Techno kids

Strain from computers and video games are giving rise to an injured breed

by becky amos, terri cameron, jennifer mesko, denyse smith & kristen tuinstra

Photo illustration by Randy Yeip

Hand braces don’t stop Teresa Henderson’s pain, but they make it more bearable. Certain movements and repetitive motions cause shooting pains up and down her hands and wrists on a daily basis.

She doesn’t have arthritis. She doesn’t lift heavy objects for a living. The 24-year-old Michigan State University graduate student injured herself by typing on a computer keyboard for eight hours a day at work and for several hours later at home.

Last year, she was diagnosed with carpal tunnel syndrome. Caused by repetitive movement for long periods of time, carpal tunnel syndrome is a debilitating injury that causes numbness and sharp pains in the wrist and hands.

Another MSU student, 20-year-old education junior Marissa Lockhart, grew up playing the piano and typing homework on her computer. Now, she wears hand braces—but her hands still hurt all the time, “even when I’m not typing or using a computer,” Lockhart says.

But Lockhart fears that young people don’t understand that repetitive strain injuries aren’t something that just happens to older individuals.

“People think that I’m just making a big deal about nothing, that it’s not a real problem, or we must be making it up because we’re so young,” she says. “But if they could feel what I feel in my hands and wrists every day, they’d know it is very, very real.”

Experts have been watching this injured breed of computer users grow. MSU’s Olin Health Center says students complaining about hand and wrist pain has doubled in the last five years.

With nearly 70 percent of the country’s 30 million elementary school children using computers in school, some experts wonder about the kids’ futures. “We may be exposing a whole generation to the potential for early injury,” says Alan Hedge, a human ecology professor at Cornell University.

Although he says it could take up to 10 years before injuries start to show up, the big concern is that tomorrow’s workforce will start out with injuries if education doesn’t begin early. “Someone who starts using the computer at age 10 likely will become an injured person shortly after they enter the workforce. If we catch it now, then no one needs to get injured unnecessarily.”

Video Games Could Be Damaging Too

Kyle Bailey began playing video games when he was eight. When he was 14, the pain in his wrists began. Then he was diagnosed with juvenile rheumatoid arthritis, which affects 70,000 to 100,000 children in the United States. There is no known cause for juvenile rheumatoid arthritis.

Now 17, the six-foot high school junior’s video game-playing habits have changed. “I used to play every day,” the Rockford, Mich., native says. “It used to be hours on end, especially with role-playing games. I would play for six hours without stopping.”

Today, Kyle says he’s too busy to play every day, but when he does play, the pain in his hands and wrists increases. “A lot of times, my neck hurts. Sometimes, my wrists hurt.”

By February, Kyle could no longer fully extend his right arm so his doctor prescribed six to eight sessions of physical therapy, which teaches him how to exercise to strengthen his wrists and shoulders. Beyond that, there’s not a lot the doctor can do.

Could Kyle have arthritis because of his video-game playing habits? His doctor, Richard Martin, doesn’t know why Kyle has arthritis. Martin is a rhematologist at Spectrum Health in Grand Rapids, and an associate professor of medicine at Michigan State University.

“I would be careful about making conclusions before the research is done,” says Dr. Martin.

Kyle takes Azulfidine, an anti-inflammatory medication, six times a day and a painkiller. “If I didn’t take the pills, the pain would be constant. The pills keep it pretty much down.”

Even with the medication and physical therapy, Kyle’s hands sometimes go into shock and he loses his grip. “I can’t always shut my fists all the way,” he says.

Linda Bailey, Kyle’s mom, says Kyle used to play video games for four to six hours a day. “If I had to do it all over again, I would limit video games.”

Now, Kyle spends about two hours a day on the Internet at home and about an hour in front of the computer at school—and little time at the video game controls.

Kyle is not alone. A recent study reported by the BBC found that almost a third of teenagers play video games daily. Of those teenagers, seven percent play at least 30 hours a week. That leaves minimal time for homework, exercise and socializing with other teenagers.

Doctors Are Concerned

A recent Roper Youth Report said 8- to 17-year-olds are using the Internet for homework, chatting and surfing. Last year, a White House report on information technology research and development said that nearly half of all American households are now using the Internet—and more than 700 new households are being connected every hour.

According to the National Institute of Occupational Safety and Health, RSIs, also known as musculoskeletal disorders, typically don’t result from any instantaneous event, such as a slip, trip or fall, but reflect a more gradual or chronic development over time.

Some well-known RSIs are tendinitis, tennis elbow and carpal tunnel.

Many of these conditions occur in the arms, wrists, hands and shoulders and are the result of gradually progressing injuries. The American Academy of Orthopaedic Surgeons says 28.6 million Americans experience musculoskeletal injuries each year, although there’s no estimate on how many of them are younger than 18.

Among adults, the Occupational Safety and Health Administration in the U.S. Department of Labor claims RSIs are “the nation’s most common and costly occupational health problem…costing more than $20 billion a year in worker’s compensation.”

David Janda, an orthopedic surgeon and director of the Institute of Preventative Sports Medicine in Ann Arbor, says 20 to 30 percent of his patients are kids. Of those, 80 percent are seen for overuse injuries.

“We’re not creating couch potatoes anymore, but computer potatoes. The physical conditioning and the physical fitness of youths and teens is plummeting,” Janda says.
“One of the reasons is because they’re in front of the computer.”

So what longterm effects will playing video games and sitting in front of the computer have on kids?

Robert Markison, an associate clinical professor of surgery at the University of California’s San Francisco School of Medicine, says it will take 20 to 25 years before research shows the effects of computer-related injuries on kids.

“Even in adults, we haven’t had a long enough period of time for studies to be conducted,” he says.

But when it comes to kids, the potential impact of computer use and injury should be considered, with or without complete research results. “In a rush to plant a computer on every child’s desktop, potential risks to children’s physical health have gone largely unnoticed,” says MacWorld in a recent article.

Medical experts agree. “We have little hands doing a lot,” Markison says. “Children sitting down at adult-size keyboards” is one of them.

Are Schools Doing Their Part to Educate Kids on Ergonomics?

A handful of schools in the United States have made it their jobs to try to prevent kids from injuring themselves by educating them about overuse, and by making sure they have the proper equipment to prevent RSIs.

At Blackwell Elementary School in Lake Washington, Wash., students learn how to “Get Techfit” through a program that uses physical education class, library time and the regular curriculum to teach ergonomics and technology safety. The program was implemented in 1999 to help students from kindergarten through high school understand what ergonomics is and how it fits into the world of technology.

Diane Tien, a Blackwell teacher, designed a program to help students avoid overuse injuries caused by long hours in front of a computer keyboard or by playing hand-held games.

“We’re trying to develop a pro-active standpoint,” she says, adding that kids from kindergarten through 12th grade are taught how to prevent repetitive strain injuries.

“We introduced the program here because the children in our district had an increase in access to computers. I wanted to increase the students’ understanding of how to use this tool.

“Ergonomics injuries are latent for a long period of time,” she says. It usually takes between five and seven years before “something snaps” and a child is injured—perhaps permanently.

In the Lansing area, this type of program could not be found. Teachers at Okemos Public Schools explain hand-positioning on the computer keyboard and the importance of chair positioning in relation to the computer. “My goal for this year is to have one adaptive computer workstation in every lab,” says Don Tregloan, who teaches computer technology at Okemos Middle and High schools.

Michelle Jennings, a technology specialist at the Capital Area Career Center in Mason teaches her students the fundamentals of ergonomics at the beginning of the school year.

“We don’t follow proper ergonomics,” she acknowledges. “It’s not that I don’t want to, but the school district doesn’t have the money for ergonomically correct keyboards. We have proper chairs so students can adjust them to the right height, but most of them are broken.”

Technology Preventing and Causing RSI in Kids

Repetitive strain injury showed up in Maureen Clancy in 1993, when she was a reporter at the Democrat and Chronicle in Rochester, N.Y.

“It got so bad, I couldn’t hold my toothbrush,” Clancy says. The newspaper tried to accommodate her injury by purchasing a voice-activated computer, but in 1995, it filled her position with someone else.

Clancy now is working on her master’s degree in social work at the University of Albany in New York but says her injury and nerve damage are permanent.

Clancy says she believes that if she had been warned earlier about the risk of RSIs, she could have avoided injury. Now, her mission is to educate people who work with
children.

“It’s critical to the health of children to train them from the beginning, from the first time they touch a keyboard, how to use a computer safely,” she says.

Most adults couldn’t care less, she adds, until they suffer from RSI themselves. But by then, it’s too late. “As a kid, you’re not paying attention to pain, and it’s hard to tell in kids—their bodies are growing. It doesn’t show up until college. That’s when the bad computing habits show up.”

Clancy suggests parents modify their existing computer furniture by adding pillows for height and back support, and boxes for children’s feet.

Technology to the Rescue

“There are certain ways around overuse problems,” says David Janda, an orthopedic surgeon and director of the Institute of Preventative Sports Medicine in Ann Arbor. “First is a graduated program in utilization—whether it’s throwing a baseball or using a computer keyboard. The other is making sure the environment around you is helping you rather than hurting you.”

One possibility is using technology available to prevent injuries in kids. A couple options are as follows:

• LittleFingers—Robert Solomon saw a need in the market and acted to fill it. In January 2000, his LittleFingers keyboard hit the market. It’s the first keyboard specifically designed for children’s smaller hands and fingers. It incorporates key size and spacing engineered to allow kids to easily reach all of the keys. It includes a trackball, which eliminates the need for a mouse.
  RSIs are definitely a problem for children, he says, and since the symptoms often begin by age 6, “it makes sense that the problems will be exacerbated” unless the proper computer equipment is used.
• Kidstation—In March 1999, Lance Lerman and his wife established Kidstation, a California company that designs, engineers, manufactures and markets ergonomically sound products for children. The company’s inaugural product, the single and double computer desk—which hit the market in March 2000—can be readjusted as kids grow.

Kidstation computer stations encourage correct posture and reduce the risk of repetitive strain injury, the company claims.

“Our product is bought mostly by parents and some schools, mostly over the Internet, although we’re setting up some retail locations,” Lerman says.

LittleFingers, the keyboard developed by Solomon, is a great fit with his child-sized furniture, Lerman says.

He predicts that schools will be required to pay attention to the injuries children incur because of computers. Today’s generation of adult workers began using computers in the late 1980s—but the new generation is using computers earlier in life and for longer periods of time.

“They’re already going to have the problems we have as adults,” he warns. “It’s important to teach good body positions early—or it will be too late.”

RSI All Grown Up

With the continuous rise in computer use and computer requirements that seem to be popping up at universities throughout the country, more and more students may be facing the same problems as MSU students Teresa Henderson and Marissa Lockhart.

In fall 1998, Provost Lou Anna Simon proposed all incoming freshmen be required to have a laptop for the 2001–02 school year. After several alterations to the original proposal, the final decision was made in 2000 to require an Internet accessible computer for each incoming freshman in fall 2001.

However, along with the estimated $1,000 each incoming freshman is expected to spend on the new requirement, computer users could be facing even more problems—larger than money—in the years to come.

So what does MSU intend to do about educating students about the potentially painful side effects that come with such technological advancement on campus?

Not much, according to Paul Hunt, vice provost for Libraries, Computers and Technology at MSU, who says he and his colleagues didn’t really consider RSI education when they implemented the computer requirement.

“We didn’t consider it because you cannot possibly police what people are doing, and to say that the university is contributing to this problem would be false,” he says. “We are merely providing the students with more opportunities to enhance their technological abilities, and they need to be policing how long they sit in front of the computer and how they sit. I don’t really know if that should be the university’s job.”

Teresa Henderson, the graduate student crippled with carpal tunnel, disagrees. “I think the university definitely needs to inform students about what can happen to them because most people my age don’t think it could ever happen to them because they’re too young,” she says. “But they’re wrong. If it can happen to me, it can happen to anyone.”

Provost Lou Anna Simon says RSI education is something MSU will be looking into within the next few years.

“The education process and how we can educate students as to the dos and do nots that come with computer use is something we’ll look at as we begin to see how it can fit into the curriculum,” she says.

Simon says it’s not the university’s job to make sure students are using their computer and video game equipment properly.

“It’s impossible to go to a university such as MSU and not expect to be in front of the computer for at least a few hours each day—it’s just not something we can avoid in this day and age,” she explains.

Eric VanFleet, professor of science and technology at Grand Valley State University, says this is something that most colleges and universities don’t even consider.

“At Grand Valley, it wasn’t even a consideration when they decided to implement the requirement of computers for students,” he says. “Everyone thinks it’s amazing that we are so technologically advanced, but what’s going to happen to us all when we’ve been sitting in front of these computers for 20 years and we can’t use our hands anymore?”

In the last three years at Grand Valley, VanFleet says complaints of hands, wrists and arms being sore or injured have risen by 16.4 percent. “These figures are startling considering the amount of people we know who don’t report problems,” he says.
But what percent of these problems in young people comes from the computer requirements by many colleges and universities, and what comes from outside use of computers and video games?

VanFleet says this question may be the toughest one of all to answer. “That’s nearly impossible to measure since we can’t very well follow people around to see when they’re using the computer for school-related activities,” he says. “If I had to put my money on it, I would bet that it’s about half-and-half. But you never know.”

The first step universities need to take, VanFleet says, is to educate students on RSIs. “We need to be informing people that this can happen to them in their 20s,” he says. “It doesn’t just affect older people. If you’re a 20-year-old student you think ‘this can’t happen to me.’ But sadly, it can.”

VanFleet says the education process shouldn’t start in college —it has to be implemented much earlier.

“The schools, before college, need to be educating people on proper ways to sit at the computer, how much is too much and what some of the symptoms of these problems are."

BACK TO TOP

'Mario Party' down?
Not without some risk

The BBC reported on a recent study of children in their teens that found almost a third play video games daily, while 7 percent play at least 30 hours a week. And the resulting bad posture and hand strain is a concern.

The Boston-based Yankee Group, an organization specializing in the analysis of trends, estimates that 100 million American homes have video games. The American Chiropractic Association attributes more than 44,000 injuries in children each year to prolonged video and computer game use.

John Triano, a chiropractor and co-director of conservative medicine at the Texas Back Institute, often treats youths for such injuries at his Plano, Tex., clinic.

“Early damage to joints is associated with increased risk of degenerative disease later in life,” he says. “The main factor is prolonged static posture and extremes of posture,” including video game playing.

It only takes about 20 minutes of video game playing to cause pain in vertebrae, so he recommends taking breaks every 20 minutes, no matter what the activity is. “What we know to be true in adults is true in children: If you overstress joints, there will be problems,” Triano says.

In March 2000, Nintendo of America settled a lawsuit with the New York Attorney
General’s office and agreed to pay $80 million to provide safety gloves to all consumers who own the “Mario Party” video game. The Attorney General’s office had received numerous complaints that children had injured their hands while playing the video game.

“Mario Party” encourages children to use all their might to rapidly rotate the joystick to succeed at various virtual tasks, says New York Attorney Gen. Eliot Spitzer. The resulting injuries included burns, lacerations, punctures, cuts, bleeding, tearing and blistering of the skin.

“This settlement is good news for parents throughout the nation,” he says. “Nintendo has agreed to take responsibility for the effect of its games on young people.”

Nintendo executives refused to grant an interview, but a public relations spokesperson for the company, who says he cannot be quoted, cannot comment on the lawsuit or on the new Repetitive Strain Warning that is now included with Nintendo’s Game Boy. He says he doesn’t know when the warning first appeared with the video game or whether it was in response to the New York lawsuit.

Stephanie Iwamasa, spokeswoman for Sony Computer Entertainment Inc., says she is not aware of any complaints regarding hand injuries or repetitive strain injuries resulting from the use of her company’s products.

She concedes that ergonomic concerns were not taken into account when Sony designed or redesigned its hand controllers. “We haven’t had any serious inquiries, but I’m sure a lot of work goes into the design.”

Sony Playstation packaging does not warn children of the possible risks of overuse injuries.

BACK TO TOP