We have been performing the PICL procedure since 2014. Special radiographic studies are required which include upper cervical MRI or rotatory CT scan. [32], However, the outcomes of surgical interventions in individuals with marked instability has large complication rates, and rarely leads to amelioration of neurological symptoms. [23] studied 91 children and young adults (4-20 years old) with DS presenting with asymptomatic AAI (>4mm). [3] [13] [14][15] [16] Several authors have concluded that routine screening using lateral radiographs are not necessary due to the variation in diagnostic criteria, technical difficulties conducting the measurements[23], the likelihood of AAI decline throughout an individuals' life[24] and the occurrence of symptomatic AAI being extremely rare. Draw two clock faces as shown to the left (click on the picture to see a bigger image). 13.7K subscribers Exercises, Physical Therapy, and Craniocervical Instability (CCI): What Should You Know? [1] Development of secondary health issues such as Craniocervical Instability (CCI) are common within the DS population compared to the general population. 1173185, Occipito-axial Instability in Down Syndrome, Atlanto-axial Instability in Down Syndrome. Table of Contents Browse by Speaker Browse by Category He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Again, these should be slow and controlled movements. For this level, you can either make a maze on the other side of your clock poster board or buy one like the one I have shown here for $25 on Amazon. The main concept is that youll be able to do more as you become more stable. Thats OK. The farther you are from the wall, the smaller and more fine-grained the movements. If its easy, repeat level 3. The cheapest way to do this is to get a 36 X 48-inch white poster board (not glossy, but matte) and a black magic marker of this clock. Some of these conditions include craniocervical instability (CCI . There are manual tests to measure cervical instability, however, there is a paucity of evidence regarding their diagnostic accuracy: Collectively, after a detailed subjective history[23], neurological exam[24], assessment of neck control and use of the British Gymnastics screening tool[25], an individual will either have unrestricted sport participation or an adapted, more restricted sport participation (if results indicate symptomatic cervical instability). Other conditions such as elbow dysplasia, shoulder instability, biceps tendon injury and shoulder OCD should be ruled out. great. When these ligaments are injured or damaged or just loose due to congenital problems (like Ehler-Danlos Syndrome which can cause stretchy ligaments), the head can become unstable on the upper neck. Craniocervical instability (CCI) is recognized as a manifestation of ligamentous laxity in EDS [Nagashima et al., 1981; Milhorat et al., 2010]. Examples include upright MRI with upright flexion/extension. It primarily occurs in patients with Ehlers-Danlos Syndrome and other hereditary . For lower functioning patients this may take the whole time periods described for those levels. One study demonstrated success combining physical therapy, cognitive behavioral therapy, and group therapy, followed by individual home exercises and weekly guidance by physiotherapist for three . Symptoms associated with AAI and OAI include: A thorough assessment of the cervical spine should be completed in order to distinguish the cause of neck pain and presenting symptoms. Put the LASER device on your head and move the LASER pointer to the center point of the clock faces. There are a few different options from low budget to medium. Physical therapy may include: Strengthening exercises Posture education Joint mobilization Soft tissue mobilization Spinal manipulation Proprioception exercises Surgery Clin Med (Lond). For this exercise, well be using the small clock face inside the bigger one. eCollection 2021. Prevalence of atlanto-occipital and atlantoaxial instability in adults with Down syndrome. There are strong ligaments that hold your head on, and these can be traumatically injured or otherwise become loose due to connective tissue disorders. More links to buy this system: I found this system on Amazon which is only 20 bucks and looks like a knock off of the SenMoCor device (click on the picture to the right to be taken to Amazon). Craniocervical instability (CCI) is a pathological condition of increased mobility at the craniocervical junction, the area where the skull meets the spine. Also, curve restoration therapies (aka chiropractic biophysics) may or may not be recommended for you, but can be continued during this program. [3], The consensus statement of the Spine Trauma Study Group concluded that the Rule of 12 is the most sensitive and replicable method in diagnosing AOI in Down Syndrome. A review of the diagnosis and treatment of atlantoaxial dislocations. There is limited evidence to support the use of plain radiography as a screening tool for asymptomatic AAI. Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, RiehleColarusso T, Cho SJ, Aggarwal D, Kirby RS. Lets dig in. You sit in a chair that moves and then point a LASER (with your hand) at various targets. Down Syndrome (DS), also known as Trisomy 21, is a condition caused by the presence of an extra chromosome (chromosome 21) which results in atypical physical and cognitive development. Yang, S. Y., Boniello, A. J., Poorman, C. E., Chang, A. L., Wang, S., Passias, P. G, 2014. In addition, the C0-C1 and C1-C2 facet joints can also get damaged. Y/N, Can just random light tasks like reaching for something or typing throw your upper neck Out or cause severe symptoms? . DOCTORS COMMUNITY HOSPITAL APRIL 13, 2016 Dr. Michael Healy discusses his physical therapy techniques for patients with craniocervical instability who have undergone Chiari decompression surgery.This lecture includes some live demonstrations. Make sure the patient's jaw is relaxed, so that there is no platysma, hyoid muscle, or sternocleidomastoid recruitment. List of CCI Exercises https://centenoschultz.com/cci-exercises/-------------------------------Download your copy of CCI 101: Understanding Craniocervical Instability and the Road to Recovery here -------- https://centenoschultz.com/CCI-101/--------------------------------Are you suffering from CCI and would like to see if you're a candidate for the PICL procedure?Start by filling out this form ------- https://centenoschultz.com/candidate-form/--------------------------------Learn more about the CCJ Instability Institute at Centeno-Schultz Clinic here: https://centenoschultz.com/craniocervical-instability-cci/-~-~~-~~~-~~-~-Please watch: \"Cervical Disc Replacement Movement vs Normal Disc\" https://www.youtube.com/watch?v=Tze7bUQXB4Q-~-~~-~~~-~~-~- What Is the Success Rate of C1-C2 Fusion? Then the SUV rear-ended you. To do these exercises, you need a LASER headlamp system. Headaches (with the sensation that your head feels too heavy). [6]argue the need for a revision in rules to exclude X-Ray screening and introduce neurological examinations instead, as a safer and more cost-effective method of pre-participation sporting assessment. Beth Potter | Catherine Stanislas | Emily Westwood | Laura Beaman. [2] Lax ligaments allow for more movement between the articulating vertebral bodies. The procedure is called Percutaneous Implantation of Cervical Ligaments (PICL) To learn more about this groundbreaking procedure please click on the video below. At its heart, its a complex and technically demanding injection rather than an invasive open surgery. In addition, there are additional studies that involve the patient moving during the examination. "Treatment of Craniocervical Instability from a Posterior-Only Approach." J Neurosurg Spine 21(2): 239-248. How is spinal instability treated? Its called a Gyrostim and it has many levels from very light to really intense. If this is a harder jump with more flare-ups, then repeat levels 1 and 2 before going on to level 3. Atlantoaxial instability in Down syndrome-guidelines for screening and detection, Clinical predictors and radiological reliability in atlantoaxial subluxation in Down's syndrome, Cervical spine abnormalities associated with Down syndrome. [18], The causes for such ligament laxity have previously been cited as being due to intrinsic collagen defects and/or a chronic inflammatory state which weakens the ligaments. The Alar ligament provides stability for your head and neck. As shown above, the internal Jugular Vein. What is the Alar Ligament? Balance disturbances vary in severity and can make a simple walk down the hall almost impossible at times. In clinical practice, neck pain, headache, and limited cervical mobility are common reasons to apply cervical manual therapy (physical therapy) interventions. [16], AAI becomes symptomatic when the displaced dens impinges on the spinal cord. Published 2016 Oct 21. doi:10.1186/s12891-016-1284-4. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. This book is a must-read for anyone diagnosed with CCI. There is a right and a left Alar ligament which is illustrated to the right. A case report of atlanto-axial instability in a Down Syndrome patient. Keep with that program for the rest of that week. Craniocervical Instability is a medical condition characterized by injury and instability of the ligaments that hold your head onto the neck. Ive also created a maze pattern that you can get printed just like the clock faces above. Physical Therapy 4. like the one I have shown here for $25 on Amazon. Committee on Sports Medicine and Fitness. Some CCI patients have slightly off-kilter head positions that feel more comfortable, but dont worry about this right now. Original Editor - Beth Potter | Catherine Stanislas | Emily Westwood | Laura Beaman, Top Contributors - Beth Potter, Cindy John-Chu, Laura Beaman, Kim Jackson and Rucha Gadgil, Down Syndrome (DS), also known as Trisomy 21, is a condition caused by the presence of an extra chromosome (chromosome 21) which results in atypical physical and cognitive development. This covers everything from conservative care to surgery to newer precise injection procedures like PICL that can help existing ligaments tighten down and stabilize the upper neck. Make sure your shoulders are back and relaxed and that youre sitting up straight (no slouching or keeping your head forward). Treatment Options for Craniocervical Instability Ehlers Danlos Syndrome There are three major treatment options for patients with Craniocervical Instability Ehlers Danlos Syndrome: conservative care, posterior injections and surgery. Outcomes of surgical correction of atlantoaxial instability in patients with Down syndrome: systematic review and meta-analysis. 1.Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. On physical examination, the patient showed limited range of cervical motion (40/70 active extension and 60/90 of bilateral rotation). The most common symptoms include: This is not your normal headache caused by your in-laws or excessive consumption of alcohol. The assessing clinical practitioner should be aware of the signs of progressive Myelopathy and address them during a subjective and objective exam, including: [25], Additionally, an in-depth subjective history of a person with DS should be undertaken by a qualified health professional before sport participation; ideally a practitioner familiar with the individual's baseline function. [3] [4][5][6] Less than 1-2% of people living with DS who have AAI later develop symptomatic AAI. Patients with CCI can struggle with memory, concentration, and ability to complete tasks. However, whats talked about less often is that the upper neck muscles that stabilize the head on the neck also become small and weak (aka atrophied). Cremers MJ, Bol E, De Roos F, Van Gijn J. Morton RE, Khan MA, Murray-Leslie C, Elliott S. British Gymnastics. This is an x-ray examination that is recorded in which the patient is put through various movements including bending the neck forward, backward, and to the side. 2014;14(4):432-436. doi:10.7861/clinmedicine.14-4-432, 3.Ischebeck BK, de Vries J, Van der Geest JN, et al. For this exercise, start at the center point and then try 11, 1, 7, 5 in the way as described above (center, number, back to center). [2] CCI can be subdivided in to Occipito-axial Instability (OAI) also known as Atlanto-occipital Instability (AOI) and Atlanto-axial Instability (AAI), affecting 17.5% and between 6.8- 30% of people with DS respectively. A qualified medical practitioner or chartered physiotherapist must complete the following tests[25]: If an individual has a positive test for the first two questions or a negative test for question three, the person should be excluded from participation in gymnastic activity. The test is ended when the pressure decreases >20% or when substitution occurs during the head nod. Act now before the injury and symptoms progress which limits your options. In most cases Ehlers-Danlos syndrome is inherited. Symptoms of cervical spine instability include sharp neck pain with motion or position, upper back pain, and an acute, on-going unstable sensation within the region. (2016) Revised: 9/2019 What Are the Long Term Effects of Untreated Whiplash? Instability in a chair that moves and then point a LASER headlamp.! A left Alar ligament provides stability for your head forward ) to see a bigger image ) wall, smaller. 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