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Stretch Break
For Kids

In this Wire Side Chat, Dr. Karen Jacobs, a clinical professor of occupational therapy and a recognized expert in the fields of ergonomics, discusses Stretch Break for Kids, a free software program designed to help children avoid injuries associated with computer use, and offers tips for preventing repetitive strain injuries (RSIs) in kids. Included: Tips for preventing RSIs and information about Stretch Break's adult version.

Stretch Break for Kids, a software program published by Para Technologies and offered free to any K-12 student or school, is designed to help kids avoid the kinds of repetitive strain injuries (RSIs) that plague so many adult computer users. The program, which offers a choice of 20 stretching exercises, provides written directions and computer animations for each stretch. Kids choose the stretches and number of repetitions they want to perform, select the desired time interval between stretches, and follow along when Stretch Break appears on the screen. Also included in the program are Ergo-Tips on workstation design, posture, keystroke shortcuts, and techniques for ergonomically safe computer use. In this Wire Side Chat, ergonomist Karen Jacobs, discusses Stretch Break for Kids and offers additional tips for parents and teachers concerned about preventing RSI in young computer users.

Dr. Jacobs is a clinical professor of occupational therapy at Boston University, a board-certified professional ergonomist, a prolific researcher, a widely published author, and a recognized expert in the fields of occupational therapy and ergonomics. She served as consultant in the development of Stretch Break for Kids.

Education World: Stretch Break for Kids is a software program that pops up on a computer screen at pre-determined intervals and leads the computer user in a series of stretching exercises. What do kids get out of the Stretch Break program?

Karen Jacobs: Stretch Break for Kids uses a very lively and engaging approach to applying ergonomics to computing. The program reinforces the idea that youths should take breaks from computing. Animations of youths exercising encourage the kids to follow along. They learn how to correctly stretch the fingers, hands, arms, shoulders, neck, and back; relax the shoulders, neck, and eyes; and walk around to promote blood flow and relieve sitting pressure. Stretch Break for Kids provides an effective intervention strategy to prevent and/or reduce the incidence of discomfort or pain associated with interactive media use. The program also helps youths develop the important life-long behavior of taking regular breaks from computer use.

Click the photo to see more stretches. Graphics courtesy Para Technologies.

EW: As an educator, occupational therapist, and ergonomist, what role did you play in the development of Stretch Break for Kids?

KJ: I played the role of consultant. In that capacity, I provided feedback on appropriate types of stretches for kids, on what types of visual images should be used to illustrate those stretches, and on the program's Ergo-Tips.

EW: Why did you feel it was necessary to help develop an ergonomics program for kids?

KJ: Arthur Saltzman, the owner of Para Technologies, the company that developed Stretch Break Pro for adults, and I share an interest in preventing the development of musculoskeletal problems in children. Children will use interactive media throughout their lives, and we believe that healthy interactive media techniques can be vital in preventing and/or reducing the incidence of discomfort or pain associated with the use of interactive media.

EW: Why can't kids just use the adult version of Stretch Break?

KJ: Kids are not adults; they have special needs when it comes to computers and work areas. Hardware and furniture need to be "kid size" and grade-level appropriate. Small keyboards, some with an embedded mini-trackball, eliminate reaching and accommodate young users. Kid size mouse options also are available.

Much emphasis has been placed on the ergonomic fit between adult workers and their computer workstations, however few researchers have focused on children's positioning at computers. The risks associated with prolonged adult computer use and improper positioning at computer workstations are frequently cited in professional literature. Some researchers have suggested that children are at even greater risk because computers and peripherals are designed for adults' larger proportions. A Stretch Break that specifically addresses kids' special needs can help reduce those risks.

EW: Do kids suffer from repetitive strain injuries (RSIs)? What are the most common causes of RSIs in kids?

KJ: A paucity of research exists on the incidence and prevalence of computer-related musculoskeletal discomfort in school-aged children. Harris and Straker (2000) reported that 60 percent of their sample of 314 students aged 10 to 17 years reported increased discomfort when they used laptop computers. Most of the discomfort was reported in the neck, upper back, wrist, and knees. This year, I reported on a study I did in which more than 50 percent of a sample of 152 sixth grade students reported musculoskeletal discomfort with computer use. I currently am conducting another study in which more than 42 percent of my sample of 314 middle-school students report musculoskeletal discomfort or pain after working on a computer. Those studies confirm that the problem exists, but more studies are needed to better understand the most common causes of the problem.

EW: What special risks does extended computer use pose for kids?

KJ: Few studies have been done on the effects of computer use on a child's physical well-being. Research on the designs of computer workstations for adults, however, suggests that poorly set up computer workstations are associated with increased musculoskeletal discomfort and musculoskeletal disorders. Those results raise concerns about the possible effects of computer workstation design on children's musculoskeletal health.

EW: What can teachers and parents do to reduce the possible physical risks associated with extended computer use?

KJ: I urge the public in general to be alert to monitoring the amount of time they spend on computers. Parents, in particular, need to collaborate with their children on the appropriate use of computers. They need to pay attention to how much time their kids are spending on the computer and what they're doing. I urge parents to talk to their kids about taking five-minute breaks from computing every 20 to 30 minutes. Stretch Break for Kids can reinforce those discussions.

"Everything You Should Know About Ergonomics and Youths, But Were Afraid to Ask," an article I co-authored that was published by the American Occupational Therapy Association (AOTA), described actions that teachers and parents can take to minimize health risks associated with kids' computer use. They include

  • Position the monitor at the youth's eye level, in line with a point 2 to 3 inches lower than the top of the screen.
  • Ensure that monitors are height- and angle-adjustable. If the monitor is not adjustable, change the height for each user by adding or removing items (such as phonebooks or crates) from underneath it or purchase monitor risers or an adjustable monitor arm.
  • Position the monitor at a comfortable distance for viewing, usually the youth's arm's length away.
  • Increase font size for easier viewing.
  • Decrease glare on the screen.
  • Provide chairs that are as ergonomically correct as possible. An ergonomically-correct computer chair has five rolling casters; adjustable seat depth, height, and angle; adjustable back height and lumbar support; and removable and adjustable arm rests for height, angle, and width.
  • Use pillows, padding, or a booster seat to raise the youth, and reduce the depth of the seat with pillows or padding to increase lower-back support.
  • Provide a footrest, or create one from phone books or a box, to support the youth's feet if they don't touch the floor.
  • Use an adjustable desk surface. If one is not available, attach an adjustable keyboard tray to the desk. An adjustable chair and monitor can be added to accommodate all students.
  • Position the mouse on the same level as the keyboard.
  • Place the mouse directly in front of the youth if the activity primarily involves mouse work. Otherwise, the mouse should remain as close to the body as possible so the child does not have to reach for it.
  • Install a movable mousing surface, which can be placed over the numeric keypad, bringing the tasks that little fingers need to accomplish closer together.
  • Provide an articulating keyboard and mouse tray to allow for negative tilt and increase the adjustability of the workstation. If one is not available, place the keyboard on a pillow on the youth's lap to promote better posture.
  • Center the alphabet section of the keyboard in front of the youth.

Computer workstations must be adjustable so users of different sizes have easy access to the reach zone of the body -- in front and to each side. Preventive education can help facilitate good computing habits, but carryover of those concepts is difficult when the environment is not easily adaptable for many users.

EW: What about laptops?

KJ: Please do not forget about laptops! Educational literature speaks favorably of laptops because they are portable, allowing for greater flexibility of learning environments and assignments. Some states are implementing programs to distribute laptops to youths in school settings, with the goal of providing greater access to information technology and equal access to computers. Although laptops have many positive qualities, they do not allow the adjustability required to ergonomically fit all users. The Harris and Straker study reported that 60 percent of children who use laptops complain of discomfort with laptop use and 61 percent report discomfort from carrying laptops. If children are using laptops, Stretch Break for Kids should be on them.

Some additional tips for laptop use include

  • Limit the amount of time a youth uses a laptop computer to one hour a day.
  • Provide an external keyboard and mouse. Place the external keyboard on a negative-tilt keyboard tray with the alphabet section centered in front of the youth, and keep the mouse pad close to the center of the body.
  • If external devices are not available, make sure the table is not too high and that screen settings allow for easier viewing, such as increasing font size.
  • Encourage youths to use their laptops at a stable work surface rather than in awkward postures, such as lying in bed or on the floor.
  • Place the monitor at the youth's eye level, approximately 12 to 18 inches away from the body.
  • Encourage frequent stretching breaks through the use of Stretch Break for Kids.
  • Use a lightweight laptop and provide an appropriate-size backpack or wheeled bag for carrying it.

EW: Should Stretch Break for Kids be used in school?

KJ: I urge schools to download Stretch Break for Kids on all school computers and to encourage parents to do the same on their home computers. Stretch Break for Kids is an important step in helping to prevent the development in kids of the kinds of musculoskeletal problems we see in adult computer users. I believe that schools and parents should advocate for discussions about ergonomics at Parents' Nights, PTA meetings, and other school gatherings.

Many school systems focus on obtaining more hardware and educational software for their students; ergonomics is not a priority. Information needs to be available to teachers, parents, school administrators, and students so everyone is aware of the need for safe computing and knows how to practice safe computing at school and at home.

EW: Stretch Break for Kids is an extremely well-done program with all the same features as the adult version. Why is it free?

KJ: Stretch Break for Kids is free because Arthur Saltzman and I are committed to preventing youths from developing the musculoskeletal problems that we see in adult computer users. It's a way for us to give back to society.

EW: Will the kids' version pop up during video games and other activities that tend to induce kids to spend long periods of time at the computer?

KJ: Yes, the kid's version will pop up during video games and similar activities.

EW:How can parents, students, and educators learn more about computer ergonomics?

KJ: They can turn to the occupational therapist in their schools for assistance in learning and instituting healthy computing strategies. All school districts in the United States employ occupational therapists who have the expertise to assist parents, teachers, and students in dealing with this important public health issue.

Stretch Break for Adults

Stretch Break Pro, according to Arthur Saltzman, president of Para Technologies, arose from his personal need to be reminded to take a break and stretch while working at the computer. "First I programmed a "Have you stretched recently?" message to show up as I shifted from one program to another," Saltzman told Education World. "But that wasn't enough. I needed something that would really get my attention every half hour or so. I thought it would be even more helpful if the program showed me some recommended stretches."

Saltzman formed a panel composed of a physical therapist, an orthopedic surgeon, a chiropractor, and a M.D. specializing in rehabilitative medicine to select and design stretches. Lifelike animations were included to encourage users to do the stretches.

From that point on, the program's development was largely determined by problem solving. "From our first version in 1995, our design philosophy has been to make the program easy to install and use and to listen to our users' suggestions," Saltzman noted. That determination led to a number of program features. The Invitation Screen allows users to choose to stretch immediately, cancel, or delay. A Usage Monitor tracks the choices the computer user makes when the invitation screen appears. In addition, users can select a set of stretches, the number of repetitions, and the time between stretches. ErgoHints and ErgoReminders offer advice on avoiding RSIs, workstation design, posture, keystroke shortcuts, and more. "Our goal," Saltzman said, " to provide a quality product that reduces the risk of repetitive strain injury and helps computer users reduce their level of stress."

Stress Break costs $44.95 for a single program. Corporations can license the software on a graduated price scale dependent on the number of employees. Special pricing is available for government agencies, schools, and other not-for-profit organizations. Stretch Break for Kids is free because, Saltzman said, "We knew that the program would help prevent RSIs, but we didn't think that most schools would have the funds to purchase it.""

This e-interview with Karen Jacobs is part of the Education World weekly Wire Side Chat series. Click here to see other articles in the series.