Copyright 1998 The Washington Post
The Washington Post
May 17, 1998, Sunday, Final Edition
LENGTH: 1377 words
HEADLINE: For Students, Painful Lesson On Computers; More Seek Treatment For Stress Injuries
BYLINE: Jacqueline L. Salmon, Washington Post Staff Writer

Brendan Connell, an honor student at Montgomery Blair High School, has been using computers since he was 5. Like many of his friends, the 18-year-old often has spent several hours a day at the keyboard, working on computer science projects, sending e-mail and surfing the Internet.

But last summer, Connell began to notice a loss of feeling in his hands, then a tingling in his arms. At night, he was kept awake by a burning sensation in his wrists. Doctors finally told him he had carpal tunnel syndrome -- a severe form of repetitive strain injury (RSI) in which muscles, tendons and nerves can be damaged through prolonged typing in an awkward position.

The diagnosis has changed the teenager's life. He wears wrist braces day and night and no longer works on the computer for more than 15 minutes at a time. His high school has provided him with someone who takes notes for him in class. And when he goes to college in the fall, he will have to use special software so he can dictate, instead of type, his papers.

"I think it's probably one of the biggest challenges I've had to face," said the tall, lanky teenager. "Usually the harder I work, the more I get done. But this is the opposite. The more I try, the worse it gets."

RSI used to be considered an illness of middle age -- the affliction of office workers who had spent their careers in front of a computer terminal, or factory workers who performed the same motion over and over. But more and more high school and college students, like Connell, are showing up at doctors' offices and health clinics with RSI symptoms -- burning wrists, stiff hands and aching fingers and forearms.

Medical experts say young people have become more vulnerable to RSI because of the growing amounts of time they spend operating a computer mouse and keyboard -- writing and researching school papers, e-mailing friends and playing computer games. And unlike office workers, whose habits often are monitored by ergonomics experts, children typically know little about proper posture.

There are no government statistics and few medical studies on the incidence of RSI in this age group. But the anecdotal evidence is mounting. At Harvard University, more than 100 students requested help from the school's Student Disability Resource Center this year because of RSI problems, compared with one student in 1991. At the Massachusetts Institute of Technology, the student health service diagnosed RSI in 220 students last year, 44 percent more than in 1995.

"Students are using computers earlier and earlier," said Anita Barkin, director of student health services at Carnegie Mellon University in Pittsburgh, which recently instituted an RSI education and prevention campaign after a survey found that 22 percent of students, faculty and staff reported RSI symptoms. "They are using them in elementary school and in high school. By the time they come here, they've already gotten into some bad habits and have not been aware that RSI is a problem."

In severe RSI cases, colleges and high schools are providing note-takers and the voice-recognition software that allows students to dictate text into their computers.

About a half-dozen students at George Washington University are receiving such help from the school, according to Christy Willis, the university's director of disabled student services, who said there were no known RSI cases two years ago. Officials at Catholic University and American University also report about a half-dozen students getting such assistance at their schools.

George Washington law student Mary Pax-Shipley suffers from carpal tunnel syndrome, an injury to the nerves in the wrists. She wanted the convenience of having voice-recognition software at home instead of having to go to the school's computer lab. So she has invested $ 5,500 in equipment to overcome her disability -- the special software, a new computer on which to run it, and various other gadgets.

Pax-Shipley tape-records class lectures, then uses the software to transcribe portions of them so she won't have to depend on anyone else's notes. The process takes about three hours for every one-hour lecture, she said. Hauling around heavy law books is painful, so she uses an electronic scanner pen to put the most important material from the books into her computer, then carries the computer printouts.

Pax-Shipley, who graduates this month, has had to face the possibility that she may never completely regain the use of her hands. Accepting that fact, she said, "was hard at first. It was a long grieving process."

Washington area doctors say they've seen patients as young as 15 with RSI-related complaints -- often high-achieving students who have been tapping away at computer keyboards and clicking on mouses for years.

"It's a real concern," said Margit Bleecker, director of the Center for Occupational and Environmental Neurology in Baltimore. Every week, she said, she sees one or two people younger than 25 who have some form of RSI. Five years ago, she said, she had no RSI patients in that age group.

Some doctors say they suspect part of the reason more young people are complaining of RSI is increased publicity about the ailment. But most medical specialists agree that previous generations of students, who wrote longhand or on typewriters, did not face as great a risk of strain because they left their desks more often -- visiting a library to research a paper, for example, or going to another room to take a phone call. Only since the computer revolution has it become possible for students to do so many things, from homework to entertainment to contacting friends, without taking a break from sitting and typing.

Moreover, the furniture that students are using at school or at home is often outdated. Typically, a computer is placed on a desk that is too high, and the height of the chair can't be adjusted to compensate. Bleecker said she has pointed out such problems to school officials, only to be told that buying new furniture would be too expensive.

A few universities have launched major efforts to combat RSI ailments by educating students, staff and faculty and by purchasing equipment more suited to computer use. Carnegie Mellon is buying adjustable chairs for dorm rooms, graduate student cubicles and computer labs to replace decades-old equipment.

Medical specialists say that young people who aren't displaying RSI symptoms don't necessarily need to cut back on time at the keyboard but that they need to take frequent breaks and make sure their work station and posture are ergonomically correct. Most experts suggest, for example, that the top of a computer monitor be slightly below eye level and that users not rest their wrists on the keyboard as they type.

College students with RSI symptoms say they weren't aware of such recommendations until it was too late. And some say that despite the pain it causes, they don't want to cut back on their typing now because they would be unable to graduate on time, even with the help their schools would provide.

"There's not a solution where you can just take a paid sick leave," said Josh Goodman, 28, a graduate student at Harvard who suffers from RSI and founded a support group for students with RSI symptoms.

Another dilemma for such students is whether to tell a prospective employer about their disability. Some say they would rather wait until after they are hired, at which point it would become harder for the employer to discriminate against them. Others say they have had to rethink their choice of profession.

Jason Solomon, 26, who works for the U.S. Treasury Department in Washington, still plans to go to law school, although his hands were injured in college when he spent up to 10 hours a day typing his senior thesis. Solomon said he finds it painful to perform such routine tasks as washing dishes and brushing his teeth. On the job, he uses voice-activated software to dictate memos and send e-mail.

He isn't sure how he will take notes, write papers and sit through exams if he goes to law school.

"Frankly, I have not figured that out yet," Solomon said. "I figure that most of the schools will work with me . . . but it's going to be tough."

GRAPHIC: Photo, susan biddle; Illustration, lon tweeten, Repetitive Strain Injury Doctors are seeing an increase in cases of repetitive strain injury in young adults -- often brought on by heavy computer use. What is RSI? Repetitive strain injury (RSI) refers to a group of injuries that affect muscles, tendons and nerves. RSI can include carpal tunnel syndrome, tendinitis, pinched nerves and a host of other ailments. Warning signs Stiffness or pain in the neck, shoulders or back Tiredness, numbness, tingling or pain in the arms, wrists, hands or fingers Weakness or loss of coordination in the hands Treatment Primary treatment for RSI is often ergonomic and only sometimes medical. Adjusting work stations and work habits may correct the problem. In some cases, splinting is used to minimize pain. Doctors may recommend applying ice to tendons and heat to muscles to reduce swelling. Aspirin or anti-inflammatories may reduce pain. Gentle stretching exercises are recommended. Strength-building activities, like lifting weights, can begin only after the injury has healed. If pain persists beyond two weeks, consult a doctor. PREVENTION RSI is an occupational disorder that often is brought on by static posture, stress and repetitive motion. Prevention methods can include making adjustments in the following: Wrists: Should not rest on anything Legs: Horizontal Forearms: Level or tilted up slightly Feet: Flat on the floor Screen top: Slightly below eye level Body: Centered in front of the monitor and keyboard Lower back: Supported by chair Techniques Avoid typing too hard Hold mouse loosely Move hand, wrist and forearm as one unit Keep forearms and hands in a straight line Pacing Taking mini-breaks every hour may help refresh tired muscles Exercise Hand, arm and neck stretches will encourage muscle relaxation and blood flow and maintain flexibility SOURCES: Carnegie Mellon University; David Diamond, MIT Brendan


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