I have been promising a series of articles on HBOT – HyperBaric Oxygeation Therapy. I’ve spent some time gathering this information an working with a Nurse who is a clinical researcher to develop this series of articles. Together we have tried to take the research we have found and summarize it here. I do not intend these article to be anything other than informational and helpful if you are researching the HBOT option. We have not yet done the therapy with my daughter and various Therapists and Doctors whom I trust truly believe it’s a wast of money. That being said many parents believe it provides tremendous help to their children and I wanted to gather the clinical information so I could make an informed decision and help others make their own informed decisions.
In the United States alone, around 500,000 individuals have cerebral palsy. In the most recent survey, it is estimated that that it affects 1.5 to 2 cases per 1,000 live births each year. In spite of the rapid scientific and technological advances related to health care, the incidence of cerebral palsy has remained unchanged for more than four decades. At present, there is no treatment which truly cures this nonprogressive neurological condition.
Some studies over the last 30 years have indicated that HBOT can provide promising results. However, in spite of its potential, it is still considered an alternative treatment. Lets see if we can understand WHY?
Causes and Pathophysiology of Cerebral Palsy
It is necessary to understand the causes of CP to fully understand the significance of utilizing HBOT.
Cerebral palsy is medically defined as a nonprogressive disorder of the developing fetal or infant brain, involving the nerve cells or neurons in the motor system. It is commonly characterized by a delay of motor development, a decrease or increase of muscle tone, joint contractures, growth delay and persistence of primitive reflexes. In some cases, seizures could also occur. Disturbances in sensation, communication, perception, cognition and behavior are noted. Since it is a nonprogressive disorder, the condition neither improves nor worsens.
The exact cause of cerebral palsy is still unknown but it is thought that the condition is brought about by the interplay of multiple factors including prenatal injuries resulting from infections, birth defects caused by certain drugs and congenital malformations. The occurrence of cerebral palsy is also commonly seen after a difficult or prolonged birth as the developing brain is cut off with oxygen for a significant period of time. Prematurity, low birth weights and abnormal birthing positions also been increase the chances of CP.
Just like any other cell, the neurons need an adequate and continuous supply of oxygen to obtain the energy they need to survive. But unlike the other cells in the body, irreversible damage of the neurons sets in if oxygen supply is cut off for 5 minutes or more. Hemorrhage and swelling of the neurons ensue and they become damaged.
As a result of neuronal damage, the brain is not able to communicate and coordinate with the rest of the body, resulting in fine and gross motor difficulties and in some cased impaired communication.
The Use Hyperbaric Oxygenation in Cerebral Palsy
The use of hyperbaric oxygenation therapy or HBOT as a treatment for various disease conditions has actually been around since the 1600s. It is believed that the first hyperbaric chamber was built by Henshaw.
HBOT is an accepted medical treatment for decompression sickness, a condition that occurs from rapid decrease of atmospheric pressure, as seen in scuba diving. It is also used as an effective therapy in air embolism, carbon monoxide poisoning and healing of chronic wounds, which include diabetic wounds and pressure ulcers. Compromised skin grafts, compartment syndrome, necrotizing soft tissue infections, delayed injuries associated to radiation, and burns are some conditions that respond well to HBOT. Clinical testing has supported the effectiveness of HBOT in these states.
In 1989, a study was conducted by Machado focusing on HBOT and its therapeutic effects in cerebral palsy. The test showed significant and promising results. Since then, many research groups have conducted their own investigations. Each study has its own results regarding its efficiency and its role in cerebral palsy treatment. Well discuss some of those tests in a future article.
What is the underlying principle of HBOT in the management of cerebral therapy? What has caused the growing interest in this treatment?
Hyperbaric oxygenation therapy involves intermittent inhalation of 100% oxygen under a controlled pressure exceeding the atmosphere, which is above sea level. At present, 1.5 atmosphere or ATA, which is equivalent to a depth of 16.5 below the sea level, is usually administered in children with cerebral palsy for 60 minutes, five to six days a week. The hyperbaric oxygen is administered in a monochamber, where a single patient is positioned or in a multichamber, where a parent or a medical attendant can be with the child as he goes through a session. Both of these chambers are pressurized with compressed air as the child breathes in 100% oxygen through a specialized mask or an oxygen hood .
Under normal conditions, we breathe air with 21% oxygen at sea level. A 100 mL of blood carries around 19 mL of oxygen combined with hemoglobin in the red blood cells and 0.32 mL is dissolved in plasma. With 100% of oxygen inspired, the amount of oxygen dissolved in plasma increases to 2.09 mL/100 mL of blood, and when you increase the atmospheric pressure to 1.5 ATA with 100% of oxygen, the plasma contains 3.26 mL/100 mL. Simply put, the 100% oxygen is mainly utilized as a drug to force more oxygen into the tissues that typically do not get that much oxygen molecules.
As we discussed earlier when someone has cerebral palsy the blood and oxygen interruption, result in death and decaying of neurons.
HBOT researchers believe that some of the nerve cells and blood vessels making up the impacted area received enough oxygen for survival but not sufficient enough to function normally. HBOT theoretically will allow the body to activate the its’ natural abilities to heal these idling cells by administering increased amounts of oxygen. Through increased availability of oxygen, the damaged blood vessels surrounding the area are healed. The leakage is significantly reduced and swelling is alleviated. Because the integrity of the blood vessels is reestablished, blood supply is improved.