MHBOT

 

 HYPERBARIC OXYGEN THERAPY (HBOT)

 WHAT IS HBOT?

Hyperbaric oxygen therapy (HBOT) involves inhaling 100% oxygen at greater than one atmosphere absolute (ATA) in a pressurized chamber.
Loss of function to the brain is both due 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.
HBOT has been used successfully in humans at varying pressures to treat a range of conditions.

 WHAT IS THE RATIONALE BEHIND USING HBOT FOR AUTISM?

Multiple independent single photon emission computed tomography (SPECT) and positron emission tomography (PET) research studies have demonstrated hypoperfusion (decreased blood flow through an organ) to several areas of the autistic brain, most notably the temporal lobes. Several studies show that reduced blood @258;ow to the temporal regions and other brain areas correlates with many of the clinical @257;ndings associated with autism including repetitive, self-stimulatory and stereotypical behaviors, and impairments in communication, sensory perception, and social interaction. Furthermore, a correlation between decreased IQ and hypoperfusion of the temporal and frontal lobes has been described in children with autism. Thecause of this decreased blood flow is not known but may be secondary to changes in cerebral arterial resistance. Under normal conditions, cerebral blood flow increases when local brain tissue metabolic rate and functioning increases. However, this response may be reversed in children with autism.
Cerebral hypoperfusion may play a role in some of the more unusual characteristics of autistic behavior. Diminished blood @258;ow to the thalamus has been correlated with the autistic clinical features of repetitive, self-stimulatory, and unusual behaviors including resistance to changes in routine and environment. Hypoperfusion of the temporal lobes has also been linked with increased autism symptom pro@257;le scores including ‘‘obsessive desire for sameness’’ and ‘‘impairments in communication and social interaction’’.

 HOW DOES HBOT HELP IN AUTISM?

Using HBOT in autistic children and anecdotal reports indicate that HBOT has improved symptoms in autistic children including enhancements in sensory and cognitive awareness, socialization, language, and repetitive behaviours. Improvements have been seen in lethargy and motivation.
Dr. Dan Rossignol (2007, 2009) comprehensively described a few of the multiple mechanisms demonstrating how HBOT may work for children with autism. A summary of these specific mechanisms, along with a couple others that have been suggested, is shown below. They include:
 
  1. Angioneogenesis from the addition of oxygen
  2. Angioneogenesis from the removal of oxygen
  3. Increased blood flow independent of new blood vessel formation
  4. Decreasing levels of inflammatory biochemicals
  5. Up-regulation of key antioxidant enzymes and decreasing oxidative stress
  6. Increased oxygenation to functioning mitochondria
  7. Increased production of new mitochondria from HBOT
  8. Bypassing functionally-impaired hemoglobin molecules, the result of abnormal porphyrin production, thereby allowing increased delivery of oxygen directly to cells
  9. Improved immune and autoimmune system disorders
  10. Decreases in the bacterial/yeast load found systemically and in the gut
  11. Decreases in the viral load found systemically and possibly decreases in a viral presence that may exist in the intestinal mucosa
  12. Increases in the production of stem cells in the bone marrow with transfer to the CNS: Studies have shown that HBOT increases the production of stem cells in the bone marrow and that transfer of stem cells to the central nervous system is possible.

 IS IT SAFE? WHAT ABOUT THE BENDS?

Generally, there is no danger involved. The chamber is very safe. Fire safety is assured with fire proof materials. The patient (and accompanying parent for small children) plays an active part in the maintenance of safety in the chamber.

 CAN THE PARENT ACCOMPANY THE CHILD INTO THE CHAMBER?

As long as the parent has the clearance from his/her doctor then this is fine. At CCAW, one parent always accompanies the child and is present throughout the dive while being 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).
  • If the child has epilepsy/seizures disorder
  • If a child is ill or has upper respiratory infection or has a bad flu/cold infection 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 can't be taken in?
  1. Deodorant or any Glycerine based products
  2. Oil based products and skin lotions
  3. Smoking materials or any Inflammable items
  4. Shoes/chappals
What can be taken in?
  1. Crayons or pencils, books, jigsaws, puzzles and 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 the child comfortable , go to wash room 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 CCAW, we provide 10 minutes to pressurize to and 10 minutes to depressurise from, a pressure of 1.3 Atmospheric pressure; we give Oxygen via concentrator for only 60 -90 minutes during the pressurized state (mHBOT).
How long does the entire cycle of treatment last for?
Patients will be treated with oxygen at 1.3 ATA via oxygen concentrator for 60 -90 minutes for once a day for total 40-60 hours over 4-6 weeks(mHBOT).  The initial session will consist of 60 -90 minutes treatments, preferably once a day. For patients out of town or who agrees, the child will be treated twice a day, the gap between the two treatments in a day will be a minimum of 4 hours.

We at CCAW have conducted mHBOT since March 2012 on more than 40 children till November 2014. The results have shown improvement in understanding, cognition, eye contact & speech & language.

 
References:
  1. Rossignol, Daniel A. And Rossignol Lanier W (2006): Hyperbaric oxygen therapy may improve symptoms in autistic children,Medical Hypotheses, 67, 216–228
  2. McCandless J. Children with starving brains, 3rd edition. Bramble books, 2007.
  3. Daniel A Rossignol, Lanier W RossignolScott SmithCindy SchneiderSally LogerquistAnju UsmanJim Neubrander,Eric M MadrenGregg HintzBarry Grushkinand Elizabeth A Mumper (2009): Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial, BMC Pediatrics9:21
 
 
 

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CENTRE FOR CHILD & ADOLESCENT WELL BEING

Main Centre: R-92, GREATER KAILASH PART-1, NEW DELHI-110048.

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