That Pain in Your Wrist, Hand, and Index Finger: Occupational Therapist, Jane Bear-Lehman, Weighs In

Jane Bear-Lehman is an associate professor and chair of Steinhardt’s Department of Occupational Therapy. She is a co-investigator in a National Institutes of Health/National Institute of Aging (NIH/NIA) grant studying the cognitive and physical bases of disablement in adults. A specialist in orthopedic and upper limb rehabilitation, she currently serves on the editorial board for The Journal of Hand Therapy.

In your Ph.D. dissertation you sought to understand emerging “upper limb cumulative trauma disorder’ that plagued early computer users. Talk a little bit about your study and what you learned.

Jane Bear-Lehman: The findings from my dissertation, now over a decade ago, note that the computer keyboarder who expresses upper limb cumulative trauma disorder presents with a collection of painful symptoms in their arms and hands that seem to resolve on weekends when they are not at work. As time continued, the discomfort spread and did not resolve itself when the keyboarder was not at work. The discomfort gradually impeded the quality and quantity of performance for daily life tasks. The control and amelioration of these symptoms was found to related to treatment on a continuous basis. Moreover, this type of problem seems to be analogous with long term, chronic medical conditions where the onset is slow and insidious over time, and the work of the practitioner is to control the patient’s symptoms rather than to treat the ‘disease’ directly.

Have you seen a difference in the type of hand-related repetitive injuries since you wrote your dissertation than you are seeing now? How do you measure these ‘injuries?’

Jane Bear-Lehman: Since I completed my doctoral work, there has been a rapid growth in the types of tools used requiring key entering, and all of the tools have become smaller, many mobile. In my study, keyboarding was primarily a desk-related function. This was just before the rapid growth of technology: laptop computers and cell phones were not a common form of communication exchange.

What can an occupation therapist offer someone who has chronic digital media-related pain?

Jane Bear-Lehman: Occupational therapists first assess the problematic or painful regions and seek to calm the symptoms through traditional therapeutic measures. Key to success is to then review the aggravating conditions and to work closely with the individual to develop safe working patterns and conditions to keep the symptoms under control. Thus, the OT will redesign how an activity is performed by changing posture, for example: to abate symptoms when the wrist is bent, the recommendation for handwriting could include the use of an enlarged pen with rubber or foam near the tip and to use an inclined plane to neutralize and de-stress the wrist position for the writer. The individual may be directed to use a knife with an 11-degree angle so that the wrist is in an unstressed position when dicing vegetables. If a change in positioning does not produced symptom control, then the OT will suggest a different type of tool, for example: changing the trackball, type of pen, or encourage the use of a timer for forced rest periods, where the individual might take a walk or do some stretches to work a different group of muscles. If these measures don’t provide relief, an OT may suggest recommend a voice-activated computer or avoiding the ‘painful’ tasks completely.

What is the prognosis for the generation that is born into this technology as we add video game playing controls, Nintendo DS keypad, and even iPod touch finger game playing into the mix?

Jane Bear-Lehman: The rate and severity of discomfort from constant use of computer and hand held-communication devices is interesting to track. The initial injuries tracked in the 1980’s were focused on office workers in workstations as described in Daniel Berman’s book, Death on the Job. The mobility, the varied types of communication, and the myriad of tasks we now perform take the single continuous force that challenged us in the 1980’s to a different level.

Whether injuries are increased or abated has a lot to do with the user and how he or she engages in the tasks and seeks variation in posture, pressure, etc. The younger population also has access to, and a strong desire to engage in some mobile (DS; PSP), or not mobile (XBOX), or physically interactive (Wii) games in addition to communicating on IM, social networks, and the like. Some question whether the increased time game playing and social networking takes away from time on the sports field and run the risk of obesity. Also, we question whether these children are putting their visual systems and fine motor skills at risk as they are over-working their eyes and small muscles groups.

Final thoughts?

Jane Bear-Lehman: Hand- held devices seem innocuous, however continuous, uninterrupted use of them can cause discomfort. The earlier the user takes notices this and modifies how they are engaging with the device by changing posture or pattern, then the sooner long-term problems can be prevented.

Learn how Kevin Weaver, a clinical assistant professor in Steinhardt’s Department of Physical Therapy, diagnoses and treats digital media-based hand pain by visiting his Q & A.

To read more about Jane Bear-Lehman’s collaborative work with cellist Duo-Lin Peng, visit this blog post.