This article is from March 2009 issue of the “Cerebral Palsy Magazine”, and provides some good insights into the benefits and nature of Hyperbaric Oxygen Therapy (HBOT).
Hyperbaric oxygen sessions, also referred to as HBOT or mHBOT, have been a controversial topic for many years now. Treatment centers, individuals and studies all vary in their practices and beliefs in reference to the amount of pressure to be utilized, types of chambers, and other topics. So what is the difference?
The simple answer is this: Pressure delivered — more is not better, the use of medical-grade oxygen and training. To begin, we wish to state there is no magic cure which comes from hyperbaric sessions. It is a therapy to be included as part of a rehabilitation process.
For those of you who might have missed any previous HBOT discussions, I will start with the statement “just what is Hyperbaric Oxygen Therapy and how if at all, can it help with CP?” Hyperbaric Oxygen Therapy involves breathing in oxygen while your body is under 4 to 15 pounds of additional pressure per square inch. To do this, a person typically goes into either an inflatable fabric or rigid steel chamber, sits up or lays down depending on the size and configuration of the chamber, and breathes oxygen in through a mask for 45 to 90 minutes at a time while additional air is pumped into the chamber, raising the pressure to the desired level.
Mild Hyperbaric Oxygen Therapy is low pressure with or without the use of medical-grade oxygen. This can vary based on the options offered by the manufacturer of the chamber. For example, there are some chambers, to which medical grade oxygen can be added as an option. Many have asked if one chamber is better than another.
Only you can decide which chamber is best for you. If you are considering doing hyperbarics at home with a steel or acrylic hard shell chamber, plan on completing some extensive reading and training on operating a home unit. If you want to operate a mild chamber, there is still a learning curve but it is not insurmountable. Most people end up learning how to use them from manuals and DVD’s supplied by the manufacturer. Some manufacturers also offer in home training and installation as an option. If you are not interested in learning to operate a home chamber, visit a facility which offers hyperbaric oxygen services.
HBOT is recognized by the medical establishment as the gold standard therapy for difficult to heal wounds. Whether burn injuries, crash injuries, electrical injuries, radiation injuries or diabetic wounds, clinics around the world turn to HBOT and mHBOT with excellent results. This is because of the unique effects of hyperbaric therapy on injured tissue. It has also shown to reduce edema, increase removal of dead tissue, decrease free radicals, generate new blood vessels and cause an 800% increase in circulating stem cells.
So, the question to ask is: If HBOT helps heal injuries, and CP is an injury to the brain, can HBOT help heal CP as well? Look at the term CP, It refers to a spectrum of clinical neurological syndromes, characterized by abnormalities in movement and posture caused by a non-progressive insult to the immature brain.
It has been assumed that the brain has a completely different set of tissue reactions to injury than the rest of the body. This is false. While there may be subtle differences in acute injury between electrical, chemical, ischemic, hypoxic, traumatic and other injuries, after a short period of time the inflammatory processes are very similar.
While brain tissue may go through the same inflammatory processes as other tissues , there are two complications that are unique to brain injuries that must be addressed if we are ever to unravel the mystery of healing the injured brain.
First, inflammation and edema are far more destructive in the brain than they are in other areas. In the brain, the increased pressure caused by inflammation and edema have nowhere to go and end up compressing the delicate brain tissue against the rigid and unyielding skull. This can cause a self-reinforcing scenario where inflammation causes pressure, pressure lowers circulation and lower circulation causes inflammation. Fortunately, HBOT has been shown to have the unique ability to decrease excessive brain pressure.
A second complication is the extreme sensitivity of brain tissue as oxygen levels decrease. Brain tissue requires 10 times as much blood flow as most other tissue; and unlike a foot, for instance, that may fall asleep for ten minutes due to an uncomfortable position, and after a moment of “pins and needles” be 100% back to operation when blood flow is restored. Ten minutes without blood flow to the brain can kill the affected neurons.
In the past, it was assumed that brain tissue has two distinct states: Living and functional (healthy) and dead and non-functional (infarct). Based on advances in diagnostic imaging, specifically SPECT scans, we now know that there is a third state called the pneumbra where the tissue is living, but not functional. These have been labeled ‘idling’ neurons. They are receiving enough oxygen to stay alive, but not enough to fire electrically and properly function.
Here is the fantastic news. These idling neurons are recoverable with HBOT. While it is best to get HBOT as soon as possible after a brain injury, even years later, these idling neurons can be recovered. The oldest documented case of a CP individual who was a prime example of idling neurons was a 59 year-old Ph.D. in the UK. His main deficit was clarity of speech. After HBOT, for the first time in his life, he was able to communicate by telephone. Does it benefit every person with CP? It depends on one’s expectations. For example: You, as an individual, consider HBOT because you would like better mobility. However, your brain may feel the additional oxygen is better suited to create increased kidney and bowel function. In your own thoughts, you feel HBOT did not benefit you, because you wanted better mobility. However, the health and well being of your body was greatly increased due to better elimination. Did HBOT not work for you? Of course it did. You just discovered mobility was not the greatest lack in your body’s opinion.
This reminds me of a story. I met a little boy who was very effected with cerebral palsy. His eating was effected, his vision very poor, he could not move a single muscle in his body with a clear purpose. His mother took him into a hyperbaric oxygen chamber with hopes of him walking. The following year I met the same woman and boy again. The boy could not walk, and still could not sit, but he could eat. His mother explained she never had even hoped to gain eating ability. G-tube feedings were just a fact of life. So they returned, to “play poker.” I have always remembered this boy and his mother. It has reminded me of the most important thing to remember with HBOT. So I will state again: what YOU want and what YOU hope to gain by utilizing oxygen therapy, may not be what YOUR brain and YOUR body feel are the most important areas needing the oxygen therapy. You might enter into trying HBOT in hopes of a clear voice and come out with great bowel function . While your entire body is left feeling great about clear bowels, your mind is depressed that HBOT did not work for your voice. So remember, for some people it is like poker better luck next time.
Basically, the only difference between how HBOT works for brain injuries vs. other tissue injuries is the fact that you cannot monitor the healing progress by taking a look at the before and after of your brain. If you were to look at a SPEC scan, the difference is clearly shown in 80-90% of thousands of marked cases. Does it work instantly? No. Think of it as a massive injury to your leg – imagine your leg almost needing to be amputated. How much time would be needed for healing and closing of the huge open wound and lacerations on your leg? How much would HBOT reduce healing time? How much physical therapy would be needed? Could you do one without the other? Now apply these same thoughts to an injured brain.
The brain consumes 20% of the oxygen but makes up only 2% of the weight. It also has 10x more oxygen requirement than average cells. However, the brain has very little area to store oxygen. Doesn’t this mean more is better? No. There is such a thing as oxygen toxicity.
3-hour exposures at 3 ATA or a 30 to 40 minute exposure at 4 ATA is where the danger point begins. For this reason, HBOT in children never goes beyond 2 ATA for neurological conditions. This is also why it is very important to consult some training before you decide to utilize a mild or home hyperbaric oxygen chamber.
There has additionally been much talk about lengths of treatment time of hyperbaric treatments. Individuals are turning to the Internet to learn more. The Internet is a great resource but it can, however, can have harmful sources. For example, I have read opinions and comments online on new groups of home chamber users stating the best approach is to follow the ideas of a famous entertainer who stated they sleep in the hyperbaric chamber. How safe is the decision this entertainer made for himself? This further compels me to discuss more about oxygen toxicity.
What is oxygen toxicity? Oxygen makes up the majority of the air we breathe. It is also the most widely prescribed “drug” in hospitals. So how can it be harmful? Oxygen toxicity occurs when a person is exposed to high oxygen levels for over 16 hours in pressures of 0.5 or more. It occurs in phases. During the first phase, fluid floods into the tissues of the lung that are normally filled with air. Bleeding then occurs between the alveoli, destroying capillaries and epithelial cells. Tissues begin producing cells in an attempt to heal the area. This causes thickening and scarring of the lungs.
Symptoms begin with a lung irritation that becomes progressively worse and is accompanied by an increasingly uncontrollable cough. The patient may experience tracheal or bronchial burning, that worsens during inspiration. The damage to the lungs is sometimes irreversible. Speaking in its most simple term, any drug can harm you if used improperly – including oxygen.
So, with this said, how is oxygen toxicity avoided? When treatment time was decreased from 90 to 60 minutes, oxygen toxicity was markedly less frequent in less than 120 treatments. As treatments exceeded 80 HBOTs, patients seemed to saturate with lesser and lesser numbers of treatments or required a reduction in pressure to 1.25 ATA to avoid toxicity.
A safe recommendation for HBOT due to chronic brain injury is treatments at 1.5 ATA per 60 minutes once per day 6 days a week for 40 treatments unless the patient has an active seizure disorder. For patients with seizures: Start at 1.25 ATA, after 40 treatments, take at least a one month break, then deliver another 40 treatments. At the conclusion of 80 treatments, carefully reassess the patient and proceed with lesser numbers of HBOTs in shorter courses at varying intervals determined by the patient’s response.
It is postulated that oxygen toxicity may be further prevented by administering supplemental Vitamins E and C prior to treatment. If oxygen toxicity does indeed occur, it can frequently be simply brought under control by a reduction in pressure or by changing the breathing gas from oxygen to air. Unfortunately, it is difficult to learn this knowledge on your own. Relatively little is published in the U.S. about administering HBOT.
The overwhelming preponderance of scientific evidence indicates that HBOT helps restore function to the injured brain. Whether or not that injury took place in the womb. As the result of a motor vehicle accident, or from a vascular accident, helping individuals come closer to living up to their potential with a higher quality of life.
HBOT reduces any pressure within the brain caused by swelling, restoring the function. It neutralizes toxic products in the brain and over a period of time enhances the growth of new blood vessels. It also acts as a scavenger of free radicals and promotes internal cleaning of debris. In fact, scientists and investigators in University of Amsterdam have restored function to human brain tissue removed 8 hours after death. Evidence has even suggested brain damage may be prevented in most infants by giving additional oxygen to the mother during birth, either at normal atmospheric pressure or under hyperbaric conditions.
All of the data in hyperbaric medicine for chronic wounding strongly suggests that HBOT acts as a signal inducer of DNA. In addition to physical, occupational and speech therapies and appropriate medications, HBOT is one of the most effective therapies currently available to children with CP or brain injuries. When properly administered over a period of time, HBOT has been helpful to the majority of individuals treated. Is it right for you? Only your body knows for sure.