Ergonomic Interventions for Computer Users with Cumulative Trauma Disorders

Abstract

This chapter examines ergonomic interventions for computer users who experience cumulative trauma disorders (CTDs) in the workplace. The complex nature of these disorders demonstrates the need for holistic, comprehensive, and personalized evaluations. Examples of occupational therapy and other interventions for these disorders and their effectiveness are reported. Recommendations for occupational therapy practice and further research are provided.

The number of computer keyboard workers with cumulative trauma disorders is as much as 12 times that of non-keyboard users.

(Weiss and Chan 2008)

Appendices

Case Study of Betty

Keywords

Computers, Cumulative trauma disorders (CTD), Ergonomics, Musculoskeletal disorders

Introduction

This case study addresses adaptation and modification of Betty’s computer workstation.

The Student’s Tasks Include

• Finding solutions for workstation modifications for Betty, who experience a CTD

• Identifying interventions for Betty

• Discussing work activity modifications that will increase her independence in the work environment

• Identifying individual ergonomic resources for her workstation modification

• Synthesizing information into a report

Major Intervention Goals

The major goals of intervention are to: (a) decrease pain, (b) slow the progression of the CTD, (c) provide alternative solutions to work stations to decrease recurrence of CTD, and (d) allow the patient to return to work .

Learning Objectives

By the end of this chapter, the student will be able to:

• Consult the literature to provide intervention for the case study

• Identify symptoms associated with different CTDs and apply acceptable interventions

• Identify appropriate modifications to a computer workstation for individuals with CTD

• Apply ergonomic interventions to alternate environments and situations

• Identify methods to assist individuals with CTDs to return to work

Background History of Case Study

Personal Information

Betty is 46 years old. She is 5’3" tall and weighs 145 pounds. She has been employed in the IT department at a corporate company for 20 years. She is at her computer workstation for approximately 7 h a day. Along with working, Betty manages the cleaning and cooking at home. She drives her daughter to and from school activities and volunteers at her daughter’s school.

Medical Information, Including Prognosis

For the past year, Betty has noticed increased pain and inflammation in her dominant right wrist. At the end of Betty’s workday, she experiences numbness and tingling in her right hand. Throughout the night, Betty awakens to shake her hand due to sensory changes. Betty has noticed that her typing has slowed and fine motor activities (e.g., buttoning her shirt, tying her shoes) cause her pain . In order to adjust her wrists when working on the computer, Betty changed her posture. As a result, Betty is now experiencing neck and lower back pain at the end of the workday. In addition, Betty compensates with her left hand, and she now notices pain in that wrist as well. Betty discussed her symptoms with her physician and was diagnosed with low back pain and right carpal tunnel syndrome. The physician warned her of the possibility that the carpal tunnel will eventually affect her left wrist as well.

OT Intervention

Betty was referred to an outpatient OT. Betty received a dorsal wrist orthoses with a removable resting finger pan that keeps her wrist in neutral and immobilizes the extrinsic finger flexors in extension. She wears the wrist and finger components at night and the wrist orthoses at work during rest periods or when fatigue and pain increases. Relaxation techniques were encouraged at work and home. She was trained to reduce extreme wrist motion during her daily activities. The OT is working with Betty to readjust her work schedule to provide regular rest periods for her wrist and hand throughout the day.

In addition, the OT educated Betty on proper body mechanics for activities at work and around the house. The OT explained the use of ice or heat to the back or neck when Betty experienced pain in those regions. Betty is anxious to return to work and does not want to cause further disability to her wrists or back.

The OT evaluated Betty’s workstation and suggested modifications that would improve Betty’s posture while working on the computer. Factors to consider when modifying Betty’s workstation include:

• Postural support

• Support for forearms and wrist

• Keeping the wrist in neutral position

• Essential job functions performed by Betty at the computer workstation

The following questions are used to guide intervention in the work space for Betty:

• 1. What modifications are appropriate that allow Betty to remain functionally independent at work yet meet the productivity standards of her position?

• 2. What evidence supports these modifications?

• 3. What are the advantages and disadvantages to the modifications suggested?

• 4. In what positions should the workstation and keyboard be to optimize functional typing for a person with carpal tunnel?

• 5. What can you teach a person with CTDs related to using the computer mouse?

• 6. What are alternative options to a keyboard and mouse?