Development of a miniaturized motion sensor for tracking warning signs of low-back pain

Low-back pain (LBP) is a widespread disease which can also be highly disabling, but physicians lack of basic understanding and diagnosis tools. During this study, we have designed and built a new wearable device capable of detecting features helpful in LBP follow-up while being non-invasive. The device has been carefully validated, and shows good metrological features, with small noise level ($\sigma$ = 1{\textdegree}) and no observable drift. Two simple exercises were proposed to two young volunteers, one of them with LBP history. These exercises are designed to target two characteristics: the lumbar lordosis angle and the hip \& shoulder dissociation. Even if no general rules can be extracted from this study, we have shown that Inertial Measurement Units (IMU) are able to pick up those characteristics and the obtained values are meaningful refereeing to LBP disease. Henceforth, we are confident in going to clinical studies to investigate the link between back related feature and LBP, in particular the hip \& shoulder dissociation which is poorly documented

Assessing the Utility of a Video-Based Motion Capture Alternative in the Assessment of Lumbar Spine Planar Angular Joint Kinematics

Markerless motion capture is a novel technique to measure human movement kinematics. The purpose of this research is to evaluate the markerless algorithm, DeepLabCut (DLC) against a 3D motion capture system (Vicon Motion Systems Ltd., Oxford, UK) in the analysis of planar spine and elbow flexion-extension movement. Data were acquired concurrently from DLC and Vicon for all movements. A novel DLC model was trained using data derived from a subset of participants (training group). Accuracy and precision were assessed from data derived from the training group as well as in a new set of participants (testing group). Two-way SPM ANOVAs were used to detect significant differences between the training vs. testing sets, capture methods (Vicon vs. DLC), as well as potential higher order interaction effect between these independent variables in the estimation of flexion extension angles and variability. No significant differences were observed in any planar angles, nor were any higher order interactions observed between each motion capture modality and the training vs. testing datasets. Bland Altman plots were also generated to depict the mean bias and level of agreement between DLC and Vicon for both training, and testing datasets. Supplemental analyses, suggest that these results are partially affected by the alignment of each participant’s body segments with respect to each planar reference frame. This research suggests that DLC-derived planar kinematics of both the elbow and lumbar spine are of acceptable accuracy and precision when compared to conventional laboratory gold-standards (Vicon)

Wearable Technology Supported Home Rehabilitation Services in Rural Areas:– Emphasis on Monitoring Structures and Activities of Functional Capacity Handbook

The sustainability of modern healthcare systems is under threat. – the ageing of the population, the prevalence of chronic disease and a need to focus on wellness and preventative health management, in parallel with the treatment of disease, pose significant social and economic challenges. The current economic situation has made these issues more acute. Across Europe, healthcare expenditure is expected to rice to almost 16% of GDP by 2020. (OECD Health Statistics 2018). Coupled with a shortage of qualified personnel, European nations are facing increasing challenges in their ability to provide better-integrated and sustainable health and social services. The focus is currently shifting from treatment in a care center to prevention and health promotion outside the care institute. Improvements in technology offers one solution to innovate health care and meet demand at a low cost. New technology has the potential to decrease the need for hospitals and health stations (Lankila et al., 2016. In the future the use of new technologies – including health technologies, sensor technologies, digital media, mobile technology etc. - and digital services will dramatically increase interaction between healthcare personnel and customers (Deloitte Center for Health Solutions, 2015a; Deloitte Center for Health Solutions 2015b). Introduction of technology is expected to drive a change in healthcare delivery models and the relationship between patients and healthcare providers. Applications of wearable sensors are the most promising technology to aid health and social care providers deliver safe, more efficient and cost-effective care as well as improving people’s ability to self-manage their health and wellbeing, alert healthcare professionals to changes in their condition and support adherence to prescribed interventions. (Tedesco et al., 2017; Majumder et al., 2017). While it is true that wearable technology can change how healthcare is monitored and delivered, it is necessary to consider a few things when working towards the successful implementation of this new shift in health care. It raises challenges for the healthcare systems in how to implement these new technologies, and how the growing amount of information in clinical practice, integrates into the clinical workflows of healthcare providers. Future challenges for healthcare include how to use the developing technology in a way that will bring added value to healthcare professionals, healthcare organizations and patients without increasing the workload and cost of the healthcare services. For wearable technology developers, the challenge will be to develop solutions that can be easily integrated and used by healthcare professionals considering the existing constraints. This handbook summarizes key findings from clinical and laboratory-controlled demonstrator trials regarding wearables to assist rehabilitation professionals, who are planning the use of wearable sensors in rehabilitation processes. The handbook can also be used by those developing wearable sensor systems for clinical work and especially for use in hometype environments with specific emphasis on elderly patients, who are our major health care consumers

Review of Wearable Devices and Data Collection Considerations for Connected Health

Wearable sensor technology has gradually extended its usability into a wide range of well-known applications. Wearable sensors can typically assess and quantify the wearer’s physiology and are commonly employed for human activity detection and quantified self-assessment. Wearable sensors are increasingly utilised to monitor patient health, rapidly assist with disease diagnosis, and help predict and often improve patient outcomes. Clinicians use various self-report questionnaires and well-known tests to report patient symptoms and assess their functional ability. These assessments are time consuming and costly and depend on subjective patient recall. Moreover, measurements may not accurately demonstrate the patient’s functional ability whilst at home. Wearable sensors can be used to detect and quantify specific movements in different applications. The volume of data collected by wearable sensors during long-term assessment of ambulatory movement can become immense in tuple size. This paper discusses current techniques used to track and record various human body movements, as well as techniques used to measure activity and sleep from long-term data collected by wearable technology devices

Multisensory Wearable Motion Analysis in Spine Biomechanics

Textile based piezoresistive transducers are an innovative category of devices that use yarns made of conductive and elastic fibers or screen printed conductive rubber coatings to sense strain. They usually satisfy wearability requirements and are used in real-time information gathering systems, being comfortable, ubiquitous and available for long term monitoring. They include knitted fiber transducers (KFTs), sewed fiber transducers (SFTs) and smeared redundant elastomer (SRETs) transducers. In the latter category, SRETs constituted by Conductive Elastomers (CEs) have been commonly employed as strain sensors networks to detect human posture and gesture. Elastic interconnection wiring is also easily realized leading to monolithic fabrication techniques which avoid the presence of metal wires and multiple solderings. Despite this, there is a strong dependence of the system performance by the body structure garment fitting. Moreover, the non-linear dynamical behaviour of SRETs requires identification algorithms, functions which relate joint angles to electrical values presented by the sensor network. The construction of these functions is quite complex and time of computation dramatically increases with the number of degrees of freedom and with the accuracy required to the system to be resolved. Recent development of CEs sensor modeling overcomed some of their main limitations and introduced new fields of operability in SRETs networks. In particular, in strain applications, a useful data processing technique is presented for treating the non-linear dynamical response, considering the different behaviour in sensor elongation and relaxation: actually, when the sensor in stretched, the breakdown of carbon black agglomerates produces an increase in resistance. Inversely, when the sensor is relaxed, the cross-link readjustment lead to different electrically conductive paths in respect to the previous states. This technique has found its implementation in multisensory systems, leading to encouraging results in biomechanical reconstruction. Furthermore, a novel approach in CEs sensing is described, relating the global curvature of a layer to its electrical resistance value variation and exploring under which conditions the resistance can be considered uncorrelated with its particular local bending profile. These devices are called Smeared Conductive Elastomer Electrogoniometers (SCEEGs) and under particular configuration they can be employed as on-body electrogoniometers. The integration of SRET arrays and SCEEGs is definitely a powerful tool for human body posture and gesture reconstruction through efficient and fast algorithms. Moreover In this study we introduce a particular realization of CE strain sensors deposed on an adhesive taping, obtaining a very low skin artifact device (VLSA). We present an electrogoniometric system in which the inextensible insulating layer has been replaced by an elastic layer, allowing the system to be employed both as strain sensor and as electrogoniometer. Finally, we present a biomechanical application in lumbar spine posture monitorization. As a matter of fact, it is known from literature that in the sagittal balance there is a strong correlation with the torso angle and geometrical parameters of lumbar vertebraes, such as the angle between subsequent upper endplates. Data obtained from piezoresistive sensors are so suitable to be used in biomechanical analysis in order to predict forces and moments acting on the functional spinal units

A wireless body sensor network for clinical assessment of the flexion-relaxation phenomenon

none5noAn accurate clinical assessment of the flexion-relaxation phenomenon on back muscles requires objective tools for the analysis of surface electromyography signals correlated with the real movement performed by the subject during the flexion-relaxation test. This paper deepens the evaluation of the flexion-relaxation phenomenon using a wireless body sensor network consisting of sEMG sensors in association with a wearable device that integrates accelerometer, gyroscope, and magnetometer. The raw data collected from the sensors during the flexion relaxation test are processed by an algorithm able to identify the phases of which the test is composed, provide an evaluation of the myoelectric activity and automatically detect the phenomenon presence/absence. The developed algorithm was used to process the data collected in an acquisition campaign conducted to evaluate the flexion-relaxation phenomenon on back muscles of subjects with and without Low Back Pain. The results have shown that the proposed method is significant for myoelectric silence detection and for clinical assessment of electromyography activity patterns.openPaoletti M.; Belli A.; Palma L.; Vallasciani M.; Pierleoni P.Paoletti, M.; Belli, A.; Palma, L.; Vallasciani, M.; Pierleoni, P

Assessment of spinal and pelvic kinematics using inertial measurement units in clinical subgroups of persistent non-specific low back pain

Inertial measurement units (IMUs) offer a portable and quantitative solution for clinical movement analysis. However, their application in non-specific low back pain (NSLBP) remains underexplored. This study compared the spine and pelvis kinematics obtained from IMUs between individuals with and without NSLBP and across clinical subgroups of NSLBP. A total of 81 participants with NSLBP with flexion (FP; n = 38) and extension (EP; n = 43) motor control impairment and 26 controls (No-NSLBP) completed 10 repetitions of spine movements (flexion, extension, lateral flexion). IMUs were placed on the sacrum, fourth and second lumbar vertebrae, and seventh cervical vertebra to measure inclination at the pelvis, lower (LLx) and upper (ULx) lumbar spine, and lower cervical spine (LCx), respectively. At each location, the range of movement (ROM) was quantified as the range of IMU orientation in the primary plane of movement. The ROM was compared between NSLBP and No-NSLBP using unpaired t-tests and across FP-NSLBP, EP-NSLBP, and No-NSLBP subgroups using one-way ANOVA. Individuals with NSLBP exhibited a smaller ROM at the ULx (p = 0.005), LLx (p = 0.003) and LCx (p = 0.01) during forward flexion, smaller ROM at the LLx during extension (p = 0.03), and a smaller ROM at the pelvis during lateral flexion (p = 0.003). Those in the EP-NSLBP group had smaller ROM than those in the No-NSLBP group at LLx during forward flexion (Bonferroni-corrected p = 0.005), extension (p = 0.013), and lateral flexion (p = 0.038), and a smaller ROM at the pelvis during lateral flexion (p = 0.005). Those in the FP-NSLBP subgroup had smaller ROM than those in the No-NSLBP group at the ULx during forward flexion (p = 0.024). IMUs detected variations in kinematics at the trunk, lumbar spine, and pelvis among individuals with and without NSLBP and across clinical NSLBP subgroups during flexion, extension, and lateral flexion. These findings consistently point to reduced ROM in NSLBP. The identified subgroup differences highlight the potential of IMU for assessing spinal and pelvic kinematics in these clinically verified subgroups of NSLBP

작업 관련 근골격계 질환의 위험성 저감을 위한 작업 자세 및 동작의 인간공학 연구

학위논문(박사) -- 서울대학교대학원 : 공과대학 산업공학과, 2022.2. 박우진.육체적 부하가 큰 자세 및 동작으로 작업을 수행하는 것은 작업자의 근골격계 질환의 위험성을 증가시킨다. 작업자의 근골격계에 가해지는 육체적 부하의 양상은 수행하는 작업의 종류에 따라 달라진다. 장시간 앉은 자세로 작업을 수행하는 경우, 작업자의 근육, 인대와 같은 연조직에 과도한 부하가 발생하여 목, 허리 등 다양한 신체 부위에서 근골격계 질환의 위험성이 증가할 수 있다. 따라서, 착좌 시 발생할 수 있는 근골격계 질환의 위험성을 저감하기 위해서는 작업자의 착좌 자세를 실시간으로 모니터링하고, 이에 대한 피드백을 제공하는 것이 필요하다. 들기 작업과 같은 동적인 움직임이 포함된 작업을 수행하는 경우, 작업자의 체중이 신체적 부하에 영향을 미칠 수 있다. 전세계적인 비만의 유행으로 인해 많은 작업자들이 체중 증가를 겪고 있고, 들기 작업과 같은 동적인 작업에서 비만은 신체적 부하에 악영향을 미칠 수 있다. 따라서, 비만과 작업 관련 근골격계 질환의 위험성은 잠재적인 연관성을 가지고 있고, 비만이 들기 작업에 미치는 생체역학적 영향을 논의할 필요성이 있다. 작업장에서의 근골격계 질환의 위험성을 저감하기 위해 다양한 연구들이 수행되어 왔지만, 작업 시스템의 인간공학적 설계 측면에서 추가적인 연구가 필요하다. 장시간 의자에 앉아 정적인 작업을 수행하는 작업자의 근골격계 질환을 저감하기 위한 유망한 방법 중 하나로, 작업자의 자세를 실시간으로 모니터링하고 분류하는 시스템을 개발하는 것이 제안되고 있다. 이러한 시스템은 작업자가 근골격계 질환의 위험성이 낮은 자세를 작업 시간 동안 유지하도록 돕는 데 활용될 수 있을 것이다. 기존의 대부분의 자세 모니터링 시스템에서는 분류할 자세를 정의하는 과정에서 인간공학적 문헌이 거의 고려되지 않았고, 사용자가 실제로 활용하기에는 여러 한계점들이 존재하였다. 들기 작업의 경우, 체질량 지수(BMI) 40 이상의 초고도 비만 작업자의 동작 패턴을 논의한 연구는 거의 찾아볼 수 없었다. 또한, 다양한 들기 작업 조건 하에서 전신 관절들의 움직임을 생체역학적 측면에서 분석한 연구는 부족한 실정이다. 따라서, 본 연구에서의 연구 목적은 1) 다양한 센서 조합을 활용한 실시간 착좌 자세를 분류하는 시스템을 개발하고, 2) 들기 작업 시 초고도 비만이 개별 관절의 움직임과 들기 동작 패턴에 미치는 영향을 이해하여, 다양한 종류의 작업에서 발생할 수 있는 근골격계 질환의 위험성을 저감하는 것이다. 연구 목적을 달성하기 위해 다음의 두 가지 연구를 수행하였다. 첫번째 연구에서는 실시간으로 착좌 자세를 분류하는 스마트 의자 시스템을 개발하였다. 스마트 의자 시스템은 각각 여섯 개의 거리 센서와 압력 센서를 조합하여 구성되었다. 착좌 관련한 근골격계 질환에 대해 문헌 조사를 수행하였고, 이를 바탕으로 결정된 자세들에 대해 서른 여섯 명의 데이터를 수집하였다. 스마트 의자 시스템에서 자세를 분류하기 위해 kNN 알고리즘을 활용하였고, 성능을 검증하기 위해 단일 종류의 센서로 구성된 기준 모델들과 비교를 수행하였다. 분류 성능을 비교한 결과, 센서를 조합한 스마트 의자 시스템이 가장 우수한 결과를 보였다. 두번째 연구에서는 들기 작업을 수행할 때 초고도 비만이 개별 관절의 움직임과 동작 패턴에 미치는 영향을 분석하기 위해 모션 캡쳐 실험을 수행하였다. 들기 실험에는 근골격계 질환 이력이 없는 서른 다섯 명이 참여하였다. 수집된 데이터를 바탕으로 주요 관절(발목, 무릎, 엉덩이, 허리, 어깨, 팔꿈치) 별 운동역학적 변수들과, 들기 동작의 패턴을 표현하는 동작 지수들을 계산하였다. 들기 작업 조건과 비만 수준에 따라, 대부분의 변수에서 통계적으로 유의한 차이를 보였다. 전체적으로 비만인은 정상체중인에 비해 다리 보다 허리를 사용하여 들기 작업을 수행하였고, 동작 수행 시 상대적으로 적은 관절 각도 변화와 느린 움직임을 보였다. 들기 작업에서 박스의 이동에 개별 관절이 기여하는 비율도 정상체중인과 비만인은 다른 패턴을 보였다. 본 연구의 결과를 활용하여 다양한 종류의 신체적 부하에 노출된 작업자들의 근골격계 질환의 위험성을 저감할 수 있고, 궁극적으로 업무의 생산성과 개인의 건강을 제고할 수 있을 것이다. 첫번째 연구에서 개발된 스마트 의자 시스템은 기존 자세 분류 시스템의 단점들을 완화하였다. 개발된 시스템은 저렴한 소수의 센서만을 활용하여 근골격계 측면에서 중요한 자세들을 높은 정확도로 분류하였다. 이러한 자세 분류 시스템은 작업자에게 실시간으로 자세 피드백을 제공하여, 근골격계 질환의 위험성이 낮은 자세를 유지하는 데 활용될 수 있을 것이다. 두번째 연구의 결과는 동적인 작업 시 초고도 비만으로 인한 잠재적인 근골격계 질환의 위험성을 이해하는 데 활용될 수 있다. 초고도 비만인과 정상체중인 간 관절의 움직임과 동작의 차이를 이해하여, 비만을 고려한 인간공학적 작업장 설계와 동작 가이드라인을 제공할 수 있을 것이다.Working in stressful postures and movements increases the risk of work-related musculoskeletal disorders (WMSDs). The physical stress on a worker’s musculoskeletal system depends on the type of work task. In the case of sedentary work, stressful sitting postures for prolonged durations could increase the load on soft connective tissues such as muscles and ligaments, resulting in the incidence of WMSDs. Therefore, to reduce the WMSDs, it is necessary to monitor a worker’s sitting posture and additionally provide ergonomic interventions. When the worker performs a task that involves dynamic movements, such as manual lifting, the worker’s own body mass affects the physical stress on the musculoskeletal system. In the global prevalence of obesity in the workforce, an increase in the body weight of the workers could adversely affect the musculoskeletal system during the manual lifting task. Therefore, obesity could be associated with the development of WMSDs, and the impacts of obesity on workers’ movement during manual lifting need to be examined. Despite previous research efforts to prevent WMSDs, there still exist research gaps concerning ergonomics design of work systems. For sedentary workers, a promising solution to reduce the occurrence of WMSDs is the development of a system capable of monitoring and classifying a seated worker's posture in real-time, which could be utilized to provide feedback to the worker to maintain a posture with a low-risk of WMSDs. However, the previous studies in relation to such a posture monitoring system lacked a review of the ergonomics literature to define posture categories for classification, and had some limitations in widespread use and user acceptance. In addition, only a few studies related to obesity impacts on manual lifting focused on severely obese population with a body mass index (BMI) of 40 or higher, and, analyzed lifting motions in terms of multi-joint movement organization or at the level of movement technique. Therefore, the purpose of this study was to: 1) develop a sensor-embedded posture classification system that is capable of classifying an instantaneous sitting posture as one of the posture categories discussed in the ergonomics literature while not suffering from the limitations of the previous system, and, 2) identify the impacts of severe obesity on joint kinematics and movement technique during manual lifting under various task conditions. To accomplish the research objectives, two major studies were conducted. In the study on the posture classification system, a novel smart chair system was developed to monitor and classify a worker’s sitting postures in real-time. The smart chair system was a mixed sensor system utilizing six pressure sensors and six infrared reflective distance sensors in combination. For a total of thirty-six participants, data collection was conducted on posture categories determined based on an analysis of the ergonomics literature on sitting postures and sitting-related musculoskeletal problems. The mixed sensor system utilized a kNN algorithm for posture classification, and, was evaluated in posture classification performance in comparison with two benchmark systems that utilized only a single type of sensors. The mixed sensor system yielded significantly superior classification performance than the two benchmark systems. In the study on the manual lifting task, optical motion capture was conducted to examine differences in joint kinematics and movement technique between severely obese and non-obese groups. A total of thirty-five subjects without a history of WMSDs participated in the experiment. The severely obese and non-obese groups show significant differences in most joint kinematics of the ankle, knee, hip, spine, shoulder, and elbow. There were also significant differences between the groups in the movement technique index, which represents a motion in terms of the relative contribution of an individual joint degree of freedom to the box trajectory in a manual lifting task. Overall, the severely obese group adopted the back lifting technique (stoop) rather than the leg lifting technique (squat), and showed less joint range of excursions and slow movements compared to the non-obese group. The findings mentioned above could be utilized to reduce the risk of WMSDs among workers performing various types of tasks, and, thus, improve work productivity and personal health. The mixed sensor system developed in this study was free from the limitations of the previous posture monitoring systems, and, is low-cost utilizing only a small number of sensors; yet, it accomplishes accurate classification of postures relevant to the ergonomic analyses of seated work tasks. The mixed sensor system could be utilized for various applications including the development of a real-time posture feedback system for preventing sitting-related musculoskeletal disorders. The findings provided in the manual lifting study would be useful in understanding the potential risk of WMSDs for severely obese workers. Differences in joint kinematics and movement techniques between severely obese and non-obese groups provide practical implications concerning the ergonomic design of work tasks and workspace layout.Chapter 1. Introduction 1 1.1 Research Background 1 1.2 Research Objectives 5 1.3 Dissertation Outline 6 Chapter 2. Literature Review 8 2.1 Work-related Musculoskeletal Disorders Among Sedentary Workers 8 2.1.1 Relationship Between Sitting Postures and Musculoskeletal Disorders 8 2.1.2 Systems for Monitoring and Classifying a Seated Worker's Postures 10 2.2 Impacts of Obesity on Manual Works 22 2.2.1 Impacts of Obesity on Work Capacity 22 2.2.2 Impacts of Obesity on Joint Kinematics and Biomechanical Demands 24 Chapter 3. Developing and Evaluating a Mixed Sensor Smart Chair System for Real-time Posture Classification: Combining Pressure and Distance Sensors 27 3.1 Introduction 27 3.2 Materials and Methods 33 3.2.1 Predefined posture categories for the mixed sensor system 33 3.2.2 Physical construction of the mixed sensor system 36 3.2.3 Posture Classifier Design for the Mixed Sensor System 38 3.2.4 Data Collection for Training and Testing the Posture Classifier of the Mixed Sensor System 41 3.2.5 Comparative Evaluation of Posture Classification Performance 43 3.3 Results 46 3.3.1 Model Parameters and Features 46 3.3.2 Posture Classification Performance 47 3.4 Discussion 50 Chapter 4. Severe Obesity Impacts on Joint Kinematics and Movement Technique During Manual Load Lifting 57 4.1 Introduction 57 4.2 Methods 61 4.2.1 Participants 61 4.2.2 Experimental Task 61 4.2.3 Experimental Procedure 64 4.2.4 Data Processing 65 4.2.5 Experimental Variables 67 4.2.6 Statistical Analysis 71 4.3 Results 72 4.3.1 Kinematic Variables 72 4.3.2 Movement Technique Indexes 83 4.4 Discussion 92 Chapter 5. Conclusion 102 5.1 Summary 102 5.2 Implications 105 5.3 Limitations and Future Directions 106 Bibliography 108 국문초록 133박