A Gen X Plague?

RSI. They're just three little letters, but over the past semester, they have been striking fear in the hearts and pain in the hands and wrists of countless students.

Suddenly, hand braces seem a la mode. People don't ask anymore when they see friends with braces on both wrists. Repetitive Strain Injury, or RSI, has become a way of life for many Harvard students. For others it is a common ailment they hope to avoid.

For many students who either have or are concerned they may be developing RSI, the first place they turn for help is University Health Services (UHS).

But some students who have been treated at UHS have expressed concerns about the quality of RSI treatment and prevention efforts.

While UHS officials said they have been working hard to educate students about RSI prevention as well as providing quality care for those students suffering from RSI, some students have said UHS has not done enough.

UHS officials agree, and over the past year they have been stepping up efforts to improve all aspects of RSI care, including physician education, prevention seminars and more accessible physical therapy.

In an effort to learn more about the relatively unstudied syndrome, the University is also sponsoring an interfaculty program to study RSI at Harvard.

Symptoms and Causes

RSI is frequently associated with such activities as typing, something that many Harvard students spend much time doing, especially near the end of the semester when most papers and final projects are due.

Students who suffer from the most extreme cases of RSI describe being unable to open doors, or even eat without intense pain.

Chief of Medicine at UHS Christopher M. Coley said during the peak times around reading period and final exams, between 12 and 14 students visit primary care physicians at UHS each day complaining of symptoms of RSI.

Students in some departments, such as Computer Science (CS), come down with RSI most frequently. After "assignment eight" this fall in CS 50: "Introduction to Computer Science I," several students complained the length of the assignment caused them to come down with RSI.

Both the signs and the severity of RSI can vary from case to case, but the most common symptoms include pain and tingling in the hands, wrists or arms.

According to the Harvard RSI Action Web Page (www.eecs.harvard.edu/rsi), a page put together by students at the Graduate School of Arts and Sciences (GSAS), RSI can be potentially debilitating, causing long-term soft tissue damage if not treated early.

Those suffering from RSI often find they have to either limit or completely stop engaging in such activities as typing or writing which could cause further damage.

The current generation of students is more at risk than others, Rosenthal said.

"It's a problem that's increasing as more and more people use computers for everyday things," Rosenthal said. "More and more people are now bringing [computers] into the classroom to take notes."

Rosenthal said when students wrote their papers using typewriters, the carriage stage at the end of each line of type provided a momentary relief for their hands which helped prevent injury.

"Now you can just type with your hands in the same position for hours," he said.

Getting Help

Coley said the normal procedure at UHS is for students to be seen first by a primary care physician. Depending upon the severity of a patient's symptoms, the primary care physician will either refer the patient to a specialist or to a physical therapist.

Those students with very minor symptoms or general concerns are directed for the Center for Wellness and Health Communication (CWHC) located on the second floor of UHS.

According to CWCH Manager Christine A. Hollis, the center can provide patients with information on the syndrome and also offers RSI workshops which focus on prevention as well as help for those students already afflicted.

But, according to RSI Action Vice President Joshua T. Goodman '92, a current GSAS student, the CWHC pamphlet which was distributed to all first-years and some GSAS students at the beginning of the year needs to be updated to include more recent findings on RSI.

While Goodman said UHS' treatment of students suffering from RSI has "actually improved somewhat over the past few years," he said UHS still needs to do much more.

"My single biggest concern is the level of education," Goodman said.

A Rough Road to Recovery

But for those students who already have RSI, the issue is the quality of treatment available for UHS patients.

For many RSI sufferers, their experience at UHS has involved primary care physicians with little knowledge about RSI.

And students with RSI treated at UHS said they waited about a month for a physical therapy appointment.

Janet E. Rosenbaum '98 developed RSI during the final exam period last semester and sought treatment at UHS. She said the primary care physician she saw on her first visit was not that helpful, but did give her a referral to a specialist.

When she finally got to physical therapy after a month's wait, Rosenbaum said the specialist "seemed generally helpful" and suggested she lighten her back-pack and do certain stretches.

But she said she found much more effective treatment at home with a different doctor over spring break. The doctor at home specifically diagnosed her problem.

Rosenbaum said her new doctor also informed her that "some of the stretches [the physical therapist at UHS] had prescribed weren't good for me."

She said she does not fault the UHS specialist for not having a detailed understanding of RSI, because the syndrome is relatively new. "I think [the treatment at UHS] is about as effective as you might expect," she said.

But she noted that each of the eight other RSI sufferers she knows has sought additional treatment off campus.

Clayton D. Scott '98 is much more critical in his assessment of UHS.

A patient at UHS for eight months, Scott said his condition did not improve, despite the fact that he stopped typing and regularly attended physical therapy.

"I was getting the exact same treatment every time I went in, and it wasn't working," Scott said.

After taking his case to Rosenthal, Scott was transferred to an outside doctor at the Spaulding Rehabilitation Center in Medford, Mass. Scott said he has made noticeable improvements since starting his treatment at Spaulding.

"I'm positive that would not have happened if I had stayed with UHS," he added.

But not all RSI patients treated at UHS are dissatisfied.

Rachel W. Podolsky '00 said despite a long wait for her initial physical therapy appointment, the treatment she has received has been quite good.

"I respect my physical therapist a lot," she said. "He really knows his stuff."

And although Roanak V. Desai '00 noted he had to wait for a physical therapy appointment, he said his UHS primary care physician was quite helpful in diagnosing and explaining his ailment.

Working to Improve Care

Practice Manager for Surgical and Dental Services Laura L. Doyle said UHS is aware of complaints about long waits for physical therapy appointments and has been working to improve the situation.

According to Doyle, while the waits for appointments were as long as three weeks in January, since then UHS has hired additional physical therapists and increased its hours.

Therapists do have room in their schedules to accommodate patients with serious cases who need to be seen immediately, she said.

Doyle admitted that there is still room for improvement. "I still think [the wait time] is probably not good," she said.

Patients who feel they are not getting the care they need can always turn to UHS Patient Advocate Kathleen Dias.

Dias said while she does occasionally get complaints about service from students, usually those complaints are not from RSI patients.

A Broader Problem

According to Coley, patient complaints about physicians' limited RSI knowledge reflect a gap in the field of medicine in general, not just at UHS.

In discussing the treatment of RSI at UHS, Coley emphasized the fact that little research has been done on RSI.

"There are a lot of orthopedists and rheumatologists who believe this doesn't exist," he said.

While some similar phenomenons like carpal tunnel syndrome are well-documented, Coley said "almost all students coming in with upper extremity symptoms do not have carpal tunnel syndrome."

"We see an awful lot of people who have some vague symptoms," which are not necessarily associated with a pinched nerve as in carpal tunnel syndrome, Coley said.

Because RSI is so under-researched, Coley said it is unclear which treatments are actually effective.

In an effort to further the understanding of RSI, Harvard has sponsored an interfaculty study of the syndrome.

According to Jeffrey N. Katz, leader of the study and a doctor at Brigham and Women's Hospital, the effort will focus on what makes the students' experience with RSI unique and will be aimed at finding treatments that work and identifying barriers to prevention.

"The students' experience is fascinating," Katz said. "We don't know much about it yet."

He said since people tend to be more susceptible to tissue problems when they are older, the frequency of RSI among undergraduates is surprising.

Katz added that it is unclear how to provide rehabilitation for students with RSI. Workers tend to have disability insurance and worker's compensation plans that allow them time to recover from RSI as well as make rehabilitation programs available.

"That's a security that students don't enjoy," he said.

Katz's study, funded by a grant from the provost's office, will bring together focus groups of students and staff who have and have not had RSI.

In addition to the research efforts, Coley and Hollis said they are working on increasing UHS physicians' understanding of RSI.

Earlier this year Coley invited Emil Pascarelli, M.D., co-author of Repetitive Strain Injuries, a Computer User's Guide, to speak to UHS physicians.

UHS has also brought two speakers on RSI to weekly "grand rounds"--meetings which most physicians regularly attend in order to meet recertification qualifications.

Coley said UHS has also been working to heighten campus awareness about RSI in the hopes that students will make the necessary changes in their work habits to prevent RSI.

"People don't listen and pay attention if they feel completely well," Coley said, adding that he believes UHS has done well if a student with the early stages of RSI comes in because of outreach efforts.

Despite all of UHS' recent efforts to increase RSI awareness, both Hollis and Coley agree that more needs to be done.

"We're doing a fair amount, but I'm hoping that we will do more next year," said Hollis, mentioning plans for more workshops and media campaigns.