Most occupational therapy practitioners use ergonomic principles in their interventions with youths. However, as part of a proactive, preventive approach, we must communicate explicitly about and use ergonomics strategies. We can do this by using the language of ergonomics. In this language, controls refers to interventions. There are three major controls: engineering, administrative, and work practice.
Engineering controls eliminate the hazard (problem) at the source. For example, the school workspace, furniture, and tools used by students are reconfigured or redesigned by adjusting heights or locations. Environmental conditions also can be modified by adjusting the thermostat, lighting, or noise level.
Administrative controls are decisions made by occupational therapists, teachers, school administrators, and parents or caregivers to reduce the duration, frequency, and severity of exposure to existing hazards. They leave the hazards in place but attempt to diminish the effects on the youth (e.g., the computer teacher requires students to take stretch breaks).
Work practice controls are self-directed, self-initiated strategies used to ensure safe and proper techniques when doing activities (e.g., adjusting backpack contents to reduce stress on the neck and shoulders).
We describe 10 areas in which ergonomics controls can be integrated easily into the delivery of occupational therapy services for youths. We have classified recommendations by controls; however, when implemented by a different individual, the category of control may change.
1. BACKPACKS
Challenges
· Select backpacks on the basis of the youth's size and age. · Look for wide, padded, adjustable shoulder straps. · Choose backpacks with several compartments for better weight distribution.
Administrative (for occupational therapy practitioners, teachers, school administrators, and parents)
· Be attentive to complaints of backaches or pain. · Monitor the youth's posture when wearing the backpack. · Schedule regular health check-ups to identify musculoskeletal problems. · Ensure that the youth carries only the items required for that particular day. · Make sure the weight of the backpack does not exceed 15% of the youth's body weight6 (see Table 1 in .pdf format). · Provide youths with information on alternative types of backpacks, such as a backpack on wheels and The Back Balancer (see "For More Information" below). · Provide textbooks on CD-ROM. · Use Web-based books. · Issue a second set of books for the home. · Limit materials and books that need to go home. · Purchase books that are bound in sections. · Ensure ample locker space. · Assign lockers close to the classroom or other convenient locations.
Work Practice (for youths)
· Position the backpack below the shoulders and resting on the hips and pelvis. · Use both straps and the chest and hip belts.7 · Fasten the straps, but not too tightly. · Replace heavier items with lighter alternatives (e.g., a plastic lunch box instead of a metal one). · Avoid packing heavy or bulky items like soda, water, shoes, and sports equipment. · Pack heavier items close to the body. · Do not place pointed or bulky objects against the back. · Stretch your shoulders, arms, and neck before carrying your backpack. · Stay fit and healthy.
2. SCHOOL WORKSPACE
Challenges
Third and fourth graders are expected to remain seated for two thirds of the school day8: "75% of the total body weight is supported by only [4 square inches]...of surface when sitting" (p. 266).9
As youths begin unpacking their backpacks at school, the ergonomic challenges have just begun. Youths spend the majority of their school day in chairs and at desks that do not adequately fit their bodies.8,9 The furniture is not designed to facilitate the two common postures of school-aged youths: sitting forward for reading and writing and sitting back for listening and watching the teacher.8,10 The chairs' backward-angled seat pan causes excessive bending forward, placing strain on the back and neck as well as eliminating back support.8,10,11
Incorrect seat height and length also can result in discomfort and add pressure and extra weight to the youth's thighs and legs. Well-designed furniture can help reduce the effects of postural problems, allowing youths to sit in ergonomically correct positions.
Controls
Engineering (for occupational therapy practitioners, school administrators, and teachers)
· Use multiple sizes of furniture, especially in a middle school, where youths have a wide range of body sizes.8,9 · Use a rolled-up towel or a small pillow to create a lumbar support with an angle of 100° to 110°, which may be as effective as a back support.11,12 · Equip a low chair with a firm cushion to prevent the youth from forced extension of the feet when sitting. · Reduce nerve pressure and discomfort with a footrest or book under the feet. Old phone books and catalogues work great! · Add wooden blocks under the desk legs when there is less than 1" of space between the youth's knees and the underside of the desk.
Administrative (for parents)
· Ask youths about the comfort of the chairs and desks at school. · Advocate for ergonomically designed furniture or modifications to current furniture to the local Parent-Teacher Association (PTA) or school administrators.
Administrative (for teachers and school administrators)
· Allow youths to choose furniture for themselves from the school's existing supplies.8,9 · Be aware of the effects of uncomfortable furniture on youths' learning ability. · Become more knowledgeable in proper body mechanics to teach and instruct youths in healthy postures.8 · Use verbal instruction, visuals, and repetitive practice tasks when teaching the use of proper body mechanics to accommodate different learning styles. This information may help youths to work more effectively in a classroom setting that does not have ideal seating.
Work Practice (for youths)
· Use proper body mechanics, such as turning the body as a whole. · Keep frequently used supplies within reaching distance. · Take brief breaks between activities and stretching breaks before, during, and after an activity.
3. HANDWRITING
Challenges
"Between 10% and 20% of school-age children have handwriting difficulties."13
"Poor performance on ergonomic factors (i.e., body positioning, paper positioning, pencil positioning, consistency of pencil grip, and stabilization of paper) are correlated with low handwriting performance scores."14
"The damage caused as a result of prolonged sitting in a writing posture [includes] pressure on the digestive and respiratory organs and cumulative pressure on the spinal cord discs."15
Controls
Engineering (for occupational therapy practitioners, teachers, and school administrators)
· Use a workstation that allows for proper positioning and back support so that the student has at least 90° of hip flexion and knee flexion, and the feet are flat on the floor with the ankles at 90°.
Administrative (for occupational therapy practitioners, teachers, and school administrators)
· Encourage teachers to incorporate a 2-minute break every 20 to 30 minutes. · Encourage teachers to do warm-up exercises with students before writing activities. · Teach relaxation techniques to improve handwriting quality.16
Work Practice (for youths)
· Take 2-minute stretching breaks every 20 to 30 minutes while doing handwriting exercises.
4. SCHOOL COMPUTER WORKSTATION
Challenges
"Between 1994 and 1999, the percentage of public elementary and secondary schools with computers connected to the Internet increased from 35% to 95%."17
Currently, approximately 45 million children attend schools in the United States, and almost all are exposed to computers in that setting. As of 1999, almost 90% of schools had Internet access, and that number is expected to grow to 100%.18
Community-based therapists have reported an increase in the number of students with musculoskeletal injuries and discomfort related to the increased use of computers, especially in the classroom.19
School systems often focus on obtaining more hardware and software for their students, and ergonomics is not a priority.18 Information needs to be available to teachers, parents, school administrators, and students so that everyone can practice safe computing at school and at home. Preventive education can help to facilitate good computing habits, but carryover of these concepts can be difficult when the environment is not easily adaptable for multiple users.20 The computer workstation should be adjustable so that different-sized users have easy access to the reach zone of their body--in front and to each side.21
Youths have special needs when it comes to computers and work areas. Hardware and furniture need to be "kid size" and appropriate for the grade level. Small keyboards are available, some with an embedded mini-trackball to eliminate reaching and to accommodate multiple users. Keyboards are available with and without the number pad. There also are "kid size" mouse options.
Controls
Engineering (for occupational therapy practitioners, teachers, and school administrators)
We have divided the engineering controls into five aspects of the workstation.
1. Monitor
· Position the monitor at the youth's eye level, in line with a point 2" to 3" 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 (e.g., phonebooks, 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.
2. Chair
· Use 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 armrests 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. · Use or create a footrest from phone books or a box to support the youth's feet if they do not touch the floor.
Do not forget the teacher, who spends much of the day leaning over to view the computer screen. An effective engineering control is to use a chair with wheeled casters in which the teacher can scoot around the classroom to stay at eye level with the youths and the monitors.
3. Desk
· 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.
4. Mouse
· Position the mouse on the same level as the keyboard. · Place the mouse directly in front of the youth if the activity primarily uses mouse work. Otherwise, the mouse should remain as close to the body as possible so that the child does not have to reach for it. · Install a movable mousing surface, which can be placed over the numeric keypad, bringing the work areas that little fingers need to cover closer together.
5. Keyboard
· Use an articulating keyboard and mouse tray to allow for negative tilt, increasing the adjustability of the workstation. If this 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.
Administrative (for school administrators, teachers, occupational therapy practitioners, parents, and caregivers)
· Enforce that youths take a 2-minute break every 20 to 30 minutes. During this time, they can stretch their fingers, hands, arms, shoulders, necks, and back; relax their shoulders, neck, and eyes; and walk around to promote blood flow and relieve sitting pressure. · Download the free Stretch Break for Kids software (see "For More Information" on p. 19). · Set time limits for weekly or daily computer use, including time spent on the Internet, online conversation tools, and e-mail. · Advocate for discussions about ergonomics at Parents' Night, PTA meetings, and other school gatherings.
Work Practice (for youths)
· Sit with the hips and knees at a 90° to 105° angle, the arms relaxed at the sides with the elbows bent at 90°, and the wrists flexed at 15° to 0°. · Make up new stretches and name them after your friends (e.g., Ariel's neck roll, Josh's shoulder stretch). Do them every 20 to 30 minutes for 2 minutes. · Keep a computer journal: List time spent, stretches done, information found, and activities done. · Monitor your peers' ergonomic practices. · Post signs that remind about good ergonomics. · Take regular breaks. · Tell an adult about any pain or discomfort.
5. HOMEWORK SPACE
Challenges
Sixty percent of school-aged youth in a study reported discomfort of the neck and shoulders. Improper fit of furniture was suggested to be responsible for these musculoskeletal problems.18
"Visually demanding work or adverse viewing conditions can result in visual fatigue and eye strain" (p. 282).22
Controls
Engineering (for occupational therapy practitioners, parents or caregivers, teachers, and school administrators)
· Provide a stable, sturdy work · surface. · Provide a chair that fits the youth. · Provide direct and task lighting. 23
Administrative (for parents)
· Monitor the youth's work practice during homework time, adhering to the above recommendations.
Work Practice (for youths)
· Choose a sturdy work surface, use an adjustable chair, and have good lighting.
6. HOME COMPUTER WORKSTATIONS
Challenges
"Among households with children ages 2 to 17, home computer ownership jumped from 48% in 1996 to 70% in 2000."24
Many youth are working and playing at computer workstations in their homes that were designed to fit the physical proportions of adults. This may cause children to sit in uncomfortable positions, making "the opportunity for long-term injuries on young bodies greater than ever" (p. 1).20
Controls
Engineering (for parents and caregivers)
· If using a chair that adjusts, raise the seat pan so that the youth's elbow is at about a 90° angle or more when working at the keyboard and push the lumbar support forward, allowing the hips and knees to be at a 90° to 105° angle. · Use a pillow on the seat to prop the youth up and a folded towel behind the back for lumbar support. · Place a phone book or box on the floor to prevent dangling feet. · Position a document holder at the youth's eye level to prevent neck strain. · Position the screen at a 90º angle to a window to avoid glare. · Choose a monitor with an antiglare screen. · Purchase a smaller keyboard and mouse or trackball.25
Administrative (for parents and caregivers)
· Monitor the amount of time the youth spends on the computer. · Use a schedule, a kitchen timer, or the Stretch Break for Kids software to remind students to take stretching breaks.
Work Practice (for youths)
· Use proper body positioning and take 2-minute stretching breaks every 20 to 30 minutes. · Decorate footrests and mark off the proper seat alignments so you can re-create your set-up.
7. LAPTOP COMPUTERS
Challenge
Sixty percent of children who use laptops complain of discomfort with their use, and 61% report discomfort with carrying their laptop.19
Educational literature speaks favorably of laptops because they are portable, allowing for greater flexibility of learning environments and assignments.19 Some states are implementing programs to distribute laptops to youths in primary-school settings with the goal of giving youths 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.19
Controls
Engineering (for teachers, administrators, parents, caregivers, and occupational therapists)
· Provide an external keyboard and mouse. · Place the monitor at the youth's eye level, approximately 12" to 18" away from the body. · 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. · Use lightweight laptops.
Administrative (for parents and caregivers)
· Limit the amount of time the youth uses a laptop computer to 1 hour · per day. · Encourage youths to use their laptops at a stable work surface rather than in awkward postures (e.g., · lying in bed, sitting on the floor). · Encourage the use of an external keyboard and mouse. · If the youth is not using external devices, make sure the table is not too high and set the screen settings to allow for easier viewing (e.g., larger font). · Encourage frequent stretching breaks. · Have the student carry the laptop in an appropriate-sized backpack or a wheeled bag.
Work Practice (for youths)
· Advocate to use an external · keyboard and mouse to decrease awkward positions and follow the recommendations for desktop · computers. · Use your laptop at a sturdy desk or table: Do not work in positions that may cause injury or discomfort (e.g., lying or sitting on the floor or in bed). · Pack the laptop closest to your body in your backpack. · Use a laptop computer for no longer than 1 hour per day. · Use proper body positioning and take 2-minute stretching breaks every 20 to 30 minutes.
8. VIDEO GAMES AND TELEVISION
Challenges
Sixty seven percent of American households reported owning at least one video game system (Nintendo, Sega) in 1999.
Sixty percent of children watching television for 1 to 2 hours per day report that they have back pain.26
Video games and television are a staple of most youths' leisure time. Unfortunately, youths are experiencing a host of problems from the long hours spent in front of a television and from pushing little buttons on a video game controller. Musculoskeletal disorders can be caused by poor posture, ill-constructed video games and furniture, not stretching or taking breaks, and vibrating controllers. These factors can exacerbate the effects of a sedentary lifestyle, including obesity, high blood pressure, and high cholesterol. Additionally, video games and television encourage isolation and separation from reality. Video games and television are not inherently negative, but excessive use of these electronic devices can result in physical and psychosocial problems that may extend into adulthood.
Controls
Engineering (for parents and caregivers)
· Provide a chair that fits the youth's size: back and neck supported; a soft, firm seat; feet flat on the floor; ample room between the back of the knees and the edge of chair; and armrests at the proper height. · Turn off the vibration option on the video game controller, either permanently or every other day. Vibration feedback causes unnecessary trauma to a youth's hand. · Place the television screen at the proper height to avoid neck strain. · Ensure that the room has proper lighting to avoid eye strain.
Administrative (for parents and caregivers)
· Educate youths on the effects of excessive video game and television use. · Control where, when, and for how long youths may participate in these activities--create a schedule of video game playing and television watching and begin a reward system (e.g., permit 30 minutes of a video game after the youth's homework has been completed). · Involve youths in sports, music, and volunteer activities and clubs. These activities promote fitness, social interaction, self-esteem, and self-exploration.
Work Practice (for youths)
· Take stretching breaks every 20 to 30 minutes while watching television or playing video games. · Practice good posture and sit far enough from the television to prevent eye strain. · Post signs near the television or video game to remember good body mechanics. · Hold the video game controller or remote lightly.
9. FITNESS
Challenges
Thirty five percent of youths do not participate in vigorous physical activity, and the number of children who are overweight doubled between 1980 and 2000.27
A 1999 survey of youths between 2 and 18 years of age found that they spent an average of more than 4 hours a day on television, videos, video games, and the computer.28
Some research supports the theory that children who are more physically active are less likely to develop musculoskeletal disorders from the physical stressors of carrying backpacks or using computers.29 Stronger muscles encourage posture that puts less stress on ligaments and weaker muscles. There also is some indication that participating in sports, particularly those involving dynamic upper-extremity use, can protect against musculoskeletal disorders of the neck and upper extremities.30 Therefore, the decline of vigorous activity of school-aged youths over the past several decades, attributed primarily to watching television, sitting at the computer, playing video games, and doing schoolwork,31 may be cause for significant concern.
Studies indicate that activity among youths32 can be encouraged through parental modeling; adult encouragement, particularly through praise in an activity to promote a perception of competence33; time spent outdoors; and direct help from parents in the activity.34
Controls
Engineering (for parents and caregivers)
· Design play areas inside and outside the home that allow for rolling, climbing, jumping, and tumbling. · Buy toys or equipment that promote fitness and vigorous activity. · Remove television sets from bedrooms. · Remove television remote controls to discourage extended "channel surfing" when bored.35
Administrative (for parents and caregivers)
· Use fun physical activities or family outings as rewards instead of food. · Give youths household chores appropriate for their age, strength, and maturity. · Praise youths for participating in fitness activities to promote a sense of accomplishment and competence. · Downplay competition. Emphasize learning, participating, and beating one's own record. · Arrange frequent, regular family outings or outdoor activities (e.g., hiking, active games, sports, gardening). · Limit television viewing to less than 2 hours a day, including movies, video games, and computer games. Encourage time outdoors instead. · Have youths earn time to watch television by the amount of active play in which they participate.35 · Model healthy habits by participating in vigorous activity and exercise. · Inquire about physical education classes in school and advocate for quality programming. · Encourage vigorous activity by emphasizing the fun, pleasure, and accomplishment it offers. · Arrange involvement in after-school physical activity programs.
Work Practice (for youths)
· Incorporate physical activity into your daily routine (e.g., walk or ride a bike instead of asking for a car ride). · Do not spend more than 2 hours a day using the computer or watching television. · Do not use the computer or television to relieve boredom.
10. SPORTS AND PERFORMING ARTS
Challenge
Daily free time for youths decreased from 40% to 25% in the past 2 decades.36
Active youths spend much of their day engaging in many different physical activities within the realm of sports and performing arts. With the multitude of activities, youths might feel pressure to perform and experience adverse psychological and physical effects of which adults should be aware. Youths often use improper techniques, ill-fitting equipment, and overloaded bags that can contribute to injuries. Musculoskeletal disorders can develop from using improper techniques while playing instruments, participating in sports, or engaging in performing arts (e.g., dancing).26,37 Repetitive stress or overuse injuries are common among youths because growing bones can be soft, and connective tissues tend to be especially tight during growth spurts.26 Equipment or instruments often are not fitted or used properly, adding to musculoskeletal strain by compromising body mechanics and positioning.
Controls
Engineering (for parents, caregivers, instructors, teachers, and administrators)
· Encourage manufacturers to develop equipment that improves safety and aesthetics for youths. · Find wheeled equipment and instrument bags or adapt them by adding wheels. · Modify instruments or use rests or supports (e.g., chin and shoulder supports for the violin). · Ensure that the equipment and the activity environment are free of hazards, such as dangerous surfaces or sharp edges. · Adapt the equipment and environment to the youth's size.
Administrative (for parents, caregivers, instructors, teachers, and administrators)
· Encourage a mix of athletic and cultural activities. · Reinforce the value of participating in activities for reasons other than winning (e.g., skill acquisition, enjoyment). · Encourage noncompetitive activities to build self-esteem and social skills. · Keep extra equipment or instruments in the car. · Monitor the amount of time youths spend participating in one activity. · Alternate among activities that place different demands on the body. · Incorporate stretching or water breaks every 30 minutes to decrease the intensity of practice or training sessions. · Ensure proper fit of equipment. · Encourage youths to stick with an activity for a trial time before quitting but do not force them to continue after this time if they still do not like it. · Balance structured and unstructured time. · Provide downtime.
Work Practice (for parents, caregivers, instructors, teachers, and administrators)
· Monitor technique, positioning, and body mechanics. · Select activities on the basis of age and physical and mental ability. · Have assistant instructors available to attend to the youths' safety and well-being. · Limit the intensity of practices. · Organize contact sport teams by size and weight instead of by age. · Make lockers available for extra gear. · Include pre-and postactivity warm-ups and stretches. · Monitor youths' pain.
Work Practice (for youths)
· Warm up and stretch before physical activity. · Use proper techniques. · Use lockers or keep your equipment in the car. · Balance structured and unstructured time. · Get involved in a variety of activities. · Tell an adult when you have pain.
CONCLUSION
Musculoskeletal injury is a concern among youths because of the weight and frequency of books, sports gear, and other equipment being lugged among home, school, and activity environments. The sedentary lifestyle of many youths increases the risk of injury. The good news is that simple ergonomics tips provided by occupational therapy practitioners can support children's occupations while preventing many injuries.
References
1. American Occupational Therapy Association. (1999). Occupational therapy services in ergonomics: AOTA Work Programs Special Interest Section Consumer Fact Sheet. Bethesda, MD: Author.
2. Pheasant, S. (1991). Ergonomics, work, and health. Gaithersburg, MD: Aspen.
3. Wang, Y. T., Pascoe, D. D., & Weimar, W. (2001). Evaluation of book pack load during walking. Ergonomics, 44, 858-869.
4. Backpack misuse causes multiple problems, chiropractors say. (2001, September 22). Pain and Central Nervous System Week.
5. Roth, C. (2001). Parents & teachers need a lesson in ergonomics. Industrial Safety and Hygiene News, 35, 62
6. Tousignant, M. (1999, September 14). Loaded for learning. The Washington Post, Z14.
7. Pascoe, D. D., Pascoe, D. E., Wang, Y., & Shim, D. M. (1997). Influence of carrying book bags on gait cycle and posture of youths. Ergonomics, 40, 631-641.
8. Knight, G., & Noyes, J. (1999). Children's behaviour and the design of school furniture. Ergonomics, 42, 747-760.
9. Parcells, C., Stommel, M., & Hubbard, R. P. (1999). Mismatch of classroom furniture and student body dimensions. Journal of Adolescent Health, 24, 265-273.
10. Troussier, B., Tesniere, C., Fauconnier, J., Grison, J., Juvin, R., & Phelip, X. (1999). Comparative study of two different kinds of school furniture among children. Ergonomics, 42, 516-526.
11. Aagaard-Hansen, J., & Storr-Paulsen, A. (1995). A comparative study of three different kinds of school furniture. Ergonomics, 38, 1025-1035.
12. Jacobs, K. (Ed.). (1999). Ergonomics for therapists (2nd ed.). Boston: Butterworth-Heinemann.
13. Hamstra Bletz, L., & Blote, A. W. (1993). A longitudinal study on dysgraphic handwriting in primary school. Journal of Learning Disabilities, 26, 689-699.
14. Parush, S., Levanon-Erez, N., & Weintraub, N. (1998). Ergonomic factors influencing handwriting performance. Work, 11, 295-305.
15. Parush, S., Pindak, V., Hahn-Markowitz, J., & Marzor-Karsenty, T. (1998). Does fatigue influence children's handwriting performance? Work, 11, 307-313.
16. Tseng, M. H., & Cermak, S. (1993). The influence of ergonomic factors and perceptual-motor abilities on handwriting performance. American Journal of Occupational Therapy, 47, 919-926.
17. National Center for Education Statistics. (2000). Internet access in public schools and classrooms: 1994-99. Washington, DC: U.S. Department of Education, Office of Educational Research and Improvement.
18. Center for Information Technology and Health Research. (2001). Children and information technology. Report of Symposium, June 11-12, 2001. Baltimore: Department of Environmental Health Services, John Hopkins University.
19. Harris, C., & Straker, I. (200). Survey of physical ergonomics issues with school children's use of laptop computers. International Journal of Industrial Ergonomics, 26, 337-346.
20. Shinn, J., Romaine, K., Casimano, T, & Jacobs, K. (2001). The effectiveness of ergonomic intervention in the classroom. Work, 18, 1-7.
21. Berro, M., & Hedge, A. (Eds.). (2000). School ergonomics
program guidelines. Ithaca, NY: Cornell University. Retrieved March 8, 2002, from the
World Wide Web: http://ergo.human.cornell.edu/MBergo/schoolguide.html
22. Holmes-Enix, D., & Wright, M. (1999). Applied ergonomics in injury prevention and disability management. In K. Jacobs (Ed.), Ergonomics for therapists (2nd ed., pp. 271-300). Boston: Butterworth Heinmann.
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27. National Center for Health Statistics. (2001). Prevalence of overweight among children and adolescents: United States, 1999. Atlanta: Centers for Disease Control and Prevention. Retrieved March 8, 2002, from the World Wide Web: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm
28. Kaiser Family Foundation. (1999, November). Kids and the media at the new millennium [Monograph]. Menlo Park, CA: Author.
29. Katz, J., Amick, B., Carroll, B., Christine, H., Fossel, A., & Coley, C.( 2000). Prevalence of upper extremity musculoskeletal disorders in college students. American Journal of Medicine, 109, 586-588.
30. Niemi, S., Levoska, S., Kemila, J., Rekola, K., & Keinanen-Kiukaanniemi, S. (1996). Neck and shoulder symptoms and leisure time activities in high school students. Journal of Orthopedic and Sports Physical Therapy, 24, 25-29.
31. Luepker, R. V. (1999). How physically active are American children and what can we do about it? International Journal of Obesity and Related Metabolic Disorders, 23, (Suppl. 2), S12-S17.
32. Sallis, J. F., Prochaska, J. J., & Taylor, W. C. (2000). A review of correlates of physical activity of children and adolescents. Medical Science Sports Exercise, 32, 963-975.
33. Biddle, S., & Goudas, M. (1996, February). Analysis of children's physical activity and its association with adult encouragement and social cognitive variables. Journal of School Health, 66, 75-78.
34. DiLorenzo, T. M., Stucky-Ropp, R. C., Vander Wal, J. S., & Gotham, H. J. (1998). Determinants of exercise among children II: A longitudinal analysis. Preventive Medicine, 27, 470-477.
35. VanScoy, H. (2001, August). Making exercise appealing for young couch potatoes. Drkoop.com. Retrieved March 8, 2002, from the World Wide Web: http://www.drkoop.com/dyncon/article.asp?at=&id=9603
36. Institute for Social Research. (1997). Children's time. Child Development Supplement--Panel Study of Income Dynamics. Retrieved February 12, 2002, from the World Wide Web: http://www.isr.umich.edu/src/child-development/printime.html
37. Quarrier, N. (2002). Theory of postural boundaries. Retrieved February 12, 2002, from the World Wide Web: http://www.ithaca.edu/faculty/nquarrie/topic.html
FOR MORE INFORMATION
The Back Balancer
Foam and plastic oval that clicks into the waist belt of a backpack and sits on the
abdomen www.outdoormedicalresearch.com/index2.html
Carpal Tunnel Syndrome: Causes and Treatments
(13-minute video)
By the American Occupational Therapy Association, 1995. Bethesda, MD: Author. ($59 for
members; $69 for nonmembers. To order, call toll free 877-404-AOTA)
Children and Computers: New Technology--Old Concerns.
By E. A. Wartella & N. Jennings, 2000. Children and Computer Technology, 10(2),
31-43.
Comparison of Selected Perceptual Variables for Backpacks With
Internal and External Frames
By B. Jacobson & K. Jones, 2000. Perceptual and Motor Skills, 90, 605-608.
Fact Sheets for Consumers
For tip sheets on children and ergonomics, go to AOTA's Web site at www.aota.org and click
on Consumers, then Fact Sheets.
Hand Care Begins With Prevention in Elementary Schools
By G. M. Lucas, 1997. Work, 9, 267-274.
OT Awareness Poster (Ergonomics)
By the American Occupational Therapy Association. Bethesda, MD: Author. ($8 for members;
$12 for nonmembers. To order, call toll free 877-404-AOTA)
Prevention of Injuries From Improper Backpack Use in Children
By A. Hamilton, 2001. Work, 16, 177-179.
Rucksack Paralysis
By J. R. Daube, 1969. Journal of the American Medical Association, 208, 2447-2452.
Rucksack Paralysis With and Without Rucksack Frames
By R. J. Bessen, V. W. Belcher, & R. J. Franklin, 1987. Military Medicine, 152,
372-375.
Stretch Break for Kids
By Para Technologies
Free software that will run in the background and prompt youths to stretch at timed
intervals as well as provide ergonomics hints. Download from http://people.bu.edu/kjacobs/
Karen Jacobs, EdD, OTR/L, CPE, FAOTA, is a clinical associate professor at Boston University and a former president of AOTA. Her coauthors are members of the Ergonomics for Therapists class at the Boston University Department of Occupational Therapy. They include undergraduate and master's-level occupational therapy students, an undergraduate student in rehabilitation counseling, and registered occupational therapists.