Summary: Brief user guidance about Hyperbaric Oxygen therapy. Discusses rules and regulations, precautions, dosages, etc. for the actual user and attendants. See the HBO page for details on Hyperbaric Oxygen Therapy. Last updated September 25, 2011

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Basics

What is HBO Therapy ?

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 Multiple Sclerosis, and now in cerebral Palsy.

By Definition, Hyperbaric Oxygen Therapy involves intermittent inhalation of 100% Oxygen under a pressure exceeding that of the atmosphere (Committee on Hyperbaric Medicine (1976 ); Undersea & Hyperbaric Medical Society , USA ).
It is now getting on time that this definition needs to be changed, in view of reports now appearing that ambient air compressed to 1.3 ATA is not inferior to HBOT at 1.5 -1.75 ATA using 100% Oxygen, in some indications at least, like CP and Autism

How does HBO-work?

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 to be delivered to the plasma for transference to the tissues (0.3 ml/dl). 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 (4 to 6 ml/dl : representing a several fold increase). Increasing oxygen intake to the bloodstream actually causes the blood vessels to shrink, reducing the amount of edema and making the blood 'oxygen-rich'. Thus the net result of giving HBO 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 HBO 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.

Reference : Hyperbaric Oxygen Trust Information For Parents Leaflet.
Ryton House, Primrose Lane, Forest Row, East Sussex. RH18 5LT (UK)

Is it safe? What about the bends?

Generally, there is no danger involved.

Can the parent accompany the child into the chamber?

As long as the parent has the all clear from his/her doctor then this is fine. At the multiplace chamber used by the children of  UDAAN, one parent always carries the child and is present throughout, though breathing ordinary air inside the chamber.

Are there any restrictions on who can take part in the therapy?

• There are a few restrictions, e.g. those with certain medical conditions or being pregnant should not take part. The most important thing to stress is that before anything like this is undertaken, consult with the child's doctor first (provided the doctor himself is well trained in HBO Therapy). He/she should then be able to warn of any problems they can foresee.
• Once treatment is underway, common sense is really the best approach. For example if a child is ill, or has a bad case of the flu etc. just give the therapy a miss for a few days.
• The above also applies to parents/helpers who will be entering the chamber. They will probably be required to get a doctor's letter first.

What equipment do we need?

Access to a Hyperbaric chamber and all the facilities that go with it. This is the hard part. In India, there is a large chamber at Mumbai (Bombay) belonging to the navy, and single patient small chambers at a few centers, mostly belonging to the Armed forces. The first civilian large chamber capable of taking in 8 sitting or two stretcher cases plus supervisory staff, has come up at Apollo Hospital Delhi. Abroad, many centers are in operation in US/UK/Europe, but very few elsewhere. The other main requirement is a 'Free-flow Oxygen Hood' for your child to wear, and optional 'Screw-fit' adapters for the hoses. Adult size hoods are easily available but infant size hoods are not available that easily. 
This is where the Belgian Business Association and the Belgian Embassy comes in. They perceived the need to help these handicapped citizens, and their magnanimity arranged the delivery of the first such masks in the civilian sector to help these children.

What can't be taken in?

1. Thermos flasks, or any container that can't be opened to stop any pressure building up.
2. Biro pens.
3. Anything containing a battery. This includes electronic toys, and watches.
4. Your shoes. (Honest)
5. Clothes that are less than fifty percent cotton.
6. In short anything your operator doesn't like the look of. Always ask first.

What can be taken in?

1. Crayons or pencils, Books and jigsaws, Small toys (Remember they have to sit still) and lots of other things to keep the children entertained. An hour can seem a long time, and so it is important to try to prevent them getting bored.
2. Drinks in spill proof containers or sipper type cup that is difficult to spill but is not sealed. This is very important. The easiest way to make your ears 'pop' is to swallow. A drink makes this easier for children.
3. In fact pretty much anything that doesn't fit into any of the categories above, and will fit! Well maybe that is an exaggeration, but once the initial strangeness of it all is over, an hour sitting still can seem a very long time.

How long does each session take?

It depends on whose regime is being followed. At some places, sessions are an hour at 24 feet below sea level. Allow at least two hours in total. You will need to get you child comfortable and load in all your toys and books. It also takes some time to pressurize and de-pressurize the chamber. Once the therapy is over you will also need to remove everything again. 
At UDAAN, we provide 15 minutes to pressurize to and 15 minutes to depressurise from, a pressure of 1.75 Atmospheric pressure; we give 100% Oxygen for only 60 minutes during the pressurized state. These limits are as per the recommendations of the FDA of USA for small children with CP.

How long does the entire cycle of treatment last for?

1. Month One : Five sessions a week for four weeks.
2. Month Two : Three sessions a week for four weeks.
3. Month Three : A month off. No treatment.
4. Month Four : Three sessions a week for four weeks.
5. For the rest of the year alternate between a month off, and a month of three times a week.

However, at UDAAN, we use a regimen of 40 days at a stretch, with Sundays off. We have been very satisfied with the tolerance, safety and efficacy so far.

For further details or personal opinions, contact :

• Mail to:
  at UDAAN (+91-11-26446978 / +91-9811157839)
• Dr. Tarun Sahni at Apollo Hospital, New Delhi (+91-11-26925858 Ext. 1032 / +91-9810038010)
• National Multiple Sclerosis Society site in USA.
• SCOPE (Research and Public Policy Department)
  Hyperbaric Oxygen Therapy (HBO) - May1997 (Slightly Negative)
• HEALTH Magazine - Medicine Corner
  Oxygen Therapy - Feb 1997 (Positive)
• The Weekly News : 'Bends' Chamber Helps Cerebral Palsy Children - October 1996 (Positive); Richard Parnell, Research Manager, Scope on 0171 387 9571
• 'Information For Parents' leaflet, published by the Hyperbaric Oxygen Trust . For more information regarding Hyperbaric: Register and put a mail on the Hyperbaric list at follows : hbo-list@hyperbaric.com . This is a public discussion forum for the field of Hyperbaric Oxygen Therapy. For more information about this list, please see http://www.hyperbaric.com/list.htm .