Indian Doctor wins international acclaim

Showcases landmark study that can improve affordability and access to hyperbaric therapies for the millions affected with Autism and Cerebral Palsy.
An Indian doctor has received one of the highest honours in international clinical hyperbaric medicine circles-the prestigious Hyperbaric Doctor of the Year 2010 award in recognition of his path breaking work that puts the focus back on developing innovative solutions that marry affordability with access when it comes to treating brain injured children with cerebral palsy. The award was presented on 24th July 2010 at Irvine, California, USA during the 7th International Symposium on Hyperbaric Oxygenation and the Future of Healing (www.hbot2010.net).
In what is being touted as a ray of hope for children who are affected by Autism or Cerebral Palsy (CP), Dr. Arun Mukherjee has show cased a study that compares the use of various hyperbaric pressures with the use of (ambient) air alone or oxygen-enrichment in the treatment of children with Cerebral Palsy (CP). The study shows that low-pressure ambient air hyperbaric therapy (1.3 atmospheres-ATA) is as or more effective than high-pressure 100% oxygen (1.5 or 1.75 ATA) in the treatment of CP. He has thus played a pioneering role in bringing affordable paediatric hyperbaric therapy to India and Asia.
"It brings into focus that the much more affordable mild hyperbaric therapy is an accessible alternative to expensive high-pressure hyperbaric therapy and does not compromise a patient's standard of care," Dr. Mukherjee admits.
The facts are stark. Internationally recognised data states that the incidence of cerebral palsy has grown to 1 in every 1000 and that of autism spectrum is a worrying 1 in every 100 of the new born children nowadays.
Dr Mukherjee has been involved in interrogating the subject matter of autism spectrum disorders and other neurological disabilities like Cerebral Palsy, Down Syndrome and Mental Retardation for 18 years in the capacity of founder-director of the UDAAN for the Disabled Center, a non-profit organization, recognized and aided by the Ministry of Social Justice & Empowerment, Govt. of India.
This study has far-reaching implications for other neurological conditions as well. Facing the sky-rocketing costs of treating brain injury caused by deficient blood flow, accidental or war injuries, stroke, cerebral palsy or autism, this study brings hope to those families struggling to afford this greatly desired therapy. This study on treating Cerebral Palsy with Hyperbaric Oxygen Therapy is making waves in India and the U.S. This study analysed data on one of the largest samples of children, studied for the longest duration, to assess rate of Neuro-developmental improvements. It focuses on a combination of standard rehabilitation therapies (Occupational + Physioherapy + Special Education + Speech Therapy), complemented by proper evidence based use of HBOT.

ANNEXURE

What is HBOT?

Hyper-Baric Oxygen Therapy (HBOT) is a treatment method to keep a patient at higher than normal atmospheric air pressure conditions for 60 to 90 minutes inside a pressure chamber, using room air (21% oxygen) or greater levels of oxygen (up to 100% oxygen). The increased pressure raises the oxygen carrying capacity of all body fluids to deliver much higher concentration of life giving oxygen to blood flow compromised tissues. In addition, it enhances Stem Cell activity, increases new blood vessel formation in deprived areas, reduces inflammation and swelling, and hastens recovery in injured swollen areas. This promotes healing even in tissues like injured brain, hitherto considered untreatable. Lately, HBOT has garnered much attention in the media, with athletes using it to train and recover from injuries, diabetics literally saving limbs, patients able to kill resistant bacteria, and most recently, new applications in neurology: brain injuries, traumas and disorders.

World wide Internet references:

The Awards

The Richard A Neubauer Research Institute was founded in memory of late Dr. Richard A Neubauer of Florida, the Father of Clinical HBOT in USA, and one of the earliest pioneers in the world on this subject. The RNRI award is given once in two years to honour the doctors with the highest scientific contribution to the field of clinical HBOT. See http://hbot2010.net/research.php for details. The major awards to physicians include:
  1. Most Innovative use of Hyperbaric Oxygen:
    The Finalist for this award for 2010 is Dr. Arun Mukherjee of Delhi, for his nine years study with the largest series of CP children with the longest follow up. He showed that the affordable mild HBOT using compressed room air technique is as effective and as safe as the twice as costly high pressure 100% oxygen using usual HBOT that is more actively promoted by affluent countries. This introduces affordable HBOT to the less affluent, to enhance the quality of life of their affected children without compromise.
  2. Hyperbaric Doctor of the year
    The winner for this award for 2010 is Dr. Arun Mukherjee for pioneering the scientific evidence based use of Paediatric HBOT in India for healing brain injury in children with Neurodevelopmental delays like CP and Autism.

The Study

The UDAAN team, lead by Dr. Mukherjee, has been working with moderate to severely affected children with cerebral palsy since 1992. Since 2001, they are doing an ongoing controlled study of Hyperbaric Oxygenation in CP, using four different pressure levels and two oxygen levels, to determine what suits whom. Their work is an extension of the landmark Mc Gill University study of HBOT in CP published in The Lancet in February 2001.
The UDAAN study has data on 145 CP children followed up for at least six months, making it the largest and longest observed HBOT in CP study in the world. The co-author of this study is Dr. Pierre Marois of Montreal in Canada, who was one of the lead authors in the McGill Study.

The UDAAN HBOT in CP study has shown that HBOT can enhance the rate of neurodevelopment as assessed by GMFM Scale from 0.4 to 0.5 per month with intensive one-to-one Standard Rehabilitation Therapies (OT + PT + Speech + Special Education, done 6 days a week with NO medical intervention) to 1.4 to 1.6 per month for 6 months if Standard Therapies are complemented by 40 sessions of HBOT (Medical Intervention Group.
This study is being designed keeping the Bayesian statistical Model in mind.
After 6 months, the rate of growth curve becomes parallel to pre-treatment growth curve but one GMFM disability level improved. There is no regression. The differences between Standard Therapy (Control Group) and the treatment arm (Standard Therapy plus HBOT using 1.75 ATA 100% Oxygen or 1.5 ATA 100% Oxygen or 1.3 ATA 21% oxygen) were statistically all significantly superior (p<0.001) with no statistically significant intergroup differences between the three treatment arms following 6 months of assessment.

That means, in paediatric age groups at least, the affordable and safer low pressure hyperbaric therapy at 1.3 ATA pressure using compressed room air is statistically as effective as the more popular but 2 to 3 times more costly HBOT using 100% Oxygen at 1.5 ATA or higher pressure. In addition, Cognitive improvement is slightly superior at the low pressure. This was also seen in the McGill study, but went unnoticed then.

This study builds on the experience of the Canadian McGill University study of 2001. Based on the collective data (107 in the McGill study plus 145 in the UDAAN Study), it is now becoming fairly evident that Hyperbaric Air or Oxygen Therapy is effective in enhancing rate of neurodevelopment for six months per HBOT course, safely and three times faster than accepted Standard Therapy given alone. Children should be chosen carefully if they have neurodevelopment delays like cerebral palsy due to anoxic brain lesions proven by CT-SPECT Fusion Scan of Brain, with clinical correlation of anoxic zones with brain-territory maps of affected areas, a technique still at its infancy in India, though being done regularly at UDAAN since 2001.

UDAAN has now well on the way to set up a state-of-the-art center at C-27 Dayanand Colony in LajpaTNAGAR - 4, New Delhi, to achieve the same quality of services and benefits in the field of Autism. Specialists on all aspects of ASD management are being gathered under one roof to provide Special Education, SIT, ABA, Speech, OT, Arts&Crafts, Music Therapy, detailed biochemical checkup, need based diet and micronutrient support to restore normal health, Mb12, oral heavy metal detoxification, Genetic Guidance, and mHBOT.

UDAAN is seeking research partners and sponsors, who wish to be associated with this world's largest, longest and most complex Autism study to date. The aim is to bring affordable standard therapy combined with medical interventions that have been shown to help significantly in Autism, assess how safe they are, how long they take to show a significant effect and how cost-effective they are.
The consultants who have already agreed to be a part of the UDAAN Autism Multimode Therapy include Dr. James Neubrander, Dr. Dan Rossignol, Dr. Paul Harch, Dr. Philip James, Prof. I C Verma and many experts in various branches of early intervention in India.

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