The magic touch

Lack
of training in the correct use of a keyboard leads to poor posture and
unnecessary musculoskeletal strain. It is time for all of us to take typing
lessons?  By Wendy Jones

Musculoskeletal problems are the most common injuries at work, according to
the HSE, and typing is one of the biggest causes1. By failing to provide proper
typing training, are we missing an opportunity to protect our staff?

Consider two work colleagues, side by side in a typical office with standard
office equipment.

Mary is a traditionally trained typist. She sits upright supported by the
back of her chair. Her eyes are focused on her computer screen, her head
balanced directly above her spine. Her arms and shoulders are relaxed, and as
she types she floats her hands lightly and rapidly across the keys.

David is a middle manager who is not trained as a typist. As he works, he
perches on the edge of his seat, leans forwards and looks down at his keyboard,
occasionally glancing up at the screen to see what he has written. He types
with two fingers, moving them quickly, hitting the keys hard and making many
typing errors.

It is obvious which of these two individuals is most at risk of work-related
upper limb disorder.

Risk factors

Traditionally, court cases involving computer-related injuries cited as
causes a high rate of input, high pressure (such as monitoring for speed and
accuracy), and inadequate or poorly adjusted equipment. These are very real
risk factors and complaints involving data input staff and secretaries are the
most common office-related cases going through the courts (these are summarised
on the Loughborough University website2).

The second scenario is a relatively new one that has emerged as companies
use e-mail as the main form of written communication, encouraging managers to
write messages themselves which would formerly have been sent by their
secretaries. The number of secretaries to help with such activities has reduced
as companies "downsize" in a bid to become more efficient.

At the same time, the availability of laptop computers encourages staff to
take work home and type at the kitchen table, whereas previously they may have
made written notes or dictated reports to be typed up by a suitably proficient
colleague the following day.

Causes of limb disorder

The early computer-related upper limb disorders to go to court were
described as repetitive strain injury (RSI), on the basis that repetition was
the main trigger. This clearly is an issue for the trained typist, working at
several hundred strokes a minute. However, the move to the term work-related
upper limb disorder (WRULD) takes account of the fact that repetition is not
the only cause of injury. Other risk factors for injury include static load,
poor posture and stress3.

Static load refers to holding a muscle tense with little or no movement –
consider the way David, the middle manager in our example, holds his hand in
mid-air while he decides which key to press next. Consider also the use of the
mouse, which the manager is likely to use more often than the trained typist
who is more likely to use "short cut" keyboard strokes as they fit in
better with rapid typing. The mouse in particular encourages static load,
especially for example when using a "drag and drop" function.
Consider also the strain of hovering the hand over the mouse, for example when
running the spell checker to correct the many errors that result from poor
typing.

Posture inevitably suffers for the individual who has never learnt to sit
properly, and who focuses on the keyboard. The fact that the head is tilted
down will increase the strain on the back of the neck, as will lifting the head
up and down to move between the keyboard and the screen. Research by Chaffin4
identified a significant increase in the risk of neck injury when the neck is
inclined at a downward angle of 30 degrees compared to an angle of 15 degrees.
Kane5 reports that strain on the neck can lead to pain in the arm even though
the injury itself is insufficient to cause neck symptoms.

Stress is highly subjective and could be an issue for either Mary or David
in the example due to deadlines, interpersonal factors, job satisfaction and so
on. However, the middle manager may have the additional problem of frustration
due to a high typing error rate, and possibly resentment at being required to
type when he knows he is inefficient at it. This will increase his muscular
tension, and hence predispose him further to musculoskeletal injury.

Training

The Health and Safety (Display Screen Equipment) Regulations6 require
employers to offer training to all those who work with DSE. This has to include
instruction in how to operate the equipment, how to adjust the chair, the
importance of closing blinds, how to get eye testing at the company’s expense
and how to report problems that may occur. There is a suggestion that this may
overlap with general training, for example the development of keyboard skills,
but there is no evidence that industry has interpreted this as being a
requirement to ensure that any individual is a competent typist. In fact, there
is minimal data published on the importance of being able to type properly in
order to use a computer safely yet, as we have seen above, this lack of
expertise clearly impacts on the known risk factors.

Responsibility for training

Historically, schools included typing in the curriculum for those
individuals who were likely to seek jobs in a secretarial environment. Students
destined for academia or physical or technical jobs were rarely offered this,
although both environments increasingly demand these skills. Schools provide
computer training to all students, but rarely teach touch typing, so the pool
of students leaving with such skills is shrinking.

Those who go on to higher education often use computers for typing course
work and notes – this would be an ideal opportunity to learn typing skills for
those who do not already have them, perhaps as a compulsory module on all first
year courses. In the author’s experience, postgraduate students in particular
are at high risk from the considerable computer-related demands of their
studies.

For those who reach employment without competent typing skills, the employer
could stand to gain by providing training. Not only may the risk of injury be
reduced, but an increase in productivity and satisfaction makes it an
economically advantageous option.

One relatively easy way is by offering teach-yourself typing packages, which
run on a computer. These are cheap and can be effective for those who are
highly motivated (see case study 1). Copies of a package were loaned to around
70 people at a major university, eight of whom reported success, most within a
few weeks. A further 15 were still attempting to learn several months later,
citing the difficulty in devoting regular time to the project as the main
limitation.

The other limitation of a teach-yourself package is that it is easy for a
student to learn bad habits, such as an ergonomically unsatisfactory typing
style. Griffin and Kahan7 outline the major errors that many people make when
touch typing and report that correcting these through a retraining process
greatly reduces the incidence of WRULD.

Both these problems can be overcome by offering support to employees
attending typing classes, which typically involve 20 hours of study time (see
case study 2). This provides an opportunity for learning in a supported
environment which helps with motivation and with supervision to encourage good
practice.

Wruld is a major issue in the workplace today. The primary goal must be
prevention, bearing in mind issues such as the importance of work breaks and
mini breaks and properly designed furniture, factors that have been implicated
in many court cases.

Perhaps in the long term we will find safer ways of inputting data – voice
recognition is developing rapidly, but brings its own problems, not least the
limitations of its use in an open plan office environment. Ergonomic keyboards
can help to reduce risk, and range from the Microsoft natural, which has
moderate benefits but is relatively easy to adapt to, through to the Maltron,
which has been designed to overcome the flaws inherent in the traditional
qwerty keyboard. Case studies of users have shown great benefit for individuals
with serious injuries, but the time taken to adapt to the unconventional style
is a major obstacle to it becoming more widely available.  The introduction of the mouse was seen as a
way forward, but this has turned out to be a double-edged sword.

For now, the qwerty keyboard remains the main tool for entering data and the
number of people not properly trained to use it continues to grow – consider
recent moves in the National Health Service to put a computer on the desk of
every consultant.

Hutson8 quotes Ramazzini who, writing in 1713 when studying
"scrivener’s palsy", identified mental stress as being a key factor
in the development of musculoskeletal injuries – yet 300 years later we are
continuing to put our employees at risk by demanding that they work long hours
doing work for which they have been inadequately prepared.

Learning to touch type is not the sole solution to preventing wruld but it
has to be a pretty good place to start.

References

1. Health and Safety Executive (2000) Work Related Upper Limb Disorders
Statistics information sheet. 1/00/EMSU. www.hse.gov.uk

2. www.lboro.ac.uk/wruld-db/sumjudg.htm

3. Pascarelli E, Quilter D (1994) Repetitive strain injury a computer user’s
guide. Chichester: John Wiley.

4. Chaffin DB (1973) Localized muscle fatigue: definition and measurement.
Journal of Occupational Medicine, 15: 346-354, cited in Work related neck and
upper limb musculoskeletal disorders (1999). European Agency for Safety and
Health at Work

5. Kane RL (1984) Role of the neck in repetitive strain injuries. The RSI
network, 19 (Aug), available through CTD Resource Network at www.ctdn.org/

6. Health and Safety Executive ( 1992) Display Screen Equipment at Work,
Guidance on Regulations. Health and Safety (Display Screen Equipment)
Regulations. HMSO London

7. Griffin V, Kahan NJ (1999) Motion-based ergonomics: Keyboard retraining.
The RSI Network, 39 (June/July).

8. Hutson MA (1997) Work-related upper limb disorders: Recognition and
management. Butterworth Heinemann

Wendy Jones is an occupational health nurse with Nottingham Occupational
Health

Case study 1: The poor typist

Peter was a senior administrator with
a developmental and support role for IT use within his department. He had a
very high computer-based workload, spending most of his working day using
either e-mail or word processing packages.

He contacted the occupational health department seeking advice
following aggravation of a long-standing back problem, coupled with aches and
pains in his neck, shoulders and right arm.

Work assessment showed that the combination of high job demands
and a poor typing style (quite fast but with a high error rate) were resulting
in stress, and a high level of muscular tension.

In addition to making small changes to the arrangements of the
work area, Peter was advised to consider learning to touch type. He installed
"Mavis Beacon Teaches Typing" on his work machine and spent at least
15 minutes every day working on it, either at the beginning of the day or
during his lunch hour.

By the end of four weeks, he had mastered all the keys, and
another month after this his typing speed had increased to be at least as good
as his pre-training level, but with a greater accuracy.  

Peter reported a progressive improvement in his symptoms,
increased job satisfaction, and increased effectiveness at work, which he
attributed to his learning to touch type.

Case Study 2: The two-finger typist

Simon first came to the attention of
the occupational health department in 1994, complaining of pain in the back of
his right hand. This was initially related to use of the mouse, but
subsequently was aggravated by typing – he was a "two finger" typist,
using only the index finger of each hand. Around half of his working day was
spent at the keyboard producing scientific reports and communicating by e-mail.
 

Over the next six years, Simon continued at work,
"managing" his symptoms with steroid injections and physiotherapy. He
typed alternately with the index and middle finger of his left hand, using his
right hand as little as possible. Voice recognition, alternate designs of
mouse, and "Mousetools" (a software package that automates the
"click" function) were all tried with limited success.

In May 2000, Simon asked to try an ergonomic keyboard. He was
provided with a Fujitsu-Siemens adjustable keyboard, on the understanding that
it would be of limited benefit if he continued to type with only one or two
fingers. Shortly afterwards, he enrolled on a 10-week night school typing
course, and seven weeks in felt ready to "switch" to touch typing at
work.

He now types at around 30 to 40 words per minute and feels that
he has recouped the 20 hours spent on the course, "many times over".
He continues to suffer from a chronic "background" discomfort, but no
longer finds this disabling. He is able to type for relatively long periods of
time, and to manage any aggravation by early recognition and rest.

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