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hi Margot, a few years ago, at a follow up of a 12 years old girl with "down" we have noticed new neurological signs like spasticity of the calf muscles. things went from bad to worse in spite of collar and latter on spinal fusion of the neck vertebrae. she died 2 years latter. she could not swallow and latter on could not speak. MRI of the neck demonstrated siringomyelia of the spinal cord. all these because instability of the atlantoaxial. so one can not be too careful. Netta Harries Paediatric P.T ISRAEL ----- Original Message ----- From: "Margot Newman" <[log in to unmask]> To: <[log in to unmask]> Sent: Thursday, January 31, 2002 7:54 AM Subject: atalnto axial instability in downs syndrome > I work with adults with a learning disability and have been asked to assess > a gentleman with severe atlanto axial instability who wears a collar > 24hrs/day. he is seen by community nursing twice weekly for skin care for > under the collar. besides the obvious no manipulation contraindications > etc, any other advice would be welocmed. i have not encountered anyone with > such a gross instability from what i understand. thanks > margot newman mcsp >