Sammanfattning Denna studie har utförts på en svensk medelstor fabrik som tillverkar gipsbaserade byggprodukter och tillhör en internationell koncern. Vissa arbetsuppgifter i fabriken innebär att personalen utför planerat underhåll och rengöring i områden som klassificeras som slutna utrymmen med otillräcklig ventilation där det kan bildas en farlig atmosfär och/eller att det kan vara svårt att komma in och ut. Brist på syre, brand och explosionsrisker kan leda till allvarliga, till och med dödliga olyckor i slutna utrymmen. Vid studiens start uppfyllde fabrikens befintliga rutiner för arbete i slutna utrymmen inte säkerhetskraven från koncernen och inte heller från lagstiftningen. Koncernen har uppmanat fabriken att ta fram ”bäst praxis” för arbete i slutna utrymmen så att andra fabriker kan implementera samma typ av åtgärder. Syftet med denna studie är därför att utveckla ett verktyg för att förebygga ohälsa och olycksfall i arbetet i slutna utrymmen. Studien avgränsas till att undersöka riskerna på två slutna utrymmen i fabriken.Studien utfördes som en fallstudie. Datainsamling har gjorts genom litteraturstudier, en översikt av lagstiftningskrav, granskning av fabrikens befintliga dokument och verktyg för riskbedömningar, anteckningar under projektmöten, intervjuer av medlemmar i projektgruppen, samt kunskapsinhämtningen via deltagandet i endagsseminarium om ”arbete i slutet utrymme”. För bedömning av kvalitet och funktionalitet av verktyget genomfördes en workshop med öppna frågor.Utifrån dessa forskningsaktiviteter har ett verktyg utvecklats för att systematiskt identifiera och hantera risker i slutna utrymmen på den aktuella fabriken som har följande cykel: 1) Bakgrund, 2) Kartläggning, 3) Risklista, 4) Stratifiering, 5) Riskbedömning, 6) Organisatoriska och tekniska åtgärder, 7) Implementering, 8) Revisioner, 9) Inspektioner, 10) Korrigerande åtgärder.Verktyget kommer att implementeras för arbete även i de andra slutna utrymmena i fabriken. Nästa steg är att testa verktyget i andra gipsfabriker i koncernen och justera efter behov samt sprida kunskapen vidare.Vi rekommenderar att 1) Fabrikens räddningsteam utvecklar specifik nöd-plan för varje slutet utrymme samt ett schema för inspektion av utrustning, samt att 2) Projektgruppen utvecklar ”ett flöde” för att underlätta genomgång av rutinerna när arbete i slutna utrymmen behövs. / Abstract The research study presented in this master thesis was done in a Swedish medium-sized factory that manufactures plaster-based construction products and belongs to an international corporate group. Some work tasks in the factory involve staff carrying out scheduled maintenance and cleaning in areas that are classified as confined spaces with inadequate ventilation that can form a hazardous atmosphere, and/or that it is difficult to get in and out. Lack of oxygen, fire and explosion risks may result in serious, even fatal, accidents in confined spaces. At the start of this research study, the existing factory procedures for working in confined spaces did not fully meet the requirements of the corporate group, nor Swedish legislation. The corporate group has challenged the factory to develop "best practices" for work in confined spaces so that other factories can implement the same kind of counter measures. The aim of this study is therefore to develop a tool to prevent accidents by identifying and managing risks associated with work in confined spaces.The research study was performed as a case study. Data collection was done through literature studies and collection an overview of legislative requirements, review of existing company documents, risk assessment tools, notes during project meetings, interviews of the project team, as well as the acquisition of knowledge through participation in the seminar on "work in the confined spaces". To evaluate the quality of the tool, a workshop was conducted with open questions.Based on these research activities a tool is developed to systematically identify and manage risks in confined spaces at the current factory and has the following cycle: 1) Background, 2) Mapping, 3) Risk List, 4) Stratification, 5) Risk Assessment, 6) Organizational and technical counter measures, 7) Implementation, 8) Audits, 9) Inspections, 10) Corrective actions (continuous improvement)The tool can be implemented in the future for the other confined spaces in the factory. The next step is to test the tool in other gypsum factories in the Group and adjust as needed, and to spread the knowledge further.We recommend that 1) the factory Rescue Team develop specific emergency plans for each confined space as well as a schedule for equipment inspection, and that the 2) Project team develop a "flow" to facilitate the review of routines when work in confined spaces is required.

De nombreuses études concluent que la charge mécanique supportée par le genou, qu’elle soit reliée à l’obésité, aux sports intenses, à une altération biomécanique des structures de l’articulation ou à une exposition à des charges lourdes durant les activités occupationnelles, est considérée comme un facteur de risque important au développement de la gonarthrose. La gonarthrose reliée au travail a été le sujet de nombreuses études et plusieurs d’entre elles ont rapporté une prévalence accrue de la gonarthrose chez les travailleurs de certains domaines en particulier, comme la construction, la pose de plancher, la peinture, l’exploitation minière, l’agriculture et le travail en atelier et en milieu de la santé. Les personnes qui travaillent dans ces métiers sont exposées à des positions ou des activités nuisibles, comme travailler à genoux ou accroupi, monter des escaliers ou des échelles, transporter des changes lourdes et marcher de façon prolongée. Ces gestes surchargent l’articulation du genou, ce qui cause des modifications aux structures de l’articulation du genou ou aux adaptations neuromusculaires de patron de mouvement du genou. Ces modifications structurelles et adaptations neuromusculaires peuvent apporter des changements cinématiques à la marche qui peuvent initier la gonarthrose ou contribuer à sa progression. L’objectif principal de la présente étude était d’analyser l’effet d’une surcharge mécanique sur l’articulation fémoro-tibiale (AF-T) subie au travail lors d’une tâche de marche et comparer le patron cinématique de l’articulation fémoro-tibiale des travailleurs exposés à une surcharge mécanique à celui des travailleurs non exposés. Vingt-quatre travailleurs exposés à une surcharge mécanique et neuf travailleurs non exposés ont participé à l’étude. Les données cinématiques de la marche ont été enregistrées au niveau du genou dans des conditions cliniques en utilisant un système de suivi du mouvement électromagnétique. Les paramètres suivant ont été extraits et utilisés pour la comparaison des groupes : l’angle maximum lors du contact initial, l’angle ii maximum de flexion durant la réponse à la charge, l’angle minimum au moment de l’appui unipodal et l’étendue max-min du cycle. La comparaison des groupes pour les variables cliniques et cinématiques a été effectué par l’utilisation de tests-t bilatéraux (« Student-t tests ») et de tests ANCOVA utilisant le poids et la vitesse comme covariables. Les travailleurs exposés à une surcharge mécanique présentaient un plus grand angle de flexion de l’articulation fémoro-tibiale au contact initial, durant la réponse au chargement et à la phase unipodale et ils ont démontré une étendue d’angle moindre que les travailleurs non exposés. Nous croyons que les données cinématiques de la marche peuvent donner des idées sur les facteurs biomécaniques qui pourraient prédisposer les travailleurs au développement ou à la progression de la gonarthrose. Une meilleure compréhension de ces facteurs pourrait être un premier pas vers le développement d’une intervention plus efficace pour cette population. / Many studies agree that mechanical knee loading, either related to obesity, intense sports, biomechanical alteration of the knee or exposition to heavy load occupational activities, is an important factor in knee OA development. Work related knee OA has been the focus of numerous studies, many of them reporting increased knee OA prevalence in workers involved in particular occupational fields such as construction, floor layer, painting, mining, agriculture, shop assistant and health care employees. Persons working in these occupations are exposed to noxious positions or activities such as kneeling, squatting, climbing stairs or ladders, carrying heavy load and prolonged walking. These gestures overload the knee joint, resulting in modifications of the knee joint structures or in neuromuscular adaptations of the knee movement pattern. These structural modifications and neuromuscular adaptations can bring about gait kinematic changes that can either initiate knee OA or contribute to its progression. The main objective of this study was to analyze the effect of mechanical overloading on the tibial-femoral joint suffered during walking tasks at work and compare the kinematics gait tibial femoral joint of workers exposed to knee overloading (KO workers) to that of non-knee overloaded workers (non-KO workers). Twenty four KO workers and 9 non-KO workers participated to the study. Gait kinematic data were recorded at the knee in a clinical setting using an electromagnetic motion tracking system. The following parameters were extracted and used for group comparison: knee angle at initial contact, peak knee flexion angle during loading response and angle range. Group comparison for clinical and kinematic variables of interest was performed with Student-t and ANCOVA tests. KO workers had greater knee flexion angle at initial contact, during loading response and single limb support, and they demonstrated a lower angle range than non-KO workers. iv We believe that gait kinematic data can suggest biomechanical factors that could predispose workers to the development or progression of knee OA. A better understanding of these factors could be a first step toward more efficient intervention within the population.

Background: Swedish law demands a systematic work environment management system (SWEM) and establishes the employer as responsible for this. In 2016, 44 % of Swedish Work Environment Authorities’ submissions regarded lack of SWEM. The law defines occupational health and safety services (OHSS) as an objective part with expert knowledge within the fields of work environment and rehabilitation. Aim of the study: The purpose of this study is to investigate how OHS engineers employed in OHSSs assist customer enterprises in the work of developing and maintaining OHS management systems. The study further aims to identify resources, factors of success, necessary skills and other factors that facilitate this work. Method: Six semi-structured interviews were conducted with OHS engineers employed in one of the top five largest OHSS companies in Sweden. Result and analyses: Respondents were found to apply similar methods in supporting clients’ OHSM although working in different regional branches and no nationwide training program exists. In working with OHSM support the OHS engineers mainly used self-produced, flexible tools along with external checklists and templates. Dialogue, an active involvement of the client in developing the OHSMS, internal motivation of the company and experience and competence of the OHS engineer was described as the most essential factors of success. Conclusions: Our study shows that the OHS engineers interviewed to a large extent work with OHSM support in a way that is consistent with what is found in other studies to be a successful way of collaborating with client companies. Areas of improvement for the OHSS company include deepening relations with clients, contracts better supporting collaboration and procedures for spotting client’s OHSM shortcomings earlier.There is a challenge to find a balance between giving OHS engineers freedom in choosing how they work, providing clients flexible solutions and assuring that certain standards of service are met.We identify the need of a mentorship program for OHS engineers within the OHSS company that would include tutoring both in OHS interventions and the consultant role.Finally, OHS engineers may need to develop their skills in OHS related business economy and how to integrate OHS interventions with the business strategies of the client companies. / Bakgrund: Svensk lagstiftning kräver att arbetsgivare arbetar med systematiskt arbetsmiljöarbete (SAM). Under 2016 ledde 44 % av Arbetsmiljöverkets inspektioner till anmärkningar på grund av brister i SAM. Lagen definierar företagshälsovård (FHV) som en objektiv part med expertkunskap inom arbetsmiljö och rehabilitering. Syfte: Syftet med studien är att undersöka hur arbetsmiljöingenjörer inom FHV hjälper kundföretag med arbetet att utveckla och underhålla ledningssystem för arbetsmiljö. Studien syftar också till att identifiera resurser, framgångsfaktorer, nödvändig kompetens samt andra faktorer som främjar arbetet med SAM. Metod: Sex semi-strukturerade intervjuer utfördes med arbetsmiljöingenjörer anställda i ett av Sveriges fem största företag inom företagshälsovård. Resultat och analys: Respondenterna använde liknande arbetssätt i arbetet med att stötta kunders SAM. Detta trots att de arbetade i olika regioner inom företaget samt avsaknad av nationella riktlinjer. I arbetet med SAM använde arbetsmiljöingenjörerna framförallt egenproducerade, flexibla verktyg samt externa checklistor och mallar. Dialog, aktiv deltagande av kund under utveckling av SAM, intern motivation hos kundföretaget samt erfarenhet och kompetens hos arbetsmiljöingenjören beskrevs som de viktigaste framgångsfaktorerna. Slutsatser: Studien visar att de intervjuade arbetsmiljöingenjörernas arbete med SAM i stor utsträckning överensstämmer med vad andra studier funnit vara ett framgångsrikt samarbete med kundföretag. Förbättringsområden för FHV-företaget inkluderar fördjupande av kundrelationer, kontrakt som bättre stödjer sådant samarbete och rutiner för att upptäcka brister i SAM tidigare.En utmaning är att hitta en lämplig balans mellan arbetsmiljöingenjörens behov av fritt arbetssätt, erbjuda kunden flexibla lösningar och samtidigt säkerställa en likartad service inom företaget.Behov av ett mentorprogram, som inkluderar handledning inom både arbetsmiljöarbete och konsultrollen, för arbetsmiljöingenjörer inom FHV-företaget identifierades.Slutligen kan arbetsmiljöingenjörer behöva utveckla kompetens inom arbetsmiljöekonomi samt hur arbetsmiljöarbetet kan integreras med affärsstrategier inom kundföretagen.

<p>  </p> <p>Highway workers are required to work close to moving traffic during road construction and maintenance activities, which exposes them to the risk of being struck by a distracted driver or intruding vehicle. In addition, work zones disturb the usual traffic flow and patterns due to changes in the existing geometric layout of a roadway, and this is also problematic for the drivers as they must navigate a layout of signs, barrels, and lane changes while keeping the vehicle in control. Moreover, late-night tasks, reckless driving, inconsistent work zones, drunk driving, and increased vehicle miles traveled are some of the additional causes of work zone incidents in the United States. Nationwide, around 40,000 accidents occur each year in highway work zones due to vehicle intrusion into the work zone and have steadily increased during the past ten years. Most often, the driver and passenger of the vehicle are the victims of such accidents. The resulting fatalities, injuries, and property damage due to such incidents lead to significant expenses, prolonged travel delays, and potential damage to expensive products in transit.</p> <p>While traditional safety precautions (e.g., truck-mounted attenuators, rumble strips, speed monitoring displays) can help enhance work zone safety, the number of work zone intrusions calls for designing and implementing emerging intrusion alert technologies to warn drivers and workers when errant vehicles intrude into the work zone. Several state Departments of Transportation (DOTs) have begun examining the use of intrusion alert technologies to mitigate work zone intrusions. While previous studies examined the general effectiveness (e.g., sound levels, work zone coverage, deployment characteristics, etc.) of these technologies in both controlled and active construction and maintenance work zones, there are still significant research gaps in investigating how well these intrusion technologies alert the driver and workers, and no documented best practices are available for transportation agencies and DOTs interested in implementing them. In addition, these technologies have been through many improvements and modifications, and further research is imperative to ascertain their chances of acceptance by workers and contractors.</p> <p>To address these gaps, this thesis focuses on (a) empirically examining the effectiveness, implications, and practices of four commercially available intrusion technologies in enhancing work zone safety through various field tests and surveys, and (b) empirically investigating the effectiveness of these technologies considering drivers’ cognitive processing (perception -reaction time) and responses in case of work zone intrusion. The findings of this research study provide detailed information on the identification and testing procedures of technologies and offer guidelines and recommendations for adopting these technologies for practitioners and professionals in the highway construction sector. The proposed decision-making matrix and multi-criteria decision-making framework are based on the empirical data obtained from the various field experiments, literature review, and evaluation survey. This study also provides valuable insights into the overall effectiveness (i.e., by considering functional characteristics, associated drivers’ responses and reactions, and current implementation) of commercially available intrusion technologies to incorporate required modifications in designing and implementing these technologies to enhance work zone safety. The long-term outcome of this study is to significantly reduce the injuries and fatalities in highway maintenance work zones in Indiana and across the country.</p>

La répétition d’efforts de faible intensité provoque de la fatigue musculaire et représente un facteur de risque de développement des troubles musculosquelettiques (TMS) à l’épaule. La détection de la fatigue musculaire permettrait de meilleures interventions de prévention de TMS liés au travail répétitif. L’objectif de ce mémoire est de développer de nouveaux indicateurs permettant d’évaluer le mouvement des travailleurs à l’aide de capteurs inertiels portatifs afin d’offrir un outil d’évaluation du niveau de fatigue employable sur le terrain. Pour ce faire, vingt-quatre travailleurs ont réalisé une tâche de travail avant et après une tâche de pointage répétitif (RPT) générant de la fatigue musculaire. La fatigue était évaluée à l’aide de l'échelle CR10 de Borg toutes les 30s et d’une contraction maximale réalisée toutes les 2 minutes. Des données de capteurs inertiels, positionnés sur le tronc et les membres supérieurs des travailleurs, ont été analysées en temps-fréquence et leur coordination inter-segment calculée afin d’extraire des indicateurs de fatigue. Les résultats montrent une augmentation du spectre de puissance et de la variabilité de la coordination sur les segments proximaux du haut du corps (tête, sternum, bassin, épaule, bras, avant-bras et main) pendant la RPT. Aussi, une augmentation du spectre de puissance moyen a été observée sur les segments du bras (main, avant-bras et bras supérieur) pendant la tâche de travail réalisée immédiatement après la RPT. En conclusion, il semblerait possible, en observant de tels changements cinématiques, de détecter la fatigue musculaire des travailleurs en industrie à l’aide de capteurs inertiels. / The repetition of low-intensity efforts causes muscle fatigue and represents a risk factor for the development of musculoskeletal disorders (MSD) in the shoulder. The detection of muscle fatigue would allow for better interventions to prevent MSDs related to repetitive work. The objective of this dissertation is to develop new indicators to evaluate the movement of workers using portable inertial sensors to provide a tool for evaluating the level of fatigue that can be used in the field. To do this, twenty-four workers performed a work task before and after a repetitive pointing task (RPT) generating muscle fatigue. Fatigue was assessed using the Borg CR10 scale every 30s and a maximal contraction performed every 2 minutes. Data from inertial sensors, positioned on the trunk and upper limbs of the workers, were analyzed in time-frequency and their inter-segment coordination calculated to extract indicators of fatigue. The results show an increase in the power spectrum and coordination variability on the proximal upper body segments (head, sternum, pelvis, shoulder, arm, forearm and hand) during RPT. Also, an increase in the average power spectrum was observed over the arm segments (hand, forearm, and upper arm) during the work task performed immediately after RPT. In conclusion, it would seem possible, by observing such changes in kinematics, to detect muscle fatigue in industrial workers using inertial sensors.

L’imagerie par résonance magnétique (IRM) est l’une des techniques les plus utilisées en neurosciences. Malheureusement, elle implique une exposition à des niveaux de bruit importants. Cette exposition peut entraîner des effets temporaires ou permanents sur l’audition, surtout lorsqu’elle est prolongée ou répétée. Plusieurs inconnus subsistent au sujet des risques pour l’audition de sujets subissant des examens en IRM à répétition. L’objectif de ce projet était de suivre six participants de recherche subissant des examens IRM hebdomadaires et d’évaluer sur une base régulière l’évolution de leur audition. L’audition des participants a été testée périodiquement sur une période d’un an et demi. Des valeurs de référence ont été récoltées pour chacun des tests avant le début de ce projet. Des séances de tests auditifs ont ensuite été planifiées immédiatement avant et après un scan ainsi qu’à la suite d’un délai variant entre deux et sept jours après un scan. Un article scientifique présentant les résultats les plus importants de ce projet a été rédigé. Il comporte les résultats à deux des tests administrés aux participants: l’audiométrie par tons purs et les émissions otoacoustiques par produit de distorsion. Aucun effet de l’exposition au bruit du scanneur n’a été révélé par ces tests. / Magnetic resonance imaging (MRI) is one of the most commonly used tools in neuroscience. However, it implies exposure to high noise levels. It is well known that exposure to noise can lead to temporary or permanent hearing damages, especially when the exposure is long or repeated. Little is known about the hearing risks of people undergoing several MRI examinations, especially in the context of prolonged longitudinal studies. The goal of this research project was to follow six research participants undergoing weekly MRI scan sessions and test the evolution of their auditory health on a regular basis. The participants’ hearing was tested periodically, over a period of a year-and-a-half. First, baseline values were acquired for each of the hearing tests before the beginning of this research project. Hearing tests were then scheduled immediately before/after a scan and with a delay between two and seven days after a scan. A scientific publication was written outlying the main results regarding two of the administered tests: pure-tone audiometry and distortion product otoacoustic emissions. No consistent impacts of the scanner noise exposure were found for those two tests.

Hybridarbete har medfört fördelar och utmaningar som arbetsgivare behöver uppmärksamma för att främja ett hälsosamt arbete. En hybrid arbetsform kan bidra med det bästa från två världar, distans- och kontorsarbete, förutsatt att arbetsgivare och arbetstagare samverkar för att utveckla nya färdigheter för att anpassa sig till det nya arbetssättet. Denna studie syftar till att skapa en djupare förståelse för den organisatoriska och sociala arbetsmiljön vid hybridarbete. Studien är genomförd med en kvalitativ ansats och materialet har samlats in med hjälp av tio semistrukturerade intervjuer med både medarbetare och chefer inom en svensk offentlig organisation. Studiens metodval är inspirerad av empirisk fenomenologi med ett hermeneutiskt förhållningssätt som syftar till att skapa förståelse. Empirin har tematiserats och analyserats med hjälp av tematisk analys. Studiens resultat visar att den främsta fördelen med hybridarbete är flexibiliteten till att påverka balansen mellan arbete och fritid. Till följd av den hybrida arbetsformen visar resultatet utmaningar i egenskap av minskade fysiska interaktioner med kollegor, digital trötthet, uteblivna pauser samt svårigheter med gränsdragningen mellan arbete och fritid. Resultatet visar att tydliga riktlinjer för hybridarbete får betydelse för hur individen upplever den organisatoriska och sociala arbetsmiljön. Studien konstaterar att tillgång till socialt stöd, delaktighet, dialog, autonomi samt explicita riktlinjer och rutiner som kan anpassas efter individuella behov främjar en god arbetsmiljö. Avslutningsvis presenteras en modell som kan användas av praktikersamhället för att bidra med kunskap om hur känslan av sammanhang (KASAM) främjas i den hybrida arbetsmodellen. / Hybrid work has brought benefits and challenges that employers must observe to promote healthy work among employees. Hybrid working can create the best of both worlds, remote and office work, if employers and workers work together to develop new skills to adapt to the new way of working. This study aims to create a deeper understanding of the organizational and social work environment in hybrid work. The study is conducted with a qualitative approach and the material has been collected using ten semi-structured interviews with employees and managers within a Swedish public organization. The study's choice of method is inspired by empirical phenomenology with a subjective hermeneutic approach that aims to create understanding. The empiricism has been thematized and analyzed using thematic analysis.The results of the study show that the main advantage of hybrid work is increased flexibility regarding the ability to influence the balance between work and leisure. The results also show some possible disadvantages of the hybrid working form, such as reduced physical interactions with colleagues, digital fatigue, missed breaks and difficulties with drawing the line between working time and free time. The results shows that clear guidelines for hybrid work are important for how the individual experiences the organizational and social work environment. The study states that access to social support, participation, dialogue, autonomy and explicit guidelines and routines that can be adapted to individual needs promote a good work environment. Finally, a model is presented that can be used by the practitioner community to contribute knowledge about how the sense of coherence (SOC) is promoted in the hybrid work model.

No description available.

Cette thèse vise à répondre à trois questions fondamentales: 1) La diminution de l’excitabilité corticospinale et le manque d’inhibition intracorticale observés suite à la stimulation magnétique transcrânienne (SMT) du cortex moteur de la main atteinte de sujets hémiparétiques sont-ils aussi présents suite à la SMT du cortex moteur de la jambe atteinte? 2) Est-ce que les altérations dans l’excitabilité corticomotrice sont corrélées aux déficits et incapacités motrices des personnes ayant subi un accident vasculaire cérébral depuis plus de 6 mois? 3) La vibration musculaire, étant la source d’une forte afférence sensorielle, peut-elle moduler l’excitabilité corticomotrice et améliorer la performance motrice de ces personnes? Premièrement, afin d’appuyer notre choix d’intervention et d’évaluer le potentiel de la vibration mécanique locale pour favoriser la réadaptation des personnes ayant une atteinte neurologique, nous avons réalisé une révision en profondeur de ses applications et intérêts cliniques à partir d’informations trouvées dans la littérature scientifique (article 1). La quantité importante d’information sur les effets physiologiques de la vibration contraste avec la pauvreté des études qui ont évalué son effet thérapeutique. Nous avons trouvé que, malgré le manque d’études, les résultats sur son utilisation sont encourageants et positifs et aucun effet adverse n’a été rapporté. Dans les trois autres articles qui composent cette thèse, l’excitabilité des circuits corticospinaux et intracorticaux a été étudiée chez 27 sujets hémiparétiques et 20 sujets sains sans atteintes neurologiques. Les fonctions sensorimotrices ont aussi été évaluées par des tests cliniques valides et fidèles. Tel qu’observé à la main chez les sujets hémiparétiques, nous avons trouvé, par rapport aux sujets sains, une diminution de l’excitabilité corticospinale ainsi qu’un manque d’inhibition intracorticale suite à la SMT du cortex moteur de la jambe atteinte (article 2). Les sujets hémiparétiques ont également montré un manque de focus de la commande motrice lors de l’activation volontaire des fléchisseurs plantaires. Ceci était caractérisé par une augmentation de l’excitabilité nerveuse des muscles agonistes, mais aussi généralisée aux synergistes et même aux antagonistes. De plus, ces altérations ont été corrélées aux déficits moteurs au membre parétique. Le but principal de cette thèse était de tester les effets potentiels de la vibration des muscles de la main (article 3) et de la cuisse (article 4) sur les mécanismes neuronaux qui contrôlent ces muscles. Nous avons trouvé que la vibration augmente l’amplitude de la réponse motrice des muscles vibrés, même chez des personnes n’ayant pas de réponse motrice au repos ou lors d’une contraction volontaire. La vibration a également diminué l’inhibition intracorticale enregistrée au quadriceps parétique (muscle vibré). La diminution n’a cependant pas été significative au niveau de la main. Finalement, lors d’un devis d’investigation croisé, la vibration de la main ou de la jambe parétique a résulté en une amélioration spécifique de la dextérité manuelle ou de la coordination de la jambe, respectivement. Au membre inférieur, la vibration du quadriceps a également diminuée la spasticité des patients. Les résultats obtenus dans cette thèse sont très prometteurs pour la rééducation de la personne hémiparétique car avec une seule séance de vibration, nous avons obtenu des améliorations neurophysiologiques et cliniques. / This thesis aims to answer three basic questions: 1) Are the decrease in corticospinal excitability and the lack of intracortical inhibition observed following transcranial magnetic stimulation (TMS) of the affected hand motor cortex of stroke patients present after TMS of the affected leg motor cortex? 2) Are the alterations in corticomotor excitability correlated with motor impairments and disabilities of subjects who have suffered a stroke for over six months? 3) Can muscle vibration, as a source of strong sensory afference modulate corticomotor excitability and improve motor performance of these subjects? First of all, to support our choice of intervention and to assess the potential of local mechanical vibration to promote the recovery of persons with neurological impairment, we conducted a thorough review of its physiological effects and clinical applications in the scientific literature (article 1). The wealth of information on the physiological effects of vibration contrasts with the lack of studies that have evaluated its therapeutic effects. Nevertheless, we found that, despite the paucity of studies, the results on its clinical use are encouraging and positive and no adverse effects were reported. In the other three articles included in this thesis, the excitability of corticospinal and intracortical circuits has been studied in 27 hemiparetic patients and in 20 healthy subjects without neurological disease or injury. Sensorimotor functions were also evaluated with valid and reliable clinical tests. Similar to that observed in the hand of hemiparetic patients, we found, compared to the healthy subjects, a decrease of corticospinal excitability and a lack of intracortical inhibition following TMS of the affected leg motor cortex (Article 2). The hemiparetic patients also showed a lack of focus of the motor output during voluntary activation of plantar flexors. This was characterized by an increase in the neural excitability not only of the agonist muscles, but also of the synergists and even the antagonist muscles. The main goal of this thesis was to test the potential effects of vibrating hand (Article 3) and thigh (Article 4) muscles on the neural mechanisms that control these muscles. We found that vibration increases the amplitude of motor responses in the vibrated muscles and even produces a response in subjects with no motor response at rest or during a voluntary contraction. The vibration also decreased the intracortical inhibition recorded in the paretic quadriceps muscle (vibrated muscle). The decrease was however not significant at the hand. Finally, using a cross-over design study, the vibration of the paretic hand or leg resulted in specific improvements in hand dexterity or leg coordination, respectively. In the lower limb, quadriceps vibration also reduced the spasticity in patients. The results obtained in this thesis are very promising for stroke rehabilitation because with a single session of vibration, we obtained neurophysiological and clinical improvements.

Health and safety during construction remains a worldwide challenge that the construction industry is facing. The German construction industry recorded an average of 110,000 accidents per year in the period of 2010 to 2019. A discernible trend toward a decrease in occupational accidents is not visible. In this context, traditional safety planning does not seem to be able to guarantee sufficient health and safety during construction. In line with the BIM Roadmap published by the German Ministry of Transport in 2015, it can be recognized that Building Information Modeling (BIM) is supposed to be increasingly used in upcoming years. This paper aims to identify how BIM could positively impact Occupational Health and Safety (OHS) during construction. Therefore, a thesis procedure, combining quantitative and qualitative research with an in depth literature review is introduced. This study reveals a high added value of using BIM for (1) safety rule checking and design validation and (2) safety education, training and communication. BIM as a decision supporting tool has the potential to reduce the underestimation of safety hazards and improve safety reporting, which have been identified as current vulnerabilities in the construction industry. Furthermore, an added benefit to sustainability following the concept of Construction Hazard Prevention through Design (CHPtD) is illustrated. In practice, however, BIM for OSH remains unused, while those working with BIM are not familiar with safety planning. This study indicates that in order to fully utilize the potential of BIM, intuitiveness and standardization is required, while those implementing BIM and those using BIM need to be aware of and willing to exploit the potential of new technologies. The challenge now is to recognize the potential of BIM in relation to OHS and to actively use BIM for health and safety purposes. / Att skapa en säker arbetsmiljö på byggarbetsplatsen är fortfarande en global utmaning för byggbranschen. I den tyska byggbranschen inträffade till exempel i genomsnitt 110 000 olyckor per år under perioden 2010-2019 och det syns ingen märkbar minskning. I detta sammanhang verkar traditionell säkerhetsplanering inte kunna garantera tillräcklig hälsa och säkerhet under byggandet. I samband med den strategiska BIM-implementeringsplanen som publicerades av det tyska transportministeriet 2015 ska Building Information Modeling (BIM) användas i allt större utsträckning under de kommande åren. Syftet med den här artikeln är att identifiera hur BIM skulle kunna ha en positiv inverkan på arbetsmiljö och säkerhet (OHS) på byggarbetsplatsen. Studien kombinerar kvantitativ och kvalitativ forskning med en djupgående litteraturgenomgång. Resultatet visar att det finns ett stort mervärde i att använda BIM för (1) kontroll av säkerhetsregler och validering av konstruktionen och (2) utbildning, träning och kommunikation om säkerhet. BIM som beslutsstöd kan möjliggöra en mer realistisk bedömning av säkerhetsrisker och förbättra säkerhetsrapporteringen, vilket har identifierats som aktuella sårbarheter i byggbranschen. Det finns också fördelar med att implementera konceptet Construction Hazard Prevention through Design (CHPtD). I praktiken är dock BIM för arbetsmiljöfrågor fortfarande oanvänd, samtidigt som de som arbetar med BIM inte är tillräckligt bekanta med säkerhetsaspekter. För att BIM:s potential ska kunna utnyttjas fullt ut krävs en ökad användarvänlighet och standardisering av verktygen. Samtidigt måste de som implementerar och använder BIM vara medvetna om och villiga att utnyttja den nya teknikens potential. Utmaningen är nu att förstå potentialen av BIM för arbetsmiljöaspekter och att proaktivt använda BIM för att öka säkerheten på byggarbetsplatser.