FORT LAUDERDALE, FLA. – Adjunctive hyperbaric oxygen therapy significantly improves cognition for children with cerebral palsy, compared with standard therapy alone, according to an open, ongoing, observational study.
All participants significantly improved their physical, speech, and motor capabilities after 6 months, compared with baseline. Interim results for 84 children whose parents chose hyperbaric oxygen therapy (HBOT) and 20 children in a non-HBOT group were presented at a symposium on hyperbaric oxygen therapy.
Changes in cognition were distinctive. “Children receiving HBOT showed statistically significant improvements in cognitive-only parameters. This is interesting and what is driving us to go on with this treatment,” said Dr. Arun Mukherjee of Majeedia Hospital, New Delhi, India.
Researchers used a modified 49-item Gross Motor Function Measure to monitor clinical progress at 2-month intervals. In an attempt to assess the effects of hyperbaric oxygenation, researchers focused on 26 cognitive-only items, which are less dependent on therapist input. “This is the closest measure we can get to brain repair,” said Dr. Mukherjee, who is also director of the UDAAN Project for Cerebral Palsy at the Foundation for Spastic and Mentally Handicapped Persons in New Delhi. UDAAN is a Hindi word for flight (of freedom).
Hyperbaric therapy consisted of 100% oxygen delivered at 1.5 atmospheres. Not included in this interim analysis is a recently added third group of patients who receive a low-pressure HBOT option (ambient air delivered at 1.3 atmospheres).
Dr. Mukherjee and his associates launched the UDAAN HBOT-Based Multimode Long-Term Observational Study in 2001 to assess the benefits, if any, of adjunctive therapy for children with cerebral palsy. They tried nerve block with Botox and phenol, computer-assisted biofeedback, and pulsed magnetic field therapy. “We were not impressed with their cost-to-benefit ratio as per Indian prices. Hence, we have dropped them.”
Standard therapy consists of special education, occupational therapy, speech therapy, and physiotherapy totaling 2 hours daily. After 5 months of HBOT, clinicians administer 60 sessions of electroacupuncture using transcutaneous electrical nerve stimulation (TENS) specifically designed for cerebral palsy. This therapy reduces pain and discomfort of intensive exercises and helps the brain recognize pathways revived by HBOT, Dr. Mukherjee said at the symposium sponsored by the Ocean Hyperbaric Neurologic Center in Fort Lauderdale, Fla. “This alerts the brain that these circuits are now working,” he said.
Short-term treatment has limited other pediatric studies of hyperbaric oxygen for cerebral palsy, Dr. Mukherjee said. In the current investigation, it took 6 months before cognitive differences between groups reached statistical significance. This suggests the need for a long-term commitment to hyperbaric therapy for cerebral palsy.