Manual handling in health care sector using kinaesthetic techniques
Authors: Alessio Silvetti, Giorgia Chini, Tiwana Varrecchia, Francesco Draicchio
Abstract: The proper mobilisation of patients affects not only the health of the caregiver but also the patient himself, since it is a critical condition for preventing treatment failure and avoiding strain injuries from pressure and wrong placement.Professional experience, using standardised handling techniques, can be modified using kinaesthetic approach.The kinaesthetic is a self-perception discipline, based on proprioception, that is, the capacity to feel and perceive the posture of the body in space, its movements and muscle contractions, also without visual input. This thecnique applied during positioning and handling presupposes, on the one hand, respect for the functional anatomy of the patient and, on the other hand, the protection of the operator performing the handling.Kinaesthetic can contribute significantly to reducee biomechanical load and to improve healthcare outcomes.By using an optoelectronic system (SMART-DX 6000 System, BTS, Milan, Italy) and 6 spherical reflective markers placed at selected landmarks (c7, bilaterally scapular acromion, sacrum, bilaterally anterior superior iliac spine (Davis, 1991)), the trunk kinematics of a worker was recorded during several patient handling tasks (lateral decubitus, sitted placement, lateral shift, side displacement, downward displacement) with (CNSTTC) and without (CTRL) kinaesthetic. Then, the ranges of motion (RoM) of the trunk in the three planes of space were calculated. Muscular activity coactivity was also recorded through sEMG from the following muscle bilaterally: Erector Spinae, Rectus Abdominis, Rectus Femoris, Biceps Femoris, Anterior Tibialis and Gastrocnemius Medialis. The co-activation index is a parameter that provides the percentage of simultaneous activation during each task of the antagonist muscles of the trunk and leg. It has been shown in previous literature studies how increased co-activation can be disadvantageous for the jointsThe most relevant kinematic results are in the trunk. Trunk flexion is reduced in all the analyzed tasks when using kinaesthetic approach. Otherwise kinematics results showed increased values of RoM for trunk lateral bending in all tasks but sitted placement.About sEMG results showed a decreased co-activation of the trunk muscles in lateral decubitus, sitted placement and side placement. Co-activazion of the legs showed decreased values for lateral shift,, side placement and downward displacement. was substantially unaffected except for lateral decubitus where kinaesthetic showed an increased value of coactivation.These are preliminar results that should be confirmed with a larger sample of experienced workers. Moreover it could be advisable to identify some sub-tasks from each subtasks that might be more noticeable from an ergonomic point of view.
Keywords: patient handling, musculoskeletal disordres
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