Implications

6.2.2 Effects of grip force level

This dissertation also demonstrated the impacts of different grip exertions classified as mild, moderate, and hard, which are approximately 10%, 30%, and 50% of the maximum grip strength. Mild and hard grip forces were investigated in Chapter 4, while moderate grip force was explored in Chapters 3 and 5. The effects of various grip force levels are evident on forearm muscle activities, distal and proximal arm discomfort, and grip strength reduction. Among the three levels, sustained mild grip during short-term vibration exposure did not stimulate any recognizable symptoms of HAVS. In this force exertion, forearm muscles activated below 15% MVC and caused mild to moderate distal arm discomfort. Moreover, only mild discomfort was perceived along the proximal arm, which indicates that the impacts are mainly concentrated on the fingers, hand, and forearm. However, these impacts are minimal and did not indicate any clear signs of neurological or musculoskeletal disorders. Meanwhile, the onset of musculoskeletal components of HAVS is apparent after sustained moderate grip. This level instigated higher forearm muscle activities than mild grip and caused moderate to severe distal arm discomfort. Although, similarly, the perceived discomfort along the proximal arm was mild, which also implies that in this force exertion, most of the impacts are focused on the fingers, hand, and forearm. Lastly, sustained hard grip led to clear manifestations of HAVS that is not only evident on higher forearm muscle activities and moderate to severe distal arm discomfort but is also noticeable on significantly higher grip strength reduction and moderate to severe proximal arm discomfort. Essentially, this force exertion caused intense physical stress along the entire upper limb that further led to reduced hand strength. In summary, the progression of HAVS symptoms, specifically the musculoskeletal aspects, are directly influenced by grip force levels. Mild to moderate grip exertion can affect the fingers, hand, and forearm while sustained hard grip can reduce hand strength and can stress the whole upper extremity.

6.2.3 Effects of forearm posture

The effects of forearm posture were clear on hard grip and indistinctive on mild grip, as discovered in Chapter 4. Hard grip on pronated forearm, can intensify the effects of short-term handle vibration through lower FF activation as a function of exposure time and higher proximal arm discomfort, as compared to hard grip on neutral forearm posture.

The relationship between grip ability and forearm posture can explain the difference in FF contraction and upper arm discomfort. Previous research indicate that pronated forearm yields lower grip strength than neutral or supinated forearm (Fan et al., 2019;

Mogk & Keir, 2003; Murugan et al., 2013; Richards et al., 1996) because of the unnatural position of the FF and other related muscles on pronated posture (Brand & Hollister, 1993). During forearm pronation, the FF wraps around the radius (Brand & Hollister, 1993; Richards et al., 1996); hence it could not contract optimally resulting to lower activation. In addition, the upper arm muscles are involved when changing forearm postures (Güleçyüz et al., 2017; Naito et al., 1995), specifically an electromyographic study showed a clear contraction gain on the brachialis and brachioradialis activities during slow supination to pronation movement (Naito, et al., 1994). This explains why the proximal arm had higher perceived discomfort on pronated than neutral posture since it is more engaged during pronation. In summary, the effects of poor forearm posture on the development of musculoskeletal aspects of HAVS are emphasized when combined with forceful movement.

6.2.4 Effects of handle grip design

Given the cumulative effects of handle vibration, forceful movement, and awkward posture when using hand-guided powered equipment, some proposed handle grip designs, which aimed to limit the development of HAVS, were investigated in Chapter 5. It was found that implementing a regular-sized circular handle provided additional layer of protection to the hand from the vibrating handle, which led to lower vibration transmissibility. Consequently, this resulted to lower hand-arm discomfort and higher grip comfort. In addition, it was discovered that handle shape influences vibration transmissibility and force exertion while surface profile affects sensation and comfort.

Handle shape affects finger force distribution and finger joint postures since the hand and handle contact area also varies with handle contour (shown in Figure 6.1), which can modify finger coordination. The unevenness of finger coordination can impact contact stiffness and grip stability, henceforth affects HTV. Previous research found that circular and double-frustum handles generate the least total finger force (Kong et al., 2008). This can suggest why, in Chapter 4, vibration transmissibility on circular handle was lower compared to other handle shapes. Similarly, the degree of hand and handle contact area can be associated with grip strength reduction. Specifically, on elliptic handle where the contact area is greater than the other two handle shapes (shown in Figure 6.1 (c)), the reduction on grip strength was significantly higher. This implies that when a larger palm area is under contact stress, it allows vibration to propagate on a bigger area as well.

During such contact stress, soft tissues of the palm are compressed between the metacarpal and the vibrating handle. This can result to temporary loss of sensation, which is essential to dexterous hand functions such as gripping (Zatsiorsky & Latash, 2004), thereby reducing grip ability. In summary, a handle shape that causes too much contact stress can provide more harmful effects, particularly on the development of upper limb musculoskeletal illnesses.

Figure 6.1. Illustration of the hand and handle contact area on: (a) circular, (b) double-frustum, and (c) elliptic-shaped handles.

Meanwhile, the main effects of handle surface profile were evident on elliptic handle and not on other handle shapes. The ring and small finger sensitivity were lower on patterned surface than smooth surface. Surface profile provides frictional condition, which gives stability and steadiness to the level of grip exertion (Cadoret & Smith, 1996;

Flanagan & Wing, 1995; Johansson & Westling, 1984). The rounded spikes on patterned surface that are prodded on the fingers due to contact stress may have caused the vibration to propagate on a deeper layer of the palm. Moreover, since the contact forces on the distal and proximal phalanges are evenly distributed when grasping elliptic handles (shown in Figure 6.1 (c)), a larger palm area was propagated by vibration. This explains how sensitivity was affected on patterned surface. The effect was specific on the ring and small fingers because the forearm was pronated during the task and this placed constant pressure on the hypothenar eminence, which affected the ulnar nerve (Dy & Mackinnon, 2016). Similarly, the more profound contact stress brought by the rounded spikes on patterned surface influenced higher fingers and hand discomfort and lower grip comfort.

In summary, the effects of surface profile are intensified by the hand and handle contact area, which also depends on the handle shape. Its influence is apparent on the neurological aspect of HAVS such as loss of finger sensitivity and musculoskeletal symptoms like fingers and hand discomfort.

6.2.5 Summary of findings

Figure 6.2 summarizes the effects of handle vibration, grip force level, and forearm posture on the hand-arm system. Each quadrant represents major findings on every grip force level and forearm posture combination investigated in Chapters 3, 4, and 5. For instance, Quadrant III briefly demonstrates the results found in Chapter 3.

Quadrants I, II, V, and VI are the findings on Chapter 4. Finally, Quadrant IV is the condition used for Chapter 5, where various handle shapes and surface profiles were examined. Meanwhile, the results in Chapter 2 were not indicated in Figure 6.2 since the grip force level and forearm posture in this preliminary study were self-imposed and not explicitly monitored during the exposure duration.

Pronated forearm (unnatural posture) Q II Chapter 4 1. WTV = 14%

2. GS reduction = 14%

3. DA discomfort = mild to moderate

4. PA discomfort = mild 5. % MVC of forearm muscles = 5-14%

Q IV Chapter 5

1. WTV = 17%

2. HTV = 70%

3. GS reduction = 23%

4. DA discomfort = moderate 5. PA discomfort = mild

6. % MVC of forearm muscles = 12-30%

Q VI Chapter 4 1. WTV = 22%

2. GS reduction = 34%

3. DA discomfort = severe 4. PA discomfort = moderate to severe

5. % MVC of forearm muscles = 13-33%

Neutral forearm (natural posture)

Q I Chapter 4 1. WTV = 17%

2. GS reduction = 12%

3. DA discomfort = mild to moderate

4. PA discomfort = mild 5. % MVC of forearm muscles = 4-15%

Q III Chapter 3

1. WTV = no data 2. HTV = no data 3. GS reduction = 15%

4. Middle finger sensitivity = decreased

5. DA discomfort = moderate to severe

6. PA discomfort = mild

7. % MVC of forearm muscles = 7-25%

Q V Chapter 4 1. WTV = 17%

2. GS reduction = 27%

3. DA discomfort = moderate to severe

4. PA discomfort = mild to moderate

5. % MVC of forearm muscles

= 13-39%

Mild grip force Moderate grip force Hard grip force

Figure 6.2. Relevant findings contributing to the progression of HAVS, based on grip force level and forearm posture, from least (Q I and II) to most impactful (Q VI).

Note: DA = distal arm; GS = grip strength; PA = proximal arm; WTV = wrist transmitted vibration.

In every quadrant, some of the common indicators considered in each study such as transmitted vibration, grip strength reduction, upper limb discomfort, and forearm muscle activities are listed. Notably, the magnitude of these parameters progresses with

grip force level (mild grip to hard grip) while the influence of forearm posture is particularly distinctive on hard grip.

In summary, the development of HAVS symptoms increases with grip force exertion, even during short-term handle vibration exposure (shown in Figure 6.3). Mild grip does not stimulate any recognizable symptoms while hard grip (Quadrant VII) instigates clear signs of musculoskeletal disorders. Temporary loss of finger sensitivity and development of moderate upper limb discomfort start to manifest during moderate grip on both forearm postures, while higher grip strength reduction, severe upper limb discomfort, and higher forearm muscle activities occur during hard grip exertion.

Generally, mild grip on neutral forearm (Q I) or pronated forearm (Q II) pose the least manifestation of HAVS symptoms while hard grip on pronated forearm (Q VI) stimulates the most apparent indication of HAVS.

Pronated forearm (unnatural posture)

Q II Did not stimulate any recognizable symptoms of HAVS

Q IV Basis for recommending various handle shapes and surface profiles

The implications are elaborated in Section 6.2.4

Q VI Higher wrist vibration transmissibility Stimulated musculoskeletal

symptoms of HAVS such as:

(1) increased proximal arm discomfort (2) lower FF activity through time

Q VII Higher wrist and elbow vibration transmissibility Stimulated musculoskeletal symptoms of HAVS such as:

(1) higher grip strength reduction (2) higher distal arm discomfort

(3) higher forearm muscle activities

Neutral forearm (natural posture)

Q I Did not stimulate any recognizable symptoms of HAVS

Q III

Stimulated neurological and musculoskeletal symptoms of HAVS such as:

(1) temporary loss of finger sensitivity

(2) increased distal arm discomfort

(3) reduced ability to sustain a grip

Q V

Mild grip force Moderate grip force Hard grip force

Figure 6.3. Major implications of the relevant findings on the development of HAVS.