1134 - Cervical Myelopathy in an Adult with Down Syndrome: Rehabilitation Outcomes and Special Considerations

This abstract describes a 55-year-old patient with Down syndrome who developed cervical myelopathy due to Down-related ligamentous laxity. The patient underwent a multi-level cervical spinal fusion from the occiput to C5 following progressive neurological symptoms.

Case Description:

The patient first presented to acute care with progressive weakness and coordination difficulties. Initially monitored, they later underwent elective fusion due to several months of symptom progression. On admission to acute rehabilitation, they were dependent for activities of daily living, transfers, and ambulation, limited by weakness and pain.

Discussions:

Rehabilitation course was initially limited by two challenges: 

The first was compliance due to poorly fitting adult Aspen collar that was both too tall and did not accommodate the patient’s Down facies. This contributed to discomfort and cervical flexion. The issue was resolved by transitioning to a properly sized Miami J collar and coordinating with the patient’s group home staff to reinforce education regarding appropriate use.

The second was inadequately controlled pain. Post-operatively, the patient was prescribed only as-needed oral anti-inflammatories, with no accommodation for breakthrough pain. A problem that was worsened further by collar fit, and was misinterpreted as agitation in the acute care setting. This led to antipsychotic administration. Upon transfer to rehabilitation, antipsychotics were discontinued and a multimodal pain management plan implemented, leading to significant improvement in both participation and affect.

Conclusions:

By discharge, the patient improved to modified independence in ADLs and ambulation at close supervision level with a rolling walker. They experienced no episodes of agitation while admitted and returned to behavioral baseline per group home staff. 

Patients with Down syndrome present unique rehabilitation challenges, particularly when managing orthopedic and spinal conditions. This case highlights the importance of coordinated care, individualized equipment fitting, appropriate pain management, and careful interpretation of behavioral symptoms in individuals with developmental disabilities undergoing spinal rehabilitation.