Accident Analysis and Prevention xxx (2003) xxxxxx

Reducing the effects of driving fatigue with magnitopuncture stimulation

Zengyong Li , Kun Jiao, Ming Chen, Chengtao Wang
School of Mechanical Engineering, Shanghai Jiaotong University, Room 411, Mechanical Building, Shanghai 200030, China Received 1 September 2002; received in revised form 24 February 2003; accepted 4 March 2003

Abstract The purpose of this study was to assess the effects of reducing driving fatigue with magnitopuncture stimuli on Dazhui (DU14) point and Neiguan (PC6) points using heart rate (HR), reaction time (RT) testing, right rate (RR), critical icker fusion frequency (CFF) and subjective evaluation. Forty healthy subjects were randomly divided into two groups: study and control groups. All subjects were required to be well rested before the experiment. The subjects were engaged in high speed driving at a constant vehicle velocity of 80 km/h continuously for 3 h on a test course simulating an expressway. During the driving magnitopunctures (Haci Five Elements Needle, 250 mT, made by Haci Company limited) were applied to the Dazhui (DU14) point and Neiguan (PC6) points for the study group when the subject performed the task for 2.5 h, and for the control group magnitopunctures were applied to non-acupuncture points during the same time session. The results of this study show a signicant effect of magnitopuncture stimuli on RT, RR and CFF. Subjective evaluation also exhibited signicant differences (P < 0.05) between the two groups after the driving task. The ndings showed that magnitopuncture stimuli on DU14 point and PC6 points could reduce the effects of driving fatigue. 2003 Elsevier Science Ltd. All rights reserved.
Keywords: Magnitopuncture; Acupuncture points; Driving fatigue; Reaction time (RT); Critical icker fusion frequency (CFF); Subjective evaluation

1. Introduction Driving fatigue is a serious problem and believed to be a direct or contributing cause of road-related accidents. Fatigue is a gradual and cumulative process and is thought to be associated with a disinclination for any effort, reduced efciency and alertness and impaired mental performance (Grandjean, 1988). Cognitive effort involves sustained vigilance, selective attention, and complex decision making and occasionally automatized perceptual-motor control skills. Performance over time, such as that required during driving, usually requires greater cognitive effort than physical effort. The major symptom of mental fatigue is a general sensation of weariness, feelings of inhibition and impaired activity. Generally, there is no desire for physical or mental effort and there is an associated heavy, drowsy feeling (Nilsson et al., 1997). Efforts to reduce the drivers workload or driver fatigue have traditionally been based on human engineering reCorresponding author. Tel.: +86-21-62932905; fax: +86-21-52541413. E-mail address: zyongli@263.net (Z. Li).

search. Typically, this has involved making evaluations and improvements on the basis of analyses that examined the correlations between design/performance factors and human factors (Dian et al., 1998, 1999). The former factors include the layout of control equipment, while the latter factors include subjective ratings of operating ease of difculty, physiological measures of fatigue and physical effort and behavioral quantities (Haruhiko et al., 1996; Se Jin et al., 2000). Magnitopuncture is a therapy depending on traditional Chinese Medicine meridians and collaterals theory. Magnitopuncture has been veried to have the same effect as acupuncture in adjusting the function state of the human body (Yulan, 1990). For example, magnitopuncture stimulation on acupuncture points had effects on the nervous system and could relieve pain (Ruifang and Wenxiang, 1997). But few studies were about the effect of magnitopuncture stimulation on workload or fatigue. The purpose of this study was to assess the effects of reducing driving fatigue of magnitopuncture stimuli on Dazhui (DU14) point and Neiguan (PC6) points using heart rate (HR), reaction time (RT) testing, right rate (RR), critical icker fusion frequency (CFF) and subjective evaluation.

0001-4575/03/$ see front matter 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0001-4575(03)00044-7

Z. Li et al. / Accident Analysis and Prevention xxx (2003) xxxxxx

2. Materials and methods 2.1. Subjects Two samples of 20 young fully licensed drivers participated in the study. They were randomly divided into two groups: study and control groups. The mean age of drivers in study group was 26.6 (range: 1830). The mean age of drivers in control group was 28.2 (range: 1830). Both samples consisted of 10 female and 10 male drivers. All participants were required to be well rested before the experiment. None of the subjects had a history of heart disease and all were paid for their participation in the study. The purpose of the test was outlined and an appropriate period of test-driving was provided in advance. 2.2. Magnitopuncture Magnitopuncture (Haci Five Elements Needle) is mainly a combination of two therapies, acupuncture point pressing and magnetic treatment. The magnetic tip of magnitopuncture is silver-plating and it could be xed on the body by the negative pressure. The magnetic tip with surface magnetic eld 250 mT, when acupuncturing the point, makes the magnetic line penetrates human body from 6 to 9 cm (equal to the depth of traditional acupuncture) (Li-wen and Ding-zhong, 2002). Being non-traumatic, void of any toxic and side effects, magnitopuncture is a kind of acupuncture instrument of magnetic treatment that not prick the skin and it will be safety and painlessness. 2.3. Procedure The subjects were engaged in high speed driving at a constant vehicle velocity of 80 km/h continuously for 3 h on a test course simulating an expressway. The research vehicle is SANTANA 2000. During the driving, magnitopunctures (Haci Five Elements Needle, 250 mT, made by Haci Company limited) were applied to the Dazhui (DU14) point and Neiguan (PC6) points for the study group after the subject performed the task for 2 h, and for the control group magnitopunctures were applied to non-acupuncture points during the same time session. In order to put the subjects under similar load conditions, the tests were conducted over consecutive days, with one test conducted on each day. To avoid the effect of the circadian rhythm with respect to the physiological variations within a day, the starting time of the test was set at the same time as the rst test, 9:00 AM. 2.4. Measurement Heart rate, reaction time testing, critical icker fusion frequency and subjective evaluation were tested, respectively, during or after the driving. 2.4.1. Measurement of heart rate Heart rate recording is suitable to the eld environment and has been used to monitor driver fatigue (Roscoe, 1993). While driving, an electrocardiogram was observed by placing three electrodes on the subjects chests. In order to observe a time series variation in the heart rate from the electrocardiogram trace, the average heart rate over 5 min was calculated every 30 min during the driving test. 2.4.2. Selective reaction time Because reaction time is the total length of time required in various physiological processes from when an organism receives a stimulus until the occurrence of a reaction, the reaction time can be considered as an index showing the degree of activity of the cerebral cortex (Evaluation and Research Committee on Advance Braking Warning System, 1998). This was tested by measuring the time taken to push a button in response to a visual stimulus. Continuous driving for long hours was imposed on each subject to create driving fatigue. In order to measure reaction time, each subject was asked to perform a vigilance task for 2 min after the driving task immediately. Fig. 1 shows the vigilance task (Yoshihiro and Masato, 1999). Three random numbers are displayed at the same time on screen and change once, randomly, every second. The subjects were asked to select click with mouse right button and promptly push it upon recognition of the three different odd numbers such as 1, 9 and 5. The time taken for subjects to respond to the three different odd numbers and the number of missed were both measured. The vigilance task, selected as the visual stimuli, appropriately reect the drivers ability to take in information necessary during driving. 2.4.3. Critical icker fusion frequency CFF was tested immediately after the driving task followed performing a vigilance task using EP403 (produced by Shanghai Science and Educational Factory). CFF was tested six times and the mean was calculated.

Fig. 1. Vigilance task.

Z. Li et al. / Accident Analysis and Prevention xxx (2003) xxxxxx Table 1 Fatigue symptoms questionnaire developed and used in the study No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Signs Physically tired Lazy Want to lie down Irritable No energy Mentally sluggish Headache Stiffness of shoulder Lumbago Easily distracted Eyestrain Feeling sleepy Nausea Trembling of hands and legs Very weak Weak Moderate S (C) Sa S Sa Sa S Strong S C C C C C S (C) S (C) S (C) S (C) Sa S (C) S (C) C Very strong C

Extremely strong

Mark S (study group) or C (control group) in the corresponding position indicating degree of fatigue (mean rating) after the driving task in both groups. a P < 0.05, statistical signicance of difference between study group (S) and control group (C) after the simulated task.

2.4.4. Subjective evaluation Self-reporting is the most frequently used method for assessing driver fatigue. Self-reporting provides useful information concerning the subjective awareness of fatigue following the completion of a task. To measure the various symptoms that occur during driving, a fatigue symptoms checklist was employed (Table 1). The Borgs category ratio (CR-10) scale (ranging 010) indicates the extent to which the subject has experienced each symptom (see Table 2) (Borg, 1982). To make it easier for our subjects to use, the scale was modied to consist of six scales as shown in Table 1. 2.4.5. Statistical analyses Differences between two continuous variables were compared with two-tailed t-test. The MannWhitney rank sum test was used to compare non-continuous parameters. Two-way analysis of variance was used to analyze the interaction of group (treatment and control) and time-of-test (before and after). Results are given as mean value. P < 0.05 was considered the level of statistical signicance.
Table 2 Borgs category ratio (CR-10) scale 0 0.5 1 2 3 4 5 6 7 8 9 10 Nothing at all Extremely weak (hardly noticeable) Very weak Weak (light) Moderate Strong (heavy) Very strong

Fig. 2. Heart rate during driving.

3. Results 3.1. The gradual decrease in the heart rate It was observed that, with the passage of time, the average heart rate tended to decrease, which was similar to those observed in the study by Milosevic (1997), with no substantial difference observed between the tests carried out in study and control groups, and all subjects were obviously in a tired state after driving for three consecutive hours. Fig. 2 shows the results of heart rate analysis. 3.2. Reaction time (RT) and right rate (RR) Table 3 shows the results of selective reaction time. The average reaction time was dened as the selective reaction
Table 3 Mean reaction time (RT) (ms) in study and control groups pre- and post-task Study group Pre-task Post-task 482 501 Control group 489 632,a

Extremely strong (almost maximal) Maximal

The subjects have to rate their perceived fatigue symptoms by a number from 0 to 10.

a Comparison of the RT between study and control groups after the driving task. P < 0.01, P < 0.05.

Z. Li et al. / Accident Analysis and Prevention xxx (2003) xxxxxx Table 7 Changes (reduce) of CFF (mean) in study and control groups F 29.84 120.96 13.92 Probability P < 0.001 P < 0.001 P < 0.01 CFF (Hz) Study group 1.22 Control group 3.12

Table 4 Results of two-way analysis of variance for RT Source Columns Rows Interaction Error Total SS 47531.2 192668.4 22177.8 121054.7 3833432.2 d.f. 1 1 1 76 79 MS 47531.2 192668.4 22177.8 1592.8

P < 0.05, statistical signicance of difference is shown between study and control groups.

Table 5 Mean right rate (RR) (ms) in study and control groups pre- and post-task Study group Pre-task Post-task

after the driving task for both groups. The change of CFF exhibited a signicant difference (P < 0.05, t = 5.24) between the two groups after the task. 3.4. Subjective evaluation The subjective rating questionnaire, for fatigue symptoms, they were given after the 3 h driving task referring to Table 1. Table 1 shows the comparison of main fatigue symptoms between study and control groups after the driving task. After the driving task, there were signicant difference in some fatigue symptoms, such as irritableness, no energy, mentally sluggish and feeling sleepy in Borg scale exhibited signicant differences between the two groups.

Control group 0.930 0.832

0.925 0.886

P < 0.05, comparison of the RR after the driving task between the study and control groups.

time. As a result, it was observed that control group exhibited a statistically signicant delay in the selective reaction time after consecutive driving for 3 h (P < 0.01, t = 11.17). With the reaction time recorded prior to driving as the reference, there was a delay in the reaction time of approximately 20.9% for the control group. However, there was only a delay in reaction time of approximately 3.9% and no statistical difference in the reaction time was observed between the pre- and post-task for the study group. Moreover a statistically signicant difference (P < 0.05, t = 3.26) in selective reaction time was observed between study and control groups after consecutive driving. Table 4 shows the results of two-way analysis of variance for RT. It can be seen that there was a signicant interaction (P < 0.01) between group (study and control) and time-of-test (before and after). Table 5 shows the mean right rate in study and control groups pre- and post-task. As a result, a statistically signicant decrease (P < 0.05, t = 3.33) in the corrective rate was observed after three consecutive hours of driving for the control group. Table 6 shows the results of two-way analysis of variance for RR. It can be seen that there was a signicant interaction (P < 0.001) between group (study and control) and time-of-test (before and after). 3.3. Changes of CFF in study and control groups CFF was tested before and after the simulated driving task in both groups. Table 7 shows the results of CFF before and
Table 6 Results of two-way analysis of variance for RR Source Columns Rows Interaction Error Total SS 0.00683 0.09501 0.0077 0.0198 0.12934 d.f. 1 1 1 76 79 MS 0.00683 0.09501 0.0077 0.00026 F 26.21 364.78 29.57 Probability P < 0.001 P < 0.001 P < 0.001

4. Discussion Overall, study group tended to be more mentally fatigued, unable to concentrate and irritable after driving than control group. There was no difference in the heart rate measurement between the two groups while driving, but a gradual decrease in the average heart rate was observed as time elapsed for both groups. This shows that the subjects were generally tired. It was also observed, from subjective evaluation, that the subjects were generally in a tired state, but after driving the subjects in control group felt more tired. The critical icker fusion frequency, has been used as an operational denition of the central nervous systems ability to process information, and some success has been reported in relating it to fatigue (Kishida, 1973; Wolle et al., 1978). The reduction in CFF exhibited a signicant difference between the two groups after the task, which shows that the ability of processing information for the subjects in control group was lower and they were more tired. When comparing selective reaction time, which was chosen as a yardstick for measuring the activities of the cerebral cortex, there was scarcely any difference between the measurements taken before and after driving for the study group. However, a statistically signicant delay was observed in the driving test conditions for the control group. Because a difference in selective reaction time occurs when the driver is fatigued, it is deemed that the degree of fatigue affected the selective reaction time. This means that with magnitopuncture stimuli on acupuncture points, the drivers fatigue was at a level capable of maintaining

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cerebral cortex activities, whereas with magnitopuncture stimuli on non-acupuncture points, the subjects ability of maintaining cerebral cortex activities deceased signicantly. Therefore, it is inferred that the support provided by magnitopuncture stimuli on Dazhui (DU14) point and Neiguan (PC6) points is effective in preventing the level of activity in the cerebral cortex from falling and in maintaining the drivers ability to carry out selective reaction to information. Heart rate variability (HRV) is also a good index of evaluating mental stress and fatigue. Although recent studies have conrmed that cardiac sinus arrhythmia is highly correlated with mental workload (Hayashi, 1997), HR is easily obtained in real time and is more resistant to the effects of outliers than the measures of heart rate variability. So in this study we just test the HR and will look into HRV in the future. The ndings of this study might be applied to preventing fatigue in actual driving through improving on the design of seat and wheel in which some attachment can be added and it has the function of stimulate human body points with magnetism.

of driving fatigue resulted from magnitopuncture stimuli on DU14 point and PC6 points during driving. Acknowledgements The authors would like to acknowledge all the participants for spending the time and effort to help out with our study. References
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5. Study limitations We did not measure and analyses heart rate variability, which is a good index of evaluating mental stress and fatigue because of the limitation of the equipment. The simple effect of magnetic elds per se on fatigue was not tested in this study. There were also other limitations. For example, would contact pressure points in the same places without the magnitopuncture produce the same effects? Would acupuncture or acupressure in the same points produce the same effects? For how long can such a treatment be effective? These study limitations will be considered in the future study.

6. Conclusions In this study many factual results have been obtained. On the basis of different approaches to the study of reducing the effects of driving fatigue with magnitopuncture stimulation on acupuncture points, some clear psychophysiological and subjective changes have been demonstrated. In spite of the complexity and ambiguity of drivers fatigue phenomena, recorded changes such as RT, CFF and drivers fatigue signs in these studies could be interpreted as reducing the effects