Abstract:
The present invention relates to a device and method for monitoring fatigue. In one embodiment, a sequential finger fatigue measuring system is provided which measures the force output from fingers while the fingers are sequentially generating forces as they strike a keyboard. Force profiles of the fingers are generated from the measurements and evaluated for fatigue. The system can be used clinically to evaluate patients, to ascertain the effectiveness of clinical intervention, pre-employment screening, to assist in minimizing the incidence of repetitive stress injuries at the keyboard, mouse, joystick, and to monitor effectiveness of various finger strengthening systems.

Description:
BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The invention relates generally to a device and method for monitoring fatigue and more particularly to a device and method for monitoring a specific body part of a person for fatigue by measuring and evaluating the forces generated by that body part as it performs a series of sequential or repetitive motions. 
     2. Description of the Related Art 
     The prior art discloses various techniques for monitoring fatigue. Generally, a single muscle or a related group of muscles is monitored for fatigue. In Eskelinen, U.S. Pat. No. 5,349,963, for example, the fatigue level of a particular muscle is determined from electromyographic (EMG) signals that are measured from that muscle. 
     EMG signals may be employed to detect muscle fatigue while the muscle undergoes isometric- or isotonic-type testing. For isometric-type testing, electrodes are attached to a muscle being studied and the test subject is instructed to apply a constant force with that muscle while maintaining that muscle in a static position. For isotonic-type testing, electrodes are attached to a muscle being studied and the test subject is instructed to perform multiple cycles of repetitive motions with that muscle. In both types of testing, EMG signals, which are measurements of muscle output activity, are collected for fatigue analysis. 
     The prior art also discloses force monitoring systems that measure the amount of force generated by a muscle or group of muscles. For example, in Krugman, U.S. Pat. No. 5,579,238 and Barker et al., U.S. Pat. No. 5,745,376, the force that a user applies to a keyboard is measured. Feedback is provided to the user when excessive force is detected so that the user can reduce the force applied to the keyboard and thereby reduce the likelihood of developing repetitive stress injuries (RSI). 
     In Krugman, finger force is measured by way of a vibration detecting device attached to the keyboard. The signals from the vibration sensor are proportional to the force produced by the fingers. The force data is used to trigger auditory warning signals if the force exceeds a certain threshold level. In Barker et al., an initial force is compared with a secondary force. If the secondary force is larger than the initial force, the system triggers an auditory warning signal. 
     The present invention differs from the teachings of Krugman and Barker, in that both of these patents relate to the detection of excessive force, whereas the present invention relates primarily to the detection of decreased force characteristic of fatigue. 
     Because of the importance of avoiding muscle fatigue, there is a general need to provide techniques and systems for monitoring the onset of fatigue. The present invention relates to such techniques and systems, which are based on evaluating the force profile of a muscle or group of muscles. 
     SUMMARY OF THE INVENTION 
     Repetitive Stress Injury (RSI) is a general term that describes the consequences of repetitive activity, usually of the fingers, wrist, elbow or shoulder resulting in numbness, pain and an inability to work productively. The basic assumption for the pathogenesis of RSI is that muscles, which are doing repetitive work, will continue to generate force even after they become fatigued. Damage occurs when the muscles are not properly rested. Thus, the prime time to protect persons from RSI is during the time when the muscles are becoming fatigued. 
     Fatigue is usually manifested as a decrease in the amount of force produced over time. Most subjects who are undergoing repetitive motion during exercise (e.g. curls, leg exercises) will generate sufficient force to continue their exercise until they fatigue, after which there is a decrease in the amount of force being generated. However, in some subjects, as the muscles become fatigued, the force will increase temporarily and then decrease. In those situations, the subject responds to fatigue by changing the exercise rate, and/or other muscles are involuntarily recruited to assist the fatigued muscles. In any event, the object of the present invention is to avoid fatigue. 
     Subjects who have RSI are not able to generate as much force as non-afflicted subjects, nor are they able to conduct an exercise for as long a period of time. However, the degree of impairment is usually not quantifiable. Thus, the clinician is left with only subjective impressions about the improvement of the patient after surgical/clinical intervention. In a preferred embodiment, the invention provides an apparatus that can evaluate the force generated by the fingers as they perform repetitive motions. The same apparatus can be used to evaluate both impaired and normal subjects. 
     The apparatus is a combined hardware/software system that is useful for measuring the onset of fatigue, such as finger fatigue caused by the repetitive force of striking a keyboard. This fatigue monitoring system (FMS) is designed to record in real-time the force generated by each finger separately or together as they strike the keys repetitively until there is a decrease in force. The “force profile” (i.e. the waveform of the force) over time is recorded by the apparatus to demonstrate the change in force characteristics associated with fatigue. The force profile may be characterized by evaluating any of a number of different parameters derived from the waveform, such as initial slope, rate of change of slope, peak height, width, etc. This system may also be coupled to the measurement of EMG signals recorded from the forearm and/or finger muscles that move the finger, so that the change in amplitude of the EMG signals may be correlated with the onset of finger fatigue. The software may provide a way also in which subject and/or patient data can be entered and printed out at a later time. 
     The invention may further provide a keyboard (regular or ergonomic) as the input device of the combined hardware/software system. The combined hardware/software system may also include a mouse, a joystick, or any other input device having finger- (or hand-) actuated keys or buttons. It should be understood that as used herein, the term “keys or buttons” contemplates other apparatus configurations as well, such as levers, switches, knobs, etc. When these input devices are included, the invention serves as an active fatigue monitor that evaluates the condition of the user from the force profile and alerts the user to rest when it determines the user has become fatigued. 
     The FMS is capable of quantifying finger fatigue recorded in real-time during repetitive motion of the fingers, either separately or together. In some regards, the FMS is like to a treadmill for fingers. It can be used clinically to evaluate patients, to ascertain the effectiveness of clinical intervention, pre-employment screening, to assist in minimizing the incidence of RSI at the keyboard, mouse, joystick, and to monitor effectiveness of various finger strengthening systems. In all applications, the key output measure is the force produced by the fingers. The conventional treadmill allows for a specific amount of work to be done until the person tires. Simultaneously, the person&#39;s heart rate can be monitored. The FMS is similar in that it allows the user or the clinician to ascertain the amount of time a person can maintain a given force while conducting repetitive finger movements. During this time, EMG signals may also be collected by the FMS and recorded from muscles in a manner similar to the recording of heart rate while using a conventional treadmill. 
     In addition, once a clinical intervention has occurred, the onset of fatigue should be increased over that of the pretreatment condition. The FMS allows the clinician to be more objective in terms of assessing the improvement of the patient. 
     The FMS solves the problem of the lack of quantification of finger fatigue for subjects with various pathologies that influence their finger movements. Whether it is musicians, computer users, or any other persons repeatedly applying force sequentially with their fingers, the FMS allows a more scientific approach toward the management of RSI. At present, all repetitive stress injuries are considered similar. By using the FMS, it is possible to begin to discriminate between various clinical RSI manifestations. 
     Additional objects, features and advantages of the invention are set forth in the claims and the detailed description of preferred embodiments which follow. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The invention is described in detail herein with reference to the drawings in which: 
     FIG. 1 is a schematic diagram illustrating the basic elements of a person&#39;s arm that work together to generate finger forces; 
     FIG. 2 represents sample EMG outputs of a subject performing repetitive motions. 
     FIG. 2A depicts the relationship between EMG signal (RMS) and time, and 
     FIG. 2B depicts the relationship of EMG signal amplitude/frequency and time; 
     FIG. 3A is an illustration of an ergonomic keyboard for the left hand for generating a finger force profile that is used to monitor fatigue using an FMS; 
     FIG. 3B is an illustration of a fatigue monitoring system for fingers, including an ergonomic keyboard for the right hand, for generating a finger force profile that is used to monitor fatigue; 
     FIG. 4 is a detailed illustration of one of the keys on the ergonomic keyboard of FIG. 3A; 
     FIG. 5 is a block diagram of a combined FMS, including hardware, software and a keyboard, for monitoring the onset of finger fatigue; 
     FIG. 6 is a schematic illustration of a digital signal processing circuit for the keyboard switches arranged on the ergonomic keyboard of FIG. 3A; 
     FIG. 7 is a schematic illustration of an analog signal processing circuit for the force sensors arranged on the ergonomic keyboard of FIG. 3A; 
     FIG. 8 illustrates side ( 8 A) and top ( 8 B) views of a calibrator used for the finger force sensors; 
     FIG. 9 is a sample display that provides visual feedback of the forces generated by the subject while the subject is being monitored for fatigue with the keyboard of FIG. 3A; 
     FIGS. 10A-10E are sample force profiles for each of the fingers on a test subject&#39;s hand as follows:  10 A-thumb,  10 B-index finger,  10 C-middle finger,  10 D-ring finger, and  10 E-little finger; 
     FIG. 11 graphically depicts the force profile (solid line) superimposed with the key depression and release (dotted apparatus line) generated using the depicted in FIG. 8; 
     FIG. 12 is an illustration of a fatigue monitoring system incorporated into a personal computer system that includes a mouse and joystick; and 
     FIG. 13 is an illustration of a fatigue monitoring system which also includes means for measuring EMG. 
    
    
     The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate presently preferred exemplary embodiments of the invention, and, together with the general description given above and the detailed description of the preferred embodiments given below, serve to explain the principles of the invention. 
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     In the workplace as well as at home, the ubiquitous nature of the computer and other “ergostressors” requires that there be apparatuses available to indicate when rest is required to prevent physical injury. 
     Repetitive stress injury (RSI) is a major problem facing clinicians and our society. Carpal Tunnel Syndrome (CTS), which is one form of RSI, is a significant health problem in the workplace today. The U.S. Department of Labor has concluded that CTS is the “chief occupational hazard of the 90&#39;s—disabling workers in epidemic proportions.” As our society gets older, the incidence of RSI will increase. In addition, as we urge all children to become computer literate, RSI will become a major problem with our youth. By the year 2000, 30 million children will have computers at home and 40 million will have computer time at their schools. 
     An apparatus that can quantify the degree of impairment of subjects suffering from CTS would be useful in the medical field. The most practical non-evasive method is to evaluate the fatigability of the fingers while conducting a standard repetitive task. Such a method would be useful to hand surgeons, and physical and occupational therapists to evaluate patients suffering from RSI before and after clinical interventions. Presently, surgical intervention is used to minimize CTS. However, if the patient begins to repeat the same behavior that produced the problem, then the person may develop CTS again. 
     The present invention provides a force monitoring system (FMS) that is useful for evaluating fatigue. When adapted for the evaluations of repetitive finger motions, it can be used to detect, avoid, and/or treat CTS. 
     When studying repetitive activities involving fingers, many factors may influence the generation of finger force, such as the activity of the muscles and the tendons shown in FIG. 1, but the end result of finger activation is force produced by the fingers. 
     As a person fatigues while performing repetitive finger motions, EMG signal amplitude from the muscles (which can be measured in terms of root mean square (RMS)), tends to increase while the time it takes to perform the motion tends to decrease. See FIG.  2 A. In addition, as the amplitude of the EMG signals increase, the frequency of the EMG signals decrease. See FIG.  2 B. These EMG signal changes can be evaluated simultaneously with force measurements to enhance the ability to obtain useful clinical information from the FMS. 
     The (FMS) according to one embodiment of the invention is illustrated in FIG.  3 A. It shows an ergonomic keyboard  10  including a housing  15  on top of which are provided a receptacle  20  for the base part of a person&#39;s left hand, and a plurality of keys  31 - 37 . One of keys  31 - 33  are provided for activation by the person&#39;s thumb, key  34  for activation by the person&#39;s index finger, key  35  for activation by the person&#39;s middle finger, key  36  for activation by the person&#39;s ring finger, and key  37  for activation by the person&#39;s little finger. The person may choose any one of keys  31 - 33  for activation by his or her thumb. Multiple keys  31 - 33  are provided for the thumb to account for differing hand sizes. 
     The FMS illustrated in FIG. 3A evaluates the fingers of the subject&#39;s left hand. FIG. 3B illustrates an FMS that evaluates the fingers of the subject&#39;s right hand. FIG. 3B also illustrates how the person&#39;s right hand is held down in a substantially fixed position by a wrist strap  38  that is attached to the keyboard  10 , so that the finger forces are generated substantially by the muscles for moving the fingers over the entire duration of the test. FIG. 3B also illustrates a signal conditioning unit  60  connected to the keyboard  10  by a cable and a power supply unit  65  for the signal conditioning unit  60  connected to an AC outlet (not shown). 
     Each of the keys  31 - 37  of the apparatus depicted in FIG. 3A is “functionally associated” with a force transducer or “sensor.” As used herein, the term “functionally associated” refers to any means of coupling the action of the keys or buttons to the production of signals that can be detected by the force sensor. Different types of force sensors can be used, such as a FlexiforceT™ sensor (Telescan, Inc., South Boston, Mass.). FIG. 4 is a more detailed illustration of a representative one of the keys  31 - 37 , and shows a force sensor  40 . The sensor  40  is supported on a key cap  41  through a resin  42 . The resin  42  fills a concave space formed on an upper surface of the key cap  41 . The finger force is applied by a person&#39;s finger  50  and transmitted through a puck  43 , which is preferably plastic, to the key cap  41  to actuate, a switch, which is sometimes referred to as “cherry switch”,  44 . The actuation state of the cherry switch  44  is transmitted to a data acquisition card  70  (see FIG. 5) over a PC board  45 . The sensor signals are transmitted to the data acquisition card  70  over a cable, which is held onto the housing or case  15  using a double-sided tape  46 . 
     In an alternate embodiment of the FMS depicted in FIG.  3 A and illustrated in FIG. 4, a force sensor like the one used for the key switches  44  is provided underneath the receptacle  20  for the base part of the hand. As with the force sensors  40  used with the key switches  44 , the force sensor for the receptacle measures the force generated by the base of the hand and transmits signals to the signal conditioning unit  60 , in particular the analog signal conditioning unit  62 , for processing. The forces generated by the base of the hand may be used as another measurement of fatigue, since as the subject becomes fatigued using the fingers, more force will be applied by the base of the hand. 
     FIG. 5 is a block diagram of the overall system including the ergonomic keyboard  10 , a digital signal conditioning circuit  61  for the keyboard switches, an analog signal conditioning circuit  62  for the force sensors, a data acquisition card  70 , a digital signal processing unit  80 , and a data display  90 . The signal conditioning unit  60  shown in FIG. 3B includes both the digital signal conditioning circuit  61  and the analog signal conditioning circuit  62 . In the exemplary embodiment, the data acquisition card  70  is installed in a personal computer and the data display  90  constitutes the display unit of the personal computer. Further, the digital signal processing unit  80  comprises a microprocessor for the personal computer executing a series of program steps to store the acquired data in a memory and to retrieve and process the data for graphic representation through the data display  90 . 
     Referring to FIG. 6, the digital signal conditioning circuit  61  for the keyboard switches  44  comprises an interface  100  connected to the keyboard switches  44  through a 25-conductor shielded cable  105 , and to the data acquisition card  70  through a 68-conductor shielded cable  106 . The interface  100  provides, for each keyboard switch  44 , an LED  101  connected in series with a pull-up resistor  102  and an inverter  103  between a 5-volt power source and ground. With this arrangement, the LED  101  turns ON when the corresponding keyboard switch  44  is pressed and a HIGH signal is supplied to the data acquisition card  70 . The LED  101  provides a visual indication that the digital signal conditioning circuit  61  and the keyboard switches  44  are working properly. 
     Referring to FIG. 7, the analog signal conditioning circuit  62  for the flexi-force sensors  40  comprises an interface  110  connected to the sensors  40  through a 25-conductor shielded cable  105  and to the data acquisition card  70  through a 68-conductor shielded cable  106 . The interface  110  includes a signal pre-amplifier  111 , a filter  112 , and an offset calibrator  113 . The signal pre-amplifier  111  and the filter  112  employ a low noise operational amplifier (not shown) in a single-ended arrangement to produce an analog output based on the force applied to the force sensor  40 . It also includes a 10-turn potentiometer  114  for signal-gain control to provide a better resolution during the gain-calibration procedures. The output filter  112  includes an operational amplifier, a resistor and a capacitor that are configured to block out high frequency signal components. The cutoff frequency may vary, but can be set to 63 MHz. The offset calibrator  113  includes a 10-turn potentiometer  115  and introduces an offset or bias to the amplified and filtered flexi-force sensor output signal in accordance with the setting of the 10-turn potentiometer  115 . 
     FIG. 8 is a top view ( 8 A) and a side view ( 8 B) of a calibrator used for the force sensors. Each key is calibrated separately after the force sensor has been fixed firmly in its place. Various known forces are applied to the force sensor and the electrical output signals are measured. The relationship between the input force magnitude and the output signal magnitude obtained in this manner is used to quantify the applied force in terms of Newtons relative to voltage output. 
     The calibrator illustrated in FIG. 8 includes a copper clad board  200 , levels  210  secured to the copper clad board  200  with wire straps  220 , a copper pipe  230  that extends below the copper clad board  200 , and a stainless steel washer  240  mounted on the outer circumference of the copper pipe  230 . The operation of the calibrator is as follows. 
     First, using micro-manipulators that encircle the stainless steel washer  240 , the copper pipe  230  is placed over the key which has the flex-force sensor. Second, the micro-manipulators that support the calibration platform (mainly the copper clad board  200 ) are positioned until the levels  210  indicate that the platform is level. Third, weights are placed incrementally on the platform. During this step, the levels, as well as the electronic output, are monitored. Fourth, additional weights are continued to be placed on the platform incrementally until the flexi-force sensor is saturated at a weight that matches the manufacturer&#39;s reported force level, e.g., 4 lbs. Fifth, the weights are removed incrementally. Preferably, these steps are repeated two additional times, and throughout this process, the weights placed on the platform and the electrical signal output are recorded. 
     Testing with the FMS is carried out in the following manner. The apparatus is set to sample signals at a given frequency. For example, setting the apparatus to take samples at a frequency of 1000/sec. allows for the accurate capture of EMG signals simultaneously with signals representing force measurements. Lower frequencies can be used when EMG signals are not being measured. 
     The subject is seated in front of the data display  90  referred to in FIG. 5, and further depicted in FIG. 9, which depicts a sample screen that is displayed to the subject during testing to provide feedback to the subject regarding finger force levels. To begin testing, the subject&#39;s hand is placed on the ergonomic keyboard  10  depicted in FIG.  4 . To determine the target force levels, the subject is first asked to generate the maximum force by way of an isometric contraction of the fingers. The fingers are contracted during this step either all at once or separately. The maximum force levels are used to define the target force level for each finger during the test. The “target force level” is the amount of force the subject is required to produce while striking the keys. This target force level can be defined as thirty percent of the maximum force level, but other percentages may be used as well. The target force levels for each of the fingers are indicated in FIG. 9 as “bubbles”  121 - 125  in the display. 
     After setting the target force level, the subject is prompted to depress each key repetitively in a particular rhythm established either by the subject or externally for a period of time. The subject can be instructed to depress the keys either individually with the same finger or in sequence by different fingers. The onset of fatigue can be correlated to a drop in finger force level below the target force level. For example, a 20% drop can be defined as the point of fatigue. It is to be understood, however, that the 20% value is only exemplary, and this value may be defined to be larger or smaller. 
     In an alternative embodiment, a metronome may be provided. The metronome aids the subject in depressing the keys according to a predetermined rhythm. The metronome also allows for fatigue monitoring of different subjects under consistent test conditions, and/or fatigue monitoring of the same subject at different times under consistent test conditions. 
     After the evaluation session, an exponential curve is fitted to the cumulative data of each peak force value recorded over time, and a drop in amplitude is monitored. FIGS. 10A-10E are sample finger force profiles, calibrated in terms of Newtons. FIG. 10A is a force profile for the thumb. FIG. 10B is a force profile for the index finger. FIG. 10C is a force profile for the middle finger. FIG. 10D is a force profile for the ring finger. FIG. 10E is a force profile for the little finger. In each of FIGS. 10A-10E, the solid line running across the center of the force profile is the “trend line” (i.e. the exponential curve based on the measurement of amplitude changes). As shown, not all fingers become fatigued at the same rate. In fact, as shown in FIG. 10B, after the onset of fatigue (drop in trend line) other muscles are recruited to compensate for the fatigue (raise in trend line). When the drop in amplitude is greater than a predetermined percentage, e.g., 20%, fatigue is considered to have developed. In addition to amplitude changes, each force profile can also be evaluated for other characteristics of the force waveform, such as the upward and downward slopes. Furthermore, rather than evaluating the force profiles separately for each finger, the collective force profile of all of the fingers may be evaluated in a similar manner. 
     Software packages are commercially available that can be used to analyze various aspects of the force profile, including the number of key strikes, the time of each key strike depression and release, the width of each force profile, the amplitude or height of the force profile, and the area of the force profile. The software may also record the data submitted by the subject, such as gender, previous complaints, work history, age, and other factors that may affect the person&#39;s finger force profile. Graphical representations include force peak, width, and area for all fingers. For example, FIG. 11 graphically represents the depression and release of the keys (dotted line) along with the force profile (solid line). 
     FIG. 12 is an illustration of a fatigue monitoring system which is interfaced with a personal computer system that includes a case  130 , a display  131 , input devices which may include a keyboard  132 , a mouse  133 , and a joystick  134 . The signal conditioning unit and the data acquisition card of the fatigue monitoring system are housed inside the case  130  and are controlled by the microprocessor of the personal computer system which is also housed inside the case  130 . 
     In one embodiment, one or more of the keys of the keyboard  132  may include a flexi-force sensor which transmits an analog signal proportional to the force applied to the corresponding key to the signal conditioning unit housed in the case  130 . Alternatively, one or both of the mouse buttons  150  may include such a flexi-force sensor. An additional sensor may be provided on the mouse to measure the forces generated by the palm of the hand as the user is holding the mouse. The signals from this palm force sensor may be used as another measurement of fatigue, since as the person becomes fatigued using the fingers, he or she will put more force on the palm force sensor. 
     In yet another embodiment, a joystick  134  with a fire button  160  and/or a fire trigger  161  may be used as the input device. Either or both of the fire button  160  and the fire trigger  161  may include a force sensor. An additional sensor may also be provided on the joystick shaft to measure the forces generated by the palm of the hand as the user is holding the joystick shaft. The signals from this palm force sensor can be used as another measurement of fatigue, since as the person becomes fatigued activating the fire trigger  161 , he or she will put more force on the palm force sensor. 
     FIG. 13 is an illustration of the fatigue monitoring system shown in FIG. 3B, which also includes a plurality of EMG preamps  180  for attachment to the test subject&#39;s muscles that generate the finger forces, namely the forearm muscles. The EMG preamps are connected to the signal conditioning unit  60  by a plurality of cables, and the EMG signals that are collected are correlated with the force profiles. The circuit for producing the EMG signals is considered to be well known in the art and is described, for example, in Eskelinen, U.S. Pat. No. 5,349,963. 
     An increase in the slope of EMG signal amplitude or a decrease in the median frequency of the EMG signal are considered to be objective signs of fatigue, and these objective signs may be correlated with various characteristics of the force profile that are measured using the FMS, including but not limited to: slope, intercept, start and end of the signal, percentage change between the start and end of the signal, the total time of the repetitive motion and the ratio between the percentage change divided by the total time. For example, the EMG data may be superimposed with the force profile and the key depression and release. This allows one to visualize the electrical activity that generates the force that causes the key depression and release simultaneously with the force measurement. 
     The fatigue monitoring system of the present invention can also be incorporated into any mechanical device that interfaces with a computer. There are several specific additional applications that are contemplated. The first is in the area of affective computing. Presently, systems are being developed to monitor, inter alia, heart rate, blood pressure and sweat rate while persons operate a computer to get an indirect reflection of their emotional state. Affective computing assumes that the way a person hits a key may not only reflect physiological forces but also an emotional component. Thus, the amount of force being generated may be influenced by emotional factors. Regardless, the force profile may provide important feedback to the subject (or other person, such as a prospective or current employer) regarding the subject&#39;s overall state of wellness. 
     The FMS may also be used in the evaluation of strengthening devices. As CTS and other forms of RSI increase, it is expected that the market for various forms of finger strengthening devices will increase. The present invention may be used in conjunction with such devices to monitor the characteristics of force produced by a body part while using such a strengthening device. 
     The fatigue monitoring system may also be incorporated into any system in which force is repetitively being produced to give feedback to the subject to decrease the amount of force that they are producing. This feedback would act to minimize RSI caused by the generation of excessive force after the onset of fatigue. 
     The fatigue monitoring system may be also used to evaluate the efficacy of various clinical interventions. Measurements of the force profile before and after clinical treatment for CTS or any other RSI may be an objective measurement of the efficacy of clinical interventions. In addition, the FMS may be used to quantify various motor problems in subjects suffering from various diseases ranging from schizophrenia to Parkinson&#39;s disease. In some cases, finger tapping is a clinical assessment of motor problems. In addition, in medical fields such as physical therapy or occupational therapy, mechanical devices are used to evaluate and/or increase the strength or dexterity of the subject. The FMS is not limited to keyboards, joysticks or a mouse but can be used in conjunction with any mechanical system that involves repetitive motor movements such as the fingers twisting a bolt or putting objects into specific locations. 
     In addition, the fatigue monitoring system may be used as an important pre-employment tool. Evaluating a person&#39;s force profile as described herein may be used before employment, and would serve as a benchmark in the event that the employee subsequently develops RSI or alleges that they do. 
     It will also be understood that the present invention may be used in situations where monitoring fatigue per se is not necessary. For example, the fatigue monitoring system may be interfaced with a computer-driven game, and the force profile may be used as input to the game to modify the scenario, the rate of presentation for the player, or any other game parameter. For example, force sensors may be included in buttons of the game controllers, and data from the force sensors can be processed by the computer to evaluate how the person is playing in terms of the characteristics (e.g. speed, amount, decline, etc.) of force that they apply to certain buttons during the game. The computer can then modify the game in any manner, such as making it more challenging. In addition, EMG data (or other data representative of physical or physiochemical manifestations, such as electrocardiograms, electroencephalograms and/or galvanic skin responses) may be monitored as well, and this activity data may be used by the computer alone or in conjunction with the force data to modify the game. To carry out the above functions, the computer may also be programmed to have some form of software interface such as a neural network configuration or other program that monitors the force profile of the player(s) and modifies the game. 
     Indeed, the fatigue monitoring system when correlated with EMG signals may be used to further evaluate the force produced and the onset of fatigue during any repetitive motions. For example, the fatigue monitoring system can be interfaced with any piece of exercise equipment, such as a bicycle, or any isotonic or isokinetic strengthening system, to provide information about force and fatigue. 
     Numerous modifications may be made to the foregoing invention without departing from the basic teachings thereof. Although the present invention has been described in substantial detail with reference to one or more specific embodiments, those of skill in the art will recognize that changes may be made to the embodiments specifically disclosed in this application, yet these modifications and improvements are within the scope and spirit of the invention as set forth in the claims which follow. All publications, patents, and patent applications cited in this specification are incorporated herein by reference as if each such publication, patent, or patent application was specifically and individually indicated to be incorporated herein by reference.