Cumulative Trauma Disorder (a.k.a. RSI)

Cumulative Trauma Disorder (CTD) and Repetitive Stress Injury (RSI) cover an array of poorly understood soft tissue problems.

Personal story

I am recovering from a such a problem, a typing injury sustained in December of 1992 (tendinitis in forearms). In the beginning, I went through multiple cortisone injections, heat and cold treatments, massage, physiotherapy, muscle release therapy, arm braces, casts, and long periods with minimum typing. For several years, I let my wife drive; I pushed typing work onto my co-authors or secretaries; and I experimented relentlessly with alternative treatments and input devices. The first four years, nothing helped—except not typing. Then, DragonDictate, an early speech recognition program, together with foot switches, slowly allowed me to use my arms less.

I have tried most kinds of “ergonomic” aids available: dozens of pointing devices, several keyboards, and various instruments for stabilizing upper extremities. I have concluded that most are ineffective and that some are harmful. Initial positive impressions almost always turned out to be wrong. There is some commercially available equipment that I prefer, see my setup.

Additionally, I have vigorously pursued ideas of my own. I have constructed three kinds of keyboards, several foot switch arrangements, and a dozen mouse designs. They have generally failed my own trials. The exceptions are the ideas I put forward in Input devices, a usage-driven approach.

Speech recognition plays a very important role in my daily work. I have found dictation system user interfaces rather unusable because of their slowness and incompleteness. For six years, I have researched alternatives. Out of these frustrating efforts has emerged an editing language I call ShortTalk. Measurements indicate that ShortTalk combined with limited pointing on the average may be much faster than conventional means of editing.

Lately, I can easily type for an hour or so, and finally my arms are well enough that I can travel with a normal load of luggage. But half a day at the keyboard still produces flare-ups lasting a couple of days. With my workspace setup explained in User interface summary, I can work all day with no adverse affects.

Added August, 2002

In the spring of this year, around the time I wrote the description above, I started old-fashioned strength training with handweights. I tried that before but gave up because of pain. When I started again, my dominant arm (which had been hurting me the most) was markedly weaker than the non-dominant one. After six-months of training, I am handling 30 lbs. weights (along with smaller ones depending on the exercise), and pain levels have subsided further. Then, interestingly, I just found out, see sidebar, that strength training according to a new tendinopathy paradigm is the primary treatment, not rest, heat, massage, or stretching. However, I wonder whether not the drastic reduction of the offensive ways of working that led to the injury should still be a primary intervention as well. Also, I find it difficult to gauge how much pain should be endured during exercise; sometimes, I find myself hurting for several days after, but in the end, the effect seems to be positive.

Added September, 2003.

This will be the last update because there has been slow but tremendous progress over the last year. I'm still using both foot keyboard and speech recognition to distribute the load of working on computers.

By Nils Klarlund. Copyright ©Nils Klarlund, 2002.
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