Therapeutic Riding

Down Syndrome and Therapeutic Riding: Medical Considerations for Therapeutic Riding
By Liz Baker, PT, Medical Committee Chairman

Serving people with Down syndrome in the therapeutic horseback riding setting can be a source of great joy and satisfaction to riders, instructors, therapists and volunteers. These riders are often among the most talented and competitive a program may ever serve. It is helpful to be familiar with a few characteristics of Down syndrome which will influence the operating center’s decisions as to how to best serve this population.

People with Down syndrome are more likely than most people to have Atlantoaxial Instability. This is a condition in which the first two vertebrae of the spine, the atlas and the axis (C-1 and C-2) are loosely connected by the corresponding ligaments that are supposed to hold the vertebrae together. This results in dislocation of the C1-C2 joint, placing pressure on and even completely disrupting the spinal cord at that level. It is presumed to be a result of the generally low muscle tone and lax ligaments commonly found in people with Down syndrome. AAI is potentially life-threatening. A person with Down syndrome with AAI may or may not demonstrate neurological symptoms.

The following is quoted from the NARHA Precautions and Contraindications, found in the NARHA Guide and the NARHA Operating Center Standards & Accreditation Manual: “Specific x-rays are needed to rule out this instability before riding is permitted. This condition can occur in adults with Down syndrome even though previous x-rays during or after childhood may have been interpreted as negative. At present, it is not known how often adults with Down syndrome should be tested to rule out Atlantoaxial instability.

Operating centers should not rely on x-rays taken before the age of 2 and ½ to 3 years, as (this area of the spine) has not (become fully formed bone) at this early age. A set of films taken just prior to riding is advisable.”

Given that a fall from a horse (or even excessive motion to the neck from the movement of the horse) could be life threatening to a person with Down syndrome-related AAI, it is imperative that all programs serving these individuals be completely familiar with this section of the Precautions and Contraindications.

This article has been provided by NARHA and is taken from their magazine:

NARHA’s Strides, October 1996 issue (Vol.2, No.4).

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