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Look, no hands (looknohands.me)
698 points by jamesisaac on Dec 28, 2014 | hide | past | favorite | 140 comments



I'm Michelle (the girl in the video). This thread is really fascinating to me. I'll add some more details to the discussion below. I was diagnosed with epicodylitis (tennis albow) and I tried a range of different treatments: electrical therapy, accipunture, anti-inflammatory tablets and some kind of light therapy(?) But without any results (probably why I can't remember the last treatment).

Also notised there were some questions about neck pains, If I adjust the nose-pad to the right level and angle it right it forces me to sit up straight. However, in the video my back is arched quite a lot because I was sitting at a table that was too low (but it was only a temporary setup).


I read the entire article and was amazed ... not by your solution per-se but rather by your attitude. I don't know anything about you but I'm going to say your greatest asset is your sense-of-humor (even shown in the picture). You're obviously talented - so much so that it had to ooze out of you somehow, but most people wouldn't consider doing what you've managed to do (and certainly wouldn't have publicized it).


A scientifically minded approach to pain can be found at https://www.painscience.com/ No magic bullets, but perhaps something that can help.

As for my two cents, I like trigger points. I have used that technique effectively for years to eliminate angry pain. While the science is apparently still questionable, it is a simple method (find some painfully acute spots somewhere around sources of pain and massage it for 20 seconds or so, several times a day). It is talked about at the site above in addition to a variety of other pain management notions, mainly with a scientifically disappointing dose of reality mixed into it all.


You might be interested to learn about John Ousterhout- a pretty famous computer guy with RSI.

http://web.stanford.edu/~ouster/cgi-bin/wrist.php http://en.wikipedia.org/wiki/John_Ousterhout


The guy at Ars Technica who writes the fantastic OS X reviews, John Siracusa, also has RSI. He uses Dragon Dictate to write most of his articles.

He recently discussed RSI in length in an episode of the Pragmatic podcast: http://techdistortion.com/podcasts/pragmatic/episode-50-acci...


@26m John explains that it's really hard to get a diagnosis for the actual problem. You'll get all kinds of advice on the web where people will tell you to go to a doctor. Unfortunately, it's really hard for a doctor to determine the source of the problem.

About a minute later he explains how the problem might not even be in your hands, it could be in your shoulder, for example, but you might feel the pain in your hands.

@1:16:25 keyboard discussion

@1:26:00 keyboard layouts

@1:36:10 Is it all in your head?


I added this information and others in this thread to my RSI org notes: http://thespanishsite.com/public_html/org/ergo/rsi.html


While we’re on it, here is a really good neck exercise: https://www.youtube.com/watch?v=LT_dFRnmdGs



Thanks Michelle for sharing your unbelievable yet amazing story. You have made me to regain trust in human power which seems infinite. God bless you and I wish and pray you get your hands cured and you use both mouse and nosePad to create awesome stuff.

Best wishes from Pakistan.


you may want to look into finding someone who teaches alexander technique: http://www.alexandertechnique.com/

helps lots of musicians and others with repetitive injuries.


I was going to suggest this as well. I found it was too difficult for me to apply it totally successfully to my playing, but studying it has been great for just everyday life and computer stuff where I tend to have a lot of unnecessary tension.


Michelle, you are a beautiful person inside and out. Most people would have quit and gone on to have a miserable life away from their occupation of choice. You did not. That's commendable.

And sharing this. Bold. Lots of people would be afraid of ridicule. Remarkable.

Finally, much must be said about Omada Health, a company that looked past your handicap and allowed you to do things your way in a nurturing environment. They deserve huge praise and recognition for this.

I hope you are able to reach out to others who might be able to benefit from your ideas. I am sure your story will be inspiring to many even when not exactly in your shoes. Sometimes people just need to realize there might just be other ways to see their problems.

You need to be a featured speaker at a TED conference.

In case it helps others, here's a picture of a custom desk I designed and built many years ago as I started to suffer from carpal tunnel, elbow, shoulder and back problems. I am convinced paying attention to ergonomics saved my hands.

http://i.imgur.com/tFVcegp.jpg


Amazing story.

Necessity is the mother of invention.

I use crazy input devices on crazy ways too. Magic trackpad and a 3d connection 3d mouse on a TV arm screwed to the wall along the computer screen so I can work standing up or with a stool.

A a lap-along wearable stenotype device instead of keyboard. Speech recognition for other things.

I can work much better, more comfortable and faster than anybody else after years of training.


It seems to me the more different input devices, the better, because one can quickly switch the input device when it becomes too repetitive. I’m currently experimenting with a vertical mouse (Anchor), a handheld trackball (IMAGE), a handheld touchpad (Perixx), a vertical keyboard (Kinesis Freestyle2), an ergonomic keyboard (Kinesis Advantage), a sitting/standing desk (IKEA) and a sitting ball. The most effective changes seem to be the vertical keyboard, the remote trackball, the new desk and a couple of streching exercises I started doing. While the Advantage does relieve the pinkies in Emacs, it still feels inferior to the vertical Freestyle2 because the forearms are still in a twisted pose. I think I tend to overly cramp my hands and fingers so that I’m experiencing RSI even without overly long working hours.


can you say more about the details of your setup? I have pretty serious RSI and I've tried all sorts of input devices, but have never found a good keyboard setup.


Thanks for sharing your story. I work as a software engineer and have struggled with mild RSI for many years. I cannot use a flat keyboard or touchpad like you have in your video. What works for me:

- Goldtouch GTU-0088 V2 Keyboard.

- Evoluent VerticalMouse 4, raised up on a book to be the same height as the keyboard.

- Single monitor at proper height.

- Hourly breaks to walk around.

- Motorized sit/stand desk, alternating after every break.

- Mindfulness meditation practice, which helps me be more sensitive to my body.

- Sitting up straight more often.

Have you tried any of these? How did they work out for you? What worked better for you?


Michelle, you are in inspiration!

Have you found yourself having different design ideas after this change? Or having developed a new style in your creations because of "mistakes" you make when you can't control your nose very well?!

Can you mention examples where you ended up designing differently?


You've got a great sense of humor and personality. You're photogenic. As for the story, it seems things worked out best when people accepted you could do great work without expecting how you had to do it. Very inspirstional story!


Michelle, I have hand and arm pain that limits my typing/mousing also. Congratulations on not giving up. I may try the nose thing now.


Is tennis elbow the only problem? Do you do anything else to help with the pain? Are there any other tools that you use?


Has the sensitivity of your n'ose changer at all?


That was really, really inspiring.

I don't know (or care) what most people associate with "Genius", but I couldn't help that word from reverberating around my mind when I was reading about your setup.

I want to ask you so many things! Would you be open to an AMA (ask me anything) of some sort? A few things that I'm curious about:

General

* How do you click? Do you have tap-to-click turned on, or do you use press harder with your nose to trigger the magic trackpad's "click" threshold? If the latter, does your nose hurt after prolonger use?

* What kind of gestures do you have? What kind of gestures would you create, if you could create any gestures at all? Have you found third-party software to facilitate this? (I imagine the default software hasn't considered mouth gestures at all)

* Do you use this setup for your creative work alone, or for casual computer usage as well?

Performance & Accuracy

* You mention that you've gained the same level of accuracy as with your hands, and that's the most important factor (to me, at least). A secondary one, though, would be speed. Do you notice any considerable difference in your "input performance" when you use the nose/mouth setup vs. traditional input methods? How was your learning curve with respect to accuracy and then speed? (I'd expect you to have gained accuracy first and then built up performance over time)

* What's your pointer speed & acceleration like? I imagine both to be quite low, otherwise you'd have to perform very precise and minute movements in order to to high-precision stuff. For example, can you move your pointer from top-left corner of your screen to your bottom right with one movement? (I would think not). Is that the kind of thing that you'd complement with a mouse?

* Tangent on previous question: Are your "nosepad" settings (speed/accel) different than your trackpad/mouse settings? If not, is that a System limitation that you have accepted (optimizing for the nosepad, I'd imagine)?

Social

* Do you receive negative real-world reactions to your setup? Are people largely accepting & encouraging?

* What kind of feedback & reactions have you received online, after publishing this?

I'd like to emphasize again that I was blown away by your creativity. You exhibit the hacker spirit to the fullest. If you receive any hate because of this, I hope my enthusiasm counteracts that a bit :) I know that one negative comment can outweigh 1000 positive ones.

EDIT - more question(s)

* How has your posture evolved through time? I'd be surprised if you never had issues with your back/neck, but it seems that you've found the right posture that minimizes that strain.


Have your arms recovered?


The elasticity of the brain is incredibly impressive. Very neat solution. My parents are surgeons, and I know they worry at least a little bit about the safety of their hands. While my hands are definitely very important to my being able to work I know I don't worry as much as they do. That's funny, because for the most part I think about Carpal Tunnel Syndrome as a career-ending condition.

I recently suffered some amount of tendonitis in my wrist and it prompted me to make quite a few changes:

* Better posture

* Better seat adjustment

* A nicer (mechanical) keyboard

* Practising touch typing more (i.e. correcting myself any time I use the wrong finger)

* Resting my wrists evenly

I made all these changes simultaneously so I don't know what changed it or if it was a one-time thing and resting fixed it. An interesting thing is that I found that I overuse my right hand.

`vim` binds simple movements to hjkl and that's fine because they're on the home row, but it also means that a lot of the time I'm holding down one key while reading code. I've switched to moving around code better now, using larger jumps, and when scrolling a lot I use my left hand. I've also rebound some other things so that they're easier with home row keys. Anyway, learning to be faster at all this took very little time. I am very impressed with how fast we learn new acts if they keep repeating them.


To me the most important factor is how relaxed your muscles are when working. That is, even while frantically typing on my keyboard my fingers spend most of their time resting. It's very easy to keep your muscle contracted the entire time and that's where the danger is.

This is something I learned from my music teachers. I would get nervous while playing and my muscles would get all stiff leading to missed notes and sounding dry and whatnot. Most importantly, I was thinking about how to position my muscles to get the sound I wanted rather than thinking about the sound I wanted and letting the muscles do their thing. They made me realize your muscles needs to breathe and to use the window between impulses to relax them.

I could have the best posture, best keyboard layout and everything else but if my muscles stay contracted the entire time I'm working I'll definitely feel it at the end of the day. Be it on the guitar or computer.


RSI can be caused by many things, and it can originate far from the pain. There doesn't seem to be one magical fix. I've been keeping Emacs org notes on RSI and I publish them here: http://thespanishsite.com/public_html/org/ergo/rsi.html


I haven't read through all of your notes, but did click on a few links. I've studied a bit of nutritional medicine along the way. Have you looked at any research or anecdotes on anti-inflammatory supplements for RSI?

Any irritated condition is characterised by inflammation. The most common medicines prescribed for RSI are anti-inflammatories. So it stands to reason that RSI is tissue-damage, caused by repetitive strain, and anywhere tissue damage is occurring immune mediated inflammation takes place.

Tenosynovitis is inflammation of the fluid-filled sheath that surrounds a tendon.[1]

So, the treatment we were taught was to address the physical injury by removing, retraining, or engineering the problem away, then give nutritional supplements that support tissue repair and help down-modulate the inflammatory response: Omega 3 EPA / DHA (fish oils), Quercetin, Rutin, Vitamin C, Bromelain, B12 & Folate, Magnesium (as citrate or diglycinate, or both), plus Turmeric and Ginger. And also give supplements that target musculoskeletal / connective tissues: Silica, proline, lysine, cysteine, glutamine, Manganese, B5, B6, Iron (as iron amino acid chelate), copper, zinc (as amino acid chelate). Where the condition has progressed to considerable over-all wear and tear of a join the also throw in Glucosamine and Chondroitin.

The theory goes: remove the mechanical cause of the condition (repetitive strain causing tissue damage) and the condition will resolve itself. Put in the nutrients the body needs to repair the damage and the condition will improve faster. Sometimes the damage is so far progressed it will respond much better if the nutrients are taken too.

Once the condition is under control we then direct the patient to look in to seeking advice to strengthen the affected joint.

I don't know about the state of nutritional medicine outside of Australia, but here we have some really good formulations available off the shelf and others as practitioner only formulas - so you need a consult.

I'll pre-empt the "supplements don't work" argument and say: yes, taking iron oxide or magnesium oxide doesn't do anything. There are formulations that are poorly absorb and poorly utilised by the body. Have a look in to, for example, magnesium diglycinate and magnesium citrate vs. magnesium oxide. Look in to mixed ascorbates with citrus bioflavanoids (Quercetin and Rutin) vs. pure Ascorbic Acid. High does Turmeric and Ginger work so well as anti-inflammatories and blood thinners they are contra-indicated if a person is taking blood thinners / blood pressure medication, eg Warfarin.

Anyway, getting carried away. Thought you might be interested.

1. http://en.wikipedia.org/wiki/Tenosynovitis

This does not constitute medical advice. Please consult your physician / nutritionist / pharmacist before taking any nutritional or herbal supplements.

Edit: formatting


If you have any good blogs that discuss this, I'll add it to my notes. I'm always skeptical of supplements but I want to aggregate all thoughts on RSI.


Not off the top of my head. I'll keep it in mind.


I found that a standing desk forced me into better ergonomics. While I don't think that most of the purported health benefits are well substantiated, just simply having to stand straight meant better ergonomics for me. Things like keyboard height for wrist alignment and monitor height for eye alignment become static variables. Slouching, crossing legs, adjusting seat height, adjusting seat recline resistance, etc all become non-issues.


I haven't experienced the RSI pains I used to get in my hands since switching back to a mechanical keyboard a few years ago... I use buckling spring model m style boards at home and work, and I like it a lot... some don't like the noise though.

That said, keyboard and monitor height properly adjusted probably help for many too... I don't bottom out with a mechanical keyboard.


In my experience, all of these are great except the last one. I used to rest my wrists and now I can't because my RSI progressed. I wish someone had told me 10 years ago to keep my wrists straight when I type.

I use an angled keyboard and a vertical mouse to reduce twisting.


Learning all the different movement commands in vim is quite worthwhile.

For just paging through code, I've also mapped the space bar to be page down in command mode, which I find quite convenient.


I used to have lots of issues in the neck and shoulders. I started going to a gym and focused mainly on training neck, back and arms carefully. It has completely removed all my symptoms in the last 6 years.

I also started using a wacom tablet as a mouse replacement. The absolute positioning of the pen removes all these small-dragging-motions.


The small Intuos tablet?

https://store.wacom.com/us/en/product/CTL480/

Which tablet is most effective as a mouse replacement?


I don't use a tablet regularly as a mouse replacement, but from my experience of using it for image manipulation:

1) Small sizes scale up surprisingly well, but one model bigger might be preferable.

2) One should test the feel of the pad -> there are different surface types (some are very glas-like, others offer more resistance), and different styles of pens, which all feel different.

3) I feel like many of the pens are quite uncomfortable to hold. If I had to use them for longer I'd probably look into finding 3rd party alternatives or a small pen I can embed into a custom grip. Different styles to exchange regularly (every 30 min or so) would also be nice.


Sincerely... all I can think about is not that she found a good solution to her problem, but the fact that she "achieved the same level of accuracy" (and I suppose speed).

This is not something about her capabilities, but about the limitation of current input devices regarding our hands.

This is the proof that using a touch pad with your nose is not worse that using it with your hand. There is something wrong in this: try using any real-world interface with your hand, how the shapes, the stiffness, the flexibility of any handle, pen, button, spring you interact with give you some kind of information and let you operate with a superior kind of consciousness.


Or you can look at it from an optimistic-almost-narcissistic point of view and say that the interfaces that we have are so well-deaigned either by accident or on purpose that the same level of accuracy can be achieved with whatever appendage.

Personally, I think we stumbled onto a design that works well after years of trials. When you look at children using tablets, for example, you quickly realize that they don't have the same dexterity as adults, yet they are able to use the device with almost the same capability as adults. With tablets in particular, I don't think this was an accident...

We could make input devices/interaction paradigms that are highly specific to one domain usable by only certain people because of learning curves or physical limitations, or input devices that can be used by anyone with sacrifice in speed and productivity.


That's a false dichotomy, saying that it's one or the other.

We could have much higher precision, and add highly sensitive pressure sensitivity. For most tasks touch sensitive surfaces would be identical and equally easy to get into, except that they would allow for much higher ceilings of mastery and skill than they do now.


>This is not something about her capabilities, but about the limitation of current input devices regarding our hands.

I think it's more a story about our adaptability in general.

Many years ago, I worked with a developer who happened to be blind. While coding, he used an audio screen reader. If you've ever heard one, you know that they can be set to read incredibly fast, such that it sounds like absolute gibberish to the untrained ear.

So, whereas I couldn't even discern the words/characters being read, it made absolute sense to him. Much as I was amazed by it, I also know that he didn't start there. Years of practice, finding shortcuts, etc. made it as much second nature to him as reading code on the monitor was for me.

Of course, it also didn't hurt that he was brilliant.


A few years ago I took a tech support call from a guy who was visually impaired and had voice over turned on. It read incredibly fast, he had no problems following instructions, and was familiar enough with what we were doing to make the call easy for both of us.

I also used to work as a personal assistant for a guy in a wheelchair who used Dragon Speakeasy, I think that was back in 2005 - '06ish, and was surprised how well he was able to use his PC. He also had a book turning machine that reliably turned one page at a time.

This also reminds me of people who ride bikes using echo location.[1]

I wonder if it's possible to generate a sound stream from video, and what sort of resolution and colour depth could be encoded in to the sound.

This TED talk by Daniel Kish is good too.[2]

1. https://www.youtube.com/watch?v=Z_E3zxx2l9g 2. https://www.youtube.com/watch?v=CRA-asTuP_Y


>I wonder if it's possible to generate a sound stream from video, and what sort of resolution and colour depth could be encoded in to the sound.

There was some work done on this. I don't remember how well it worked. I think this is it: http://www.seeingwithsound.com/sonar.htm


Your post is very reminiscent of this[0], which was posted on HN a long time ago.

[0]: http://worrydream.com/ABriefRantOnTheFutureOfInteractionDesi...


Bingo :)


I wonder if her neck started getting tired from all that movement.

It seems that it's mostly people who grip their mouse really tightly/type with tense fingers that experience the most problems - I remember when I first started typing, my fingers tired too easily because the keys were heavy, and I was exerting a lot of force trying to get the fingers to exactly where I wanted them to go. Later, when I got a "looser" keyboard and discovered that I didn't really need to hit the keys exactly in the middle but whatever could actuate them worked, my speed more than doubled and I could type for hours without feeling tired at all. The relaxation really helps. Same with mousing - if you find that you have to grip your mouse tightly to make precise movements, turn down the DPI and try lubricating it so it requires as little effort as possible to move. Personally, I don't really like using trackpads because of that friction.


People's mouse grip varies immensely. But the one thing that should be easily controlled, in any reasonable case, is the surface.

A mouse mat will often reduce friction greatly, and you can augment your mouse with custom teflon "feet". Gamer peripherals, basically.

I see a lot of people who just run their mice across their desk, which no doubt works, but is sub-optimal in that it's not a particularly durable surface in most cases. This will lead to scratches, and thus increased friction on top of the noise and now ruined surface.

Another thing I've seen is a really nasty build-up of gunk (for lack of a better term) underneath the mouse. All of this adds up to increased friction and a "sticky" feel at times, which results in erratic movement and possibly a need for tighter grip.

Then, of course, there's always the option to switch the mice out. A wired option will obviously forgo the batteries, lowering the weight of the unit, at a negligible convenience price.


I switched to a thumb-operated trackball. My fingers like it.


File in the "for what its worth" file:

When I started to get some pain in my wrists, I noticed it most when I was using photoshop and clicking a great deal. I tore apart an old USB mouse and wired a pair of foot switches in so I could click with my feet as well. It helped quite a bit. Now I rather prefer it, especially the right click action.


That's a really fun idea. I wonder how you could control programs differently with 2 or even 4 input devices?

Ie, twin cursors on the screen, each controlled by a separate mouse? Tablets introduced a number of interesting new interface mechanisms - double tap, pinch, stretch etc. Could we bring these to non touch-screens?


Sure, have a look at ICon (for instance) if you want to add custom input devices to your setup : http://inputconf.sourceforge.net/


Do you play the piano? I wonder if doing something like this would affect or improve your ability to play piano. I always found one of the hardest things to learn was the pedal rhythm while playing.


Have you checked Dr. Sarno's approach for RSI and related problems. If you have tried all those options and they didn't work you should definitely give a try.

You can check a story very similar to mine: http://www.pgbovine.net/back-pain-guest-article.htm

Disclaimer: I am CS PhD student in a top tier US school. Suffered from RSI, tried everything. Was cured by Dr. Sarno's technique.


I can second this: I spent years looking in utterly the wrong direction with things, even making this: http://tiledtext.com so that I could program with motion sensors instead—then someone recommended to me (for a second time, since I ignored it the first time) Dr. Sarno's work.

BTW: that you're left hand started in so soon after is probably a good indication that this isn't entirely physical!

Sarno's stuff works (as you'll find plenty evidence of on the internet (e.g. http://www.satori.org/rist/)), but the theory it's framed in is pretty bad, so be prepared for that...

An alternative talking about the same stuff without annoyingly trying to theorize so much is (check out the reviews, you'll see the title is quite misleading): http://www.amazon.com/Rapid-Recovery-Back-Neck-Pain/dp/09669...


I was also cured from RSI by Dr Sarno's approach. I highly recommend you give this serious consideration.


I stopped using mice, knobs (IBM/Lenovo) and touchpads (built-in or external) probably twenty years ago. A few months into an intense design project I started to feel burning pain on my wrists. I was working 18 hour days, 7 days a week. Yes, if I was awake I was in front of the computer.

This was a hardware and software project and I was doing it all. This meant lots of precise motion at times. Running Solidworks or Altium Designer often meant very accurate tiny movement while pressing down on a button. Horrible stuff for your wrist.

I had been exposed to just how bad this could get. I was friends with several people who did visual effects for motion pictures. Same kind of work. They ran 3D workstations for a dozen or more hours per day, every day. One fellow had to have surgery on both wrists due to the damage he caused. His was always in pain after that.

I decided I had to deal with the situation. I didn't want to end-up like that.

First decision was that mice and touch pads where horrible input devices. I tested everything and concluded that low friction thumb-operated trackballs were the best.

Beyond that, the relative angle of the hand to the forearm seemed to have a HUGE effect on causing inflammation, pain and injury. The flatter and more relaxed,the better. In fact, the most relaxed position had my hands drooping over the keyboard and trackball with virtually no tension on the upper tendons. This meant my standard desk had to go.

What I needed was a desk with a cavity into which my hands would droop and meet the keyboard or trackball. My forearms had to be fully supported in order to remove pressure from shoulders and posture.

I welded together a few iterations of the idea and ended-up with a desk that was just fantastic. I could work on this thing for 16 to 18 hours a day and have no wrist burn whatsoever. Of course, I also implemented regimented breaks and exercises, but the desk, as well as switching to a trackball, made the most difference.

I can't help but think this girl did herself huge damage by using the touch-pad for long hours. I particularly dislike touch-pads on laptops (of any make and model) the are in the wrong place and add tension to your tendons precisely where you don't want it.

As for Michelle, wow, what an amazing person she must be.


I'd love to see a photo of that!


Image posted, see comment for link.


Here's a good picture of the desk:

http://i.imgur.com/tFVcegp.jpg

That's what a garage hardware startup looks like! A bit of a mess but some of my most productive time was spent in that room designing hardware, writing FPGA, embedded and workstation code. Oh, yes, doing our website too. Crazy times.

It was a year and a half of 14 to 18 hour days, 7 days a week from inception to launch. Behind the camera there's the rest of the garage (two cars wide) full of manufacturing equipment. No cars have ever entered my garages in my life. No room for them.


This looks way more like a normal desk than I expected. Is that the "cavity" you referred to?


Yes. The key in many ways is the piece of wood used to suppport your forearm at the correct height. As I said before, you want your hands to droop onto the keybaord and trackball. Also, note that the trackball is positioned to be able to hit the "Enter" key on the numeric keypad with minimal motion.

The arm support is sanded down with 800 grit sandpaper and then treated with Tung oil. The edges are generously rounded. This makes it very smooth and comfortable.

I should also note that the underlying structure is welded steel. I tried drop-down trays on conventional desks. They are flimsy and have enough give to make them uncomfortable. The cavity on my desk is strong enough to stand on so it feels very solid during normal use.


second the photo request....


She mentions being excited about the Leap Motion. That's not very accurate so she probably had to give up. There is better hand tracking software under development. This company's Kickstarter project got canceled when Oculus bought them: https://www.kickstarter.com/projects/nimblevr/nimble-sense-b...

And Control VR uses gloves but might prove to be very accurate: http://controlvr.com

The VR headsets are driving the development of this technology.


Beyond the obviously admirable content of the story, just wanted to say: beautiful website, the pacing of the story was really well done. Loved the animations, the optional extra reading, breaking up the story with pictures. Very simplistic but well done.


That's got to be tough on the skin at the tip of the nose, that's not exactly the most rugged spot to be rubbing on something all day long.

Related:

http://www.mfpa.uk/


The surface is very smooth glass, so it's probably not that bad.


I had RSI 3 times. The first time I did not know what it was and ended-up not being able to hold a pen. Took many months of recovery and I was lucky my doctor knew what it was. I had heat treatment, some sort of laser and vibration therapies and a couple of other things. Don't know which of them helped, but they sure did.

The second time, I was in a different country and was sent to a surgeon. He had no clue what RSI was and said that I should not worry until it gets worse and ready for Carpal Tunnel surgery. I said "no thanks" and found a sports therapist instead who was ready to help.

The main lesson here is that "see a doctor" does not always work. I am sure if I saw surgeon the first time, I'd be having some stitches on my wrists right now. Back then, RSI was not well known thing at all. Hopefully, it is more easily recognized now.


Is this Cold Laser Therapy?

http://www.rsitips.com/cold-laser-therapy/

http://www.brooklinephysicaltherapy.com/page4/page18/

I've never heard it mentioned before.


It may well have been, though I don't remember any glasses.


SmartNav by NaturalPoint (http://www.naturalpoint.com/smartnav/). I'm using it for over 8 years for moving the cursor. Clicking is via a regular mouse, though voice and switches are supported. All typing is done through an on-screen virtual keyboard (Hot Virtual Keyboard). After short self-training the speed and accuracy are above of a regular mouse. Neck fatigue is a rare issue even after 8-10 hours of daily usage, the "trick" is calibrating the settings for minimal movement. I'm using this setup for everything from programming to some light gaming (RTS). Adjusting and configuring the environment can bring substantial improvement. For example, using ReSharper for Visual Studio vastly reduces typing.


Hi, your article was really inspirational, very well written and indicative of your amazing motivation and passion for your career. Dystonias are neurological disorders that can cause muscle spasms and cramping and do not go away with rest, anti-inflammatories, trigger point therapy, etc. Unfortunately dystonias are often misdiagnosed and untreated, even sometimes by well-trained specialists. The main treatment for dystonia-related conditions is Botox. I have cervical dystonia and have had wonderful success with Botox. To correctly diagnose a dystonia you need to see a neurologist that specializes in movement disorders.


I remember CMU (or a site that was linked from a links page in CMU vision site) had a project called Nouse where you can operate the computer with a video camera using your nose. The nose doesn't touch anything.


This product? http://www.nouse.ca


yes this one! it didn't show up in the first 10 in my google search for "Nouse".


Great example of adaptability and resilience. I understand a little bit about her pain as I had to move to my left hand after experience pains in my right. Though I did nothing as extreme as the OP.

Thanks for the inspiration Michelle


Just reading the responses here - am I the only person who has zero problem using a trackpad and keyboard with my hands for >=8 hours a day? Maybe it's that I'm not a designer and so the precision of my motions isn't such that I'd experience problems like this. I think the only problem I've ever had was back when I tried using a Microsoft Natural keyboard, and my hands were sore after an hour.

Also, good for her, finding a solution that works well for her, strange though it seems at first blush. I like her work, too.


Same, using computers every waking moment, no wrist issue. Personally I attribute it to the way I type. I never learned to type 'properly', instead I use two fingers and my hands move all over the place. I still type very fast. No issue, tho.


I use my hands and wrists a whole lot, and regularly type upward of 140 WPM, but I've never experienced any RSI. I imagine genetics plays a fairly big role.


No problem here either, and I've been at a computer at least an hour - usually more - a day since I was 8 (I'm now 37).

I did have some keyboards that cause more "tired hands" than others in the past. I also prefer trackpads to mice. Lately I'm using Apple keyboard/trackpads.


> am I the only person who has zero problem using a trackpad and keyboard with my hands for >=8 hours a day?

Of course not, it's just selection bias. People without similar problems don't feel the need to provide contrasting (and unavoidably boring) stories.


I've tried head tracking devices and found my neck and shoulders get stressed. I imagine the same thing would happen hunched over a trackpad with the nose. The small neck movements are similar to head tracking.

Check out the Imak SmartGlove with Thumb, I can't use a computer without it. Well, of course I can but it is much less comfortable. The glove plus a Kensington Expert Mouse (which is actually a trackball with a scroll ring) plus a good chair (eg Steelcase Leap) will help a LOT.


Dominic Wilcox created something similar to this in 2011, I think as a satiric art project. It looks like a plague doctor's mask: http://dominicwilcox.com/portfolio/finger-nose-stylus/

To see a proper implementation, which allows someone to work at a high level, is awesome.


My cousin was born without hands. He is using his feets for most things. Today he is 22, he drives a car, handles computer and tablets... His typing is ok, so he could be programmer if he chooses to. And he wants (and probably will) to move to his own place.

He does not use special devices, just big mouse and large AT/IBM keyboard.


I just wonder if she could've easily fixed all the issues by changing her mouse or how she hold it instead of opting for this nose-touch-pad.

If she is still doing thous 11-15 hour work days and her neck doesn't get tiered, I really think she might have had too hard of a grip on her mouse or just a bad mouse in general.


This is really amazing and inspiring to see. Every now and then, I get scared when thinking about what would happen if my eyes or my hands started to lose functionality.

I sometimes feel pain in my pinky fingers when typing, forcing me to adapt to using only my other fingers.


If it's your right pinky, remap your backspace key immediately. Caps lock is my choice, and I make backspace into a proper (forward) delete key. This has eliminated all typing pain for me.


It's impacting both of them, but mostly my left. I only ever hit the Shift key with that one, and usually use my right middle finger to hit backspace.


This is something that might sound tangential, but using nose as an input medium is not the worst idea, even with perfectly capable hands.

I've been using my nose awkwardly a lot on Android Wear, and honestly, this article makes me much better about it. We have so many screens, so many interfaces, yet only two hands. Anytime I'm typing, driving, running, my nose does the job on the smartwatch. I'm sure a lot of people have been doing it.

I wish there was more studies regarding these, most that I find keep talking about gestures, which I think is overdoing things, which humans tend to do at first with every problem we try to solve.


Or: how I developed carpal tunnel in my neck

Just kidding. Glad to see such resourcefulness.


This is awesome. Fun to see someone trying something new and pushing the boundaries of how computer interaction is done, considering how stressful on the body it can be to use a mouse.


Hi Michelle, I was wondering if you had tried the Tyler Twist or the reverse Tyler Twist. I had tennis elbow and golfer's elbow and nothing worked until I tried those exercises.


Upon watching the video, my first thought was: I should try this! Not because I have RSI (used to though), but because it seems an excellent solution for keeping my hands on the keyboard whilst having a third "hand" for the pointer, thereby increasing overall speed and efficiency. If it is possible to achieve the same accuracy, this should be great.

I even happen to have one of those touchpads.


Also worth taking a look:

"The Association of Mouth and Foot Painting Artists of the World"

http://www.vdmfk.com/worldwide/en.html

"VDMFK supports and promotes artists who, due to disability or disease, cannot create their works of art with their hands, but have to use their mouths or their feet."


I also have hand problems. I use speech recognition to type everything, including code, and a game controller to move around the mouse. The controller I'm currently using, a PS4 controller, has a trackpad in the middle, so I was able to mash that against my face and give her technique a shot.

It works better than you'd think. The PS4 trackpad isn't exactly brilliant, but I can move around the mouse and click on what I want to with some accuracy. Of course, the trackpad on the controller is very small and not very accurate, so it's not really practical for artwork or anything. But, with a better, larger trackpad, I can imagine this technique actually working. I might give it a shot at some point.

I am a bit worried about the inevitable neck and nose pain, though. I wish she had gone into a little more detail about how she avoids that. Maybe she just has a neck of steel?

For the curious, these are some other resources I've found about people working around RSI. Most of these are about using Dragon NaturallySpeaking to code by voice, since that's what I'm most interested in, but I think it's still interesting.

There really needs to be a list somewhere for open-source workarounds to disabilities. To the best of my knowledge, there really isn't one.

Natlink + Dragon NaturallySpeaking:

(NatLink, which lets you make custom speech commands for Dragon in Python, is currently being developed at http://qh.antenna.nl/unimacro/index.html, but that site's pretty incomprehensible. The original author's site is at http://www.synapseadaptive.com/joel/welcomeapage.htm. It's pretty out of date, but explains the fundamentals of the system better, I think.)

https://www.youtube.com/watch?v=8SkdfdXWYaI (don't bother looking around, the source code of this was never released)

https://github.com/simianhacker/code-by-voice

https://github.com/tgrosinger/aenea-grammars

Libraries for using Dragon NaturallySpeaking on Linux with VMs:

https://github.com/dictation-toolbox/aenea

https://github.com/russell/damselfly

It seems a post about this kind of thing pops up about every other month or so. I'm thinking of showing off my system here when I polish it up a bit. It's not nearly as complicated as some of these other ones, but I'm beginning to get pretty close to normal typing speed coding by voice.


> don't bother looking around, the source code of this was never released

But the video like has a comment(1 week old) from Tavis Rudd linking github repository of his code : https://github.com/dictation-toolbox.

And about your setup, please do post it! :)


I'm not completely sure it's his code. In his comments, he says it is for "those who are interested in trying something like this," and the readmes of most of the repos thank Tavis Rudd for inspiration, which would be a little strange if he wrote them. It might be based on his system, though, since he said he had privately sent some people his code. I haven't looked into it too much, though.

You can find my setup on GitHub fairly easily right now (my screenname's the same), but at the moment a good portion of the code is embarrassingly terrible. Making voice commands to code while using those voice commands to code is predictably awkward. Besides, I want to write some documentation on how to get it working and stuff.


Great story, and great reminder not to let minor pains progress to the point where they cripple you. I say this as someone whose right thumb is in a brace due to deQuervain's tendosynovitis, brought on by banging too hard on spacebars.


Speaking as someone who has done quite a few of these Carpal tunnel surgeries, the story do not fit very well with it. The symptoms are worse at night and tremors are unusual. Common complaints are pain, pin and needle sensation, weakness


Carpal tunnel symptoms present in many different ways. For instance, I have no pain at night, only "buzzing" and numbness in my fingers with decreased grip strength.


Reminds of this TED with Phil Hansen: Embrace the shake - http://www.ted.com/talks/phil_hansen_embrace_the_shake?langu...


I know that this is off topic, but what a beautifully designed website!


Beautiful maybe, but in my opinion, multiple columns for continuous text makes for a bad UX.

I've seen this starting to popup in a few websites recently and it always annoys me.


On my tablet it does look good-ish, with two columns, but still, two columns..


Multiple columns would be fine if the page scrolled horizontally, or if all the content fit nicely on one screen and didn't need to be scrolled vertically, but having columns with vertical scrolling just breaks how I typically read websites.

Typically when reading something on the web I scroll as I go which means that when I get to the end of column one it's in about the middle of the screen. Now I need to scroll back in the opposite direction because the top of column 2 is now off the screen and then read back down again.

It really breaks the flow of reading.


This is an excellent modern example of the tenacity of humanity.


You obviously have a nose for good design.

Seriously though, that is awesome.


And here I am complaining about the weather. You are a true inspiration. Great going Michelle and I hope that one day your epicondilytis gets cured.


Wow, impressive!

Had pain in my arm as well in the past (it was not very severe but annoying). Using a mouse with a trackball solved the issue for me.


A need or problem encourages creative efforts to meet the need or solve the problem - Necessity is the mother of Invention. Kudos!!


Am I the only one that can't load the site? There are just blank spots everywhere. Chrome 39.0.2171.95 (64-bit), Arch Linux.


Just FYI - if you're interested, make sure to read the full story in No.2. "Read more" shows the rest of it.


Wow, I bet The Setup would love to interview you:

http://usesthis.com/


I just went "Holy shit" when I read this article and realized what a lazy dumba*s I am.


This, my friends, is a good ole fashioned "hack."


Don't we all use our nose for a keypress or swipe every now and then? :P


This is amazing.


I salute your perseverance.


Neat, but something tells me this won't be catching on.


If you think this is about that specific accommodation, I think you're missing the point a bit.


Most people tend to get RSI when they first he very active in computer work,and after a year or so they find a healthy posture and their hands strengthen and it isn't an issue.

This article seems like a gimmick by someone who wants to be special instead of using perfectly effective solutions. Or it is a joke.


I think it's pretty presumptuous to claim that this person is suffering from RSI and should just "find a healthy posture".

There are very many causes for wrist pain, ranging from carpal tunnel syndrome to osteoarthritis. A bad posture might contribute to wrist pain, but even the best posture won't cure someone suffering from gout.

The author hasn't shared the reason for her wrist pain, most likely because she doesn't know the reason herself. She knows that her wrists hurt when she uses them too much.

Please don't belittle other people's ways of coping with imperfections.


Not defending the original commenter, but to be fair, she did mention RSI specifically in the article.

    I'd somehow managed to complete my first project course without making my RSI worse


The way I understood the story was that she didn't know what the problem with her hands was, but she called it RSI for lack of a better word. I didn't read that line as stating she was actually diagnosed with RSI.

But even if she had meant it that way, it's still presumptuous to claim a better posture would cure her.


Do you have any references to back up this statement? From everything that I've read, it'e incorrect. Take these well-known programmers: http://ergoemacs.org/emacs/emacs_hand_pain_celebrity.html


Only one mention of a doctor, once in the whole page, and he says to give it a rest and she'll be ok. Then she says she spends 50% of the time using her hands normally? No mention of further deterioration, or further attempts to figure out the problem? It seems like it's more important to her to say "look I am clever" than actually solve the problem here.


The article is about the amazing things she's doing, how she's doing them, and, more broadly, all the fun she's having with design. It will benefit many people. She's under no obligation to report the details of her medical investigations.


Adding medical information would benefit those people more.


I have a hard time believing someone would just stop using their hands if they had the ability to do otherwise.

I do agree it would have been nice to know more of the details of what went wrong, though, and why she seemed to experience severe RSI when some other people don't. (Like me - I probably don't use the mouse/trackpad as much as a designer, but I've been clacking away at the keyboard for 25+ years with no significant issues so far.)


I would have loved to hear a bit more about the RSI and the issues that it caused her. The writing left it very unclear to me what the extent of her injury was, and made it seem like her hands were virtually useless.


I too thought that was odd, but I think the point is the method and its potential accessibility benefits, not a specific medical case.


I think you've missed the point entirely. This article sheds light on alternative ways of human input for computing devices. It also presents an innovative, if not slightly impractical solution to a problem the author faced. This could potentially open up new ways of interacting with computing devices.


I'll admit that bothered me too. RSI is real and it is crippling, although it is also almost completely curable with surgery and some physical therapy [1]. However, I found her story of working on tasks that typically need arms and hands, without them, pretty awesome. So on balance the story worked for me.

[1] http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-... -- If you feel tingling in your fingers when you type STOP TYPING seriously.


You are confusing RSI and carpel tunnel. You don't treat RSI with surgery.


The author wrote: "... ended up working roughly 10-15 hours per day. I felt very proud of myself for working so hard and I remember joking about my arms the day I started noticing a slight tingling sensation in my fingers. if I had only known..."

She called it RSI and described classic carpal tunnel. Without the additional detail provided by the author, carpal tunnel is consistent with here description.


Slight tingling in the fingers could mean RSI too. Most people get RSI and not carpel tunnel.

http://www.amazon.com/Its-Carpal-Tunnel-Syndrome-Professiona...


Stopped reading after I knew this wasn't going to be addressed. I get that the author might not want to divulge specific medical information but the whole point of this idea is dependent on not being able to use your hands. I think it is a very important part of the story if you want me to listen to the rest.


Integrate a tissue on the nose pad and you're ready for any season!


tl;dr. Young ambitious person gets first chance at job she is trained for, feels pressure to work long hours without complaint. Because of too much work, now she can't use her arms half of the time, instead draws with nose and made portfolio site with nose-drawing as central focus.


There's also the part where she moved to a country with very expensive health care.


RSI is curable almost always! Read "Pain Free at Your PC" or "Pain Free" by Pete Egoscue. Message me and I'll gift either to you.




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