Muscular Dystrophy And Workplace Ergonomics: Motor Function Measure And Recommendations

Challenges Faced by Individuals with Muscular Dystrophy

Discuss about the Motor Function Measure and Quantitative.

Muscular dystrophy is characterized by progressive muscle mass loss and eventually loss of strength. Muscular dystrophy is muscle-wasting disease that affects one in every 5,000 males. The main reason for this disease is genetic mutation interfering with muscle protein production that is necessary for building and maintenance of healthy muscles (Mah et al. 2014). The signs and symptoms of disease includes wadding gait, stiffness and pain in muscles, difficulty in jumping, sitting or standing and prone to frequent falls (Smith et al. 2014). Dystrophin is a complex protein that anchors components within muscles linking it to outer membrane-sarcolemma. The largest coding genes that is known, dystrophin is almost absent or deformed that worsen the symptoms and aetiology of muscular dystrophy. People suffering from muscular dystrophy face difficulties at workplaces that bind their working abilities and limit their mobility. Workplace designing is required for the people with this particular disability that involves ergonomics as poor workplace designing can cause fatigue, frustration and further harm of workers (Pontonnier et al. 2014). Poor worksite designing can be painful for the workers that lead to poor quality and low productivity. Therefore, the following report deals with the ergonomic investigations at the worksite and recommendations so that workers with muscular dystrophy can better adapt to his or her duty at the workplace.

People with MD are unable to continue working if the workplace environment is not better adaptable for them. They face difficulty in joining workplace, as it is a muscle debilitating disease.  During the early phase of the disease, the movements appear to become labored and there is visible physical changes noticed in walking and sitting positions. An also enlarged calf muscle causes difficulty in walking as the heel tendons become tightened. The person with MD may have trouble in standing and from sitting position s the muscles start to become weak in the legs (Landfeldt et al. 2016).

As individuals with MD are prone to falls, it become difficult for them to stand from sitting position and in this course, they might fall on floor. Another challenge people with MD face is picking of objects from floor and stair climbing. Climbing stairs increases muscle stress and hastens damage of muscles. MD mainly poses challenge for people in the voluntary muscles that affect arms and legs. Concisely, MD pose challenges in the movement of voluntary muscles and they face difficulty in walking, standing from sitting position and moving arms (Soim et al. 2016).

Ergonomic Investigation of a Construction Site Worker with Muscular Dystrophy

As the company’s main business is construction work, workers are assigned to work at the building construction sites to carry out welding of metals that are very common at these workplace sites. One day, a worker complained of difficulty in walking in his legs and deep pain in calf muscles. After the worker consulted doctor, he confirmed that it was initial sign of muscular dystrophy that worker is suffering from.

After this diagnosis, an investigation is carried out with causes of MD effect on the worker. After the investigation, it was found that worker was using welding machine to join the metal rods on the windowpane. During this process, the worker found difficulty in getting up from the sitting position after the welding process. It was also found that he has to hold the welding arc steadily with his right hand and hold the shield with his left hand in order to protect his eyes and perform soldering with his right hand. Then, he used his finger to pull witch of the machine.

MD results in losing of muscular strength and therefore, assessment is required to determine the degree of decrement so that proper interventions can be developed. Motor assessment for the valuation of motor function and muscle force is important for the worker for measuring the strength of extensors of elbow, shoulder, ankle, knee, wrist and strength of flexors. Motor Function Measure (MFM) was done to measure score that identify significant muscle strength loss and ability to perform activities that is important for evaluation of ergonomic evaluation (Vuillerot et al. 2013).

When this assessment was done, he scored one in the test that indicates high risk for loss of muscle strength in upper proximal part of the body. As a part of survey method, this assessment is used in ergonomic investigation of workplace for assessing the extent of loss of muscle strength due to MD. After observation, it was found that the final score of one showed high risk for loss of muscular strength of the worker and require implementation of changing of work or engineering control methods that eliminate or reduce MD risk and its effect (Fischer et al. 2016).

Questions	Yes	No	NA	Remarks
Is the worker performing the right task?		Ö		The supervision activities is well suited
Does the activity require excessive force?	Ö			Need to apply excessive force for welding
Does the worker need to bend or move wrist in awkward position?	Ö			After getting up from sitting position, the worker loses control and prone to falls
Does the worker require repetitive movements?	Ö			The welding is continuous process that require hands in repetitive motion
Is any job rotation happened for the reduction of long exposure?		Ö		No job rotation happened
Does worker encounter any kind of difficulty while performing this task?	Ö			Worker encountered difficulty in making movements of arms and legs.
Is there any other way to carry out the task for the elimination of MD effect?	Ö			Job rotation can be used for the reduction of ergonomics.
Recommendation: There is need for job rotation with proper scheduling and assigning of supervisor for the conduction of ergonomic training.

After the completion of checklist, interview questionnaire is given to worker for a better understanding of challenges that he is facing with the task.

Sr No.	Questions and Answers
1.	Q. How long do you perform the welding task repetitively? A. In the morning from 9:00 a.m. to 12:00 p.m. and in the afternoon from 1:00 p.m. to 6:00 p.m.
2.	Q. How long you have break between works. A. No break except for lunchtime. (12:00-1:00)
3.	Q. How frequently the task is performed in a day. A. Almost every day, but at different intervals.
4.	Q. Do you feel any pain or discomfort while performing the task and in which part of the body? A. Yes, discomfort, pain in arms and legs while standing from sitting position.
5.	Do you need to sit in that awkward position for long time? A. Yes, as I have to stand up and sit down according to the welding needs at height or ground level
6.	Q. Do you need to remain in one position for longer time whether sitting or standing? A. Yes, need to hold the arc and machine until the welding process is done.
Recommendation: It is important to lessen the prolong holding of arc and soldering machine with frequent breaks, job rotation and ergonomics training.

After the process of conduction of checklist and questionnaire, the worker is 30 years. There is risk for pain in arms and legs while being in sitting position, then standing, and prolonged holding of welding machine and arc. The risk for increase in pain due to MD is likely to increase and in extreme cases, he might feel contractures around his joints (shortening of tendons or muscles) or inability to work.

Motor Function Measure and Its Significance for Evaluating Muscle Strength Loss

There is difference between persons with and without MD where there is limited movements of arms and legs.

Sr/No.	Normal person	MD persons
1.	Increased productivity and ability to work for longer durations	Decreased productivity as inability to work for long intervals
2.	More motivation	Worker feel fatigue and stressed to work for longer hours
3.	More concentration to work and as a result, reduction in workplace accidents	Less concentration as they lack stamina and fatigue
4.	Better working relationships and increased team work	Frustration, stress and exhaustion
5.	Good stamina and sustainability to perform work	Prone to workplace accidents due to exhaustion

MD effect can be reduced by preventing the use of welding tools and arranging workstation for the task. The control or elimination of risk factors need to be designed using the solutions listed below:

Worker Augmentation- Ekso Bionics Zero G ergonomics tool arm can be helpful in relieving the stress applied on muscular skeletal system that can allow worker to perform his task as one normally do. This engineering solution is effective and direct that reduces the incidence of effect of MD on skeletal muscular system. The technology investment is small and relative to muscular skeletal injury at workplaces. This method is significant for the reduction of injury during manual handling of welding machine (Pruess et al. 2016).

Workstation designing- This solution ensures to keep the physical area safe for the optimization and reinforcing of ideal body movements and reduction of awkward positions. Muscular stress can be reduced by designing of workplaces where the necessary components for the worker is within reach and reduces the events of bending down, getting up while the worker needs anything. This easy access and workshop trolley system that help to make the worker get adapted to the workplace and use of parts or tools that are heavy needs to be avoided (Golabchi et al. 2015).

Administrative control- Worker rotation and frequent breaks can be helpful for minimizing the MD effect. Rest breaks would aid in counteracting the exposure of worker to holding of welding tool and arc. The tight schedule can result in fatigue and risk for further skeletal muscle damage. As mentioned above, there are no frequent breaks given except for lunchtime from 12:00 p.m. to 1:00 p.m. that can result n prolong working times that can further increases the risk for MD damage (Martin, Kolomitro and Lam 2014).

Ergonomics training- This method is effective that increases the level of awareness among the worker for the prevention of MD effect and associated injury. The program requires considerable amount of time and so, workers cannot attend training conducted by construction safety personnel (Kincl et al. 2016).

As agreed, Ekso Bionics Zero G ergonomics tool arm will be used for the reduction MD effect. This tool has numerous advantages where the worker does not have to apply prolong pressure by holding the arc and welding machine to weld the metal bars together. The worker would feel less effect by applying this ergonomic tool to work piece.

Recommendations for Improving Workplace Ergonomics and Reducing the Risk of Muscular Dystrophy

Firstly, this tool can be used for manoeuvring heavy tools weightlessly. It helps arms to balance weight used in sanding, welding and other applications. This tool also aid in holding heavy loads and balances weight that will allow worker to move safely, freely and accurately balance load in any direction without fatigue or injury (Young and Ferris 2017).

Job rotation can also be useful that lessens stress, physical fatigue and weakness of muscles and tendons by shifting his job among others. The worker can be assigned for supervision job at the construction workstation by the administrative control body where he can have a scheduled job rotation. The worker can rotate job every 3 hours between his task and supervision work for the prevention of prolonged working hours of holding machine. This would be helpful for the worker by lessening the exposure to prolonged welding process (Padula et al. 2017).

Supervision and monitoring by safety personnel should be appointed so that briefing of associated MD risk is explained and related consequences of musculoskeletal disorders and implementation of control measures to reduce MD effect.

Ergonomic training can also be helpful for the worker where it improves his level of awareness regarding ergonomic issues and recognition of hazards arising from MD effect. In this way, he can pay more attention to prevention of an injury and as a result, decrease in pain and stress.

Frequent breaks can also be helpful that reduces the prolonged holding of machine where the worker can prevent further MD related risk. A break of 15 mins after 11:00 a.m. and then after 3:00 p.m. can be helpful in reducing the exposure to prolonged holding or sitting position during welding process. It is also advantageous in reducing the chances of prolonged sitting and then standing position and putting pressure with his right arm.

After the implementation of these measures, evaluation and follow-up is required to ensure its effectiveness and motion of his arms and legs.

The Ergonomics Programme in the company helped in managing hazards associated with workplace. 

• Management Committee helped in creating a safer place by providing ergonomics training, adequate resources, tools, and implementation of access by workers by defining individual roles and responsibilities.
• Employee participation helped in enhancing motivation, improving workplace condition and employee satisfaction. Employees cooperated in reporting of any potential work related injury affecting muscular skeletal system.
• Implementation of Ergonomic training- This would help to create awareness regarding ergonomic risk factors and musculoskeletal disorders. Proper monitoring and evaluation of ergonomic issues with active reporting and feedback should be done.
• Medical Management- Treatment for ergonomic injuries should be done to prevent further worsening of situations that may result in permanent disability.
• Evaluation and periodic review- The programme needs to be evaluated periodically for ensuring that programme elements are effective and adequate. Ergonomics auditing can also be helpful at workplace to ensure productivity and efficiency of workers.

After one-month evaluation, Motor Function Measure (MFM) assessment was again done to evaluate ergonomic program.

The below chart illustrates the motor function scale assessment test on a scale of 5 where the worker scored one previously that depicts no joint movement, but muscle movement. After the administrative control measures, there was movement at the joint scoring 2, however, not against gravity.

Impact of Muscular Dystrophy on Work Performance and Workplace Accidents

Conclusion

In the above report, it is evident that worker working at construction sites with prolonged holding and sitting are subjected to high MD risk. The ergonomic improvements are found to be useful at the workstation that kept ergonomic risks under control. Training programs are also advantageous for controlling ergonomic issues and in increasing awareness levels among workers in reducing MD risk effects. Appropriate equipments like tool arm can be adapted to reduce musculoskeletal disorders risk as per ergonomic standards to have enhanced efficiency and productivity at workplaces with reduced injuries.

References  

Fischer, D., Hafner, P., Rubino, D., Schmid, M., Neuhaus, C., Jung, H., Bieri, O., Haas, T., Gloor, M., Fischmann, A. and Bonati, U., 2016. The 6-minute walk test, motor function measure and quantitative thigh muscle MRI in Becker muscular dystrophy: A cross-sectional study. Neuromuscular Disorders, 26(7), pp.414-422. Motor function test is a validated test for clinical assessment in musculoskeletal disorders like muscular dystrophy as it provides validated clinical scores.

Golabchi, A., Han, S., Seo, J., Han, S., Lee, S. and Al-Hussein, M., 2015. An automated biomechanical simulation approach to ergonomic job analysis for workplace design. Journal of Construction Engineering and Management, 141(8), p.04015020. Workplace designing is an ergonomic approach for the reduction in musculoskeletal injuries or occupational injuries. Risk assessment for musculoskeletal injuries helps to estimate internal injuries and motion of selected joints of worker. 

Kincl, L.D., Anton, D., Hess, J.A. and Weeks, D.L., 2016. Safety voice for ergonomics (SAVE) project: protocol for a workplace cluster-randomized controlled trial to reduce musculoskeletal disorders in masonry apprentices. BMC public health, 16(1), p.362.

Landfeldt, E., Lindgren, P., Bell, C.F., Guglieri, M., Straub, V., Lochmüller, H. and Bushby, K., 2016. Health?related quality of life in patients with Duchenne muscular dystrophy: a multinational, cross?sectional study. Developmental Medicine & Child Neurology, 58(5), pp.508-515.

Mah, J.K., Korngut, L., Dykeman, J., Day, L., Pringsheim, T. and Jette, N., 2014. A systematic review and meta-analysis on the epidemiology of Duchenne and Becker muscular dystrophy. Neuromuscular Disorders, 24(6), pp.482-491. Among the musculoskeletal disorders, DMD are more prevalent than BMD according to global estimates as well as case ascertainment sources.

Martin, B.O., Kolomitro, K. and Lam, T.C., 2014. Training methods: A review and analysis. Human Resource Development Review, 13(1), pp.11-35.

Nunes, M.F., Hukuda, M.E., Favero, F.M., Oliveira, A.B., Voos, M.C. and Caromano, F.A., 2016. Relationship between muscle strength and motor function in Duchenne muscular dystrophy. Arquivos de neuro-psiquiatria, 74(7), pp.530-535.

Padula, R.S., Comper, M.L.C., Sparer, E.H. and Dennerlein, J.T., 2017. Job rotation designed to prevent musculoskeletal disorders and control risk in manufacturing industries: a systematic review. Applied ergonomics, 58, pp.386-397. Job rotation is an effective method for reducing the impact of musculoskeletal injuries and its related risk at workplaces, however, requires more studies that are rigorous in this regard.

Pontonnier, C., Dumont, G., Samani, A., Madeleine, P. and Badawi, M., 2014. Designing and evaluating a workstation in real and virtual environment: toward virtual reality based ergonomic design sessions. Journal on Multimodal User Interfaces, 8(2), pp.199-208.

Pruess, A., Meadows, C., Amundson, K., Angold, R., Lubin, J., Solano, M., Mastaler, T., Fleming, N. and Sweeney, M., Ekso Bionics, Inc., 2016. Human Exoskeleton Devices for Heavy Tool Support and Use. U.S. Patent Application 15/339,293. An artificial arm is useful for providing support to the arms, thighs and hips like exoskeleton for people who use heavy tools. They are designed to transfer weight of the tool to the exoskeleton structure.

Smith, A.E., McMullen, K., Jensen, M.P., Carter, G.T. and Molton, I.R., 2014. Symptom burden in persons with myotonic and facioscapulohumeral muscular dystrophy. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists, 93(5), p.387.

Soim, A., Lamb, M., Campbell, K., Pandya, S., Peay, H., Howard Jr, J.F. and Fox, D., 2016. A Cross-Sectional Study of School Experiences of Boys with Duchenne and Becker Muscular Dystrophy. Physical Disabilities: Education and Related Services, 35(2), pp.1-22.

Vuillerot, C., Payan, C., Iwaz, J., Ecochard, R., Bérard, C. and MFM Spinal Muscular Atrophy Study Group, 2013. Responsiveness of the motor function measure in patients with spinal muscular atrophy. Archives of physical medicine and rehabilitation, 94(8), pp.1555-1561.

Young, A.J. and Ferris, D.P., 2017. State of the Art and Future Directions for Lower Limb Robotic Exoskeletons. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 25(2), pp.171-182.