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                                                                                HEALTH, Page 70

Crippled by Computers


As more U.S. workers spend their days at keyboards, hand injuries
and lawsuits are multiplying

By JANICE M. HOROWITZ - With reporting by David S. Jackson/San
Francisco


    As jobs in journalism go, Grant McCool's was a plum
assignment. Based in Hong Kong for the Reuters news service,
McCool covered breaking news throughout east Asia, traveling to
South Korea, China and Pakistan. But in 1989, after five hectic
years, the native of Scotland was ready for a change. That's
when his bosses transferred him to New York City to be an
editor.

    That's also when the trouble started. After typing on his
computer keyboard for hours a day over several months, McCool
developed excruciating pain in his hands; some mornings he would
awake with his arms throbbing and burning. "The doctor told me
to stop typing immediately," recalls McCool, 32. He hasn't
written or edited a story on deadline since. Nor has he been
able to clean house, carry heavy objects or play squash. He
cannot even drive a car; controlling the steering wheel with his
injured hands is impossible.

    McCool suffers from a severe case of cumulative trauma
disorder, a syndrome that results from overusing the muscles and
tendons of the fingers, hands, arms and shoulders. The condition
brings pain, numbness, weakness and sometimes longterm
disability. Such problems, more commonly known as repetitive
stress injuries (RSI), now strike an estimated 185,000 U.S.
office and factory workers a year. The cases account for more
than half the country's occupational illnesses, compared with
about 20% a decade ago.


    Typical victims are meat packers who slice scores of
carcasses a day, or autoworkers who drive the same screws hour
after hour. But a particularly fast-growing category of victims
includes white-collar professional and clerical workers who
spend their days pounding away at keyboards. An increasing
number are responding in a white-collar way: with lawsuits.
Hundreds of injured telephone reservationists, cashiers, word
processors and journalists, McCool among them, are suing
computer manufacturers, blaming the machines for their
disabilities. IBM, Apple Computers, AT&T and Kodak's
Atex-division, which produces a word-processing system designed
for journalists, have all been named in the suits, which demand
damages of up to a $1 million or more per victim. Last June, a
U.S. district judge in Brooklyn lumped together more than 44
suits against 63 manufacturers in an attempt to arrive at some
ground rules for dealing with such cases. More than 200 cases
have been added since. Although the final outcome could take
years, some liability experts predict that the ultimate payout
on RSI suits could rival the $4 billion paid on asbestos-related
claims.

    Employers are quickly learning that they too must face up
to the problem. Already, RSI costs about $7 billion a year in
lost productivity and medical costs. Moreover, under the
provisions of the Americans with Disabilities Act, which went
into effect this summer, employers are now required to
accommodate "reasonably" workers with physical impairments.
Companies may have to transfer employees with RSI to less
stressful jobs or give them special help. Increasingly, unions
and other worker groups are demanding that companies provide
better keyboards and office furniture and give employees more
frequent breaks to reduce the risk of injury. The Occupational
Safety and Health Administration has announced plans to create
national workplace standards for the prevention of RSI.

    How ironic that computers, the very technology celebrated
for making office work easier, would cause such harm. By now,
nearly half the U.S. work force -- some 45 million workers --
use computers (though not all spend hour after hour punching
keys). "We thought technology was going to help us, which it
does. But we did not consider that we would also have to adjust
the workplace at the same time," says Barbara Silverstein,
research director of Washington State's department of labor and
industries.

    RSI involves not just one but an array of ailments
resulting from tugging, pounding and straining crucial tissues
in the upper body. It usually begins innocuously. "People think
they've had a particularly hard day or that they're getting
old," says Frank Fernandez, an Oakland, California, attorney who
has filed suit against several computer manufacturers on behalf
of RSI sufferers.

    But as the hands continue to be overworked, symptoms
worsen. Tendons, which are like long pulleys directing the
movement of the fingers from many places in the hands and arms,
can swell up, producing painful tendinitis. Soreness can also
result from the inflammation of sheaths surrounding the tendons.
Muscles in the forearm that control the movement of fingers may
become irritated, a condition called myositis. As tissues become
inflamed and swollen, they can press on nearby nerves, causing
tingling and weakness in the fingers. Sometimes scar tissue
develops in the area. All together these injuries, if not
treated, can result in diminished coordination and strength:
patients may literally lose their grip and have trouble managing
simple manual tasks.



    AMONG THE MORE EXTREME -- and less common -- cumulative
traumas is carpal tunnel syndrome. It develops when tissues in
the palmar side of the wrist swell, squeezing a vital nerve that
runs through the area. Carpal tunnel syndrome can cause
crippling pain for months or years, though surgery can sometimes
help.

    It is hard to conceive how the gentle patter of fingers
over a computer keyboard could do such damage. People have,
after all, been typing for decades, and computers would seem to
be an improvement over clunky typewriters. But word processors
pose special problems. They allow workers to sit with their
fingers flying across the keyboard at 240 strokes a minute for
hours without a break. A typewriter, by contrast, forces
workers to pause every so often to move the carriage or change
the paper. The amount of time spent at the keyboard is critical:
a study in Australia found that people who typed for more than
five hours a day at a computer had 12 times as great a risk of
developing RSI as those who spent less time.

    Workers at computer stations may position their hands over
the keyboard with the sensitive wrist cocked upward or
downward, compressing the tendons, ligaments and nerves that run
through its narrow confines. People working with typewriters are
more likely to hold their hands suspended straight forward, the
wrists flat. Old-style typewriter keys also generally have a
certain amount of spring, while computer keys often strike
against a hard, unforgiving base. "These simple things sound
trivial, but they are not when you're locked into one position,
working all day long," says Marvin Dainoff, director of the
Center for Ergonomic Research at Miami University, in Ohio.

    The modern office has left many employees with little
variation in their daily tasks. "Instead of running to the file
cabinet to pull out information or going to the library, workers
can do everything they need to by just sitting at the
keyboard," says Silverstein. "They don't even have to get up to
talk to each other. Now they have electronic messaging." Even
today's phones with push buttons instead of dials strain the
same tired tendons.

    Computer makers defend their machines vigorously. They
stress that the problem lies not with their keyboards but with
how they are used. They also point out that other office
equipment, such as chairs and desks, must be designed
ergonomically, which means that they fit the individual's body
and specific job needs. Says IBM spokesperson Brian Doyle:
"IBM's position is that aches and pains in the workplace can
come from a number of sources, including posture, adjustment of
equipment and the amount of time spent performing a given task.
Applying good work habits and good ergonomic principles is a
shared responsibility of both employers and employees."

    But U.S. employers have so far done a poor job of
shouldering this responsibility. Chairs, desks, lighting are
chosen more on the basis of price or decorating schemes than
ergonomics. "We're just not doing as much as we could," says
Michael Smith, professor of industrial engineering at the
University of Wisconisin. Several other countries are further
along in protecting workers. Sweden, for example, has had a
strict ergonomic standard since 1979, and in Germany insurance
companies scale back benefits to companies that do not
adequately guard against RSI.

    Admittedly, personal traits and habits often influence who
will develop RSI. A pioneer in treating the injuries, Dr. Emil
Pascarelli, medical director of New York City's Miller Institute
at St. Luke's-Roosevelt Hospital, points out how very heavy
people can get into trouble. For their hands to reach the
keyboard, they have to maneuver their arms around their own
girth, and wind up contorting their wrists inward.
Double-jointedness can also be a risk factor. Smokers may have
fewer injuries, thanks to their periodic breaks away from the
terminal to satisfy nicotine cravings. And what goes on outside
the office can be just as damaging as what happens in it.
Observes Katy Keller, a physical therapist at the Miller
Institute: "Injured people go home and talk on the telephone,
stir the supper and carry the baby all at the same time. All
this does is add to the physical stress of the workday."

    For many workers, physical stress is just part of the
problem. A three-year study by the National Institute for
Occupational Safety and Health of telephone workers at U.S. West
Communications found that 111 out of 518 employees who used
computers had RSI. The most revealing discovery was that all the
sufferers reported high levels of psychological strain, such as
job insecurity and pressures to work fast. Psychological stress
probably does its mischief by creating muscle tension, which
reduces blood flow to hard-working muscles and tendons; without
enough oxygen, these tissues become fatigued and prone to
injury.

    Fearful of lawsuits or just concerned about the health of
their workers, a few employers are beginning to take action.
They are providing fully adjustable, ergonomic chairs and wrist
supports to employees who complain of pain. Others are trying
to break up the daily routine by giving people different tasks.
The Los Angeles Times has set up its own repetitive stress
injury room, stocked with a set of light weights for
strengthening hands, a freezer full of ice packs to calm
inflamed tendons and a floor mat for ailing workers to stretch
out on. The paper has customized its software program to flash
"Take a Break" reminders. IBM has given ergonomic furniture to
many of its most pressured keyboard workers, including
800-number operators.

    New, more benign technology would help. In the U.S. and
elsewhere designers are scrambling to create radically different
keyboards that will be easier on the hands. But the ultimate
goal is to do away with the keyboard. Reuters has given McCool
a voice-activated computer that can type words and perform other
functions in response to his verbal commands. Such machines are
still slow and unreliable and can "understand" only a limited
vocabulary, but the technology is improving rapidly. When
voice-activated computers spread through the workplace, probably
sometime early in the next century, the only occupational risk
might be an occasional bout of laryngitis.