biomechanics, 83, 97–103. https://doi.org/10.1016/j.jbiomech.2018.11.033
24.
KoopmanA. S.NäfM.BaltruschS. J.KingmaI.Rodriguez-GuerreroC.BabičJ.de LoozeM. P.van DieënJ. H. (2020b). Biomechanical evaluation of a new passive back support exoskeleton. Journal of Biomechanics, 105, 109795. https://doi.org/10.1016/j.jbiomech.2020.10979
25.
KoopmanA. S.ToxiriS.PowerV.KingmaI.van DieënJ. H.OrtizJ.de LoozeM. P. (2019b). The effect of control strategies for an active back-support exoskeleton on spine loading and kinematics during lifting. Journal of Biomechanics, 91, 14–22. https://doi.org/10.1016/j.jbiomech.2019.04.044
26.
LamersE. P.SoltysJ. C.ScherpereelK. L.YangA. J.ZelikK. E. (2020). Low-profile elastic exosuit reduces back muscle fatigue. Scientific Reports, 10(1), 15958. https://doi.org/10.1038/s41598-020-72531-4
27.
LamersE. P.YangA. J.ZelikK. E. (2018). Feasibility of a biomechanically-assistive garment to reduce low back loading during leaning and lifting. IEEE transactions on bio-medical engineering, 65(8), 1674–1680. https://doi.org/10.1109/TBME.2017.2761455
28.
LugerT.BärM.SeibtR.RimmeleP.RiegerM. A.SteinhilberB. (2021). A passive back exoskeleton supporting symmetric and asymmetric lifting in stoop and squat posture reduces trunk and hip extensor muscle activity and adjusts body posture – A laboratory study. Applied Ergonomics, 97, 103530. https://doi.org/10.1016/j.apergo.2021.103530
29.
MadineiS.AlemiM. M.KimS.SrinivasanD.NussbaumM. A. (2020a). Biomechanical assessment of two back-support exoskeletons in symmetric and asymmetric repetitive lifting with moderate postural demands. Applied Ergonomics, 88, 103156. https://doi.org/10.1016/j.apergo.2020.103156
30.
MadineiS.AlemiM. M.KimS.SrinivasanD.NussbaumM. A. (2020b). Biomechanical evaluation of passive back-support exoskeletons in a precision manual assembly task: “Expected” effects on trunk muscle activity, perceived exertion, and task performance. Human Factors, 62(3), 441–457. https://doi.org/10.1177/0018720819890966
31.
MarrasW. S.DavisK. G.GranataK. P. (1998). Trunk muscle activities during asymmetric twisting motions. Journal of Electromyography and Kinesiology: official journal of the International Society of Electrophysiological Kinesiology, 8(4), 247–256. https://doi.org/10.1016/s1050-6411(98)00011-x
32.
MarrasW. S.MirkaG. A. (1990). Muscle activities during asymmetric trunk angular accelerations. Journal of Orthopaedic Research: official publication of the Orthopaedic Research Society, 8(6), 824–832. https://doi.org/10.1002/jor.110008060
MeltzerA. J.HallbeckM. S.MorrowM. M.LowndesB. R.DavilaV. J.StoneW. M.MoneyS. R. (2020). Measuring ergonomic risk in operating surgeons by using wearable technology. JAMA Surgery, 155(5), 444–446. https://doi.org/10.1001/jamasurg.2019.6384
35.
NingX.HaddadO.JinS.MirkaG. A. (2011). Influence of asymmetry on the flexion relaxation response of the low back musculature. Clinical Biomechanics, 26(1), 35–39. https://doi.org/10.1016/j.clinbiomech.2010.08.012
36.
NorasiH.TettehE.MoneyS. R.DavilaV. J.MeltzerA. J.MorrowM. M.FortuneE.MendesB. C.HallbeckM. S. (2021). Intraoperative posture and workload assessment in vascular surgery. Applied Ergonomics, 92, 103344. https://doi.org/10.1016/j.apergo.2020.103344
37.
ParkA.LeeG.SeagullF. J.MeenaghanN.DexterD. (2010). Patients benefit while surgeons suffer: An impending epidemic. Journal of the American College of Surgeons, 210(3), 306–313. https://doi.org/10.1016/j.jamcollsurg.2009.10.017
38.
PicchiottiM. T.WestonE. B.KnapikG. G.DufourJ. S.MarrasW. S. (2019). Impact of two postural assist exoskeletons on biomechanical loading of the lumbar spine. Applied Ergonomics, 75, 1–7. https://doi.org/10.1016/j.apergo.2018.09.006
39.
TempletonG. F. (2011). A two-step approach for transforming continuous variables to normal: Implications and recommendations for IS research. Communications of the Association for Information Systems, 28. https://doi.org/10.17705/1cais.02804
40.
TettehE.HallbeckM. S.MirkaG. A. (2022). Effects of passive exoskeleton support on EMG measures of the neck, shoulder and trunk muscles while holding simulated surgical postures and performing a simulated surgical procedure. Applied Ergonomics, 100, 103646. https://doi.org/10.1016/j.apergo.2021.103646
41.
UlreyB. L.FathallahF. A. (2013). Effect of a personal weight transfer device on muscle activities and joint flexions in the stooped posture. Journal of Electromyography and Kinesiology: official journal of the International Society of Electrophysiological Kinesiology, 23(1), 195–205. https://doi.org/10.1016/j.jelekin.2012.08.014
42.
WestonE. B.AlizadehM.KnapikG. G.WangX.MarrasW. S. (2018). Biomechanical evaluation of exoskeleton use on loading of the lumbar spine. Applied Ergonomics, 68, 101–108. https://doi.org/10.1016/j.apergo.2017.11.006
43.
WohlauerM.ColemanD. M.SheahanM.MeltzerA. J.HalloranB.HallbeckM. S.MoneyS. (2019). SS12. I feel your pain—A day in the life of a vascular surgeon: Results of a national survey. Journal of Vascular Surgery, 69(6), 189. https://doi.org/10.1016/j.jvs.2019.04.268
44.
YangL.WangT.WeidnerT. K.MaduraJ. A.MorrowM. M.HallbeckM. S. (2020). Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery. Surgical Endoscopy, 35(11), 6335–6343. https://doi.org/10.1007/s00464-020-08085-3
