Erik Peper, Ph.D. and Katherine H. Gibney

Institute for Holistic Healing Studies
San Francisco State University

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"Numbness, pain and/or tingling in [my] right arm/elbow after prolonged use of mouse."

"Fatigue, dryness, lessened ability to see far-away objects when I spend more than 3 hours on the computer."

"My neck and shoulders become tense from typing and working the mouse."

"Get tired from typing, feeling of pain in [my] hands".

"I have a neck pain that continues the next day if I work for many hours."

student comments

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Prof. Erik Peper is one of the highly respected advisor of the Backshop formula and teaches Dutch and International Physicians how to add EMG in their therapy to reduce Computer and other Work Related injuries.

Computer use among students has increased dramatically in the last few years. Many universities now require a computer and computer literacy for enrollment. When questioned about computer use most students report discomfort such as dry eyes, neck and shoulder tightness, back pain and exhaustion. Students describe similar symptoms as those reported by employees using computers. These symptoms associated with computing are labeled repetitive motion injury (RMI). The frequency and distribution of symptoms among college students, or how these may relate to factors such as the number of hours worked, are not known. This survey investigates the discomfort associated with computer use.

Method:

A two-page symptom questionnaire was filled out by 95 students (23 males, 71 females, and 1 not identified; mean age 25.5, S.D 6.33, range 19-55) enrolled in upper division classes at San Francisco State University. Included were questions about: 1) the subjects (age, sex, height and weight); 2) computer usage (number of hours, percentage of mouse use); 3) a linear self-rating scale indicating the level of discomfort during and after computer use (0=none to 9=extreme) and a description of the subjective experience of discomfort in each body area (eyes, head, neck and shoulders, arms, wrists and hand

s, back, legs, tiredness and other); and 4) strategies used to prevent computer related discomfort and ergonomic work setting.

Results:

92 out of 95 subjects (96.8 %) reported some discomfort while only 3 subjects reported no discomfort. The responses on the self-rating discomfort scale (0=none to 9=extreme) for each body location were grouped into three categories according to the responses: low (1,2,3), medium (4,5,6) and high (7,8,9) (see Figure 1).

Fig 1. Distribution of discomfort for different body areas. Categories high, medium, low are derived from the responses on the self-rating discomfort scale (0=none to 9=extreme).

Table 1. Frequency of remediation practices reported by 77 out of 95 students while working at working at the computer. Many reported more than one practice.

Only 14 subjects (15 %) reported using special ergonomic equipment. The use of ergonomic adaptations correlated 0.37 with the hours worked. There were no significant differences in male and female responses for computer and mouse use, age, sex, hours worked at the computer, percentage of mouse use, and reports of discomfort as shown in table 2 (click to view).

Table 2. Correlation between responses on computer discomfort questionnaire.

Discussion:

Discomfort during and after computing among college students appears remarkably high for the short amount of time they work at the computer. Almost every student reported discomfort--only 3 reported none. When responses of the discomfort intensity are grouped into thirds (low, medium or high), more than 44 % of the respondents reported a high intensity of neck and shoulder discomfort. The major correlation in the survey is between the symptom areas (e.g., neck and shoulder discomfort is correlated with back discomfort).

Discomfort occurred despite the fact that 81% of the respondents reported doing something to feel better. Many reported doing interventions which are universally recommended (e.g., breaks, stretching or posture changes); none reported doing a system’s approach for prevention nor taking frequent micro-breaks (every 30-60 seconds). Consequently, they continued to work at the computer with covert increased sympathetic arousal and low level muscle tension (Peper et al, 1994; Peper, Harvey and Shumay, 1997).

We speculate that students did something only after experiencing discomfort. At that point they were attempting to remediate pain rather than prevent it. Hence, they did not change their work style patterns which contributed to the etiology of discomfort. When people work they are usually focused on the task and unaware of increased sympathetic arousal as indicated by low level muscle tension, increased breathing rate, and decreased peripheral temperature (Schleifer and Ley, 1994; Peper, 1994). This postulated lack of awareness matches the observations that, when keyboard placement was altered, there was no significant correlation between muscle tension and subjective awareness of muscle tension (Shumay, Peper and Tibbetts, 1995). Similarly, interpreters for the deaf were usually unaware of the drastic increase in respiration rate and decrease in peripheral hand temperature during interpreting (Peper et al, 1997).

The non-significant correlation between hours of computer use and discomfort reinforces the hypothesis that the etiology of computer related disorders (repetitive motion injury) is multi-causal. Factors such as ergonomics, somatic awareness, strength and flexibility, stress and work style contribute to discomfort. The majority of the respondents reported that their computer work setting lacked optimum ergonomics. Many worked under extreme time pressure to finish papers. Hence, working even a short time at the computer, especially if one is under stress, increases the risk of discomfort.

This disturbing high incidence of discomfort, despite students’s reports of interventions, suggests that they need to actively participate in prevention programs to maintain health. They should be taught similar skills as are taught to individuals in the workforce to prevent RMI while working at the computer. When such employees are trained in an active prevention program, such as the Healthy Computing Program at San Francisco State University, their symptoms are significantly reduced. This six session training program includes biofeedback, somatic awareness, work-style, stress management, strengthening, and ergonomics. Symptoms remain low a year later as measured by a telephone interview (Shumay and Peper, 1997). Similarly, when employees receive weekly Healthy Computing Email TipsÔ as part of the Healthy Computing Program they report a reduction of symptoms (Peper and Gibney, 1997).

This survey data suggests that students should shift from remediation to prevention. Most important is learning awareness and work style skills that actually prevent discomfort from occurring. Learning how to stay healthy at the computer should be the first step when they are introduced to computers. This training should be an integral part of every computer class -- from grade school to university. Armed with this training, students can enter the work force with the skills to prevent computer related injuries, and avoid the painful consequences of developing RMI.

References:

Peper, E. , Gibney, K.H., Giere, L. and Keller, L. (1997). Proceedings of the 1997 meeting of the International Society for the Advancement for Respiratory Psychophysiology. Falmouth, MA.

Peper, E., Harvey, R., and Shumay, D. (1997). How to use applied psychophysiology/biofeedback in the prevention and assessment of upper extremity musculoskeletal disorders. In: Salvendy, G., Smith, M. J. and Koubek, R.J. (eds). Design of Computing Systems: Cognitive Considerations. New York: Elsevier, 551-554.

Peper, E., Wilson, V.S., Taylor, W., Pierce, A., Bender, K., & Tibbetts, V. (1994). Repetitive Strain Injury. Prevent computer user injury with biofeedback: Assessment and training protocol. Physical Therapy Products. 5(5), 17-22.

Schleifer, L. M. & Ley, R. (1994). End-tidal PCO₂ as an index of psychophysiological activity during VDT data-entry work and relaxation. Ergonomics. 37 (2), 245-254.

Shumay, D. and Peper, E. (1997). Healthy Computing: A comprehensive group training approach using biofeedback. In: Salvendy, G., Smith, M. J. and Koubek, R.J. (eds). Design of Computing Systems: Cognitive Considerations. New York: Elsevier, 555-558.

Shumay, D.M., Peper, E., & Tibbetts, V. (1995). Lack of muscle awareness at the workstation: Implications for repetitive strain injury. Fifth International Conference on Stress Management Book of Abstracts. Noordwijkerhout, The Netherlands, 128.