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ACCOMMODATING PEOPLE WITH MUSCULAR DYSTROPHYAccording to the Muscular Dystrophy Association, the standard Myotonic Dystrophy is among the most common of Muscular Dystrophies with an incident of 1 in 7000 or 1 in 8000. Today, many individuals are living and working with MD, and employers are seeing more incidents of MD among their employees. This coupled with the requirements of the Americans with Disabilities Act (ADA) show why knowing about workplace accommodations for people with MD is important. When considering accommodations for people with MD, the accommodation process must be conducted on a case-by-case basis. Symptoms caused by MD vary so when determining effective accommodations, the person’s individual abilities and limitations should be considered and problematic job tasks must be identified. Therefore, the person with MD should be involved in the accommodation process. Not all people with MD will need accommodations to perform their jobs and many others may need only a few accommodations. For those who need accommodation, the following pages provide basic information about common limitations, symptoms, useful questions to consider, and accommodation possibilities. The following is only a sample of possibilities to consider; numerous other solutions and considerations may exist. Also included in this publication is a list of resources for additional information. This publication was written by Beth A. Loy, Ph.D., and Linda C. Batiste, MS, Human Factors Consultants with the Job Accommodation Network. If further information is needed, please call JAN at 1-800-526-7234 (V/TTY). 5/01 Muscular DystrophyWhat is muscular dystrophy?MD is the common name for several progressive hereditary diseases that cause muscles to weaken and degenerate. MD is caused by defects in genes for muscle proteins. Most of these proteins appear to play a role in supporting the structure of muscle fibers. The term “muscular dystrophy” refers to a group of genetic diseases marked by progressive weakness and degeneration of the skeletal, or voluntary, muscles, which control movement. The muscles of the heart and other involuntary muscles are also affected in some forms of MD, and a few forms involve other organs as well. There are forty different neuromuscular diseases; the major forms of muscular dystrophy are myotonic, Duchenne, Becker, limb-girdle, facioscapulohumeral, congenital, oculopharyngeal, distal, and Emery-Dreifuss. Some of these names are based on the locations of the affected muscles or the doctors who first described the diseases. For additional information on the major characteristics of the nine MDs, see Facts About Muscular Dystrophy (MD) from the Muscular Dystrophy Association at: <http://www.mdausa.org/publications/fa-md-9.html>. What causes muscular dystrophy?Flaws in muscle protein genes cause MD, which prevents the body from manufacturing essential substances in adequate amounts to maintain and fuel the muscles. All genes are inherited, half coming from a child’s mother, the other half from the father. Flaws in genes can be inherited along with the parents’ genes, although they can also occur for the first time in a child. Scientists use the term spontaneous mutation when this happens. The different forms of MD can be passed from parent to child by one of three inheritance patterns: 1) autosomal dominant (when only one parent passes on one defective gene), 2) autosomal recessive (when both parents pass on the same or similar gene defects), and 3) X-linked recessive (when gene defects on the X chromosome occur). What are the symptoms of muscular dystrophy?Individuals with MD usually exhibit contractures, a condition often associated with shortened muscles around the joints. Due to the abnormal and sometimes painful positioning of the joints, most individuals with MD have extreme fatigue and weakness as well as speech, mobility, and fine motor limitations. In addition, scoliosis, or curvature of the spine, is common. Who gets muscular dystrophy?MD is generally inherited but in some cases no family history of the disease may exist. MD can affect people of all ages. While some forms first become apparent in infancy or childhood, others may not appear until middle age or later. Duchenne and Becker are the most common types of MD and they occur in the male sex. X-linked recessive MD usually affect males since males do not have a “backup” copy of a normal gene on a second X chromosome. Females have two X chromosomes, so a normal gene on the female’s other X chromosome serves as a “backup” copy. A woman with an X-linked gene defect usually does not show any signs of an X-linked disease. However, she is a carrier of the disease and has a 50 percent chance of passing it to her sons. Her daughters each have a 50 percent chance of inheriting the gene and being carriers of the disorder. How is muscular dystrophy treated?Moderate exercise programs and physical therapy can minimize contractures, and certain exercises may prevent or delay scoliosis. Surgery can sometimes be helpful in relieving muscle shortening. In addition, respiratory care for some individuals with MD may also help. Medications known as corticosteroids have been found to slow muscle destruction in Duchenne MD. However, these potent anti-inflammatory drugs, used for many conditions besides MD, have serious side effects, such as weight gain, bone loss, cataracts, skin problems, high blood pressure, susceptibility to infection, and psychological difficulties. Researchers are testing new corticosteroids that may have fewer side effects. Researchers have developed accurate protein and DNA-based carrier detection tests for families affected by Duchenne and Becker MDs. Carrier testing for other types of MD is being developed. The prognosis of MD varies according to the type of MD and the progression of the disorder. Some cases may be mild and very slowly progressive, with normal lifespan, while other cases may have more marked progression of muscle weakness, functional disability and loss of ambulation. Life expectancy may depend on the degree of progression and late respiratory deficit. In Duchenne MD, death usually occurs in the late teens to early 20s. QUESTIONS TO CONSIDER WHEN DETERMINING ACCOMMODATIONSHow do these symptoms or limitations affect the person and the person’s job performance? What specific job tasks are problematic as a result of these symptoms and 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 MD been consulted regarding possible accommodations? Once accommodations are in place, would it be useful to meet with the person with MD to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed? Do supervisory personnel and employees need training regarding MD, other disability areas, or the Americans with Disabilities Act? ACCOMMODATION CONSIDERATIONS FOR PEOPLE WITH MD(Note: People with MD will develop some of these limitations/symptoms, but seldom develop all of them. Limitations will vary among individuals. Also note that not all people who have MD will need accommodations to perform their jobs and many others may need only a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions exist as well.) Activities of Daily Living:
Fatigue/Weakness:
Gross Motor:
Fine Motor Impairment:
Medical Treatment Allowances:
Speech Impairment:
Stress:
EXAMPLE ACCOMMODATIONS FOR PEOPLE WITH MDA student with MD was limited in her use of the computer. She was accommodated with the Magic Wand Keyboard, a miniature computer keyboard and mouse. The keyboard worked with the slightest touch of a wand and no force was needed to activate the keys. A staff employee with MD who operated a power chair with a joystick was having difficulty opening doors. The individual could not grasp door handles and was accommodated with automatic door openers. A physician with MD was having problems getting up from a seated position after consulting with patients. The individual was accommodated with a lift cushion for his chair. A counselor was having difficulty performing psychological evaluations due to cognitive limitations. Her manager agreed to provide written job instructions when possible, and make memory aids such as schedulers or organizers readily available. A service worker was having difficulty maintaining a full workday due to fatigue. The individual was accommodated with periodic rest breaks away from the workstation, a flexible work schedule, flexible use of leave time, parking close to the work-site, and periodic work from home. A technical writer with MD was having difficulty reaching her workstation. The individual was accommodated with a flat screen monitor, monitor arm, keyboard tray, footrest, headset, and strategically placed filing racks. A secretary with MD was restricted from typing information into her computer due to fine motor limitations. She was accommodated with speech recognition. A manager with MD was having difficulty with daily living needs. The individual was allowed to bring her service animal to work and provided an accessible restroom. A lawyer with MD was having difficulty climbing stairs. He was accommodated with a stair lift. An office worker with MD who distributed mail was having difficulty carrying mail to workstations. He was accommodated with a cart. A writer with MD had severe hand weakness and was limited in her ability to use the keyboard. The individual was accommodated with a miniature keyboard with light touch features. RESOURCES
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