Injured workers, disabled workers, and workers recovering from surgery all have onething in common; they all have special needs, requirements, or limits in their workcapacity. Furthermore, they all need an ergonomically correct workstation to help them be productive and successful in their jobs. The ergonomics of the workstation can "make or break" the return to work or sustained work effort. If the workstation is not correctly fitted to the worker's particular needs, the worker's condition may worsen,there may be unnecessary rehabilitation costs, and in the worst-case scenario - the worker may be forced to leave the job.
Ergonomics - the science of fitting the job to the worker by matching the demands of the job to the workers capabilities - can do wonders for people with special needs. Ergonomic changes to a workstation can make the job more efficient, more productive,and physically acceptable to a greater percentage of the population. Ergonomic changes to a workstation can reduce or eliminate irritating, harmful, or difficult motions and activities. Some of these motions, activities, and postures may be physically unacceptable to people with special needs. In some cases these motions may have been the cause of the disability in the first place.
When evaluating a job for ergonomic stressors and correct fit, involve the individual that actually performs the job. Try to identify, with input from the operator, what parts of the job are difficult or painful for them to perform. Visualize how they perform the job with an eye for deviations from neutral posture in the joints. Look for things such as bending, twisting, and reaching. Keep the basic ergonomic risk factors in mind:
- Force (static muscle loading, or high dynamic forces)
- Repetition (too much, or not enough)
- Posture (occasional moderate deviation from neutral is often a good thing, too much deviation from neutral can strain the tissues)
These basic ergonomic risk factors account for many of the causes of discomfort andpain for people at work. These risk factors apply to fingers on a keyboard, as well asthe neck and shoulder area while working at a desk.
Once you have identified the ergonomic stressors, and the parts of the job that are notacceptable for your worker, you then set out to find what adaptations are required. Recognize that many times "poor posture" and un-natural positions are a result of the workstation layout, physical obstructions or a visual or lighting problem. The types of questions you need to ask and the detective-work you need to perform is illustrated in the following questions:
- Can you manipulate the work materials or workstation so that the individual remains in a better, less stressful position? Bend the work - not the person.
- Are parts of the workstation such as pencil drawers, file cabinets, arm rests, and recycle bins, preventing the chair from sliding under the desk? If so, the person maybe forced to bend forward and reach to perform their work.
- If the disability is in the arm or wrist can you use a split keyboard and a keyboard support to improve wrist positioning?
- Do you need to consider administrative controls such as alternate duty, light duty, or job rotation?
To get a better feel of the common ergonomic changes needed to accommodate disabled workers, read through the following case studies of actual changes I have made for my clients. These are given to illustrate diagnosis and resolution techniques. Other situations may require other solutions.
Case Study #1 - Bill
Bill is a tall individual who had developed chronic back and tailbone pain from years ofwork as a collections officer for a law firm. A Neurologist diagnosed lumbar disc degeneration and referred Bill for an ergonomic evaluation. When observing Bill at hisdesk, it became readily apparent that his workstation did not fit him well. Bill's legs rubbed the underside of his desk. This was uncomfortable for him and tended to messup his dress slacks. Bill's adaptation to this was to lower the chair. This, it turns out,was not a good thing for him to do. By lowering the chair Bill was focusing much of his body weight on the tailbone, and causing the back to bend forward. The forward bend was further exacerbated by the fact that he was tall and that he had to bend a considerable distance to see and focus on the material on his desk.
The ergonomic changes for Bill included adjusting his chair up high enough so his knees and hips were approximately level. This distributed his weight over the entire thigh instead of focusing it on the butt and tailbone. We then changed the settings onhis chair to allow the chair to rock back or recline when Bill pushed back. This further Presented by un-weighted his low back and tail bone by shifting some of the upper body weight ontothe backrest. With the higher chair position we now needed to raise Bill's desk. We did this with a set of small plastic discs called "deskalators", although a piece of wood or other such material would work as well. (In other similar cases we sometimes remove the pencil drawer to increase leg clearance.)
Once we got Bill into a better seated position we then looked at his forward bent posturehe uses when writing. Due to his declining eye strength Bill needed to bend over to getcloser to his papers for reading and writing. We provided him with an inclined writing surface that was like having a mini drafting table on his desktop. This allowed him to sit more upright, have better back support, and still be able to read his materials.
The last change I recommended for Bill was for him to stand and move as often aspossible. Standing generally places less strain on the back than sitting, therefore, wewant to get him up as much as possible. To facilitate this we needed to make sure that Bill could continue to work and be productive while standing. Our solution here was tomove a 3-drawer file cabinet adjacent to his desk. This cabinet was about elbow high for Bill and provided a good writing surface. We gave him a telephone headset with along cord and Bill was in business.
Case Study #2 - Sue
Another client of mine named Sue, suffered with Carpal Tunnel Syndrome (CTS), and was returning to work following surgery. Sue's job was in accounting and involved hand-intensive work such as keying, handling papers, stapling, and writing. Sue was returnedto work on a graduated basis. We needed to ensure that she kept the finger and wrist strain to a minimum. We first looked at her typing technique to evaluate the wrist motions and postures she uses when typing. This was done with video taping and revealed that Sue had excessive bending in her wrist (both flexion - wrist bent up, and ulnar deviation - wrist cocked to the side). Both of these motions cause increased pressure in the carpal tunnel. The solution here was to give Sue a split keyboard similar to the Microsoft Natural keyboard, and to retrain her to type with movements of the whole arm vs. simply twisting the wrist to the side when hitting the return key. We also set the keyboard flat on the tray so Sue wouldn't need to bend the wrist up for her fingers to clear the keys. Sue also had some excessive wrist motion while mousing. We got her a mouse with a scroll knob to reduce the amount of travel required to move through spread sheets, and we changed her settings on the control panel to have the mouse automatically go to the default button when bringing up dialog boxes in Windows. All of these changes reduced the amount of wrist movement required to get through her programs.
We then looked at hand use when writing and working with papers. To reduce grip forces when writing we got Sue an over-sized pen with a large diameter shaft and a sticky, soft rubber grip surface. Instead of pulling staples out by hand Sue ordered a straight shaft staple remover that is simply "pushed" under a staple to pop them out. To put staples in Sue was provided with an electric stapler that automatically stapled any papers put under the head.
These changes all helped to reduce the strain of her job, but Sue also needed someother tasks that were less hand intensive. The employer responded by enlarging her job so she could temporarily rotate to other work areas with fewer demands on the hands and lower arm.
The common threads in ergonomic adaptations for individuals with special needs are to involve the individual, identify the ergonomic risk factors they are exposed to (Force,Repetition, Posture), and identify ergonomic changes that are necessary to improve those risk factors. Identify the issues and then look for design and work practice changes to correct the problem. The Ergonomics Consortium has materials and an expert staff available to help you if needed.