Atlantoaxial Instability in Down Syndrome As Related to Equestrian Activities
Potential participants and parents of potential participants should be aware of the inherent risks involved with equestrian activities for individuals diagnosed with Down syndrome and/or atlantoaxial instability. Mane Stream is guided by the recommendations of Professional Association of Therapeutic Horsemanship International and Special Olympics, both recognized experts in the area of sports activities for people with disabilities.
There is evidence that 10-20% of individuals with Down syndrome have Atlantoaxial Instability. Atlantoaxial Instability can be defined as instability, subluxation or dislocation of the joint between the first and second cervical vertebrae (atlantoaxial joint). Instability of the joint is generally due to poor muscle tone and ligament laxity that is common with Down syndrome.
A lax joint may begin to put pressure on the spinal cord resulting in the following neurologic symptoms:
• Change of head control-head tilt, torticollis/wry neck, stiff neck
• Change of gait- progressive clumsiness, toe walking or scissoring, falling, posturing
• Change of hand control- progressive weakness, fisting, change of dominant hand, increasing tremor
• Change of bladder function
• Change of bowel function
Neurologic signs always supersede radiographs and can be considered a contraindication.
Atlantoaxial Instability exposes individuals with Down syndrome to the possibility of injury if they participate in any activity the hyper-extends, radically flexes or creates direct pressure on the neck or upper spine. This condition can occur spontaneously or be induced by injury that results from excessive anterior movement of the upper spine.
Although every precaution is taken at Mane Stream to make lessons as safe and as risk free as possible, there is always risk involved when working around or riding on a horse. Equestrian sports are considered a high-risk activity. Even the quietest of horses are by nature unpredictable, thereby increasing the possibility of an injury while horseback riding. A fall from a horse, a sudden movement of the horse or even the horse’s normal stride/movement can create hyper-extension or hyper-flexion of the neck and upper spine.
PATH International requires that all potential participants with Down syndrome have a medical examination by a licensed physician including a complete neurological exam that shows no evidence of AAI or neurologic symptoms. This information must be noted on the Annual Medical History and Physicians Statement. Thereafter an annual examination from a physician or qualified medical professional stating that the participant’s physical exam reveals no signs of AAI or decrease in neurologic function is required for continued participation in any equine assisted activity at Mane Stream.