Internet Info 1994 March/Internet Info CD-ROM (Walnut Creek) (March 1994).iso/answers/news/typing-injury-faq/general

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From: Dan Wallach <[e-mail]>
Subject: FAQ: Typing Injuries (2/5): General Info [monthly posting]
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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 <[e-mail]>

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 [e-mail]
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 [e-mail],
 [e-mail], and [e-mail]]

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 <[e-mail]> 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:  [phone], or 800-554-4CTD to order
    Fax:    [phone]


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 <[e-mail]>
            and distributed online by Craig O'Donnell
            <[e-mail]>

                    (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 <[e-mail]>.

            (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:

                [e-mail]

            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:

                [e-mail]

            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:

                                [e-mail]

                        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:

        [e-mail]
        [e-mail]
        [e-mail]
        [e-mail]

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 [e-mail] 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 <[e-mail]> for reviewing this posting.
--
Dan Wallach                "One of the most attractive features of a Connection
[e-mail]  Machine is the array of blinking lights on the faces
Phone#: [phone]       of its cabinet." -- CM Paris Ref. Manual, v6.0, p48.

(World-Wide-Web) http://www.cs.princeton.edu/grad/Dan_Wallach/top.html