1. Physical limitations:

   • Shaking (tremors), muscular control and cramping, poor coordination, and balance problems,

   • Abnormal eye movements or eye movements so severe as to functionally cause blindness,

   • Constipation,

   • Sleep disorders such as insomnia.

2. Language and communication:

   • Inability to write legibly,

   • Weakness in or inability to control speech,

   • Tics that can involve the voice or parts of the body and are seen in Tourette's syndrome.

3. Psychosocial limitations:

   • Intellectual deterioration,

   • Personality changes,

   • Confusion,

   • Hallucinations,

   • Memory loss,

   • Fainting,

   • Dementia.

4. Complications:

   • Permanent physical deformities,

   • Disabilities that affect the ability to perform day-to-day activities,

   • Social misunderstanding of the disorder,

   • Pain and fatigue,

   • Muscle aches and pains,

   • Rigid or stiff muscles.

5. Other commonly associated problems:

   • Depression,

   • Reactions to certain drugs,

   • Anxiety, stress, and tension,

   • Lack of support systems.

Not available in The Disability Handbook.

Fine Motor (Writing, Keyboarding, Gripping)

• Implement ergonomic workstation design

• Provide alternative computer access and alternative mice designed to reduce the effects of spasticity

• Provide alternative telephone access such as auto-dialers, gooseneck holders, hands-free telephones, headsets, and speech recognition integration

• Provide arm supports

• Provide writing and grip aids

• Provide a page turner and a book holder

• Provide a note taker or tape recorder

Communicating

• 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

Dealing with Fatigue

• 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

• Implement ergonomic workstation design

Reducing Stress and Anxiety

• Provide praise and positive reinforcement

• Refer to counseling and employee assistance programs

• Allow telephone calls during work hours to support person

• Allow the presence of a support animal

• Allow breaks as needed

Temperature Sensitivity

• Adjust work-site temperature

• Use cooling or heating clothing

• Use fan/air-conditioner/space heater at the workstation

• Allow flexible scheduling and flexible use of leave time

• Allow work from home during extreme hot or cold weather

Performing Activities of Daily Living

• Allow use of a personal attendant at work

• Allow use of a service animal at work

• Provide grip aids

• Allow longer breaks

List of accommodations was downloaded from the Job Accommodation Network at http://askjan.org/soar/other/esstremor.html.