**1. Introduction**

This chapter aims to develop a biofeedback tool to train people, especially K-12 students, to maintain good posture while sitting. The rapid rise of poor posture in students—the curse of modern era has drawn more public attention recently due to their long-lasting use of smartphones, tablets and computers in head forward flexion postures. The phrase *text neck* [1] is invented to describe the repeated stress injury to the body caused by poor posture and brought

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

on largely by overuse of all digital devices. Chiropractors and spinal specialists worldwide have seen an increase in the number of young patients experiencing text neck. Text neck and its syndrome are threatening to turn today's children into a generation of hunchbacks.

To avoid neck and shoulder straining, it is important to be aware of and timely improve the

Collaborative, Social-Networked Posture Training with Posturing Monitoring and Biofeedback

http://dx.doi.org/10.5772/intechopen.74791

39

Furthermore, to know is one thing and to do is another thing. For children on the brink of adolescence, posture awareness and maintaining a good posture is more difficult to achieve. Texting and gaming are very interesting to teens. The effects caused by poor posture are neither obvious nor immediate to people. Their sequelae of annoying neck and shoulder pains can only appear over a long period of time. Parents and teachers can frequently remind kids to sit and stand up straight. However, they are unable to stay aside with children all the time, and most young people do not like so. Adolescents are most influenced by their friends and classmates. As the first generation of the twenty-first century, current teenagers were born into an entirely digital world. They grew up with Internet connection and have been surrounded with new technologies—mobile phones and social network software all days long. No matter good or bad, collaborative social networks have become an integral part of their lives and open up a new way with peers and improve engagement as well as effectiveness to their activities.

In the childhood, kids learn a lot from their parents and other significant adults. But their influences become less as children grow up. Peers become most influenced to adolescents who adopt or mimic many behaviors of their peers in some social settings in order to be accepted by their peers. Teenagers urge encouragement and recognition from their peers. Several factors like what characteristics of the individuals are, how responsible the group members are, and so on, may have positive or negative influences on teens' imitation to their peers. The influences whether they are strong or weak are heavily relied on teens' trust to each

The twenty-first century born teens, the "*i-Generation*," are digital natives. Their learning and social networking are all with the Internet, mobile phones and social network apps. While technologies and software websites may rise and fade, social network software still plays an important role in the *i-Generation* for their identity formation, status negation and peer-to-

In both ethnographic and empirical studies, it is commonly observed that the behavior of individuals is affected by that of their peers [17]. Group interactions are an important influence on individual decisions. In education, the returns to programs such as athletics and art cannot be measured simply by their direct effects on grade points. The participation and group interactions among students are also important earnings. With harmonious social relations, academic achievement may be easy to attain, even in schools in the most disadvantaged

Some researchers have conducted experiments in which subjects receive information about others' choices [18, 19]. In these experiments, a subject's choice depends on both subject's preference as well as others' choices. Brechwald and Prinstein [20] review empirical and theoretical contributions to a multidisciplinary understanding of peer influence processes in adolescence over the past decade. They identify five themes of peer influence research, including behaviors relevant to peer influence, peer influence mechanisms, peer influence moderators,

other and their competition among the peers of the group [14, 15].

peer sociality [16].

neighborhoods.

posture to keep the body aligned in a neutral position, that is, a good posture.

Poor posture not only causes structural and spinal problems to people, but it can also lead to cognitive problems that may incur anxiety and depression [2, 3], especially to those emotional and sensitive people like teenagers. Poor posture of moving the head forward and bending down in a hunched position for typing or gaming imposes high pressure in the spine. The pressure increases drastically with every degree of head/neck flexing. Digitally savvy teens are likely the most affected because they use smartphones, tablets and computers the most. For head position of bending 45 degrees, the head exerts 22.5 kg, comparing with 5.5 kg in its normal position [4]. Keeping a good posture with the body aligned in a neutral position is the key to avoid straining the body. Posture awareness and timely improvement are important to stretch and relax the tense muscles. In practice, it is not easy to aware poor posture, not to say to timely correct the poor posture.

Based on biomechanical measurements and measurements of the physiological systems of the body, biofeedback is the technique providing biological information to patients in real time that would otherwise be unknown [5]. The idea is to provide individuals with increased information about what is going on inside their bodies and brains. A close field called *cybernetics* [6] deals most directly with information processing and feedback, which makes learning possible. From a cybernetic perspective, individuals receive clear and direct biofeedback about their physiology which helps them learn to control the corresponding functions. Applications of biofeedback techniques can be traced back to the late 1950s, in the United States with the convergence of many disciplines [7]. Biofeedback methods have been used for more than six decades in rehabilitation to facilitate gait retraining [8]. The growth of biofeedback has been evolving with the development of new, more refined techniques for providing individuals with feedback for specific physiological processes.

Biofeedback devices have been used successfully in improving head control and balancing in children with cerebral palsy [9]. The investigation results on the effects of biofeedback on the sitting posture of a 14-year-old girl with cerebral palsy indicate a significant improvement in posture [10]. Breen et al. [11] develop a biofeedback system for real-time correction of neck posture in computer users. All the six subjects have a significant decrease in the percentage of time spent in bad posture when using biofeedback. Mirelman et al. [12] use an audio-biofeedback training system with headphones and successfully improve patients with Parkinson's disease from dysrhythmic and disturbed gait, impaired balance and decreased postural responses. Franco et al. [13] develop a smartphone-based system to monitor the trunk angular evolution during bipedal stance and help the user to improve balance through a configurable and integrated auditory-biofeedback loop.

Prolonged poor posture could cause permanent pains in neck and shoulder, especially for older people. However, for kids and adolescents, the severity can be reduced through proper exercise of neck and shoulder. Taking frequent breaks at work with neck and shoulder stretches can boost our productivity and also help improve blood flow and relieve tension. To avoid neck and shoulder straining, it is important to be aware of and timely improve the posture to keep the body aligned in a neutral position, that is, a good posture.

on largely by overuse of all digital devices. Chiropractors and spinal specialists worldwide have seen an increase in the number of young patients experiencing text neck. Text neck and its syndrome are threatening to turn today's children into a generation of hunchbacks.

Poor posture not only causes structural and spinal problems to people, but it can also lead to cognitive problems that may incur anxiety and depression [2, 3], especially to those emotional and sensitive people like teenagers. Poor posture of moving the head forward and bending down in a hunched position for typing or gaming imposes high pressure in the spine. The pressure increases drastically with every degree of head/neck flexing. Digitally savvy teens are likely the most affected because they use smartphones, tablets and computers the most. For head position of bending 45 degrees, the head exerts 22.5 kg, comparing with 5.5 kg in its normal position [4]. Keeping a good posture with the body aligned in a neutral position is the key to avoid straining the body. Posture awareness and timely improvement are important to stretch and relax the tense muscles. In practice, it is not easy to aware poor posture, not to say

Based on biomechanical measurements and measurements of the physiological systems of the body, biofeedback is the technique providing biological information to patients in real time that would otherwise be unknown [5]. The idea is to provide individuals with increased information about what is going on inside their bodies and brains. A close field called *cybernetics* [6] deals most directly with information processing and feedback, which makes learning possible. From a cybernetic perspective, individuals receive clear and direct biofeedback about their physiology which helps them learn to control the corresponding functions. Applications of biofeedback techniques can be traced back to the late 1950s, in the United States with the convergence of many disciplines [7]. Biofeedback methods have been used for more than six decades in rehabilitation to facilitate gait retraining [8]. The growth of biofeedback has been evolving with the development of new, more refined techniques for providing individuals

Biofeedback devices have been used successfully in improving head control and balancing in children with cerebral palsy [9]. The investigation results on the effects of biofeedback on the sitting posture of a 14-year-old girl with cerebral palsy indicate a significant improvement in posture [10]. Breen et al. [11] develop a biofeedback system for real-time correction of neck posture in computer users. All the six subjects have a significant decrease in the percentage of time spent in bad posture when using biofeedback. Mirelman et al. [12] use an audio-biofeedback training system with headphones and successfully improve patients with Parkinson's disease from dysrhythmic and disturbed gait, impaired balance and decreased postural responses. Franco et al. [13] develop a smartphone-based system to monitor the trunk angular evolution during bipedal stance and help the user to improve balance through

Prolonged poor posture could cause permanent pains in neck and shoulder, especially for older people. However, for kids and adolescents, the severity can be reduced through proper exercise of neck and shoulder. Taking frequent breaks at work with neck and shoulder stretches can boost our productivity and also help improve blood flow and relieve tension.

to timely correct the poor posture.

38 Biofeedback

with feedback for specific physiological processes.

a configurable and integrated auditory-biofeedback loop.

Furthermore, to know is one thing and to do is another thing. For children on the brink of adolescence, posture awareness and maintaining a good posture is more difficult to achieve. Texting and gaming are very interesting to teens. The effects caused by poor posture are neither obvious nor immediate to people. Their sequelae of annoying neck and shoulder pains can only appear over a long period of time. Parents and teachers can frequently remind kids to sit and stand up straight. However, they are unable to stay aside with children all the time, and most young people do not like so. Adolescents are most influenced by their friends and classmates. As the first generation of the twenty-first century, current teenagers were born into an entirely digital world. They grew up with Internet connection and have been surrounded with new technologies—mobile phones and social network software all days long. No matter good or bad, collaborative social networks have become an integral part of their lives and open up a new way with peers and improve engagement as well as effectiveness to their activities.

In the childhood, kids learn a lot from their parents and other significant adults. But their influences become less as children grow up. Peers become most influenced to adolescents who adopt or mimic many behaviors of their peers in some social settings in order to be accepted by their peers. Teenagers urge encouragement and recognition from their peers. Several factors like what characteristics of the individuals are, how responsible the group members are, and so on, may have positive or negative influences on teens' imitation to their peers. The influences whether they are strong or weak are heavily relied on teens' trust to each other and their competition among the peers of the group [14, 15].

The twenty-first century born teens, the "*i-Generation*," are digital natives. Their learning and social networking are all with the Internet, mobile phones and social network apps. While technologies and software websites may rise and fade, social network software still plays an important role in the *i-Generation* for their identity formation, status negation and peer-topeer sociality [16].

In both ethnographic and empirical studies, it is commonly observed that the behavior of individuals is affected by that of their peers [17]. Group interactions are an important influence on individual decisions. In education, the returns to programs such as athletics and art cannot be measured simply by their direct effects on grade points. The participation and group interactions among students are also important earnings. With harmonious social relations, academic achievement may be easy to attain, even in schools in the most disadvantaged neighborhoods.

Some researchers have conducted experiments in which subjects receive information about others' choices [18, 19]. In these experiments, a subject's choice depends on both subject's preference as well as others' choices. Brechwald and Prinstein [20] review empirical and theoretical contributions to a multidisciplinary understanding of peer influence processes in adolescence over the past decade. They identify five themes of peer influence research, including behaviors relevant to peer influence, peer influence mechanisms, peer influence moderators, integration of behavioral genetics, neuroscience and peer influence research. While most previous research emphasize on the dynamic, reciprocal associations between selection and socialization in adolescent peer relations, their review focuses predominantly on their socialization processes as the mechanisms in the past decade have continued to vary considerably due to new mobile and social network technologies.

the same network. Both are needed in order for a group to achieve its goals as well as experi-

Collaborative, Social-Networked Posture Training with Posturing Monitoring and Biofeedback

http://dx.doi.org/10.5772/intechopen.74791

41

This chapter presents the research that uses biofeedback techniques to train people to be aware of their bad posture to timely improve the posture. We develop a collaborative, socialnetworked posture training tool which is composed of a wearable posture training headset, a posture training belt, a social network App and cloud storage and computing services. The wearable training headset is equipped with real-time sensors to monitor head and neck posture. The training belt is used with a smartphone to monitor the lumbar-spine and low back posture. The App provides biofeedbacks of sound, voice and vibration to remind students of their poor posture. In the App, students can glance over their friends' posture performance to

This chapter is organized as follows. Section 1 describes the motivation and identifies the importance and challenges of this research. In Section 2, we present the techniques of posture training with biofeedback. Section 3 proposes the collaborative, social-networked posture training (CSPT) approach. Section 4 details the systematic design and integration of the developed posture training system. Section 5 presents the design of experiments to validate the effectiveness of collaborative, social-networked posture training. Experiment results are analyzed in Section 6. Finally, in Section 7, the concluding remarks are made with some future

Biofeedback is an autonomic feedback mechanism that gains awareness of physiological functions from the information measured by instruments [32]. Biofeedback monitors and uses physiologic information (e.g., hearing, vision, feeling) to teach people to change specific physiologic functions (e.g., posture) accordingly. A biofeedback mechanism involves measuring biomedical variables and relaying them to the user using either direct feedback regarding the measured variables with a numerical value displayed, or transformed feedback where the measured variables are transformed into an adaptive auditory signal, visual display or tactile feedback method. The majority of biofeedback therapy has focused on the treatment of upper

**Figure 1** depicts the biofeedback posture training loop, where head, neck and lower back posture is monitored and biofeedback to the human sensory nervous system with sound, light and vibration in order to notify the people to improve her head, neck and lower back posture accordingly. In the biofeedback process, posture signals are first measured by sensory and filtering devices where filtered sensor data are generated and sent to posture estimator to construct the corresponding posture angles. The posture angles are used by fuzzy logic trainer to diagnose the posture and determine what alters (sound, light, or vibration) to biofeedback to

encing the group as socially rewarding.

encourage good posture.

research directions.

**2.1. Biofeedback**

**2. Posture training with biofeedback**

the human sensor nervous system.

limb and lower limb motor deficits in neurological disorders.

It is difficult to detect and measure peer effects precisely. Peer effects are the average intragroup external effects which are identical on all the members of a given group. Due to the disaggregation and availability of data, the group boundaries for such peer effects are often random and varying. Calvó-Armengol et al. [21] propose a peer-effect model to relate analytically equilibrium behavior to network location. Their results show that the outcome of each individual embedded in a network is proportional to her Katz-Bonacich centrality measure [22, 23] at the Nash equilibrium. For each individual, the Katz-Bonacich centrality measure considers both her direct and indirect friends but puts less weight to her distant friends.

The term *social network* refers to the web of social relationships that surround individuals [24, 25]. Social networks are a social structure of nodes that represent individuals and the relationships between them within a certain domain. This research adopts social networks as the linkages between students. The closeness of students is embedded in an informal group where group members can provide social functions like informational, instrumental, emotional and appraisal supports to individuals. Social supports and collaboration can be very constructive to physical, mental and social health of individuals. The wide use of smartphones and social networking apps offer opportunities for the development of innovative interventions to promote physical activity. Ayubi et al. [26] develop a persuasive and social mHealth application designed to monitor and motivate users to walk more every day. Collaborative social networks open up new ways to work with peers and improve engagement and effectiveness to activities [27].

Publics, where norms are set and reinforced, play a crucial role in the development of individuals. However, society's norms and rules only provide the collectively imagined boundaries. People, especially teenagers, learn through action, not just theory. They are also tasked with deciding how they want to fit into the structures that society provides. Their social identity is partially defined by themselves and partially defined by others. The answer to why students joined social network sites is usually simple: "That's where my friends are." The rapid adoption of social network sites by teenagers in the United States and in many other countries around the world has drawn much research attention [28]. Centola [29] studied the spread of health behaviors through artificially structured online communities and the effects of network structure on diffusion. His research reveals that when participants receive social reinforcement from multiple neighbors in the social network, individual adoption is much more likely.

Social presence is shown to have an effect in different virtual learning environments [30]. Liccardi et al. demonstrated the social dimensions of a collaborative learning network, its formation, its presence and its influence on different social networks in education [31]. They found that group composition may affect how efficiently a group achieves its set goals. It is optimal that there are both goal-oriented group members and socially oriented people within the same network. Both are needed in order for a group to achieve its goals as well as experiencing the group as socially rewarding.

This chapter presents the research that uses biofeedback techniques to train people to be aware of their bad posture to timely improve the posture. We develop a collaborative, socialnetworked posture training tool which is composed of a wearable posture training headset, a posture training belt, a social network App and cloud storage and computing services. The wearable training headset is equipped with real-time sensors to monitor head and neck posture. The training belt is used with a smartphone to monitor the lumbar-spine and low back posture. The App provides biofeedbacks of sound, voice and vibration to remind students of their poor posture. In the App, students can glance over their friends' posture performance to encourage good posture.

This chapter is organized as follows. Section 1 describes the motivation and identifies the importance and challenges of this research. In Section 2, we present the techniques of posture training with biofeedback. Section 3 proposes the collaborative, social-networked posture training (CSPT) approach. Section 4 details the systematic design and integration of the developed posture training system. Section 5 presents the design of experiments to validate the effectiveness of collaborative, social-networked posture training. Experiment results are analyzed in Section 6. Finally, in Section 7, the concluding remarks are made with some future research directions.
