Atlanto-Axial Instability Guidelines
- The risk of neurological problems caused by cervical spine instability is small in people with Down syndrome
- Acute atlanto-axial dislocation/subluxation cannot be predicted by cervical spine x-rays
- Currently no screening procedure can predict those at risk
It is recommended by the Medical Management Guidelines that:
The following signs and symptoms must not be ignored and would indicate the need for immediate specialist referral (usually a neurologist or a spinal orthopaedic surgeon).
- Develops pain behind the ear or elsewhere in the neck
- A stiff neck which doesn’t get better quickly.
- Alteration in the way a child walks – an obvious deterioration/change in their gait
- Deterioration in a child’s ability to manipulate things with his/her hands.
- Reduced bowel and/or bladder control developing in a person who has previously had no problems.
- Cervical spine protection is important in a child undergoing anaesthesia. Theatre staff should be alerted to the diagnosis of Down syndrome to avoid cervical spine injury
- Meticulous cervical spine management is required when a person with Down syndrome is involved in a road traffic accident
- Exclusion from sporting activities should not be encouraged, as currently no evidence exists that participation in sports increases the risk of cervical spine injury
The British Gymnastic Association have developed an Atlanto Axial Information and Guideline Pack
All participants who have Down syndrome (whether they wish to enter competitive gymnastics or otherwise) are required to be screened under the following guidelines.
These guidelines have been prepared to assist coaches in their coaching of those who have Down syndrome, and have received approval from British Gymnastics Medical commission, The Joint Technical Committee and the Gymnastics and Movement for People with Disabilities Technical Committee.
The aim of the screening is to provide access to gymnastics for all persons who can benefit from involvement in this sport and who are at no greater risk than other gymnasts.
Participation in gymnastics by people with Down syndrome is permitted subject to the following provisos:
- Parent/Guardian consent is obtained. (under 18’s)
- There is no evidence of progressive myopathy in the person concerned
- That neck flexion to allow the chin to rest on the chest is possible
- That the person has good head/neck muscular control