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Design, development and

implementation of wearable devices for
backstress measurement

Low back pain (LBP) is a major health and socioeconomic problem in modern
society. There is little information about LBP in general or working population in
developing and low income country. LBP prevalence has been found to range from
6.2% to 92% with increase of prevalence with age and female population. Low
back pain is a leading cause of disability. It occurs in similar proportions in all
cultures, interferes with quality of life and work performance, and is the most
common reason for medical consultations. Few cases of back pain are due to
specific causes; most cases are non-specific.
Low socioeconomic status, poor education, previous history of LBP, physical
factors such as lifting heavy loads, repetitive job, prolonged static posture and
awkward posture, psychosocial factors such as anxiety, depression, job
dissatisfaction, lack of job control and mental stress, working hours and obesity
have been found to be associated with LBP. Cross-sectional and prospective
studies have consistently shown that smokers have a 1.5 2.5 increased risk of
back pain compared to non-smoker.
It will eventually affect almost everyone in life, men and women equally.The
lifetime prevalence of low back pain is estimated at 60-85%,while the annual
prevalence in the general population is ranging from 15-45%.The annual incidence
of back pain in thegeneral population is estimated between 10%-15%.
Low back pain causes more disability around the globe than any other condition,
and accounts for a third of all work related disability, according to new research.
Almost one in 10 people (9.4 per cent) worldwide suffer from low back pain,
researchers found.
It is widely believed that 90% of episodes of low back pain seen in general practice
resolve within one month.In a large population based study we examined the
outcome of episodes of low back pain in general practice with respect to both
consultation behaviour and self reported pain and disabilityWhile 90% of subjects
consulting general practice with low back pain ceased to consult about the
symptoms within three months, most still had substantial low back pain and related
disability.Only 25% of the patients who consulted about low back pain had fully
recovered 12 months later.Since most consulters continue to have long term low
back pain and disability, effective early treatment could reduce the burden of these
symptoms and their social, economic, and medical impact.

Mean direct and indirect costs for LBP care are about twice as high for patients
with chronic LBP compared to acutely ill patients.Indirect costs account for more
than 52% to 54% of total costs.About 25% of direct costs refer to theraputeic
procedures and hospital or rehabilitational care.Patients with high disability and
limitations in daily living show a 2-5 fold change for subsequent high health care
costs.Depression seems to be highly relevant for direct health care utilization.

What is back pain?

Back pain is pain felt in the back. Episodes of back pain may be acute, sub-acute,
or chronic depending on the duration. The pain may be characterized as a dull
ache, shooting or piercing pain, or a burning sensation.

Lower back strain is acute pain caused by damage to the muscles and ligaments of
the back. It is often referred to as a pulled muscle. The back is supported by a
large, complex group of muscles that hold up the spine, including the extensor,
flexor, and oblique muscles. The soft tissues surrounding the spine enable bending
forward, lifting, arching, and twisting movements.

Lumbar muscle strain occurs when a back muscle is over-stretched or torn, which
damages the muscle fibers. When one of the ligaments in the back tears, it is
referred to as a sprain.Movements that put stress on the back can result in pulled
muscles. For example, lifting a heavy object, twisting while lifting, falling, or some
sports could cause lumbar muscle strain.Symptoms of lumbar muscle strain include
sudden onset of pain, localized pain that does not radiate into the leg, and
tenderness in the lower back.Muscle strain can by accompanied by muscle spasms,
as the body tries to stabilize the injury.

Acute pain from a lower back strain can resolve in a short amount of time, but low
levels of pain or flare-ups can continue for weeks or months after the initial injury.
After two weeks, back muscles can atrophy from lack of use and cause more pain.

LBP is one of the most common musculoskeletal disorders, with a reported

lifetime prevalence of up to 90% . In the working-age population, the medical costs
associated with LBP exceed those of coronary artery disease, respiratory
infections, and diabetes [4]. More importantly, the indirect costs of LBP because of
lost productivity and early retirement likely surpass the substantial medical costs .
Given its occurrence in working-age adults, LBP is as a major occupational health

Causes of back pain-

Poor posture

Overexerting yourself at work or while playing

Sitting incorrectly at the desk or at the steering wheel

Pushing, pulling, and lifting things carelessly

For instance, one study published in June 2015 in the Saudi Medical
Journal looked at 1,669 patients at a Saudi university hospital.

After studying the individuals in that region, researchers concluded that lumbar
spine disorders affected just over half (53 percent) of that population and cervical
spine disorders accounted for 27 percent. Furthermore, they also found that
cervical spondylosis occurred with relative frequency for patients over 30 years of

Another study was conducted in Hungary, some 3,440 air miles away, and
published in International Orthopaedics. It looked at 10,000 people from that
region and noted that slightly fewer, or 44 percent of the people studied, reportedly
experienced pain in the lower back within the previous 30 days.

Literature review-
1) Rahman Shiri [1]- : in this the 40 studies were conducted from which author
concluded that both current and former smokers have a higher prevalence and
incidence of low back pain than people who never smoke, but the association is
fairly modest. It was found that The association between current smoking and the
incidence of low back pain is stronger in adolescents than in adults.

2) Federico Balagu[2]-it discusses the causes Non-specifi c low back pain which
has become a major public health problem worldwide. Mechanical factors, such as
lifting and carrying, probably do not have a major pathogenic role, but genetic
constitution is important. It also discusses the clinical examination that are
included in most diagnostic guidelines, but the use of clinical imaging for
diagnosis should be restricted. The effects of treatment is low so both patient
preferences and clinical evidence should be taken into account for pain
management, but generally self-management is recommended and surgery and
overtreatment should be avoided.

3) Simon Dagenais[3]- : The economic burden of low back pain (LBP) is very
large and appears to be growing.The jounal discusses the indirect and direct cost
for low back pain.Direct pain includes medical services,doctor visits,diagnostic
testing incurred during findings of disease.It may also include transportation
costs,meal taken outside while addressing the disease.Indirect costs may incur loss
of productivity ,more often absent from work which may cause loss of work for the
clients indirectly increasing economic burden on nation. It did studies on various
countries and calculated its direct and indirect cost occurring due to low back pain.

4) A. Chhikara[4]-This authors discusses the need for all time monitoring for low
back pain instead of visiting a doctor everytime.It does assessment of inertial
sensors i.e(3-d accelerometer and 3-d gyroscope) being employed on human body
which can act as a measure for detecting pain.It discusses the placement of sensors
on to the body.

5) Alexandros[7]-In this the author describes the various sensors which are
available for monitoring biosignals in humans e.g accelerometers,skin galvanic
response,pulse oximeters.It discusses the recent developments in wearable
prototypes being made for humans.e.gsystem based on smart textiles.It discusses
various communication technologies being used for these devices.e.g
Bluetooth,zigbee,Wimax etc.It gives advantages and disadvantages of using these
technologies.It also discusses some of the commercially available prototypes in the
market.e.gLiveNet.smartvest,CodeBlue,Magic,LifeGuard etc

6) E. Sardini[8]- This journal discusses wearable belt device is composed of the

electronics and sensors for the monitoring of electrocardiogram (ECG), heart rate
(HR) derived from ECG signals by determining the R-R intervals, body
temperature, respiratory rate, and three axis movement (acceleration and position)
of the subject measured using an accelerometer. The experimental results showed
that the the heartbeats and the patient movements can be obtained clearly by the
device. The instrumented wearable belt was made in mind especially for home
health care management of aged people.

7)Baquapuri HI[9]-In this journal a prototype for backstress is made using

accelerometers,audio sensors to measure position and respiration rate of subject on
which device is implemented.They implemented it on a vest which was worn by
the subject.The data from sensors was passed on to adc then to the atmege 328
microcontroller for preprocessing.The data was transmitted wirelessly using
Bluetooth to a sub-station i.e a cell phone.

8)Carlo J[10]- EMG signal undergoes a compression in the frequency domain

during a sustained muscle contraction .This journal discusses how the frequencies
of Emg pattens of back muscles can be used to distinguish people having low back
pain. Special electrodes for Emg and fatigue monitoring are utilized and put in use

9)Corey Hunter[11]- As muscles account for greater than 50% of the body by
weight, it is not surprising that nearly 70% of the cases diagnosed as nonspecific or
idiopathic back pain are assumed to be the result of soft tissue sprains and strains.
This article discusses a MPDD device that uses an interferential current produced
through an aluminum head that moves easily over the skin and causes the
stimulated muscle to contract. This allows the examiner to run the current along
the suspected muscle from origin to see if pain is consistently produced. When
used on an unaffected or normal muscle, the patient will simply experience
painless contraction of the muscle.

10) Yong Yu[18]-This device was constructed as a need to lessen the tension in
back muscles during stooping activity in agriculture. They made a device which
could reduce the stress or strain in back muscles by using tension bands clung at
the back of body from the shoulder to the feet level. During bending a whole
circuit of pulley,sevomotors and tension bands operate together to reduce the strain
occurred during bending.its advantage was it weight which was lighter than earlier
measuring devices around 400gm.The disadvantage was the battery which has to
be recharged every 1.625hrs.also the system was curbomesome to wear for all day

11)Moshri[19]-They employed flexible textile sensors around 20 to be integrated

on to the back to measure body and trunk movements.They were integrated on to
clothing i.e at the back of shirtIt is a comfort table system as compared to other
trunk measurement devices.No proper measurements were done for proper location
of sensors.

12)noura[20]-They developed a system for continuous measurement of spine and

neck through use of inclinometer at neck and load cells at soles of shoes .The
sensor at neck was used to measure the bend angle of neck i.e in correcting the
forward posture of neck and the soles at shoes were used to calculate time spent
during each of these activity(standing,walking,sitting).A particular threshold value
was calculated which when exceeded would go beyond a limit and issue a warning
through sms.

13)zawawi[21]-zawawi used a plastic fibre optic sensor to measure the tilt angle of
spine for self correcting of posture.the range of sensor for measurement was
limited to low range of bending angle i.e -10 degree to 19 degree.after this the
sensor showed inaccuracy in sensor readings .also the output would be deviated
due to temperature changes in the sensor.

14)Hosub[22]-He designed a system smartpose in which first the facial features of

face are extracted using an algorithm to detect whether the user is looking on to the
phone .if confirmed then the tilt angle of mobile is measured using orientation
sensor as a person goes on to a foreward head posture while looking on to the
phone which generates a alarm on exceeding a level .

Key findings from literature review-

Lowback pain is increasing at a rapid rate in india.A lot of research on causes of

back pain and its prevention have been formulated by many researchers.Many
theories and some prototype for back pain detection have been formulated and
implemented.They have been done using batteries .But I propose it to do using
energy harvesting technique e.g piezoelectric transducer as energy is a very scarce
resource and making a wearable device for for all day monitoring may cause lot of
energy consumption.

Problem Formulation- My problem formulation is-

Design,development and implementation of wearable devices for backstress

1. To design a backstress or backpain measurement system for detection of
pain .
2. Implementation of system by hardware
3. Validation of system

Methodology of Research Work-











The sensor used is flexi force sensor.zigbee will be used for wireless
transmission.piezoelectric transducer will be used for power generation whose
power will be saved in a mobile phone battery or capacitor.The simulation will be
done on matlab.

1.Algorithm software-
Study of sensors
Study and testing of zigbee module
Study of matlab software and tools
2.Algorithm for hardware-

Selection of sensor and components

Study of microcontroller and integrating all components with
microcontroller on a platform.
Integrating wireless module with sensor and platform
3.Integrating hardware with software
4.Testing and evaluation of design on subject.

Operation Schedule
1. Course Work Completion
2. Abstract/ Synopsis
3. Progress Presentation (Literature Review)
4. Progress Presentation (Development)
5. Progress Presentation (Experimental Analysis)
6. Progress Presentation (Pre Thesis Submission)
7. Thesis Writing and Submission
8. Final Defense

Future scope- At later stage, a more robust and wearable approach will be
adopted as local placement increases susceptibility to damage outside a controlled
environment and allows limits patient monitoring. The suitability of smart textile
technology to develop a wearable sensing garment can also be investigated.

Conclusion-Back pain is not a disease but a constellation of symptoms which

origins remain in most cases unknown even though risks factors have been
identified. Low back pain is disabling and causes enormous socioeconomic
impacts on societies. Treatments for now are focused on reducing the pain. Back
pain is both a major cause of temporary disability and a challenge to medical and
surgical treatment decisions. It imposes high socio-economic burden in modern
western countries, since it not only affects the elderly population but also the
working population from 2560 years.So need for 24*7 time monitoring is
required so that we are warned before any harmful effect is incurred on to our
backs as prevention is better then cure.