distributed the force over a larger surface area of the hand, and corrected the positioning of the hand through specially shaped handles that did not impinge on the median nerve area of the palm. These tools were designed to reduce risk factors associated with cumulative trauma disorders such as CTS. For example, specialized spring-loaded pliers reduced the force required to cut wire for electronic assembly purposes. Adaptive aids can be useful in enabling individuals with CTS to participate in their chosen activities. One such adaptation is increasing the diameter of handles so that less grip strength is needed to grasp an object. Any handle can be built up in this way. For example, someone who has CTS may have difficulty holding their toothbrush or utensils while eating. Therapists can easily adapt these tools or purchase already adapted tools for a client. Specific risk factors that can contribute to CTS such as vibration can be reduced by introducing new tools with lower vibration levels as well as anti-vibration gloves. Modification of environment Another important avenue of therapy is adapting the environment to facilitate occupational performance of a particular task. When modifying an environment, often the equipment and tool adaptations are part of that environmental change. In the management of CTS, workstation modification (i.e., adapting the work environment) is a large part of the intervention. By adjusting the workstation equipment, such as desks, chairs, monitors, and keyboards, the ideal position of the wrist and forearm can be achieved. This can help alleviate symptoms of CTS as well as prevent further damage and strain. For example, there is moderate evidence that a modified ergonomic keyboard is more effective than a regular keyboard at relieving symptoms of CTS. The addition of forearm supports can help to facilitate appropriate posture of the wrist by preventing extension while using a mouse. Attention should also be given to psychosocial aspects of a work environment, such as job demands and job control, as they may help or hinder return to work and level of functioning within the workplace for those individuals with CTS. Similar to the work environment, therapists can help adapt the home environment through the introduction of adaptive aids and adjustment of furniture or equipment. The interventions for CTS mentioned above can be used together as illustrated in a study by Bash and Farber. These authors found that many hand therapists with symptoms of CTS not