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Due to the epochal changes introduced by “Industry 4.0”, it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human–robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative “direct instrumental evaluations” and “rating of standard methods”, allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers’ awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities.

The aim of this study was to analyze the effect of the level of amputation and various prosthetic devices on the muscle activation of the sound limb in people with unilateral transfemoral and transtibial amputation. We calculated the global coactivation of 12 muscles using the time-varying multimuscle coactivation function method in 37 subjects with unilateral transfemoral amputation (10, 16, and 11 with mechanical, electronic, and bionic prostheses, respectively), 11 subjects with transtibial amputation, and 22 healthy subjects representing the control group. The results highlighted that people with amputation had a global coactivation temporal profile similar to that of healthy subjects. However, amputation increased the level of the simultaneous activation of many muscles during the loading response and push-off phases of the gait cycle and decreased it in the midstance and swing subphases. This increased coactivation probably plays a role in prosthetic gait asymmetry and energy consumption. Furthermore, people with amputation and wearing electronic prosthesis showed lower global coactivation when compared with people wearing mechanical and bionic prostheses. These findings suggest that the global lower limb coactivation behavior can be a useful tool to analyze the motor control strategies adopted and the ability to adapt to the prosthetic device.

Spinal cord injury (SCI) causes major challenges to mobility and daily life activities and maintaining balance becomes a crucial issue. Individuals with SCI often need to adopt new strategies to manage balance with minimal discomfort. Sports and physical activities have become one of the most popular rehabilitation methods for people with SCI. The assessment of balance improvement currently relies on subjective evaluation scales, and this study aims to quantitively assess the efficacy of sports on the balance strategies of people with SCI. Twenty-two SCI people remained seated still for 30 s, with their eyes open and closed, and we recorded trunk kinematics with an optoelectronic system before and after a three-months sports program. We also computed trunk total sway length, mean velocity, and sway density curve. Statistical analyses were performed to compare SCI people before and after the rehabilitation program and to investigate any correlations between the trunk balance parameters and the clinical scales. The results demonstrate improvements in static balance, with significant reductions in sway length and mean velocity. In conclusion, our findings confirm the potential of sports to enhance balance in SCI individuals and suggest that integrating structured sports programs into rehabilitation can improve stability and postural control.

In the Industry 4.0 scenario, human–robot collaboration (HRC) plays a key role in factories to reduce costs, increase production, and help aged and/or sick workers maintain their job. The approaches of the ISO 11228 series commonly used for biomechanical risk assessments cannot be applied in Industry 4.0, as they do not involve interactions between workers and HRC technologies. The use of wearable sensor networks and software for biomechanical risk assessments could help us develop a more reliable idea about the effectiveness of collaborative robots (coBots) in reducing the biomechanical load for workers. The aim of the present study was to investigate some biomechanical parameters with the 3D Static Strength Prediction Program (3DSSPP) software v.7.1.3, on workers executing a practical manual material-handling task, by comparing a dual-arm coBot-assisted scenario with a no-coBot scenario. In this study, we calculated the mean and the standard deviation (SD) values from eleven participants for some 3DSSPP parameters. We considered the following parameters: the percentage of maximum voluntary contraction (%MVC), the maximum allowed static exertion time (MaxST), the low-back spine compression forces at the L4/L5 level (L4Ort), and the strength percent capable value (SPC). The advantages of introducing the coBot, according to our statistics, concerned trunk flexion (SPC from 85.8% without coBot to 95.2%; %MVC from 63.5% without coBot to 43.4%; MaxST from 33.9 s without coBot to 86.2 s), left shoulder abdo-adduction (%MVC from 46.1% without coBot to 32.6%; MaxST from 32.7 s without coBot to 65 s), and right shoulder abdo-adduction (%MVC from 43.9% without coBot to 30.0%; MaxST from 37.2 s without coBot to 70.7 s) in Phase 1, and right shoulder humeral rotation (%MVC from 68.4% without coBot to 7.4%; MaxST from 873.0 s without coBot to 125.2 s), right shoulder abdo-adduction (%MVC from 31.0% without coBot to 18.3%; MaxST from 60.3 s without coBot to 183.6 s), and right wrist flexion/extension rotation (%MVC from 50.2% without coBot to 3.0%; MaxST from 58.8 s without coBot to 1200.0 s) in Phase 2. Moreover, Phase 3, which consisted of another manual handling task, would be removed by using a coBot. In summary, using a coBot in this industrial scenario would reduce the biomechanical risk for workers, particularly for the trunk, both shoulders, and the right wrist. Finally, the 3DSSPP software could be an easy, fast, and costless tool for biomechanical risk assessments in an Industry 4.0 scenario where ISO 11228 series cannot be applied; it could be used by occupational medicine physicians and health and safety technicians, and could also help employers to justify a long-term investment.

Biomechanical overload is considered a significant occupational risk in manufacturing and a potential cause of musculoskeletal disorders. This research aims to introduce new methodologies for the quantitative risk evaluation of biomechanical risk by combining surface electromyography with a motion acquisition system based on inertial measurement units. Due to the lack of experimental data in the literature acquired in a real industrial environment during the working shift, an on-the-field study regarding an automotive assembly line workstation has been carried out in collaboration with Fiat Chrysler Automobiles Italy S.p.A. Data related to the trunk flexion forward and the erector spinae muscle activity have been acquired for several consecutive working cycles by considering three different workers. Data analyses indicated kinematic and muscular activity patterns consistent with those expected and that the proposed wearable technologies can be integrated and used simultaneously during work activities. Furthermore, the results demonstrated data repeatability, strengthening the feasibility and usefulness of the combined use of kinematic and electromyography technologies to assess biomechanical overload in production lines. This study could lay the bases for the future definition of a method for assessing biomechanical overload due to awkward postures.

Background: In order to reduce the risk of work-related musculoskeletal disorders (WMSDs) several methods have been developed, accepted by the international literature and used in the workplace. The purpose of this systematic review was to describe recent implementations of wearable sensors for quantitative instrumental-based biomechanical risk assessments in prevention of WMSDs. Methods: Articles written until 7 May 2018 were selected from PubMed, Scopus, Google Scholar and Web of Science using specific keywords. Results: Instrumental approaches based on inertial measurement units and sEMG sensors have been used for direct evaluations to classify lifting tasks into low and high risk categories. Wearable sensors have also been used for direct instrumental evaluations in handling of low loads at high frequency activities by using the local myoelectric manifestation of muscle fatigue estimation. In the field of the rating of standard methods, on-body wireless sensors network-based approaches for real-time ergonomic assessment in industrial manufacturing have been proposed. Conclusions: Few studies foresee the use of wearable technologies for biomechanical risk assessment although the requirement to obtain increasingly quantitative evaluations, the recent miniaturization process and the need to follow a constantly evolving manual handling scenario is prompting their use.

Due to an error during production, the first author’s name of the published paper [...]

The coordinative pattern is an important feature of locomotion that has been studied in a number of pathologies. It has been observed that adaptive changes in coordination patterns are due to both external and internal constraints. Obesity is characterized by the presence of excess mass at pelvis and lower-limb areas, causing mechanical constraints that central nervous system could manage modifying the physiological interjoint coupling relationships. Since an altered coordination pattern may induce joint diseases and falls risk, the aim of this study was to analyze whether and how coordination during walking is affected by obesity. We evaluated interjoint coordination during walking in 25 obese subjects as well as in a control group. The time-distance parameters and joint kinematics were also measured. When compared with the control group, obese people displayed a substantial similarity in joint kinematic parameters and some differences in the time-distance and in the coupling parameters. Obese subjects revealed higher values in stride-to-stride intrasubjects variability in interjoint coupling parameters, whereas the coordinative mean pattern was unaltered. The increased variability in the coupling parameters is associated with an increased risk of falls and thus should be taken into account when designing treatments aimed at restoring a normal locomotion pattern.

Type 2 diabetes mellitus (T2DM) is a disease characterized by a prolonged hyperglycemic condition caused by insulin resistance mechanisms in muscle and liver, reduced insulin production by pancreatic β cells, and a chronic inflammatory state with increased levels of the pro-inflammatory marker semaphorin 3E. Phytochemicals present in several foods have been used to complement oral hypoglycemic drugs for the management of T2DM. Notably, dipeptidyl peptidase IV (DPPIV) inhibitors have demonstrated efficacy in the treatment of T2DM. Our study aimed to investigate, in in vitro models of insulin resistance, the ability of the flavanones naringenin and hesperetin, used alone and in combination with the anti-inflammatory natural molecules curcumin, polydatin, and quercetin, to counteract the insulin resistance and pro-inflammatory molecular mechanisms that are involved in T2DM development. Our results show for the first time that the combination of naringenin, hesperetin, curcumin, polydatin, and quercetin (that mirror the nutraceutical formulation GliceFen®, Mivell, Italy) synergistically decreases expression levels of the pro-inflammatory gene SEMA3E in insulin-resistant HepG2 cells and synergistically decreases DPPIV activity in insulin-resistant Hep3B cells, indicating that the combination of these five phytochemicals is able to inhibit pro-inflammatory and insulin resistance molecular mechanisms and could represent an effective innovative complementary approach to T2DM pharmacological treatment.

Purpose: to investigate the role of selective avoidance of hematopoietically active BM within the pelvis, as defined with 18FDG-PET, employing a targeted IMRT approach, to reduce acute hematologic toxicity (HT) profile in anal cancer patients undergoing concurrent chemo-radiation. Methods: a one-armed two-stage Simon’s design was selected to test the hypothesis that BM-sparing approach would improve by 20% the rate of G0–G2 (vs. G3–G4) HT, from 42% of RTOG 0529 historical data to 62% (α = 0.05 and the β = 0.20). At the first stage, among 21 enrolled patients, at least 9 should report G0–G2 acute HT to further proceed with the trial. We employed 18FDG-PET to identify active BM within the pelvis. Acute HT was assessed via weekly blood counts and scored as per the Common Toxicity Criteria for Adverse Effects version 4.0. Results: from December 2017 to October 2019, 21 patients were enrolled. Maximum observed acute HT comprised 9% rate of ≥G3 leukopenia and 5% rate of ≥G3 neutropenia and anemia. Overall, only 4 out of 21 treated patients (19%) experienced ≥G3 acute HT. Conversely, 17 patients (81%) experienced G0–G2 events, way above the threshold set by the trial design. Conclusion: 18FDG-PET-guided BM-sparing IMRT was able to reduce acute HT in anal cancer patients treated with concomitant chemo-radiation. These results prompted us to conclude the second part of this prospective phase II trial.