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Date: Mon, 9 Nov 1992 20:36:04 PST Reply-To: Dan Wallach <dwallach@EDU.BERKELEY.cs> Sender: "Discussion of Carpal Tunnel Syndrome, Tendonitis etc.." <SOREHAND@UCSFVM.earn> From: Dan Wallach <dwallach@EDU.BERKELEY.cs> Subject: FAQ: Typing Injuries (1/3): General Info [monthly posting] X-To: sorehand@ucsfvm.ucsf.EDU To: Multiple recipients of list SOREHAND <SOREHAND@UCSFVM.earn> Status: OR Archive-name: typing-injury-faq/general Version: $Revision: 4.15 $ $Date: 1992/11/10 04:13:37 $ ==================================================================== NOTE: I completely and utterly rewrote the info on injuries section! Pretty much all three sections of the FAQ have undergone major surgery since the last posting. ==================================================================== The Typing Injury FAQ -- sources of information for people with typing injuries, repetitive stress injuries, carpal tunnel syndrome, etc. Copyright 1992 By Dan Wallach <dwallach@cs.berkeley.edu> The opinions in here are my own, unless otherwise mentioned, and do not represent the opinions of any organization or vendor. I'm not a medical doctor, so my advice should be taken with many grains of salt. [Current distribution: sci.med, news.answers, and e-mail to c+health@iubvm.ucs.indiana.edu and sorehand@vm.ucsf.edu] Table of Contents: ==1== Mailing lists, newsgroups, etc. ==2== The soda.berkeley.edu archive ==3== General info on injuries ==4== Typing posture, ergonomics, prevention, treatment ==5== Requests for more info ==6== References ==1== Mailing lists, newsgroups, etc. USENET News: ----------- comp.human-factors occasionally has discussion about alternative input devices. comp.risks has an occasional posting relevant to injuries via computers. sci.med and misc.handicap also tend to have relevant traffic. There's a Brand New newsgroup, sci.med.occupational, chartered specifically to discuss these things. This would be the recommended place to post. Mailing lists: ------------- The RSI Network: Available both on paper and via e-mail, this publication covers issues relevant to those with repetitive stress injuries. For a sample issue and subscription information, send a stamped, self-addressed business envelope to Caroline Rose, 970 Paradise Way, Palo Alto CA 94306. E-mail to <crose@applelink.apple.com> $2 donation, requested. c+health and sorehand are both IBM Listserv things. For those familiar with Listserv, here's the quick info: c+health -- subscribe to listserv@iubvm.ucs.indiana.edu post to c+health@iubvm.ucs.indiana.edu sorehand -- subscribe to listserv@vm.ucsf.edu post to sorehand@vm.ucsf.edu Quick tutorial on subscribing to a Listserv: % mail listserv@vm.ucsf.edu Subject: Total Listserv Mania! SUBSCRIBE SOREHAND J. Random Hacker INFO ? . That's all there is to it. You'll get bunches of mail back from the Listserv, including a list of other possible commands you can mail. Cool, huh? What'll those BITNET people think of, next? ==2== The soda.berkeley.edu archive I've started an archive site for info related to typing injuries. Just anonymous ftp to soda.berkeley.edu:pub/typing-injury. (128.32.149.19) Currently, you'll find: Informative files: typing-injury-faq/ general -- information about typing injuries keyboards -- products to replace your keyboard software -- software to watch your keyboard usage keyboard-commentary -- my personal opinions on the keyboard replacements carpal.info -- info on Carpal Tunnel Syndrome carpal.surgery -- JAMA article on CTS surgery carpal.tidbits -- TidBITS article on CTS tendonitis.info -- info on Tendonitis datahand.review -- detailed review of the DataHand datahand.review2 -- follow-up to above datahand.desc -- description of the DataHand's appearance rsi.biblio -- bibliography of RSI-related publications rsi-network/* -- archive of the RSI Network newsletter Programs: hsh.shar -- a program for one-handed usage of normal keyboards typewatch.shar -- tells you when to take a break xdvorak.c -- turns your QWERTY keyboard into Dvorak xidle.shar -- keeps track of how long you've been typing rest-reminder.shar -- yet another idle watcher Pictures (in the gifs subdirectory): howtosit.gif -- picture of good sitting posture accukey1.gif -- fuzzy picture accukey2.gif -- fuzzy picture with somebody using it bat.gif -- the InfoGrip Bat comfort.gif -- the Health Care Comfort Keyboard datahand1.gif -- fuzzy picture datahand2.gif -- key layout schematic datahand3.gif -- a much better picture of the datahand kinesis.gif -- the Kinesis Ergonomic Keyboard maltron[1-4].gif -- several pictures of Maltron products mikey1.gif -- the MIKey mikey2.gif -- Schematic Picture of the MIKey twiddler1.gif -- "front" view twiddler2.gif -- "side" view wave.gif -- the Iocomm `Wave' keyboard Note: Many of the actual files are compressed (have a .Z ending). If you can't uncompress a file locally, soda will do it for you. Just ask for the file, without the .Z extension. If you're unable to ftp to soda, send me e-mail and we'll see what we can arrange. ==3== General info on injuries First, and foremost of importance: if you experience pain at all, then you absolutely need to go see a doctor. As soon as you possibly can. The difference of a day or two can mean the difference between a short recovery and a long, drawn-out ordeal. GO SEE A DOCTOR. Now, your garden-variety doctor may not necessarily be familiar with this sort of injury. Generally, any hospital with an occupational therapy clinic will offer specialists in these kinds of problems. DON'T WAIT, THOUGH. GO SEE A DOCTOR. The remainder of this information is paraphrased, without permission, from a wonderful report by New Zealand's Department of Labour (Occupational Safety and Health Service): "Occupational Overuse Syndrome. Treatment and Rehabilitation: A Practitioner's Guide". First, a glossary (or, fancy names for how you shouldn't have your hands): (note: you're likely to hear these terms from doctors and keyboard vendors :) RSI: Repetitive Strain Injury - a general term for many kinds of injuries OOS: Occupational Overuse Syndrome -- synonym for RSI CTD: Cumulative Trauma Disorder -- another synonym for RSI WRULD: Work-Related Upper Limb Disorders -- yet another synonym for RSI CTS: Carpal Tunnel Syndrome (see below) Hyperextension: Marked bending at a joint. Pronation: Turning the palm down. Wrist extension: Bending the wrist up. Supination: Turning the palm up. Wrist flexion: Bending the wrist down. Pinch grip: The grip used for a pencil. Ulnar deviation: Bending the wrist towards the little finger. Power grip: The grip used for a hammer. Radial Deviation: Bending the wrist toward the thumb. Abduction: Moving away from the body. Overspanning: Opening the fingers out wide. Now then, problems come in two main types: Local conditions and diffuse conditions. Local problems are what you'd expect: specific muscles, tendons, tendon sheaths, nerves, etc. being inflamed or otherwise hurt. Diffuse conditions, often mistaken for local problems, can involve muscle discomfort, pain, burning and/or tingling; with identifiable areas of tenderness in muscles, although they're not necessarily "the problem." --- Why does Occupational Overuse Syndrome occur? Here's the theory. Normally, your muscles and tendons get blood through capillaries which pass among the muscle fibers. When you tense a muscle, you restrict the blood flow. By the time you're exerting 50% of your full power, you're completely restricting your blood flow. Without fresh blood, your muscles use stored energy until they run out, then they switch to anaerobic (without oxygen) metabolism, which generates nasty by-products like lactic acid, which cause pain. Once one muscle hurts, all its neighbors tense up, perhaps to relieve the load. This makes sense for your normal sort of injury, but it only makes things worse with repetitive motion. More tension means less blood flow, and the cycle continues. Another by-product of the lack of blood flow is tingling and numbness from your nerves. They need blood too. Anyway, when you're typing too much, you're never really giving a change for the blood to get back where it belongs, because your muscles never relax enough to let the blood through. Stress, poor posture, and poor ergonomics, only make things worse. --- Specific injuries you may have heard of: (note: most injuries come in two flavors: acute and chronic. Acute injuries are severely painful and noticable. Chronic conditions have less pronounced symptoms but are every bit as real.) Tenosynovitis -- an inflamation of the tendon sheath. Chronic tenosynovitis occurs when the repetitive activity is mild or intermittent: not enough to cause acute inflamation, but enough to exceed the tendon sheath's ability to lubricate the tendon. As a result, the tendon sheath thickens, gets inflamed, and you've got your problem. Tendonitis -- an inflammation of a tendon. Repeated tensing of a tendon can cause inflamation. Eventually, the fibers of the tendon start separating, and can even break, leaving behind debris which induces more friction, more swelling, and more pain. "Sub-acute" tendonitis is more common, which entails a dull ache over the wrist and forearm, some tenderness, and it gets worse with repetitive activity. Carpal Tunnel Syndrome -- the nerves that run through your wrist into your fingers get trapped by the inflamed muscles around them. Symptoms include feeling "pins and needles", tingling, numbness, and even loss of sensation. CTS is often confused for a diffuse condition. Adverse Mechanical Tension -- also known as 'neural tension', this is where the nerves running down to your arm have become contracted and possibly compressed as a result of muscle spasms in the shoulders and elsewhere. AMT can often misdiagnosed as or associated with one of the other OOS disorders. It is largely reversible and can be treated with physiotherapy (brachial plexus stretches and trigger point therapy). Others: for just about every part of your body, there's a fancy name for a way to injure it. By now, you should be getting an idea of how OOS conditions occur and why. Just be careful: many inexperienced doctors misdiagnose problems as Carpal Tunnel Syndrome, when in reality, you may have a completely different problem. Always get a second opinion before somebody does something drastic to you (like surgery). ==4== Typing posture, ergonomics, prevention, treatment The most important element of both prevention and recovery is to reduce tension in the muscles and tendons. This requires learning how to relax. If you're under a load of stress, this is doubly important. Tune out the world and breath deep and regular. Relaxing should become a guiding principle in your work: every three minutes take a three second break. EVERY THREE MINUTES, TAKE A THREE SECOND BREAK. Really, do it every three minutes. It's also helpful to work in comfortable surroundings, calm down, and relax. If you can't sleep, you really need to focus on this. Rest, sleep, and relaxation are really a big deal. There are all kinds of other treatments, of course. Drugs can reduce inflamation and pain. Custom-molded splints can forcefully prevent bad posture. Surgery can fix some problems. Exercise can help strengthen your muscles. Regular stretching can help prevent injury. Good posture and a good ergonomic workspace promote reduced tension. Ice or hot-cold contrast baths also reduce swelling. Only your doctor can say what's best for you. --- Posture -- here are some basic guidelines. [I so liked the way this was written in the New Zealand book that I'm lifting it almost verbatim from Appendix 10. -- dwallach] . Let your shoulders relax. . Let your elbows swing free. . Keep your wrists straight. . Pull your chin in to look down - don't flop your head forward. . Keep the hollow in the base of your spine. . Try leaning back in the chair. . Don't slouch or slump forward. . Alter your posture from time to time. . Every 20 minutes, get up and bend your spine backward. Set the seat height, first. Your feet should be flat on the floor. There should be no undue pressure on the underside of your thighs near the knees, and your thighs should not slope too much. Now, draw yourself up to your desk and see that its height is comfortable to work at. If you are short, this may be impossible. The beest remedy is to raise the seat height and prevent your legs from dangling by using a footrest. Now, adjust the backrest height so that your buttocks fit into the space between the backrest and the seat pan. The backrest should support you in the hollow of your back, so adjust its tilt to give firm support in this area. If you operate a keyboard, you will be able to spend more time leaning back, so experiment with a chair with a taller backrest, if available. [Now, I diverge a little from the text] A good chair makes a big difference. If you don't like your chair, go find a better one. You really want adjustments for height, back angle, back height, and maybe even seat tilt. Most arm rests seem to get in the way, although some more expensive chairs have height adjustable arm rests which you can also rotate out of the way. You should find a good store and play with all these chairs -- pick one that's right for you. In the San Francisco Bay Area, I highly recommend "Just Chairs." The name says it all. --- Keyboard drawers, wrist pads, and keyboard replacements: There is a fair amount of controvery on how to get this right. For some people, wrist pads seem to work wonders. However, with good posture, you shouldn't be resting your wrists on anything -- you would prefer your keyboard to be "right there". If you drop your arms at your side and then lift your hands up at the elbow, you want your keyboard under your hands when your elbows are at about 90 degrees. Of course, you want to avoid pronation, wrist extension, and ulnar deviation at all costs. Wrist pads may or may not help at this. You should get somebody else to come and look at how you work: how you sit, how you type, and how you relax. It's often easier for somebody else to notice your hunched shoulders or deviated hands. Some argue that the normal, flat keyboard is antiquated and poorly designed. A number of replacements are available, on the market, today. Check out the accompanying typing-injury-faq/keyboards for much detail. ==5== Requests for more info Clearly, the above information is incomplete. The typing-injury archive is incomplete. There's always more information out there. If you'd like to submit something, please send me mail, and I'll gladly throw it in. If you'd like to maintain a list of products or vendors, that would be wonderful! I'd love somebody to make a list of chair/desk vendors. I'd love somebody to make a list of doctors. I'd love somebody to edit the above sections, looking for places where I've obviously goofed. ==6== References I completely rewrote the information section here, using a wonderful guide produced in New Zealand by their Occupational Safety & Health Service, a service of their Department of Labour. Special thanks to the authors: Wigley, Turner, Blake, Darby, McInnes, and Harding. Semi-bibliographic reference: . Occupational Overuse Syndrome . Treatment and Rehabilitation: A Practitioner's Guide Published by the Occupational Safety and Health Service Department of Labour Wellington, New Zealand. First Edition: June 1992 ISBM 0-477-3499-3 Price: $9.95 (New Zealand $'s, of course) Thanks to Richard Donkin <richardd@hoskyns.co.uk> for reviewing this posting. Mailing date: Mon Nov 9 20:36:03 PST 1992 -- Dan Wallach "One of the most attractive features of a Connection dwallach@cs.berkeley.edu Machine is the array of blinking lights on the faces Office#: 510-642-9585 of its cabinet." -- CM Paris Ref. Manual, v6.0, p48. Date: Mon, 9 Nov 1992 20:36:06 PST Reply-To: Dan Wallach <dwallach@EDU.BERKELEY.cs> Sender: "Discussion of Carpal Tunnel Syndrome, Tendonitis etc.." <SOREHAND@UCSFVM.earn> From: Dan Wallach <dwallach@EDU.BERKELEY.cs> Subject: FAQ: Typing Injuries (2/3): Keyboard Alternatives [monthly posting X-To: sorehand@ucsfvm.ucsf.EDU To: Multiple recipients of list SOREHAND <SOREHAND@UCSFVM.earn> Status: O Archive-name: typing-injury-faq/keyboards Version: $Revision: 4.9 $ $Date: 1992/11/10 04:05:51 $ The Alternative Keyboard FAQ Copyright 1992 By Dan Wallach <dwallach@cs.berkeley.edu> The opinions in here are my own, unless otherwise mentioned, and do not represent the opinions of any organization or vendor. [Current distribution: sci.med, news.answers, and e-mail to c+health@iubvm.ucs.indiana.edu and sorehand@vm.ucsf.edu] Information in this FAQ has been pieced together from phone conversations, e-mail, and product literature. While I hope it's useful, the information in here is neither comprehensive nor error free. If you find something wrong or missing, please mail me, and I'll update my list. Thanks. All phone numbers, unless otherwise mentioned, are U.S.A. phone numbers. All monetary figures, unless otherwise mentioned, are U.S.A. dollars. Products covered in this FAQ: Apple Computer, Inc -- rumors of a new keyboard! Dragon Systems The Bat DataHand Comfort Keyboard System Kinesis Ergonomic Keyboard Maltron The Tony! Ergonomic KeySystem The MIKey The Wave The Minimal Motion Computer Access System Twiddler Half-QWERTY Microwriter Braille 'n Speak Octima AccuKey GIF pictures of many of these products are available via anonymous ftp from soda.berkeley.edu:pub/typing-injury. (128.32.149.19) If you can't ftp, send me mail, and I'll uuencode and mail them to you (they're pretty big...) ============== Apple Computer, Inc. Sales offices all over the place. The following rumor appeared in TidBITS#149/26-Oct-92: I've heard that Apple is working on a new mouse with more rounded curves that users might find more comfortable than the current mouse. That's not terribly exciting, but what is exciting is the new keyboard Apple also has in the works, reportedly slated for a January release. The keyboard should list for about $250, which compares relatively well with the $185 Extended Keyboard II, considering the extra hardware that goes into the ergonomics. Like some of the more esoteric keyboards from small companies, Apple's new keyboard "breaks" in the center, so that the left and right halves rotate around pivot points. You can also angle the sides when it is broken for maximum comfort, and the keyboard even comes with palm rests. Although this is terribly hard to visualize, and I don't have a QuickTime movie for you, I've heard that the design makes typing extremely comfortable. DragonDictate-30K (and numerous other Dragon products) Dragon Systems, Inc. 320 Nevada Street Newton, MA 02160 Phone: 800-TALK-TYP or 617-965-5200 Fax: 617-527-0372 Shipping: Now. Price: DragonDictate-30K -- $4995 (end user system) DragonWriter 1000 -- $1595 / $2495 (end user/developer system) various other prices for service contracts, site licenses, etc. Compatibility: 386 (or higher) PC only (3rd party support for Mac) Dragon Systems sells a number of voice recognition products. Most (if not all) of them seem to run on PC's and compatibles (including PS/2's and other MicroChannel boxes). They sell you a hardware board and software which sits in front of a number of popular word processors and spreadsheets. Each user `trains' the system to their voice, and there are provisions to correct the system when it makes mistakes, on the fly. Multiple people can use it, but you have to load a different personality file for each person. You still get the use of your normal keyboard, too. On the Dragon- Dictate-30K you need to pause 1/10th sec between words. Dragon claims typical input speeds of 30-40 words per minute. I don't have specs on the DragonWriter 1000. The DragonDictate-30K can recognize 30,000 words at a time. The DragonWriter 1000 can recognize (you guessed it) 1000 words at a time. Dragon's technology is also part of the following products (about which I have no other info): Microsoft Windows Sound System (Voice Pilot) IBM VoiceType Voice Navigator II (by Articulate Systems -- for Macintosh) EMStation (by Lanier Voice Products -- "emergency medical workstation") The Bat old phone number: 504-336-0033 current phone number: 504-766-8082 Infogrip, Inc. 812 North Blvd. Baton Rouge, Louisiana 70802, U.S.A. Ward Bond (main contact) David Vicknair (did the Unix software) 504-766-1029 Shipping: Now. Supports: Mac, IBM PC (serial port -- native keyboard port version coming very soon...). No other workstations supported, but serial support for Unix with X Windows has been written. PC and Mac are getting all the real attention from the company. Price: $495 (dual set -- each one is a complete keyboard by itself) $295 (single) (cheaper prices were seen at MacWorld Expo as a show-special.) DataHand 602-860-8584 Industrial Innovations, Inc. 10789 North 90th Street Scottsdale, Arizona 85260-6727, U.S.A. Mark Roggenbuck (contact) Supports: IBM PC and Macintosh. Shipping: In beta. "Big backlog" -- could take 3 months to get one. Making them "as-needed." Made by hand. Price: $1200/unit for the pair. Minimum order: 2. Each of the four main fingers has five switches each: forward, back, left, right, and down. The thumbs have a number of switches. The idea is that your hands never have to move to use the keyboard. The whole unit tilts in its base, as a mouse. (see also: the detailed review, written by Cliff Lasser <cal@THINK.COM> available via anonymous ftp from soda.berkeley.edu) Comfort Keyboard System 414-253-4131 FAX: 414-253-4177 Health Care Keyboard Company N61 W15150 Wigwam Drive Menomonee Falls, Wisconsin 53051 U.S.A. Theoretical New Address: N82 W15340 Appleton Ave Jeffrey Szmanda (Vice President -- contact) Shipping: Now. 30 day wait. Should be FCC approved by the time you read this. Supports: PC Mac Planned future support: IBM 122-key layout (3270-style, I believe) -- sometime in December Sun Sparc -- possibly by the end of the year or January '93 Decision Data Unisys UTS-40 Silicon Graphics Others to be supported later. The hardware design is relatively easy for the company to re-configure. Price: starts at $590. The idea is that one keyboard works with everything. You purchase "compatibility modules", a new cord, and possibly new keycaps, and then you can move your one keyboard around among different machines. It's a three-piece folding keyboard. The layout resembles the standard 101-key keyboard, except sliced into three sections. Each section is on a "custom telescoping universal mount." Each section independently adjusts to an infinite number of positions allowing each individual to type in a natural posture. You can rearrange the three sections, too (have the keypad in the middle if you want). Each section is otherwise normal-shaped (i.e.: you put all three sections flat, and you have what looks like a normal 101-key keyboard). Kinesis Ergonomic Keyboard 206-455-9220 206-455-9233 (fax) Kinesis Corporation 15245 Pacific Highway South, Seattle, Washington 98188, U.S.A. Shirley Lunde (VP Marketing -- contact) Shipping: currently catching up with backlogged orders. By the time you read this, they should be FCC-approved. Still, expect a 30-60 day backlog for your order. Supports: PC. Mac and Sun Sparc in the works. Price: $690. Volume discounts available. Other prices for various accessories, including custom wrist pads, foot pedals, etc. The layout has a large blank space in the middle, even though the keyboard is about the size of a normal PC keyboard -- slightly smaller. Each hand has its own set of keys, laid out to minimize finger travel. Thumb buttons handle many major functions (enter, backspace, etc.). You can remap the keyboard in firmware (very nice when software won't allow the reconfig). Foot pedals are also available, and can be mapped to any key on the keyboard (shift, control, whatever). Maltron (+44) 081 398 3265 (United Kingdom) PCD-Maltron Limited 15 Orchard Lane, Each Moseley Surrey KT8 OBN, United Kingdon Pamela and Stephen Hobday (contacts) U.S. Distributor: Jim Barrett Applied Learning Corp. 1376 Glen Hardie Road Wayne, PA 19087 Phone: 215-688-6866 (NOTE: I had a typo here, last time) Supports: PC's, Amstrad 1512/1640, BBC B, BBC Master, should have Mac by the end of the year Price: 375 pounds $735 shipped in the U.S.A. (basically, converted price + shipping) The cost is less for BBC computers, and they have a number of accessories, including carrying cases, switch boxes to use both your normal keyboard and the Maltron, an articulated arm that clamps on to your table, and training 'courses' to help you learn to type on your Maltron. You can also rent a keyboard for 10 pounds/week + taxes. U.S. price: $120/month, and then $60 off purchase if you want it. Shipping: Now (in your choice of colors: black or grey) Maltron has four main products -- a two-handed keyboard, two one-handed keyboards, and a keyboard designed for handicapped people to control with a mouth-stick. The Tony! Ergonomic KeySystem 415-969-8669 Tony Hodges The Tony! Corporation 2332 Thompson Court Mountain View, CA 94043, U.S.A. Supports: Mac, PC, IBM 3270, Sun, and DEC. Shipping: possibly by the end of the year. Price: $625 (you commit now, and then you're in line to buy the keyboard. When it ships, if it's cheaper, you pay the cheaper price. If it's more expensive, you still pay $625) The Tony! should allow separate positioning of every key, to allow the keyboard to be personally customized. A thumb-operated mouse will also be available. The MIKey 301-933-1111 Dr. Alan Grant 3208 Woodhollow Drive Chevy Chase, Maryland 20815, U.S.A. Shipping: As of July: "Should be Available in One Year." Supports: PC, Mac (maybe) Price: $200 (estimated) The keyboard is at a fixed angle, and incorporates a built-in mouse operated by the thumbs. Function keys are arranged in a circle at the keyboard's left. The Wave (was: 213-) 310-644-6100 FAX: 310-644-6068 Iocomm International Technology 12700 Yukon Avenue Hawthorne, California 90250, U.S.A. Robin Hunter (contact -- in sales) Cost: $99.95 + $15 for a set of cables Works with: PC only. Shipping: now. Iocomm also manufactures "ordinary" 101-key keyboard (PC/AT) and 84-key keyboard (PC/XT), so make sure you get the right one. The one-piece keyboard has a built-in wrist-rest. It looks *exactly* like a normal 101-key PC keyboard, with two inches of built-in wrist rest. The key switch feel is reported to be greatly improved. The Minimal Motion Computer Access System 508-263-6437 508-263-6537 (fax) Equal Access Computer Technology Dr. Michael Weinreigh 39 Oneida Rd. Acton, MA 01720, U.S.A. Price: InfoGrip-compatible: "a few hundred dollars" + a one- handed Bat For their own system: $300 (DOS software) + "a few hundred dollars" Shipping: these are custom-made, so an occupational therapist would make moulds/do whatever to make it for you. You can buy one now. Supports: PC only, although the InfoGrip-compatible version might work with a Mac. In a one-handed version, there is exactly one button per finger. In a two-handed version, you get four buttons per finger, and the thumbs don't do anything. You can also get one-handed versions with three thumb buttons -- compatible with the InfoGrip Bat. Basically, get it any way you want. They also have a software tutorial to help you learn the chording. Works on a PC under DOS, not Windows. Planning on Macintosh and PC/Windows support. No work has been done on a Unix version, yet. Twiddler 516-474-4405, or 800-638-2352 Handykey 141 Mt. Sinai Ave. Mt. Sinai, NY 11766 Chris George (President) Shipping: now. Price: $199. Supports: PC only. Mac and X Windows in the works. The Twiddler is both a keyboard and a mouse, and it fits in one hand.