Crippled by Computers

By Janice M. Horowitz

AS JOBS IN JOURNALISM GO, Grant McCool's was a plum assignment. Based in Hong Kong for the Reuters news service, McCool covered breaking news throughout east Asia, traveling to South Korea, China and Pakistan. But in 1989, after five hectic years, the native of Scotland was ready for a change. That's when his bosses transferred him to New York City to be an editor.

That's also when the trouble started. After typing on his computer keyboard for hours a day over several months, McCool developed excruciating pain in his hands; some mornings he would awake with his arms throbbing and burning. "The doctor told me to stop typing immediately," recalls McCool, 32. He hasn't written or edited a story on deadline since. Nor has he been able to clean house, carry heavy objects or play squash. He cannot even drive a car; controlling the steering wheel with his injured hands is impossible.

McCool suffers from a severe case of cumulative trauma disorder, a syndrome that results from overusing the muscles and tendons of the fingers, hands, arms and shoulders. The condition brings pain, numbness, weakness and sometimes longterm disability. Such problems, more commonly known as repetitive stress injuries (RSI), now strike an estimated 185,000 U.S. office and factory workers a year. The cases account for more than half the country's occupational illnesses, compared with about 20% a decade ago.

Typical victims are meat packers who slice scores of carcasses a day, or autoworkers who drive the same screws hour after hour. But a particularly fast-growing category of victims includes white-collar professional and clerical workers who spend their days pounding away at keyboards. An increasing number are responding in a white-collar way: with lawsuits. Hundreds of injured telephone reservationists, cashiers, word processors and journalists, McCool among them, are suing computer manufacturers, blaming the machines for their disabilities. IBM, Apple Computers, AT&T and Kodak's Atex- division, which produces a word-processing system designed for journalists, have all been named in the suits, which demand damages of up to a $1 million or more per victim. Last June, a U.S. district judge in Brooklyn lumped together more than 44 suits against 63 manufacturers in an attempt to arrive at some ground rules for dealing with such cases. More than 200 cases have been added since. Although the final outcome could take years, some liability experts predict that the ultimate payout on RSI suits could rival the $4 billion paid on asbestos-related claims.

Employers are quickly learning that they too must face up to the problem. Already, RSI costs about $7 billion a year in lost productivity and medical costs. Moreover, under the provisions of the Americans with Disabilities Act, which went into effect this summer, employers are now required to accommodate "reasonably" workers with physical impairments. Companies may have to transfer employees with RSI to less stressful jobs or give them special help. Increasingly, unions and other worker groups are demanding that companies provide better keyboards and office furniture and give employees more frequent breaks to reduce the risk of injury. The Occupational Safety and Health Administration has announced plans to create national workplace standards for the prevention of RSI.

How ironic that computers, the very technology celebrated for making office work easier, would cause such harm. By now, nearly half the U.S. work force -- some 45 million workers -- use computers (though not all spend hour after hour punching keys). "We thought technology was going to help us, which it does. But we did not consider that we would also have to adjust the workplace at the same time," says Barbara Silverstein, research director of Washington State's department of labor and industries.

RSI involves not just one but an array of ailments resulting from tugging, pounding and straining crucial tissues in the upper body. It usually begins innocuously. "People think they've had a particularly hard day or that they're getting old," says Frank Fernandez, an Oakland, California, attorney who has filed suit against several computer manufacturers on behalf of RSI sufferers.

But as the hands continue to be overworked, symptoms worsen. Tendons, which are like long pulleys directing the movement of the fingers from many places in the hands and arms, can swell up, producing painful tendinitis. Soreness can also result from the inflammation of sheaths surrounding the tendons. Muscles in the forearm that control the movement of fingers may become irritated, a condition called myositis. As tissues become inflamed and swollen, they can press on nearby nerves, causing tingling and weakness in the fingers. Sometimes scar tissue develops in the area. All together these injuries, if not treated, can result in diminished coordination and strength: patients may literally lose their grip and have trouble managing simple manual tasks.

AMONG THE MORE EXTREME -- and less common -- cumulative traumas is carpal tunnel syndrome. It develops when tissues in the palmar side of the wrist swell, squeezing a vital nerve that runs through the area. Carpal tunnel syndrome can cause crippling pain for months or years, though surgery can sometimes help.

It is hard to conceive how the gentle patter of fingers over a computer keyboard could do such damage. People have, after all, been typing for decades, and computers would seem to be an improvement over clunky ) typewriters. But word processors pose special problems. They allow workers to sit with their fingers flying across the keyboard at 240 strokes a minute for hours without a break. A typewriter, by contrast, forces workers to pause every so often to move the carriage or change the paper. The amount of time spent at the keyboard is critical: a study in Australia found that people who typed for more than five hours a day at a computer had 12 times as great a risk of developing RSI as those who spent less time.

Workers at computer stations may position their hands over the keyboard with the sensitive wrist cocked upward or downward, compressing the tendons, ligaments and nerves that run through its narrow confines. People working with typewriters are more likely to hold their hands suspended straight forward, the wrists flat. Old-style typewriter keys also generally have a certain amount of spring, while computer keys often strike against a hard, unforgiving base. "These simple things sound trivial, but they are not when you're locked into one position, working all day long," says Marvin Dainoff, director of the Center for Ergonomic Research at Miami University, in Ohio.

The modern office has left many employees with little variation in their daily tasks. "Instead of running to the file cabinet to pull out information or going to the library, workers can do everything they need to by just sitting at the keyboard," says Silverstein. "They don't even have to get up to talk to each other. Now they have electronic messaging." Even today's phones with push buttons instead of dials strain the same tired tendons.

Computer makers defend their machines vigorously. They stress that the problem lies not with their keyboards but with how they are used. They also point out that other office equipment, such as chairs and desks, must be designed ergonomically, which means that they fit the individual's body and specific job needs. Says IBM spokesperson Brian Doyle: "IBM's position is that aches and pains in the workplace can come from a number of sources, including posture, adjustment of equipment and the amount of time spent performing a given task. Applying good work habits and good ergonomic principles is a shared responsibility of both employers and employees."

But U.S. employers have so far done a poor job of shouldering this responsibility. Chairs, desks, lighting are chosen more on the basis of price or decorating schemes than ergonomics. "We're just not doing as much as we could," says Michael Smith, professor of industrial engineering at the University of Wisconisin. Several other countries are further along in protecting workers. Sweden, for example, has had a strict ergonomic standard since 1979, and in Germany insurance companies scale back benefits to companies that do not adequately guard against RSI.

Admittedly, personal traits and habits often influence who will develop RSI. A pioneer in treating the injuries, Dr. Emil Pascarelli, medical director of New York City's Miller Institute at St. Luke's-Roosevelt Hospital, points out how very heavy people can get into trouble. For their hands to reach the keyboard, they have to maneuver their arms around their own girth, and wind up contorting their wrists inward. Double-jointedness can also be a risk factor. Smokers may have fewer injuries, thanks to their periodic breaks away from the terminal to satisfy nicotine cravings. And what goes on outside the office can be just as damaging as what happens in it. Observes Katy Keller, a physical therapist at the Miller Institute: "Injured people go home and talk on the telephone, stir the supper and carry the baby all at the same time. All this does is add to the physical stress of the workday."

For many workers, physical stress is just part of the problem. A three-year study by the National Institute for Occupational Safety and Health of telephone workers at U.S. West Communications found that 111 out of 518 employees who used computers had RSI. The most revealing discovery was that all the sufferers reported high levels of psychological strain, such as job insecurity and pressures to work fast. Psychological stress probably does its mischief by creating muscle tension, which reduces blood flow to hard-working muscles and tendons; without enough oxygen, these tissues become fatigued and prone to injury.

Fearful of lawsuits or just concerned about the health of their workers, a few employers are beginning to take action. They are providing fully adjustable, ergonomic chairs and wrist supports to employees who complain of pain. Others are trying to break up the daily routine by giving people different tasks. The Los Angeles Times has set up its own repetitive stress injury room, stocked with a set of light weights for strengthening hands, a freezer full of ice packs to calm inflamed tendons and a floor mat for ailing workers to stretch out on. The paper has customized its software program to flash "Take a Break" reminders. IBM has given ergonomic furniture to many of its most pressured keyboard workers, including 800-number operators.

New, more benign technology would help. In the U.S. and elsewhere designers are scrambling to create radically different keyboards that will be easier on the hands. But the ultimate goal is to do away with the keyboard. Reuters has given McCool a voice-activated computer that can type words and perform other functions in response to his verbal commands. Such machines are still slow and unreliable and can "understand" only a limited vocabulary, but the technology is improving rapidly. When voice-activated computers spread through the workplace, probably sometime early in the next century, the only occupational risk might be an occasional bout of laryngitis.

With reporting by David S. Jackson/San Francisco