Accommodation and Compliance Series:
Employees with Myasthenia Gravis
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://AskJAN.org/soar.
How prevalent is MG?
According to the Myasthenia Gravis Foundation of America, approximately 14 out of 100,000 individuals in the U.S. have been diagnosed with MG. Though this totals 36,000 people, MG is considered under-diagnosed and the prevalence is thought to be much higher. Previous studies showed that women are more likely to be affected than men are. The most common age at onset is the second and third decades in women and the seventh and eighth decades in men. As the population ages, the average age at onset increases correspondingly; now males are more often affected than females, and the onset of symptoms is usually after age 50 (Howard, 2006).
What is MG?
The name “Myasthenia Gravis” comes from the Greek and Latin words meaning “grave muscular weakness.” The most common form of MG is a chronic autoimmune neuromuscular disorder that is characterized by fluctuating weakness of the voluntary muscle groups (Myasthenia Gravis Foundation of America, 2001).
What are the symptoms of MG?
MG causes muscle weakness, which worsens with use of the affected muscle. Different muscle groups are affected in different patients with MG. Certain muscles are more frequently involved, including the ones that control eye movements, eyelids, chewing, swallowing, coughing, and facial expression. Muscles that control breathing and movements of the arms and legs may also be affected. Weakness of the muscles needed for breathing may cause shortness of breath, difficulty taking a deep breath, and coughing. The "gravis" or seriousness of myasthenia is noticeable when breathing muscles are affected (Myasthenia Gravis Foundation of America, 2001).
How is MG treated?
There is no known cure for MG, but there are effective treatments that allow many people with MG to lead full lives. Common treatments include medications, thymectomy, and plasmapheresis. Spontaneous improvement and even remission may occur without specific therapy. Rest and a well-balanced diet can help reverse the weakness (Myasthenia Gravis Foundation of America, 2001).
Is MG 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 Regulations . . ., 2011). 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 an impairment (EEOC Regulations . . . , 2011). For more information about how to determine whether a person has a disability under the ADA, visit http://AskJAN.org/corner/vol05iss04.htm.
Note: People with MG 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 MG 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:
- What limitations is the employee with MG experiencing?
- How do these limitations affect the employee and the employee’s job performance?
- What specific job tasks are problematic as a result of these limitations?
- What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?
- Has the employee with MG been consulted regarding possible accommodations?
- Once accommodations are in place, would it be useful to meet with the employee with MG to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
- Do supervisory personnel and employees need training regarding MG?
- Reduce or eliminate physical exertion and workplace stress
- Schedule periodic rest breaks away from the workstation
- Allow a flexible work schedule and flexible use of leave time
- Allow work from home
- Provide a scooter or other mobility aid if walking cannot be reduced
- Provide large print material or screen reading software
- Control glare by adding a glare screen to the computer
- Install proper office lighting
- Allow frequent rest breaks
- Magnify written material using hand/stand/optical magnifiers
- Alternate covering one eye
- Provide speech amplification, speech enhancement, or other communication device
- Use written communication, such as email or fax
- Transfer to a position that does not require a lot of communication
- Allow periodic rest breaks
Fine Motor Impairment:
- Implement ergonomic workstation design
- Provide alternative computer and telephone access
- Provide arm supports
- Provide writing and grip aids
- Provide a page turner and a book holder
- Provide a note taker
Gross Motor Impairment:
- Provide parking close to the work-site
- Install automatic door openers
- Provide proper ergonomics
- Make sure materials and equipment at workstation are within reach range
- Move workstation close to other work areas, office equipment, and break rooms
Situations and Solutions:
A teacher with MG was having difficulty meeting the physical demands of her job due to muscle fatigue. She was accommodated with a fulltime teaching aid, frequently used supplies/equipment were moved closer to her desk, and she was allowed several short rest breaks during the day.
A delivery person was having difficulty loading and unloading his truck due to lower extremity weakness from MG. He was accommodated with a transfer to a less physically demanding delivery route.
A clerical worker with MG was missing a lot of work because of problems breathing, speaking, and walking. She was allowed to work at home part-time and to communicate via email as an accommodation.
An administrator was having problems handling stress and had some double vision from MG. He was allowed to take rest breaks, assigned a support person in the workplace, and provided a reader as an accommodation.
A hospital employee was having difficulty walking. She was accommodated with a parking space closer to her work-site and was provided a scooter to use at work.
There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://AskJAN.org/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.
EEOC Regulations To Implement the Equal Employment Provisions of the Americans With Disabilities Act, as Amended, 29 C.F.R. § 1630 (2011).
Howard, J.F. Jr., Myasthenia Gravis Foundation of America. (2006). Myasthenia Gravis-a summary. Retrieved September 5, 2008, from http://www.myasthenia.org/hp_clinicaloverview.cfm
Myasthenia Gravis Foundation of America. (2001) Facts about autoimmune Myasthenia Gravis. Retrieved September 5, 2008, from http://www.myasthenia.org/docs/MGFA_Brochure_FactsAboutMG.pdf (no longer available)