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R.S.I. Recovery - The way forward In recent years many keyboard operators have experienced the pain and frustration of injuries arising from their work. This has often led to enforced unemployment and subsequent legal action to seek compensation. A recent Court award of £150,000 underlines the extent of the damage that can occur and the costs involved. The Maltron Design Maltron keyboards are specifically designed and shaped to fit the easy movements of hands, fingers and thumbs. As a result they look very different from the usual flat keyboard and this can be a daunting sight for some. By using a Maltron keyboard the result for well over 2000 users who have adapted is a substantial reduction of pain and often a recovery of their career prospects. Although not everyone is freed of all problems the majority do benefit. Note in the anatomical image how all the tendons come together at the wrist. Correct hand posture at this point is essential to prevent restriction of movement which can lead to injury. In addition this is why, despite their popularity, soft gel wrist support pads are NOT recommended as they press into the soft part of the wrist and put further pressure on the tendons and may also restrict blood flow to the hand.

TRIALS

To enable trials to see if a Maltron keyboard would be helpful we make them available at £10.00 per week. We recommend a 4 week trial to get used to the new shape and to have some idea if recovery is possible. Often the changeover takes only a few days but sometimes this convalescent or rehabilitation period requires several weeks of persevering effort to overcome past habits. During this time there must be WILLING acceptance by both operator and management, however frustrating this may be, that there will be reduced output. The essential point is that REGARDLESS of WORK or ANY OTHER PRESSURES there must be NO RETURN to a flat keyboard during the trial.

The reason for this is quite simple. It is that keyboard injury is the personal bodily response of the operator to the static strain of holding the hands in the typing position when using a flat keyboard. For this reason there is no real 'cure' and a return to using it will destroy the benefit from using the Maltron keyboard and re- create the previous condition. Operator comment has been made, that during initial adaptation, the slower operation caused by the new shape is itself beneficial in forcing a more controlled and gentle finger action. Many users have felt pain, often within minutes, on attempting to return to a flat keyboard. If the NO RETURN condition cannot be set up, then there is little point in attempting a trial as it will only lead to failure and disappointment for all concerned.

"AMAZINGLY" EFFECTIVE

As noted above, the well being and careers of over 2000 operators have been saved by the change to a Maltron keyboard. Elaine Housby comments "Conventional keyboards now seem quite ridiculous to me." And MacUser Magazine reported "The Maltron keyboard is perfect for those suffering from or trying to elude RSI."

Dr. John Foster, until recently Medical Adviser to East Midlands Electricity has written of his "pleasure" "surprise" and "amazement" at the way the change to Maltron keyboards rapidly enabled 2 of their operators to return to full time work after being off work for months with painful hands and arms. His original letter follows and is in turn followed by his more recent ideas for a way forward for serious RSI cases now that the Government is taking a more positive view about getting people back to work.

East Midlands Electricity, Nottingham.
10th February 1997

Dear Sir,

I felt that I must write to you and express my pleasure and I must confess surprise which occurred when two of our employees started using a Maltron keyboard. Both these two ladies had developed a severe problem in the use of conventional keyboards resulting in both of them developing painful hands and forearms - a typical W.R.U.L.D. They were sent to an orthopaedic surgeon who confirmed this diagnosis, by this time they had been off work for several months and faced a very uncertain future.

By sheer chance our occupational nurse saw an advertisement for your keyboard and we hired one for both. Much to my amazement this seemed to solve the problem rapidly and five months later they are still in full time work doing the same job that caused the problem in the first place.

I was even more surprised to be told by one of them that due to a fault she used a standard keyboard and developed the symptoms within half an hour. We shall certainly use these keyboards as first choice if we have any other problems.

Yours sincerely,
Dr. J. Foster. Company Medical Adviser.

RSI Rehabilitation

by Dr John Foster

The treatment of the RSI Group of disorders is undoubtedly complicated; it is becoming apparent that the group of problems called upper limb disorders is a varied and complex group and there are many ways of approaching the problem.

One of the ways that is gaining acceptance is by the use of rehabilitation techniques such as are used in chronic pain syndromes. Patients will probably encounter this approach in 'Pain clinics' where the use of cognitive behavioural therapy is practised along with other aids to recovery. There are unfortunately long waiting lists on the NHS for this kind of treatment and there does not seem to be much chance of these shortening in the near future.

There are however some bright spots on the horizon, one of which is the government's interest in getting people back to work and their willingness to provide money for treatment of long-term sufferers and there is no doubt that many RSI sufferers will come into this category. As yet this is all in its infancy, but bids have been put forward for money with the treatment of RSI conditions in mind.

One of the treatment centres that has put forward proposals of this kind is Sketchley Hall in Hinkley. This is a centre which specialises in the treatment of musculo-skeletal conditions. Previously it has concentrated on back and neck problems but now has courses designed for RSI sufferers specifically. It is hoped that if Sketchley Hall is successful in it's bid, that this course can be fully operational. Obviously being a non NHS centre it has to obtain funding from somewhere. It is also hoped that industry may see the importance of this rehabilitation avenue and will fund some of its employees in this course.

One of the aims of the course is to get people back to work as it doesn't see 'cure' as a theoretical concept but something that will be expressed in the fact that the patient / employee is back at work. In patients who have upper limb disorder this means that they will have to return to work and for most of them, this will mean some form of keyboard work. It is therefore hoped that part of the rehabilitation process will be retraining on an ergonomic keyboard so that the fear and indeed possibility of recurrence of the symptoms is reduced.

One of the most successful keyboards has been shown pragmatically to be the Maltron design. This is one of the rehabilitation aids which will be used by the patient, as there is a self training module which will enable the patient to learn at the same time as the course continues.

It is hoped that with an ergonomic keyboard and the training in pain management and an increase in general fitness that this may be an enlightened approach to the overall problem of returning to work. This does not exclude other forms of treatment which the patient may need but it is a more comprehensive way of tackling this growing problem of pain associated with the increased use of keyboards.

5th March 1998.

A LEGAL POINT

The fact that the MALTRON keyboard has been available for so long and is now proved to be so effective, puts special responsibility and "duty of care" on employers and professional advisers to become fully aware of it. They must then ensure that where there is any intensive keyboard work, the assessment and advice given includes the recommendation that, as a proactive measure to avoid the problem and costs of keyboard related RSI:-

1. It should be experienced by all operators by means of a hire trial so that they will be aware that there is a likely answer to the problem should it arise

2. Where there is any report of pain, it should be installed without delay and the operator given adequate time to adjust to the new shape as stated above

Paper and screen based adaptation courses are available

While there is no certainty that a MALTRON keyboard will give recovery, experience so far, as reported above, shows that RSI sufferers who do adapt to it obtain a substantial reduction in pain with improved freedom of movement and recovery of career prospects. From this it follows that failure to offer this option could leave both Company and adviser open to a charge of failure to exercise "Due Care" in the event of legal action.

REFERENCES

(1) Osanai H., Ill Health of Key-punchers, Journal of Science of Labour, July 1968, pp367-371.

(2) Ferguson, D. and Duncan, J., Keyboard Design and Operating Posture, Ergonomics, November 1974, pp 731-744.

(3) Zipp, P., Haider, E., Halpern, N. and Rhomert, W., Keyboard Design through physiological strain measurements. Applied Ergonomics, Vol. 14.2 June 1983, pp 117-122.

(4) Hobday, Stephen, W., Keyboards designed to fit hands and reduce postural stress. Proceedings of the Ninth International Ergonomics Association, September 1985, pp 457-458. Bournmouth, UK.

(5) Hobday, Stephen W., A Keyboard to Increase Productivity and Reduce Postural Stress. Paper presented at - The International Industrial Ergonomics and Safety Conference. 8-10 June 1988 New Orleans, USA. Published in Trends in Ergonomics / Human Factors V, pp 321-330. by Elsevier Science Publishers B.V. Amsterdam August 1988

(6) Hobday, Stephen, W., Computer Related Upper Limb Disorder. A Keyboard to eliminate the Stress ∓ the Pain. An Interim Success Report. Paper presented at the 19th Annual Congress of IMART. (International Medical Association for Radio & TV) The Royal Society of Medicine. 1 Wimpole St. London. 4th May 1994.

(7) Hobday, Stephen, W., The Maltron Keyboards. A review paper presenting the range of ergonomic keyboards, the development process, practical designs and operational results. Presented at the IEE Computing and Control Division Colloquium "Interfaces - The Leading Edge" organised by Professional Group C5 (Human-Computer Interaction) at the University of Abertay, Dundee, 3rd April 1996. Digest No 96/126.