CEREBRAL PALSY & DEVELOPMENT DELAY, NEAR DROWNING, SPEECH DELAY

 * Autism, Infantile Stroke, Near Drowning, Delayed Development Syndrome, Speech Delay, Behavioral & Learning Difficulties, Compulsive Obsessive Disorders, Motor Skill Delay ...

  •  Malcolm R Hooper Hyperbaric Oxygen Therapy Combined with Robotic Exoskeleton Assisted Walking for Cerebral Palsy

Additional Review

Why Breast Is Best

Digested Early Preterm Human Milk Suppresses Tumor Necrosis Factor-induced Inflammation and Cytotoxicity in Intestinal Epithelial Cells.

J Pediatr Gastroenterol Nutr 2018 Feb 21. Epub 2018 Feb 21.

University of Illinois at Chicago, Chicago, IL.

  • February 2018

 

Objectives: The aim of this study was to determine the effect of digested whole human milk (HM; first sample available after birth from mothers of premature infants) on inflammation, oxidative stress, and cytotoxicity in Caco-2 human intestinal epithelial cells stimulated with lipopolysaccharides or tumor necrosis factor (TNF) to mimic the potential in vivo insults facing the premature infant's gastrointestinal tract.

Methods: Fully differentiated Caco-2 cells were exposed to digested HM (n = 10; samples from 10 different individuals) before stimulation with lipopolysaccharides, TNF, or no stimulation overnight. Inflammation was determined by production of interleukin-8, oxidative stress by levels of F2-isoprostane, and cytotoxicity by released lactate dehydrogenase.

Results: HM significantly suppressed interleukin-8 production and cytotoxicity in TNF-stimulated cells, while also suppressing cell death under baseline conditions. Individual HM samples differed widely in their ability to modulate cellular responses.

Conclusions: Results from this study provide evidence that digested HM can reduce both an exaggerated inflammatory response and intestinal damage that contribute to the pathogenesis of necrotizing enterocolitis.

Med Gas Res. 2017 Jun 30;7(2):144-149. doi: 10.4103/2045-9912.208521. eCollection 2017 Apr-Jun.

Subacute normobaric oxygen and hyperbaric oxygen therapy in drowning, reversal of brain volume loss: a case report.

Harch PG1, Fogarty EF2.

A 2-year-old girl experienced cardiac arrest after cold water drowning. Magnetic resonance imaging (MRI) showed deep gray matter injury on day 4 and cerebral atrophy with gray and white matter loss on day 32. Patient had no speech, gait, or responsiveness to commands on day 48 at hospital discharge. She received normobaric 100% oxygen treatment (2 L/minute for 45 minutes by nasal cannula, twice/day) since day 56 and then hyperbaric oxygen treatment (HBOT) at 1.3 atmosphere absolute (131.7 kPa) air/45 minutes, 5 days/week for 40 sessions since day 79; visually apparent and/or physical examination-documented neurological improvement occurred upon initiating each therapy. After HBOT, the patient had normal speech and cognition, assisted gait, residual fine motor and temperament deficits. MRI at 5 months after injury and 27 days after HBOT showed near-normalization of ventricles and reversal of atrophy. Subacute normobaric oxygen and HBOT were able to restore drowning-induced cortical gray matter and white matter loss, as documented by sequential MRI, and simultaneous neurological function, as documented by video and physical examinations.

99mTc-ECD brain perfusion SPECT imaging for the assessment of brain perfusion in cerebral palsy (CP) patients with evaluation of the effect of hyperbaric oxygen therapy.

Int J Clin Exp Med. 2015 Jan 15;8(1):1101-7. eCollection 2015.

Asl MT1, Yousefi F2, Nemati R2, Assadi M3.

Author information

Abstract

OBJECTIVE:

The present study was carried out to evaluate cerebral perfusion in different types of cerebral palsy (CP) patients. For those patients who underwent hyperbaric oxygen therapy, brain perfusion before and after the therapy was compared.

METHODS:

A total of 11 CP patients were enrolled in this study, of which 4 patients underwent oxygen therapy. Before oxygen therapy and at the end of 40 sessions of oxygen treatment, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) was performed , and the results were compared.

RESULTS:

A total of 11 CP patients, 7 females and 4 males with an age range of 5-27 years participated in the study. In brain SPECT studies, all the patients showed perfusion impairments.

The region most significantly involved was the frontal lobe (54.54%), followed by the temporal lobe (27.27%), the occipital lobe (18.18%), the visual cortex (18.18%), the basal ganglia (9.09%), the parietal lobe (9.09%), and the cerebellum (9.09%).  Frontal-lobe hypoperfusion was seen in all types of cerebral palsy. Two out of 4 patients (2 males and 2 females) who underwent oxygen therapy revealed certain degree of brain perfusion improvement.

 

CONCLUSION:

This study demonstrated decreased cerebral perfusion in different types of CP patients. The study also showed that hyperbaric oxygen therapy improved cerebral perfusion in a few CP patients. However, it could keep the physiological discussion open and strenghten a link with other areas of neurology in which this approach may have some value.

What Have We Learned in 2014? 

 * Dr Pierre Marois

 ** A follow up on more than 1000 children with cerebral palsy treated with HBOT. What have we learned?

 

World Leading Expert In Pediatric Brain Injury & Rehabilitation Presents At The International Hyperbaric Medicine Association HBOT2014 (August) USA New Mexico

Intensive rehabilitation combined with HBO2 therapy in children with cerebral palsy: a controlled longitudinal study.

Undersea Hyperb Med 2014 Vol41 No2.

Mukherjee A, Raison M, Sahni T, Arya A, Lambert J, Marois P, James PB, Parent A, Ballaz L.

Abstract

OBJECTIVE:

The present study aimed to assess the effect of intensive rehabilitation combined with hyperbaric oxygen (HBO2) therapy on gross motor function in children with cerebral palsy (CP).

METHODS:

We carried out an open, observational, platform-independent study in 150 children with cerebral palsy with follow-up over eight months to compare the effects of standard intensive rehabilitation only (control group n = 20) to standard intensive rehabilitation combined with one of three different hyperbaric treatments.

The three hyperbaric treatments used were: air (FiO2 = 21%) pressurized to 1.3 atmospheres absolute/atm abs (n = 40); 100% oxygen pressurized at 1.5 atm abs (n = 32); and 100% oxygen, pressurized at 1.75 atm abs (n = 58). Each subject assigned to a hyperbaric arm was treated one hour per day, six days per week during seven weeks (40 sessions). Gross motor function measure (GMFM) was evaluated before the treatments and at two, four, six and eight months after beginning the treatments.

RESULTS:

All four groups showed improvements over the course of the treatments in the follow-up evaluations (p < 0.001). However, GMFM improvement in the three hyperbaric groups was significantly superior to the GMFM improvement in the control group (p < 0.001). There was no significant difference between the three hyperbaric groups.

CONCLUSION:

The eight-month-long benefits we have observed with combined treatments vs. rehabilitation can only have been due to a beneficial effect of hyperbaric treatment.

WORLD Leading Experts

Dr Pierre Marois - Paediatric Medical Rehabilitation Specialist, Quebec Canada

Dr Pierre Marois is a pediatric physiatrist working at Ste-Justine University Hospital (Montreal), as well as in many rehabilitation centers in the province of Quebec, for the past 25 years.

  • He has been associated with cerebral palsy research projects at McGill University. In his career, he has had the opportunity to observe and to treat several thousand children with cerebral palsy and brain insults. He has expertise in this field and is a highly respected physician. He is responsible for the treatment of 1,500 children having the diagnosis of cerebral palsy, working with many rehabilitation teams in the province of Quebec.

  • Dr. Marois has specific expertise in the oxygenation process, having been one of the leaders of a research team involved in oxygenation projects from 1998-2001 for which he received the inaugural Richard A. Neubauer award. He has put together in 1982 the first dorsal rhizotomy clinic in North America, for the treatment of cerebral palsy. He is actively involved in researches and in the development of techniques for the treatment of handicapped children. He initiated and participated in the three studies that were completed in Canada on Hyperbaric Oxygen Therapy and Cerebral palsy and has lectured in many international meetings on that subject.

Dr Marois reply letter to  Annals of Neurology 2013

  • "As a senior clinician involved in the largest randomized trial of hyperbaric oxygen treatment (HBOT) for children with cerebral palsy (CP)1 as well as in the previous pilot study on the same subject, 2 I would like to comment on the editorial by Novak and Badawi 3 published in Annals of Neurology." ... "This point is also supported by in a recent editorial in Undersea and Hyperbaric Medicine.7 Mychaskiw also finds it disconcerting that this study is still held up as proof of HBOT’s lack of efficacy in CP. Based on these different points, I strongly believe that it is a blatant misrepresentation to refer to Collet et al’s study to claim that HBOT is not effective. 

  • In this trial, the motor improvements that were measured with the Gross Motor Function Measure (GMFM) were more important and were obtained over a shorter period than most of the changes found in any other studies evaluating the effects of recognized therapies."

Dr Marois - 'What are the results of children who received Hyperbaric Oxygen Therapy'?  (Georgia Court Administrative Appeal Hearings 2006)

Court Transcripts 2006 State of Georgia USA

  • "Most children had permanent improvements after 40 treatments. More than 80% of the parents report positive changes in cognition, communication, gross motor and fine motor function. We have evaluated with objective standardised testing more than 350 children (at 2006) and have measured impressive gross motor changes in the vast majority of them (more than 65%). The cognitive changes are even more frequent. The positive changes seem to be permanent as we have 7-years follow up on many children".

  • Georgia Administrative Appeal Hearings Says YES to HBOT for Cerebral Palsy Children (August 2006).

Hyperbaric Oxygen Treatment Cerebral Palsy: Review and Comparison to 'Accepted' Therapies (Dr Marois 2007)

"A recent study that showed notable improvements in children with CP treated with slightly pressurized air, as well as those treated with a standard protocol for HBOT, is invoked to deny effectiveness of HBOT!

Political and economic considerations rather than purely scientific ones play an important role in this controversy.

Their is unusual resistance to expanding the indications for this modality ..."

Dr Arun Mukherjee

Hyperbaric Therapy-Based Multimode Therapy for children with Cerebral Palsy. 

UDAAN for the Disabled is a non-profit organization, recognized and partially aided by the Government of India.

Undersea Hyperb Med. 2014 Mar-Apr;41(2):77-85.

Intensive rehabilitation combined with HBO2 therapy in children with cerebral palsy: a controlled longitudinal study.

Arun Mukherjee, MBBS, MD1, Maxime Raison, PhD2, Tarun Sahni, MBBS, MD3, Anand Arya, BPt4, Jean Lambert, PhD5, Pierre Marois, MD, FRCP2, Philip James, MB6, Audrey Parent, B.Sc2, Laurent Ballaz, PhD2  

1 Internal Medicine, New Delhi, India. 2 Centre de Réadaptation Marie-Enfant, CHU Sainte-Justine, Montréal, Qc, Canada.  3 Internal Medicine & Hyperbaric Medicine, Delhi, India. 4 UDAAN for the Differently Abled, Delhi, India. 5 Université de Montréal, Montréal, Qc, Canada. 6 University of Dundee, Dundee, Scotland, UK

Background: Hyperbaric oxygen treatment (HBOT) has shown to have positive therapeutic effects on children with cerebral palsy (CP) in many clinical trials. However, there is still controversy and resistance to the recognition of CP as an indication for HBOT.

Methods: 

We carried out an open, observational, platform-independent study in 150 children with cerebral palsy with follow up over eight months to compare the effects of standard intensive rehabilitation only (control group, n = 20) to standard intensive rehabilitation combined with one of three different hyperbaric treatments.

The three hyperbaric treatments used were: air (FiO2=21%) pressurized to 1·3 ATA (n = 40), 100% oxygen pressurized at 1·5 ATA (n = 32), and 100% oxygen, pressurized at 1·75 ATA (n = 58). Each subject assigned to a hyperbaric arm was treated one hour per day, six days per week during seven weeks (40 sessions). The standard intensive rehabilitation program consisted in individual treatments of physical therapy, occupational therapy, speech therapy and special education, each for half an hour/day, six days/week during six months.

Gross motor function measure (GMFM) was evaluated before the treatments and at two, four, six and eight months after beginning the treatments. 

Findings All four groups showed improvements over the course of the treatments in the follow up evaluations (p<0·001). However, GMFM improvement in the three hyperbaric groups was significantly superior to the GMFM improvement in the control group (p<0·001). There was no significant difference between the three hyperbaric groups.

Interpretation: The eight month long benefits we have observed with combined treatments versus rehabilitation can only have been due to a beneficial effect of hyperbaric treatment.

Funding Received as Grant in Aid from Govt. of India for the Rehabilitation Department, and from many donors to FSMHP-UDAAN, a registered non-profit charitable organization dedicated to help brain damaged children.

Additional Review