Path: bloom-beacon.mit.edu!hri.com!noc.near.net!MathWorks.Com!europa.eng.gtefsd.com!darwin.sura.net!wvnvms.wvnet.edu!marshall.wvnet.edu!newsmgr Newsgroups: sci.med,sci.med.occupational,comp.human-factors,comp.answers,sci.answers,news.a,nswers Subject: FAQ: Typing Injuries (2/5): General Info [monthly posting] Message-ID: <9403182358.AA05295@cs> From: Dan Wallach Date: Fri, 18 Mar 1994 18:58:21 -0500 Reply-To: Dan Wallach Sender: Health effects of computer use Followup-To: sci.med.occupational Summary: information about where to get more information Approved: news-answers-request@MIT.Edu To: IN%"NEWSMGR@MUVMS6.WVNET.EDU" "Marshall University" CC: Return-path: Return-path: dwallach <@IUBVM.UCS.INDIANA.EDU:dwallach@CS.PRINCETON.EDU> To: Marshall University Content-type: text/plain; version=1.0;title="Typing Injury FAQ: (2/5) General info" Content-transfer-encoding: 7BIT Comments: To: c+health@iubvm.ucs.indiana.edu Lines: 590 Xref: bloom-beacon.mit.edu sci.med:36400 sci.med.occupational:1270 comp.human-factors:5010 comp.answers:4258 sci.answers:998 Archive-name: typing-injury-faq/general Version: $Revision: 4.53 $ $Date: 1994/03/18 23:55:39 $ Prologue -------- This FAQ may be cited as: Wallach, Dan S. (1994) "Typing Injury FAQ: General Info" Usenet news.answers. Available via anonymous ftp from rtfm.mit.edu in pub/usenet/news.answers/typing-injury-faq/general. 7 pages. World-Wide-Web users will find this available as hypertext: http://www.cis.ohio-state.edu/hypertext/faq/usenet/typing-injury-faq/top.html (Dan Wallach's page) http://www.cs.princeton.edu/grad/Dan_Wallach/top.html Answers To Frequently Asked Questions about Typing Injuries ----------------------------------------------------------- The Typing Injury FAQ -- sources of information for people with typing injuries, repetitive stress injuries, carpal tunnel syndrome, etc. Copyright 1992-1994 by Dan Wallach Many FAQs, including this one, are available on the archive site rtfm.mit.edu:/pub/usenet/news.answers [18.70.0.209]. The name under which a FAQ is archived appears in the Archive-name line at the top of the article. This FAQ is archived as typing-injury-faq/general.Z There's a mail server also. Just e-mail mail-server@rtfm.mit.edu with the word 'help' on a line by itself in the body. The opinions in here are my own, unless otherwise mentioned, and do not represent the opinions of any organization or vendor. I'm not a medical doctor, so my advice should be taken with many grains of salt. [Current distribution: sci.med.occupational, sci.med, comp.human-factors, {news,sci,comp}.answers, and e-mail to c+health@iubvm.ucs.indiana.edu, sorehand@vm.ucsf.edu, and cstg-L@vtvm1.cc.vt.edu] Changes since previously distributed versions are marked with change || bars to the right of the text, as is this paragraph. || Table of Contents: 1) Publications, mailing lists, newsgroups, etc. 2) The soda.berkeley.edu archive 3) General info on injuries 4) Typing posture, ergonomics, prevention, treatment 5) Requests for more info 6) References Publications, mailing lists, newsgroups, etc. --------------------------------------------- (thanks to Rik Ahlberg for parts of this info) 1) Publications CTDNews is a monthly newsletter that covers cumulative trauma disorder. It's a bit pricey ($95/year) but fairly concise. They'll send you your first issue free, so you can look it over. CTDNews PO Box 239 Haverford, PA 10941 Phone: 215 896 4902, or 800-554-4CTD to order Fax: 215 896 1488 2) FTP & Gopher sites world.std.com This site is accessible via gopher The home of the Boston RSI Archive (URL) ftp://world.std.com/pub/boston-rsi or gopher://ftp.std.com/11/FTP/world/pub/boston-rsi The RSI Network Newsletter is a bi-monthly online newsletter produced by Caroline Rose and distributed online by Craig O'Donnell (URL) ftp://world.std.com/pub/rsi or gopher://ftp.std.com/11/FTP/world/pub/rsi soda.berkeley.edu Extensive anonymous ftp archive, including the typing injury FAQ (frequently asked questions), alternative input device information (descriptions, reviews, and GIF images), and some software. Maintained by Dan Wallach . (URL) ftp://soda.berkeley.edu/pub/tuping-injury (more info below...) sjuvm.stjohns.edu A gopher site containing the Electronic Rehabilitation Resource Center. Lots of disability information, including a searchable database of national disability resources and access to other gopher sites with geographically local disability information. Also home to RSI-East, its message archive, and an archive of the RSI Network Newsletter. (URL) gopher://sjuvm.stjohns.edu/11/disabled 3) Listserv Mailing Lists Sorehand Sorehand is a San Francisco-based listserv mailing list for people with RSIs. Subscribe by sending mail with any subject to: listserv@vm.ucsf.edu with the message body reading: subscribe sorehand Your Name C+Health C+Health (Computers & Health) is a listserv mailing list which deals with the technologies causing injuries to folks who use them. Subscribe by sending mail with any subject to: listserv@iubvm.ucs.indiana.edu with the message body reading: subscribe c+health Your Name RSI-East RSI-East is the east coast's answer to sorehand, where users discuss their experiences and offer support, referral, and treatment information to one another. Subscriptions are available to anyone with an interest in RSIs, but with the caveat that the list is intended as a regional resource for networking. Subscribe by sending mail with any subject to: listserv@sjuvm.stjohns.edu with the message body reading: subscribe rsi-east Your Name 4) Usenet Newsgroups sci.med.occupational A Usenet newsgroup which deals in occupational medicine. Lots of practitioners read it! [My doctor reads my posts!] (URL) news:sci.med.occupational comp.human-factors Mostly software design, but occasional discussion of accessibility issues for people with RSIs. (URL) news:comp.human-factors alt.support.arthritis Support for those with arthritis. New as of 11/93. (URL) news:alt.support.arthritis bit.listserv.ada-law Usenet feed of the ada-law listserv. Covers issues relating to the Americans with Disabilities Act (ADA). (URL) news:bit.listserv.ada-law bit.listserv.dsshe-l Usenet feed of the disabled student services listserv. Particularly of interest to computer science students dealing with RSIs or folks pondering a return to school and/or retraining after a disabling RSI. (URL) news:bit.listserv.dsshe-l The soda.berkeley.edu archive ----------------------------- I've started an archive site for info related to typing injuries. Just anonymous ftp to soda.berkeley.edu:/pub/typing-injury. (128.32.149.19) Currently, you'll find: Informative files: typing-injury-faq/ general -- information about typing injuries keyboards -- products to replace your keyboard software -- software to watch your keyboard usage furniture -- details about various desks, chairs, etc. changes -- changes since last month's edition amt.advice -- about Adverse Mechanical Tension amt.more_info -- e-mail from Dr. Peter Bower about this stuff amt.references -- a bibliography for more AMT info || caringforwrists.sit.hqx -- PageMaker4 document about your wrists caringforwrists.ps -- PostScript converted version of above... carpal.info -- info on Carpal Tunnel Syndrome carpal.explained -- very detailed information about CTS carpal.self_care -- excerpt from Rosemarie Atencio's book carpal.surgery -- JAMA article on CTS surgery carpal.tidbits -- TidBITS article on CTS ctdnews.info -- info about the CTDNews publication dvorak.info -- lots of into about Dvorak keyboarding exotic-mice -- info on some newer mice || handeze.info -- info about Handeze gloves keyboard-commentary -- Dan's opinions on the keyboard replacements no-rsi-in-uk -- info about British judge saying RSI isn't real pointing-devices -- advice if pointing devices are your problem rsi.article -- Article in The Independent (London, UK) rsi.biblio -- bibliography of RSI-related publications rsi-network/* -- archive of the RSI Network newsletter (currently, containing issues 1 through 12) rsi.details -- long detailed information about RSI rsi.physical -- study showing RSI isn't just psychological tendonitis.info -- info on Tendonitis thoracic.info -- info about thoracic outlet syndrome voice-recognition-critique -- all about using a voice recognition system as a programmer Various product literature and reviews: apple-press -- press release on the Apple Adjustable Keyboard apple-tidbits -- extensive info about Apple's Adjustable Keybd bat-info -- MacWeek review on the Bat comfort-* -- marketing info on the Comfort Keyboard comfort-review -- one user's personal opinions datahand-review -- detailed opinions of the DataHand datahand-review2 -- follow-up to above datahand-desc -- description of the DataHand's appearance dragon2.info -- info about DragonDictate 2.0 in3-press -- details about the IN3 Voice Commander kinesis-review -- one user's personal opinions kurzweil-review -- info about the Kurzweil voice recognizer maltron-* -- marketing info on various Maltron products maltron-review -- one user's personal opinions vertical-info -- marketing info on the Vertical voicetype2-info -- marketing info on IBM VoiceType worksafe-australia.info -- how to get more info from Australia's govt workstation-setup -- how to arrange your computer/chair/desk Programs: (in the software subdirectory) UNIX/X Software: hsh.shar -- a program for one-handed usage of normal keyboards typewatch.shar -- tells you when to take a break xdvorak.c -- turns your QWERTY keyboard into Dvorak xidle.shar -- keeps track of how long you've been typing rest-reminder.sh -- yet another idle watcher kt18.tar -- generates fake X keyboard events from the serial port -- use a PC keyboard on anything! serkey.sh -- like kt, generates fake X key events, but from a raw PC keyboard via the serial port spacebar_hacks.patches -- patches for X11R5 to allow the spacebar to be both a spacebar and a control key watch.shar -- OpenWindows activity monitor / rest reminder (Note: a2x.tar and rk.tar are both from ftp.x.org:contrib/ so they may have a more current version than soda.) a2x.tar -- a more sophisticated X keyboard/mouse spoofing program. Supports DragonDictate. a2x-RawPC-1.2.tar -- a hacked version of a2x that can take input directly from PC keyboards via the serial port and an adaptor. rk.tar -- the reactive keyboard -- predicts what you'll type next -- saves typing PC/DOS Software: accpak.exe -- a serial port keyboard spoofer for MS Windows getup.com getup.readme -- simple TSR program - remind you to take breaks Pictures (in the gifs subdirectory): howtosit.gif -- picture of good sitting posture (the caringforwrists document is better for this) (NOTE: I threw out the old accukey pictures -- these are much better. Also, since the ergoLogic and the FlexPro are the same, and the old picture of the FlexPro was poor quality, the current flexpro.gif is just a symbolic link to ergologic.gif) 1handpic.gif -- keymappings for the Half-QWERTY accukey1.gif -- beautiful grey-scale picture accukey2.gif -- chord-mappings for the accukey apple.gif -- the Apple Adjustable Keyboard bat.gif -- the InfoGrip Bat comfort.gif -- the Health Care Comfort Keyboard datahand1.gif -- fuzzy picture datahand2.gif -- key layout schematic datahand3.gif -- a much better picture of the datahand E2H_Grahl.gif -- Grahl split-back ergonomic chair || E_Graph.gif -- Grahl normal-back ergonomic chair || ergologic.gif -- the ergoLogic 7.1 keyboard (same as flexpro) ergomax.gif -- the Maxi Switch ErgoMax keyboard flexpro.gif -- the Key Tronic FlexPro keyboard (same as ergologic) fountain_hills.gif -- the Fountain Hills keyboard handeze.gif -- hand size chart for Handeze gloves handeze.ps -- properly scaled Postscript of handeze.gif kinesis1.gif -- the Kinesis Ergonomic Keyboard kinesis2.gif -- multiple views of the Kinesis maltron[1-4].gif -- several pictures of Maltron products marquardt.gif -- the Marquardt MiniErgo mykey.gif -- ErgonomiXX MyKey || somers1.gif -- Somers EK1 Ergonomic Keyboard somers2.gif -- schematic picture of the keyboard tony.gif -- The Tony! Ergonomic Keysystem twiddler1.gif -- "front" view twiddler2.gif -- "side" view vertical.gif -- the Vertical keyboard wave.gif -- the Iocomm `Wave' keyboard Many files are compressed (have a .Z ending). If you can't uncompress a file locally, soda will do it. Just ask for the file, without the .Z extension. If you can't FTP from your site, use one of the following ftp-by-mail servers: ftpmail@decwrl.dec.com ftpmail@src.doc.ic.ac.uk ftpmail@cs.uow.edu.au ftpmail@grasp.insa-lyon.fr For complete instructions, send a message reading "help" to the server. If you don't know exactly what you're looking for, or exactly where it is, there are programs and servers that can help you. For more info, send e-mail to mail-server@rtfm.mit.edu with with the body of the message reading "send usenet/news.answers/finding-sources" General info on injuries ------------------------ First, and foremost of importance: if you experience pain at all, then you absolutely need to go see a doctor. As soon as you possibly can. The difference of a day or two can mean the difference between a short recovery and a long, drawn-out ordeal. GO SEE A DOCTOR. Now, your garden-variety doctor may not necessarily be familiar with this sort of injury. Generally, any hospital with an occupational therapy clinic will offer specialists in these kinds of problems. DON'T WAIT, THOUGH. GO SEE A DOCTOR. The remainder of this information is paraphrased, without permission, from a wonderful report by New Zealand's Department of Labour (Occupational Safety and Health Service): "Occupational Overuse Syndrome. Treatment and Rehabilitation: A Practitioner's Guide". First, a glossary (or, fancy names for how you shouldn't have your hands): (note: you're likely to hear these terms from doctors and keyboard vendors :) RSI: Repetitive Strain Injury - a general term for many kinds of injuries OOS: Occupational Overuse Syndrome -- synonym for RSI CTD: Cumulative Trauma Disorder -- another synonym for RSI WRULD: Work-Related Upper Limb Disorders -- yet another synonym for RSI CTS: Carpal Tunnel Syndrome (see below) Hyperextension: Marked bending at a joint. Pronation: Turning the palm down. Wrist extension: Bending the wrist up. Supination: Turning the palm up. Wrist flexion: Bending the wrist down. Pinch grip: The grip used for a pencil. Ulnar deviation: Bending the wrist towards the little finger. Power grip: The grip used for a hammer. Radial Deviation: Bending the wrist toward the thumb. Abduction: Moving away from the body. Overspanning: Opening the fingers out wide. Now then, problems come in two main types: Local conditions and diffuse conditions. Local problems are what you'd expect: specific muscles, tendons, tendon sheaths, nerves, etc. being inflamed or otherwise hurt. Diffuse conditions, often mistaken for local problems, can involve muscle discomfort, pain, burning and/or tingling; with identifiable areas of tenderness in muscles, although they're not necessarily "the problem." --- Why does Occupational Overuse Syndrome occur? Here's the theory. Normally, your muscles and tendons get blood through capillaries which pass among the muscle fibers. When you tense a muscle, you restrict the blood flow. By the time you're exerting 50% of your full power, you're completely restricting your blood flow. Without fresh blood, your muscles use stored energy until they run out, then they switch to anaerobic (without oxygen) metabolism, which generates nasty by-products like lactic acid, which cause pain. Once one muscle hurts, all its neighbors tense up, perhaps to relieve the load. This makes sense for your normal sort of injury, but it only makes things worse with repetitive motion. More tension means less blood flow, and the cycle continues. Another by-product of the lack of blood flow is tingling and numbness from your nerves. They need blood too. Anyway, when you're typing too much, you're never really giving a change for the blood to get back where it belongs, because your muscles never relax enough to let the blood through. Stress, poor posture, and poor ergonomics, only make things worse. --- Specific injuries you may have heard of: (note: most injuries come in two flavors: acute and chronic. Acute injuries are severely painful and noticable. Chronic conditions have less pronounced symptoms but are every bit as real.) Tenosynovitis -- an inflamation of the tendon sheath. Chronic tenosynovitis occurs when the repetitive activity is mild or intermittent: not enough to cause acute inflamation, but enough to exceed the tendon sheath's ability to lubricate the tendon. As a result, the tendon sheath thickens, gets inflamed, and you've got your problem. Tendonitis -- an inflammation of a tendon. Repeated tensing of a tendon can cause inflamation. Eventually, the fibers of the tendon start separating, and can even break, leaving behind debris which induces more friction, more swelling, and more pain. "Sub-acute" tendonitis is more common, which entails a dull ache over the wrist and forearm, some tenderness, and it gets worse with repetitive activity. Carpal Tunnel Syndrome -- the nerves that run through your wrist into your fingers get trapped by the inflamed muscles around them. Symptoms include feeling "pins and needles", tingling, numbness, and even loss of sensation. CTS is often confused for a diffuse condition. Adverse Mechanical Tension -- also known as 'neural tension', this is where the nerves running down to your arm have become contracted and possibly compressed as a result of muscle spasms in the shoulders and elsewhere. AMT can often misdiagnosed as or associated with one of the other OOS disorders. It is largely reversible and can be treated with physiotherapy (brachial plexus stretches and trigger point therapy). Others: for just about every part of your body, there's a fancy name for a way to injure it. By now, you should be getting an idea of how OOS conditions occur and why. Just be careful: many inexperienced doctors misdiagnose problems as Carpal Tunnel Syndrome, when in reality, you may have a completely different problem. Always get a second opinion before somebody does something drastic to you (like surgery). Typing posture, ergonomics, prevention, treatment ------------------------------------------------- The most important element of both prevention and recovery is to reduce tension in the muscles and tendons. This requires learning how to relax. If you're under a load of stress, this is doubly important. Tune out the world and breath deep and regular. Relaxing should become a guiding principle in your work: every three minutes take a three second break. EVERY THREE MINUTES, TAKE A THREE SECOND BREAK. Really, do it every three minutes. It's also helpful to work in comfortable surroundings, calm down, and relax. If you can't sleep, you really need to focus on this. Rest, sleep, and relaxation are really a big deal. There are all kinds of other treatments, of course. Drugs can reduce inflamation and pain. Custom-molded splints can forcefully prevent bad posture. Surgery can fix some problems. Exercise can help strengthen your muscles. Regular stretching can help prevent injury. Good posture and a good ergonomic workspace promote reduced tension. Ice or hot-cold contrast baths also reduce swelling. Only your doctor can say what's best for you. --- Posture -- here are some basic guidelines. [I so liked the way this was written in the New Zealand book that I'm lifting it almost verbatim from Appendix 10. -- dwallach] . Let your shoulders relax. . Let your elbows swing free. . Keep your wrists straight. . Pull your chin in to look down - don't flop your head forward. . Keep the hollow in the base of your spine. . Try leaning back in the chair. . Don't slouch or slump forward. . Alter your posture from time to time. . Every 20 minutes, get up and bend your spine backward. Set the seat height, first. Your feet should be flat on the floor. There should be no undue pressure on the underside of your thighs near the knees, and your thighs should not slope too much. Now, draw yourself up to your desk and see that its height is comfortable to work at. If you are short, this may be impossible. The beest remedy is to raise the seat height and prevent your legs from dangling by using a footrest. Now, adjust the backrest height so that your buttocks fit into the space between the backrest and the seat pan. The backrest should support you in the hollow of your back, so adjust its tilt to give firm support in this area. If you operate a keyboard, you will be able to spend more time leaning back, so experiment with a chair with a taller backrest, if available. [Now, I diverge a little from the text] A good chair makes a big difference. If you don't like your chair, go find a better one. You really want adjustments for height, back angle, back height, and maybe even seat tilt. Most arm rests seem to get in the way, although some more expensive chairs have height adjustable arm rests which you can also rotate out of the way. You should find a good store and play with all these chairs -- pick one that's right for you. In the San Francisco Bay Area, I highly recommend "Just Chairs." The name says it all. --- Keyboard drawers, wrist pads, and keyboard replacements: There is a fair amount of controvery on how to get this right. For some people, wrist pads seem to work wonders. However, with good posture, you shouldn't be resting your wrists on anything -- you would prefer your keyboard to be "right there". If you drop your arms at your side and then lift your hands up at the elbow, you want your keyboard under your hands when your elbows are at about 90 degrees. Of course, you want to avoid pronation, wrist extension, and ulnar deviation at all costs. Wrist pads may or may not help at this. You should get somebody else to come and look at how you work: how you sit, how you type, and how you relax. It's often easier for somebody else to notice your hunched shoulders or deviated hands. Some argue that the normal, flat keyboard is antiquated and poorly designed. A number of replacements are available, on the market, today. Check out the accompanying typing-injury-faq/keyboards for much detail. Lately, a number of people have been having luck with gloves. You may want to try some light gloves, possibly with the fingers removed if they're too warm. Many seem to like the Handeze Gloves, available for around $20 from Patternworks, P.O. Box 1690, Poughkeepsie, NY 12601 (800/438-5464). See the soda file "handeze.info" for details. Another place you may be able to get stuff: a company called Enrichments has a catalog of ergonomic products you may find interesting. Their phone number is 800/323-5547. Or, you might want to contact AliMed || at 800/225-2610 and ask for their Ergonomics catalog. || Here are some sources for fancy keyboard drawers: || Ergotron, Eagan, MN, 800/888-8458. A wide tray that mounts under a desk || and is adjustable, has a wrist rest, and is wide enough to accomodate a || mouse pad. || Ergo Systems, East Hartford, CT, 203/282-9767. They make keyboard trays || and a retractrable mouse pad, too. || I've also seen some simple $20 plastic affairs you can screw into your desk.|| Requests for more info ---------------------- Clearly, the above information is incomplete. The typing-injury archive is incomplete. There's always more information out there. If you'd like to submit something, please send me mail, and I'll gladly throw it in. If you'd like to maintain a list of products or vendors, that would be wonderful! I'd love somebody to make a comprehensive list of mice. I'd love somebody to make a list of doctors. I'd love somebody to edit the above sections, looking for places where I've obviously goofed. References ---------- I completely rewrote the information section here, using a wonderful guide produced in New Zealand by their Occupational Safety & Health Service, a service of their Department of Labour. Special thanks to the authors: Wigley, Turner, Blake, Darby, McInnes, and Harding. Semi-bibliographic reference: . Occupational Overuse Syndrome . Treatment and Rehabilitation: A Practitioner's Guide Published by the Occupational Safety and Health Service Department of Labour Wellington, New Zealand. First Edition: June 1992 ISBN 0-477-3499-3 Price: $9.95 (New Zealand $'s, of course) Thanks to Richard Donkin for reviewing this posting. Mailing date: Fri Mar 18 18:58:21 EST 1994 -- Dan Wallach "One of the most attractive features of a Connection dwallach@cs.princeton.edu Machine is the array of blinking lights on the faces Phone#: 609-452-8446 of its cabinet." -- CM Paris Ref. Manual, v6.0, p48. (World-Wide-Web) http://www.cs.princeton.edu/grad/Dan_Wallach/top.html