Walking Belt Research Articles

Near-1: the evaluation of usability and task load demand of a motorized lifter for patient transfer

Purpose Despite the proven benefits of motorized lifting devices in reducing the physical stresses experienced by nurses during patient transfers, the low adoption of these devices remains limited. The study aimed to assess the perceptions of nurses regarding the new motorized lifting device (NEAR-1) in terms of their perceived workload and usability during patient transfers. Materials and Methods A cross-sectional study was conducted to evaluate the perceptions of nurses (n = 45) and students (n = 6) when performing patient transfers from bed to wheelchair and vice versa using the NEAR-1 compared to an existing floor lift, walking belt, and manual transfer. Participants filled out surveys evaluating the perceived task demands and usability of the NEAR-1, as well as open-ended interviews. Results The use of the NEAR-1 significantly reduced the mean of all NASA-TLX constructs (p < 0.001) when compared to manual transfer. When comparing with other existing lifting devices, the NEAR-1 (24.4 ± 3.0) recorded the lowest overall score of NASA-TLX perceived workload, followed by the existing floor lift (26.1 ± 11.6), a robotic-assisted transfer device (28.3 ± 6.8) and mechanical floor lift (31.5 ± 9.3). The participants recorded a usability score of 76.86, indicating positive perceptions of the nurses towards the technology. Conclusions Overall, the NEAR-1 has the potential to reduce the physical stresses on nurses and decrease the likelihood of work-related musculoskeletal disorders (WMSDs). The NEAR-1 may represent a promising new intervention for transferring patients that is capable of minimizing the nurses’ perceived workload in clinical and non-clinical settings. IMPLICATIONS FOR REHABILITATION: The NEAR-1 motorized lifting device reduced perceived workload for nurses while handling and transferring patients between a bed and wheelchair. The nurses recorded a usability score of 76.86 for the NEAR-1, reflecting their positive perceptions towards the technology. The new device has the potential to reduce the physical stress on nurses and decrease the incidence of work-related musculoskeletal disorders.

Biomechanical Evaluations of Bed-to-Wheelchair Transfer: Gait Belt Versus Walking Belt.

Nursing personnel, particularly caregivers who frequently perform manual patient transfer tasks, are at risk for work-related musculoskeletal disorders (WMSDs). The purpose of this study was to perform biomechanical evaluations of bed-to-wheelchair transfer using two low-cost assistive devices: walking belt and gait belt. Twenty-eight college students, serving as caregivers, transferred 14 students, serving as patients. "Caregiver" spinal loading and strength requirements at major joints were measured using a 3D Static Strength Prediction Model. "Caregiver"-perceived stresses were assessed using the Borg CR-10 Scale. "Patient" safety and comfort ratings were determined using Likert-type scales. The findings indicated that transferring "patients" using walking belts with a pulling technique produced significantly lower biomechanical stress than using gait belts. "Patients" also felt more comfortable and safer during walking belt transfers. It is recommended that health care facilities should consider use of walking belts in place of gait belts to transfer partially weight-bearing patients.

O ultrassom terapêutico na medula espinhal acelera a regeneração do nervo ciático de ratos

OBJETIVO: Estudar os efeitos da irradiação ultrassônica de baixa intensidade aplicada sobre a medula espinhal na regeneração do nervo ciático de ratos após lesão por esmagamento controlado, avaliando os resultados pelo índice funcional do ciático (SFI), medido nas imagens vídeo-filmadas das plantas das patas. MÉTODOS: Dezoito ratos foram submetidos a esmagamento controlado (do nervo ciático direito e divididos em dois grupos de acordo com o tratamento: Grupo 1 (n=9), irradiação simulada; Grupo 2 (n=9), irradiação efetiva. Irradiação ultrassônica de baixa intensidade foi iniciada no 7º dia pós-operatório e aplicada diariamente por 6 semanas. Imagens das plantas das patas dos animais foram vídeo-filmadas em uma esteira transparente sob velocidade controlada a intervalos semanais até a 6ª semana de irradiação e o correspondente SFI medido com um programa de computador específico. RESULTADOS: O SFI durante a 1ª e a 6ª semana de tratamento foi de -59,12 e -12,55 no Grupo 1, e -53,31 e -1,32 no Grupo 2, indicando uma melhora de 79% e 97%, respectivamente, mas as diferenças entre os grupos somente foram significantes (p&lt;0,05) durante a 3ª semana de tratamento. CONCLUSÃO: Os autores concluem que o ultrassom terapêutico de baixa intensidade estimula a regeneração nervosa, com significância durante a 3ª semana de tratamento. Nivel de Evidência II, Prospectivo Comparativo.

A new treadmill-type motorized walking belt machine for video recording of the rat's gait and sciatic functional index measurement. A comparative study with other methods

The sciatic functional index (SFI) is a remarkable tool to assess dysfunction and functional recovery of the sciatic nerve of rats. Usually measured on hind foot imprints on paper, a new method is now being proposed, by direct analysis of video recorded foot sole images obtained with a treadmill-type walking belt machine functioning with gait speed control (G1). Results were compared with the SFI measured on imprints on paper (G2) and on video recorded foot sole images obtained with a static see-through runway (G3). The right sciatic nerve of 19 adult female Wistar rats was crushed by the application of a controlled load. Impressions/images obtained both preoperatively and at weekly intervals for eight consecutive postoperative weeks were digitized, stored and analyzed in a computer loaded with specific software, the SFI being automatically calculated after measuring the appropriate parameters. SFI differed significantly between G1 and G2 and G1 and G3 (p<0.05), but not between G2 and G3 (p>0.05) during the first and second postoperative weeks, nonsignificant differences (p>0.05) being observed for any comparison between groups during the third through eighth postoperative weeks. We conclude that the three methods yielded equivalent results from the third week onward, but both video recording methods (G2 and G3) permitted a more adequate early evaluation (first and second weeks), since the SFI parameters were more easily identifiable. Images obtained with the walking belt machine are more uniform and sharper, thus contributing to reduce the influence of biases observed with imprints on paper.

Back injuries among nurses – A comparison of the accident processes after a 10-year follow-up

A prospective dynamic-population-based study was conducted to investigate whether factors involved in the accident process preceding over-exertion back injuries among nursing personnel had changed compared with 10 years earlier. The study covers all reported occupational over-exertion back injuries due to accident among nurses in the hospitals of Stockholm County during the years 1992–1993 and 2002–2003. The assumption was that several factors and events interact in the accident process causing a back injury. Detailed information about the accident process was obtained for each injury by interviews with the injured person. During the two study periods, interviews were conducted with 130 and 132 nurses, respectively. In both studies, most accidents occurred during ordinary planned patient transfers, and the distributions of the type of patient transfer were very similar. Mostly, draw sheets and walking belts were used as transfer equipment, although in about half of the cases, the patients had both physical and psychological limitations, which restricted their cooperation in the transfer. In 2002–2003, the nurses were older and had longer experience of the specific task they were doing; fewer had been given instructions on how to perform the specific task; they were more stressed and rated their RPE higher compared with nurses in 1992–1993. In 2002–2003, the injury more often led to sick leave and to longer sick leave; furthermore, the nurses more often sought medical care and more often took analgesics compared with 10 years earlier. There were no relation between age and if the injury led to a sick-leave or not or the length of sick-leave.

Auditory lateralization in bushcrickets: a new dichotic paradigm

Pair formation in the bushcricket Gampsocleis gratiosa is achieved through acoustic signalling by the male and phonotactic approaches of the female towards the calling song. On a walking belt in the free sound field, females tracked the position of the speaker broadcasting the male calling song with a remarkable precision, deviating by no more than 10 cm in either direction from the ideal course. Starting with stimulus angles of 6-10 degrees the females significantly turned to the correct side, and with stimulus angles greater than 25 degrees no incorrect turns were made. Using neurophysiological data on the directionality of the ear we calculated that with such stimulus angles the available binaural intensity difference is in the order of 1-2 dB. We developed a dichotic ear stimulation device for freely moving females with a cross-talk barrier of about 50 dB, which allowed to precisely apply small binaural intensity differences. In such a dichotic stimulation paradigm, females on average turned to the tronger stimulated side starting with a 1 dB difference between both ears. The significance of such a reliable lateralization behaviour with small interaural intensity differences for phonotactic behaviour under natural conditions is discussed.

Prevention of Disabling Back Injuries in Nurses by the Use of Mechanical Patient Lift Systems

Occupational back pain in nurses (OBPN) constitutes a major source of morbidity in the health care environment. According to the National Institute for Occupational Safety and Health (NIOSH), occupational back injury is the second leading occupational injury in the United States. Among health care personnel, nurses have the highest rate of back pain, with an annual prevalence of 40-50% and a lifetime prevalence of 35-80%. The American Nursing Association believes that manual patient handling is unsafe and is directly responsible for musculoskeletal disorders encountered in nurses. It has been well documented that patient handling can be done safely with the use of assistive equipment and devices that eliminate these hazards to nurses that invite serious back injuries. The benefit of assistive patient handling equipment is characterized by the simultaneous reduction of the risk of musculoskeletal injury to the nursing staff and improvement in the quality of care for patient populations. To understand the cause of disabling injuries in health care workers, several factors must be considered, including the following: (1) anatomy/physiology of the back, (2) risk factors, (3) medical legal implications, and (4) prevention. Among nurses, back, neck, and shoulder injuries are commonly noted as the most prevalent and debilitating. While mostly associated with dependant patient care, the risk for musculoskeletal injury secondary to manual patient handling crosses all specialty areas of nursing. The skeletal defects of an abnormal back make the back more susceptible to occupational injury, even under normal stress conditions. Workers compensation guidelines for occupational back injury differ in public and private health care sectors from state to state. Nursing personnel should be reminded that the development of back pain following occupational activities in the hospital should be reported immediately to the Occupational Health Department. A nurse's failure to report OBPN immediately has resulted in numerous denials of claims for rehabilitation and compensation that nurses deserve. Experts believe that training in proper body mechanics does not prevent back injury. Consequently, focus has been placed on other innovative injury prevention programs, including the use of engineering controls as well as the "lift team" method. Ergonomics involves the use of mechanical devices (e.g., walking belt and mechanical hoist) to aid in patient lifting and transferring tasks. Guldmann Inc. has devised ceiling lift systems and slings during the past 20 years. They have successfully completed thousands of installations worldwide, covering a wide range of challenging conditions and complex environments. The Guldmann ceiling-mounted hoist system consists of a wide range of lifting units, rail components, and a complete assortment of lifting slings and accessories. Its sling is made of polyester, which is characterized by its strength and elasticity. It retains its shape and is dirt repellent and easy to maintain. The Guldmann network has one of the largest and indisputably most experienced group of certified installers in the United States. The "lift team" method was devised to remove nursing personnel from the everyday task of moving patients. This type of intervention assumes that lifting is a specialized skill to be performed only by expert professional patient movers who have been thoroughly trained in the latest lifting device techniques.

Rehabilitation System to Prevent Falls during Walking in Older Adults. Planning of Design Concept and Primary Experiments.

This paper describes a rehabilitation system to provide therapeutic exercise in order to prevent falls during walking in older adults. The rehabilitation system consists of a treadmill having two separate walking belts and a personal computer controlling the servomotors in the treadmill. Experiments were conducted in which falling perturbations were generated by suddenly and randomly reducing the speed of the walking belt on the left side. In the primary experiments, 10 young adults and 10 older adults were recruited, and electromyography data were collected during walking with falling perturbation. The reaction time of the musculus tibialis anterior in the non-perturbed leg in the older adults was significantly longer than in the young adults. The activation patterns in the electromyography data were characterized by a stepping reaction to control the posture. These results indicate that instability of walking in older adults may be caused by reduced functioning of the stepping reaction under dynamic balance control. It is believed that the proposed rehabilitation system may provide a novel therapeutic effect to prevent falling in older adults.

Ergonomic Evaluation of a New Patient-Handling Device

Nursing and personal care is one of the fastest growing but also most injurious U.S. industries. The majority of these injuries is due to patient handling and can be mitigated through the use of various assist devices. One such novel device, the Williamson turn stand, was evaluated and compared to the traditional manual walking belt as well as the more elaborate Hoyer-type lift. Averaged data from 6 healthy subjects across five dependent variables (shoulder EMG, low back EMG, low back compressive force, Borg's rating of perceived exertion and task completion time) indicated that the turn stand was ranked in the middle of the three devices; i.e. it required less effort than the walking belt, but more effort than using a lift device. On the other hand, it was quicker than the lift but not as fast as the purely manual walking belt. Overall the turn stand is an effective patient-handling device for weight-bearing individuals.

Psychophysical assessment of assistive devices for transferring patients/residents

This article reports the psychophysical assessment of nine battery-powered lifts, a sliding board, a walking belt, and a baseline manual method for transferring nursing home patients/residents from a bed to a chair. A separate article reports the biomechanical evaluation of the same task and devices. The objectives of the psychophysical assessment were to investigate the effects of resident-transferring methods on the psychophysical stress to nursing assistants performing the transferring task, and to identify transfer methods that could reduce the psychophysical stress reported by nursing assistants. Nine nursing assistants served as test subjects. Two elderly persons participated as residents. The results indicated that the psychophysical stresses on nursing assistants were significantly lower when performing resident transfers with some of the assistive devices than when performing transfers with the baseline manual transfer method. The nursing assistants generally preferred the basket-sling lift and stand-up lift to other methods. The residents’ comfort and security ratings indicated the comfort and security with most of the assistive devices were greater than or equal to the baseline manual method. Most of the comments of the nursing assistants and residents on the assistive devices were favourable.

Biomechanical evaluation of assistive devices for transferring residents

This is the first of two articles to report a biomechanical evaluation and psychophysical assessment of nine battery-powered lifts, a sliding board, a walking belt, and a baseline manual method for transferring nursing home residents from a bed to a chair. The objectives of the biomechanical evaluation were: (1) to investigate the effects of transfer method and resident weight on the biomechanical stress to nursing assistants performing the transferring task, and (2) to identify resident-transferring methods that could reduce the biomechanical stress to the nursing assistants. Nine nursing assistants served as test subjects; two elderly persons participated as residents. A four-camera motion analysis system, two force platforms, and a three-dimensional biomechanical model were used to measure biomechanical load. The results indicate that transfer method and resident weight affect a nursing assistant’s low-back loading. The basket-sling and overhead lift devices significantly reduced the nursing assistants’ back-compressive forces during the preparation phase of a resident transfer. In addition, the use of basket-sling, overhead, and stand-up lifts removed about two-thirds of the exposure to low-back stress (lifting activities per transfer) as compared to the baseline manual method. Thus, the use of these devices reduces biomechanical stress, and thereby will decrease the occurrence of resident-handling-related low-back injuries. Furthermore, lifting device maneuvering forces were found to be significantly different and a number of design/use problems were identified with various assistive devices. The second article will detail the psychophysical assessment of the same resident-transferring methods.

Prevention of back injuries in healthcare workers

A laboratory study was conducted to evaluate five different manual techniques (two-person lifting; rocking and pulling the patient using a gait belt with two persons; walking belt with handles with one and two persons; and a patient handling sling with cutouts with one person) for transferring patients from wheelchair to toilet and toilet to wheelchair. In addition, three different mechanical hoists (H, T and A) were studied for transferring patients from toilet to wheelchair. Six female nursing students with prior patient transfer experience served both as nurses and passive patients. The mean trunk flexion moments, erector spinae muscle forces and compressive forces for the four manual pulling methods ranged from 93 to 133 Nm, 1861 to 2653 N and 1974 to 2745 N, respectively, as compared to about 200 Nm, 4100 N and 4800 N for two-person manual lifting. Manual lifting was perceived to be the most stressful by the nurses and the least comfortable and secure by the patients. Hoist A was perceived to be the least stressful and the most comfortable and secure. Hoists H and T were perceived to be more stressful, less comfortable and less secure than the walking belt. An intervention study was conducted in two units of a nursing home (140 beds and 57 NAs) to determine the effectiveness of ergonomic changes. Nursing assistants (NAs) in the two units of the nursing home were trained in the use of selected devices and shower rooms and toilets were modified. The mean acceptability rates for walking belt and hoist A were 81% and 87%, respectively. The reported incidence and severity rates for back injuries over 13 months decreased from 83 to 43 and from 634 to 0, respectively, after the intervention. Nursing assistants perceived their job as “very light” after the intervention as compared to between “somewhat hard” and “hard” before intervention.

Reducing back stress to nursing personnel: an ergonomic intervention in a nursing home.

A prospective epidemiologic study was conducted in two units (140 beds and 57 nursing assistants) of a nursing home to demonstrate the efficacy of an ergonomic intervention strategy to reduce back stress to nursing personnel. The total programme involved the following: determining patient handling tasks perceived to be most stressful by the nursing assistants (NAs); performing an ergonomic evaluation of these tasks; and conducting a laboratory study to select patient transferring devices perceived to produce less physical stress than existing manual patient-handling methods. The intervention phase included training NAs in the use of these devices, modifying toilets and shower rooms, and applying techniques to patient care. Immediately after completing the intervention programme, a post-intervention analysis (which lasted eight months in unit 1 and four months in unit 2) was performed. A biomechanical evaluation of the physical demands required to perform stressful patient-handling tasks showed that the mean compressive force on the L5/S1 disc, the mean hand force required to make a transfer, and the strength requirements (expressed as percentage female population capable) were 1964 N, 122 N, and 83% after intervention as compared to 4751 N, 312 N, and 41% before intervention. Subjectively, the mean rating of perceived exertion was less than 'very light' after intervention as compared to between 'somewhat hard' and 'hard' before intervention. Overall, the mean acceptability rates for the walking belt and the mechanical hoist were 81% and 87% for patient transfers. The incidence rate for back injuries prior to the intervention, 83 per 200,000 work-hours, decreased to 47 per 200,000 work-hours after the intervention. There were no injuries resulting in lost or restricted work days during the last four months of the post-intervention. It is concluded that an appropriate ergonomic intervention programme offers great promise in reducing physical stress and risk of low-back pain to nursing personnel. However, large-scale studies in different nursing homes are needed to confirm the above findings.

A biomechanical and ergonomic evaluation of patient transferring tasks: wheelchair to shower chair and shower chair to wheelchair

A laboratory study was conducted to evaluate five different manual techniques (two-person manual lifting; rocking and pulling the patient using a gait belt with two persons; walking belt with one and two persons) and three different mechanical hoists (Hoyer lift, Trans-Aid and Ambulift) for transferring patients from wheelchair to shower chair and shower chair to wheelchair. Six female nursing students with prior patient transfer experience served both as nurses and as passive patients. Static biomechanical evaluation showed that the mean trunk flexion moments, erector spinae muscle forces and compressive and shear forces at the L5S1 disc for the four pulling methods ranged from 92 to 125 Nm, 1845 to 2507 N, 1973 to 2641 N and 442 to 580 N, respectively, as compared to about 213 Nm, 4260 N, 5050 N and 926 N for two-person manual lifting. Perceived stress ratings for the shoulder, upper back, lower back and whole body were significantly lower for pulling methods than those for lifting the patient (p less than or equal to 0.01). Patients found pulling techniques, except the gait belt, to be more comfortable and secure than the lifting method (p less than or equal to 0.01). However, most of the nurses believed that Medesign and the one-person walking belt would not work on those patients who cannot bear weight and those who are heavy, contracted or combative. A two-person walking belt was the most preferred method. Two out of three hoists (Hoyer lift and Trans-Aid) were perceived by the nurses to be more stressful than one- and two-person walking belts. The patients found these two hoists to be more uncomfortable and less secure than with three of the five manual methods (one- and two-person walking belts and Medesign). Pulling techniques and hoists took significantly longer amounts of time to make the transfer than manually lifting the patient (p less than or equal to 0.01). The two-person walking belt, using a gentle rocking motion to utilize momentum and a pulling technique, and Ambulift are recommended for transferring patients from wheelchair to shower chair and shower chair to wheelchair.

A biomechanical and ergonomic evaluation of patient transferring tasks: bed to wheelchair and wheelchair to bed

A laboratory study was conducted in an effort to reduce back stress for nursing personnel while performing the patient handling tasks of transferring the patient from bed to wheelchair and wheelchair to bed. These patient handling tasks were studied using five manual techniques and three hoist-assisted techniques. The manual techniques involved one-person and two-person transfers. One manual technique involved a two-person lift of the patient under the arms; the others used a rocking and pulling action and included the use of assistive devices (a gait belt using a two-person transfer, a walking belt with handles using a one-person and a two-person transfer, and a patient handling sling with cutout areas to allow for a hand grip (Medesign) for a one-person transfer). The three mechanical hoists were Hoyer, Trans-Aid and Ambulift. Six female nursing students with prior patient transfer experience served both as nurses and as passive patients. Static biomechanical evaluation showed that pulling techniques, as compared to lifting the patient, required significantly lower hand forces and produced significantly lower erector spinae and compressive forces at the L5/S1 disc (P greater than or equal to 0.01). Shear force, trunk moments and the percentage of females who were capable of performing the transfers (based on static strength simulation) also favoured pulling methods. Perceived stress ratings for the shoulder, upper back, lower back and whole body were lower for pulling methods than those for lifting the patient (P less than or equal to 0.01). Patients found the pulling techniques, with the exception of when using the gait belt, felt more comfortable and more secure than the lifting method (P less than or equal to 0.01). However, a number of subjects believed that the patient handling sling (Medesign) and the walking belt with one person making the transfer would not work for those patients who could not bear weight and those who were heavy, contracted or combative. A walking belt with two persons was the preferred manual method. Two out of three hoists (Hoyer lift and Trans-Aid) were perceived by the nurses to be as physically stressful as manual methods. Patients found these two hoists to be more uncomfortable and felt less secure than with three of the five manual methods (one- and two-person walking belts and Medesign). Ambulift was found to be the least stressful, the most comfortable, and the most secure among all eight methods. Pulling techniques and hoists took significantly longer amounts of time to make the transfer than manually lifting the patient (P less than or equal to 0.01). The two-person walking belt using a pulling technique and Ambulift are recommended for transferring patients from bed to wheelchair and wheelchair to bed. A large-scale field study is needed to verify these recommendations.

The contralateral coordination of walking legs in the crayfish Astacus leptodactylus

The coupling mechanisms which coordinate the movement of ipsilateral walking legs in the crayfish have been described in earlier investigations. Concerning the coupling between contralateral legs it was only known that these influences are weaker than those acting between ipsilateral legs. The nature of these coupling mechanisms between contralateral legs of the crayfish are investigated here by running left and right legs on separate walking belts at different speeds. The results show that coordination is performed by a phase-dependent shift of the anterior extreme position of the influenced leg. This backward shift leads to a shortening of both the return stroke and the following power stroke. As the coupling influence is only weak, several steps might be necessary to retain normal coordination after a disturbance. This corresponds to v. Holst's relative coordination. The influences act in both directions, from left to right and vice versa. However, one side may be more or less dominant. A gradient was found in the way that anterior leg pairs show less strong coordination than posterior legs. In some cases the coupling between diagonally neighbouring legs was found to be stronger than between contralateral legs of the same segment. The interpretation of this result is still open.

Reducing Risk for Back Pain in Nursing Personnel

Transferring the clients from toilet to wheelchair was the task ranked as most stressful by nursing assistants in a nursing home. The compressive force to the L5S1 disc by client weight during the toilet to wheelchair transfer exceeded the action limit permitted as safe by NIOSH. Two of the three mechanical hoists were perceived to be as stressful or more stressful than the moment transfer methods with the walking belt. Of the five manual methods for transferring, the use of the walking belt was determined to be least stressful and most comfortable for nursing subjects and clients.

Macro-behavioral patterns in a crowd of pedestrians on a large crosswalk (I)

Macro-behavioral Patterns (MBP) shown by a crowd of pedestrians walking on a large crosswalk was measured in terms of two indexes-“entropy index”represented the degree to which walking paths of individual pedestrians converged in a limited number of walking belts, and“flux index”represented the average flow of pedestrians in a belt. Theoretically, MBP is established more firmly when the entropy index is small and the flux index is large. Fluctuations of the indexes adequately reflected the results obtained from independent observations of crowd behavior. Individual behavior leading to MBP was further examined in a laboratory experiment. The results suggested that the accidental simultaneous occurrence of specific behaviors by a few individuals provided the potential for the subsequent development of MBP, and this was followed by a stage where increasing numbers of individuals adapted their behavior to the developing MBP.