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In the computer laboratories of the Science Center, where I write most of my papers and often check my e-mail, the click-click of chattering keyboards can fill the air late into the night as students hammer away on term papers, thesis chapters, and electronic missives. The buzz used to seem charming, or at least motivational, as words flew from fingertips onto computer screens. But lately, the pain of thinking up a cogent argument has been supplemented by raw physical pain, and typing seems more a hazard than a tool.
Sometimes dubbed the "epidemic of the '90s," but often little understood, repetitive strain injury (RSI) has prevented students from taking notes and writing papers and has nearly paralyzed entire departments and labs. A broad syndrome rather than a specific diagnosis, RSI includes conditions ranging from hand and wrist tendinitis to the more serious carpal tunnel syndrome--a disorder, sometimes requiring surgery, with which RSI often is confused.
RSI is caused by prolonged repetitive, stressful, or awkward hand movements, combined with poor posture or bad ergonomic habits. In the work force it has affected people ranging from seamstresses to journalists. Among students, RSI is most frequently associated with excessive and continuous keyboard and mouse use. It has become the bane of departments such as computer science and physics, where students must spend intense sessions in front of a computer. The discomfort associated with RSI varies as much as the range of conditions it comprises. Initial symptoms include pain or weakness in the hands, numbness or tingling in the extremities, and cold or hypersensitive joints. In its full-blown stages, RSI can lead to near-total loss of control and coordination in the hands and extreme pain in the wrists, forearms, shoulders, and back, even while at rest.
At Harvard, the numbers indicate that RSI is becoming much more prevalent. In the fall of 1991, one undergraduate, an accomplished pianist, requested assistance from the Student Disability Resource Center because of RSI. By the fall of 1997, a total of 80 students with RSI were registered (nearly a third of all students served by the center), requiring help that ranged from specially administered exams to help getting books off library shelves. "Most of the students we meet with RSI get it after they come to Harvard," says Louise H. Russell, the director of the center. "While some secondary schools have a lot of pressure associated with them, I don't think it's anything compared to Harvard, where the pressure to generate written work is enormous."
Besides making academic arrangements for students with RSI, the center also pays scribes to help with homework in the sciences, math, and foreign languages, where assignments must often be written out. The University also offers technical resources for students with RSI. At Lamont Library and at the Adaptive Technology Lab in the Science Center, computers are equipped with voice-recognition software that enables the user to dictate text--which the machine transcribes with varying degrees of accuracy.
The availability of new technologies doesn't address the biggest problem--lack of awareness--says Joshua Goodman '92, a Ph.D. candidate in computer science who first developed RSI as a senior during marathon programming sessions. Because the initial symptoms went away, Goodman continued to type intensively in graduate school, until a summer job in Japan made him aware that his condition was grave. "One day drinking a can of Coke was enough to put me in real pain," he recalls. "I said, 'Oops, I've gone too far.' So I quit work, which is a tough thing to do in Japan."
Goodman is vice president of the RSI Action Group, founded two years ago by students at the Graduate School of Arts and Sciences. The group has started a popular website ("http://www.eecs.harvard.edu/rsi") offering information on how to prevent RSI, and has arranged for mouse pads to be placed throughout the Science Center describing RSI and the "prayer stretch," which is intended to relieve hand strain. The group has expanded from an initial membership of 10 to 15 students to about 100, drawn from all the University's schools.
But in a high-pressure environment, even students who are in pain may be reluctant to seek help. "Students who are very ambitious often think of themselves as bulletproof," says Louise Russell. "You keep plugging away and you ignore the signs. The devastation that students face when they are basically ordered by a physician to stop using their hands is pretty serious." Goodman says the RSI Action Group provides emotional support to RSI sufferers. "It's not that infrequent for people to cry while they're talking to me," he says.
The painful lessons of hindsight have hit home in my last year at Harvard. Shortly before Thanksgiving, I began experiencing soreness and tingling in my hands following weeks of mid-terms, papers, and editing sessions at the Harvard Crimson. Since then, the frenzied work pace that has characterized much of my time here has been altered in important ways. Because writing for long stretches is even more painful for me than typing, I have stopped taking notes in my classes, and started relying on copies of lectures. Twenty kind friends helped me transcribe more than 200 pages of interview notes for my senior thesis in social studies, and the committee was compassionate enough to grant me a three-week extension of the thesis deadline. I've spent countless hours at the Science Center with a software package called Dragon Dictate, slowly speaking into a microphone and spelling out proper names and uncommon words using military-style codes ("alpha, bravo, charlie, delta, echo..."). I've asked friends to check e-mail, lift heavy items, and even carry library books for me.
The adjustments have not gone without a hitch. Getting a physical-therapy appointment at University Health Services sometimes entails a four-week wait. During a specially administered final last semester, the laptop I was using to type a Shakespeare essay crashed three times, and a technician had to remove the computer to retrieve my final from the hard disk while I completed the exam on another computer.
Other students with RSI describe similar challenges to their hectic lifestyles. Rachel Podolsky '00, a computer-science concentrator, is taking only three classes this term, because doing work through dictation "probably takes about twice as long" as it did previously. She developed RSI in December while taking an introductory computer-science course. "I never thought this would happen to me, and I was never warned at all," she says. "I didn't believe something like an intro class could damage you that much physically." Unfortunately, hours of talking to her computer have given Podolsky another health problem: soreness and swelling in her throat and jaw. In the future, she hopes to balance dictation with limited keyboard use to get her work done.
Charlene Ahn '98, a physics concentrator whose hands started hurting in February 1997, has been forced to resign as a violinist with the Harvard-Radcliffe Orchestra and also to stop singing with Collegium Musicum because of the increased strain on her voice from dictation. She's witnessed first-hand the prevalence of RSI on campus: two of her three roommates last summer also experienced hand and wrist pain. "You're used to your body working, especially when you're 20," she says. "I'm the sort of person who hates asking for help, and I've had to learn to do a lot of that over the past year. I've had to learn what was important to me. When I was a freshman I would have said that playing violin and being in a super-awesome orchestra like HRO was extremely important to me, and of course it still is, but I learned that it couldn't be that important to me."
RSI was so painful for Joshua McDermott '98 that he was compelled to take last fall semester off. McDermott, who developed RSI in March 1997, works at a brain and cognitive science lab at MIT, where he estimates that 80 percent of the staff has RSI. Leisure activities, like weightlifting, playing the guitar, and basketball, have been curtailed. "My productivity is probably like 30 percent of what it used to be, but I work a lot, so I'm able to get by," says McDermott, a special concentrator in brain and cognitive sciences. "The voice recognition is great for dictating texts. For writing papers, I think I'm almost as fast as I was typing. It's mainly just programming that is tedious and takes forever."
Critics of the University caution that bad habits acquired at Harvard may lead to long-term RSI problems. Rab Cross '68, an occupational-health physician, says the standard furniture in Harvard undergraduate rooms does not meet ergonomic health standards: old-fashioned wooden chairs do not accommodate students of different heights, and the keyboard trays on dorm-room desks often force students to contort their wrists and fingers. "These injuries are all cumulative trauma disorders," Cross says. "It may well be that some of the initial injuries begin in the undergraduate area and that by the time somebody gets out and works for a company for a few years, lo and behold, you have a genuine problem that may have started back in school."
Nancy Curtin, Harvard's manager of industrial hygiene, says the University will do individual work-station evaluations, consultations, and training sessions for staff and students on request, although she acknowledges that many students may not be aware of the available resources. Harvard, she says, is gradually acquiring better designed workstations as its offices and buildings are renovated. The Office of Environmental Health and Safety is working on distributing information about RSI in student orientation packages, and is developing a website with links to RSI resources. "We are certainly trying to do more outreach," Curtin says. Still, students bear the burden of buying adjustable chairs or computer tables, although Louise Russell notes that FAS does respond to individual requests for adjustable furniture.
The demands of the student lifestyle may pose the greatest threat of RSI. Joshua Goodman, who intends to refine speech-recognition technology after receiving his doctorate, recalls that when he was an undergraduate in the early 1990s, e-mail was used by only a few students and "you were a geek if you were checking it every day." At a time when the temptations of the Internet and of instant communication collide with the daily academic demands of problem sets and term papers, the spread of RSI may force us to critically examine how we, and our hands, spend their time.
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