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« on: February 12, 2003, 10:08:24 PM »

Many thanks to Doctor Smith for supplying us this instruction document.



I think that if many of us were asked what one thing has had the greatest impact on our lives in modern times, we would likely say the computer. Over the past twenty years or so, computers have gone from being monstrous curiosities taking up the entire space in large rooms, to relatively small boxes on almost every desk. Along with smaller size and lower prices has come an explosion in the number of PC's, putting them within the reach of the vast majority of Americans.

The speed and efficiency of the computers has made most businesses and institutions dependent on the technology. As a result, many people spend a large part of their time working with computers.

The relatively recent advent of the widespread availability of the Internet has meant that even those individuals who don't use computers at work likely use them at home to, ASurf the Net@. What this has meant is that many people are spending many hours on the computer at work and then again at home. As a result, there has been a significant increase in the reporting of health problems related to the use of computers.

Common computer related syndromes:

Carpal Tunnel Syndrome:

Carpal Tunnel Syndrome is a condition that occurs when the median nerve is squeezed as it crosses the wrist to enter the hand. The median nerve arises at the level of the sixth cervical vertebra in the neck. It supplies the muscles of the forearm responsible for pronating the forearm or turning it inwards. It also supplies the muscles that bend the middle finger as well as the muscles of the thumb. It also provides sensation for the palmar surface of the thumb, index and middle fingers and half of the ring finger.

The Carpal Tunnel is an area on the palm side of the wrist bordered on one side by the carpal bones and on the other by the Carpal Ligament, a fibrous band. Because these structures are quite rigid, if edema or other conditions cause a shrinkage of the space in the tunnel, the structures within the tunnel come under increasing pressure.

It has been recognized that repetitive movement at the wrist, as occurs with prolonged use of a computer keyboard can lead to inflammation in the carpal tunnel and the resultant painful syndrome. Patients usually feel pain in the forearm area as well as numbness in the affected hand in the finger distribution described above.


If the symptoms are not very severe, CTS is treated conservatively with rest, warm compresses, wrist splints (worn mainly at night), anti-inflammatory medications and sometimes steroid injections. If the symptoms are severe or worsening, a surgical carpal ligament release procedure may be necessary.

Eye Strain:

Long hours staring at a computer screen will inevitably lead to asthenopia or eyestrain. Persons tend not to blink as frequently, which also leads to drying of the eyes. Over a prolonged period, this can lead to some deterioration in vision especially in those prone to visual problems.

In order to prevent this, it is suggested that one take regular breaks from staring at the screen maybe with brief eye closure.

Neck and Back Pain:

Poor positioning of the keyboard and monitor in relation to the user can lead to discomfort of the neck and back. The monitor screen should be at a level such that the user can easily see the screen with the head held at a comfortable and neutral position. If the head has to be constantly turned or tilted in order to see the screen, this will lead to chronic aches and pains in the neck area. This along with any eye strain that occurs can lead to tension headaches. The chair or keyboard stand should be adjusted so that when sitting with the hands resting on the keyboard, the elbows should be slightly above the wrists. The chair should have firm lumbar support and it is important that the individual maintain good posture to minimize back strain.


Another syndrome more recently recognized and associated primarily with the Internet is depression. A recent study found a high degree of correlation between the time spent on line, including chat rooms, and an increased incidence of depression. It is believed that at least some of the individuals who spend long periods of time on line may have somewhat unfulfilled social lives. This is very likely the reason they spend many hours on line in the first place. However, the time on line may also serve to magnify the very loneliness the user may have been attempting to blunt. It is also likely that as one spends more and more time on the computer, it naturally takes away from the time the individual has for normal social or family relations and this in turn may lead to depression.

Electromagnetic Radiation:

There has been much debate about the possible effects of electromagnetic radiation. Most people agree that long term exposure to strong EMR fields, as occur near high voltage lines, can lead to health problems over the years. What is not clear is whether exposure to the much weaker fields that are generated by computers and other types of electronic equipment present any threat to one's health. To date there has been no clear evidence of a link. However, computers are still in their relative infancy and so we do not have decades of data to go on. Also this is really the first generation of children with widespread access to and use of computers. The odds are though, that no one will suffer significant ill effects from the weak EMR fields generated by computers.

The following recommendations for prevention of computer related injuries have been recently issued and posted on the Internet:

Work Habits:

Use proper posture to reduce stress on the muscles, bones and tendons.
Use as little force as possible - avoid pounding the keys on the keyboard or holding the mouse or pens and pencils in a death grip.
Use a telephone headset or a shoulder rest on the telephone receiver to avoid bending the neck and raising the shoulder to hold the phone.
Keep the shoulders and arms relazed while typing. Keep your whole body as relaxed as possible.
Breathe regularly and deeply. This can help keep you relaxed and alert.
Alternate non-computer jobs with computer jobs to keep your work routine varied and give yourself a break from computer use.
Try to relax mentally. Stress can make your body tense and your work less efficient.
Use your eyes properly: blink, see more than the computer screen, and look into the distance frequently.


Break up the repetition of keying. Take frequent breaks and use stretching exercises to improve blood circulation, provide rest for muscles and tendons, relieve tension and stress and improve efficiency. Short 'micro breaks' should be taken frequently, at least every 15 minutes to 30 minutes. If necessary, use one of the 'break reminder' software packages that are available. Longer breaks should be taken after every hour or two of intensive computer use.
Blink and rest the eyes frequently to reduce eyestrain and moisturize the eyes. Your normal blink rate (6-15 times per minute) is reduced dramatically while staring at a computer screen. Take a few seconds about every 10 minutes to close and cover the eyes (palming) or to focus on distant objects.

Your Body and Mind:

Maintaining a healthy physical and mental condition is important in the prevention of workplace injury.

Engage in a regular exercise program, with the advice of your doctor.
Eat a healthy diet.
Drink lots of water to keep joints and tendons lubricated.
Get plenty of rest.
Explore ways to relieve stress, such as meditation or massage in addition to exercise.
Whenever possible, take advantage of macros, function keys and other ways of mapping multiple keystrokes to a single key in order to reduce keystrokes.
Computer users with disabilities or with severe CTD injury may wish to investigate speech recognition software as an alternative to keyboard input.


The mouse should be placed in an easy reach zone so that the shoulders and upper arms can be relaxed and close to the body while operating the mouse. Keep the wrist and hand in a neutral position, never bent. Use as little force as possible when clicking or dragging.

Alternative devices on the market include graphic tablets and pens, touchpads, touchscreens, and footswitch-operated mice. Mouse wrist supports are available to elevate the hand and wrist. These may or may not be any better for the user, depending on their design and on the user's size, abilities or preferences.


The computer monitor should be positioned so that the worker does not have to bend the neck up or down or twist the neck sideways to view the screen. The top of the display screen should be at or slightly below eye level and at about 18" to 24" away from the face. Copy should be placed on a copy stand in front of the worker and at about the same height as the monitor.

The angle of the screen should be easily visible. Dark letters on a light background should be used to reduce eyestrain. Brightness and contrast should be adjusted.

Choose a monitor with good resolution for clarity of characters on the screen. The screen refresh rate should be at least 60 Hertz to eliminate screen flicker.

The screen should be cleaned of dust frequently to ensure the image is sharp.


Eyestrain is the most common health complaint of computer users. Symptoms of eyestrain can include: burning, itching, tiredness, aching, watering, blurry vision or altered color perception. Visual problems can cause headaches, fatigue, concentration difficulties and irritability.

Have your vision checked frequently. Undercorrected or overcorrected vision can strain your eyes and force you to lean forward to read the screen.

If you were corrective lenses, ask about lenses that have a focal distance designed for working at a computer.

Contact lense wearers should blink frequently and use eye moisturizing drops to avoid 'dry eye' syndrome.

Investigate Vision Enhancement Training and exercises to strengthen your eyes and enhance your visual abilities. Some visual skills important for computer users are:
  • tracking fixation
  • focus change
  • near vision acuity
  • binocularity
  • maintaining attention

Palming Exercise

For your mind and provide much-needed rejuvenation.


20-30 seconds


Briskly rub your hands and palms together for 5 to 10 seconds until they are warm.
Cup your warmed palms over your closed eyes. Relax your brow. As you exhale, imagine letting go of the tension from your eyes. Breathe regularly and easily.

Other Considerations

Keep your office temperature at a comfortable 68-72 degrees F.
Keep office noise at a level that is not distracting.
Reduce exposure to electromagnetic radiation by placing workstations more than 4 feet from the backs of other workstations and moving copiers and laser printers away from workstation areas.
Symptoms of Cumulative Trauma Disorders

How do you know if you have one of these disorders? Some of the signs and symptoms include:
  • pain or stiffness in the fingers, hands, wrists, forearms, elbows or shoulders
  • pain or stiffness in the back or neck
  • tingling or numbness n the hands or fingers
  • loss of strength or coordination in the hands
  • pain in the hands or arms that wakes you up at night
  • feeling a need to massage the hands, wrists and forearms

Because CTDs develop slowly over a period of time the symptoms of these illnesses can be initially very mild. But a CTD can rapidly become very painful and even crippling if left untreated and if the worker does not change faulty work habits. If you have any of these symptoms, see your doctor immediately! Delaying treatment of a CTD can only make the healing process more difficult.


The right workstation setup and equipment can help reduce the risk of injury and fatigue, but the other half of the equation is the user. It is possible to work long hours at a computer workstation without stress, fatigue or injury, if you learn how to correctly use your body, your eyes and your mind.

In addition to having your workstation set up properly, here are some of the things YOU should do to reduce your risk of injury.

Workstation Work Risk Factors

Risk factors are elements of a job that increase the chance of work-related injury. The potential of a risk factor to cause injury is affected by the duration of the worker's exposure to it. In an office environment where employees use computer workstations, there are four primary risk factors that can lead to the development of Cumulative Trauma Disorders:

posture - holding a fixed or awkward work posture
force - using forceful hand exertions
repetition - performing the same pattern of motions
insufficient rest - not allowing the body time to recover
Prevention of CTDs: Using Ergonomics in the Office

Prevention of CTDs involves eliminating risk factors in the workplace. The harmful effects of fixed and awkward work postures can be avoided or reduced through several means:

establishing an ergonomically correct workstation setup
using a neutral posture and avoiding positions that place strain
on the musculoskeletal system

shifting position frequently while sitting
taking frequent breaks
performing stretches and exercises during work breaks

The Workstation

An ergonomically correct workstation setup is one that allows the worker to maintain a neutral posture, free from awkward angles or positions. Ideally, the worker should be able to sit with feet on the floor (or a footrest), thighs parallel to the floor, back resting against the chair back in a slight backward lean, head and neck upright, elbows comfortably against the sides of the body, and wrists and forearms parallel to the floor. Elements of a good workstation setup include:

a good, adjustable chair with firm support
good seat cushioning with a waterfall front edge
pneumatic seat height adjustability
swivel seat
five legs with casters
The seat back should provide firm support to the lumbar region of the back, and should accommodate a slight backward lean. A pillow or rolled towel can be placed against the back of the chair for extra support if needed. The chair's adjustment controls should be easy to operate and to reach. If the chair height is too high at the lowest adjustment, a footrest can be used.


The computer keyboard should be placed at approximately elbow height with the surface at a comfortable angle. The hands and wrists should be held in a neutral position when typing: the wrists should be straight and not be bent upward, downward or sideways. This is the position that places the least pressure on the tendons and nerves passing through the carpal tunnel. The shoulders should be relaxed, the upper arms should hang comfortably down along the sides of the body and the elbows should not be cocked out away from the body.

There are many ergonomic keyboards on the market that are supposed to promote a neutral hand and writs position and decrease the strain of typing. There is no scientific evidence yet that they are ergonomically better, but computer users claim that some of them are a lot more 'comfortable' to use.

Wrist rests can be used to cushion and support wrists in breaks between typing. They should not be used to support wrists or hands while typing as this usually puts a bend in the wrist.
Some computer users claim that special gloves, wrist supports and wrist splints can relieve discomfort while typing. Check with your doctor before trying any of these devices.

From what we have stated above, it appears that there are definite syndromes that can occur with prolonged computer use. It is also clear, however, that if certain rules are observed and appropriate precautions taken, the risk of any of these occurring can be minimized.

« Last Edit: September 13, 2009, 05:17:45 PM by Admin » Logged

Sylvain Amyot

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