INTRODUCTION TO REPETITIVE STRAIN INJURY PATIENT BILL OF RIGHTS

Technology and handheld devices are crucial for working in today's world. Unfortunately, using these devices has led to severe and permanent Repetitive Strain Injury (RSI) to the hand, wrist, arm, shoulder and neck for millions of people around the globe. Risk factors that contribute to these injuries include: lack of education about Repetitive Strain Injury, improper tool design, sitting for prolonged periods, repetitive movements in awkward postitions and many other factors.

Prevention is the only cure. That's why there must be an international awareness campaign about Repetitive Strain Injury as well as better tool design (especially input devices), improvements in how RSI is diagnosed and treated, and an emphasis on proper posture and technique in the population who uses these tools.

So far, the United States legislature has not addressed this issue. To avoid crippling disabilities from technology use, the government must take the following steps:

REPETITIVE STRAIN INJURY PATIENT BILL OF RIGHTS

1.     Repetitive Strain Injury (RSI) is a severely disabling and potentially career-ending disorder affecting the muscles, tendons and nerves of the fingers, wrist, forearm, elbow, shoulder and neck. Prevention is the only cure, but people cannot prevent an injury they have never heard of. The government must institute comprehensive public awareness campaigns warning people about the risk factors and warning signs of Repetitive Strain Injury, and the serious consequences of ignoring them. Public health programs have reduced the number of deaths related to smoking and have mandated curb cuts for wheelchair users. The same effort must be applied to this disabling disease, because once injured, the injury impacts virtually the person’s whole life because normal hand use is essential for working and activities of daily living such as driving, cooking and self-care. Many of these activities are problematic or no longer possible (i.e., driving) for injured people. Education is key for prevention.

2.     Government health agencies must revise and post proper information about ergonomics and suggested workstation design. These guidelines must be written by medical doctors with expertise in Repetitive Strain Injury and soft tissue injuries rather than people with vested interest in selling ergonomic products.

3.     The current Occupational Safety and Health Administration (OSHA) computer ergonomic guidelines recommend that people work in the 90/90/90 position, which can lead to many forms of RSI as well as spinal injuries. While somewhat helpful, ergonomic adjustments do not cure or necessarily prevent Repetitive Strain Injury and must not be promoted as such. Computer users must be trained in proper posture, pacing and keying techniques – and use dictation programs whenever feasible.

4.     The government must fund useful, comprehensive research on the risk factors and effective treatment of Repetitive Strain Injury. Long-term studies of injured people are particularly needed because many of these people become significantly worse after their initial diagnosis. Repetitive Strain Injury tends to become worse over time.

5.     Every working person has the right to a proper workstation and working conditions. Manual jobs must include a variety of tasks to avoid constant repetitive hand use and people must be encouraged to take frequent breaks from repetitive tasks and to stop activities that cause pain, fatigue, numbness or tingling or other symptoms of RSI – even if they occur during the workday.

6.     Manufacturers must design tools and devices such as computer keyboards and smartphones that enable safer use of the hand and body. Designers must understand the hand/tool interface so they can design for safety.

7.     People with Repetitive Strain Injury have the right to timely, appropriate medical care by physicians who are trained to diagnose and treat these injuries.

8.     Repetitive Strain Injury can become much worse if people are not given prompt, proper medical treatment, postural and biomechanical training and ergonomic equipment. Injured people must have the right to prompt treatment and reasonable accommodation to help them to do their work, such as: voice-activated software and ergonomic devices. They should receive appropriate limitations on hand use, on-site ergonomic assessments by properly trained staff paid for by Workers Comp, insurance or the employer.

9.     Workers Compensation programs must be overhauled so as not to delay and/or limit the amount of treatment injured people can receive. It must not discourage doctors from treating work-related injuries by overburdening them with unnecessary paperwork or not compensating them properly for their work.

10. Physicians and physician assistants must be well trained to recognize the subtle warning signs of the Repetitive Strain Injury, which includes injuries to the muscles, tendons, and nerves. They must learn the interaction between repetitive movement and these injuries, how to treat RSI properly, including technique evaluation and postural and biomechanical retraining. If they are not willing to take on RSI patients themselves, they must refer to a physician who is properly qualified to do so. Physical therapists also need to be trained how to treat patients with RSI. Delayed or improper treatment can make the injury significantly worse.

11. Insurance companies must appropriately compensate doctors and other healthcare professionals who treat Repetitive Strain Injury for the time it takes to diagnose and treat this disease. A thorough initial examination may take 90 minutes.

12. Children must be properly trained in good posture, pacing and technique when they are in school. They must be provided with ergonomic equipment and given plenty of breaks for whole-body exercise. Computer gaming is particularly dangerous since it combines the possibility of addiction with overuse and poor technique. Parents and teachers must be made aware of this issue. Because of the danger to the upper extremity, computers and other handheld devices must not be used as ways of keeping children occupied and entertained.