ASHT News Bulletin Kids and Electronics

A majority of children are now using desk computers, hand-held electronics such as smart phones and PDAs, and gaming controls on a daily basis.  Parents should take an active part in teaching their children techniques that will help them prevent future injuries such as carpal tunnel syndrome and tendinitis. 

The American Society of Hand Therapists (ASHT) stresses the importance of developing good habits early on in children to prevent hand and wrist injuries in adulthood.  Healthy techniques learned at a young age can carry over into other aspects of life where there is a similar injury risk such as sitting in front of a computer or playing musical instruments. The ASHT Media News Bureau provided the following overall tips and health guidelines for kids and video gamers of all ages: 

Prevent Future Injuries such as Carpal Tunnel Syndrome and Tendonitis

• Tell your child to use a neutral grip when holding the controller. A neutral grip is when the wrist is straight, not bent in either direction (not strong or weak). It will allow for wrist motion in a plane where more motion is available in the wrist. 


• Ask your child to take a break every hour or switch to another activity. Overuse of repetitive motions, such as pressing buttons, can cause tendonitis of the elbow or lead to Carpal Tunnel Syndrome. 


• Don’t let your child sit back on his/her knees. Bending the knees this far is not only a hard position for the knee joint, but it requires your child to push most of his/her body weight up with his/her hands and wrists, placing increased pressure on these joints as well.


• Make sure the monitor is at the correct height.  While looking at the horizon, your child’s eyes should be looking at the top of the monitor.(this may vary if child wears glasses)


• If your child is typing, the keyboard should be at a height so that with his/her wrist/hands are straight, his/her forearms are parallel to the keyboard surface. 


• When using a GameBoy (or other hand held gaming devices), encourage your child to put pillows in their laps and rest arms on pillows. This will allow them to keep their head in a more upright position and therefore decrease neck strain.  The pillows will help support the arms so they do not have to be held up in the air.


• Whenever, possible your child should be sitting in an appropriate chair.  This would be a chair that allows your child to comfortably put their feet on the floor and also provides good back support. 


• When s/he is using a single control device (like a mouse), encourage your child to switch hands frequently.  This will allow the one hand to rest and reduce fatigue. 


• Have your child frequently focus on a distant object (away from the monitor) to help reduce eye fatigue.

The ASHT Media News Bureau is a central source for information on the specialized profession of hand therapy. ASHT members serve millions of patients nationwide, providing treatment for injuries and preventative care.  For more information about prevention technique and professional hand therapy, visit www.asht.org.
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing at the Hand Therapy & Occupational Fitness Center in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Pain-Free Mousing

When performing ergonomic assessments, the main factors that I have found that contribute to mousing pain include:

• Mouse Positioning
  
• Mouse Movement
  
• Muscular Tension When Activating the Mouse
  
• Forearm Positioning on the Mouse

Here are some tips to help reduce your risk of developing a repetitive strain injury or tendonitis from mouse use.

MOUSE POSITIONING

Causes of Pain

• Reaching forward for the mouse onto a desk that is higher than the keyboard.
  
• Reaching for a mouse placed to the far side of the keyboard.
  
• Planting the wrist down and swiveling the mouse using wrist motion.

Tips for Preventing Pain

• Position the mouse in a more comfortable and ergonomic location
  
  • Use an attachable mouse holder that adjusts to fit over numerical key pad (if you do not use the 10-key) or as closely to it as possible.
    
  • Or use a keyboard bridge over the numerical keys if you do not use the 10-key portion of the keyboard.
    
  • Or use a keyboard station such as the Contour Roller Pro which has a rollerbar mouse that is positioned immediately below the space bar of the keyboard.

MOUSE MOVEMENT

Causes of Pain

• Excessive wrist or arm movement when activating the mouse.
  
• Planting the wrist down placing pressure against the carpal tunnel.
  
• The wrist bent backward (estended) when using the mouse.

Tips for Preventing Pain

• The mouse should be at about the same level of the keyboard and positioned as closely to the keyboard as possible.
  
• Avoid reaching forward, up, or out to the side when using the mouse.  Position the mouse to avoid these movements (see mouse positioning tips).
  
• Activate the mouse by using small movements from the shoulder and elbow muscles rather than the wrist muscles.

Ergonomics

• Keep the shoulders relaxed.
  
• The elbow should be held loosely at the side in a direct line under the shoulder.
  
• The wrist should be held in a neutral position (not bent forward or back or angled to one side or the other).
  
• Do not plant the wrist down on that desk or on a wrist rest.  Glide the wrist over surfaces always maintaining the neutral position.

MUSCULAR TENSION ACTIVATING THE MOUSE

Causes of Pain

Forcefully squeezing the mouse between the thumb and small finger.

Forcefully activating the mouse buttons or switches.

Tips for Preventing Pain

• Hold the mouse as lightly as you can while still maintaining control.
  
• Keep the fingers held loosely against buttons and switches, not floating tensely in the air.
  
• Do not pound mouse buttons or forcefully squeeze switches.  Use only the lightest force necessary to activate controls.
  
• Using a wireless mouse can eliminate the tension of pulling against the cord (even these small tensions add up by the end of the day).
  
• Use a mouse and mouse pad that can be switched easily from right to left hand to share the work load between the two hands.
  
• A keyboard station such as the Contour Roller Pro that incorporates a rollerbar mouse eliminates the need to hold the mouse.
  
• Research mousing options such as the NoHands foot-activated mouse or a head-activated mouse placed in a baseball cap.
  
• Perform forearm and wrist stretches throughout the day.
  
• Gently stretch the thumb into the “hitch-hiking” position.

FOREARM POSITIONING

Causes of Pain

• The forearm rotated into the palm-down position for long periods of time.

Tips for Preventing Pain

• Vertical mice are good choices as the “hand shake” position with the forearm neutral rather than palm down can relieve forearm stress.
  
• Stretch into the palm-up position throughout the day.

Related Articles

Ergonomic ABCs

The Wrist and Repetitive Strain Injuries

DeQuervain’s Tenosynovitis – Repetitive Strain Thumb Pain

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.

Samples of Products Mentioned in this Article

Rounded Shoulders

When working at a desk or a computer, we often tend to lean forward, hunching over the desk, rounding our shoulders.  Or we crane our heads forward to better view the monitor.  Over time, these activities tend to round our shoulders, stretching the back muscles and tightening the chest muscles.  This poor posture not only makes work more difficult to accomplish, placing stress on the upper back, shoulder and neck and leading to soreness, but it also can impact the effectiveness of our internal organs.

One way to check your posture is to have a friend stand at your side and observe the alignment of your ears in relationship to your shoulders.  If your ears and shoulders are not in line, chances are your shoulders are rounded.

Another way to check your posture is to let your hands rest at your side.  Normal posture would be for the thumbs to face forward, your palms facing towards your thighs.  If the palms are facing towards the back, your chest muscles may be tight causing your shoulders to hunch forward.

Try this exercise to help your body ease into a more neutral posture. 

Shoulder Circles

• A good exercise is to roll your shoulders - move your shoulders forward, then up, then back, then down. Do this in a smooth, rolling motion several times. Emphasize the back and down motions. 

For More Helpful Exercises

• Check out this article at the Ergonomics Site at BellaOnline for additional stretches that will help you improve your posture and reduce your chances for developing work-related pain and strain.
  
• Stretching for the Computer Athlete
  

Sleeping Tips

• Sometimes a rounded shoulder problem can be made worse if you sleep on your side, curled up in a fetal position. You are rounding your back all night long. Instead, try learning to sleep flat on your back at least sometimes. It can be hard to learn a new sleep position - it feels very unnatural at first. However, give it a serious effort for at least two weeks.
  
• Also, use a pillow that supports the neck but that does not push the shoulders or head forward such as the memory foam cervical pillow available at Amazon.com.
  
  

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.