LOW PRESSURE HYPERBARICS AT UDAAN
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A lot of studies are going on worldwide on the effects of Hyperbaric air or oxygen to treat a variety of diseases, disorders or disabilities. The optimum pressure is still needed to be conclusively established.
Wassman's (Munich, Germany; Paper presented at the 4th int. Symp on HBOT presented at Fort lauderdale, Florida, in june 2004) showed that the befits of HBOT in brain follow a bell-shaed curve, with peak benefit to Intracerebral blood flow, intracranial tension, lactate levels, alpha waves on EEG) seen at 1.5 ATA and with 1.3 ATA and 1.75 VATA marginally insignificatly less.
The higher two pressures are usually given wn a rigid chamber using 100% Oxygen to breathe, the former is done in a soft chamber usig ambient or oom air.
The lead paper and editorial in UHM Journal of March 2014 show that the benefitso lhe three Hyperbaric Therapies is similar.
A Double Blind Placebo Controlled Study was planned in Quebec, Canada, in late 1990s to see if HBOT works in improving cases of Cerebral Palsy in grown up children aged 5 to 12 years. The plans called for the use of HBOT at 1.75 ATA with 100% Oxygen as per standard protocol, versus "Placebo" therapy using 1.3 ATA and ambient air. The research team considered 1.3 ATA with ambient air as "Placebo" because that is the minimum pressure that could be felt, and was then assumed to have no therapeutic benefit whatsoever. the study had a number of weaknesses:
This HBOT study, as almost ALL such studies in the world are, was conducted by HBOT authorities who were doing HBOT for a lot of causes including Cerebral Palsy. They were NOT planned by Cerebral Palsy centers doing usual therapies, with HBOT as one of the therapies. As a result, most research teams lack a basic understanding of what they were trying to treat.
The post HBOT follow up was only for 3 months. It was evidently too short. The axons arising from the ischemic neurons in the Penumbra area, and going down the spinal cord to the lower motor neurons, get de-myelinated over 4 to 12 months due to the injured state of their neurons. After the revival of some of those neurons by HBOT, these axons need the same 4 to 8 months or more to re-myelinate. AFTER that, the revived neurons, which had never functioned till now and therefore are "experience-less", need another 1 to 2 years to learn how to use the re-innervated limb (the same as any normal new born child). That means that follow-ups must be for more than 6 to 8 months to observe motor benefits, and at least 4 to 6 months to observe benefits in Speech and Cognitive abilities, dependent as they are only on short intra-cranial axons and nerves that need much less time to re-myelinate due to their shorter length.
The children chosen for the study were aged 5 to 12 years, by which time most of the Neuro-development period was already over, significant Leukodystrophy in brain had already occurred, and muscle contractures had already begun.
Both groups improved statistically significantly after the 3 months of follow up, but there was no statistically significant difference between the two groups of 50+ children. Hence the sponsors of the trial claimed in Press that HBOT was equivalent to Placebo. In contrast, the researchers said the opposite. The latter (Dr. P Marois) pointed out that both groups improved 3% in 2 months in contrast to the improvement of only 0.3% seen in similar CP children at similarly treated children (without HBOT) in Canada at similar quality centers: that is, an improvement 10 times greater in less time.
At last, by early 2005, the Quebec authorities were convinced that HBOT does work and that the trial showed that even ambient air at 1.3 ATA had therapeutic potential. Hence, they have now decided to permit some Insurance re-imbursement of HBOT in CP, though when the law will be finally allowed to start functioning remains to be seen.
The Quebec study also showed that 1.3 ATA ambient air was therapeutic. This is understandable if we recall that as per standard Physics laws, the amount of oxygen that dissolves in water under normal circumstances is 0.3 ml/100 ml whereas at 1.3 ATA it increases to somewhere about 0.4%. Even though 0.1% increase seems minuscule, do realize that an increase of 0.1% represents 33% rise in Oxygen delivery over 0.3%. That is why even 1.3 ATA is therapeutic.
Is a change of 33% important for the body? Judge for
a) Normal body temperature is 37° Centigrade. If someone has a fever of 40°C, we call it high fever. A reduction of that state by only 10% makes it normal.
b) Normal Blood Pressure is 120/80 mm of mercury, or so. Someone with the lower value at 100 mm mercury is said to have high blood pressure. A reduction of only 20% makes him normal.
c) Here we are observing an increased oxygen perfusion in brain by 33% at 1.3 ATA. No wonder both groups in the Quebec Study showed equally significant benefits.
Based on such facts, a number of workers have studied the effects of giving 1.3 ATA ambient air to small children with CP (http://www.oceanhbo.com/client/4.html ) and the results seem to be encouraging.
We planed to carry on our parallel studies on small CP children treated as follows:
Standard Therapy only (OT + PT + SPEECH + OCCUPATIONAL THERAPY)
After 2004, Standard Therapy plus 1.5 ATA HBOT with 100% Oxygen to those parents who want it for their child.
Since 2006, after we acquired our own soft chamber, newer batches to be offered Standard Therapy plus the low cost 1.3 ATA Hyperbaric ambient air to those parents who want it for their child.
Thus, we ended up with a 4 way controlled study with 6 to 8 months of follow up at least. The results were presented at the 7th Int. Symp.on HBOT at Irvine, CA, USA in July 2010 and published in UHM Journal, March 2014.
With the arrival of our first Hyperbaric chamber, the plans to make an international standard Institute for advanced pioneering research on early medical interventions in small children with Neuro-developmental Disorders (INDIRA Project) has now been initiated.
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