Summary: Hyperbaric Oxygen therapy is now given under carefully controlled regimen in experimental situations like cerebral palsy and similar diseases, that are not universally recognized as indications for HBOT. We are giving below the protocol for an USA based research project for use of HBOT in Cerebral Palsy. Last revised January 21, 2007.
Instructions, Tests and Check Lists for HBOT
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Dr. Chadha has opened a state of the art Hyperbaric Oxygen Therapy Centre facility in Scarborough Toronto Ontario. He is currently treating Cerebral Palsy, Stroke, MS, Traumatic Brain Injury and, sports injury under investigational/experimental protocol. Dr. Uday Chadha is former Chief of Neonatology and Director of Special Care Nursery at Ottawa Hospital. He is American and Canadian board certified in Neonatal – Perinatal Medicine and Pediatrics. He is also on the Board of Directors of 'The International Society for Hyperbaric Oxygenation in Cerebral Palsy and the Brain Injured Child.'
The fee per session charged there is $ 95-125 depending on the chamber used. In contrast, the fees at Delhi are about Rs.2000 ($45) per session, with concessions available for multiple use as per rules.
The long term maintenance therapy is not yet defined, but we feel that once a week for one hour would be a good starting point to assess the need for long term therapy.
Date ______________ ; Time ____________
Age _____, Sex M/F ____
Chief complaints cerebral palsy/stroke/multiple sclerosis/developmental delay/autism/prematurity
Pregnancy normal/abnormal (describe if abnormal)
Birth wt.: _____ Pounds; APGAR score _______ ; Gestational age weeks. ___________
Complication of delivery
Past Medical History Infections Seizures
Asthma ______ ; High B.P. _________
Immunization ________________________________ ; Allergy ______________________________
Developmental history ____________________________; Can sit yes/no ___; Can stand yes/no ______
Can walk yes/no ______; Can speak yes/no _____
How many words vocabulary
Tone spasticity yes/no _____
Fine motor skills ___________________________; Can hold objects yes/no _______ ; Can write y/n _________
Previous HBO Sessions Where?
Complications of Previous HBOT if any (Please describe)
Physical exam. B.P.
Eye / ENT
Medical History Attendant /Parent Date
Name Age Sex m/f
Date of Birth
High Blood Pressure Yes/No
Past Medical History: Please give details of medical conditions that you think we should know, if need be write on the back page:
Allergies No/Yes: Give details
Physical Exam. B.P. Pulse
Risks, Benefits and experimental nature of HBO Therapy discussed in details.
This is to certify that __________________________ (patient or patient's parent /guardian) has been instructed in the following safety instructions with regards to Hyperbaric Oxygen Therapy for themselves and/or their child.
The chamber is very safe.
Fire safety is assured with fire proof materials. The patient (and accompanying parent for small children) plays an active part in the maintenance of safety in the chamber.
Patient's Signature (Parent/guardian if minor); Date
Name Age ______ Diagnosis _________
Number of sessions received so far
Improved: yes no
I,________________________, resident of __________________________________________________ and the _______________ of ______________ , a child diagnosed by competent medical authorities after all necessary examinations and investigations, as suffering from cerebral palsy, do hereby give Foundation for Spastic and Mentally Handicapped Persons, its main activity center UDAAN for the Disabled, and Apollo Hospital where HBOT will be carried out, my consent to administer Hyperbaric Oxygen Therapy to my ________________________as treatment for the following condition (s):_______________________________________________________ In doing so, I acknowledge that I have been advised for the following.
Although Hyperbaric Oxygen Therapy is considered adjunctive therapy for several conditions such as decompression, gas gangrene and carbon monoxide poisoning, and such as is generally accepted and recognized as effective in the medical community its use is considered "investigational" by many physicians when it is used to treat certain illnesses, injuries and disorders such as cerebral palsy.
Thus I understand the therapy to which I am agreeing may be characterized as "investigational and experimental".
The known risks of Hyperbaric Oxygen Therapy include: temporary visual changes (near sightedness), ear pressure –sinus pressure (similar to pressure changes experienced during an airplane flight), in the worst case scenario there is a risk of rupture of ear drums. Fire hazard (extremely remote) and confinement anxiety (claustrophobia) are some of the other side effects. If the pressure is increased beyond 3.0 ATA the risk of oxygen toxicity increases in the form of seizures. These risks have been fully explained to me and I have had the opportunity to ask and have answered to my satisfaction any questions regarding the safety of this treatment.
No representations have been made to me by Foundation for Spastic and Mentally Handicapped Persons, its main activity center UDAAN for the Disabled, or Apollo Hospital where HBOT will be carried out, or any other person associated with them implying that treatments to which I hereby consent will produce any specific result or benefit. This therapy in children is experimental. No representations have been made, except as set forth in this Informed Consent concerning the accuracy, validity or efficacy of Hyperbaric Oxygen Therapy.
The cost of performing Hyperbaric Oxygen Therapy is Rs. _______________ as applicable for my ___________________________ . I fully understand and expressly agree that I will be personally responsible for full cost of services rendered.
I , the undersigned , have fully explained the procedure to the above Parent/ patient/guardian.
The risks of Hyperbaric Oxygen Therapy and the the investigational nature of such therapy has been explained to me in detail and I have had the full opportunity to ask questions and such have been answered to my satisfaction.
Patient/Parent/Guardian Signature Date ___________________
Witness Signature Date _____________________
Following points needs be checked before patient/attendant enters the chamber
Before the patient or the parent/guardian/or any designated family member /friend enters the chamber following safety precautions must be discussed and documented in the chart.
Thank you for your cooperation.
Please be aware there would be times during your treatment when for circumstances beyond our control we may not be able to keep the schedule on time , so be patient we would try to do our best to avoid such circumstances.
But the management does not take any responsibility for such occurrences.
Please be advised that for safety reasons and limited space in the chamber room not more than one family member will be allowed at a given time in the chamber room except in exceptional circumstances (at the discretion of the management.)
The rest of family should wait in the waiting area.
Your cooperation will be greatly appreciated
Signature of Patient/Parent/Guardian
The assignment of chamber will be at the discretion of management keeping the safety of the children in mind.
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