Is Speech Recognition Improving Ergonomic Isuses?

Vol. 18 •Issue 4 • Page 12
Is Speech Recognition Improving Ergonomic Isuses?

Speech recognition technology may improve ergonomics, but only if you’re willing to embrace proper ergonomic techniques.

This is the way you sit. This is the way you’ve always sat. This is where your monitor’s been since you got it, and it isn’t moving. Yes, your mouse goes there—it always has; why change what works? Your squeaky, floppy 10-year-old office chair, now worn down to include a perfect groove for your back and backside, is perfectly comfortable. It’s not going anywhere, and unfortunately, neither is that nagging back pain that’s been keeping you up at night.

You’re an MT set in her ways—or are you? You remember transcription belts (and you had one!) and you have spent time painstakingly splicing busted tapes. Now you’re using digital technology, and you just found out that soon you’ll be trained on speech recognition. Over the years, the way you work has changed dramatically. But has your workstation?

Speech recognition (SR) may have a positive impact on musculoskeletal symptoms. SR involves less keyboarding and reduces repetition, which makes it easier on the hands. The technology allows for more time to pause the muscles in the forearm and shoulders, which can also reduce risk for musculoskeletal disorders.

If you begin your career as an editor with the same bad ergonomic habits you had when you were an MT, however, you could miss out on any potential ergonomic benefit that editing may provide. When you’re preparing to make the change to speech recognition, capitalize on the potential ergonomic advantages by making positive changes. You’re already getting used to something new; it’s the perfect time to make all those ergonomic adjustments you’ve been meaning to make all those years.

The Barriers to Change

Changing the way you work might not be easy, especially if you’ve been transcribing for many years, according to Brett Frankenberg, PT, CAE, physical therapist, certified associate ergonomist and independent ergonomics consultant, San Diego. If long-term damage exists in your arm, neck or shoulder, making positive ergonomic decisions may not have an instantaneous effect, Frankenberg said. Along the way, your bad habits may have led to coping strategies–your muscles compensated for your slouched posture or your non-supportive chair, and coping can put you at risk for injury. Changing your ergonomic set up will take those coping strategies away, but only with a little self-discipline.

When you’re used to slouching, sitting up in the proper posture can feel very uncomfortable. Frankenberg often finds people resistant to ergonomic changes because they might feel a little bit more pain than usual in the short term. Keeping the long-term benefits in mind is key, along with accepting the change and the need to change. If you’re planning to alter your ergonomic work style, then be prepared for some possible discomfort, and don’t expect any pain that you’ve been experiencing to vanish overnight. Know what to expect and be prepared. “The sensation that people have been made used to feeling is not changing, and if they’re not prepared for that, then they’ve had it–they get scared, and rightfully so,” Frankenberg said.

Reap the Benefits

Even if there might be a period of being uncomfortable involved, changing ergonomic habits obviously has its benefits. MTs are open to risk factors like static posture, awkward posture and possibly contact stress, Frankenberg said. An example of contact stress is resting forearms at a right angle on the edge of a desk while sitting at a computer. Contact stress can occlude blood flow to the distal hand and fingers and deprive the muscles there of the fuel they need to operate consistently.

Postural risks are usually the most dangerous, however. The results of these risks can include shoulder, neck, eye and back strain as well as headaches. The risks can also lead to a host of diagnoses of musculoskeletal disorders including carpal tunnel, tendonitis and rotator cuff injuries, among others, Frankenberg said. While SR editors may still face ergonomic risk, they may be better off than MTs doing straight typing.

Less keying means less hand fatigue. Your wrists, arms and shoulders needn’t be stuck in a static position. You might use the mouse more, but that’s not necessarily a bad thing, according to Frankenberg, as long as you’re using it correctly (see sidebar). The repetitive nature of straight typing, as opposed to the less physically taxing SR editing, does not allow the body much time for recovery. “Continuous typing involves repeating the same task over and over again to the point where you’re not allowing the physiological processes of recovery, which is driven by circulation and blood flow, to establish themselves, and so as a result, you have a change of metabolism at the cellular level, and that creates risk,” Frankenberg explained.

Cindy McCoy, an MT with a medical transcription service organization, Deventure, Canton, OH, has worked as an MT for more than 25 years. Four years ago, she became an editor, switching to speech recognition. McCoy considers herself lucky because she was never plagued with musculoskeletal disorders, but she still finds speech recognition less physically taxing than straight typing. “I can see where it definitely eases up on your keystrokes,” McCoy said.

Patricia Walinski, who edits using software from eScription, Needham, MA, is in the same boat as McCoy—she never had any serious musculoskeletal disorders, just the “typical aches and pains.” When Walinski, who began her transcription career in 2002, took her job as a speech recognition editor 3 years ago, she did feel her achiness ease, but that may also be because Walinski changed her ergonomic habits when she began editing. Walinski had previously been a reporter, so becoming an MT was a complete lifestyle change. She had previously been up and about, but now found herself static for 6-8 hours at a time. When she landed her gig as an editor, she decided to make a change. “At the time I didn’t have proper tools in terms of a really good ergonomic station with a good chair and a good desk, so when I started with eScription, that’s when I said, you know what, I have to have a whole change of how I do this,” Walinski explained.

It’s Up to You

Like Walinski, many MTs and editors work from home. They can set up their at-home workstation any way they see fit, and generally they get little guidance from their employer when it comes to ergonomics. Jay Vance, CMT, president and CEO of Vance Digital, Yuma, AZ, works with small medical transcription service organizations who are using SR or who are thinking of making the switch to SR. He doesn’t see ergonomics as a big priority in a lot of companies. “Transcriptionists to a great degree are kind of on their own in terms of finding a good combination of workstation set up, monitor placement, keyboard, chair, all sorts of things,” Vance said.

Editors might at times be on their own when it comes to certain aspects of SR training, as well, Vance said. SR vendors sometimes skimp on training that could help make editors’ lives easier while having the additional benefit of improving an editor’s ergonomic situation. According to Vance, trainers sometimes skim over or ignore teaching keyboard shortcuts. With the shortcuts, editors can avoid the constant back and forth between the mouse and keyboard, which could lead to ergonomic risk, and Vance said most platforms allow the use of such shortcuts.

If the platform has the audio player built into it, an additional set of keyboard shortcuts could control the playback and supplement the use of the foot pedal, as well. “One of the things that I have encountered from one facility to the next and even from one transcription company to the next, not all of the transcriptionists and editors are familiar with the keyboard shortcuts that are available,” Vance said.

Vendors who don’t cover the keyboard shortcuts during SR training might include the shortcuts and other productivity tips in documentation, Vance added, but the documentation might be hundreds of pages. “You’re not going to be able to give a transcriptionist—who’s working on a deadline already—hundreds of pages of documentation and say, here, go through this, learn all this, and in the meantime you still have to meet your quota,” Vance said.

With keyboard shortcuts, Walinski is lucky. eScription offers training in feature usage and shortcuts that are proven to increase productivity and help the editors become less dependent on the mouse. She admits that she does use the mouse for a few things, but she now relies almost entirely on the keyboard alone. “I’ve realized that the more I do this, you really don’t need the mouse,” she said. “Everything is completely on that keyboard.”

If you’re not familiar with the keyboard shortcuts, sometimes called hotkeys, check with the platform you’ll be working on. Many use the Word hotkeys, Vance said, so you may already be familiar with some of the shortcuts. And if your platform has an embedded audio player, see if you can work on eliminating the use of the foot pedal as well so you can keep those feet flat on the floor.

A New You

While some MTs will eagerly toss that mouse out of the closest window and embrace SR training and their new roles as editors, others will be more resistant to the change. If SR’s already in your department or company or if it’s coming soon, there’s not much you can do to stop it. You do have control over your workstation, however, and if you’re not already practicing proper ergonomics, you may potentially feel some benefits of the switch to SR.

If you haven’t given a thought to your ergonomic well being, maybe it’s time to start thinking about it whether or not SR is on your horizon. A new chair, a keyboard tray, a repositioned mouse or monitor or an ergonomic keyboard may take some getting used to, but keep the long-term benefits in your sights. You can find tons of information online about ergonomic basics, but be sure to choose a reputable Web site such as

And while SR might have certain ergonomic benefits, it won’t make much of a difference if your workstation isn’t already set up in ergonomic fashion. Frankenberg is happy that the level of awareness of ergonomic issues has risen in the past few years, but many employees haven’t considered ergonomics when they set up their workstations, and when they do consider it, it’s already after they’re experiencing pain. The key to SR ergonomic benefits lies in how it is handled. “I do think [SR’s] a good thing overall, but like any change, it needs to be rolled out in the right way, and that includes employee education and coping strategies,” Frankenberg said.

Lynn Jusinski is an assistant editor with ADVANCE.

Making the Most Out of Ergonomics

No matter what your profession, if you work in front of a computer all day, you should be aware of some ergonomic techniques that can help ease those aches and pains. Here are some general ergonomics tips.

The mouse trap: Kicking the mouse to the curb and learning to use keyboard shortcuts can reap ergonomic benefits because many people don’t know how to use a mouse in ergonomically correct fashion. If you must mouse, though, Brett Frankenberg, PT, CAE, physical therapist, certified associate ergonomist, independent ergonomics consultant, San Diego, provided tips on clicking correctly. “You always want to keep your elbow at your side, not out in front of you toward the screen, and not out to your side, away from your body, because that will force you to use your muscles to support the weight of your arm against gravity, and once those muscles fatigue, you’re going to start to compensate by changing your shoulder posture, and that puts the whole shoulder girdle at risk,” he explained.

OK, but what’s it for?: Some employers provide ergonomically friendly furniture and devices to help keep their employees healthy. That’s great, but it doesn’t matter one bit if they don’t know how to use it, Frankenberg said. The same goes for you personally. If you go out and spend lots of money on some new ergonomic gear but don’t know how to properly use it, you might not see much benefit.

Think outside the box: While that discount chair you picked up at the big box store may have been a steal, it might not be the best ergonomic choice. When Patricia Walinski, an MT who edits using software from eScription, Needham, MA, began her editing job, she made a choice to make her workstation more ergonomic. “Just sitting all day, it wears on you,” Walinski said. “I alleviated a lot of that by not buying a chair from a retail store, and instead getting a chair from an actual furniture store that was a computer chair.”

Gimme a break: Many MTs work on production, which may make it much harder for them to take a break every now and then. New MTs especially may find themselves glued to the keyboard. Walinski reflected on her time as a newbie: “I was typing furiously, and I know I was probably sitting wrong,” she said.

She also found herself absorbed in her work and determined to meet quota, and that meant few, if any, breaks. Now, Walinski makes an effort to take breaks to get herself moving. While SR editing may have a slight ergonomic edge on straight typing, it still has the editor sitting at a computer, and Frankenberg pointed out that editors may find themselves at more risk for eye strain than would a regular MT. Breaks prove helpful. Many ergonomists recommend the 20/20/20 rule: every 20 minutes, take a 20 second break and focus on a spot 20 feet away.

–By Lynn Jusinski

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