All for one and one for all?

In the world of IT, one size certainly doesn’t suit all. Fitting the individual to the computer instead of the reverse may make financial sense in the short-term with the economies of scale it generates, but long-term it can be a highly-problematic approach. Awareness of what can be achieved through adapting technology to the needs of individual employees is a prerequisite for the OH professional.

Reported cases of repetative strain injury (RSI) show no sign of abating, and the rise is graphically illustrated by the 2,000-plus cases currently pending in the UK against employers, and an estimated incidence nationally in excess of half a million cases.

It has been suggested that RSI affects as many as one in four computer operators – a startling figure, but one which, with the right support, expertise and training could be significantly reduced.

The business case for early intervention is compelling, but the legislative context is also clear. Two major pieces of legislation demand flexibility and a focus on the needs of employees – all employees – as individuals. The Disability Discrimination Act (DDA) requires employers to provide ‘reasonable adjustments’ for disabled employees – an obligation which applies to technology in the office environment as much as it does to building access. But the term ‘disability’ does not describe all those at risk who would benefit from ‘adjustments’. The DSE Regulations mean employers must assess risk at every workstation and take the appropriate steps to minimise it when found; and it is often present.

A recent survey of 15,000 US adults of working age showed that some 60% could benefit from the use of accessible technology due to physical or visual difficulties and impairments which had a negative impact on their computer use.3 What is good for employee health and morale is undoubtedly beneficial for the bottom line too.

Many problems that affect PC use in terms of comfort and productivity can be avoided with the appropriate technology. Simple adjustments, often using free facilities in the existing operating system, can be of tremendous help to staff with dyslexia or poor sight, in addition to temporary conditions such as whiplash, a neck injury or a broken arm. None of these, in themselves, should prevent an employee from gaining full and effective computer access.

For employers, the good news is that PCs can be modified for use by virtually anyone, whatever their disability, in many cases without any significant financial outlay.

When valued employees become disabled or limited while in employment – which affects one in five people who become disabled every year – their employer is deprived of a considerable asset reflecting not only a significant financial investment, but also the skills and experience accumulated over many years.

The Employers Forum on Disability has calculated this loss to be around £160,000 per employee.

Awareness that computer technology can be adapted to individual needs requires a change of culture that can benefit everyone. Some organisations still regard ‘disability’ and ‘access’ as issues affecting a small minority of their workforce; but the provisions required to adjust their systems to accommodate disabled employees can help existing staff who would not perceive themselves as ‘disabled’ at all. After all, today’s eye strain, back pain or wrist ache could be tomorrow’s chronic condition.

Anna’s story illustrates this. An employee of a privatised industry, Anna developed a usage-related injury as a result of intensive computer work, diagnosed as ‘de Quervain’s tenosynovitis’ of the right (dominant) wrist. She had no prior condition or identified sensitivity that would have pre-disposed her to this condition.

By January 2004, her symptoms had become ‘unbearable’, and she was signed off as ‘unfit for work’ by her GP and specialist. After a year off work, the muscles in her right wrist and forearm have atrophied from lack of use and the area is still painful, especially if she attempts activities such as handwriting.

AbilityNet was called in to advise on Anna’s gradual return to work with appropriate equipment and support. Some months on, Anna is back at her desk using voice recognition in combination with her left hand. It was clearly important not to expose her left hand to the physical stresses implicit in unfamiliar use by careful choice of kit and overall computer usage technique. Anna has since expanded her knowledge of the keyboard shortcuts that provide an alternative to mouse use, on the basis that mouse use will continue to involve, on balance, more physical pressures than keyboard use.

Anna uses a compact keyboard – which has significant advantages, especially for those who wish to use only one hand some of the time. They are ‘laptop-style’, do not have a separate number pad and require less ‘reach’. When Anna needs to use a lot of numbers – for example, when completing a spread sheet – she will use a separate number pad instead of a keyboard. This can be used with the left hand and placed at the back of the desk when not required.

There are also several options within Windows Accessibility that have proven useful to Anna, including ‘sticky keys’ – a facility that enables the user to use only one hand to press one key at a time, thereby avoiding the unnatural twists and stretches otherwise involved in pressing two keys at once (when using the shift, alt and ctrl keys). Similarly, the speed of the mouse cursor and the double click has been slowed down and her mouse retuned for left-handed use.

The potential of voice recognition, once deemed appropriate, is dependent on several factors. The specification of the machine involved must support the necessary software. The commitment and enthusiasm required of the end user cannot be underestimated either. Voice recognition is a powerful solution, but it is a new skill and requires attention and care to master and implement. Training and support are not an option – they are a prerequisite of a successful outcome.

Happily in Anna’s situation, practice really has made perfect, and her delight at being back in the office is equalled only by her pleasure at becoming a productive member of staff once more on her PC.

The unfortunate truth in Anna’s case is that all the practical improvements were available from the first day that she experienced pain. It is entirely likely that a whole year at home – with all the associated psychological damage this implies, not to mention the loss of her considerable skills and experience to the organisation – might have been avoided. And a higher level of awareness in those concerned with her diagnosis and treatment, the development of the most severe of her symptoms might well have been prevented.

What can we learn from Anna’s case? The organisation involved is now looking at developing internal procedures that will ensure that reporting early symptoms is encouraged and perceived as helpful, positive and most importantly, unremarkable.

Training will take place to enable those involved in the reporting structure to be very clear about the next steps to take in such situations, and will also equip them with a working understanding of the nature and potential of alternative and adaptive technology.

In addition, the IT support team will have a ‘technological toolkit’ at their disposal, comprising some of the most widely used adaptations available, including keyboards of different shapes and sizes, mouse alternatives, lap-trays, wrist rests, a screen magnifier, a document reader, and voice-recognition technology.

The organisation also plans to develop expertise in voice recognition specifically, so that it’s more widely used by all employees as an alternative to keyboard use.

At BP, a more enlightened approach is already in operation, as Angela Whitehead, regional OHN director, Europe, explains: “BP is developing a detailed protocol regarding healthy computing, which benefits everyone. By understanding and applying the basic principles of adaptive technology, we are preventing health issues from converting into problems for our staff, who are benefiting significantly both in terms of well-being and productivity,” she says.

“We are determined to stop health issues becoming more serious issues, and our DSE assessors and co-ordinators all receive initial training and regular refresher sessions on the basic principles of adaptive technology. This ensures that they have the confidence to make an initial assessment of a situation and can ‘fast track’ a consultation with an OH nurse or a physiotherapist if required.”

She adds: “Our OH and physiotherapist teams attend more in-depth courses and are equipped with the knowledge, know-how and equipment to take the preventative action necessary.”

There are plans to disseminate information more widely through the company’s intranet and give all staff the opportunity to learn about healthier computing and how to customise their PC, says Whitehead.

“We have been looking at AbilityNet’s online service – My Computer My Way ( – and are looking at ways of offering some of this information to BP employees – a self-help approach that can run in tandem with the other procedures in place. This could be linked into the compulsory DSE self-assessment procedure in which all employees participate online,” she says.

A third and final strand to the ‘best practice’ initiative at BP is the implementation of voice recognition as an established option across the organisation. People find it difficult to abandon old ways of working and do not want to ‘feel different’ from their colleagues. But we are confident that with the right package of support and training in place, many of our employees will feel enthusiastic about its possibilities and see it not as a ‘second best’ alternative to the traditional access method, but as a similarly viable way of getting on with their work.”

1. CBI Room for Improvement report, May 2004
2. RSI Association
3. The wide range of abilities and its impact on computer technology – a research report commissioned by Microsoft Corporation and conducted by Forrester Research Inc. 2003

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