Kids and Keyboard Injuries
Surfing the Web may be good for children's minds, but what's it doing to their bodies? Cumulative trauma disorders, or CTDs, are epidemic. CTDs, also called repetitive stress injuries, occur when a movement is repeated over and over, hundreds and thousands of times, for prolonged periods: for instance, when typing on a computer keyboard. Some 13 to 20 million American adults are affected by repetitive stress injuries. Now there is growing evidence that children are also susceptible. The cause is the same: too much time on the computer, surfing the Web, typing papers and e-mailing friends.
Children are at risk for repetitive stress injuries because they are using computers at younger and younger ages, says Patrick Foye, MD, assistant professor of physical medicine and rehabilitation, UMDNJ-New Jersey Medical School. To make matters worse, they are not taught proper posture when using a computer and are not provided with ergonomically correct workstations.
In many classrooms, computer keyboards sit on the desktop or tabletop, rather than within an adjustable drop-down keyboard tray. If the desk or table is too high for a child, the forearms must continuously reach upward, which causes muscle fatigue and places unnecessary pressure on nerves in the wrists. Ideally, the elbows should be flexed no more than 90 degrees. The wrists should be horizontal and relaxed.
Also, too often the mouse is kept on the desktop and off to one side. This haphazard arrangement forces children to repeatedly reach for the mouse, which can cause inflamed tendons within that arm and shoulder. Preferably the mouse should be at the same height as the drop-down keyboard.
Even at home, work areas tend to be ergonomically unsuitable for children. "If the computer is set up for an adult, chances are the monitor and keyboard are too high for a child," says Foye. The result: over time, a CTD may develop, with symptoms that include pain, numbness, loss of strength, or decreased joint motion. Left untreated, some of the symptoms may become permanent. Foye is seeing a significant number of patients in their early 20s and 30s with repetitive stress injuries. "Since these are cumulative disorders, some of them may have started when the patients were adolescents," he adds. "The earlier people start performing repetitive tasks, and the more often they do them, the more likely they are to develop a CTD."
Repetitive stress injuries are nothing new. They have almost certainly been around for centuries, long before computers. "The workers who chiseled huge blocks of stone to build the Egyptian pyramids probably suffered from CTDs in their hands and arms," says Foye. Computer-related injuries include muscular strains, tendinitis, and nerve compressions, particularly in the back, neck, shoulders, arms, wrists and hands.
One of the most debilitating CTDs is carpal tunnel syndrome, a leading workplace occupational hazard caused by repetitive hand motions. Typically, it takes many years to develop. While Foye hasn't seen carpal tunnel syndrome in any adolescent patients, he doesn't rule it out for the future. "It's conceivable that 10 years from now, we may be seeing 15- or 16-year-olds who are affected," he says.
Most CTDs are treated with non-surgical rehabilitation. The first step is a thorough evaluation to make a diagnosis and identify any ergonomic or repetitive precipitating factors. Rehabilitation may include medications, splinting, injections, physical therapy or occupational therapy. However, these measures usually will not provide complete relief unless the causative factors are properly identified and modified. Using a properly designed workstation and maintaining good posture while working at a computer are the best way to avoid CTDs, says Foye. Feet should be flat on the floor or on a footrest, wrists in a horizontal position, and the head facing forward and tilted slightly downward. "Anyone who uses a computer, whether it's a child or an adult, should take frequent breaks to relieve the physical stress," says Foye.