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Atlanto-axial Instability

Posted Apr 01 2010 12:00am
Last week, Logan had x-rays done on his neck to check for atlanto-axial instability because we want to take him to hippotherapy. Hippotherapy promotes the use of the movement of the horse as a treatment strategy in physical, occupational and speech-language therapy sessions for people living with disabilities. Hippotherapy has been shown to improve muscle tone, balance, posture, coordination, motor development as well as emotional well-being. Logan needed the x-ray before starting therapy.

Atlanto-axial instability or AAI describes an increased flexibility between the first and second bones of the neck. Most individuals with Down syndrome have some increased flexibility of joints, called ligamentous laxity, which can affect any of their joints. AAI refers to this condition when it affects the joint between the first and second cervical vertebrae. Since the vertebrae surround and protect the spinal cord, instability of the joint could place the spinal cord at risk for injury.

85% of individuals with Down syndrome have no evidence of atlanto-axial instability. 13-14% show evidence of instability by x-ray only and have no symptoms. This is called asymptomatic atlanto-axial instability. Only 1-2% have symptoms that may require treatment. These individuals are referred to as having symptomatic atlanto-axial instability.

Symptoms may include neck pain or persistent head tilt, intermittent or progressive weakness, changes in gait pattern or loss of motor skills, loss of bowel or bladder control, increased muscle tone in the legs, or changes in sensation in the hands and feet.

I was told today, by Logan's doctor's nurse, that Logan has AAI, but she couldn't give me any other details. I asked if he can do hippotherapy or what restrictions he will have for physical activites, but she didn't have any information for me. She is supposed to talk to Logan's doctor and call me back.

I wish I knew more! If anyone has had experiences with AAI please contact me.

I am sad that Logan's physical activities may be limited. He wants to tumble in gymnastics and I was looking forward to getting good x-ray results so that he could start doing those things in his class.

I hope to get some answers soon, or I will be contacting other doctors who are more experienced with AAI and Down syndrome.
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