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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 list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. 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. 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:
- What limitations is the employee 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?
- 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?
- Do supervisory personnel and employees need training?
Situations and Solutions:
An applicant disclosed that he has dopa-responsive dystonia and stated that this causes his ability to walk to degrade throughout the day.
The employer agreed to arrange the applicant’s schedule so that duties requiring extensive walking was done near the beginning of the shift and less physical duties were done near the end of the shift.
An employee diagnosed with cervical dystonia has reported difficulties holding the phone and using the keyboard at the same time.
This was due to their uncontrollable head movements. The employer provided a phone headset as an accommodation.
An employee with spasmodic dystonia has been having trouble with clients hanging up when he calls them due to the speech difficulty he experiences.
The employer allows the employee to correspond with his clients via e-mail, text messaging, and live chat rather than telephone as an accommodation.
An applicant with blepharospasm raised concerns about the on-the-job driving duties required for the position.
The employer arranged for another employee to perform the driving duties as an accommodation. The employer felt this was a marginal function because the employee rarely traveled alone due to the nature of the job.
An employee with focal hand dystonia mentioned difficulty keeping up with prolonged writing tasks.
The employer provided ergonomic writing aids as an accommodation.