Computers and Health
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Within the past two years, substantial media
attention has been directed at potential adverse health effects of long-term
computer use. Renewed concerns about radiation, combined with reports of
newly-recognized "repetitive stress injuries" such as carpal tunnel
syndrome, have led some to call for regulation in the workplace and others to rearrange
their offices and computer labs. There is little evidence that computer use is
on the decline, however. On the contrary, more people are spending more time
doing more tasks with computers -- and faculty, students and staff at colleges
and universities have some of the most computer-intensive work styles in the
If, as is widely suspected, health effects
are cumulative, then many of us are at risk in our offices, labs, dormitories,
and homes. Unfortunately, many years will be required before epidemiological
studies can provide definitive guidelines for computer users, managers,
furniture suppliers, and office designers. In the interim, individuals and
institutions must educate themselves about these issues and protective
One set of issues concerns workstation
design, setup, and illumination, together with users' work habits. The City of
San Francisco, which recently enacted worker safety legislation, cited research
by the National Institute of Occupational Safety and Health (NIOSH) into VDT
operator complaints of eyestrain, headaches, general malaise, and other visual
and musculoskeletal problems as the rationale for imposing workplace standards,
to be phased in over the next four years.
A second set of issues relates to suspected
radiation hazards, including miscarriage and cancer. A special concern with
radiation is that nearby colleagues could be affected as well, since radiation
is emitted from the backs and sides of some terminals. The most recent NIOSH
study is reassuring, but some caution still seems prudent.
Ergonomics and work habits
Most people can ride any bicycle on flat
ground for a short distance with no problems. On a fifty mile ride over hilly
terrain, however, minor adjustments in seat height, handlebar angle, and the
like can mean the difference between top performance and severe pain. Similarly,
occasional computer users may notice no ill effects from poorly designed or
badly adjusted workstations, whereas those who spend several hours a day for
many years should pay careful attention to ergonomics, the study of man-machine interfaces.
The key to most workstation comfort
guidelines is adjustability--to accommodate different body dimensions, personal
workstyle preferences, and the need to change positions to avoid fatigue. A
recommended working posture shows the body directly facing the keyboard and
terminal, back straight, feet flat on the floor, eyes aligned at or slightly
below the top of the screen, and thighs, forearms, wrists, and hands roughly
parallel to the floor. Achieving this posture may require:
A chair with a seat pan that adjusts both
vertically and fore-and-aft, an adjustable height backrest, and adjustable
An adjustable height work surface or
separate keyboard/mouse tray (note that many keyboard trays are too narrow to
accommodate a mouse pad, leaving the mouse at an awkward height or reach on the
A height adjustment for the video display
(a good use for those manuals you'll never read!)
An adjustable document holder to minimize
head movement and eyestrain
Adjustable foot rests, arms rests, and/or
Studies show that many people are unaware
of the range of adjustments possible in their chairs and workstations. Although
the best chairs permit adjustment while seated, you may have to turn the chair
upside down to read the instructions. (Be careful not to strain your back while
upending and righting the chair!) If your posture deviates substantially from
that in the diagram--or if you are experiencing discomfort--experiment with
adjustments or try exchanging chairs or workstations with colleagues. A posture cushion, which
maintains the natural curvature of the spine and pelvis while supporting the
lumbar region, may also prove helpful. It should be noted that any adjustment
may feel uncomfortable for a week or so while your body readjusts itself.
(Some people have been advised by their
physicians to use a backless "Balans" chair, which minimizes
compression of the spine and shifts the body weight forward with the aid of a
shin rest. This posture may be uncomfortable, however, since it requires
stronger abdominal and leg muscles than conventional sitting positions. The
Balans chair is not recommended for overweight or exceptionally tall persons)
Light and glare
Eyestrain, headaches, and impaired vision
are often a product of improper illumination resulting in glare, which is light
within the field of vision that is brighter than other objects to which the
eyes are adapted. Both direct glare from sunlight and lighting fixtures
directed at the user's eyes and indirect glare due to reflections from video screens or glossy surfaces are common
problems for VDT users.
Many offices are too bright for computer
use, which may be a carryover from the days when paperwork required such
brightness or the result of many office workers' preferences for sunlight and
open windows. A NIOSH study recommends 200-500 lux for general office work;
other sources suggest 500-700 lux for light characters on dark monitors and
somewhat more for dark-on-light. If documents are not sufficiently illuminated,
desk lights are recommended in preference to ceiling lights, which increase reflections from video screens. Reducing
overhead lighting could also result in substantial energy savings.
VDT workstation placement is also
important. Terminal screens should be positioned at right angles to windows, so
sunlight is neither directly behind the monitor nor behind the operator, where
it will reflect off the screen. If this is infeasible, blinds or drapes should
be installed. Screens should also be positioned between rows of overhead
fixtures, which can be fitted with baffles or parabolic louvers to project
light downward rather than horizontally into the eyes or terminal screens.
Some users have found filters placed in
front of the screen to be effective in reducing reflections, however some
dimming or blurring of the display may result. Experts 1advise trial and error,
since the best solution appears to depend upon specific conditions and user
preferences. Finally, if you wear glasses or contact lenses, be sure
your physician is aware of the amount of terminal work you do; special lenses
are sometimes necessary. Bifocals, in particular, are not recommended for
extensive terminal work, since the unnatural neck position compresses the
Breaks and exercises
Working in the same position for too long causes tension
buildup and is thought to increase the risk of repetitive motion injuries, such
as carpal tunnel syndrome. Remedies include changing postures frequently,
performing other work interspersed with computing (some studies recommend a
10-15 minute break from the keyboard every hour), and doing exercises such as
tightening and releasing fists and rotating arms and hands to increase
circulation. Be aware, also, that the extra stress created by deadline pressure
exacerbates the effects of long hours at the computer.
For at least a decade, concerns have been raised about
possible effects of radiation from video display terminals, including cancer
and miscarriages. Earlier fears about ionizing radiation, such as X rays, have been laid to rest, since these rays are blocked by
modern glass screens. Also well below exposure standards are ultraviolet,
infrared, and ultrasound radiation.
More recent controversy surrounds very low frequency (VLF)
and extremely low frequency (ELF) electromagnetic radiation produced by video
displays' horizontal and vertical deflection circuits, respectively.
Researchers have reported a number of ways that electromagnetic fields can
affect biological functions, including changes in hormone levels, alterations
in binding of ions to cell membranes, and modification of biochemical processes inside the cell. It is not clear,
however, whether these biological effects translate into health effects.
Several epidemiological studies have found a correlation
between VDT use and adverse pregnancy outcomes, whereas other studies found no
effect. The most recent analysis, published this year by NIOSH, found no
increased risk of spontaneous abortions associated with VDT use and exposure to
electromagnetic fields in a survey of 2,430 telephone operators. This study,
which measured actual electromagnetic field strength rather than relying on
retrospective estimates, seems the most trustworthy to date. The authors note,
however, that they surveyed only women between 18 and 33 years of age and did
not address physical or psychological stress factors.
A 1990 Macworld article by noted industry critic, Paul
Brodeur, proposed that users maintain the following distances to minimize VLF
and ELF exposure:
28 inches or more from the video screen
48 inches or more from the sides and backs of any VDTs.
Although these guidelines seem overly cautious, a
fundamental principle is that magnetic field strength diminishes rapidly with
distance. Users could, for example, select fonts with larger point sizes to
permit working farther from the screen. Remember that magnetic fields penetrate
Over-reaction to ELF and VLF radiation can also compromise
ergonomics. In a campus computer lab, for example, all displays and keyboards
were angled thirty degrees from the front of desktops to reduce the radiation
exposure of students behind the machines. The risks of poor working posture in
this case appear to be greater than the radiation risks.
A final form of radiation, static electric, can cause
discomfort by bombarding the user with ions that attract dust particles,
leading to eye and skin irritations. Anti-static pads, increasing humidity, and
grounded glare screens are effective remedies for these symptoms.
A continuing process
Massive computerization of offices, laboratories,
dormitories, and homes represents a fundamental change in the way many of us
work and communicate. It would be surprising if there were no adverse effects
from such profound changes. It would also be surprising if all policy debates
were based on sound scientific evidence, rather than parochial politics and
media exposes. But, as University of Pennsylvania bioengineering professor
Kenneth Foster has written, "One difficulty is that 'safety,' if
considered to be the absence of increased risk, can never be demonstrated. A
hazard can be shown to exist; absence of hazard cannot."
To monitor research and develop institutional guidelines,
the University of Pennsylvania has created a Task Force on Computing in the
Workplace, with representatives from the Offices of Environmental Health and
Safety, Fire and Occupational Safety, Information Systems and Computing,
Radiation Safety, Purchasing, University Life as well as staff and faculty from
the Wharton School and Schools of Engineering, Medicine and Nursing. Interested
readers are welcome to contact the authors for information on the Task Force
and its work.
Until more conclusive research becomes available,
individuals, departments, and institutions will have to weigh the evidence and
make their own decisions about protective measures to minimize the risks of
computing. And, in our opinion, the information technology managers and their
vendor partners who provided the leadership to computerize our campuses, now
owe it to their colleagues to work with epidemiology and ergonomics experts to
create computer-intensive environments that are both productive and healthful.
Avoiding carpal tunnel syndrome: A guide for computer
Carpal tunnel syndrome (CTS) is a painful, debilitating
condition. It involves the median nerve and the flexor tendons that extend from
the forearm into the hand through a "tunnel" made up of the wrist
bones, or carpals, and the transverse carpal ligament. As you move your hand
and fingers, the flexor tendons rub against the sides of the tunnel. This
rubbing can cause irritation of the tendons, causing them to swell. When the
tendons swell they apply pressure to the median nerve. The result can be
tingling, numbness, and eventually debilitating pain.
CTS affects workers in many fields. It is common among
draftsmen, meatcutters, secretaries, musicians, assembly-line workers, computer
users, automotive repair workers, and many others. CTS can be treated with
steroids, anti-inflammatories, or physical therapy, or with surgery to loosen
the transverse carpal ligament. Recovery of wrist and hand function is often,
but not always, complete.
Like many skeletomuscular disorders, CTS has a variety of
causes. It is most often the result of a combination of factors. Among these
Genetic predisposition. Certain people are more likely than
others to get CTS. The amount of natural lubrication of the flexor tendons
varies from person to person. The less lubrication, the more likely is CTS. One
study has related the cross-sectional shape of the wrist, and the associated
geometry of the carpal tunnel, to CTS. Certain tunnel geometries are more
susceptible to tendon irritation.
Health and lifestyle. People with diabetes, gout, and
rheumatoid arthritis are more prone than others to develop CTS, as are those
experiencing the hormonal changes related to pregnancy, menopause, and the use
of birth control pills. Job stress has also been linked to an increased
likelihood of CTS. And CTS seems to be more frequent among alcoholics.
Repetitive motion. The most common cause of CTS that's been
attributed to the workplace is repetitive motion. When you flex your hand or
fingers the flexor tendons rub against the walls of the carpal tunnel. If you
allow your hand time to recover, this rubbing is not likely to lead to irritation.
The amount of recovery time you need varies from fractions of a second to
minutes, depending on many circumstances, including the genetic and health
factors mentioned above, as well as the intensity of the flexing, the weight of
any objects in your hand, and the extent to which you bend your wrist during
Trauma. A blow to the wrist or forearm can make the tendons
swell and cause or encourage the onset of CTS.
Computer keyboard users can take several steps to lower
their chances of developing CTS. Some of these center around the configuration
of the workplace, or "ergonomics." Others have to do with human
Ergonomics. Proper seating is crucial to good ergonomics.
The height of your seat and the position of your backrest should be adjustable.
The chair should be on wheels so you can move it easily. Arm rests on the
chair, though optional, are often helpful.
Table height. To adjust the chair properly, look first at
the height of the table or desk surface on which your keyboard rests. On the
average, a height of 27-29 inches above the floor is recommended. Taller people
will prefer slightly higher tables than do shorter people. If you can adjust
your table, set your waist angle at 90 degree, then adjust your table so that your
elbow makes a 90 degree angle when your hands are on the keyboard.
Wrist angle. If your keyboard is positioned properly your
wrists should be able to rest comfortably on the table in front of it. Some
keyboards are so "thick" that they require you to bend your hands
uncomfortably upward to reach the keys. If so, it will help to place a raised
wrist rest on the table in front of the keyboard. A keyboard that requires you
to bend your wrists is a common cause of CTS among computer users.
Elbow angle. With your hands resting comfortably at the
keyboard and your upper arms vertical, measure the angle between your forearm
and your upper arm (the elbow angle). If it is less than 90 degree, raise the
seat of your chair. If the angle is greater than 90 degree, lower the seat. Try
to hold your elbows close to your sides to help minimize "ulnar
displacement" - the sideways bending of the wrist (as when reaching for
the "Z" key).
Waist angle. With your elbow angle at 90 degree, measure the
angle between your upper legs and your spine (the waist angle). This too should
be about 90 degree. If it is less than 90 degree, your chair may be too low
(and your knees too high). Otherwise, you may need to alter the position of the
backrest or adjust your own posture (nothing provides better support than
sitting up straight). (Note: If making your waist angle 90 degree changes your
elbow angle, you may need to readjust the height of your chair or table.)
Feet. With your elbows and waist at 90 degree angles, your
feet should rest comfortably flat on the floor. If they don't, adjust your
chair and table height and repeat the steps above. If your table isn't
adjustable and your feet don't comfortably reach the floor, a raised footrest can help. Otherwise, you
may need a different table.
You need very little recovery time between keystrokes to
cool and lubricate the flexor tendons. If you type constantly, however, the
need for recovery builds. Further, working with your hands bent upward at the
wrists or frequently bending your wrists sideways heightens the friction within
the carpal tunnel. It takes longer to recover from these motions. Working under
stress (deadline pressure, anger, or other anxiety) can make matters even
Many studies recommend a 10-15 minute break each hour to
give yourself the recovery time you need. This needn't be a break from
productive activities - just a break from your keyboard. Exercises can help,
too. Try the following:
a) Make tight fists, hold for one second, then stretch your
fingers out wide and hold for five seconds. Repeat several times.
b) With arms outstretched in front of you, raise and lower
your hands several times. Rotate your hands ten times (make circles in the air
with the fingertips).
Variety is the key. CTS occurs most frequently in workers
whose motions are not only repetitious but are kept up for hours at a time. If
you use a keyboard, structure your workdays to include a mix of activities each
hour. For example, instead of typing all morning and filing all afternoon, mix
typing and filing throughout the day.
The most painful cases of CTS are those that have gone
undetected or untreated over a long time. CTS can be caught easily in its early
stages, however, and much of the pain and all of the disability avoided.
Early symptoms include a tingling in the fingers, often
beginning several hours after work activity has stopped. Because of this delay
in the appearance of symptoms, many CTS sufferers don't make the connection
between their work activities and the pain they feel until it's too late. The
tingling can lead, over time, to stiffness and numbness in the fingers and
hand, and then to severe wrist and hand pain.
For many individuals the early symptoms of CTS go unnoticed.
Employers and co-workers can help one another identify the onset of CTS by
watching for and pointing out any unconscious shaking of the hands, rubbing of
the wrists, or unusual postures or hand positions at the keyboard.
At the first sign of CTS, you should be examined by a doctor
who specializes in hand and wrist disorders. The doctor can perform a number of
simple tests to detect CTS, and can prescribe specific steps for avoiding the
Carpal tunnel syndrome is common among computer keyboard users.
It can strike anyone, and its consequences are serious. Awareness of the
problem and its causes is crucial to preventing CTS. With proper ergonomics and
attention to the work routine you can prevent CTS; with early detection and
treatment it need never become debilitating. The employer's attention to stress
levels, proper ergonomics, and the early warning signs of CTS are important in
keeping the ailment at bay in the workplace.
We hear a lot about hazards associated with working with
computers, and learn from experience that long hours at the keyboard can bring
on eyestrain and various aches and pains. These concerns, and the steps we can
take to make computer work safer and more comfortable are the subject of many books and
The good news is that problems can be avoided through
well-designed offices, properly set-up workstations, and sensible work habits.
Checklists and guidelines for setting up and using computers abound. The bad
news: there is substantial variation in opinion as to what constitutes proper
workstation set-up, quick and easy solutions to ergonomic problems are not
always possible, and checklists don't capture the complexities of the possible
combinations of people, task, equipment, and workspace. Fortunately, there are
measures that really do work. A few quick and universally agreed upon
Use the minimum force necessary to press the keys.
Vary your tasks during the day to avoid sitting in one
position for several hours or performing the same hand motions without
Take periodic breaks.
Keep your wrists in a natural, unforced, straight position.
Bibliography of computer and health materials
Ross, Randy. "VDTs: Are They Safe?" PC/Computing .
March, 1989, pp. 146-7.
Sheehan, Mark. "Avoiding carpal tunnel syndrome: A
guide for computer keyboard users," University Computing Times (Indiana
University, Bloomington). July-August 1990, pp. 17-19.
Updegrove, Kimberly H., Daniel A. Updegrove. "Computers
and Health - Issues and Protective Measures." Penn Printout. February, 1991.
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