Summary: Results of first seven months of therapy to six children, aged 2 to 4 years, with moderately severe Cerebral Palsy, given Hyperbaric Oxygen Therapy, Intensive Pediatric Therapy of CP (Occupational Therapy + Physiotherapy + Special Education + Speech Therapy + ADL Training) and Nerve Block as required. (Last updated January 21, 2007

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Background

The pathology of Cerebral Palsy is as variable as its manifestations. The therapy, too, is variable and varied. It is like a Jigsaw puzzle. No one therapy works completely. Many experimental therapies have been tried in isolation along with Standard Pediatric Therapy, with mixed results. These therapies include Hyperbaric Oxygen Therapy, Botox / Phenol Nerve Block, Acupuncture, Unani Neuroprotective drugs, Reflexology, surgical tendon length correction, selective dorsal rhizotomy, etc. We believe, that therapy of CP must resemble solving a Jigsaw puzzle. We need all the pieces put together to make out the whole picture. That means giving an individual child as many types of therapy as is available, and which suits the requirements of an individual child. However there has been no effort to  provide all these therapies simultaneously to provide maximal benefit to these children .

As a   millennium gift to  the disabled child,  FSMHP  (Foundation for Spastic & Mentally Handicapped Persons ) and UDAAN for the Differently Abled started a Multimode Early Medical  Intervention Therapy project for children with CP.  This  is the  first such project in the world. It provides sequential therapy with  intensive PT/OT/Speech and Special Education, Behavior modification, etc. supplemented by HBO Therapy, Botulinum/Phenol Nerve Block, Acupuncture,  and Unani Neuro-restorative agents, in a one year research  project, to CP children aged 4 or less, who had SPECT Scan proof of penumbra of ischemic injury in brain that may recover with HBOT.

Progress at seven months:

1. Six children with Cerebral Palsy in the ages 2.5 to 3.5 years at start of therapy, were examined and their neurological and motor capabilities documented  in May '01. Each child was also sent as a routine Outpatient case to the Rehabilitation Department of Safdarjung Hospital, one of the foremost hospitals for Rehabilitation Therapy in North India. They were requested to make an independent assessment, without showing us their results till we completed our objective.
2. Each child was examined for fitness for Hyperbaric Oxygen Therapy as per a protocol used in US FDA approved centers in USA. A SPECT SCAN of Brain was carried out on all prior to starting the study and three weeks after completing their Hyperbaric Oxygen Therapy Phase.
3. Intensive Standard Pediatric Therapy with Physiotherapy, Occupational Therapy, Speech Therapy and Special Education was carried out simultaneously with detailed muscle charting, video recording and detailed assessment every two weeks. 
4. The children were given  40 sessions of Hyperbaric Oxygen therapy ( 6 days a week x 7 weeks),   90 minutes at 1.75 ATA.
5. A SPECT scan and detailed assessment was repeated after 40 therapies in all children
6. After  completion of the  Hyperbaric Oxygen therapy phase the children in the trial were given need-based Botox (1 child) or Phenol Injection (4 children) followed by three months of Acupuncture Therapy. Standard Therapy was never stopped.
7. A detailed assessment was repeated in all children

Preliminary Results

1. SPECT Scan shows improved perfusion (Click here to see the pictures) of normal areas as well as partially occluded areas in the six children. There seems to be only a fair degree of correlation with areas showing improved blood perfusion and the zone of brain showing improvement. However, the correlation is not very strong. This suggests that HBOT improves perfusion, as proved by SPECT. But, that does not prove that the nerve cells have come alive, or are functioning normally. In other words, we still do not have a means of recording improvement of brain nerve cell function, except by standard physical assessment. The SPECT Scan may be used to select CP due to ischemic injury as opposed to non-ischemic pathologies where HBOT is unlikely to be of any benefit.
2. HBOT produced a significant improvement in cognitive skills in all the six children. This was reflected in better communication ability, better obeying of commands, greater cooperation in exercises, better limb control, better speech, better eye contact, and a more cooperative and less restless child.
3. As a consequence of better cognitive powers, all children have shown a very good progress in their physical controls and ability, better sitting, posture control, limb control, walking, etc.
4. Following Nerve Block, and using AFO, etc., the six children have started crawling, side walking, supported standing and walking with aids.
5. Unani Neuro-restorative Therapy given during the 4th to 6th month gave an enhanced rate of benefit in Cognitive Function. Click here to see the results.
6. NOW (April 2003), three of the children coming for regular follow up are still improving and have become independent walkers (TM, AG, SA). The other three have not come for recent follow up.

To examine the results in detail and to see the case reports, please click here.

Acknowledgements

UDAAN is sincerely grateful to the following for their contributions to make Multimode Early Medical Intervention Therapy of Cerebral Palsy a reality:

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