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An interactive 3D acupressure model for self treatment in reducing pain

Article · November 2015

DOI: 10.11113/jt.v77.6536

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Jurnal
Full Paper
Teknologi
AN INTERACTIVE 3D ACUPRESSURE MODEL FOR SELF Article history
Received
TREATMENT IN REDUCING PAIN 15 May 2015
Received in revised form
Nur Azman Abu, Mohd Adili Norasikin*, Zulisman Maksom 1 July 2015
Accepted
11 August 2015
Faculty of ICT, Universiti Teknikal Malaysia Melaka, Hang Tuah
Jaya, Durian Tunggal, Melaka, Malaysia
*Corresponding author
[email protected]

Graphical abstract Abstract

There are many pressure points on a human body. The pressure points are specific sensitive
areas on the surface of the human body going into deep tissue where the pain
concentrate and accumulate on. Acupressure is an alternative way to relieve pain. This
method is applied by using fingers. On medication, an effort to relieve pain by taking
painkillers will cause many side effects to a human body. The objectives of this paper is to
show acupressure points and its set of interconnection point in an interactive 3D visual
model. This model will recommend a set of self-acupressure points for a natural self-curative
therapy to relieve pain. The self-acupressure visual model has been embedded in a mobile
application. This interactive 3D visual model provides an alternative way to relieve pain. It is
an effective aid to help a user learn and apply self-acupressure treatment.

Keywords: Acupressure points, an interactive 3D visual model

© 2015 Penerbit UTM Press. All rights reserved

1.0 INTRODUCTION sensitivity. Pressure points in the human body can be

massaged and stimulated used to help relieve a
Historically, the knowledge on pressure points are well pain.
established since ancient time. In recent years, Nowadays, many people suffer from a serious pain
scientists have begun to document the existence on their body parts and most of them opt to take
and benefits of pressure point therapy. Research has painkillers to relieve the pain. Painkillers can relieve
demonstrated that a flow of electrical current along pain effectively. However, it only relieves the pain
the pathways the ancient text labelled as the temporarily and it will cause side effects to our body.
meridians [1] for which its conductivity has been While acupuncture is widely used to manage a
found greater at just those keys point traditionally chronic pain [3], acupressure is more practical and
designated as the pressure points. Substantial cost effective in reducing pain. Acupressure is also
evidence now exists that pressure point therapy can an effective alternative way to relieve pain in a
be instrumental in regulating the nervous system and variety of conditions. At the same time, acupressure is
blood circulatory system [2]. easy to learn and can be self-practice.
A pressure point is a specific location on human This paper introduces an interactive 3D visual
body where the intersection of vessels, nerves or model in mobile application for self-acupressure
muscular structures are concentrated for particular treatment. It is developed for the purpose of

77:19 (2015) 97–105 | www.jurnalteknologi.utm.my | eISSN 2180–3722 |

98 Nur Azman, Mohd Adili & Zulisman / Jurnal Teknologi (Sciences & Engineering) 77:19 (2015) 97–105

encouraging people to do self-treatment using supply to a muscle, however, also enters at the same
acupressure to relieve pain. Thus, a self-treatment place as the blood supply. Each skeletal muscle fibre
based on acupressure can be practical. is supplied by a single nerve ending. The nerve
There are many visual mobile on acupressure entering the muscle usually contains roughly equal
points. However, most of the mobile applications do proportions of sensory and motor nerve fibres [5].
not support interactive 3D visual model and hardly Acupressure points are practically hard points in
focus on the interconnect pressure point of the myofascia that hurt to the touch and render
acupressure to relieve pain. In addition, most of the pain. Fascia is the semiflexible fibrous membrane of
people do not know about the self-treatment using connective tissue that binds together the various
acupressure point. components of the body. The myofascia is the fascia
For this research project, an interactive 3D visual relating to the muscles. It covers individual muscle
model mobile application for self-treatment using fibers, bundles them together and covers the whole
acupressure is developed. This application includes muscles [6]. Acupressure points can be felt as hard
an interactive 3D visual model, which contains all the knots in our muscles. And they hurt when pressed.
acupressure points and its interconnection points to Acupressure points arise at predictable places in the
relieve pain. Thus, users can check the acupressure muscle and cause predictable patterns of referred
points for each part of the body and its pain.
interconnection points using this application. Acupuncture and acupressure point are the same
Therefore, it is more convenient for the users to learn points on a human body. While an acupuncture
about the self-treatment using acupressure. This treatment uses thin hair needles to stimulate the
application can be installed on the Smartphone and points, an acupressure treatment will just use hands
can use anytime and anywhere to stimulate and press on the intended points.
There are few mobile applications about Acupressure is easy to learn and can be self-
acupressure, but most of them using 2D image for treatment. Self-treatment acupressure is applied
acupressure points representation where the using the thumb or finger to specific interconnecting
interactive between users and the model. Moreover, pressure points of the acupressure point in pain.
a user may find it difficult to identify the actual part of Acupressure points place on the body skin. It is
the acupressure points on their body. sensitive to bio-electrical impulses in the body. There
Most of visual models does not focus on the are 14 long meridians around our body. There are
interconnect pressure points to relieve pain. more than 360 acupressure points along the
Interconnecting pressure points are the points to meridians [7].
apply pressure to relieve the pain which are not These acupressure points have its interconnection
located anywhere near the area in pain. The current points. The interconnection points are the point to
application does not show the interconnect pressure apply pressure on it to relieve pain of its acupressure
points of acupressure points, users need to find out points. The pressure is applied gently and is often
the point by searching it. increased for about 30 seconds. Next, hold 30
This interactive application is mainly focused on seconds to 2 minutes and decreased the pressure for
self-treatment acupressure points and its 30 seconds. The steps need to repeat for 3 to 5 times
interconnecting acupressure points to relieve pain for when applying self-treatment acupressure, a mental
self-treatment. It provides an easy to learn interaction attitude of calmness and concentration is important.
on ancient technique of self-healing. Loose and thin clothing is recommended when
giving acupressure [7].
Acupressure self-treatment is cost-free since it does
2.0 ACUPRESSURE POINTS not have to depend neither to any specific tools nor
any earlier appointment with anyone. The only
Human muscle accounts for about 50 percent of equipment needed is only acupressure mobile
body weight but 85 percent of human pain application in a smartphone and fingers. This mobile
complaints [4]. Human muscles are covering nearly based application therapy can be practiced at
every other tissue or structure in the body. A pressure anytime, anywhere. It empowers not only curative
point of pain on human muscle associated to pain is abilities but also the body’s wisdom and expressions.
commonly referred to as an acupressure point. Furthermore, it increases the awareness and morale
In general, each muscle receives one artery to of the practitioner since they have to determine how
bring nutrients via blood supply into it but several much the pressure and which approach is most
veins to take away metabolic waste products beneficial [8].
surrendered by the muscle into the blood. The nerve
99 Nur Azman, Mohd Adili & Zulisman / Jurnal Teknologi (Sciences & Engineering) 77:19 (2015) 97–105

not feel the painful stress of massage pressure since

the hand is not in pain.
Figure 1 shows the acupressure points on the arm
and respective set of interconnecting acupressure
points on the leg. These sets of interconnecting points
have been collected from a traditional pressure point
therapist in Melaka Malaysia. Even though the
knowledge on the interconnection is traditionally
known among the experienced therapist, it is not
explicitly written in any modern literatures.

Figure 2 A therapist is locating a pressure point on a patient

ankle the interconnection acupressure point as the
treatment and vice versa

Figure 1 shows the arm and leg potential point of pain and
the interconnection acupressure point as the treatment and
vice versa

Pressure point therapy is one of the most intriguing

and fastest-growing bodywork styles in the world.
Medical doctors, chiropractors, physical therapists
and massage therapists are all beginning to use this
technique to relieve formerly undiagnosable muscle
and joint pain [9]. The stimulation of the point causes
an increase in the oxygen level in the area and
produces instant relief. The current therapy is simply
applying on series of pressure points a gentle but firm
Figure 3 A therapist is applying a pressure on the
finger pressure. Here, we are proposing the concept interconnecting point on the hand
of symmetrical pressure points. Currently, the pressure
points are mapped in most pressure point reference
chart as static with minimal inter-connection across Suppose a person suffers from a strong pain on his
body symmetry. leg, a well-trained therapist can apply a medium
stimulating touch on his respective pressure point on
his hand to ease the pain. In this case, the patient will
3.0 AN INTERCONNECTION AMONG SETS OF not feel the painful stress of massage pressure since
ACUPRESSURE POINTS the hand is not in pain.
A human body is internally governed by the
In general, every acupressure points on human is combination of interconnecting pathway of energy
highly inter-related to each other. For every pressure channels, also often called meridian lines. When an
point on the hand, there will be another at the acupressure point is stimulated, it has been observed
equivalent respective location on the opposite leg. that the patient will often experience a change in
Suppose a person suffers from a strong pain on his seconds and this change frequently occurs at the
leg, a well-trained therapist can apply a medium opposite end and contralateral side of the body from
stimulating touch on his respective pressure point on the point stimulated. The exact mechanism of this
his hand to ease the pain. In this case, the patient will action is not yet fully understood, although certain
100 Nur Azman, Mohd Adili & Zulisman / Jurnal Teknologi (Sciences & Engineering) 77:19 (2015) 97–105

aspects appear to be based on established present pain intensity [11]. Zero indicates no pain, 5 is
neurophysiologic concepts [10]. moderate pain and 10 is worst possible pain. The
The pain will be checked by applying pressure on score 1-3 is considered, the score from 4-6 is
the point and it will be relieved by rubbing on the moderate and 7-10 is severe. This is a practical
interconnect acupressure point and vice versa. quantitative measure of pain. Visual Analog Scale
Figure 2 shows pressure was applied to the subject (VAS) rates pain on 10 continuum numbers from 0 to
where the pain is located at the ankle joint 10, that reflects 0 as no pain and 10 reflects pain at its
meanwhile Figure 3 shows the interconnection points worst.
on the wrist joint has been rubbed as the acupressure
treatment to relieve the pain.
In computer science, the visual representation of
the pressure point shall be more like an expert
system. It shall convey the knowledge of traditional
measurements used by experts in this field. It may be
used as an aid to locate a set of pressure points on
the body. Typically, pain in one part of the body is a
result of a blockage in a channel in another part of
the body It shall guide a novice practitioner where to
apply pressure.
The depth of the points listed on the visual can be
different and requires different amounts of pressure.
Typically, basic learning process on how to apply
pressure for both surface and deep pressure points
takes several years to acquire. This research shall not
only try to preserve the knowledge but also to speed
up the learning process of pressure points in
Figure 4 The distribution treatment by patient suffering a
reflexology massage therapy.
serious pain

4.0 RESULT SURVEY ON INTERCONNECTING 5.0 USER BACKGROUND SURVEY

ACUPRESSURE POINT TECHNIQUE
A preliminary survey has been conducted prior to the
A pain assessment test and pain relief assessment test development of this mobile application. The subjects
has been conducted to 10 street soccer players have been selected among the patients of a
immediately after a soccer match. The result through reflexology service centre in Melaka, Malaysia.
an interview with patient after the technique on There are 37 female (74%) and 13 male
interconnection acupressure points has been applied respondents (26%). Among the respondents, there
is depicted in Table 1. are different age groups. The respondents are mainly
around 21-30 years old (91%). There are 3
Table 1 Pain Assessment show an improvement after respondents (6%) are more than 55 years old and 1
pressure point treatment respondent(2%) respondent is 31-40 years old. On the
respondent background, 40 respondents (80%) or
No Pain Mild Moderate Severe their family members have suffered from serious pain
Player Pain Area
(0) (1,2,3) (4,5,6) (7,8,9)
during their lifetime.
1 Ankle Out of those who have suffered serious pain, half of
2 Knee them take painkillers to relieve pain. There are 26
3 Knee
respondents (52%) who have taken painkillers to
relieve pain. While, 13 respondents (26%) state that
4 Knee they do not take any treatment for the pain. There
5 Heel are 2 respondents (4%) use acupuncture to relieve
6 Thigh pain and 3 respondents (6%) only try to relieve pain
by acupressure treatment. The rest of the
7 Thigh
respondents (12 %) relieve their pain problem by
8 Calf taking massage treatment. The choice of treatments
9 Calf in dealing with a serious pain is depicted in the Figure
4.
10 Dorsal
In general, a pain killer is still a popular medication
in dealing with serious pain while an acupressure
treatment is lagging behind. Even though, most of
Using zero to ten Numeric Rating Scale (NRS). Brief the respondents (92%) know the painkillers will cause
Pain Inventory (BPI) asks a patient to rate his/her some kind of side effect to the body. And only 4
101 Nur Azman, Mohd Adili & Zulisman / Jurnal Teknologi (Sciences & Engineering) 77:19 (2015) 97–105

respondents (8%) do not know that the pain killers will compatibility of OpenGL is maintained to prevent
cause long term side effects to the body. loss of functionality.
Among the respondents, there are 30 respondents In OpenGL ES, it only consists of vertex array to
(60%) who do not know acupressure is an alternative specify the geometry. The 3D model in android is
way to relieve pain. There are 20 respondents (40%) drawn from the vertex array in OpenGL ES. All the
know acupressure can relieve pain. coordinates are determined in the vertex array.
OpenGL ES also can use to texture the model to
make the model look more realistic.
User Content Preference(%)
A 3D model can be implemented the touch events
80 72 to response for the users touch on the screen. The 3D
70 66 model can let users to rotate, zoom, drag and point
58 to specific coordinates by implement the touch
60
50 event to provide interactivity to the users.
50 46 There are several applications on acupressure
application available in the market. The current
40
existing system does not fully meet the requirement of
30 user. Most of the applications provide less information
about the acupressure point to relieve pain and are
20
more focus to acupressure point for symptoms.
10 There are many people taking painkillers to relieve
0
pain. However, painkillers will cause many side
effects to our body. This interactive application has
been developed to encourage people to relieve
pain in an efficient way. This application mainly
focuses on self-acupressure to relieve pain.
By developing this application, user can check the
interconnect pressure point to relieve point. Thus, this
project will enable users to learn self-treatment
Figure 5 The content preferences chosen by the user is in acupressure. There are many applications about
favour of an interactive 3D Model
acupressure, but mostly focus on acupressure for
symptoms. Users may not have any more information
about the self-treatment acupressure point to relieve
Majority of respondents (48/50) have a smartphone
pain.
while only 2 respondents do not own a smartphone.
This project is developing an application for
When asked about their willingness to try and use
Android smartphone. Nowadays most of the people
mobile application on acupressure for relieving pain,
have Smartphone, thus the user can use this
39 respondents (78%) state that they are willing to try
application in anywhere and anytime. The system
while there are 11 respondents (22%) will not use such
does not only provide the location of the
applications.
acupressure points but also its interconnection
On the content preference in the self-treatment
pressure point in a 3D model.
acupressure application, 36 respondents (72%)
The architectures in this application are android
choose an interactive 3D model followed by a video
application, a user interface and a database. The
33 respondents (66%). There are 29 respondents (58%)
database stores all the object information on the 3D
state that they also prefer to view images in the
models. The 3D model has been modelled in
application followed by an animation 25 respondents
Autodesk Maya which is touch interactive that can
(50%) and text only 23 respondents (46%). These
rotate, zoom and drag.
preference ratings are depicted in the Figure 5.

6.0 AN INTERACTIVE 3D MODEL ON 7.0 SELF-CURATIVE THERAPY

ACUPRESSURE POINTS IN SMARTPHONE
A pain is a major physiological and psychological
An interactive 3D model in mobile application is unpleasant experience of human beings. In order to
processed by the graphical processing unit (GPU) of identify an acupressure point in pain, physiotherapists
a mobile unit. An open graphic library (OpenGL) or physicians compare a patient complaints to the
embedded system (ES) is a cross-platform pain pattern of pressure points they know and to
application programming interface (API) for 3D catalogs of common pressure points and then feel
graphics. around in muscles for hard knots in the likely places.
It handles 2D and 3D graphics on embedded They will know that they find the right spot when the
devices. An OpenGL ES removes any redundancies patient makes a sudden reaction in agony when the
to create an API that suitable for various devices. The knot is pressed [4].
102 Nur Azman, Mohd Adili & Zulisman / Jurnal Teknologi (Sciences & Engineering) 77:19 (2015) 97–105

A user will seek for remedy to ease off his/her pain.

One will assess the presence and intensity of pain by
applying some amount pressure to the pain area. A
user may estimate the pain intensity on a scale of 1
to 10. A user can check the interconnecting pressure
point from the Interactive 3D Acupressure Model to
relieve point of pain.

Figure 7 The main menu of the self-treatment acupressure

application

The user interface in Figure 7 shows user interface

Figure 6 The front page of the self-treatment acupressure of the application that contains a menu set for
application potential acupressure pain points. The menu then will
be navigated to a screen that display selected
model with points. The model can be rotated,
The user may opt to apply sufficient pressure on the zoomed in or out to ease user in seeking potential
interconnecting point to relieve the pain. Thus, this pain points.
project will enable users to do self-treatment A user may select any acupressure point as shown
acupressure. Surrounding an acupressure point, on the left of Figure 8. The system will navigate to the
painful knots that develop in muscles and tissues are respective interconnecting point for the acupressure
a common cause of chronic pain. Sustained self- point in pain as shown on the right of Figure 8.
treatment is by far the most effective acupressure
point therapy.
A user is encouraged to do self-acupressure
therapy. As the condition improves, he or she may
forget how intense his/her symptoms were originally,
and think the user is not getting any better. Typically,
a user will be able to see an improvement even with
an occasional setback (DeLaune, 2011).
A 3D model will be stored in database and will be
query back using xml file to be displayed in an
application interface on a smart phone screen as
shown in Figure 6.
103 Nur Azman, Mohd Adili & Zulisman / Jurnal Teknologi (Sciences & Engineering) 77:19 (2015) 97–105

8.0 A USER ACCEPTANCE TEST

A qualitative evaluation survey has been carried out

based on the beta version. The user acceptance is
important to evaluate the system functionality of this
application. Each group of test users will get a set of
questionnaire respectively. In early parts of the
questionnaire, there are 5 different rates for each
question. Test user need to answer required to rate
the question with the rating as shown in the following
Table 2.
The questionnaire has been prepared based on
the system visual clarity, navigation and interactivity,
functionality, content and the effectiveness of this
interactive 3D acupressure model.
Technically, the respondents have given high
marks on the interactivity of the system as shown in
Parts A, B and C as shown in Table 3.

Table 3 Evaluation scores on the interactive 3D acupressure

model

No. Aspect / Module Mean Median Mode

PART A: VISUAL CLARITY

The interface is bright
1 4.6 5 5
and clear.
The text for instruction
2 4.5 4.5 5
is easy to read.
The menu button
3 labelled with body 4.4 4 4
part is easy to identify.
Figure 8 The navigation of interconnecting acupressure The use of colour on
points during a self-treatment therapy 4 the button is 4.8 5 5
meaningful.
The seek bar on the
The main objective of this paper is to develop an 5 right of the screen is 4.5 4.5 5
interactive 3D acupressure model that can promote easy to see.
alternative way to relieve pain. According to The use colour on the
DeLauni in [12], any pain on acupressure points on acupressure points on
6 4.4 4 4
the body should be treated immediately and 3D model is easy to
identify.
reduced in order to avoid the potential of becoming
a chronic pain. A longer time taken to cure a pain PART B: NAVIGATION AND INTERACTIVITY
may contribute to a muscle get entangled and The menu button
involved in chain reaction chronic pain and 1 divided by body part is 4.4 4.0 4
dysfunction. easy to press.
The slide button on top
Table 2 Basic quantitative rating scores 2 of screen is clear and 4.8 5.0 5
easy to slide.
Description Rating Score The seek bar on right
Strongly disagree 1 3 of the screen is easy to 4.8 5.0 5
use.
Disagree 2
The button response
Not sure 3 4 4.8 5.0 5
time is fast.
Agree 4 The back button is
5 4.3 4.0 4
Strongly agree 5 easy to press.
The colour change on
a selected
6 acupressure point is 4.6 5.0 5
easy to identify.
104 Nur Azman, Mohd Adili & Zulisman / Jurnal Teknologi (Sciences & Engineering) 77:19 (2015) 97–105

PART C: FUNCTIONALITY AND CONTENT The results from the user acceptance test on this
interactive 3D visual model proves that the
The interactive 3D application which has been developed works well
1 model illustrates the 4.3 4 4 and meets the objectives.
human body clearly. This application provides an interactive 3D model
The use of colours on to view acupressure points and the interconnect
acupressure points pressure point to relieve pain. Each acupressure point
2 4.6 5 5
make them easier to is specifically labelled to prevent confusion.
identify. In the end, the user will always have more control
The acupressure points over his/her own therapy. The user may obtain either
3 in smartphone 4.3 4 4 substantial or complete relief from pain without any
presented attractively.
additional treatment. In fact, he or she may not get
The acupressure points more temporary relief from self-help pressure
4 in smartphone is simple 4.2 4 4
techniques than from limited period of time within a
and clear.
session with practitioners’ treatments.
The tutorial on bottom
of the screen to apply
5 4.8 5 5
acupressure is easy to
follow. 9.0 CONCLUSION
PART D: EFFECTIVENESS
Answer Answer The acupressure technique proposed in this paper
No. Question
Correctly Wrong provides an alternative way to relieve pain
What is the name of this effectively. Furthermore, the acupressure technique
treatment? can be made for a self-treatment and easy to learn.
A. Acupuncture The self-treatment acupressure is applied using the
1 30 0
B. Acupressure finger to apply pressure to acupressure interconnect
C. Reflexology pressure points. In addition, relieve pain by
D. Massage acupressure will not cause any side effect to human
What is the inter-connecting body system. This project has been developed to
part for upper leg? encourage people to relieve pain without using
A. Lower leg
2 27 3 painkillers. The self-acupressure visual model has
B. Upper Arm
C. Lower Arm been embedded in a mobile application. This
D. Foot interactive 3D visual model provides an alternative
What is the colour of
way to relieve pain. It is an effective aid to help a
selected point on 3D user learn and apply self-acupressure treatment.
model?
3 A. Red 28 2
B. Green Acknowledgement
C. Yellow
D. Blue The authors would like to express a very special
What is name of the point to gratitude to Ministry of Education, Malaysia for
apply pressure for providing the financial support on this research
acupressure point?
project by Research Acculturation Grant Scheme
4 A. Acupressure point 29 1
(RAGS/2012/FTMK/SKK10/1 B00017).
B. Pressure point
C. Interconnection point
D. Connection point
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