CHAPTER 99 • SPECIAL OLYMPICS ATHLETES 583
clumsiness, and changes in bowel and bladder
control. Paraplegia, hemiplegia, quadriplegia,
and death are rare, but reported, outcomes.
- SOI policy: Since 1983, Special Olympics has
required screening for atlantoaxial instability in
athletes with Down syndrome before participa-
tion in any high risk sport that places excess
stress on the head or the neck.
a.High risk activities: Butterfly stroke and
diving starts in swimming, diving, pentathlon,
high jump, squat lifts, equestrian sports, artis-
tic gymnastics, football (soccer), alpine skiing,
and any warm-up exercise placing undue
stress on the head and neck.
b.Participation is permitted in these activities if:
i. An athlete undergoes an examination,
including X-rays, by a physician who
understands atlantoaxial instability and who
determines that the athlete does not have
atlantoaxial instability.
ii. An athlete (or parent/guardian of a minor)
with known atlantoaxial instability confirms
in writing own decision to participate
regardless of risk and two licensed medical
physicians certify in writing that they have
explained these risks and that, in their judg-
ment, the athlete’s condition does not pre-
clude the athlete from participating.
5.Screening controversy: In 1995, the AAP
Committee on Sports Medicine and Fitness
abandoned its previous recommendation of uni-
versal preparticipation radiographic screening of
all Down syndrome athletes due to unproven
value of radiographs in detecting patients at risk.
AAP now recommends careful neurologic eval-
uation annually of Down syndrome athletes for
symptoms and signs consistent with spinal cord
injury. Symptoms of AAI include neck pain and
stiffness, torticollis, progressive weakness or
change in sensation in any extremity, decreasing
endurance, loss of bowel or bladder control or a
change in bowel habits, increased clumsiness or
change in gait pattern. Neurologic signs include
sensory deficits, spasticity, hyperreflexia,
clonus, extensor-plantar reflex, and other upper
motor neuron and posterior column signs.
- Diagnosis: AAI is screened with lateral radi-
ographs of the cervical spine in flexion, exten-
sion, and neutral. The atlantodens interval
(ADI), the distance between the odontoid
process of the axis and the anterior arch of the
atlas, is calculated. The ADI is normally less
than 2.5 mm. An ADI greater than 4.5 mm is
abnormal.
- Restrictions: In addition to the guidelines man-
dated by SOI, any symptomatic athletes regard-
less of ADI and those with an ADI greater than
6 mm should be restricted from all strenuous
activities and evaluated for possible operative
stabilization of the cervical spine.
- Screening intervals: Screening for AAI should
be initiated when an individual with Down syn-
drome starts school, plans to participate in any
high-risk activity or if the individual has neuro-
logic symptoms. Although no evidence in the
literature currently supports the need for follow-
up imaging, many physicians still recommend
repeat screening at 3- to 5-year intervals till
skeletal maturity is achieved. The presence of
neurologic symptoms at any time is a reason for
further evaluation and screening radiographs.
INJURY AND ILLNESS PATTERNS
- Incidence of injury and illness
- Incidence of illness and injury at state, national,
and international competitions has ranged from 2.8
to 13%.
- Majority of athletes are seen for acute, minor
injuries particularly sprains and strains to the lower
extremities.
- Seizures account for 7–10% of all encounters.
- Athletic injury claims are greatest for athletics,
basketball, and softball.
- Injury rates are less than those reported for the
physically disabled athlete and the able-bodied
athlete.
6.Sport-specific injuries are similar for Special
Olympics athletes and able-bodied athletes.
- Summer sports
- Injuries and illness patterns: Epidemiologic data
have been reported for multiple state, national, and
international events. The most commonly encoun-
tered illnesses and injuries are listed in Table 99-3.
TABLE 99-3 Summer Sport Injuries and Illness
INJURIES ILLNESSES
Abrasion Heat-related illness
Strain Gastrointestinal discomfort
Sprain Seizure
Contusion Headache
Laceration Asthma
Blister Diabetes management
Nail avulsion Sunburn
Fracture Conjunctivitis
Dermatitis
Insect bite
