Repetitive strain injuries crippling high tech workplace

By Simson L. Garfinkel, Globe correspondent

Computers are helping people with disabilities as never before. But ironically, experts who work in the field say that the largest and fastest growing group of disabled computer users are otherwise healthy people whose hands and wrists have been injured from years at the keyboard.

"More and more people are getting hurt, and they don't feel that they have any job security," says Hilary Marcus, program director of the Coalition on New Office Technology, a workers' advocacy group in Boston. "We know far too many people who have had to leave their jobs on workers compensation and whose professional lives are threatened because of these injuries."

It's difficult to know how many people are affected by computer-related repetitive strain injury, or RSI. But it is clear that the impact of RSI can be devastating: According to the Bureau of Labor Statistics, half of all workers with carpal tunnel syndrome, a form of RSI, in 1995 missed 30 days of work or more.

It's also clear that computer-induced disabilities are by far the most significant in a growing number of high-tech organizations. For example, the MIT Adaptive Technology for Information and Computing Laboratory, which helps students, staff and faculty with disabilities use computers, served 150 new clients last year, 105 of whom had cases of RSI, says Kathy Cahill, the labs coordinator.

"I would say that about 70 percent of the students and staff that I see that have RSI have developed it while they have been here," says Cahill. "There is a small percentage that have RSI prior to coming here -- graduate students who come in and say `I had some of this as an undergrad.' "

Under the Americans with Disabilities Act, employers have an obligation to meet the disabled employee's needs, says D.J. Hendricks, assistant project manager of the Job Accommodations Network, a nonprofit organization funded by the President's Committee on Employment of People with Disabilities.

"They can't say, `You go off on disability.' They have requirements to accommodate," says Hendricks.

But that frequently doesn't happen.

Kathy Greenough, a marketing and communications consultant, remembers how her case of RSI started. "All of a sudden, out of the blue, I got tingling in my wrists one afternoon while using the computer," she recalls. Although she had used a computer for 10 years, she wasn't a heavy user -- just four or five hours a day. Nevertheless, she says, "The pain got worse and worse. I got more and more scared."

Despite her fear, Greenough kept working at her keyboard for another month -- until the pain was so severe that she just had to stop. And then it was too late. "Just doing every day things, doing my hair, trying to do laundry, trying to do grocery shopping, opening doors, shaking hands, you name it, it was horribly painful. And the worst pain of all was writing."

Greenough says that she visited 10 doctors, none of whom were any help.

"One of them told me it was all in my head," she says. "There were several who were kind, but couldn't help me."

Eventually she saw a nationally regarded physician in New York City who specialized in RSI. "He did an examination of my hands, arms and shoulders that was incredibly detailed, down to each section of each finger," says Greenough. The doctor set her in front a computer, videotaped her working, and then showed her what she was doing wrong. "I squeezed the mouse way too hard instead of tapping it. I wasn't sitting correctly, I sat with my legs crossed and shoulders hunched. I probably used too much force on the keys."

The doctor assured Greenough that the pain wasn't in her head, and diagnosed her with nearly a dozen different but related ailments.

"Unfortunately," she says, "I walked out of there feeling the way I think that cancer patients do. What do I do now? How am I going to live with this?"

Kimberly Patch developed a severe case of RSI four years ago. At the time she was a journalist for a Boston-based computer magazine. Although her employer was supportive at first, she says, her disability soon became a major source of contention. One reason, she suspects, had to do with the uncertainty of her prognosis.

"If somebody breaks a leg and you know they are going to be OK in 6 weeks, you know," she says. "But if the hands hurt," it isn't clear if the employee will be better in months, years, or ever. Eventually, Patch was forced to leave her job.

That should never have happened, says Hendricks. And indeed, she says, things might be different today. "Thankfully, there are now a number of options available in terms of alternative input devices and ergonomic keyboards, which for a number of people really help to relieve the strain that typing or a normal keyboard can cause."

Many workers with RSI can be helped by making relatively straightforward changes to the workplace -- such as using a special tray to lower the height of a keyboard, or switching from a mouse to a trackball. Many people with severe injuries have been able to keep working by abandoning the keyboard altogether, and using their voice instead.

But even voice systems are not without their problems. Until last summer, every voice recognition system on the market required that the user pause between each spoken word to make it easier for the computer to understand what was being said.

Kimberly Patch tried one of these systems and soon found that her voice was becoming as damaged as her hands. "My voice got hoarse and it started to hurt," she says. The reason, she notes, was that forcing herself to pause between each spoken word antagonized the same muscles in her neck that the RSI did.

"There is [a significant] percentage of people with RSI that are prone to problems with their voice," she says.

Last summer, two of the leading vendors of speech recognition software introduced "continuous recognition" programs that can transcribe the words of a person speaking in a natural voice, without pauses. Although the software is relatively inexpensive, with different versions priced between $50 and $300, it requires a high-speed computer with a Pentium 120 processor, at least 32 megabytes of RAM, and a high-quality sound card.

"The continuous thing is so much better," says Patch. "It [works] the way you think. You think in phrases. You don't think in individual words."

Today Patch does all of her work on computer using her voice instead of a keyboard. And she's had to make other compromises as well. "I've changed my habits a lot. I used to take notes on the computer. I don't do that at all anymore." Instead of working in a big office where she can't control the temperature, she works at home. She gets special "trigger point" massages on a regular basis. And she takes classes in Alexander movement therapy.

Unfortunately, says CNOT's Marcus, the relative happy ending to Patch's story is more the exception than the rule. "For many workers, employers are not prepared to spend the money that it takes to set up a voice activated system. For more highly paid professionals that might be an option. For a data entry option, to date, employers are not willing to spend the money. As the cost of the technology comes down it is possible that might be an option."

One way for computer workers to prevent injury in the first place is to educate themselves about the danger, and pay attention to issues of keyboard and mouse placement, have a good chair, and take frequent breaks while they are at the keyboard. But unfortunately, says Hendricks, while employers are required to attend to the needs of an injured worker, there is no such requirement to prevent the injury in the first place.

"It's really working backwards," she says. "It would be really nice if companies would say `This ergonomic stuff makes sense. We need to look at what it will mean for or company's long term and for the productivity of our workers.' But in a lot of companies you are just having to run to keep up."

Such thinking is awfully shortsighted, says Cahill. "In the long run, it will cost a business or university a lot more money if they don't perform preventative things such as buying keyboard trays, adjustable chairs and so forth. If they wait until an employee gets RSI they are going to end up paying a lot more in adjustments, workers comp, and lawsuits."