Easy-to-Use Biosignal Monitoring: Wearable Device for Title Muscle Activity Measurement during Sleep in Daily Life( Dissertation_全文 ) Author(s) Eguchi, Kana Citation 京都大学 Issue Date 2020-03-23 URL https://doi.org/10.14989/doctor.k22578 許諾条件により本文は2021-03-23に公開; 許諾条件により Right 要旨は2020-06-25に公開 Type Thesis or Dissertation Textversion ETD Kyoto University Ph.D Thesis Easy-to-Use Biosignal Monitoring: Wearable Device for Muscle Activity Measurement during Sleep in Daily Life Supervisor Professor Tomohiro Kuroda Department of Social Informatics Graduate School of Informatics Kyoto University Kana Eguchi Copyright c 2020 by Kana Eguchi Kyoto University, Japan All rights reserved. Vita brevis, ars longa, occasio praeceps, experimentum periculosum, iudicium difficile. ———Hippocrates “Aphorisms”——— iii Easy-to-Use Biosignal Monitoring: Wearable Device for Muscle Activity Measurement during Sleep in Daily Life Kana Eguchi Abstract In recent years, medical care targets have drastically changed from acute diseases to lifestyle-related diseases such as sleep disorders, in which many lifestyle-related factors, including habitual ones, may influence each other. It is quite hard for physicians to collect all the information on lifestyle-related diseases in outpatient service within a limited time and with limited resources. Therefore, a change from reactive disease care to P4 medicine (predictive, preventive, personalized, and participatory care) has been advocated. A healthy life depends on a well-balanced diet, moderate physical activity, and good sleep. Although sleep undoubtedly plays an important role, full understanding of how well people sleep remains an unsolved issue. Just as sleeplessness influences daily activities, it is even worse among patients with sleep disorders. Because the symptoms of sleep disorders vary, it is important to incorporate home telemedicine in the field of sleep medicine, called out-of-center sleep testing (OCST), to enable appropriate objective observation on sleep conditions outside a hospital. This requires developing easy-to-use devices that non-experts can use in their daily life environments. By considering currently available devices for OCST together with the potential patients of each sleep disorder, this doctoral research sets periodic limb movement disorder (PLMD) as the target sleep disorder. Most patients with PLMD remain undiagnosed because of the lack of appropriate monitoring devices for its unique symptoms, namely, periodic short-lasting involuntary movements called periodic limb movements (PLMs), which mainly occur in the lower extremities. Furthermore, this lack of devices can disrupt precise treatment of patients with PLMD even after a definitive diagnosis. This doctoral research aims to develop novel easy-to-use wearable devices for unaided surface electromyography (EMG) measurement by non-experts, specifically targeting home monitoring of PLMs by capturing their essential biosignals (i.e., surface EMG). The main contributions are the following three: iv to propose a combination of target muscles for surface EMG-based PLM home monitoring; to develop an easy-to-use sock-type wearable device for unaided surface EMG measurement by non-experts; and to confirm the performance of the developed device in actual PLM home monitoring. This dissertation first clarifies the issues and organizes the requirements in developing a surface EMG measurement device assuming unaided home use by non-experts. For the first contribution, this research investigated all the muscles related to PLMs after visually observing the induced leg movements, and determined the target muscles for surface EMG-based PLM home monitoring, then confirmed that the performance of EMG could exceed that of the current de facto standard method based on acceleration. For the second contribution, this research developed an easy-to-use wearable device for unaided surface EMG measurement by non-experts, comprising a sock-type fabric adaptor with embedded fabric electrodes. Then, through a preliminary validation targeting voluntary movements, the device’s basic performance on surface EMG measurement was confirmed to be sufficient for discriminating the presence/absence of muscle activity. For the third contribution, through comparative evaluation against visual observation of PLMs by a physician, this research confirmed that the PLM home monitoring performance of the device was better than that of the current acceleration-based method. These contributions can foment future researches on revealing PLMs condition outside a hospital, thus enabling better understanding of the relationship between medication and actual PLM conditions. The work here will also enable exploration of new treatment strategies based on the aforementioned findings. Finally, it will contribute to providing the big data collection essential for physicians at the bottom layer of the data, information, knowledge, and wisdom (DIKW) pyramid, which is the key enabler of P4 medicine. Easy-to-Use Biosignal Monitoring: Wearable Device for Muscle Activity Measurement during Sleep in Daily Life Contents Chapter 1 Introduction 1 1.1 BackgroundandAims ............................. 1 1.2 Position of Research . 4 1.3 ThesisStructure.................................. 6 Chapter 2 Sleep and Home Telemedicine 8 2.1 OverviewofSleep................................. 9 2.1.1 Growth of Sleep and Recommended Sleep Time . 9 2.1.2 Architecture of Sleep and Its Status Transition . 10 2.2 SleepDisorders.................................. 11 2.2.1 Sleep Disorders and Its Classification . 11 2.2.2 Target Sleep Disorder: Periodic Limb Movement Disorder(PLMD)........................... 13 2.2.3 Diagnostic Procedure and Treatment after Diagnosis . 15 2.2.4 Sleep Monitoring in Hospital Laboratory . 19 2.2.5 WantsforHomeMonitoring.................... 20 2.3 Home Telemedicine and Sleep Testing outside Hospitals . 23 2.3.1 HomeTelemedicine.......................... 23 2.3.2 Out-of-Center Sleep Testing (OCST) and Its Classification 23 2.3.3 Current OCST in Practice and Remaining Issues . 25 2.3.4 Research toward Next-Generation OCST . 28 Chapter 3 Socks-Type Wearable Device for Surface EMG-Based PLMs Monitoring at Home 30 3.1 TargetMovements................................ 31 3.1.1 LegMovementsInducedbyPLMs............... 31 3.1.2 ScoringCriteriaofPLMs...................... 31 3.1.3 Issues Toward Surface EMG-Based PLMs Home Monitoring................................ 34 3.2 Essential Characteristics of Muscle Activity and Surface EMG Measurement.................................... 34 3.2.1 MechanismofMuscleActivity.................. 34 3.2.2 Surface EMG Measurement and Its Requirements . 35 3.2.3 Issues to Address for Unaided Surface EMG Measurement byNon-Experts............................ 37 3.3 Wearable Devices for Biosignal Measurement . 38 3.4 ProposedMethod................................. 40 3.4.1 Concept.................................. 40 3.4.2 Research Objectives and Requirements . 41 Chapter 4 Surface EMG-Based PLMs Monitoring Targeting Sock-Type Wearable Device Development 44 4.1 Method........................................ 44 4.1.1 DesignConcept............................ 44 4.1.2 RelatedWork.............................. 46 4.1.3 Revisiting Leg Movements Induced by PLMs . 46 4.1.4 TargetMuscles............................. 52 4.2 Experiment..................................... 52 4.2.1 Overview................................. 52 4.2.2 TargetParticipant.......................... 53 4.2.3 ExperimentalEnvironment.................... 54 4.2.4 ArrangementofTargetDevices................. 54 4.2.5 OverviewofDataCollection................... 56 4.2.6 Settings in Surface EMG Measurement . 57 4.2.7 Settings in Acceleration-Based Method . 60 4.2.8 Results.................................. 61 4.3 Discussion...................................... 70 Chapter 5 Surface EMG Measurement with Sock-Type Wearable Device 72 5.1 DesignConceptandRequirements..................... 72 5.2 Sock-type Wearable Device for Unaided Surface EMG MeasurementbyNon-ExpertUsers.................... 73 5.2.1 TargetMuscles............................. 73 5.2.2 Overview of NISHIJIN Electrodes for Measurement Electrodes................................ 74 5.2.3 Overview of Base Socks for Prototype . 74 5.2.4 Prototype................................ 75 5.3 Evaluation...................................... 77 5.3.1 Overview................................. 77 5.3.2 Settings.................................. 77 5.3.3 Results.................................. 81 5.4 Discussion...................................... 81 Chapter 6 Surface EMG-Based PLMs Evaluation with Sock-Type Wearable Device 85 6.1 Remodeling of Sock-Type Wearable Device . 85 6.1.1 Overview of Base Socks for Remodeled Prototype . 85 6.1.2 Prototype................................ 86 6.2 Evaluation...................................... 89 6.2.1 Overview................................. 89 6.2.2 TargetParticipant.......................... 90 6.2.3 ExperimentalEnvironment.................... 90 6.2.4 ArrangementofTargetDevices................. 91 6.2.5 OverviewofDataCollection................... 92 6.2.6 Video Analysis by Visual Observation . 93 6.2.7 Settings in Surface EMG Measurement . 93 6.2.8 Settings in Acceleration-Based Method . 95 6.2.9 Results.................................. 96 6.3 Discussion......................................101 Chapter 7 Conclusion 104 7.1 Main Contributions . 104 7.2 Limitations . ........107 7.3 Discussion on Future Issues to Address . 108 7.4 FutureProspects.................................111