This brochure is one of a series on human resources practices and workplace accommodations for persons with disabilities edited by Susanne M. Bruyère, Ph.D., CRC, Director, Employment and Disability Institute, Cornell University ILR School. This brochure was developed in 2001 for Cornell University by Kurt L. Johnson, Ph.D., CRC., co-Principal Investigator for the University of Washington Rehabilitation Research and Training Center on Multiple Sclerosis. He reviewed and updated it in 2010. It recieved legal review in in 2011 by Beth Reiter, an independent legal consultant, Ithaca, N.Y., with assistance from Sara Furguson, a Cornell University Employment and Disability Institute student research assistant

Johnson, Kurt

English

DigitalCommons@ILR

	 W W W . H R T I P S . O R G 	 1A D V A N C I N G 	 T H E 	 W O R L D 	 O F 	 W O R K w w w . h r t i p s . o r g
Multiple Sclerosis (MS) is a chronic and often disabling disease of the central 
nervous system that affects approximately 400,000 people living in the U.S.  MS 
is most commonly diagnosed in Caucasian women from northern European 
backgrounds who are between the ages of 18 and 30.  People living with MS are 
employed at a much lower rate than others.  Although 95% of people with MS 
have a history of employment, in surveys of people 5 to 15 years after diagnosis, 
fewer than 35% are working.  There are a number of reasons for this high unem-
ployment rate, but it is clear that many people living with MS would prefer to be 
working and could work productively with fairly minor accommodations in the 
workplace.
What is MS?
MS is a chronic disease characterized by the progressive destruction of the 
“white” matter in the nervous system – the myelin sheath that protects the 
nerves and allows for uninterrupted transmission of nerve impulses.  This pro-
gressive demyelinization is initially an inflammatory process that ultimately 
leads to the destruction of the nerve.  The initial inflammation is called an “exac-
erbation” and can often be treated using medications to reduce the residual dam-
age. MS is now thought to be an autoimmune disorder that develops without 
apparent symptoms earlier in life and for which there is some genetic vulnerabil-
ity.  There are new medications and other treatments that seem to be effective in 
altering the course of the disease for many people living with MS.  Researchers 
Workplace Accommodations 
for People Living with 
Multiple Sclerosis
2 	 Workplace	Accommodations	for	People	Living	with	Multiple	Sclerosis
believe a cure is on the not-too-distant hori-
zon.  It is critical that employers and co-work-
ers understand that MS is not a contagious dis-
ease:  it cannot be transmitted to others under 
any circumstances.
What are the different courses MS 
takes?
There are three primary courses MS can take.  
With the “relapsing-remitting” course, people 
experience “relapses” or “attacks” of symp-
toms, also called exacerbations.  People experi-
ence partial or total recovery of function after 
these exacerbations.  This is the most common 
form of MS in the U.S.  For some people, the 
relapsing-remitting course becomes progres-
sive as they get older – that is, the relapses are 
less noticeable and the symptoms progress 
steadily.  This is the “secondary progressive” 
course.  A minority of people with MS have 
the “primary progressive” course in which 
symptoms progress without remission.  Un-
derstanding which course MS is taking is criti-
cal to designing effective employment accom-
modations.
What are the symptoms or limitations 
associated with MS?
It is impossible to predict which symptoms an 
individual with MS will have, and individu-
als may experience symptoms or limitations 
during an exacerbation that either resolve or 
are less troubling during remission.  Because 
MS is a disease of the central nervous system, 
it can cause many kinds of limitations depend-
ing on where the “flare” up occurs.  The most 
common limitation people living with MS re-
port is fatigue – what people with MS call MS 
fatigue because it is more profound than the 
fatigue with which most people are familiar.  
People can also experience difficulty walk-
ing, using their hands, or with vision.  Some 
people have difficulty controlling their blad-
ders or bowels.  Balance can be affected, as can 
sensation (e.g., in one’s hands or fingertips).  
One troubling limitation experienced by some 
people living with MS is related to cognitive 
changes, which can include problems with 
memory, handling multiple tasks, and think-
ing and responding quickly.  It is important 
to remember that, because most people liv-
ing with MS have relapsing and remitting 
symptoms, an individual who experiences 
significant fatigue, vision changes, problems 
walking, or memory problems one week may 
have fewer problems once the exacerbation 
resolves.  In many ways, the unpredictability 
of the disease and the difficulty others have 
in “seeing” the limitations are as disabling as 
the limitations themselves.  For many, living 
with MS is living with an invisible disability – 
a disability that is difficult for the individual 
him or herself to understand and even more 
difficult for employers, co-workers, and others 
to grasp.  And yet, when both the individual 
with MS and others are fully informed, the 
individual may well be able to continue work-
ing productively.
The American with Disabilities Act and 
Reasonable Accommodations 
Title I of the Americans with Disabilities Act 
(ADA) protects qualified individuals with dis-
abilities against discrimination on the basis of 
disability in all terms, conditions, and privi-
leges of employment, including recruitment, 
pre-employment screening, hiring, benefits, 
promotions, layoff, and termination.  The ADA 
defines disability as a physical or mental im-
pairment that substantially limits a major life 
activity, and it specifically identifies the ability 
to see and to walk, the performance of manual 
tasks, and the normal operation of neurologi-
cal functions, among other things, as major life 
activities.
	 W W W . H R T I P S . O R G 	 3
In determining whether MS substantially 
limits one or more major life activities, miti-
gating measures are not considered.  Thus, if 
an individual’s MS is substantially controlled 
with medication, he or she could neverthe-
less qualify as an individual with a disability 
entitled to ADA protections.  Furthermore, 
as long as a person’s MS substantially limits 
a major life activity when active, its episodic 
nature will not prevent it from being classified 
as a disability.
Employers must reasonably accommodate 
qualified persons with disabilities so that they 
may perform the essential functions of jobs 
held or desired, but employers do not have 
to provide an accommodation if it would 
impose an undue hardship on the business. 
Successful accommodations are often minor, 
however, requiring little or no expense.   Suc-
cessful accommodations should be conceived 
and implemented in collaboration with the 
employee with MS – this employee has the 
most expertise on his or her own disease, 
limitations, and potentially successful accom-
modations.  In fact, most people with MS have 
developed and employed a variety of informal 
accommodations on their own. Employees 
with MS also may require accommodations 
for several limitations and it is important that 
these accommodations be coordinated.
Fatigue.    During or immediately after an ex-
acerbation, an individual may feel profoundly 
fatigued most of the time and may need to 
limit work activities for several weeks. For 
others, fatigue may be a constant limitation.  
It is not unusual for individuals to report that 
their “best times” are in the morning and they 
become progressively more fatigued dur-
ing the day.  Modifying the schedule of work 
activities so that the employee can engage in 
tasks demanding more physical and cognitive 
effort in the morning may be useful.  Strate-
gies to provide an “economy” of energy also 
may be of benefit.  For example, reducing the 
amount of travel necessary by combining trips 
to the photocopy machine, or trips out of the 
building, or using a powered scooter for trips 
more than 10 feet from the desk may conserve 
energy.  Built in rest time can be very useful.  
Many people living with MS report that even 
brief 10-minute rests can help them make it 
through the day. The trick is to schedule rest 
frequently enough to disrupt the development 
of more significant fatigue. The option to work 
at home can be very helpful since the process 
of getting to and from work requires signifi-
cant energy.  Many people with MS report that 
if they can work for a portion of the workday 
or workweek from home, they are more pro-
ductive and less fatigued.  Regardless of the 
work setting, the ergonomic accommodations 
described next also limit fatigue.
Motor weakness.  An ergonomic work envi-
ronment is a critical first step in the accom-
modation process.  Ensure that the employee 
is properly positioned in the seat to minimize 
pain and fatigue, and that tasks in which the 
employee must engage are ergonomically po-
sitioned.  When considering an office setting, 
this includes not only the keyboard, but also 
the computer mouse, alternative computer 
access tools, and monitor height.  A number of 
reasonably priced adjustable workstations are 
now available that allow the keyboard, mouse, 
and monitor to be positioned independently.  
Some employees will find that using voice 
recognition software such as Dragon Naturally 
Speaking is helpful.  This software allows the 
employee to dictate text to the computer.  With 
either voice recognition or keyboarding, com-
puter use becomes more efficient when routine 
tasks are automated using macro language.  
For example, in Microsoft Word, the autotext 
or auto-correct features may be employed 
so that the user can substitute a two or three 
letter combination for blocks of frequently 
4 	 Workplace	Accommodations	for	People	Living	with	Multiple	Sclerosis
used text. Using compressed keyboards may 
reduce fatigue and alternative mouse devices 
may improve access to the computer.  An 
employee can try out a variety of off-the-shelf 
devices at most well-stocked computer stores.  
The employee may want to consider keeping 
some type of power mobility at work, such 
as a scooter or power chair, to facilitate travel 
within the workplace.  Similar considerations 
should be made in other work settings as well.
Vision changes.  Vision changes are often tran-
sitory but vision may deteriorate over time.  
High quality computer monitors with good 
contrast provide a good foundation for a com-
puter station.  Screen enlargement software 
and contrast enhancement included as acces-
sibility features in both Microsoft and Mac op-
erating systems.  Excellent screen enlargement 
software, which also “reads” to the user with 
synthesized speech, is available from vendors 
such as ZoomText.  Closed Circuit TV (CCTV) 
can be used to enhance the contrast and size of 
print for employees.  Various fixed and move-
able lenses can allow people to magnify their 
work.  Accommodating vision changes often 
requires consultation with a specialist in low 
vision.
Bowel and Bladder Control.  These issues are 
usually managed by the employee and the 
employee’s medical team.  As an accommoda-
tion, the employer may need to provide easy 
access to the restroom, an opportunity for the 
employee to change clothes, the opportunity 
to carefully schedule meals, and perhaps the 
option to work at home during times when 
bowel and bladder problems could be more 
acute.
Changes in Sensation.  The most common 
workplace accommodation for changes in 
sensation would be related to loss of sensation 
in the fingers and hands.  This loss of sensa-
tion would often be accompanied by a loss of 
strength.  For someone with decreased sensa-
tion, it is more difficult to type accurately and 
manipulate small objects.  Keyboarding can 
be enhanced by placing Velcro or other tactile 
stimuli on “location” keys, or by using soft-
ware which gives confirmation of keystrokes.  
Experimenting with different computer point-
ing devices such as joysticks may also be 
useful.  Some people will find the voice rec-
ognition systems described earlier helpful in 
reducing the amount of keyboarding required. 
For assembly work or related tasks, jigs may 
be designed to hold or guide objects and small 
parts.
Cognitive Changes.   The idea of requiring 
accommodation for cognitive changes may 
be frightening for an employee, but many of 
these accommodations are quite simple, non-
intrusive, and allow the employee to work 
more effectively.  In some cases, these accom-
modations have been so intuitive and efficient 
that other employees have asked to have ac-
cess to them! The accommodations described 
earlier for fatigue may also be helpful to ad-
dress cognitive changes since the two are often 
intertwined.  Many people use memory books 
or computer calendars to help with memory 
problems.  Some employees email themselves 
reminders to keep a “to do” list in their in-
boxes.  There are both PC, Mac, and web-
based integrated calendar, task list, and email 
systems.  These calendar programs can also be 
configured to alerts or emails to smart phones 
and other computers, and/or SMS text messag-
es to mobile phones.  This allows an employee 
to put reminders into a computer calendar 
system and have those reminders sent to his or 
her phone, or computer during the day.  Struc-
turing the work tasks to maximize routine, 
minimize distractions, and to sequence work 
efforts to reduce the demands of multitasking 
may be helpful.  Employers and employees 
with MS should begin by completing an analy-
sis of the cognitive demands of the job, includ-
ing interpersonal demands, before beginning 
the accommodation process.
	 W W W . H R T I P S . O R G 	 5
Unpredictability of symptoms.  When plan-
ning accommodations in the workplace for 
people with MS, it is critical to consider the 
progression of MS.  While the progression of 
limitations cannot be predicted, it makes sense 
when planning accommodations for current 
needs to consider the future as well.  Accom-
modations should also address episodic ex-
acerbations where an employee may require 
a week of hospitalization or recovery from an 
exacerbation and perhaps a brief, graduated 
return to work.
Working and Living with MS
Most people with MS are of working age and 
either want to continue working or, if not cur-
rently at work, return to the workforce.  Many 
people with MS do not have limitations that 
impact their employment.  For those indi-
viduals who do have significant MS-related 
limitations affecting their employment, many 
can work successfully with reasonable accom-
modations that are typically minor in nature.  
With recent medical advances relating to MS 
and advances in awareness and technology 
regarding job accommodations, MS will pres-
ent fewer barriers to employment in the near 
future.
Resources
National Multiple Sclerosis Society
www.nmss.org
Disability and Business Technical Assistance 
Centers 800.949.4232, www.adata.org
Job Accommodation Network
800.526.7234, www.askjan.org
University of Washington Rehabilitation 
Research and Training Center on Multiple 
Sclerosis
http://msrrtc.washington.edu  
U.S. Department of Justice
202.514.2000
www.usdoj.gov/crt/ada/adahom1.htm
Equal Employment Opportunity Commission 
For the nearest field office, call 800.669.4000 
(voice), 800.669.6820 (TTY).  
For publications on ADA employment issues, 
call 800.669.3362 (voice), 800.669.3302 (TTY).  
For online information, www.eeoc.gov
Tech Act Projects in each state for information 
and referral with reference to assistive tech-
nologies.
http://resnaprojects.org/nattap/scripts/nattap-
contacts.pl
	 W W W . H R T I P S . O R G 	 7
About this Brochure
This brochure is one of a series on human 
resources practices and workplace accommo-
dations for persons with disabilities edited by 
Susanne M. Bruyère, Ph.D., CRC,  Director, 
Employment and Disability Institute, Cornell 
University ILR School. 
This brochure was developed  in 2001 for 
Cornell University by Kurt L. Johnson, Ph.D., 
CRC., co-Principal Investigator for the Uni-
versity of Washington Rehabilitation Research 
and Training Center on Multiple Sclerosis.  
He reviewed and updated it in 2010.   It re-
cieved legal review in  in 2011 by Beth Reiter, 
an independent legal consultant, Ithaca, N.Y.,  
with assistance from Sara Furguson, a Cornell 
University Employment and Disability Insti-
tute student research assistant.
These updates, and the development of new 
brochures, were funded by Cornell, the Na-
tional ADA Center Network, and other sup-
porters.
The full text of this brochure, and others in 
this series, can be found at www.hrtips.org. 
More information on accessibility and accom-
modation is available from the ADA National 
Network at 800.949.4232 (voice/ TTY),  
www.adata.org.
Disclaimer
This material was produced by the Employment 
and Disability Institute in the Cornell University ILR 
School.   Development of the original brochure series 
was funded by a grant from the National Institute on 
Disability and Rehabilitation Research (NIDRR) (grant 
#H133D10155).   Content updates were funded by 
NIDRR grant number H133 A110020.  However, those 
contents do not necessarily represent the policy of the 
Department of Education, and you should not assume 
endorsement by the Federal Government.  
The U.S. Equal Employment Opportunity Commission 
has reviewed it for accuracy.  However, opinions about 
the Americans with Disabilities Act (ADA) expressed 
in this material are those of the author, and do not 
necessarily reflect the viewpoint of the Commission or 
the publisher.  EEOC interpretations of the ADA are 
reflected in its ADA regulations (29 CFR Part 1630), 
Technical Assistance Manual for Title I of the Act, and 
Enforcement Guidance.  
Cornell University is authorized by NIDRR to provide 
information, materials, and technical assistance to indi-
viduals and entities that are covered by the Americans 
with Disabilities Act (ADA).  You should be aware that 
NIDRR is not responsible for enforcement of the ADA.  
The information, materials, and/or technical assistance 
are intended solely as informal guidance, and are 
neither a determination of your legal rights or responsi-
bilities under the Act, nor binding on any agency with 
enforcement responsibility under the ADA.
The Equal Employment Opportunity Commission has 
issued enforcement guidance which provides ad-
ditional clarification of various elements of the Title 
I provisions under the ADA.  Copies of the guidance 
documents are available for viewing and downloading 
from the EEOC web site at: 
http://www.eeoc.gov
	 Workplace	Accommodations	for	People	Living	with	Multiple	Sclerosis
Contact Information
Susanne M. Bruyère, Ph.D., CRC
Director, Employment and Disability Institute
Cornell University
ILR School
201 Dolgen Hall
Ithaca, New York 14853-3201
Voice: 607.255.7727
Fax: 607.255.2763
TTY: 607.255.2891
Email: smb23@cornell.edu
Web: www.edi.cornell.edu
To view all the brochures in this series, please visit:
www.hrtips.org


Workplace Accommodations for People Living with Multiple Sclerosis

This material was produced by the Employment and Disability Institute in the Cornell University ILR School. Development of the original brochure series was funded by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR) (grant #H133D10155). Content updates were funded by NIDRR grant number H133 A110020. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.This brochure is one of a series on human resources practices and workplace accommodations for persons with disabilities edited by Susanne M. Bruyère, Ph.D., CRC, Director, Employment and Disability Institute, Cornell University ILR School. This brochure was developed in 2001 for Cornell University by Kurt L. Johnson, Ph.D., CRC., co-Principal Investigator for the University of Washington Rehabilitation Research and Training Center on Multiple Sclerosis. He reviewed and updated it in 2010. It recieved legal review in in 2011 by Beth Reiter, an independent legal consultant, Ithaca, N.Y., with assistance from Sara Furguson, a Cornell University Employment and Disability Institute student research assistant.A94_PDF.pdf: 961 downloads, before Oct. 1, 2020

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