The MouseKeyDo System: Research and Development

Computing Without Pain With the MouseKeyDo System

Research & Development

What is the MouseKeyDo System?

The MouseKeyDo System is a health and safety training program developed by Dr. Norman Kahan to specifically address and prevent computer-related repetitive stress injuries (RSI). Based on clinical practice, research, and scientific methodology, the System includes an interactive manual and CD-ROM that teach a complete set of techniques for workplace setup, sitting, mousing, keyboarding, and laptop use. The program is self-guided and fully portable, making training completely flexible and relatively inexpensive.

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On what is the MouseKeyDo System based?

A significant amount of computer-related RSI is caused by improper work habits and poor computer operator technique, despite a well-designed ergonomic office environment (Punnett, 1994). The MouseKeyDo System is designed to address the factors beyond office equipment that cause and exacerbate RSI.

The program was founded in part through Dr. Kahan's experience working with patients in computer-centric Silicon Valley, where RSI is a common work-related complaint. His personal experience learning to play piano also significantly influenced the program's keyboarding techniques. His research is summarized in a "live," 47-minute PowerPoint presentation developed by Dr. Kahan, which he presented at a medical conference for the physician community at El Camino Hospital in Mountain View, California. Much of the development process is summarized in a two-part article Dr. Kahan wrote for the professional journal Occupational Medicine about the causes of RSI, guidelines to prevent it, and corrective measures to alleviate it. You may download the "live" PowerPoint presentation and both parts of the article from this website (requires Adobe Acrobat Reader).

"Computing Without Pain Live: Demonstrating a New Technique for the Treatment of Computer-Related Repetitive Stress Injuries (RSI)," a 47-minute PowerPoint presentation with audio, presented and developed by Dr. Kahan, which summarizes his research (Note, this link will take you to another website. For best quality, select "Microsoft Office Live Meeting Replay" option).

"Technique Addresses Computer-Related RSI, Part One." Clinical Care Update: Occupational Medicine, Volume 8, Number 17, March 11, 2002.

"Technique Addresses Computer-Related RSI, Part Two." Clinical Care Update: Occupational Medicine, Volume 8, Number 18, March 25, 2002. [link to PDF]

In addition, Dr. Kahan drew from more than 50 years of research into ergonomics, orthopedics, and physiology. A list of more than 150 references is available here.

Has the MouseKeyDo System been studied for efficacy?

Researchers have conducted a three-phase investigation into the MouseKeyDo System.

Phase I evaluated the treatment outcome of 102 workers' compensation claimants who underwent individual MouseKeyDo training in a clinic-based setting.

Phase II evaluated the training experience of 81 injured employees who received MouseKeyDo training through a worksite-based group intervention program. Each was evaluated before, immediately after, and 1.3 years after the training.

Phase III further evaluated seven subjects from Phase II by examining muscle activity (as measured by surface electromyography (surface EMG) and joint ranges of motion in the upper limb and neck while they used a keyboard and mouse. Subjects were simultaneously measured for all variables both before and after the training, correlating pain and function.

Phase III subject fitted with surface EMG recording electrodes. Each strap secures two electrodes on the skin surface of the arm and one over the trapezius muscle.

An occupational therapist certified in hand therapy uses a handheld Goniometer to measure joint range of motion on a Phase III subject.

What was the outcome of the study?

The percentage of patients reporting less pain and the same or better function immediately after undergoing MouseKeyDo training, by group:
Phase I - 85%
Phase II - 89%
Phase III - 100%

Among subjects in Phase I and Phase II:

On average, patients in Phase I reached maximum medical improvement and were declared "permanent and stationary" at six months. After training, the average time a patient could work on a keyboard increased by one hour. Those completely unable to type due to pain before training could type for 3.6 hours after training.
Group training in Phase II was as effective as individual training in Phase I and improved group satisfaction at the worksite.
Phase II participants reported persistence of skill, less pain, and the same or better function at 1.3 years follow-up.

Patients learned the MouseKeyDo System 50 to 75 percent faster using the manual and CD-ROM than without.

Among subjects in Phase III:

Every patient reported less pain in all body parts recorded -- neck, forearm, and wrist -- after training.
Surface EMG decreased in the wrist and forearm muscles after training
Surface EMG increased in the neck, scapula, and trapezius muscles after training, without increases in neck pain.
Joint range of motion changed toward mid-range, with wrist, elbow, and shoulder joints working collectively in the middle (most comfortable) of their full or capable ranges of motion. Patients avoided extreme angles, such as twisting the wrist sideways or reaching from the shoulder, achieving motion at the lowest level of joint stress and muscle tension.

Where can I find more details of this study?

Complete details are available in a two-part article published in the journal Occupational Medicine. You may download both parts of the article from this website (requires Adobe Acrobat Reader).

"Outcomes of Mouse-Keyboard Training, Part One." Clinical Care Update: Occupational Medicine, Volume 10, Number 15, February 9, 2004.

"Outcomes of Mouse-Keyboard Training, Part Two." Clinical Care Update: Occupational Medicine, Volume 10, Number 16, February 23, 2004.