Yoko Ellie Fukumura
Shawn C. Roll PhD, OTR/L, RMSKS, FAOTA, FAIUM
Research Lab: Musculoskeletal Sonography and Occupational Performance (MSOP)
Year of Entry: 2019
Workplace injury continues to prevail despite guidelines and policy level change. Through the PhD program, I hope to further understand musculoskeletal injury from an occupational science perspective to change the ways in which we address injury prevention. As a research assistant in the Musculoskeletal Sonography and Occupational Performance lab, I am working on an interdisciplinary project to create an office workstation that uses machine learning to promote health behavior change and prevent injury. We are currently studying ergonomics of computer users to develop an algorithm that accurately senses the user’s posture in a pilot study. Through this study, we also hope to enhance our understanding of ergonomics and human behavior at the office workstation. I hope to apply the knowledge I gain from this project to address injury prevention in musicians in the future.
Master of Arts (MA)
in Occupational Therapy
2019 | University of Southern California
Bachelor of Music
in Piano Performance
2017 | New England Conservatory of Music
Fukumura, Y. E., Sommerich, C. M., Evans, K. D., & Roll, S. C. (2024). Work-related musculoskeletal disorders and associated work systems factors: Are there differences between sonography practice areas? Journal of Diagnostic Medical Sonography, 40(1), 4–18. https://doi.org/10.1177/87564793231205612 Show abstract
Objective. Explore the differing associations of Sonography Work Systems (SWS) model factors with work-related discomfort outcomes among sonographers in four sonographic practice areas.
Materials and Methods. Survey data from a national cross-disciplinary cohort of sonographers was analyzed to explore experiences of work factors and work-related discomfort in sonographers across four practice areas: abdominal (ABD+), adult echocardiography (Echo), obstetrics/gynecology (OB/GYN), and vascular technology (VT). One-way analyses of variance (ANOVAs) and chi-square tests were conducted on SWS factors and work-related discomfort to examine differences across practice area groups. Associative analyses were conducted between upper extremity musculoskeletal discomfort and hand used during sonography examinations. For each practice group, regression analyses examined associations of SWS factors with work-related discomfort (i.e., musculoskeletal and visual discomfort, headaches).
Results. 2924 survey respondents (n = 1747 ABD+, n = 519 Echo, n = 351 VT, and n = 307 OB/GYN) were identified. Descriptive differences were identified in SWS factors and discomfort across practice area groups. Significant differences were noted in distribution of upper extremity pain compared with the hand used to complete sonography examinations (P < .001).
Conclusion. This study identified multiple organizational, tool, and process factors commonly associated with discomfort across specialties, which underscores the need for multidimensional approaches to worker health that include effective administrative and engineering controls.
Evans, K. D., Weikle, A. N., Fukumura, Y. E., Roll, S. C., & Sommerich, C. M. (2023). Understanding the downstream effects of the COVID-19 pandemic on sonographers and vascular technologists: Healthcare heroes’ Kryptonite! Journal of Diagnostic Medical Sonography, 39(5), 430–440. https://doi.org/10.1177/87564793231185297 Show abstract
Objective. This work aimed to explore how the COVID-19 pandemic affected the work of sonographers and vascular technologists.
Materials and Methods. A follow-up questionnaire was sent to an established registry of ultrasonography users who opted into a longitudinal research study examining worker health and wellbeing. Multiple questions related to the general impacts of COVID-19 on sonography work practices, workload, and considerations of remaining or leaving their current job were included; responses to these questions were descriptively tabulated. Participants indicated specific changes that occurred and provided general comments related to COVID-19 impacts in two free-text questions. These comments were qualitatively analyzed by two sonographers who used an interpretive grounded theory approach to formatively code and memo the comments. Four summative interviews were conducted with participants who represented varied practice areas to gain deeper insights into the experiences expressed by the total respondent pool. Qualitative coding of the free-text responses and interview transcripts was completed independently by the two sonographers using the Sonography Work Systems (SWS) framework, and the full research team contributed to the interpretation of the findings.
Results. A total of 1389 ultrasonography users completed the questionnaire. The pandemic changed the ways in which examinations were performed for approximately half of the respondents. A higher or somewhat higher workload was noted by 48% of the sample, while only 10% experienced a lower or somewhat lower workload. Components of the work system were a major concern for respondents, and a lack of support from supervisors and hospital administration was a key finding. Participants felt limited in their ability to provide care, experienced posttraumatic stress, and reported a lack of reciprocity, which were all underscored as undesirable outcomes.
Conclusion. Sonographers and vascular technologists suffered negative consequences during the COVID-19 pandemic. The most marked outcome was the undesirable effects on the work system, which resulted in the need for these workers to engage in herculean efforts over a sustained period. Findings suggest that these health care heroes may have experienced physical and mental harm while trying to provide health care services, despite numerous institutional challenges.
Roll, S. C., Fukumura, Y. E., Sommerich, C. M., Stigall-Weikle, A. N., & Evans, K. D. (2023). Cross-disciplinary prevalence and associated factors for work-related discomfort in users of ultrasonography: Implications for sonography professionals and health care administrators. Journal of Diagnostic Medical Sonography, 39(4), 314-330. https://doi.org/10.1177/87564793231170016 Show abstract
Objective. Work-related discomfort is a pervasive issue among ultrasonography users. The Sonography Work Systems (SWS) framework was constructed as a means of examining relationships within and across components of the sonography work systems, work processes, and work/worker outcomes. A database of ultrasonography users was established as a foundation for a longitudinal survey study to examine worker health and well-being and explore the most salient work systems and process factors associated with work-related discomfort.
Materials and Methods. An estimated 100 000 unique ultrasonography users were invited to complete the online questionnaire through an e-mail campaign. Snowball sampling occurred through social media posts and encouragement for respondents to share the survey link with colleagues. The questionnaire included items that examined participant demographics, selected constructs from the SWS, and the prevalence of work-related musculoskeletal discomfort, visual discomfort, and headaches. Individual and multi-factorial regression models were conducted to examine SWS factors associated with the likelihood of experiencing the three types of work-related discomfort.
Results. A total of 3659 valid responses were included in the analysis, with 86% of respondents reporting that they regularly experienced musculoskeletal discomfort that they directly attributed to their work. About half (54.2%) of the respondents have engaged in sonography-related ergonomics training, and respondents indicated using adjustable equipment approximately 74% of the time. Workplace culture was rated as primarily positive, but respondents indicated that employers implement only two of seven commonly recommended ergonomic policies and procedures. Working in an organization with more policies, using adjustable equipment more frequently, taking more work breaks, engaging in a positive work culture, and minimizing interruptions to workflow were key factors associated with reduced likelihood of work-related discomfort.
Conclusion. This study provides a new framework for examining and addressing factors that contribute to ultrasonography users’ experience of work-related discomfort. Despite increased participation in ergonomics training and the use of adjustable equipment, the prevalence of work-related discomfort remains high among ultrasonography users. The findings highlight the need for attention to be directed at organizational factors and work processes to identify and implement evidence-based solutions to improve the health and well-being of medical ultrasound users.
Fukumura, Y. E., & Roll, S. C. (2023). Injury prevention through ergonomic assessment, education, and intervention: Healthy backpack wearing in school-aged children. In E. A. Pyatak & E. S. Lee (Eds.), 50 studies every occupational therapist should know (pp. 107-112). Oxford, UK: Oxford University Press. https://doi.org/10.1093/med/9780197630402.003.0015 Show abstract
Occupational therapists apply a holistic and transactional approach that differentiates them from other professionals who provide injury prevention services. The study reviewed in this chapter provides one example of how occupational therapists can provide an ergonomics intervention to promote healthy habits and postures, even in non-work settings. Specifically, the study by Feingold and Jacobs describes how a 30-minute ergonomics education session tailored to middle school children resulted in a change in backpack-wearing habits and reports of discomfort. This study is related to a national campaign led by occupational therapists for backpack safety awareness that includes an annual backpack awareness day at the start of each school year in the fall. Additional studies are noted that provide support for occupational therapy’s role in promoting healthy behaviors and reducing occupational and work-related injuries both within the profession and in other areas through ergonomic assessments, education, intervention, and product design.
Keywords. ergonomics, posture, school-aged child, trunk, musculoskeletal, occupational therapy, health education, prevention
Donnelly, M. R., Fukumura, Y. E., & Richter, M. (2022). Untapped sources of contextualized knowledge: Exploring occupational disruption during COVID-19 as showcased through YouTube parodies. Journal of Occupational Science, 29(3), 417-429. https://doi.org/10.1080/14427591.2021.1991841 Show abstract
The COVID-19 pandemic led to stay-at-home mandates and lockdowns around the globe. During this time of occupational disruption and social distancing measures, many engaged through online environments. Social media are ever-increasing hosts of occupation and participation, rich with research opportunities. In this study, we explored COVID-19 experiences by analyzing parody videos posted on YouTube by various content creators. We analyzed the lyrics of 27 viral videos (accrued 1 million or more views) by 20 content creators. Using a transactional framework, we identified five themes related to occupational disruption in the lyrics and explored the polarity of the concepts within each theme: old norms vs. new normal, time expanded vs. time condensed, control seeking vs. lack of control, social isolation vs. excess socialization, and cynicism vs. hope. Our findings demonstrated the complex transactions between previous habits and routines, changing spaces of occupation, and meaning of daily occupations within evolving social, economic, and physical contexts. While this study showcased YouTube videos as one untapped source of contextualized knowledge for occupational science, there is a need for further exploration of methodological and ethical challenges of studying digital content.
Rodrigues, P. B., Xiao, Y., Fukumura, Y. E., Awada, M., Aryal, A., Becerik-Gerber, B., Lucas, G., & Roll, S. C. (2022). Ergonomic assessment of office worker postures using 3D automated joint angle assessment. Advanced Engineering Informatics, 52, 101596. https://doi.org/10.1016/j.aei.2022.101596 Show abstract
Sedentary activity and static postures are associated with work-related musculoskeletal disorders (WMSDs) and worker discomfort. Ergonomic evaluation for office workers is commonly performed by experts using tools such as the Rapid Upper Limb Assessment (RULA), but there is limited evidence suggesting sustained compliance with expert’s recommendations. Assessing postural shifts across a day and identifying poor postures would benefit from automation by means of real-time, continuous feedback. Automated postural assessment methods exist; however, they are usually based on ideal conditions that may restrict users’ postures, clothing, and hair styles, or may require unobstructed views of the participants. Using a Microsoft Kinect camera and open-source computer vision algorithms, we propose an automated ergonomic assessment algorithm to monitor office worker postures, the 3D Automated Joint Angle Assessment, 3D-AJA. The validity of the 3D-AJA was tested by comparing algorithm-calculated joint angles to the angles obtained from manual goniometry and the Kinect Software Development Kit (SDK) for 20 participants in an office space. The results of the assessment show that the 3D-AJA has mean absolute errors ranging from 5.6° ± 5.1° to 8.5° ± 8.1° for shoulder flexion, shoulder abduction, and elbow flexion relative to joint angle measurements from goniometry. Additionally, the 3D-AJA showed relatively good performance on the classification of RULA score A using a Random Forest model (micro averages F1-score = 0.759, G-mean = 0.811), even at high levels of occlusion on the subjects’ lower limbs. The results of the study provide a basis for the development of a full-body ergonomic assessment for office workers, which can support personalized behavior change and help office workers to adjust their postures, thus reducing their risks of WMSDs.
Keywords. Ergonomic assessment; RULA; Engineering office environments; Depth camera; Computer vision; Machine learning
Fukumura, Y. E., Schott, J. M., Lucas, G. M., Becerik-Gerber, B., & Roll, S. C. (2021). Negotiating time and space when working from home: Experiences during COVID-19. OTJR: Occupation, Participation and Health, 41(4), 223-231. https://doi.org/10.1177/15394492211033830 Show abstract
Stay-at-home mandates following the COVID-19 pandemic increased work from home (WFH). While WFH offers many benefits, navigating work in nontraditional contexts can be a challenge. The objective of this study was to explore the benefits and challenges of WFH during COVID-19 to identify supports and resources necessary. Comments from two free-response questions on a survey regarding experiences of WFH (N = 648, N = 366) were analyzed using inductive qualitative content analysis. Four themes emerged: time use, considerations of working in the home space, intersections between work-life and home-life, and temporality of WFH as situated within a pandemic. Across all themes were concerns related to participation in both work and home roles, work performance, and well-being. Findings highlight the importance of support during times of disruption of occupational patterns, roles, and routines. Despite challenges, many individuals hoped to continue WFH. Organizations should consider the complex intersections of work-life and home-life to develop supportive policies and resources.
Keywords. work; survey; context; health; occupational balance
Fukumura, Y. E., McLaughlin Gray, J., Lucas, G., Becerik-Gerber, B., & Roll, S. C. (2021). Office worker perspective on an artificial intelligence workstation: A qualitative study. American Journal of Occupational Therapy, 75(Supplement_2), 7512505154. https://doi.org/10.5014/ajot.2021.75S2-RP154 Show abstract
Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This study explored office workers' perspectives on including artificial intelligence (AI) in their office workspace. Following an iterative analysis of six focus-group interviews with a total of 45 participants, three constructs emerged. Rich discussions demonstrated how acceptability of an AI workstation is complex and affected by the person, context, and their occupations.
Fukumura, Y. E., McLaughlin Gray, J., Lucas, G. M., Becerik-Gerber, B., & Roll, S. C. (2021). Worker perspectives on incorporating artificial intelligence into office workspaces: Implications for the future of office work. International Journal of Environmental Research and Public Health, 1(4), 1690. https://doi.org/10.3390/ijerph18041690 Show abstract
Workplace environments have a significant impact on worker performance, health, and well-being. With machine learning capabilities, artificial intelligence (AI) can be developed to automate individualized adjustments to work environments (e.g., lighting, temperature) and to facilitate healthier worker behaviors (e.g., posture). Worker perspectives on incorporating AI into office workspaces are largely unexplored. Thus, the purpose of this study was to explore office workers’ views on including AI in their office workspace. Six focus group interviews with a total of 45 participants were conducted. Interview questions were designed to generate discussion on benefits, challenges, and pragmatic considerations for incorporating AI into office settings. Sessions were audio-recorded, transcribed, and analyzed using an iterative approach. Two primary constructs emerged. First, participants shared perspectives related to preferences and concerns regarding communication and interactions with the technology. Second, numerous conversations highlighted the dualistic nature of a system that collects large amounts of data; that is, the potential benefits for behavior change to improve health and the pitfalls of trust and privacy. Across both constructs, there was an overarching discussion related to the intersections of AI with the complexity of work performance. Numerous thoughts were shared relative to future AI solutions that could enhance the office workplace. This study’s findings indicate that the acceptability of AI in the workplace is complex and dependent upon the benefits outweighing the potential detriments. Office worker needs are complex and diverse, and AI systems should aim to accommodate individual needs.
Keywords. workspace; office work; computer workstations; artificial intelligence
Tung, K. D., Fukumura, Y. E., Baker, N. A., Forrest, J. L., & Roll, S. C. (2019). Identifying an optimal sampling method to estimate postural risk in a dynamic work task. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 63(1), 1028-1033. https://doi.org/10.1177/1071181319631180 Show abstract
Introduction. The Rapid Upper Limb Assessment (RULA) is an ergonomic assessment tool used to screen for risk of musculoskeletal injury due to working posture. The RULA is traditionally applied once during a work task to approximate overall risk. No method exists for estimating a RULA score for work requiring frequent shifts in posture across an extended period of time.
Purpose. The goal of this study was to identify an optimal sampling method for applying the RULA across a long time-period that accurately represents overall risk.
Methods. Four right-handed female dental hygiene students were video recorded from three angles while performing hand scaling during patient clinic visits (88.97 minutes on average). RULA was continuously scored across the entire session, updating the score when a significant postural shift lasting for more than 15 seconds occurred. A time-weighted average (TWA) RULA score was calculated. Three sampling methods were evaluated: equivalent interval samples, random samples, and random samples selection weighted within “clock positions.” Each method was compared to the TWA using a paired samples t-test and percent difference.
Results. TWA RULA across the four students ranged from 3.4 to 4.3. Preliminary sampling averages using 10 samples were all within 0.2 of the TWA. Further iterations evaluating various sample sizes is ongoing.
Discussion. Preliminary results suggest that all three sampling methods provide a reasonably accurate approximation of the TWA score at the sampling rate tested. Future iterations of this analysis will be continued to identify the minimum required sampling rate to meet our TWA criterion.
Roll, S. C., Tung, K. D., Chang, H., Sehremelis, T. A., Fukumura, Y. E., Randolph, S., & Forrest, J. L. (2019). Prevention and rehabilitation of musculoskeletal disorders in oral health care professionals: A systematic review. The Journal of the American Dental Association, 150(6), 489-502. https://doi.org/10.1016/j.adaj.2019.01.031 Show abstract
Background. The authors’ objective in this systematic review was to describe the evidence for preventive and rehabilitative interventions for musculoskeletal disorders in oral health care.
Types of Studies Reviewed. The authors conducted systematic search, screening, and eligibility processes to identify experimental, quasiexperimental, observational, and survey research studies in which the investigators either directly evaluated or predicted the effects of preventive or rehabilitative interventions on the reduction of musculoskeletal symptoms in oral health care professionals.
Results. The authors identified and screened 3,571 unique abstracts, assessed 256 full-text articles for eligibility, and included 34 articles in the review. Investigators in 17 experimental studies described the results of preventive or rehabilitation interventions and in 17 survey research studies predicted or correlated preventive or protective techniques to a reduction in musculoskeletal symptoms. The primary techniques evaluated in the studies included equipment modification, ergonomic training, and physical exercise.
Conclusions and Practical Implications. The evidence suggests that magnification loupes and indirect-vision techniques have a positive effect on the reduction of musculoskeletal symptoms. In terms of evaluating intervention efficacy, other techniques have mixed evidence or are limited by low-level study design.
Keywords. Ergonomics; injury prevention; musculoskeletal disorders; dentists; dental hygienists
Work-from-home survey reveals pandemic’s impacts upon employees’ physical and mental health, productivity and daily routines ⟩
November 17, 2021
How to support office workers’ health and wellness, when the “office” can be located anywhere.
July 9, 2018
Student-led Occupational Therapy and Science Council organizes OT Month activities.