arganoid | RSI: The Non-Early Months

Before I begin this part of my story, I'll briefly describe two types of RSI symptom which I forgot to mention last time. First, there are what I call "nerve spikes". This feels like a burst of electricity suddenly lighting up the entire length of a nerve for a brief moment. This is obviously quite disturbing, but fortunately I haven't had this sensation for a long time - perhaps not since late 2007. The other symptom is a "nerve jolt". This is a sensation generally felt in the fingers or fingertips - it feels like the nerve has suddenly moved slightly. This usually happened to me when pulling on the heavy door handles at my local swimming pool, although it also happened on two occasions when doing a particular physiotherapy exercise. Again, these have not happened for a while. Now, on with my RSI story:

By the beginning of February 2008, my RSI had greatly improved, at least in the sense that I no longer got the various pains, aches and tingling symptoms as often as I had a few months back - and when I did, they were less severe than they had been. However, I was still not spending much time on the keyboard and mouse - I didn't need to as I was doing most of my work using speech recognition.

However, I was increasingly having problems with my voice becoming tired, to the point where I felt able to use speech recognition less and less. The full details of my voice problems will be discussed in a future part; here, I will talk about how this development affected my RSI.

(Edit: Oct 2014 - I failed to mention at this point that I went off work sick in Feb 08, due to the combination of RSI and voice strain)

Speech recognition, despite its many drawbacks, had been my lifeline. Without it, I wouldn't have been able to work for the last few months. When my voice problems became bad enough, it was clear that I simply couldn't use it any more. I was back to being reliant on using my hands for computing. I was also reluctant to speak to people, since I wanted to rest my voice as much as possible - so I was now reliant on email and texting to have any form of communication with other humans. As previously mentioned, my RSI symptoms where a lot better than they had been, so I felt quite confident about my ability to increase the amount of typing I was doing - which is exactly what I did. I had a day or two in which I wrote a few emails and spent a small amount of time using instant messaging. It felt great to be able to type again rather than being tied to the cumbersome and tiring speech recognition software.

Unfortunately, it turned out that I had over-exerted myself. I simply wasn't ready for that amount of keyboard use, and I soon felt the consequences. Within a few days my symptoms had got much worse, partly in the form of high levels of weakness. I wondered if I had set back my recovery by months.

Just before the voice problem had got bad, my physiotherapist had advised me to begin "keyboard training", in which I would do a brief bit of full-speed typing each day. I would start at doing one minute per day, the idea being to gradually increase this in small increments so as to gradually build up my endurance and find out what my level was without overdoing things. Looking at my records, this started on the 2nd of February, and I did one minute of keyboard training for the next few days. It looks like I had difficulty even with that small amount, since my records show increasing gaps in which I didn't do keyboard training for days at a time. The over-exertion I described in the previous paragraph occurred on the 25th of February, when I had spent perhaps a total of 20 minutes typing (although not all in one go). Following that, I took a break of about two weeks, and then started again at one minute - occasionally increasing to 1m 30s, but it looks like this once again caused my symptoms to increase since there followed another gap of about a week in which I mostly stopped altogether. From that point onwards, I did manage to do it each day, but felt unable to increase beyond 1m 30s. By this point it was approaching the end of April. I had been off work for two months, yet my ability to type seemed to be showing little or no improvements.

There was, however, one small reason for optimism. A while back I had managed to swim 15 lengths in 15 minutes, which I regarded as quite an achievement given that a few months before that I couldn't swim half a length without stopping. My swimming ability continued to slowly improve. It was only around the end of April that I actually started writing down the results of my swimming sessions, but they show that by that point I had reached 25 lengths in 25 minutes. Although I was going swimming every day, on the advice of my physiotherapist I would only push myself hard on alternate sessions, so that I would not over-exert myself. My improvements weren't always steady - on achieving a new high, it would often be a while before I could reach that level again. However, I was very encouraged at the rate I was able to improve my records - 30 lengths in 30 mins followed within two weeks.

Another reason for optimism became apparent in early April. I had recently watched a documentary about Stephen Hawking. He controls his computer using only the movements of a single cheek muscle. This got me thinking - there must be some way of typing that is part-way between what Hawking does and what an able-bodied person can do. After all, I can use much more of my body than he can, so there must be some kind of innovative system out there which could help me type. I got onto Google and had soon found exactly what I was looking for: Dasher. This program is hard to describe - I recommend looking up a video of it on YouTube (or even downloading it, given that it's free), but essentially it allows you to type at a surprisingly high speed using a mouse pointer. It also has alternative input methods for people who can't use any kind of pointing device, but those methods are a lot slower. I tried it out and was able to get the hang of it very quickly (although it helped to watch some of the instructional videos on YouTube). Soon I was using it to write emails and use online chat. One advantage of Dasher is that while typing you don't need to use the mouse buttons, which reduces the strain. However, it seemed unlikely that I would be able to use it for hours every day - using the mouse obviously involves a lot of hand and arm movement, which is a problem for many people with RSI. Therefore, I started looking into alternative pointing devices. I read about various systems such as eye trackers, head mice and foot mice. Eye trackers were prohibitively expensive, and I had heard that foot mice could lead to back problems, so I focused mainly on the head mouse, which moves your mouse pointer by tracking a reflective dot on your forehead.

I spoke to my physiotherapist about head mice, and she told me about a patient she had seen who had developed problems with his neck after about 6 months of using one. However, the time he spent using the device allowed him to gradually recover the use of his arms for typing, and the neck problems apparently went away once he stopped using the head mouse. I arranged an meeting with work, and ordered a head mouse (the SmartNav 4) so I could try it out. I felt that the combination of the head mouse and Dasher would be enough to save me from my predicament.

The meeting with work did not go as I'd hoped. They were completely opposed to the idea of me using a head mouse, mainly because it was 'experimental technology', and because of the risk of causing neck problems. They also expressed doubts as to whether I actually had RSI at all. Their argument was that there were other people at the company who have RSI who were still able to work. I got the impression that since they hadn't seen an RSI case as bad as me before, they didn't even know that RSI could get that bad. It was even suggested that I might have Motor Neuron Disease. They asked me to see a specialist so that I could be checked for other conditions. They also stated that they wanted me to come back to work using my hands (which clearly wasn't going to be possible for the foreseeable future). Their blanket ruling out of any alternative hardware (even if used for only a limited time per day) made no sense to me - surely each technology should be judged on its own merits?

I soon received the head mouse that I had ordered, and after a bit of practice found it to be reasonably usable with Dasher. However, having spoken to a number of people about it, I became increasingly concerned about the possibility of overworking my neck muscles. Given that tension in the neck was suspected of being a major factor in both my RSI and voice strain, I stopped using the head mouse. However, I did continue to use Dasher with the mouse on a regular basis.

Around the end of March, I had started monitoring the amount of typing I did, using the program "Desktop Counters". Another program which can be used for this purpose (and which tracks more stats) is RSIGuard, although this costs money. Looking back, I wish I had started tracking this information all the way back when I first got RSI, or even earlier. This information has been very useful in tracking my progress. My stats show that on the 19th of March, I made approx 1200 keypresses and 220 mouse clicks. For a long time these stats didn't change much. Sometimes I would be able to do just over 2000 keypresses in a day, but my symptoms would get worse and I would cut back my computer use again. By the start of May, it seemed I was barely able to do any more work on the computer than I had been in March, with my keyboard training on a paltry 2 minutes. The improvements in my swimming ability didn't seem to be translating into improvements in typing ability.

In the first few days of May, I felt increasingly weak. I started cutting down on swimming, keyboard training and my various other physiotherapy exercises. It got so bad that I decided to start recording how bad my symptoms were on a daily basis. On the fourth of May I rated myself as 4 out of 5 for weakness - meaning that it was almost the worst it had ever been. For the next week or two, I continued to remain at a low level of activity. The weakness mostly went away, but I couldn't see any prospect of my typing ability improving.

Things were looking pretty bleak. I expect you'd like to find out what happened next, but this part is getting a bit long, so I'm going to split it into two. It's like a cliffhanger, only more tedious due to centring on stats like keypresses per day and weakness ratings out of 5.