Summary: Hyperbaric
Oxygen therapy comprises keeping patients of brain injury, non-healing wounds,
etc. at high atmospheric pressure (~ 1.5 Atmospheres) in an environment (with
mask/hood) of pure oxygen, for an hour or so daily, to enhance oxygen delivery
to tissues to promote and hasten healing.
The UDAAN experience suggests that the first benefit is seen in Cognitive
functions, due to which the child understands better, obeys better, and has
greater capacity and desire to excel in his physical therapies: this is followed
2 to 6 months later by observable physical benefits. It is mandatory to have an excellent follow
up Standard Therapy Program (PT + OT + Speech Therapy + Special Education) for at least 8 months, to take full advantage of the hyper-perfusion
state of the HBOT regimen. We have now extended the study to use 1.3 ATA with
ambient air (mHBT) which enhances brain oxygen delivery by 30 to 50%. So far,
our limited data on mHBT suggests that it may be similar to regular HBOT, but at
least two more years of study is required before we can draw any
conclusion..
Last updated January 21, 2007
HYPERBARIC OXYGEN THERAPY for Cerebral Palsy |
Acknowledgement: Dr. Tarun Sahni, Head of Dept. of Hyperbaric Medicine, Apollo Hospital, Sarita Vihar, New Delhi
Hyperbaric Oxygen Therapy is a form of medical treatment in which the patient breathes 100% pure oxygen at a pressure greater than the atmospheric pressure, usually twice the level, bringing the plasma oxygen level to 200% more than that achieved by any other method. The therapy is administered as two hour sessions (including compression and decompression times) once (or twice, in very serious cases) a day, for 5 to 60 or more sessions, depending upon the case. Even though each session costs about Rs.1500/- at Apollo, and similar amounts abroad, it reduces hospitalization duration and treatment costs in properly selected cases by 25 to 50%, thereby reducing overall hospitalization cost, morbidity and future suffering.
We have heard that when a deep sea diver comes up too fast from great depths, then gasses dissolved into his blood under pressure start to bubble out of solution, causing air embolus, that causes severe pain and may even cause death. These divers are immediately placed inside a pressure chamber where air pressure is kept at deep sea level, and then released slowly to enable gasses to dissolve out harmlessly and out of lungs. These chambers are now being used therapeutically in about 15 selected indications, and now experimentally in cerebral Palsy. The benefits are better if there is still a zone of injury around the dead focus in the brain. Such cases therefore refer to children in the first 1 to 3 or 4 years of life. Afterwards, spasticity sets in, and botulinum therapy or dorsal rhizotomy operation may prove to be a better idea.
Loss of function to the brain is due both to tissue destruction
(irreversible) and to tissue swelling, which can be reversed. Humans use
only up to 20% of their brain capacity throughout their lives, and it has been
shown that dormant cells around the destroyed areas can be revived and taught to
take over the function of the dead cells.
Computerized scanning of subjects has identified the tissue swelling (which in
cases is extensive) as being caused by damaged blood capillaries leaking fluid
around the area of cell death. Pressure is thus put on healthy brain tissue
preventing all but a maintenance blood supply getting through.
An increased amount of oxygen is necessary to heal these capillaries. Under normal conditions there is a limit to the amount of oxygen that can be carried by the red blood cells. Even HBOT cannot significantly increase the oxygen carried by the red blood cells. Moreover, the capillary damage prevents red blood cells getting through to the areas where oxygen is most needed.
However, giving oxygen under increased atmospheric pressure dramatically
increases the oxygen carried in the blood plasma, from 0.3 ml/dl
to 4 to 6 ml/dl.
Besides, increasing oxygen intake to the bloodstream actually causes the blood
vessels to shrink, reducing the amount of edema fluid and making the blood
'oxygen-rich'. Thus the net result of giving HBOT therapy, by both increasing
oxygen delivery and decreasing fluid outpouring, is that oxygen-rich plasma is
able to run freely into constricted areas of capillary damage in the brain to
promote healing.
Scans indicate that, during HBOT therapy, capillary healing occurs, fluid leakage is reduced, swelling recedes and effective blood supply is thus restored to previously oxygen-restricted brain tissue.
With the help of exercise and therapeutic treatment, functional ability can begin to be restored, as newly revived brain cells are trained to take over the function of dead cells.
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