The first time I saw the occupational therapist about my shoulder, she went through an amazingly long list with me. The list can't really be called "What Do People Do All Day?" Do I do this and that? Do I need help with it? Does it hurt? How much of a problem is it? Some things (child care, gardening), aren't problems because I'm not trying to do them. Others (walking, putting on shoes), aren't problems because they're easy for me. I knew I was doing better since the summer, but I still sort of surprised myself when I said laundry and grocery shopping were only a little challenging...this spring and summer, they were much more difficult. I asked for help with driving. The fact that driving makes my pain so much worse makes everything more difficult. This is supposed to be the sort of thing OT can help with, and I've brought the car to several appointments in the hope we would be able to work with it. (There hasn't been time. Recent visits to the clinic have been deeply fraught.)
The OT asked if I used a computer a lot. (Not compared to most of my friends, but I suppose some people would consider it a lot.) According to all the best practices of occupational therapy, this is a Problem that should be addressed with Proper Ergonomic Body Mechanics. It doesn't feel like a problem. When I just use my laptop on a table, with improper body mechanics, it doesn't aggravate any of my pain problems. Not even when I use the computer all day. That's why I bought the laptop in the first place. Using a mouse is just terrible for my hand pain, and most auxiliary monitors are migraine triggers. I'm aware of those problems on a fairly short time scale (5-10 minutes for the mouse, usually less for the migraine triggers).
According to the OT, good body mechanics require having the computer monitor at eye level and the keyboard low enough to type with forearms parallel to thighs. Obviously, this isn't possible while looking at a laptop screen and typing on the same laptop.* According to the OT, any other position is bad for a person's neck and back. Even though I am not aware of any short-term correlations between shoulder pain and computer use, unnecessary strain on my neck and back are unlikely to do my shoulder any good in the long run. So I am trying hard to follow her suggestions:
1) I elevated the laptop so the screen is approximately at eye level. I try to increase text size instead of leaning forwards to see things.
2) I bought an extra keyboard to plug into the laptop. It's this thinghttp://www.amazon.com/Microsoft-Digital-Media-Pro-Keyboard/dp/B0002CPBUK
which has an extra row of keys for keyboard shortcuts. I know there are users who find it not only tolerable but actively useful (because more than 100 of them posted to Amazon), but it's driving me crazy. The keyboard driver slows down the whole computer like it's telegraphing Redmond for permission to display each letter I type on the screen. The added function keys are for things I haven't used in the last 2 weeks, or for things like "open web browser," which hadn't been a navigational problem before. The trade-off is that the labels "F1", "F2", etc are small and almost illegible, under the keys instead of on them. And that the keyboard shortcut I used to rely on (F5=screen refresh) does not work anymore.
3) I plugged in the auxiliary touchpad I bought in order to use with desktop computers at work. It claimed to work as a simple touchpad if you just plugged it into a USB port, but more elaborate functionality was available if you installed the driver from the CD. No such luck. http://www.cirque.com/cpages/?page=23
Just plugging it into the USB port makes it work like an inert piece of plastic. I've disabled most of the elaborate touchpad functions, but the driver still slows the laptop down even worse than the keyboard alone.
I hadn't appreciated how much of the reason I valued my touchpad before was that I could use it in a central position, with both hands. I don't mean with either hand--most pointing devices advertise that users can set them up for right or left hand use. I mean BOTH hands. When I was mostly using my right hand, I'd sometimes bring in the left for a moment to push a button. Or when I was mostly using the left hand, I'd bring in the right to manipulate the cursor through something fiddly. It happened so easily, without pause or profanity, I hardly noticed I was doing it. But now I have a touchpad I can put to the left or right of my keyboard, and it matters. (Because both sides are wrong.)
4) Most of the time I'm online (ie, most of the time I use the computer) involves websites set up to require frequent touchpad or mouse use. I don't know how to avoid this.** Sometimes I use the auxiliary touchpad, which twists on its cord so often I need to look down and orient myself to it. Sometimes I reach up to use the touchpad in the laptop, which is at an inconvenient level, but is at least central
so there's no lateral strain in reaching for it. And it keeps itself stable. Either way, I need to look down at the keyboard to find my place again, even after just using the touchpad very briefly.***
5) This setup is a lot less comfortable than what I was doing before. It's so bad for both my shoulders**** that I've been avoiding the computer, which is terrible for my job search as well as my social life. I know this is really trivial, as adaptive technology goes, even as OT goes. But it's enough of a change from what I'm familiar with that I'm having real trouble with it.
* Is it possible to connect two laptops, using the input devices from one and screen from the other? With the processor and memory from the one providing input devices, or from whichever is more powerful?
** I use Hotmail, which is profoundly cursor-driven. One can't even delete a message, or read the next one, without clicking a box. I started using Hotmail because of the ease of reading mail from different computers, and that's still valuable to me. Now it's important to me to maintain that email address because it's on my business cards and resumes, and I want to be reachable through it. Still, the GUI is becoming problematic...is there a way to read Hotmail through another mailreading program?
Is it possible to program keyboard shortcuts to navigate websites like CareerBuilder? The hundreds of variations of BrassRing? (Every large corporation seems to have their own, these days.) What about those popup windows that ask if you want to [Continue] or [Cancel]? (where no part of either word is emphasized in any way.)
*** Having the keyboard in that little drawer under the desk makes it hard to see at night, because the desktop shades it from the lamp on top of the desk. (I don't want to put a floor lamp right behind my chair, because I'd knock it over when I stood up.) Is this a solved problem, or is the Proper Ergonomic Solution to only type in full daylight? Or in rooms with overhead lights (presumably not in New England apartments. This problem has almost certainly been addressed before.)
**** When I say it's bad for my shoulders, I'm talking about a time scale of hours and days. The OT says it will be good for my shoulder on a time scale of months and years. That's why I haven't given up on the whole thing already.