This publication is funded under a contract supported by the Office of Disability Employment Policy of the U.S. Department of Labor, contract #J-9-M-2-0022. The opinions contained in this publication are those of the contractor and do not necessarily reflect those of the U.S. Department of Labor.

Job Accommodation Network

Home     Contact    About    FAQs 
New Media Sitemap Search
 JAN Logo

Accommodation and Compliance Series:
Employees with Dystonia
By Eddie Whidden, MA

Preface

Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Dystonia

What is dystonia?

The term dystonia refers to movement disorders characterized by involuntary muscle contractions causing abnormal, often painful, movements or postures. Any part of the body can be affected including the arms, legs, neck, trunk, eyelids, face, or vocal cords. Symptoms may be presented during childhood, adolescence, or adulthood (Dystonia Medical Research Foundation, 2004).

How prevalent is dystonia?

According to the Dystonia Medical Research Foundation, dystonia is the third most common movement disorder after Parkinsons Disease and Tremor. It affects more than 300,000 people in North America and is not limited by race or ethnicity (Dystonia Medical Research Foundation, 2004).

What types of dystonias are there?

There are several classifications of dystonias based on the body parts affected as listed by the National Institute of Neurological Disorders and Stroke. Generalized dystonia affects most or all of the body. Focal dystonia is localized to a specific part of the body. Multifocal dystonia involves two or more unrelated body parts. Segmental dystonia affects two or more adjacent parts of the body. Hemidystonia involves the arm and leg on the same side of the body (National Institute of Neurological Disorders and Stroke, 2006).

Cervical dystonia is the most common of the focal dystonias and is sometimes referred to as spasmodic torticollis. The neck muscles that control the position of the head are affected resulting in pulling the head forward or backward or twisting from side to side (National Institute of Neurological Disorders and Stroke, 2006).

Blepharospasm, the second most common form of focal dystonia results in closure of the eyelids or rapid eye blinking causing obvious vision problems (National Institute of Neurological Disorders and Stroke, 2006).

Cranial dystonia affects the muscles of the head, face, and neck. Spasmotic dystonia affects the muscles of the throat causing speech difficulty. Oromandibular dystonia causes speech and swallowing difficulties because the muscles of the jaw, lips, and tongue are affected (National Institute of Neurological Disorders and Stroke, 2006).

Writer's cramp is a form of dystonia many people have experienced temporarily. This condition is task specific, but can eventually affect other tasks such as eating (National Institute of Neurological Disorders and Stroke, 2006).

Dopa-responsive dystonia (DRD) manifests symptoms in childhood or adolescence and affects walking with progression worsening during the day (National Institute of Neurological Disorders and Stroke, 2006).

How is dystonia treated?

There is no cure for dystonia, but various treatments are available including medications on an individual basis; botulinum toxin injections; surgery; and therapies such as speech or physical therapy, splinting, and biofeedback. Because dystonic spasms increase during periods of stress, emotionality, or fatigue and often decrease during periods of rest or sleep, many patients use temporary techniques to decrease or suppress movements by touching the affected parts of the body and by applying some pressure to those areas (National Institute of Neurological Disorders and Stroke, 2006).

Dystonia and the Americans with Disabilities Act

Is dystonia a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with MG will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with Dystonia

(Note: People with dystonia may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with dystonia will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with dystonia experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with dystonia been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with dystonia to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding dystonia?

Accommodation Ideas:

Large Blue Triangle Bullet General Accommodation Considerations:

Small Triangle Blue Bullet Accessible work-site
Small Triangle Blue Bullet Parking close to the work-site
Small Triangle Blue Bullet Accessible entrance
Small Triangle Blue Bullet Automatic door openers
Small Triangle Blue Bullet Accessible restroom and break area
Small Triangle Blue Bullet Accessible route of travel to other work areas used by the employee
Small Triangle Blue Bullet Accessible workstation
Small Triangle Blue Bullet Materials and equipment within reach
Small Triangle Blue Bullet Workstation close to restrooms, break areas, and other common use areas
Small Triangle Blue Bullet Alternative computer, phone, writing aids, and other assistive devices
Small Triangle Blue Bullet Ergonomic workstation design
Small Triangle Blue Bullet Sensitivity training to coworkers and supervisors

Large Blue Triangle Bullet Keyboarding and Mousing:

Small Triangle Blue Bullet Speech recognition software
Small Triangle Blue Bullet Large-key keyboards and on-screen keyboard software used in conjunction with a mouse
Small Triangle Blue Bullet Alternative mice including trackballs, touchpads, foot mice, head pointers, and programmable mice
Small Triangle Blue Bullet Word prediction and alternative mouse software

Large Blue Triangle Bullet Writing:

Small Triangle Blue Bullet Grip aids
Small Triangle Blue Bullet Weighted pens
Small Triangle Blue Bullet Writing cuffs
Small Triangle Blue Bullet Orthotic devices
Small Triangle Blue Bullet Soft grasp build-ups
Small Triangle Blue Bullet Portable recording products
Small Triangle Blue Bullet Clipboards
Small Triangle Blue Bullet Desk slants

Large Blue Triangle Bullet Using the Telephone:

Small Triangle Blue Bullet Speaker-phones
Small Triangle Blue Bullet Telephones with programmable number storage
Small Triangle Blue Bullet Phone holders
Small Triangle Blue Bullet Telephone headsets

Large Blue Triangle Bullet Using Tools:

Small Triangle Blue Bullet Grasping cuffs
Small Triangle Blue Bullet Ergonomically designed tools and handles
Small Triangle Blue Bullet Vibration dampening wraps and gloves
Small Triangle Blue Bullet Vises
Small Triangle Blue Bullet Work positioners
Small Triangle Blue Bullet Foot controls
Small Triangle Blue Bullet Pistol grip attachments
Small Triangle Blue Bullet Orthotic devices

Large Blue Triangle Bullet Lifting:

Small Triangle Blue Bullet Portable lift equipment
Small Triangle Blue Bullet Hoists
Small Triangle Blue Bullet Tilt-tables
Small Triangle Blue Bullet Tailgate lifts

Large Blue Triangle Bullet Carrying:

Small Triangle Blue Bullet Lightweight carts
Small Triangle Blue Bullet Shoulder bags
Small Triangle Blue Bullet Backpacks
Small Triangle Blue Bullet Electrically powered carts or scooters with baskets

Large Blue Triangle Bullet Standing:

Small Triangle Blue Bullet Sit/stand stools
Small Triangle Blue Bullet Standing frames
Small Triangle Blue Bullet Lumbar support stands
Small Triangle Blue Bullet Anti-fatigue matting
Small Triangle Blue Bullet Rest breaks as needed

Large Blue Triangle Bullet Climbing:

Small Triangle Blue Bullet Stair-lifts
Small Triangle Blue Bullet Wheelchair platform lifts
Small Triangle Blue Bullet Rolling safety ladders with handrails
Small Triangle Blue Bullet Work platforms
Small Triangle Blue Bullet Step-stands
Small Triangle Blue Bullet Hydraulic personnel lifts

Large Blue Triangle Bullet Walking:

Small Triangle Blue Bullet Canes
Small Triangle Blue Bullet Crutches
Small Triangle Blue Bullet Rolling walkers with seats
Small Triangle Blue Bullet Wheelchairs
Small Triangle Blue Bullet Powered wheelchairs or scooters

Large Blue Triangle Bullet Driving:

Small Triangle Blue Bullet Hand controls
Small Triangle Blue Bullet Steering wheel knobs
Small Triangle Blue Bullet Powered steering
Small Triangle Blue Bullet Automatic transmission vehicles
Small Triangle Blue Bullet Designated parking

Large Blue Triangle Bullet Housekeeping/Cleaning:

Small Triangle Blue Bullet Lightweight vacuum cleaners
Small Triangle Blue Bullet Back-pack vacuums
Small Triangle Blue Bullet Grasping cuffs

Large Blue Triangle Bullet Speech:

Small Triangle Blue Bullet Augmentative and alternative communication devices
Small Triangle Blue Bullet Voice amplifiers

Large Blue Triangle Bullet Vision:

Small Triangle Blue Bullet Task lighting
Small Triangle Blue Bullet Dark glasses
Small Triangle Blue Bullet Anti-glare monitor filters for the computer

Situations and Solutions:

A student who has dystonia affecting the eyelids was having trouble in the classroom. JAN suggested the avoidance of bright lights, the use of sunglasses, stress reduction techniques, a good night's sleep, and concentration on specific tasks.

An office worker with neck and shoulder limitations was having difficulty using the PC while seated. JAN suggested the use of speech recognition software, rest breaks as needed, and the use of a supine workstation that allows computer use while in a reclined posture.

An assembly worker was not able to meet production standards due to cervical dystonia resulting in head movement and pain. JAN suggested the use of a tilt-table and ergonomic seating featuring neck support.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

Dystonia Medical Research Foundation. (2004). Dystonia defined. Retrieved June 28, 2006, from http://www.dystonia-foundation.org/defined

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

National Institute of Neurological Disorders and Stroke. (2006). Dystonias information page. Retrieved June 28, 2006, from http://www.ninds.nih.gov/disorders/dystonias/dystonias.htm

If you have a question about accommodations and/or the employment provisions of the Americans with Disabilities Act (ADA), click here:
JAN on Demand

Accessibility | Copyright | Privacy Statement | Disclaimer
A service of the Office of Disability Employment Policy, U.S. Department of Labor


Go Back