RISK OF SPORTS ACTIVITIES IN CHILDREN WITH DOWNS-SYNDROME AND ATLANTOAXIAL INSTABILITY

10-40% of children with Down's syndrome have atlantoaxial instability. These children might run the risk of spinal cord compression if they play sport. The aim of our study was to assess this presumed risk. We obtained 282 radiographs of the cervical spine from a cohort of 400 ch ildren and young adults with Down's syndrome who attended special scho ols and who were between 4 and 20 years old (about 25% of all such chi ldren in the Netherlands). The atlantoaxial distance was more than 4 m m in 91 children. These children were randomly assigned to two groups, with the provision that all children at any particular school were as signed to the same group. Children of one group were allowed to contin ue their habitual sports and exercise activities, whereas those in the other group were advised not to play ''risky'' sports (as defined by a panel of four experts) and not to make ''risky'' movements during ph ysical education lessons. The compliance of the experimental group was good. After a year, there were no differences between the groups in s cores on a functional motor scale, the frequency of neurological signs , or changes in the atlantoaxial distance. The motor function of a thi rd group of 44 children with Down's syndrome but normal atlantoaxial d istances was similar to that of children in the other two groups, as w as the frequency of neurological signs. These findings suggest there i s no reason to stop children with Down's syndrome from playing certain sports and no need to screen them by radiography before they take up such sports activities.