Summary: Hyperbaric Oxygen Therapy is a useful but much maligned therapeutic option in CP. Though some usefulness is seen at all ages, it works best within 5 years of injury, or, in CP, before 5 years age. It usually shows most predictable results in those who show definite evidence of anoxic damage and hypoperfusion in clinically corresponding brain areas on CT-SPECT Perfusion Scan of brain. We give below our regimen to use HBOT as a part of the UDAAN Multimode Early medical Intervention Therapy Project for CP. Last updated 9 May, 2011

Plan of HBOT in CP

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Background

To improve outcome of children with Cerebral Palsy a large number of therapies have been tried with conflicting reports on its actual efficacy. There are also claims of substantial improvement following these therapies. However there has been no effort to provide all these therapies sequentially and simultaneously so as to provide maximal benefit to these children.

UDAAN for the Disabled is proud to have pioneered the introduction of paediatric HBOT in India in 2001, when the whole Indian Medical world was still laughing at the concept. Today, those very centres are quietly introducing the chamber and following the UDAAN protocol esrablished over 1Ĺ decades of experience. We are today confident of doing HBOT even in many cases with epilepsy and in children a few months old.

Aim

To provide a holistic approach and all possible available therapeutic modalities to children with cerebral palsy at ages less then 410 years and preferably below 5 years, with detailed documentation for future guideline and analysis.

Phase 1: Ongoing

  1. Select children with Cerebral Palsy after carefully evaluating their fitness and suitability. They are examined and their neurological and motor capabilities documented using GMFM and other scales.
  2. A SPECT study is carried out on all prior to starting the study, and after where possible.
  3. Intensive Standard Therapy with Physiotherapy, Occupational Therapy, Speech and Special Education as per need, is carried out simultaneously with detailed assessment every two months. 
  4. The children are given 40 or more sessions of Hyperbaric Oxygen therapy or Hyperbaric Air Therapy, 6 days a week, one or two sessions per day, with 60 minutes at full targeted pressure.
  5. After completion of the Hyperbaric Therapy phase the children continue usual Standard Therapy only or rTMS or other therapies.
  6. Thereafter, after the 4th month GMFM assessment, provided the child has improved at a rate greater that 1 point on the GMFM Scale per month, rHBOT or mHBOT is repeated if the parent desires.
  7. The children are requested to come back for re-assessment 2 to 3 times a year till adult life.

Hyperbaric Oxygen Therapy in Cerebral Palsy:

How can cerebral palsy children be helped?

Ideally the appropriate time to use of oxygen is at the start of a disease process, not after a delay of months or years. Nevertheless, a course of oxygen therapy sessions at increased pressure has been shown to resolve tissue swelling after the lapse of years in patients with stroke. It works by constricting blood vessels and interrupting the vicious cycle where oxygen lack leads to tissue swelling, which then leads to further oxygen deficiency. There is every reason to believe that exactly the same effect that is seen in stroke patients can occur in children with CP. Also in children the brain is still developing and therefore the prospects for improvement are very much greater than in adults. The pilot report of McGill University, Montreal Canada Study on 25 children who received 20 one-hour HBO treatments administered at a pressure of 1.75 atmospheres has demonstrated that HBO therapy improves function in children with spastic diplegia. Further studies are being carried out to provide definite data.

References

  1. Hyperbaric Oxygen Therapy for Children with Cerebral Palsy: A Pilot Study ; Preliminary Results. Marois P, Lacroix V, Vanasse M, Montgomery D,  Amar M, Lambert J. McGill University, Marie Enfant Hospital,  Rimouski Hospital, Montreal, Canada.
  2. Hyperbaric Oxygen Therapy For Cerebral Palsy Children :Philip James MB ChB,  DIH,  PhD,  FFOM,  Wolfson Hyperbaric MedicineUnit, The University of Dundee, Ninewells Medical School, Dundee DD1 9SY.
  3. Hyperbaric Oxygen Therapy for Individuals with Neurological Dysfunction :by Ginny Paleg, MS PT for Advance for Physical Therapy

 

Inclusion criteria

Exclusion criteria

Preferable Age less than 10 years, and 5 years if possible

Age greater than 2 months as far as possible

Sex no restriction

Any uncontrolled respiratory illness, infection or epilepsy

Some selected other neurological illnesses

Diagnosis other than CP (Conditions apply, in view of experience gained)

CONFIRMATION OF INSTRUCTIONS

This is to certify that __________________________ (patient or patientís parent /guardian) has been instructed in the following safety instructions with regards to Hyperbaric Oxygen Therapy for themselves and/or their child.

Safety Instructions

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. The following materials are not allowed in the chamber. Carbonated drinks and smoking should be withheld at least 2 hours prior to the treatment. Water bottles can be taken into the chamber. 100 percent cotton clothing is worn in the chamber.

AVOID

Contraindications for HBO


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