Using Dragon Dictate and other accessibility tools for writing/research
May 13, 2014 9:35 AM   Subscribe

If you have figured out how to write research papers as a student with RSI (De Quervain's in this instance), please share tips, tools, or online resources that have helped you.

It seems I have De Quervain's tenosyvitis in my dominant hand. I'd modified my typing (but probably typed more than I should have) and in a very short period have found myself unable to use a knife or grip a glass. I still have to write things, though. Right now I am pecking with my whole hand. What are some up to date and effective ways of doing things that have worked for you? Lots of questions here already but wondering if new research or tools or advice have come along since.

- I got Dragon Dictate 4 for Mac. It has controls to operate various programs and is ok for dictation, except I've so far had issues with vocal fatigue (after 10 minutes of training it up). Any resources or experiential advice on building up to talking that much and often without ruining my voice (e.g. a schedule)? I want to keep my voice in good shape. Apparently people prone to tendinopathies are vulnerable here. I have a background in voice but my technique is shit now and was probably never 100%. I trained Dragon up on a good mic and speak quietly but it's still led to hoarseness.

- Talking my thoughts out in a logical way when I am by myself is not something I am good at, it appears. It feels like a totally different skill from regular writing, which seems to let me tap into a broader base of vocabulary, and elaborate more complex ideas. Any resources on this? Emails and short, plain-language writing are fine, but I have to use some vocab that for now is still on the passive side. Thinking about grammar and formatting, as you must in Dictate ("new paragraph, period, comma"), at the same time as thinking analytically and creatively is a challenge. (I'm pausing a lot, reaching for ideas - they're just not to hand.)

- Text expanders for Mac - any good ones? Thinking this might help. Or a keyboard with predictive text as good as my HTC One's?

- Worried about overusing my non-dominant hand - any thoughts on this? I remember from using crutches that when you use weaker bits more than usual, they start to go funny. I need at least one good hand.

Obviously people manage with broken arms and all kinds of other issues so this is doable.
posted by cotton dress sock to Education (10 answers total) 8 users marked this as a favorite
Are you an undergraduate or graduate student? Your school should have a disability or accessibility office that can help you, and may in fact hold clinics on specific software and hardware tools that may help.
posted by DarlingBri at 12:03 PM on May 13, 2014 [2 favorites]

Best answer: The only way I got to a point where I could type papers for grad school was to heal from the RSI, including de Quarvain's. It was the nineties, and most clinicians didn't know what to recommend other than massage therapy and rest.

My job tried to accommodate me with an early version of Dragon Dictate - and it also strained my vocal chords.

I learned that saying. Each. Word. Into. Dragon. Meant that there was no breath flowing through my vocal chords. Each word started from a hard stop. Dragon might allow more natural speech now...

But I also learned that as a woman from the northeastern US, I'd been speaking in a lower voice than my natural voice because of cultural norms. My natural voice is quite high and sing-songy. The speech therapist told me that British women and women from the Southern US are culturally allowed/encouraged to use higher voices, and that speaking lower was also stressing my vocal chords.

Deep relaxation and massage therapy helped me overtime with the RSI (but I stopped working for a year.) Core exercises to support good posture, high doses of naproxen (but don't do that without a doctor'a advice! Those high doses might've been damaging, and they just didn't know it then!) I slept on the floor at night and cut my hair short because I couldn't rinse it all out in the shower. I was really hurting for a long time and could no longer work. Left NYC and moved back in with my parents in my small town. Gah!

Definitely go to the disability offices at your school with your diagnosis. And you're right -- writing by speaking is a completely different process and is really difficult. I went back to grad school because I couldn't work and figured they'd have to accommodate me and it would buy me time to heal. It worked, largely. (Although they didn't do a good job of accommodating me, times have changed!)
posted by vitabellosi at 2:22 PM on May 13, 2014 [2 favorites]

Best answer: Take breaks consistently! Use a program like Workrave (Windows/Linux) or AntiRSI (Mac) to force yourself to stop at regular intervals. This will give your muscles and vocal chords a chance to rest a little, and help to prevent further injury.
posted by vasi at 12:22 AM on May 14, 2014 [1 favorite]

Response by poster: I will definitely be talking to the disability office, thank you!

vitabellosi, thank you so much for sharing your experience. It sounds like it was just awful :( but I am really glad to hear it's a memory, and that you came out the other end! Yeah, hair washing is annoying but for now will try minimal shampoo + weekly blowout I think, have a guy who does it for $20 :)

You're so right about speaking at a higher pitch - thank you! Already I can feel it's easier to use my breath to support a stronger, more focal tone when it's placed there. I guess I must have been using my voice in a more glottally compromising way. Dragon Dictate 4 itself is very fast; it picks up speech at normal rate and fluency. So if airflow problems are there, it would be from my own speech production - so something I can correct. I'll review my old books and see what new I can find about vocal health. If it means a lesson or two, so be it.

If anyone else who uses VR technology or lives off public speaking can offer a tip or two, that'd be great :)

For interested readers: I've found this effort asking a group of scientists to use the 'mind to paper' technique to dictate an article in a day. It emphasized the importance of a highly structured workflow: lots of pre-dictation lit review, planning and organization, followed by an uncensored, 'free flow' dictation session, and then again by a longer extensive editing process. Output was sufficiently complex compared to publication standards. Upside: some participants felt freed from perfectionism by this bracketing off of 'free' dictation with prep and revision.

More on this sort of idea. Also (pdf): Writing with speech recognition: The adaptation process of professional writers with and without dictating experience (Leijten & Van Waes, 2005) (cited in these). Basically, do a solid outline, is the suggestion (as ever).

(Not much changed since your bout, really. I'm getting soft tissue manipulation, stretches and gut-safe naproxen, which I'm trying not to take + review by rheumatologist. Work is a serious problem. Intended to scale back with school and work ft for my last semesters. Offices now out, retail out, restaurants out except for hosting, which isn't great money. Customer service jobs, maybe. Almost contemplating dragging out my old songbooks to do Girl From Ipanema ten million times at corporate functions, if those still happen and DJs don't play it now instead and I can find an accompanist/sound guy with a PA, plus magically turn into an entrepreneur. Anyway :)

Thanks for your thoughts :)
posted by cotton dress sock at 12:22 AM on May 14, 2014 [3 favorites]

Is there a reason you have skipped over diagnosis and treatment and gone right to work arounds? I'm a hand surgeon, so obviously a little biased, but if your diagnosis is correct, I can treat 80-85% of patients with one injection and about 5 minutes of your life. See a doctor before labeling yourself disabled. Refractory cases may require surgery but you will need to see a specialist to find out for sure.
posted by karlos at 5:32 AM on May 14, 2014 [1 favorite]

Sorry, re-reading your post makes it sound like you did see a doctor. What kind? How did they make the diagnosis? What were his or her recommendations?
posted by karlos at 5:34 AM on May 14, 2014 [1 favorite]

Best answer: I use VR for academic writing. It's true, at least for me, that talking is a different kind of thinking from typing, and if I just try to start talking it comes out a bit rambly. Sometimes that's good: you get inspiration from stream-of-consciousness that can be very valuable. Sometimes you're writing something very structured and that's no good at all. So, my techniques depend on the kind of writing, but roughly they are:

Technique #1: make a semi-detailed outline either on paper or using typing, and then with a notebook or split-screen, use that as a prompt for VR writing. Doing this, I only write one paragraph or concept at a time, taking a break for 30 seconds between each.

Technique #2 might require the full version of Dragon (which I recommend, there is an educational discount which makes it affordable and the editing functions are brilliant) but is actually much better for me: write whatever using VR, and then edit extensively also using VR.

An occupational therapist might have some other suggestions as well.
posted by epanalepsis at 7:32 AM on May 14, 2014 [2 favorites]

Response by poster: Hi karlos, I memailed you :)
posted by cotton dress sock at 7:54 AM on May 14, 2014

Oh! I keep forgetting this one route I took. I got breast reduction surgery. : (

My RSI problems are linked to tension in my back/shoulders/neck. My breasts weren't doing me any favors, whether it was just that I didn't have a strong enough core, or that I was just carrying too much weight on the front, or that the shoulder straps of my bra pinching off flow through my neck and shoulders...

And I had one clinician explain to me that fingers doing a lot of typing are doing a lot of work, and would like more oxygen in the blood, please. But the heart tends to only hear that kind of request for more oxygen when it comes from larger muscles. Holding my body still while typing for hours (and, I'm sure, slouching) was creating a total disconnect. No communication whatsoever. No idea if that's all true, but it's a useful metaphor for "flow" and now I make an effort to move larger muscles during typing breaks.

I liked Feldenkrais, too, but didn't stick with it.

I still get flare ups, but they don't take me out of work or panic me. I also just used a cheap IKEA hack to create a standing desk -- which is probably better than sitting for both typing and voice work.
posted by vitabellosi at 10:58 AM on May 14, 2014 [1 favorite]

Response by poster: I don't have the issue you did, but moving around more will surely help!

I actually got a report back yesterday and it's now unclear whether this is De Quervain's [tenosynovitis, not teno whatever I wrote above] or what, will be following it up. (Thank you, karlos, for clearing up treatment options for DQ - I am glad others reading will see what's possible with a definitive diagnosis.)

In the meantime, all these contributions will help me get what I need to do done. I really appreciate the help, thank you!
posted by cotton dress sock at 11:29 AM on May 14, 2014

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