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Accommodation and Compliance: Dystonia

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About 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. Dystonia can be diagnosed in childhood, adolescence, or adulthood. There are several classifications of dystonias based on the body parts affected. For example, 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. 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. Blepharospasm, the second most common form of focal dystonia results in closure of the eyelids or rapid eye blinking causing vision problems. 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. Writer’s cramp is a form of dystonia many people have experienced temporarily. Dopa-responsive dystonia (DRD) manifests symptoms in childhood or adolescence and affects walking with progression worsening during the day.

Dystonia and the Americans with Disabilities Act

The ADA does not contain a definitive list of medical conditions that constitute disabilities. Instead, the ADA defines a person with a disability as someone who (1) has a physical or mental impairment that substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3) is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, see How to Determine Whether a Person Has a Disability under the Americans with Disabilities Act Amendments Act (ADAAA).

Accommodating Employees with Dystonia

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 arthritis 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 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. Once accommodations are in place, would it be useful to meet with the employee to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?
  6. Do supervisory personnel and employees need training?

Accommodation Ideas:

Situations and Solutions:

The following situations and solutions are real-life examples of accommodations that were made by JAN customers. Because accommodations are made on a case-by-case basis, these examples may not be effective for every workplace but give you an idea about the types of accommodations that are possible.

Events Regarding Dystonia