Looking for advice on RSI related to clicking (esp touch screens, game c
August 13, 2020 7:29 PM   Subscribe

I'm a long term RSI sufferer who had, until recently, largely had things under control. I have symptoms brought on by repetitive clicking (a switch controller; a mouse button; the enter key) and am weighing my options.

I know that the easiest way to make this go away is "don't do the thing," but...I've already made so, so many sacrifices and changes in my life because of RSI that I want to see if I can do anything less extreme.

I'll explain more about my specifics, but I guess I'm curious about...stretches? Exercises? "Clicking technique"? Basically any options that might help besides "just stop." Note that I really despise audio control and will only consider that as a true last resort. I really despise it.

I already take RSI really seriously. I have a standing desk, I use a split keyboard (I have pronation issues in my elbows), I use a trackball mouse (though this could probably be better?), I use break software, I do stretches and related exercise every day (though I'm open to recommendations about specific stretches or exercises). On the whole my computer use is fine, I am a programmer and I can program fine, but lately other things have brought on some issues.

The thing that has broken the previous balance is that I've gotten into reading (playing?) visual novels, which require a lot of repetitive button pressing. I like them a lot and would rather not have to give up a whole medium if I can. I first played on my computer, which seems ideal, but the repetitive pressing of "enter" started aggravating things. The aggravation comes in the form of tenderness in my forearms, and a sort of...weird feeling in my wrist. It's hard to explain, I always call it a "presence," but it's a sort of...well, feeling like there's a presence in my wrist. So then I switched to trying to play on the switch, because historically the switch gave me no issues (as long as didn't use the controllers separately and mounted them in the controller mount that presents the two controllers as one controller). But I guess because of having to repetitive press the button, that has been problematic too...I've tried changing which finger I use, change the angle of my hand etc, but whatever I'm doing isn't working. It's not awful yet, but I know how RSI stuff can build, thus this question, seeing if there might be any tips that I haven't found in the past.

For context, touch screens (eg cell phones) have always given me problems. In an un-aggravated state I can use them a moderate amount every day and be fine, but in an aggravated state (like right now), touch screens have always been awful. Repeatedly pressing a touch screen, or things like typing texts have always been bad for my RSI. Until recently, mechanical buttons (keyboards, mouses, video game controllers) were not an issue -- only touch screens more. But clearly something is up and I'm guessing that the same issue that has made me sensitive to touch screens in the past has gotten more sensitive or something. It's extremely frustrating.

Again, I realize "just don't do the thing" is always an option and if things get bad, I will do that, because visual novels are not worth destroying my wrists over. But I enjoy the medium and it would be very depressing to have to give up yet another thing to RSI, so I want to see if maybe there is something I can do. In particular I'm wondering about the proper way to use a mouse, because that's one area I never spent too much time on, as in the past using a trackball was enough. Though fixing mouse use won't explain why the switch is suddenly creating issues...
posted by wooh to Health & Fitness (22 answers total) 6 users marked this as a favorite
The clear answer here is a foot pedal. I know they're sold, but I don't personally have any information on how well people like them or price ranges, but search ergonomic foot controls.
posted by liminal_shadows at 8:04 PM on August 13, 2020

Here's one model: https://kinesis-ergo.com/shop/savant-elite2-triple-pedal/

Pricy. But cheaper than surgery.
posted by liminal_shadows at 8:06 PM on August 13, 2020

For touch screens, is using a stylus an option you've tried? If holding and using a pen (and, by extension, a stylus) is also a problem for your RSI, there are a variety of adapted styluses for touch screens that can be strapped to the wrist/forearm, and which take the hand partially or completely out of the equation depending on the design. There are also styluses with different grip options or diameters that are easier to hold.

A few examples:

Easy Flex Stylus

Limitless Stylus

Wide-Grip Stylus for Touchscreens
posted by mandolin conspiracy at 8:43 PM on August 13, 2020

Response by poster: I did try using a stylus, and it didn't help. That said, I should probably investigate alternate grips etc.

Foot pedal is definitely an idea. I stand while working, but I guess I could still make it work...
posted by wooh at 8:48 PM on August 13, 2020

In the VN, you could use auto-advance. It's slower than reading in many cases, so it's not a perfect solution. I don't use it consistently, and I'm in a similar RSI/VN boat. Spacebar to advance is pretty universal, so you could alternate with clicks.

Talon has a nice "pop" sound you can make with your lips to click, but Windows support is $15 a month through the Patreon. Might be interesting for your programming work, though. (This should be released publicly, eventually.)

You can also use a presentation remote or handheld trackball to avoid the clicking motion of the mouse. Less helpful, as you said it's not really finger dependent.

The foot pedal might be perfect. The Kinesis one is overkill, Amazon has single action pedals for ~$25.

Dwell clicking might also be perfect for the VN use case. I've used an eye tracker (Tobii 4C) with the "pop" clicking, but other people have tried it with dwell clicking (I think).

Further out there:

Company is dead, but the Myo arm band would let you tense an arm muscle to click. $80 on Ebay, no idea if the software still works or not.

The Emotiv Insight is a lower cost ($299) EEG which apparently can detect specific brainwave patterns to click. Or facial expressions.

OpenCV with a webcam, click when smile/wink/etc. detected. I could have sworn I saw this on GitHub, but I lost it.
This is also baked into MacOS Catalina, so remote desktop from Mac to Windows with the VN is possible if you have the hardware.
posted by Anonymous Function at 9:02 PM on August 13, 2020

Response by poster: I'm running the VNs on Windows via parallels on a Mac, so I have a lot of flexibility around software.

Pop clicking sounds really really interesting. Can you comment on the accuracy of the eye tracker?

An EEG to control things...I def have to investigate that. I am skeptical that the fidelity is there but ohgod I want will-driven input so badly.
posted by wooh at 9:38 PM on August 13, 2020

If you can afford it, I'd consider trying a vertical mouse instead of a trackball. For me it has been life-changing. I have annoyingly slim little wrists and even the slightest hint of inflammation yields carpal tunnel symptoms. I have a weird stockpile of wrist and thumb braces in my house because my wrists and hands are so fiddly. But switching to a vertical mouse is the single most impactful thing I've done to help my wrists cope with my clicky tech job. I have two Evoluents and consider them pretty much the gold standard. I used to have a Wowpen Joy that I liked OK but the Evoluent seems to be a higher quality device and I expect it to last longer.

For touch screens usually the fatigue for me comes from too much use of my thumb. I've found that in general if I am feeling fatigue in my thumbs and wrists, I can give them a rest for a few days and use my elbows and shoulders to move my near-rigid finger around the screen and that usually does the job. YMMV, of course.
posted by potrzebie at 9:56 PM on August 13, 2020 [1 favorite]

Response by poster: Money is not an object when it comes to thsi stuff. Well, it's an object, but my keyboard already is like 250USD...for a programmer, this stuff is life or death, so I'm fine with investing in it. The bigger issue is actually that I live in China (for the time being), and can't get everything. But I can get more than you think...

Will look into vertical mice. I wonder if there are any vertical trackballs! That would be perfect. I actually use the kinesis fully split keboard (freestyle 2) at an 80 degree angle so vertical works well for me
posted by wooh at 10:08 PM on August 13, 2020

Response by poster: There have been some great suggestions about computer peripherals/software, and I highly welcome those.

Would be curious if anyone has had any experience with...ergonomic switch inputs (or video game controllers in general)? Feels so weird asking b/c for such a long time there was no issue...*sigh*
posted by wooh at 10:12 PM on August 13, 2020

I also have similar RSI and use a vertical mouse for my day to day work. For game controller input, I use an Xbox Elite Controller, which helps with my RSI because it has paddles on the back that duplicate the face buttons, so I can use my lesser used fingers instead of always using my thumb. However it's PC/XBox only and quite expensive. Personally I find the switch controller inputs to be quite awful for my wrist when attached to the device or dock thing so I usually take them off and hold them independently. Or, you could maybe look into a third party switch controller like this one that has back paddles. That's just one I found in a search, I am not personally advocating it
posted by JZig at 10:34 PM on August 13, 2020

Heavy mouse use has always given me problems as well. I started wearing the IMAK Smart Glove as a preventative measure anytime I am using the mouse for any length of time and it helps tremendously. It's comfortable and keeps my wrist positioned properly. It comes in a couple different sizes so make sure you check the measurements before ordering.
posted by platinum at 10:34 PM on August 13, 2020

I wonder if there are any vertical trackballs!

Here is a very good one: Logitech MX Ergo. Not fully vertical, but a good tilt.
posted by His thoughts were red thoughts at 11:05 PM on August 13, 2020

Regarding the Tobii accuracy, it's okay. Not unusable, but your eye is constantly jittering (saccades). Controlling the cursor with eye movement directly means that it's *constantly* flying around the screen, so Talon averages it out if the eye is staying in one general area. The cursor settles down over time, and you nudge it into place with a bit of head tracking. It's still a *lot* of random movement, so I tend to turn it on briefly as needed, or hide the cursor.

If you are doing a lot of mousing this way, it can definitely lead to unusual feeling eye and neck strain.

Pop to click is a bit more useful, https://www.youtube.com/watch?v=i6_fdMtmv6c is an older demo of pop to click, eye-tracking to move, and he's hissing to drag.

Re: the MX ergo, it's very nice. If you get the "MX Ergo Plus" it comes with an additional rubber wedge to get even more vertical, which I'd recommend.
posted by Anonymous Function at 11:54 PM on August 13, 2020

One option is to have a whole lot of different physical inputs available and switch between them as much as possible:

- foot pedals
- left handed AND right handed mouse
- graphics tablet, where usually you hold a stylus like a pen and tap it on the base to click. To me it feels different than using a stylus on a phone/tablet, maybe because of how you can rest your hand between clicks and the gentleness of the tapping. I think you often also have a setting (probably only on desktop computers) where you can hover in place until a click registers, without actually tapping it.
- button switches like this, where instead of using fingers/wrist you could use your whole arm to tap (technically you could use foot pedals for this. I've only had experience with the cheap kind and find they have a little too much resistance to be used comfortably this way. Since you're in China, I wonder if you could find someone who could affordably adapt a cheap foot pedal or whatever (or rig up something from scratch) to let you build more comfortable customized button-type inputs.)
- keyboard shortcuts - say, ctrl+spacebar to click, plus sticky keys so you can press them one at a time, ideally using your whole hand to come down on the keys instead of the usual muscles.

For tablets/phones (android, I assume it's the same for iOS?), you can connect a USB hub and use your external inputs that way.

I know you said you hate voice control (I empathize very much) but it might be worth using for a few weeks until things start feeling better. Or take a short break from games just to give your body a time to catch up.

Sometimes "kinesiology" tape helps a little.

Do all the stretches you can find (gently - it's tempting to stretch as hard as you can, but you want to gently take your muscles to their maximum point, hold there for a few seconds until the stretch feeling recedes, and then stretch a tiny bit further)
posted by trig at 11:59 PM on August 13, 2020

There's also an assistive technology called hover to click (probably not supported on mobile devices, though I'm not sure). I don't know how well it works on Windows (it might only be for selecting individual windows, though surely there's some software that expands that). On Linux it can be used for any kind of clicking (for example).
posted by trig at 12:06 AM on August 14, 2020

I had wrist issues a few years back and switched to using a Magic Trackpad instead. It lets me keep my hand at what feels like a more natural angle for me and the swiping, pinching and tapping gestures can be very minimal compared to doing the same things with mice. The size of the trackpad means I can move from one side of a 27in monitor to the other in a single swipe, and I have also turned on various things like momentum and speed of cursor movement that makes very easy to move around the screen and tap to click instead of physical clicking. It is very much not like using a touchscreen for me, it feels both very precise while requiring minimal hand, finger and wrist movement.
posted by Happy Dave at 12:41 AM on August 14, 2020 [1 favorite]

You asked about stretches and I think you're onto something.
I can't recommend this book enough: Conquering Carpal Tunnel Syndrome and Other Repetitive Strain Injuries
posted by richb at 1:24 AM on August 14, 2020

The bursar at the school where I used to work as an IT technician was susceptible to RSI, and she had one of these Fellowes gel wrist cushions for her mousing hand that she said helped keep it at bay. I used it as well whenever I worked on her machine, though only because it was there, and also found it very comfortable.
posted by flabdablet at 6:09 AM on August 14, 2020

If you're at all handy with a soldering iron, it's pretty easy to butcher a cheap USB keyboard and wire cheap foot switches across whichever keys you need to use repeatedly.
posted by flabdablet at 6:19 AM on August 14, 2020

The only thing that helped my 5+ year struggle with RSI was physical therapy (from a good place – the first time I tried, it wasn't that great, but the care was not that great). For a few years I thought it was all wrist problems, but I'm pretty sure it was secretly my right shoulder and neck all along (just a lot of posture problems). I have a sitting/standing desk, an expensive desk chair, a split keyboard, and I also alternate between a Wacom Intuous tablet and a vertical mouse. Getting PT and learning strengthening exercises for the muscles that were causing all my problems is the only thing that is finally making me feel almost completely normal on a daily basis again.
posted by caitcadieux at 8:24 AM on August 14, 2020 [2 favorites]

Another consideration: I was flirting with RSI and started indoor rock climbing. The exercise and strengthening of my hands helped my hands considerably. You might consider and indoor rock climbing fingerboard and exercises to help strengthen your hands and arms.
posted by nickggully at 10:09 AM on August 14, 2020

You didn't say which split keyboard you have, so... if it's a Kinesis, its keys are reprogrammable. Long ago and far away, I reprogrammed my Kinesis so that the shift keys were thumb instead of pinky keys, and the difference was just remarkable.

Short of that, your VNs might let you change which keys do what -- check the settings?
posted by humbug at 3:28 PM on August 14, 2020

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