Multimode Therapy is a means of providing very small children
with cerebral palsy, with sequential treatment with Hyperbaric Oxygen,
and intensive OT, PT, Special Education and Speech Therapy, spread over six to eight months at a stretch.
Last updated June 5, 2010
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Statements, Precautions, Warnings and Selection Criteria
|Hyperbaric air or oxygen therapy is still classified under Experimental
Please see this website for details. UDAAN is trying to bring all these modes of therapy under one roof in the best interests of a CP child, in case parents wish to avail of them under their own informed voluntary consent, with the help of experienced specialists.
We do not guarantee any cure or remarkable degree of improvement. Our MMT is not any type of Magic Remedy, but lots and lots of hard work, supported by HBOT and other therapies.
We do HOPE to reduce the growing gap in the scale of development of a normal child and a CP child, even though some gap will always remain. The CP child is expected to become much more self reliant and self independent in ADL and activities of life. Degree of benefit depends on early intervention before age of 5 years, before significant brain Leukodystrophy develops.
Just as Phenol/Botox Nerve Block effects wear off after 4 to 12 months when the nerve fibers regenerate, similarly, the re-myelination of brain to spinal neuron nerve tract / reactivation takes the same 4 to 12 months after completing HBOT (which recovers stunned nerve cells and maybe re-grows new nerve cells by activation of Stem cells). Thereafter, the brain needs another 1 to 3 years to 'learn" how to use the limb properly, just as even a normal child needs 1 to 3 years to gain full control over the body. Hence, expect the full benefits of MMT start from about the 4th month AFTER starting MMT and reaching maximum effects 2 to 3 years after completing MMT. We advise a repeat 40 sessions of HBOT any time after 4 months of the last HBOT, as long as there is a jump in Neuro-development scale, and the parent can afford it..
Standard Therapy (Target oriented need based Physiotherapy, Occupational Therapy, Special Education and Speech Therapy, each for half an hour, six days a week, on a one-to-one basis) for 6 to 8 months plus therapy with HBOT
Diagnosed cases of CP, less than 5 years old, preferably less than 1 to 3 years old.. Now-a-days, we have included a few cases of Neuro-developmental delays, MR and Autism, for study purposes, on intense persuasion by the parents of these children, because many CP children having such problems in addition to CP, have benefited from HBOT.
Parents have to give informed written voluntary consent to include their child for MMT
The child will have to satisfy the medical board regarding fitness for MMT, especially HBOT. We expect the SPECT Scan to show a penumbra of ischemic injury. In addition, the child WILL have a general health test especially of lungs, ENT test (to assess fitness for HBOT), and may also have, if required, detailed blood test, eye test, BERA test for hearing, session with dietician to improve nutritional status, hematinics for improving iron status, consultation with visiting consultants for evaluation of Speech / Communication skills, Orthopedician for assessing need for surgery in future, on a case to case basis.
The decision of the board of Trustees and Medical Sspecialists to include or exclude any child is final and binding on all. This is necessary to ensure the safety of the child above all else.
These therapies are available at our OPD service for such children. The parent will get hands on training to manage the child as per our guidelines. A selected child will have a chance to start the HBOT phase only when a vacancy exists, though standard therapy may start at any time on a monthly basis outside the package deal of six months.
New children are examined by prior booking on a Monday, and the procedure usually takes 3 to 5 days. Parents will be called to UDAAN, C/27-28 Dayanand Colony, Lajpatnagar - 4; New Delhi, 110014 on Monday at 9 AM to 5 PM daily for up to 5 days for initial assessment and programming. Initial medical clearance by Pediatrician and ENT Specialist (Amount may vary depending on tests and consultations required in an individual case).
For booking, do any of the following:
Send snail-mail to Administrator, OPD Project of UDAAN, C/27-28 Dayanand Colony, Lajpatnagar - 4; New Delhi, 110014; India, Phone No. +91-11-41621137, between the hours 09.30 to 17.00 Indian Standard Time, Monday to Friday.
Send snail-mail to Dr. Arun Mukherjee, Director - FSMHP-UDAAN; 61 Deshbandhu Apartments, Kalkaji, New Delhi 110019
Phone numbers: FSMHP / Residence of Dr. Mukherjee: +91-11-26446978; UDAAN: +91-11-41631140; Mobile of Dr. Mukherjee: +91-9811157839
For the best results: NO
Our understanding gained so far is as follows, based on observation of results:
|OUR OBSERVATIONS||OUR OPINION / CONCLUSIONS|
revives nerve cells in the penumbra region through flooding the
surrounding normal brain cells with oxygen: the high level of left-over
oxygen leaks into the penumbra area to revive it (Time:
2 months). The revived cells induce re-myelination and
revival in corresponding nerve fibers to limb muscles (Time:
2 to 8 months). Then, the re-established brain to muscle
communication learns to develop the brain training required to control the
body parts (Time: 1 to 3 years, same as that
of a normal child after birth)
If we quantify the total benefit obtained at six to eight months, then Standard Therapy contributes 55% and HBOT 45%.
|Just because the damaged area brain cells have partially revived does not mean that it will work. If you are placed before a piano and asked to play a Beethoven piece, can you? No. But it does not mean that you are brain disabled. Your brain centers for eye, ear, finger, coordination areas, etc. have not learnt to associate together to play the piano the way you are being asked to. In the same way, the revived brain cells are non-functional until "taught" how to function. That is the job of the OT/PT therapists. This takes some months of dedicated, target oriented, specific work by therapists trained in what to expect after HBOT.|
Based on our experience so far, we therefore recommend a minimum period of 8 months of multimode therapy to take full advantage of each phase of therapy as outlined above. A shorter period will not do full justice to the benefits of HBOT, which take time to develop, and must be supported by the other therapies during that follow up period of 4 to 8 months post-HBOT by therapists experienced in what to expect after HBOT.The success rate is higher, the earlier we start, starting at 1-year age. We like children aged less than 5 years, as the chances of permanent brain recovery is highest then. We need some degree of cooperation from the child also, and some degree of understanding. Hence, we do not usually prefer children below 1 year. As per results obtained, Multimode Therapy gives faster and better results than any other therapy module we have studied so far. For details, visit our website page: http://udaan.org/multimode/index.html to see some of the results.
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