1. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers Colantoni A., Cecchini M., Monarca D., Menghini G., Bunescu M., Bedini R., Marucci A.

2. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers Introduction The herbaceous grafting in horticulture is a practice widely spread and it permits to join the quality and productivity characteristics with those of resistance to pathology transmitted by the soil, much more quickly as regards the time necessary for genetic improvement. The herbaceous grafting in horticulture is a practice widely spread and it permits to join the quality and productivity characteristics with those of resistance to pathology transmitted by the soil, much more quickly as regards the time necessary for genetic improvement. There are different methods of grafting (crown, cleft, whip grafting, etc.): anyhow grafting must be effected by skilled workers and is effected with a grafting knife. There are different methods of grafting (crown, cleft, whip grafting, etc.): anyhow grafting must be effected by skilled workers and is effected with a grafting knife. The workers who effect grafting for more than six hours a day, may damage their health owing to repeated movements. The workers who effect grafting for more than six hours a day, may damage their health owing to repeated movements.

3. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers Introduction Eurostat, 2009 INAIL, 2012

4. Materials and Methods OCcupational Repetitive Actions (OCRA) index OCcupational Repetitive Actions (OCRA) index ISO 11228-3:2009 Ergonomics - Manual handling - Part 3: Handling of low loads at high frequency. ISO 11228-3:2009 Ergonomics - Manual handling - Part 3: Handling of low loads at high frequency. EN 1005-5:2007 Safety of machinery - Human physical performance - Part 5: Risk assessment for repetitive handling at high frequency. EN 1005-5:2007 Safety of machinery - Human physical performance - Part 5: Risk assessment for repetitive handling at high frequency. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

5. The model uses an “exposure index” (OCRA index), which is defined by the ratio: ATA = overall number of actual technical actions needed in the workers’ shift RTA = overall number of reference technical actions (i.e., the total number of actions recommended so as not to expose the workers to risks) in the shift. The OCRA index Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

6. RTA is obtained from the following equation: CF = “constant of frequency” of technical actions per minute recommended in good conditions (= 30) FoM = multiplicative coefficient for force PoM = multiplicative coefficient for posture AdM = multiplicative coefficient for additional factors ReM = multiplicative coefficient for repetitiveness D = net duration of the repetitive task in minutes RcM = multiplicative coefficient for the “lack of recovery period” DuM = multiplicative coefficient for the overall duration of repetitive tasks during a shift. The OCRA index: definition of RTA Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

7. The OCRA index: definition of FoM Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

8. The OCRA index: definition of PoM Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

9. The OCRA index: definition of PoM Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

10. The OCRA index: definition of AdM The main additional factors include the use of vibrating tools, gestures implying countershock (such as hammering), requirement for absolute accuracy, localized compression of anatomical structures, exposure to cold surfaces and environments, the use of gloves interfering with handling ability and high pace completely determined by the machinery. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

11. The OCRA index: definition of ReM Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

12. The OCRA index: definition of RcM Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

13. The OCRA index: definition of DuM Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

14. Classification of OCRA Index results for evaluation purposes Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

15. The case study Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers Study of the workshift (actions/min)(actions/shift)

16. Results Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers To graft a vegetable, 15 actions with the right limb and 6 with the left limb are performed in 20 seconds. The workers make movements that involve the same portions of the limb for almost all the time. takes the plant (1) places it on the table (2) removes the right basal leaf (3) removes the left basal leaf (4) puts removed leaves in the container (5) takes the knife (6) cut the plant at the base on the right side (7) cut the plant at the base on the left side (8) rests the knife on the table (9) takes the rootstock (10) insert the plant into the rootstock (11) takes the clip (12) inserts the clip at the base junction between the rootstock and the plant (13) insert the grafted plant into the container (14) moves the arm to the new plant (15) RIGHT LEFT stretches out towards the plant (1) takes hold of it (2) picks it up (3) pulls back the arm (4) bends the wrist downwards (5) cuts the plant into two different parts (6)

17. Results Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers LEFT RIGHT actions/min ATA r = 45 actions/min  225 min/shift = 10125 actions/shift ATA l = 18 actions/min  225 min/shift = 4050 actions/shift Borg0.5FoM1.00 Borg1FoM0.85 PoM0.33 PoM0.33 Presence in the cycle time 1-31-3 AdM0.95 Presence in the cycle time 2-32-3 AdM0.90 Force Posture Complementary factors Force Posture Complementary factors

18. Results Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers LEFT RIGHT Time devoted to repetitive tasks during shift 181  240 min DuM1.50 working time/recovery periods 7/1  11/1 RcM0.80 Recovery periods Duration Time devoted to repetitive tasks during shift 181  240 min DuM1.50 working time/recovery periods 7/1  11/1 RcM0.80 Duration Recovery periods Movements that involve the same portions of the limb for almost all the time ReM0.70 Repetitiveness Movements that involve the same portions of the limb for almost all the time ReM0.70 Repetitiveness

19. Results Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers LEFT RIGHT

20. Conclusion The results of this research show a high risk for the right limb which effects the cutting up on the small vegetables to be grafted and a low risk for the left limb. The results of this research show a high risk for the right limb which effects the cutting up on the small vegetables to be grafted and a low risk for the left limb. The factors which have contributed to reach such results are to be attributed to the continuous pinch of the knife, to the great number of movements and to the lack of recovering time. The factors which have contributed to reach such results are to be attributed to the continuous pinch of the knife, to the great number of movements and to the lack of recovering time. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

21. Grafting operations force workers to maintain an elbow pronation greater than 60°, with respect to a resting position, for 80% of the cycle time. Grafting operations force workers to maintain an elbow pronation greater than 60°, with respect to a resting position, for 80% of the cycle time. Repetition is particularly risky due to very short cycles that are repeated for more than 50% of the working time. Repetition is particularly risky due to very short cycles that are repeated for more than 50% of the working time. It does not seem possible to eliminate the risk of biomechanical overload in this job, but at least it could be reduced. It does not seem possible to eliminate the risk of biomechanical overload in this job, but at least it could be reduced. Conclusion cont’d Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

22. Conclusion cont’d Despite these limitations, the findings from our study demonstrate that alternative patterns of rest breaks, including brief rest breaks early in the work shift, may reduce workers’ musculoskeletal discomfort and fatigue over the course of the day with modest impact on production. Despite these limitations, the findings from our study demonstrate that alternative patterns of rest breaks, including brief rest breaks early in the work shift, may reduce workers’ musculoskeletal discomfort and fatigue over the course of the day with modest impact on production. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers Therefore, it would be a good idea to reorganize such work by including recovery times right from the earliest working hours. Although we tested the rest break intervention in agriculture, similar interventions are likely to benefit workers in other strenuous jobs such as construction and manufacturing Therefore, it would be a good idea to reorganize such work by including recovery times right from the earliest working hours. Although we tested the rest break intervention in agriculture, similar interventions are likely to benefit workers in other strenuous jobs such as construction and manufacturing

23. Conclusion cont’d Repetitive tasks can be an important factor in these processes, but not the only cause (Barr and Barbe, 2002). Some studies show that pathology may develop as a result of the summation of several constitutional and environmental factors, some of which are not related to work. In addition to biomechanical constraints, psychosocial and personal factors play a role (Leclerc et al., 2001). Repetitive tasks can be an important factor in these processes, but not the only cause (Barr and Barbe, 2002). Some studies show that pathology may develop as a result of the summation of several constitutional and environmental factors, some of which are not related to work. In addition to biomechanical constraints, psychosocial and personal factors play a role (Leclerc et al., 2001). Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

24. Conclusion cont’d In order to reduce the incidence of upper limb work- related musculoskeletal disorders (UL-WMSDs) health surveillance must start in preemployeed phase. In order to reduce the incidence of upper limb work- related musculoskeletal disorders (UL-WMSDs) health surveillance must start in preemployeed phase. A good anamnesis and a clinical examination performed with attention may identify hyper-susceptible persons. It's recommended to avoid exposure of these persons to repetitive actions with high risk. A good anamnesis and a clinical examination performed with attention may identify hyper-susceptible persons. It's recommended to avoid exposure of these persons to repetitive actions with high risk. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

25. Conclusion cont’d After employment must carry out an information about risks and specific training of workers. The aim is to learn the right movements and maintaining proper posture during work shift. After employment must carry out an information about risks and specific training of workers. The aim is to learn the right movements and maintaining proper posture during work shift. When the risk intensity is higher health surveillance should focus on the recognition of early symptoms and signs of musculoskeletal disturbances. When the risk intensity is higher health surveillance should focus on the recognition of early symptoms and signs of musculoskeletal disturbances. Workers showing early disturbances as a result of repetitive movements must start medical rehabilitation. Two stages (according to the clinical aspect): a first acute- subacute stage which is potentially reversible and a chronic stage which is non-reversible. Workers showing early disturbances as a result of repetitive movements must start medical rehabilitation. Two stages (according to the clinical aspect): a first acute- subacute stage which is potentially reversible and a chronic stage which is non-reversible. The health surveillance programme should be adopted to the workplace. The health surveillance programme should be adopted to the workplace. Repetitive Movements of Upper Limbs in Vegetable Grafting: the Risk of Musculoskeletal Disorders for Workers

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