Employees with Dystonia 

Accommodation and Compliance Series
Practical Solutions • Workplace Success 

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Preface 

The Job Accommodation Network (JAN) is a service of the Office of Disability 

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contact JAN. 

Authored by Eddie Whidden. Updated 03/22/10. 
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JAN’S ACCOMMODATION AND COMPLIANCE SERIES

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://askjan.org/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, 2006). 

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, 2006). 

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, 

2007). 

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 
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affected resulting in pulling the head forward or backward or twisting from side to side 

(National Institute of Neurological Disorders and Stroke, 2007). 

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, 2007). 

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, 2007). 

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, 2007). 

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, 2007). 

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, 2007). 

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 dystonia 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://askjan.org/corner/vol02iss04.htm. 
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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:

General Accommodation Considerations: 

• Accessible work-site 

• Parking close to the work-site 

• Accessible entrance 

• Automatic door openers 

• Accessible restroom and break area 

• Accessible route of travel to other work areas used by the employee 

• Accessible workstation 

• Materials and equipment within reach 

• Workstation close to restrooms, break areas, and other common use areas 

• Alternative computer, phone, writing aids, and other assistive devices 

• Ergonomic workstation design 

• Sensitivity training to coworkers and supervisors 
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Keyboarding and Mousing: 

• Speech recognition software 

• Large-key keyboards and on-screen keyboard software used in conjunction 

with a mouse 

• Alternative mice including trackballs, touchpads, foot mice, head pointers, and 

programmable mice 

• Word prediction and alternative mouse software 

Writing: 

• Grip aids 

• Weighted pens 

• Writing cuffs 

• Orthotic devices 

• Soft grasp build-ups 

• Portable recording products 

• Clipboards 

• Desk slants 

Using the Telephone: 

• Speaker-phones 

• Telephones with programmable number storage 

• Phone holders 

• Telephone headsets 

Using Tools: 

• Grasping cuffs 

• Ergonomically designed tools and handles 

• Vibration dampening wraps and gloves 

• Vises 

• Work positioners 

• Foot controls 

• Pistol grip attachments 

• Orthotic devices 

Lifting: 

• Portable lift equipment 

• Hoists 

• Tilt-tables 

• Tailgate lifts 
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Carrying: 

• Lightweight carts 

• Shoulder bags 

• Backpacks 

• Electrically powered carts or scooters with baskets 

Standing: 

• Sit/stand stools 

• Standing frames 

• Lumbar support stands 

• Anti-fatigue matting 

• Rest breaks as needed 

Climbing: 

• Stair-lifts 

• Wheelchair platform lifts 

• Rolling safety ladders with handrails 

• Work platforms 

• Step-stands 

• Hydraulic personnel lifts 

Walking: 

• Canes 

• Crutches 

• Rolling walkers with seats 

• Wheelchairs 

• Powered wheelchairs or scooters 

Driving: 

• Hand controls 

• Steering wheel knobs 

• Powered steering 

• Automatic transmission vehicles 

• Designated parking 

Housekeeping/Cleaning: 

• Lightweight vacuum cleaners 

• Back-pack vacuums 

• Grasping cuffs 
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Speech: 

• Augmentative and alternative communication devices 

• Voice amplifiers 

Vision: 

• Task lighting 

• Dark glasses 

• 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://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. 
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Resources 

Job Accommodation Network 

West Virginia University 

PO Box 6080 

Morgantown, WV 26506-6080 

Toll Free: (800)526-7234 

TTY: (877)781-9403 

Fax: (304)293-5407 

jan@askjan.org 

http://askjan.org 

The Job Accommodation Network (JAN) is a free consulting service that provides 

information about job accommodations, the Americans with Disabilities Act (ADA), and 

the employability of people with disabilities. 

Office of Disability Employment Policy 

200 Constitution Avenue, NW, Room S-1303 

Washington, DC 20210 

Toll Free: (866)633-7635 

TTY: (877)889-5627 

Fax: (202)693-7888 

http://www.dol.gov/odep/ 

The Office of Disability Employment Policy (ODEP) is an agency within the U.S. 

Department of Labor. ODEP provides national leadership to increase employment 

opportunities for adults and youth with disabilities while striving to eliminate barriers to 

employment. 

Benign Essential Blepharospasm Research Foundation 

BEBRF 

P. O. Box 12468 

Beaumont, TX 77726-2468 

Direct: (409)832-0788 

Fax: (409)832-0890 

bebrf@blepharospasm.org 

http://www.blepharospasm.org/ 

Informational page sponsored by the Benign Essential Blepharospasm Research 

Foundation, whose purpose is to undertake, promote, develop and carry on the search 

for the cause and a cure for benign essential blepharospasm and other related 

disorders and infirmities of the facial musculature. 

Dystonia Medical Research Foundation 

Dystonia Dialogue 

1 East Wacker Drive 
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Suite 2810 

Chicago, IL 60601-1905 

Toll Free: (800)377-3978 

Direct: (312)755-0198 

Fax: (312)803-0138 

dystonia@dystonia-foundation.org 

http://www.dystonia-foundation.org 

Advances research into the causes and treatments for dystonia, builds awareness of 

dystonia in the medical and the lay communities, and sponsors patient and family 

support groups and programs. 

NIH Neurological Institute 

P. O. Box 5801 

Bethesda, MD 20824 

Toll Free: (800)352-9424 

http://www.ninds.nih.gov 

The mission of NINDS is to reduce the burden of neurological disease - a burden borne 

by every age group, by every segment of society, by people all over the world. 

National Spasmodic Torticollis Association 

9920 Talbert Avenue 

Fountain Valley, CA 92708 

Toll Free: (800)487-8385 

NSTAmail@aol.com 

http://www.torticollis.org 

NSTA provides information on research, treatments, and support groups available to 

spasmodic torticollis. 

Worldwide Education & Awareness for Movement Disorders 

204 West 84th Street 

New York, NY 10024 

wemove@wemove.org 

http://www.wemove.org 

WE MOVE is the Internet's most comprehensive resource for movement disorder 

information and education and the only organization of its kind. 
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References 

Dystonia Medical Research Foundation. (2006). Dystonia defined. Retrieved September 

5, 2008, from ht http://www.dystoniafoundation.org/pages/dystonia_defined/2.php 

Equal Employment Opportunity Commission. (1992). A technical assistance manual on 

the employment provisions (title I) of the Americans with Disabilities Act. 

Retrieved September 5, 2008, from http://askjan.org/links/ADAtam1.html 

National Institute of Neurological Disorders and Stroke. (2007). Dystonias information 

page. Retrieved September 5, 2008, from 

http://www.ninds.nih.gov/disorders/dystonias/dystonias.htm 
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This document was developed by the Job Accommodation Network, funded by a 

contract agreement from the U.S. Department of Labor, Office of Disability Employment 

Policy (DOL079RP20426). The opinions expressed herein do not necessarily reflect the 

position or policy of the U.S. Department of Labor. Nor does mention of trade names, 

commercial products, or organizations imply endorsement by the U.S. Department of 

Labor.