Physical exposure differences between children and adults when using standard and small computer input devices

By the age of five years, 75% of the children in the USA are using computers and at this age they are only one-half to two-thirds the size of and about one-fifth as strong as their adult counterparts. Fourteen children between five and eight years of age and their same-gender biological parents (giving a total of 28 subjects) were evaluated using both a standard and a smaller, child-proportional input device during standardised mouse and keyboard tasks. Typing and computer mouse performance were measured with tracking software, wrist posture was measured with an electrogoniometer and electromyography was used to measure finger flexor and extensor muscle activity in the right arm. With the small mouse, both children and adults performed the mouse task significantly faster and made significantly fewer errors. When using the standard-sized mouse and keyboard, children worked with significantly greater ulnar deviation and significantly less extension than their adult counterparts. When children used the smaller mouse, finger flexor muscle activity, finger extensor muscle activity and ulnar deviation significantly decreased, with little change in wrist extension compared to the standard mouse. No significant differences were observed between the standard and small keyboards for children or their parents. Compared to their adult counterparts, children had to apply twice the relative force, as a percentage of their maximum capacity, to activate the buttons and keys on the input devices. These measured differences may have application in the design of computer input devices for children.     

Active-Input Provides More Movement and Muscle Activity During Electronic Game Playing by Children

The majority of children in affluent countries now play electronic games, and this has lead to concerns about the health impact of this activity. Traditional electronic games have used gamepad, keyboard, and mouse input, but newer game interfaces that require more movement are now available. However the movement and muscle activity demands of electronic games have not been described. This study compared the amount of movement and muscle activity while 20 children aged 9 to 12 years watched a DVD and played games using handheld computer, gamepad, keyboard, steering wheel and, active-input (Webcam motion analysis–Sony EyeToy®) devices. Movement of the head, sacrum, foot, shoulder, wrist, and thumb was measured along with activity in cervical erector spinae, lumbar erector spinae, rectus femoris, upper trapezius, anterior deltoid, and wrist extensor muscles. Use of the wheel resulted in some increase in upper limb movement and muscle activity, but the other traditional input devices were usually as sedentary as watching a DVD. In contrast, use of the active-input device (EyeToy) resulted in substantial movement and muscle activity in limbs and torso. These results suggest that playing traditional electronic games is indeed a sedentary activity but that new active-input technologies may be useful in encouraging more movement and muscle activity in children.     

Effect of horizontal position of the computer keyboard on upper extremity posture and muscular load during computer work

The distance of the keyboard from the edge of a work surface has been associated with hand and arm pain; however, the variation in postural and muscular effects with the horizontal position have not been explicitly explored in previous studies. It was hypothesized that the wrist approaches more of a neutral posture as the keyboard distance from the edge of table increases. In a laboratory setting, 20 adults completed computer tasks using four workstation configurations: with the keyboard at the edge of the work surface (NEAR), 8 cm from the edge and 15 cm from the edge, the latter condition also with a pad that raised the work surface proximal to the keyboard (FWP). Electrogoniometers and an electromagnetic motion analysis system measured wrist and upper arm postures and surface electromyography measured muscle activity of two forearm and two shoulder muscles. Wrist ulnar deviation decreased by 50% (4 degrees ) as the keyboard position moved away from the user. Without a pad, wrist extension increased by 20% (4 degrees ) as the keyboard moved away but when the pad was added, wrist extension did not differ from that in the NEAR configuration. Median values of wrist extensor muscle activity decreased by 4% maximum voluntary contraction for the farthest position with a pad (FWP). The upper arm followed suit: flexion increased while abduction and internal rotation decreased as the keyboard was positioned further away from the edge of the table. In order to achieve neutral postures of the upper extremity, the keyboard position in the horizontal plane has an important role and needs to be considered within the context of workstation designs and interventions.     

Effect of horizontal position of the computer keyboard on upper extremity posture and muscular load during computer work

The distance of the keyboard from the edge of a work surface has been associated with hand and arm pain; however, the variation in postural and muscular effects with the horizontal position have not been explicitly explored in previous studies. It was hypothesized that the wrist approaches more of a neutral posture as the keyboard distance from the edge of table increases. In a laboratory setting, 20 adults completed computer tasks using four workstation configurations: with the keyboard at the edge of the work surface (NEAR), 8 cm from the edge and 15 cm from the edge, the latter condition also with a pad that raised the work surface proximal to the keyboard (FWP). Electrogoniometers and an electromagnetic motion analysis system measured wrist and upper arm postures and surface electromyography measured muscle activity of two forearm and two shoulder muscles. Wrist ulnar deviation decreased by 50% (4°) as the keyboard position moved away from the user. Without a pad, wrist extension increased by 20% (4°) as the keyboard moved away but when the pad was added, wrist extension did not differ from that in the NEAR configuration. Median values of wrist extensor muscle activity decreased by 4% maximum voluntary contraction for the farthest position with a pad (FWP). The upper arm followed suit: flexion increased while abduction and internal rotation decreased as the keyboard was positioned further away from the edge of the table. In order to achieve neutral postures of the upper extremity, the keyboard position in the horizontal plane has an important role and needs to be considered within the context of workstation designs and interventions.     

Wrist posture affects hand and forearm muscle stress during tapping

Non-neutral wrist posture is a risk factor of the musculoskeletal disorders among computer users. This study aimed to assess internal loads on hand and forearm musculature while tapping in different wrist postures. Ten healthy subjects tapped on a key switch using their index finger in four wrist postures: straight, ulnar deviated, flexed and extended. Torque at the finger and wrist joints were calculated from measured joint postures and fingertip force. Muscle stresses of the six finger muscles and four wrist muscles that balanced the calculated joint torques were estimated using a musculoskeletal model and optimization algorithm minimizing the squared sum of muscle stress. Non-neutral wrist postures resulted in greater muscle stresses than the neutral (straight) wrist posture, and the stress in the extensor muscles were greater than the flexors in all conditions. Wrist extensors stress remained higher than 4.5 N/cm² and wrist flexor stress remained below 0.5 N/cm² during tapping. The sustained high motor unit recruitment of extensors suggests a greater risk than other muscles especially in flexed wrist posture. This study demonstrated from the perspective of internal tissue loading the importance of maintaining neutral wrist posture during keying activities.     

The effect of upper extremity support on upper extremity posture and muscle activity during keyboard use

Forearm support during keyboard use has been reported to reduce neck and shoulder muscle activity and discomfort. However, the effect of forearm support on wrist posture has not been examined. The aim of this study was to examine the effect of 3 different postures during keyboard use: forearm support, wrist support and "floating". The floating posture (no support) was used as the reference condition. A wrist rest was present in all test conditions. Thirteen participants completed 20 min wordprocessing tasks in each of the test conditions. Electromyography was used to monitor neck, shoulder and forearm muscle activity. Bilateral and overhead video cameras recorded left and right wrist extension, shoulder and elbow flexion and radial and ulnar deviation. The forearm support condition resulted in significantly less ulnar deviation (p < or = 0.007), less time spent in extreme ulnar deviation (p = 0.002) and less reports of discomfort than the "floating" condition (p = 0.002). The wrist support but not the forearm support condition resulted in less trapezius and anterior deltoid muscular activity (p < 0.007). These findings indicate that typing with upper extremity support in conjunction with a wrist rest may be preferable to the "floating" posture implicit in current guidelines.     

Biomechanics and performance when using a standard and a vertical computer mouse

Objective: to compare the biomechanics and performance while using a vertical computer mouse (VM) and a standard mouse (SM). Methods: muscle activation (electromyography), forearm movements (electrogoniometers), performance (Fitts' Law test) and satisfaction (questionnaire) of 16 subjects were evaluated. Results: there were significant differences between the VM and the SM, respectively, on motion (28° vs. 42° pronation, p = 0.001; 5° ulnar vs. 7° radial deviation, p = 0.016) and muscle activity (13% vs. 16% of extensor carpi activity, p = 0.006; 10% vs. 13% extensor digitorum activity, p = 0.001). VM user satisfaction was good (68); however, time to target was longer (4.2 vs. 3.4 s, p < 0.001). Conclusions: using the VM decreased wrist pronation and lowered wrist extensor muscle activity, but additional training and familiarisation time may be required to improve user performance.

Practitioner Summary: Using a vertical mouse can decrease the exposure to biomechanical risk factors for computer mouse use-related musculoskeletal disorders. Using a vertical computer mouse resulted in less wrist pronation and lower wrist extensor muscle activity. But, training and familiarisation are required.     

A laboratory study of the effects of wrist splint orthoses on forearm muscle activity and upper extremity posture

OBJECTIVE: To evaluate the effects of wrist splint orthoses (WSOs) on forearm muscle activity and upper extremity/torso postures. BACKGROUND: WSOs are ubiquitous in industry, but the literature as to their biomechanical effects is limited. METHOD: Study 1: Participants performed single-plane wrist exertions with or without a WSO while the electromyographic (EMG) activity of the flexor carpi radialis, flexor carpi ulnaris, and extensor carpi ulnaris was captured. Study 2: Participants performed simple computer jumper installation tasks with or without a WSO while upper extremity/torso postures were recorded. RESULTS: Study 1: A significant interaction between WSOs and wrist angle was observed in the response of forearm muscles (e.g., normalized EMG of the flexor carpi radialis increased from 4.2% to 15.9% as flexion increased from 0 degree to 36 degrees in the orthosis conditions, whereas in the no-orthosis condition it remained approximately 5% at all wrist flexion angles). Study 2: WSOs were found to effect wrist, torso, and shoulder postures, with the orthoses creating a 48% decrease (36 degrees vs. 18.6 degrees) in wrist flexion and 80% decrease (15 degrees vs. -3 degrees) in ulnar deviation but at a cost of increased shoulder abduction of 22% (36.5 degrees vs. 44.5 degrees) and increased lateral bend of torso of 30% (6 degrees vs. 7.8 degrees). CONCLUSIONS: WSOs increased forearm muscle activity at large wrist deviation angles and induced awkward shoulder postures in tasks requiring significant wrist deviation. APPLICATION: Use of WSOs in occupational settings should be carefully considered relative to task requirements, as orthoses may do more harm than good.     

Observed finger behaviour during computer mouse use

Two-button computer mouse users may exhibit sustained, static finger lifting behaviours to prevent inadvertent activations by avoiding finger pressure on the buttons, which leads to prolonged, static finger extensor muscle loading. One hundred graduate students were observed during normal computer work in a university computer facility to qualify and quantify the prevalence of lifted finger behaviours and extended finger postures, as well as wrist/forearm and grip behaviour, during specific mouse activities. The highest prevalences observed were 48% of the students lifted their middle finger during mouse drag activities, and 23% extended their middle finger while moving the mouse. In addition, 98% of the students rested their wrist and forearm (77%) or wrist only (21%) on the workstation surface, and 97% had an extended wrist posture (15 degrees -30 degrees ) when using the mouse. Potential applications of these findings include future computer input device designs to reduce finger lifting behaviour and exposures to risk factors of hand/forearm musculoskeletal pain.     

Keyboard operating posture and actuation force: implications for muscle over-use

A substantial proportion of the problems in keyboard operator 'Over-use Syndromes' occur in the wrist and finger extensor muscle group. Biomechanical analysis shows these muscles to be subject to substantial sustained static (isometric) muscle contraction during the work task. This study measured the maximum relaxed finger press forces for 60 subjects in three arm support methods, in order to predict what the minimum keypress force should be to permit finger support sufficient to facilitate relaxation of finger extensor muscles. It was postulated that the minimum key activation force should accommodate the 95 percentile predicted population relaxed finger weights. The predicted force of 0.8 newton is within limits previously proposed for performance criteria, and which have been found practical commercially.     

Physical workload during use of speech recognition and traditional computer input devices

Musculoskeletal symptoms among computer users are frequently found. The aim was to investigate the musculoskeletal workload during computer work using speech recognition and traditional computer input devices (keyboard/mouse). Ten experienced computer users (nine female, one male) participated. They performed three different computer tasks: (1). text entry and (2). text editing of a standard text and (3). a self-selected work task. These tasks were performed twice using speech recognition and traditional computer input devices (keyboard/mouse). Additionally, a task consisting of reading aloud of the standard text was performed. Surface EMG from the forearm (m. extensor carpi ulnaris, m. extensor carpi radialis), the shoulder (m. trapezius) and the neck extensor muscles was recorded, in addition to the voice-related muscles (m. scalenii, m. cricothyroideus). Using speech recognition during text entry and text editing reduced the static muscle activity of the forearm, neck and to some extent the shoulder muscles. Furthermore, tendencies to longer periods of muscle activity pause (relative time with EMG gaps) in the forearm and shoulder muscles were found. This was seen at the expense of a tendency to an increased static activity and a decreased relative time with EMG gaps in m. cricothyroideus. Finally, during use of speech recognition the hand was tied to the keyboard/mouse for a shorter period of time, while the eyes were viewing the screen for a longer period of time compared to the condition with traditional computer input devices. It is recommended to use speech recognition as a supplementary tool to traditional computer input devices.     

The effect of typing posture on wrist extensor muscle loading

High static loading of the forearm extensor musculature has been observed during keying tasks. To reduce the level of loading, one must first understand the contributing factors. A simulation of the human finger was used to determine muscle force contributions during a static index finger key press at several wrist postures. The planar model included active and passive muscle forces of the intrinsic and extrinsic finger muscles. The model was expanded to include the passive forces from the other fingers as well as the weight of the hand to determine the exertion required of the wrist extensor muscles to maintain the given wrist and finger postures. Model results indicated that greater than 25% of maximal exertion is required of the wrist extensors when the wrist is extended to 30. The increased moment contribution from passive forces of the extrinsic finger flexor muscles was responsible for the majority of the increased wrist extensor contribution as the wrist was extended. These findings are in relative agreement with previous electromyographic studies and may indicate a mechanism for forearm extensor pain in office workers. Potential applications of this research include ergonomic modeling of the upper limb to determine internal loads that may lead to work-related disorders.     

Wrist and forearm posture from typing on split and vertically inclined computer keyboards

A study was conducted on 90 experienced office workers to determine how commercially available alternative computer keyboards affected wrist and forearm posture. The alternative keyboards tested had the QWERTY layout of keys and were of three designs: split fixed angle, split adjustable angle, and vertically inclined (tilted or tented). When set up correctly, commercially available split keyboards reduced mean ulnar deviation of the right and left wrists from 12 degrees to within 5 degrees of a neutral position compared with a conventional keyboard. The finding that split keyboards place the wrist closer to a neutral posture in the radial/ulnar plane substantially reduces one occupational risk factor of work-related musculoskeletal disorders (WMSDs): ulnar deviation of the wrist. Applications of this research include commercially available computer keyboard designs that typists can use and ergonomists can recommend to their clients in order to minimize wrist ulnar deviation from typing.     

Interactive effects of acute experimental pain in trapezius and sored wrist extensor on the electromyography of the forearm muscles during computer work

We investigated the interactive effects of shoulder pain and wrist extensor muscle soreness on surface electromyography (EMG) during computer mouse work. On day one, subjects (N = 12) performed computer work with/without acute muscle pain induced in the trapezius muscle. Subsequently, eccentric exercise was performed to induce delayed onset muscle soreness (DOMS) in wrist extensor muscles. In presence of DOMS on day two, computer work recordings with/without pain were repeated. EMG signals were recorded from the descending part of trapezius bilaterally, flexor carpi ulnaris and extensor carpi radialis brevis. Experimental muscle pain in trapezius led to a decrease in the muscular activity of the wrist extensor (P < 0.02) and decreased the relative rest time in the wrist flexor even in presence of DOMS (P < 0.01). The present result suggests that shoulder pain plays a role in the coordination of wrist flexors and extensors during computer work.     

Alternative computer mouse design and testing to reduce finger extensor muscle activity during mouse use

OBJECTIVE: The purpose of this study was to design and test alternative computer mouse designs that attempted to reduce extensor muscle loading of the index and middle fingers by altering the orientation of the button switch direction and the force of the switch. BACKGROUND: Computer users of two-button mouse designs exhibit sustained lifted finger behaviors above the buttons, which may contribute to hand and forearm musculoskeletal pain associated with intensive mouse use. METHODS: In a repeated-measures laboratory experiment, 20 participants completed point-and-click, steering, and drag tasks with four alternative mouse designs and a reference mouse. Intramuscular and surface electromyography (EMG) measured muscle loading, and movement times recorded by software provided a measure of performance. RESULTS: Changing the direction of the switch from a conventional downward to a forward design reduced (up to 2.5% maximum voluntary contraction [MVC]) sustained muscle activity (10th percentile EMG amplitude distribution) in the finger extensors but increased (up to 0.6% MVC) flexor EMG and increased movement times (up to 31%) compared with the reference mouse (p < .001). Implementing a high switch force design also increased flexor EMG but did not differ in movement times compared with the reference mouse (p < .001). CONCLUSION: The alternative mouse designs with altered switch direction reduced sustained extensor muscle loading; however, trade-offs with higher flexor muscle loading and lower performance existed. APPLICATION: Potential applications of this study include ergonomic and human computer interface design strategies in reducing the exposure to risk factors that may lead to upper extremity musculoskeletal disorders.     

Prediction of forearm muscle activity during gripping

Occupational exposure is typically assessed by measuring forces and body postures to infer muscular loading. Better understanding of workplace muscle activity levels would aid in indicating which muscles may be at risk for overexertion and injury. However, electromyography collection in the workplace is often not practical. Therefore, a set of equations was developed and validated using data from two separate days to predict forearm muscle activity (involving six wrist and finger muscles) from grip force and posture of the wrist (flexed, neutral and extended) and forearm (pronated, neutral, supinated). The error in predicting activation levels of each forearm muscle across the range of grip forces, using the first day data (root mean square error; RMSEmodel), ranged from 8.9% maximal voluntary electrical activation (MVE) (flexor carpi radialis) to 11% MVE (extensor digitorum communis). Grip force was the main contributor to predicting muscle activity levels, explaining over 70% of the variance in flexor activation levels and up to 60% in extensor activation levels, respectively. Inclusion of gender as a variable in the model improved estimates of flexor but not extensor activity. While posture itself explained minimal variance in activation without grip force (< 10% MVE), wrist and forearm posture were required (with grip force) to explain over 70% of the variance of all six muscles. The validation process indicated good day-to-day reliability of each equation, with similar error for flexor muscle models but slightly higher error in the extensor models when predicting activity levels for the second day of data (RMSEvalid ranging from 8.9% to 12.7% MVE). Detailed error analysis during validation revealed that inclusion of posture in the model effectively decreased error at grip forces above 25% maximum, but was detrimental at very low grip forces. This study presents a potential new tool to estimate forearm muscle loading in the workplace using grip force and posture, as a surrogate to use of a complex biomechanical model.     

Observed differences in upper extremity forces, muscle efforts, postures, velocities and accelerations across computer activities in a field study of office workers

This study, a part of the PRedicting Occupational biomechanics in OFfice workers (PROOF) study, investigated whether there are differences in field-measured forces, muscle efforts, postures, velocities and accelerations across computer activities. These parameters were measured continuously for 120 office workers performing their own work for two hours each. There were differences in nearly all forces, muscle efforts, postures, velocities and accelerations across keyboard, mouse and idle activities. Keyboard activities showed a 50% increase in the median right trapezius muscle effort when compared to mouse activities. Median shoulder rotation changed from 25 degrees internal rotation during keyboard use to 15 degrees external rotation during mouse use. Only keyboard use was associated with median ulnar deviations greater than 5 degrees. Idle activities led to the greatest variability observed in all muscle efforts and postures measured. In future studies, measurements of computer activities could be used to provide information on the physical exposures experienced during computer use. Practitioner Summary: Computer users may develop musculoskeletal disorders due to their force, muscle effort, posture and wrist velocity and acceleration exposures during computer use. We report that many physical exposures are different across computer activities. This information may be used to estimate physical exposures based on patterns of computer activities over time.     

Changes in upper extremity biomechanics across different mouse positions in a computer workstation

In order to determine differences in biomechanical risk factors across different mouse positions within computer workstations a repeated measures laboratory study was completed with 30 adults (15 females 15 males). The subjects performed mouse-intensive tasks during two experiments. One experiment examined three mouse positions: a standard mouse (SM) position with the mouse directly to the right of the keyboard; a central mouse (CM) position with the mouse between the keyboard and the body, positioned in the body's mid-sagittal plane; a high mouse (HM) position, which simulated using a keyboard drawer with the mouse on the primary work surface. The second experiment compared two mouse positions: the SM position and a more central position using a keyboard without a number keypad (NM). Electrogoniometers and inclinometers measured wrist and upper arm postures and surface electromyography measured muscle activity of four forearm muscles and three shoulder muscles. The CM mouse position was found to produce the most neutral upper extremity posture across all measures. The HM position produced the least neutral posture and resulted in the highest level of muscle activity. Compared to the SM position, the NM position reduced wrist extension slightly and promoted a more neutral shoulder posture. Little difference in muscle activity was observed between the SM and NM positions. In conclusion, of these alternative mouse positions, the HM position was the least desirable, whereas the CM position reduced overall awkward postures associated with mouse-intensive computer tasks.     

Changes in upper extremity biomechanics across different mouse positions in a computer workstation

In order to determine differences in biomechanical risk factors across different mouse positions within computer workstations a repeated measures laboratory study was completed with 30 adults (15 females 15 males). The subjects performed mouse-intensive tasks during two experiments. One experiment examined three mouse positions: a standard mouse (SM) position with the mouse directly to the right of the keyboard; a central mouse (CM) position with the mouse between the keyboard and the body, positioned in the body's mid-sagittal plane; a high mouse (HM) position, which simulated using a keyboard drawer with the mouse on the primary work surface. The second experiment compared two mouse positions: the SM position and a more central position using a keyboard without a number keypad (NM). Electrogoniometers and inclinometers measured wrist and upper arm postures and surface electromyography measured muscle activity of four forearm muscles and three shoulder muscles. The CM mouse position was found to produce the most neutral upper extremity posture across all measures. The HM position produced the least neutral posture and resulted in the highest level of muscle activity. Compared to the SM position, the NM position reduced wrist extension slightly and promoted a more neutral shoulder posture. Little difference in muscle activity was observed between the SM and NM positions. In conclusion, of these alternative mouse positions, the HM position was the least desirable, whereas the CM position reduced overall awkward postures associated with mouse-intensive computer tasks.     

Design and evaluation of a curved computer keyboard

Conventional, straight keyboards remain the most popular design among keyboards sold and used with personal computers despite the biomechanical benefits offered by alternative keyboard designs. Some typists indicate that the daunting medical device-like appearance of these alternative ‘ergonomic’ keyboards is the reason for not purchasing an alternative keyboard design. The purpose of this research was to create a new computer keyboard that promoted more neutral postures in the wrist while maintaining the approachability and typing performance of a straight keyboard. The design process created a curved alphanumeric keyboard, designed to reduce ulnar deviation, and a built-in, padded wrist-rest to reduce wrist extension. Typing performance, wrist postures and perceptions of fatigue when using the new curved keyboard were compared to those when using a straight keyboard design. The curved keyboard reduced ulnar deviation by 2.2° ± 0.7 (p < 0.01). Relative to the straight keyboard without a built-in wrist-rest, the prototype curved keyboard with the built-in padded wrist-rest reduced wrist extension by 6.3° ± 1.2 (p < 0.01). There were no differences in typing speed or accuracy between keyboards. Perceived fatigue ratings were significantly lower in the hands, forearms and shoulders with the curved keyboard. The new curved keyboard achieved its design goal of reducing discomfort and promoting more neutral wrist postures while not compromising users' preferences and typing performance.