How to Select the Right Keyboard in Office Ergonomics Ergo Equipment (Part 3 of 3)

Discover the complex world of ergonomic keyboard selection. This episode wraps up a three-part series on office ergonomic equipment selection, focusing on the challenges of recommending the best ergonomic keyboard. Learn about the historical development of keyboards and the inherent biomechanical issues with standard designs. 

The episode details the most common mistakes consultants make, introduces various types of ergonomic keyboards, and provides a practical decision tree to help make informed recommendations. Listeners will also learn about related considerations such as keyboard placement, the role of palm supports, and the importance of setting client expectations.  

Check out the blogpost for downloads and awesome information to make this in-depth episode make sense: https://www.ergonomicshelp.com/blog/keyboard-selection-office-ergonomics 

Are you a healthcare professional curious about how office ergonomics assessments could fit into your services? I’ve got you covered with some valuable (and free!) resources at www.ergonomicshelp.com/free-training.

Transcript

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Well, hey there. Today we're talking about how to recommend the best ergonomic keyboard for your client. Let's do this. Welcome to the Business of Ergonomics podcast. I'm your host, Darcy Jeremy. I'm a board certified professional agonist with over 15 years of experience delivering ergonomics programs to employers of all different types. In this podcast, I share what other healthcare professionals are already doing and being with ergonomics assessments and how to land those clients that you dream of. Without further ado, let's jump into this episode right now. we're wrapping up our three part series on office ergonomic Equipment Selection with what I consider one of the most challenging topics we face as consultants choosing the right keyboard. Am I right? If you haven't listened to parts one and two, I really wanna strongly encourage you to go back and start there. In part one, we covered root cause analysis and basically that's the foundation that makes everything else work. Whether you're gonna recommend the best mouse keyboard, anything, you gotta start there. If we were to recommend the most ergonomic chair, keyboard, mouse, if you don't do a thorough root cause analysis, then you're gonna make a mistake. Today in part three, we're applying those same principles to keyboards, but with some added complexity that I think you'll find really valuable. here's the truth that took me years to fully appreciate. Keyboard selection is where a lot of well-meaning ergonomists get into trouble. The market is absolutely flooded with options, mechanical keyboards, split keyboards, tented designs, compact layouts, alternative key arrangements, and every manufacturer claims their product is the most ergonomic solution. So today I'm gonna dive into the framework I use after 15 plus years. In this field, we're gonna cover problems with modern keyboards, the top mistakes I see consultants make a brief history that explains why we're where we are at today, which I find is really interesting and a deep dive into each keyboard category. And finally, I'm gonna walk you through a bit of a decision tree that you can use in your practice, ASAP. So let's dive into this right now. Let me first start by stating something that might seem obvious, but is absolutely critical. The standard keyboard was never designed with human biomechanics in mind. Think about that for a moment. This device that millions of people use for hours every day. The primary interface between the human operator and the machine was designed to solve a mechanical problem, not an ergonomic one. We'll get into the history shortly, but the key point is the Q-W-E-R-T-Y layout and the flat rectangular keyboard design we all know wasn't created to fit our bodies. It was created to prevent typewriter jams. The research on this is quite clear. Studies have consistently shown the standard flat keyboard design requires users to make postural adaptions to conform to the keyboard during typing movements of the wrist. We're talking extension, flexion, radial and ulnar deviation causes tendons and nerves to compress against or stretch over adjacent anatomical and anatomic situations. maintaining these positions for long periods without rest may eventually result an injury for some people or at least pain. And we don't want that, and that's why they call people like us in. To deal with it from a biomechanical perspective, the standard keyboard creates several problematic exposures. Number one, forearm pronation often approaches the limit. Number two, NAR deviation typically 20 to 40 degrees from neutral especially when the keyboard feet that's in the back part of the keyboard are raised. Number four, there is prolonged shoulder abduction to position the arms over the wide keyboard. And number five, There is excessive lateral reach when using a standard keyboard for right-handed mouse users Due to the numeric keypad. The increased use of computers both at work and at home has resulted in a higher incidence of musculoskeletal disorders. research has identified that heavy keyboard users, particularly those spending more than five hours per day on computer work, face significantly elevated risk. And let's face it, that's everyone who works in the office today, plus those folks that are doing the exact same things when they go home at the end of the day and game and do whatever they need to do on their desktop. So it's the combination of repetitive motion, sustained awkward postures and insufficient rest time. That creates what we might call the perfect storm for msds. And here is what makes us particularly challenging for us as agonists. Our clients often don't correct their symptoms to the keyboard. They come in with wrist pain, elbow pain, shoulder pain, and even neck pain. But they're rarely thinking about their keyboard as being the culprit. In this situation, more often you're gonna hear complaints about their chair being old and crappy and their monitor just not being good enough But at the end of the day, their keyboard is just there, and it's not overly giving them those red flag moments that it's causing problems. Which brings me to the mistakes I see consultants make over the years. I've reviewed thousands of ergonomic assessments, my own early work, and those of students in my programs. Specifically the ergonomics blueprint, and if you wanna get into this program of how I can show you how to do effective office ergonomics assessments, and then you get that overall support from me as well and that mentorship. Then you can go to the description here and you can find out how to get started. All you gotta do is go to ergonomics help.com/freetraining. That's ergonomics help.com/free-training super easy. I'll put it in the description too, so you can get started with that. You'll also find a bunch of awesome free resources, including how to Land Your First Pain Client, why Office, ergo is a perfect fit for health professionals, how to choose the right equipment for every client without guessing, and your step-by-step guide for Clear, impactful Office or Go Reports. You'll get all that stuff there. So you definitely don't wanna miss this opportunity to jump into office or go right now. So when it comes to keyboard recommendations, I see the same errors coming up again and again. let me walk you through the five most common ones. Mistake number one, recommending an ergonomic keyboard without root cause analysis. This is a big one y'all, and it's why I insisted that you listen to part one of the series. First, I can't tell you how many times I've seen a consultant walk into an assessment, see a client with wrist pain, and immediately recommend a split keyboard or a tented keyboard without ever understanding what's actually driving the load. Wrist pain might be caused by NAR deviation during typing, in which case a split keyboard might help, but it might also be caused by wrist extension from a desk that is too high, or contact stress from resting on a hard edge or excessive reaching because a keyboard is too far away. A fancy ergonomic keyboard isn't gonna fix any of those problems. Remember the five why's from part one. Use them maybe it's the keyboard, maybe it's not. Maybe it's just that the workstation is just not set up well for them, but you gotta figure that out. Mistake number two, ignoring touch typing proficiency. This is a critical factor that gets overlooked constantly. Many alternative keyboard designs, I'm talking about split keyboards, contoured keyboards, dramatically tented keyboards. these are all fundamentally designed for touch typists. If your client is a hunt and peck typist who needs to see all the keys, putting them on a split keyboard will likely be a disaster, because there's gonna be so much frustration. I always ask about typing proficiency in my intake interview. It's not about judging anyone. Plenty of highly effective professionals never learn to touch type, but it's essential information for keyboard selection. A client who looks at the keyboard while typing needs visual access to the keys period that limits your options significantly. Mistake number three, forgetting about mouse placement. This connects directly with what we talked about in part two. The keyboard and mouse work together as a system. Obviously, Sometimes the best keyboard intervention isn't a fancy ergonomic design at all. It's about switching to a compact keyboard to optimize the mouse placement on the right hand side, so it's in line with the shoulder and there's no more lateral reach I've seen ergonomists recommend expensive split keyboards while completely ignoring that the client's primary issue was shoulder pain from reaching for a mouse that was positioned too far away. The split keyboard did nothing to address that. A compact keyboard might have solved the problem at a fraction of the cost. Mistake number four, underestimating the learning curve. Any new keyboard is a motor learning task. When you change the keyboard, you change how movement is generated. The speed, accuracy, trade-off, and the cognitive effort required during work. Our short term dip in speed and accuracy is completely normal. comfort improvements often lag behind the initial change. The mistake is failing to see this expectation with clients. If you give someone a new keyboard and they abandon it after one day because it felt weird, that tells you nothing about whether it was actually a good recommendation. Most users need several days to adapt, sometimes longer for more dramatic design changes. Setting appropriate expectations upfront is part of good ergonomics practice. I tell my clients This may feel awkward for the first week, but that's totally normal. Let's check in after a couple weeks and see how it's going. And if you don't notice significant influence in your pain, then we gotta look at another option here. Mistake number five. Treating all split keyboards as equal. There's an enormous range of design within the ergonomic keyboard category. A keyboard with a gentle 12 degree split is a completely different intervention than a fully separated keyboard with 40 degree tenting, they address different exposures and have totally different learning curves. I see consultants recommend a split keyboard without specifying the type or the reason why. These are really important, especially for those folks that have no idea about ergonomics and that's why you get paid the big bucks recommending the specific type of keyboard, specific website link and how they can get started. So let's talk about keyboard design. I think this is so fascinating this is gonna be a little bit of a longer podcast today because it's going to allow me to dive into the details of keyboard design, specifically the history of it. I find this stuff so fascinating, and it's gonna give you another tool in your tool belt as an ergonomic specialist so you can answer those questions from your clients about why the heck are keyboards even designed this way in the first place, because you might be recommending a different type of keyboard for them. So I wanna give a really condensed version here. it all starts in 1868. Christopher Laham Shoals invented the typewriter and introduced what we now call the Q-W-E-R-T-Y layout. Here's the irony. Shoals apparently tried to make typing easy for users, familiar with the alphabet, But that design resulted in type bar jams when keys were pressed quickly, so the layout was rearranged not to help humans type faster, but to slow them down enough to prevent mechanical jams. Today's Q-W-E-R-T-Y keyboard literally has its roots in an attempt to reduce typing speed. think about that the next time someone tells you about the latest optimized keyboard layout a hundred years ago, a German researcher named clock Inberg described the postural problems inherent keyboard work. He suggested splitting the keyboard in the center and laterally tilting the left and right sections. Does that sound familiar? Mind blown. Right. 1926. This is going down. between the 1970s and mid 1980s, European researchers refined these concepts. They experimented with 10 to 15 degrees of horizontal rotation to reduce ulnar deviation, 25 to 60 degrees of lateral inclination to reduce forearm pronation. And they even looked at crescent shaped IES to conform to the natural arc of finger movement as getting more ergonomic. But did that translate to our keyboard designs that we see today? We'll dive into that. And here's what's fascinating about this. Despite decades of research and despite ergonomists, knowing that the standard keyboard was problematic it largely rejected proposed changes, shocking the scientific evidence wasn't considered strong enough to justify the costs of retraining and obtaining new equipment. That started to change in the mid 1980s when a spike in reported msds. Among computer workers, studies revealed that females were affected more than males and that the percentage of the workday devoted to typing was positively related to symptom development. when people started getting hurt in significant numbers, this attracted a lot of attention. Today, we have more than 15 alternative keyboard designs that are commercially available, but here's what the research tell us. Despite ISO guidelines, no. Clearly established methodology has emerged for evaluating these designs. Different studies use different approaches geometry, video analysis, EMG 3D, motion analysis, and the results don't always align. In many studies, and I looked at a bunch of studies when putting this episode together, what we do know is this Alternative keyboard designs generally place the and closer to neutral positions than a standard keyboard, but. The trade-offs in terms of productivity, learning curve, and user acceptance be different among those designs and users. We're gonna shift the conversation to keyboard designs here. For each one, I'm gonna cover the key features, the biomechanical rationale, who's the best candidates for the use, limitations and conditions where I would typically recommend it. This is gonna be in a blog post too. I'm gonna link the blog post in the show notes because we're gonna get into some of the nitty gritty details that we as ergonomics professionals got to know. Right? Let's jump into number one standard full size keyboard. This is the keyboard that's Usually comes with a desktop. We've known it, we've loved it, we've known it for years. It's a full-sized keyboard with an integrated numeric keypad on the right hand side. It has the traditional key W-E-R-T-Y layout. It integrates the numeric keypad on the right hand side, super flat profile, and has the optional rear feet for a positive. has a flat profile with optional rear feet for positive tilt. There's a low cognitive load here because everyone knows how to use it because this is the one that has always existed. The positives of this keyboard is that it's very easy to use, especially for those people that require visual input. these are the hunt and pack typists. It has a familiar design, and this means that there's absolutely no learning curve here. it seems to be always available in any work environment, It can achieve a high accuracy and typing speed for people that are proficient with this, The limitations of this is that increases the lateral reach due to the location of the numeric keypad. It pushes the mouse further away leading to external rotation of the shoulder lateral reaches, and overall more risk for MSD development. This also promotes NAR deviation and extension requires near maximum forearm pronation, keeps the hands close together, limiting shoulder mobility if someone's using this keyboard for long work periods, it can be quite fatiguing for the wrists. best case scenario, people who don't show any symptoms, who are occasional keyboard users or where the primary issue is unrelated to keyboard posture are gonna use this. It's also appropriate where there's no alternative available or if the client is not a touch typist, and visual access to keys is essential. The second keyboard that we're gonna look at is the compact keyboard, This is often my first recommendation when someone has shoulder or elbow symptoms on their mouthing side. It's a simple low risk intervention in my humble opinion. key features of this keyboard is that it has the standard W-E-R-T-Y layout, and it doesn't have the numeric keypad on the right hand side, so it has a narrow footprint. It usually has about four inches less width, and it may or may not include the arrow keys and navigation cluster. the positives is that it allows for optimal mouse placement and it significantly decreases the lateral reach, which I love this reduces shoulder moment, arm and abduction requirements. There's a minimal learning curve here because the layout is pretty much the same as a standard keyboard generally has a lower cost than specialized ergonomic keyboards too, which is always a win. The limitations here is that there's no integrated numeric keypad, so this may require a separate external keypad for heavy number entry. It does also not address on our deviation or pronation. This is best used for. Clients with right sided shoulder, elbow, or upper arm symptoms where lateral reach is a contributing factor. It's also excellent for workstations with limited desk space. I usually pair this with an independent numeric keypad positioned on the left or the right for clients who need a number entry, but also mouse heavily in their right hand. We're gonna jump into the inverse keyboard for our third keyboard on the list. This is where the left side has the numeric keypad. It's an essentially a mere image solution. to the reach problem. The key features of this keyboard is that the numeric keypad is located on the left side instead of the right. therefore, in a much more neutral posture. The positives of this keyboard is it reduces lateral reach for right-handed mouse users maintains access to the numeric keyboard for heavy number entry. There's no change in alphabetic key layouts, and that means it's going to be. A really familiar typing experience for the user as well, which is always a positive. Now, here are the limitations with this. There might be some curve balls here, but overall, if your client is ready for a new challenge, it might be ideal for them. This is ideal for right-handed users only. Keynote here, not left-handed users. If that left-handed Mouser is gonna be using an inverse keyboard, then they're gonna fall into the same trap as a standard keyboard design. This may be difficult to transition to left-handed numeric keypad use. This is best used for right-handed Clients who do significant number entry and have symptoms related to lateral mouse use, these people need to be up for the challenge. But if they are ready to make the commitment to this type of keyboard, it can absolutely be a game changer for their productivity and their pain. That transition to left-handed number entry can take practice. So obviously this is gonna work best for your clients who are motivated, or for those folks that don't use a number pad very often, but still wanna have it close at hand. The fourth keyboard that we're gonna look at today is the split keyboard, but this is basically gonna be a fixed split. We're getting more into the keyboards that directly address wrist posture. Split keyboards come in several variations, so I'm gonna break these down for you. The key features of this design is that the alphabetic keys are divided into the left and the right sections. the fixed angle of separation is typically between 10 to 15 degrees. this may also include a modest lateral tilt, and this often includes built-in palm supports too. The positives of this keyboard is that it reduces all our deviation by allowing the risk to remain straighter. this has a moderate design, right? So that means that many people are gonna have a faster adaption to this type of. Keyboard than more radical designs that we're gonna get into in a bit. The research shows that these designs keep the hands closer to neutral positions, and this is often described as comfortable and easy to use in a bunch of research This preserves relatively high levels of typing productivity. The limitations of this design is that it's difficult to use if the person is not a really good touch typist, and they might actually require more workstation depth to use this optimally as well. There's a fixed angle here and although that makes it easier to have a learning curve at this, it may not fit all users because there's no adjustability here. So you gotta keep that in mind when looking at this type of solution. And some users may find the keys to spread out for small hands or vice versa for bigger hands. Keep that in mind for users that fall into either the fifth or 95th percentile. These types of keyboards are best used for risk discomfort related to deviation. It's also good for users transitioning from a standard keyboard who want ergonomic benefits without a dramatic change. Research suggests that these. Moderate designs offer a good balance of posture improvement and productivity preservation For our fifth keyboard, we're gonna jump more into the split keyboard, but it's going to be fully separated, split keyboard design. All right, so basically what we're looking at here is two completely independent keyboard halves. The features of this product that there's two independent keyboard sections and they can be positioned anywhere on the work surface. this allows for so much freedom and flexibility for that user. They can determine the spacing, the angle, the tilt, the tent, you name it. It's all in that person's discretion. Some models include adjustable tenting as well, and those are things that you really wanna pay attention to as an ergonomists. so the positives of this design. is that it will allow for more neutral wrist, hand, and elbow postures. There's an independent placement and this allows for preferred configuration by the user so they can technically do a lot of positivity to reduce where their discomfort is. If they know how to position it properly, they can position the keyboard halves at shoulder width to reduce shoulder abduction too, which is huge. This offers the freedom of movement and a relaxed arm position. The limitations of this type of design, it's difficult to use if they are not proficient at typing, and it's even more critical than With fixed split keyboards. research shows that approximately 20% productivity reduction during the adaptation phase of this. So that really needs to be clearly communicated to those folks so they don't get discouraged with the first couple weeks of getting used to this. Some users report that sections can feel a little bit shaky or bouncy. It can be difficult to find the keys to especially. Function, keys and special characters, they may require significantly more desk space, and often this is something that's really good to know. Actually often there's a lower user preference for these types of keyboards, despite there's way better biomechanics and neutral positioning from the ergonomics perspective. this is best used for highly proficient touch typist with significant symptoms related to shoulder posture, NAR deviation, and pronation. Where the biomechanical benefits justify the productivity and adaptation costs. I often reserve this recommendation for clients who have tried other interventions without success. Number six, we're looking at tented and laterally inclined keyboards. tenting refers to raising the inner half of each keyboard, so looks like a tent, and this reduces forearm pronation. the key features of this type of keyboard is that there's lateral inclination ranging from 10 degrees to over 40 degrees. This can be fixed or adjustable, and It's often combined with split design. The benefits of this is that it significantly reduces forearm pronation and research shows, which is really interesting, that there's less for our muscle activation compared to flat keyboards. It moves toward the handshake position that reduces the internal tissue loading. There's also really important research finding that you gotta know. Keyboards with extreme tenting around 40 degrees or more are superior at reducing pronation, obviously, but they may keep the wrist in substantial extension and radial deviation. In other words, they reduce one risk factor while potentially increasing another moderate tenting of 10 to 15 degrees appears to offer a better balance. the limitations of this type of design is that the extreme angles can be super frustrating and create awkward hand positions, which does not in the long run do a lot of positivity for that person. It definitely requires that person being a really good typist and it's probably gonna take a lot longer to adapt. Then only split designs. this is best used for excellent typers with symptoms related to forearm pronation, and that's often presented as lateral elbow pain. Or forearm muscle fatigue. I generally recommend moderate tenting over extreme angles unless the client has specifically tried moderate angles without relief. We're gonna jump into our seventh keyboard, You can find that in the show notes. The seventh keyboard that we're looking at today is contoured keyboards. Contoured keyboards a really good example of this is the Kinesis Advantage, The, features of this keyboard is so with this keyboards, you're gonna probably see the keys. With these keyboards, the keys are arranged in wells or curved services that match their finger length differences. They often include integrated tenting and splitting. And there's also some clusters for frequently used. Keys and there's built-in palm supports too. The positives of this is that it allows for more neutral wrist and hand positions. It reduces finger travel distance and redistributes the work from pinky fingers to the thumb. The limitations of this is that it's really difficult to use if you're not good at typing, which is so common with these alternative keyboard designs. There is a significant learning curve as well. It can take weeks to reach the previous typing speed, and some may result in awkward postures for certain hand sizes as well. These have a higher cost than other keyboard types, and it definitely requires additional workstation depth. This is best used for professionals. That are very good at typing with persistent symptoms who have tried other interventions and are willing to invest significant time in getting used to this design. So these are high commitment interventions with potentially high rewards for the right person. Our eighth on the list is mechanical keyboards. I get a lot of questions about these and some of these alternative types of designs will have the mechanical keys in them. So keep that in mind when we're going through this. There's a bunch of different types of switches with different actuation forces and feedback, and there's higher key travel than membrane keyboards. there's distinct tactile and auditory feedback too with mechanical keyboards. You've probably heard that before. However, that's the positive involved with this too. The ergonomic consideration here is that mechanical keyboards are inherently more or less ergonomic than membrane keyboards. In terms of posture, what they offer is a different force and feedback characteristic. low profile mechanical keys can require less force to press down and are often preferred by touch. Typists, high profile keys with stronger tactile feedback are sometimes preferred by users who need that sensory confirmation of key actuation. The research here suggests that individual typing technique affects outcome more than the keyboard switch type, which is so interesting. If a client is bottoming out keys forcefully on a membrane keyboard, a mechanical keyboard with appropriate switches might reduce impact forces. This is best used for clients who report finger fatigue or who type with excessive force. The switch type matters. Lighter switches for those who need less resistance. Tactile switches for those who need feedback without bottoming out. And this is more about force modulation than posture. The posture is more related to the type of keyboard because many alternative keyboards will have the mechanical option involved. Okay. Are you still with me at this point? Good. And remember, I have lots of show notes for you. Just check out the episode description. We have only one type of keyboard left. That's right. We're at number nine and we are finishing up this list with different key layouts. Dvorack and Coleman, and I include this for completeness, but let me be direct. I rarely, if at all, recommend alternative key layouts in practice. The theory of this is that layouts like the and claim to reduce finger travel and place more commonly used keys under stronger fingers. The theory is sound and doak himself proposed these changes in the early 20th century. The reality is that the research has never conclusively demonstrated that alternative layouts reduce injury rates or significantly improve productivity. For most users, what they definitely do is require massive retraining. We're talking months to regain proficiency, and the user can no longer easily use any other computer too. My position is that unless a client specifically requests information about alternative layouts and is prepared for the investment. I focus on interventions with better evidence and faster payoff. The physical keyboard design specifically the splint, tented, contoured has way more robust research support than the key arrangement. So that's something that you can share with your clients. The first thing I wanna talk about is keyboard placement. No keyboard recommendation is complete without addressing placement. The keyboard should be positioned slightly below elbow height, close to the body to maintain neutral postures flat or at a slight negative tilt. Never with those rear feet raised unless there's a situation that calls for it that is very, very unique. I'm talking like one or 2% of all ergonomics assessments that you might see may require this setup, And lastly, the keyboard placement should be centered on the most frequently used keys, not the center of the keyboard. I cannot emphasize this enough. The fanciest ergonomic keyboard in the world won't help if it's positioned incorrectly. Let's talk about wired versus wireless setups. wireless keyboards may be beneficial because it allows a user to freely relocate the keyboard as required. And it's who share workstations. The ergonomic benefit is flexibility, not the wireless technology itself. Let's talk about palm and supports, and it's something I emphasize with every client. Palm supports are for resting during pauses, not for typing, Typing should be performed with the hands floating above the keyboard. The heel of the hand should only rest when taking a break from typing. When palm supports are used, they should keep the hands and wrists in neutral. Postures not angled up or down. I seen poorly designed wrist rests wrist extension. the support should be firm enough to maintain position, but not hard enough to create contact stress. Let's look at independent numeric keypads. These are for clients who need numeric entry, but would benefit from a compact keyboard. These are for clients who need or really enjoy that keypad, for the number keys, but they would actually really benefit from a compact keyboard too, because their current setup is leading too much external rotation of the shoulder. So an independent numeric keypad is a really nice solution. It can be positioned either on the left-hand side for right-handed users or they can be positioned closer to the right, But you gotta be really careful about where you're positioning this because you don't wanna reintroduce the ergonomic risk that you engineered out. So significant coaching should be here. So you should really identify this with the user about limiting the reach distance when using the numeric pad, but at the same time ensuring that the shoulder a really good position when you are mouthing. It kind of gives you the best of both worlds in that situation. Okay. so I know that there's a lot of information here and I really wanna help you succeed when choosing the best keyboard. So I wanted to break this down in a way that makes sense. I have a decision tree. and really most agonists have some sort of system that they use to figure this out. I'm gonna walk you through when that can work for you here. The first thing that you wanna do, you gotta do a complete root cause analysis first, before looking at any sort of keyboard, you gotta look at the five why's and do thorough measurements and observations and interviewing of that person because you wanna figure out. if the keyboard is actually contributing to that person's problem. and then you wanna ask yourself if that issue could be resolved with workstation adjustments instead, what specific postures or movements? And then you wanna look at the specific postures or movements that are problematic, and if this is an engineering fix or if it's another type of solution that can be put in place instead of the keyboard. The second thing you wanna look at is the typing proficiency. Can they type without looking at the keyboard? it's the most critical factor in getting the right keyboard for them. The second thing you wanna look at here is hand dominance. Are they right-handed? Are they left-handed? This affects mouse placement and the numeric, considerations. One thing you might wanna consider here is, can you just recommend left-handed ing and would that be sufficient enough to reduce the reported symptoms? The next thing you wanna look at here, then you wanna look at the numeric keypad usage. How frequently are they using this? Are they entering numbers as an essential part of their job, or is it just a nice to have. Is it daily heavy use or occasional use, or maybe not at all. What about their physical characteristics? How about their hand size, their existing conditions affecting the grip or movement? You wanna look at that as well. If they're maybe in the fifth or the 95th percentile, you gotta make a note there because some alternative keyboards aren't gonna be useful for those parts of the population. And then you wanna really dial in and focus on their symptoms. Where is the symptoms located? What's the nature of this? Where is the discomfort? When does it occur? And pinpoint that because that's gonna help you get the keyboard that works for them. Step three. in step three, we're matching the exposure to the intervention. This is the core of the decision tree, and this is really gonna be useful for you. If the primary issue is lateral reach and shoulder loading. The first choice will likely be either a compact keyboard or left handed mounting. If a numeric entry is needed, then you wanna add an independent left side keypad or look at an inverse keyboard instead. if the primary issue is NAR deviation, you first wanna look at the workstation adjustments, obviously, make sure there's nothing to recommend. And if you do need to recommend a keyboard, a fixed split keyboard with 10 to 15 degree angle will be useful here. If the primary issue is forearm pronation, you wanna look at a tented keyboard, you wanna start with a moderate 10 to 15 degree tilt because there are some issues with more extreme tent. If the primary issue is wrist extension. First thing that you gotta do here is address the desk height and the keyboard tilt. you might wanna consider a keyboard tray with a negative tilt. the keyboard type here is less critical than placement for this issue if multiple issues are present. So if someone has significant symptoms, you want to consider a split intent to design. If the persistent symptoms are still present after the moderate intervention, then you wanna look at a contoured keyboard. Step four of this whole decision, treat set expectations. I really want you to encourage them to understand. So you have to. Step number four is to set expectations with that client. Discuss that there is going to be a learning curve. It could take one to two weeks of minor changes. step four. You wanna set expectations with that client, discuss with them that there is going to be a learning curve. And if it's just like a minor change, it might take one or two weeks for them to get really used to whatever changes you're putting into place. And it's gonna take longer If it's a dramatic change that you're putting into place, you gotta explain that the temporary productivity tips are normal. And if you can, I wanna encourage you to schedule a follow up to assess the adaptation and effectiveness, but I wanna encourage you to include that in the contract so that follow up is included. Step five, I want you to consider layered solutions. Remember that hierarchy from part one, and you can combine an engineering control with administrative and behavioral approaches. paired With workstation adjustments, specifically desk height and keyboard tray with task. And you can also look at task variation too. So to, whether you're looking alternate between keyboard intensive and mouse intensive task, maybe you can look at getting, proper pump support for use during breaks as a comfort item. And then you wanna really encourage them to have frequent short breaks to allow the rest periods in. So I have a quick reference for you. It's going to be in the blog post, so I want to encourage you to go to the blog post And check out this table last but not least, I'm gonna tie a ribbon on this episode. Thanks for sticking with me and because you are still with me, I have a really quick reference for you in that blog post. It's looking at keyboard selection by condition. Okay? So this is gonna be really valuable for you, especially if you're driving somewhere right now and you need to get the deets on the best type of keyboard to recommend for what condition. All right, well thank you so much for listening Thanks for sticking with me in this episode. I know it was a long one, however it needed to be the long one so I can set you up for recommending the best keyboard moving forward, the best keyboard for your client when you're doing office ergonomics assessments. If this episode has left you with more questions than answers, I can certainly help. I have programs and coaching available for ergonomics consultants so they can make the best recommendations for their clients and get paid what they are worth. I want you to head to my website, listen to my little outro to see how I can help you get to where you want to be. I'll chat to you soon. You can get started with office ergonomics assessments. Today, healthcare professionals are seeing the potential and opportunity to add office ergonomics assessments to their practice and services. Go to ergonomics help.com. Slash begin to get the exact seven step process that works so that you can get started today without the confusion or overwhelm. Just head to ergonomics help.com/begin now.