下背痛的罹患率逐年攀升，若能及早發現肌群的不正常活化，於疼痛發作前及時警示有下背痛歷史的人放鬆可能疲勞的肌群，降低引發下背痛的風險，達到事前預防以避免事後治療的目的。本研究開發可攜式個人下背肌電監測系統，結合手機應用程式建立肌電訊號(Electromyography)的採集、紀錄與分析，並於肌群疲勞時警示受試者，避免肌肉疲勞引發的下背痛。
本研究招收15名健康受試者使用本肌電系統與醫療等級系統同時監測下背肌群訊號，分析兩者訊號波形的一致性，各下背肌群在五種功能性動作下兩系統間相關係數平均介於0.75至0.94；各下背肌群在重量與肌電訊號強度間相關係數平均介於0.91至0.98，兩者均呈現高度相關，證實本系統可行性和確效性。以5名健康受試者設計施測者間信度(inter-rater reliability)和施測者內信度(intra-rater reliability)實驗，施測者間信度相關係數平均介於0.77至0.98，施測者內信度相關係數平均介於0.74至0.97，兩者均呈現高度相關證實本系統穩定性和可重複性。本研究分別以一位健康和一位下背痛受試者測試系統警示功能，下背痛受試者於下背肌群疲勞時成功警示。

More and more people have suffered from low back pain in recent years. The chance of experiencing pain can be reduced if patients with a history of low back pain are notified when their low back muscles are about to fatigue, allowing the low back muscles to be relaxed. The aim of this study is to establish a portable surface electromyography (sEMG) monitoring system to monitor low back muscles, and using a mobile application to notify the users when the low back muscles have become fatigued, and thus avoiding suffering low back pain.
In this study, 15 healthy subjects were asked to perform functional tasks whilst the electromyography signals from their low back muscles were monitored using both a medical grade sEMG system and our system in order to analyze the consistency of both sEMG systems. The average coefficients of multiple correlation between the two sEMG monitored by different sEMG system are from 0.74 to 0.94 and the average coefficients of multiple correlation between the weight and the amplitudes of sEMG are from 0.91 to 0.98. These coefficients are highly correlated and thus proving the feasibility and validity of our system. In other tests, 5 healthy subjects were asked to participate in the inter-rater and intra-rater reliability experiments. The average coefficients of multiple correlation in the inter-rater reliability experiment are from 0.77 to 0.98 and the average coefficients of multiple correlation in the intra-rater reliability experiment are from 0.74 to 0.97. These coefficients are also highly correlated and thus proving the reliability of our system. One healthy subject and one subject with potential low back pain had participated in the alarm test, and our system was able to notify the subject with potential low back pain to relax from overusing the low back muscles.

1. Kienbacher, T., Fehrmann, E., Habenicht, R., Koller, D., Oeffel, C., Kollmitzer, J., Mair, P., and Ebenbichler, G., "Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients," Journal of Neuroengineering and Rehabilitation, Vol.13, No.1, p.16, 2016.
2. Triano, J. J. and Schultz, A. B., "Correlation of objective measure of trunk motion and muscle function with low-back disability ratings," Spine, Vol.12, No.6, pp.561-565, 1987.
3. Tissot, F., Messing, K., and Stock, S., "Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day," Ergonomics, Vol.52, No.11, pp.1402-1418, 2009.
4. 衛生福利部中央健康保險署, "107年國人全民健康保險就醫疾病資料," <https://www.nhi.gov.tw/Content_List.aspx?n=D529CAC4D8F8E77B&topn=23C660CAACAA159D>, Accessed on 17 December 2019.
5. 衛生福利部中央健康保險署, "肌肉骨骼系統與結締組織疾病," <https://www.mohw.gov.tw/dl-22774-0f5e80b0-eaa2-423d-89e0-f89041fe2615.html>, Accessed on 27 December 2019.
6. Hodges, P. W. and Moseley, G. L., "Pain and motor control of the lumbopelvic region: effect and possible mechanisms," Journal of Electromyography and Kinesiology, Vol.13, No.4, pp.361-370, 2003.
7. Hwang, J. H., Lee, Y.-T., Park, D. S., and Kwon, T.-K., "Age affects the latency of the erector spinae response to sudden loading," Clinical Biomechanics, Vol.23, No.1, pp.23-29, 2008.
8. 國軍高雄總醫院, "下背痛的診斷," <https://802.mnd.gov.tw/ListP0400102.ShowItemListState.do?QueryRecord.CreateDate=2008-09-27%2018:23:24&QueryRecord.ShowAdmin=false&WebId=>, Accessed on 27 December 2019.
9. 張原道, "下背痛與全身振動和人工物料搬運相關之探討─以宅配業勞工為例," 公共衛生學研究所, 臺北醫學大學, 台北市, 2008.
10. DELSYS, "Trigno Avanti Platform," <https://www.delsys.com/trigno/>, Accessed on 5 January 2020.
11. SeeedStudio, "Grove - EMG Detector," <https://www.seeedstudio.com/Grove-EMG-Detector-p-1737.html>, Accessed on 10 January 2020.
12. 新高中體育課程, "神經肌肉控制," <http://www.hksports.net/hkpe/nss_pe/human_body/neuromuscular_control.htm>, accessed on 8 October 2019.
13. Waterbury, C., "The Secret to Motor Unit Recruitment," <http://chadwaterbury.com/the-science-of-motor-unit-recruitment-part-1/>, accessed on 8 October 2019.
14. Konrad, P., "The abc of emg," A Practical Introduction to Kinesiological Electromyography, Vol.1, No.2005, pp.30-35, 2005.
15. 嚴震東, "動作或不動作？由電決定—動作電位的離子流機制," <http://scimonth.blogspot.com/2013/08/blog-post_4567.html>, accessed on 8 October 2019.
16. 葉明杰, "手臂運動之肌電訊號特性分析與應用," 電機與控制工程系所, 國立交通大學, 新竹市, 2005.
17. 蔡政龍, "肌電圖強度與速度分析於機器手臂控制之應用," 電機與控制工程系所, 國立交通大學, 新竹市, 2006.
18. De Luca, C. J., Gilmore, L. D., Kuznetsov, M., and Roy, S. H., "Filtering the surface EMG signal: Movement artifact and baseline noise contamination," Journal of Biomechanics, Vol.43, No.8, pp.1573-1579, 2010.
19. Wang, J., Tang, L., and Bronlund, J. E., "Surface EMG signal amplification and filtering," International Journal of Computer Applications, Vol.82, No.1, 2013.
20. Keller, T. and Popovic, M. R., "Real-time stimulation artifact removal in EMG signals for neuroprosthesis control applications," in Proceedings of the IFESS'2000 Conference, Cleveland, USA, 2001.
21. Potvin, J. and Brown, S., "Less is more: high pass filtering, to remove up to 99% of the surface EMG signal power, improves EMG-based biceps brachii muscle force estimates," Journal of Electromyography and Kinesiology, Vol.14, No.3, pp.389-399, 2004.
22. Winter, D. A., Rau, G., Kadefors, R., Broman, H., and De Luca, C., "Units, terms and standards in the reporting of EMG research," Report by the Ad hoc committee of the International Society of Electrophysiological Kinesiology, 1980.
23. Merletti, R. and Di Torino, P., "Standards for reporting EMG data," J Electromyogr Kinesiol, Vol.9, No.1, pp.3-4, 1999.
24. Stegeman, D. and Hermens, H., "Standards for surface electromyography: The European project Surface EMG for non-invasive assessment of muscles (SENIAM)," Enschede: Roessingh Research and Development, pp.108-12, 2007.
25. Kiguchi, K., Tanaka, T., and Fukuda, T., "Neuro-fuzzy control of a robotic exoskeleton with EMG signals," IEEE Transactions on fuzzy systems, Vol.12, No.4, pp.481-490, 2004.
26. Perry, J. and Davids, J. R., "Gait analysis: normal and pathological function," Journal of Pediatric Orthopaedics, Vol.12, No.6, p.815, 1992.
27. Erdelyil, A., Sihvonen, T., Helin, P., and Hänninen, O., "Shoulder strain in keyboard workers and its alleviation by arm supports," International Archives of Occupational and Environmental Health, Vol.60, No.2, pp.119-124, 1988.
28. Allison, G., Marshall, R., and Singer, K., "EMG signal amplitude normalization technique in stretch-shortening cycle movements," Journal of Electromyography and Kinesiology, Vol.3, No.4, pp.236-244, 1993.
29. Allison, G., Godfrey, P., and Robinson, G., "EMG signal amplitude assessment during abdominal bracing and hollowing," Journal of Electromyography and Kinesiology, Vol.8, No.1, pp.51-57, 1998.
30. Ekstrom, R. A., Soderberg, G. L., and Donatelli, R. A., "Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis," Journal of Electromyography and Kinesiology, Vol.15, No.4, pp.418-428, 2005.
31. Boettcher, C. E., Ginn, K. A., and Cathers, I., "Standard maximum isometric voluntary contraction tests for normalizing shoulder muscle EMG," Journal of Orthopaedic Research, Vol.26, No.12, pp.1591-1597, 2008.
32. Ginn, K., Halaki, M., and Cathers, I., "Revision of the shoulder normalization tests is required to include rhomboid major and teres major," Journal of Orthopaedic Research, Vol.29, No.12, pp.1846-1849, 2011.
33. Kumar, S., Electromyography in ergonomics, Routledge, 2017.
34. Jobe, F. W., Moynes, D. R., Tibone, J. E., and Perry, J., "An EMG analysis of the shoulder in pitching: a second report," The American Journal of Sports Medicine, Vol.12, No.3, pp.218-220, 1984.
35. Sousa, A. S. and Tavares, J. M. R., "Surface electromyographic amplitude normalization methods: a review," Electromyography: New Developments, Procedures and Applications, 2012.
36. Albertus-Kajee, Y., Tucker, R., Derman, W., Lamberts, R. P., and Lambert, M. I., "Alternative methods of normalising EMG during running," Journal of Electromyography and Kinesiology, Vol.21, No.4, pp.579-586, 2011.
37. Fernández-Pena, E., Lucertini, F., and Ditroilo, M., "A maximal isokinetic pedalling exercise for EMG normalization in cycling," Journal of Electromyography and Kinesiology, Vol.19, No.3, pp.e162-e170, 2009.
38. Thongpanja, S., Phinyomark, A., Phukpattaranont, P., and Limsakul, C., "Mean and median frequency of EMG signal to determine muscle force based on time-dependent power spectrum," Elektronika ir Elektrotechnika, Vol.19, No.3, pp.51-56, 2013.
39. Masuda, K., Masuda, T., Sadoyama, T., Inaki, M., and Katsuta, S., "Changes in surface EMG parameters during static and dynamic fatiguing contractions," Journal of Electromyography and Kinesiology, Vol.9, No.1, pp.39-46, 1999.
40. da Silva, R. A., Vieira, E. R., Cabrera, M., Altimari, L. R., Aguiar, A. F., Nowotny, A. H., Carvalho, A. F., and Oliveira, M. R., "Back muscle fatigue of younger and older adults with and without chronic low back pain using two protocols: a case-control study," Journal of Electromyography and Kinesiology, Vol.25, No.6, pp.928-936, 2015.
41. Ahern, D. K., Follick, M. J., Council, J. R., Laser-Wolston, N., and Litchman, H., "Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls," Pain, Vol.34, No.2, pp.153-160, 1988.
42. Kumar, S. and Prasad, N., "Torso muscle EMG profile differences between patients of back pain and control," Clinical Biomechanics, Vol.25, No.2, pp.103-109, 2010.
43. Heydari, A., Nargol, A. V., Jones, A. P., Humphrey, A. R., and Greenough, C. G., "EMG analysis of lumbar paraspinal muscles as a predictor of the risk of low-back pain," European Spine Journal, Vol.19, No.7, pp.1145-1152, 2010.
44. 蔡旻錡, "胸椎鬆動術對於腰椎退化性滑脫之慢性下背痛患者在肌肉活性、腰部受力及疼痛感覺立即性影響," 物理治療學系, 國立成功大學, 台南市, 2016.
45. Dolan, P. and Adams, M., "Repetitive lifting tasks fatigue the back muscles and increase the bending moment acting on the lumbar spine," Journal of Biomechanics, Vol.31, No.8, pp.713-721, 1998.
46. Yoshitake, Y., Ue, H., Miyazaki, M., and Moritani, T., "Assessment of lower-back muscle fatigue using electromyography, mechanomyography, and near-infrared spectroscopy," European journal of Applied Physiology, Vol.84, No.3, pp.174-179, 2001.
47. Coorevits, P., Danneels, L., Cambier, D., Ramon, H., and Vanderstraeten, G., "Assessment of the validity of the Biering-Sørensen test for measuring back muscle fatigue based on EMG median frequency characteristics of back and hip muscles," Journal of Electromyography and Kinesiology, Vol.18, No.6, pp.997-1005, 2008.
48. Technologies, A., "MyoWare™ Muscle Sensor (AT-04-001) " <https://cdn.sparkfun.com/datasheets/Sensors/Biometric/MyowareUserManualAT-04-001.pdf>, accessed on 17 July 2019.
49. Electronic, S., "Teensy3.6(Headers)," <https://media.digikey.com/pdf/Data%20Sheets/Sparkfun%20PDFs/DEV-14058_Web.pdf>, accessed on 11 November 2019.
50. 振瓏科技股份有限公司, "電極貼片KENDALL(Covidien)," <http://www.carelifetech.com.tw/?%E9%9B%BB%E6%A5%B5%E8%B2%BC%E7%89%87kendall(covidien),15>, accessed on 13 July 2019.
51. 台灣可威有限公司, "亞瑟康 神經刺激電療貼片," <http://www.ucinet.com.tw/product_description.php?PNo=32>, accessed on 13 July 2019.
52. kosme, "arduinoFFT," <https://github.com/kosme/arduinoFFT>, accessed on 13 July 2019.
53. Developers, A., "Canvas," <https://developer.android.com/reference/android/graphics/Canvas>, accessed on 11 November 2019.
54. Developers, A., "Paint," <https://developer.android.com/reference/kotlin/android/graphics/Paint>, accessed on 11 November 2019.
55. Brumitt, J., Core assessment and training, Human Kinetics, 2010.
56. Nesser, T. W., Huxel, K. C., Tincher, J. L., and Okada, T., "The relationship between core stability and performance in division I football players," The Journal of Strength & Conditioning Research, Vol.22, No.6, pp.1750-1754, 2008.
57. TREK, "McGill Core Endurance Test," <http://exercise.trekeducation.org/2017/10/01/mcgill-core-endurance-test/>, accessed on 28 November 2019.
58. Ives, J. C. and Wigglesworth, J. K., "Sampling rate effects on surface EMG timing and amplitude measures," Clinical Biomechanics, Vol.18, No.6, pp.543-552, 2003.
59. 沈子恒, "我所理解的快速傅立葉變換(FFT)," <https://blog.csdn.net/shenziheng1/article/details/52891807>, accessed on 13 July 2019.
60. DELSYS, "Trigno Mini Sensor," <https://www.delsys.com/trigno-mini/>, accessed on 21 November 2019.
61. Aghamohammadi-Sereshki, A., Bayazi, M.-J. D., Ghomsheh, F. T., and Amirabdollahian, F., "Investigation of Fatigue Using Different EMG Features," in 2019 IEEE 16th International Conference on Rehabilitation Robotics (ICORR), pp.115-120, 2019.