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In recent years, Dr. Margit Bleeker has watched college students
and teenagers walk through her door seeking help for pain in their
wrists, arms, necks, and backs. Her diagnosis? Repetitive-stress
injuries. The culprit? Excessive typing and bad posture while
using a computer.
"It's not uncommon to see postgrad students in pretty bad shape,"
says Bleeker, director of the Center for Occupational and Environmental
Neurology in Baltimore. Doctors at Harvard University, the University
of California, and other higher ed institutions have reported
similar increases in the number of students seeking treatment
for carpal tunnel syndrome, tendinitis, and other medical conditions
indicating damage in muscles, tendons, and nerves.
The growing number of college students suffering injuries traditionally
associated with office workers has prompted some ergonomics experts
to sound a warning: Schools that don't practice ergonomics in
the classroom could be putting students at risk for future injuries.
Neglecting ergonomics, they say, means schools might be contributing
to such long-term health problems as repetitive-stress injuries
and near-sightedness.
Taking cues from the business world, many schools have long
recognized the need to provide ergonomically correct equipment
for administrative staff. School officials say they don't hesitate
to respond to employees' requests for wrist rests, back supports,
and adjustable keyboards and chairs.
But providing the right equipment for the classroom is a different
story. In the rush to equip schools with the latest technology,
experts say, schools are ignoring or paying scant attention to
the other parts of the equation: buying the right furniture, installing
proper lighting, and helping students develop the good posture
and work habits necessary to avoid injury.
"All of the focus is on either computers or cabling, and there's
really no attention paid to the environmental factors," says Alan
Hedge, ergonomics professor at Cornell
University and coauthor of two studies about what he calls
the "striking misfits" between students and computer workstations.
One of Hedge's studies showed that children adopt healthier
postures when using adjustable trays for the keyboard and mouse.
The other study showed schools often place monitors and keyboards
too high and fail to provide wrist or palm rests. Hedge found
more than half of the monitors intended for kids exceeded the
recommended maximum height for adult users.
"The two studies point to the fact that where you are introducing
a large number of computers, you need to think about the kind
of furniture you're using," he says. "The whole point of the research
is not to try and scare anybody that there's a huge problem. It's
to point out that children are not learning good posture in schools."
The vision thing
In computer labs and classrooms, health problems can arise from
a variety of causes. Vision problems, for instance, can result
from sitting too close to the monitor and from improper lighting
that throws glare onto the computer screen.
"The primary problem with kids and computers -- and it's worse
the younger they are -- is environmentally induced myopia," says
Dennis Ankrum, director of human factors research at Nova Solutions,
a computer furniture manufacturer in Effingham, Ill. "Excessive
near visual work can cause the visual system to think this is
sort of normal, and the cornea changes shape to optimize itself.
That's what near-sightedness is. These work stations you see,
where little kids are sitting on their mothers' laps staring at
the computer -- that's a prescription for near-sightedness."
Monitors should be placed so the top of the screen is at eye
level. If the monitor is higher than recommended levels, the user
is forced to look up, which can contribute to neck- and eyestrain.
Some experts recommend tables on which the monitor is located
below the keyboard, requiring the eyes to look down at a less
stressful angle.
The proper distance to place a monitor from a user is subject
to debate. Some experts recommend a distance of 18 to 30 inches
between the monitor and the user, but Ankrum says 25 inches is
an adequate distance. "There's no basis for estimating the maximum
distance other than the ability to see the screen," he says.
The problems presented by classroom lighting, which can throw
glare onto monitors, can be difficult to solve. Monitors should
be placed perpendicular to windows to eliminate glare. If that's
not possible, shades should be drawn while students are using
computers. Antiglare shields also can help.
"Part of the problem you have in schools is that you have to
have lighting for both computer work and classroom work," Ankrum
says. "One of the things that anyone considering a new building
or remodeling ... [should consider] is to invest in ceiling-suspended
indirect lighting" that can be focused on areas where students
need more light.
The keyboard and chair
Schools sometimes forget that "they are actually training the
workforce of the future," Bleeker says. "You teach someone how
to write correctly. Why should it be any different than to teach
how to use a keyboard correctly?"
Adjustability is the key to setting up ergonomically correct
workstations -- especially when dealing with students, who can
vary greatly in size, says Karen Jacobs, president of the American
Occupational Therapy Association and a clinical associate
professor of occupational therapy at Boston University.
Jacobs and other ergonomics experts say tables and chairs should
have adjustable trays for keyboards that can be lowered or raised
to fit the user. The keyboard should be placed just below elbow
height, flat on the desk or tray. The size of the keyboard probably
doesn't matter as much as its location in relation to the mouse.
"You want to avoid having the arm in a swing-out position" to
use the mouse, Jacobs says. For left-handed children, the mouse
should be located left of the keyboard.
One of the most critical pieces of furniture is the chair, says
Bleeker: "You can make up for a lot of bad features in your workstation
with an adjustable chair." The chair's height should be low enough
to keep the feet from dangling, which can hamper circulation.
Adjustable lumbar pads can help support the lower back, and a
rounded seat edge will avoid cutting circulation to the thighs,
Jacobs says.
Doing the right thing
There are a lot of factors to consider, but many schools are
nevertheless trying to do the ergonomically correct thing. Betsy
Willey, director of technology for East Brunswick Public Schools
in New Jersey, says the 8,600-student district has tried to maintain
appropriate ergonomic standards in the classroom. For example,
officials observed students' behavior before deciding to buy ergonomically
correct computer carts with adjustable, pullout keyboards.
"The problem with school districts is that you're dealing with
youngsters who vary in height from three and a half feet tall
to six and a half feet tall," Willey says. "You will never be
ergonomically appropriate for every single child in the district."
But attention to ergonomic detail doesn't always pay off. In
Oswego, N.Y., Ken Eastwood, assistant superintendent for instruction
and technology, says school officials seriously considered ergonomics
when they began equipping classrooms with computers a few years
ago. The 5,600-student district spent about $100,000 to buy ergonomically
correct furniture, including computer tables with monitors built
in underneath, but found most of it wasn't useful. The tables
are no longer used in classrooms.
"We stopped buying [the tables] because we found that, from
a posture perspective for the smaller child, they weren't designed
well," Eastwood says. "The kids lean way over and almost put their
nose on the screen."
Adjustable pullout keyboard trays didn't work well in Oswego,
either. "The kids actually would lean over and put their hands
under the desk to reach the keyboard when it was in the hideaway
position," he says.
In East Detroit, school officials strove to find a balance between
what students needed to be comfortable and what the Michigan district
could afford when equipping schools with technology, says Terri
Spencer, director of educational technology.
"We tried to follow guidelines and information we found on setting
up computers, but overall, the theme we got from the literature
was that children should be comfortable and taught how to use
computers, but in short-term spurts of use. There should not be
anything detrimental," Spencer says. "We really felt it was more
important to spend more on getting the best technology. Schools
really have to find a balance -- we can't spend $200 or $300 on
a chair."
Budgeting for ergonomics
Experts acknowledge that equipping classrooms with ergonomically
correct furniture might not be economically feasible or practical.
School officials sometimes decide the short amount of time that
each student spends at a classroom computer doesn't justify the
expense of, say, a $300 or $400 chair. And some experts tend to
agree.
"There's been no study that I know of that has identified musculoskeletal
problems among grade school kids," says David Rempel, director
of an ergonomics program run jointly by the University of California-San
Francisco and UC-Berkeley. "It's a sexy topic that we're hurting
our kids with computers, but there's no evidence that this is
the case."
Some experts and school officials say children are naturally
resilient, and the fact that they're not shackled to the keyboard
for hours at a time makes damage even less likely.
"We kind of learned early on that if you're at a computer three,
four hours a day, ergonomics is pretty important. If you're a
kid being cycled in and out [of the computer lab], it's not really
an issue," says Doug Hamilton, manager of instructional technology
at the 21,000-student Evergreen School District in Vancouver,
Wash.
But even if children aren't damaged by their current computer
use, most people acknowledge the long-term importance of helping
kids develop safe work habits and using adjustable furniture that
can protect both students and staff members. And doing the right
thing doesn't have to be expensive, Jacobs says. If districts
can't afford adjustable chairs, students can put their feet on
a crate or knapsack to keep them from dangling. A rolled towel
or jacket can provide back support.
"I save Yellow Pages," Jacobs says. "They're the best for boosting
people up and raising monitors. You do the best you can."
Just as important as using the proper equipment is training
students and staff to sit correctly, to type properly, and to
take frequent rest breaks. "All it is, is just coming up with
a simple checklist and explaining to students why you do these
things when you use a computer," Bleeker says. "That's not going
to cost a lot."
Advice on what to teach is as close as your nearest computer.
The American Occupational Therapy Association web site offers
tips -- and a screen saver -- on proper posture and exercises
to reduce repetitive-stress injuries, and the Global Schoolhouse,
a nonprofit Internet educational organization, has teamed with
Jazzercise to offer
free ergonomics software for students.
Experts stress the importance of developing healthy habits as
early as possible but point out that repetitive-stress injuries
and other medical problems don't develop overnight. "Kids are
tremendously resilient," says Ankrum. "What's going to happen
will occur over a period of years. Something that might take you
or me a year or two to develop might take them five years to develop."
Which raises the question of whether ergonomic lawsuits might
be on the horizon.
Potential liability
Anyone who's watched school case law develop over the past generation
knows that any issue can wind up in court, but observers say the
increasing use of home computers would make it difficult to prove
liability for injuries suffered in the classroom. More and more
young students are coming to school with bad computer habits they've
picked up at home -- which means that plaintiffs will be "hard-pressed"
to prove that the injury resulted from computer use at school,
Eastwood says.
The same is apparently true for teachers. "As far as workers'
compensation is concerned, it's difficult for teachers to get
compensated for exposures they have at school. It would take some
fight to get this recognized as work-related," says Darryl Alexander,
an American Federation of Teachers (AFT) occupational health expert.
"I think the risk is out there, but I don't think people see it
now."
That could change if new federal regulations on workplace ergonomics
go into effect as planned.
Meanwhile, many districts are finding ways to alleviate ergonomic
problems. In Vancouver, Doug Hamilton says his district has dealt
with complaints about repetitive-stress injuries by giving employees
the equipment they need to work comfortably and by changing work
assignments if necessary.
"It's not a black-and-white issue," Hamilton says. "What works
for one person may not be what works for the person right next
to him or her using the same equipment."
And liability for student injuries? "Certainly, it's something
we need to be sensitive to, but I don't see that as an urgent
need," Hamilton says, adding that most schools see students tripping
over electrical cords as a bigger liability issue than anything
involving ergonomics.
Because computer-related injuries can occur both at home and
in class, parents and schools share responsibility for instilling
proper computer habits. But convincing people of the dangers posed
by prolonged computer use is "going to take a very huge culture
change and a lot of research to show administrators and parents,"
says AFT's Alexander.
Still, the biological fact remains that "the human form is not
meant to sit in one place for hours at a time," Alexander says.
"It would be great if that awareness were instilled in children
at a very young age. You don't want a bunch of disabled students
in college."
Julie Rasicot is a Silver Spring, Md., writer.
SOLUTIONS AND SOURCES
Ergonomics should be a consideration for students as well as
for adults. "If you take the basic principles and apply them to
a child, you have the same concerns," says Vicki Napper, director
of technology and teacher education at Weber State University
in Ogden, Utah.
In an office, workstations can be adjusted for each user. But
in a school, several students may use one computer. "Schools should
be very concerned with adjustability of the monitor and of the
chair," says Napper. "A child's head is proportionally larger,
and therefore heavier, than an adult's. Staring up at a computer
monitor strains a child's neck muscles. Placing the computer monitor
on top of the CPU case causes those muscles excess strain and
should be avoided."
Another issue is chair height. "The chairs used in many classrooms
aren't geared toward computer use," says Napper. A child should
look straight ahead or down at a 45-degree angle. Ideally, a fully
adjustable chair should be used, but if that's not in the budget,
Napper recommends that children sit on a piece of thick foam rubber.
Another option for students whose feet don't touch the floor is
an adjustable footstool. Other considerations:
* Monitor distance. Depending on the student's size, putting
the monitor 26" to 40" causes the least eyestrain.
* Mouse. Most mice are too large for students' hands. Schools
should have a variety of mice available so students can choose
the most comfortable.
* Keyboard. Distance between keys and touch-pressure are concerns
for smaller hands. Students should depress the keys lightly, which
helps eliminate stresses on the fingers. Napper recommends portable
keyboards, which tend to be smaller.
When possible, Napper suggests, students should work standing,
which keeps their feet on the floor, allows them to look down
at the monitor, and keeps their bodies moving, thus helping to
avoid repetitive stress injuries. Young students should not use
the computer for longer than half an hour at once, she says, and
older students should take a break every half-hour.
Selected product sources
* Grammer offers
a chair designed especially for children. The seat and back are
adjustable, and a locking brake keeps the chair from toppling
over.
* Kensington Technology
Group offers several ergonomic mice. For the youngest students,
the Microsoft Easy Ball
offers a stationary mousing solution.
* Air Technology Corporation
carries several adjustable footstools.
* Cyberstretch, by
Jazzercise, is a software program offering stretch breaks in a
screensaver format. A giveaway is currently available to schools.
-- Jessica Rommel, Director of Corporate Communications,
Nova Solutions.
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