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Andrew M. Ball PT PhD -> Re: hyperbaric chamber treatment (January 10, 2003 10:50:00 AM)
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That's a great question. HBO is being used with increasing frequency and members of clinical doctoring professions and non-doctoring heatlhcare professional alike need to be aware of the current state of the research.
Hyperbaric oxygen is traditionally used to aid healing in damdged superficial or lung tissue as in the Lee, Fielden, and Murray studies. This has lead to the hypothesis that by using hyperbaric oxygen, the tissue of the central nervous system could be similarly repaired, and the child's function improved. Unfortunately the central nervous system doesn't heal itself in quite the same way as most other body tissues. That said, clinical research must be conducted to know for sure. The articles listed below have sought to do just that. Given these results, which tested cognitive and learning outcomes, evidence-based doctors of physical therapy, chiropractic and osteopathy and medicine must question and call to task the motives of professionals suggesting HBO to their patients with cerebral palsy for these purposes.
Collet JP, Vanasse M, Marois P, Amar M, Goldberg J, Lambert J, Lassonde M, Hardy P, Fortin J, Tremblay SD, Montgomery D, Lacroix J, Robinson A, Majnemer A. Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group. Lancet 2001 Feb 24;357(9256):582-6.
BACKGROUND: The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We did a randomised trial to assess the efficacy and side-effects of this form of therapy in children with cerebral palsy. METHODS: 111 children with cerebral palsy aged 3-12 years were randomly assigned hyperbaric oxygen (n=57) or slightly pressurised room air (n=54). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was 1 h in 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurised air received air at 1.3 ATA (the lowest pressure at which pressure can be felt, thereby ensuring the maintenance of masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech. FINDINGS: For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. The score on the global gross motor function measure increased by 3.0% in the children on slightly pressurised air and 2.9% in those on hyperbaric oxygen. The mean difference between treatments was -0.40 (95% CI -1.69 to 0.90, p=0.544). Other changes were seen in speech, attention, memory, and functional skills. Ear problems occurred in 27 children treated by hyperbaric oxygen and in 15 treated with hyperbaric air (p=0.004). INTERPRETATION: In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurised air. The improvement seen in both groups for all dimensions tested deserves further consideration.
Hardy P, Collet JP, Goldberg J, Ducruet T, Vanasse M, Lambert J, Marois P, Amar M, Montgomery DL, Lecomte JM, Johnston KM, Lassonde M. Neuropsychological effects of hyperbaric oxygen therapy in cerebral palsy. Dev Med Child Neurol 2002 Jul;44(7):436-46
We conducted a double-blind placebo study to investigate the claim that hyperbaric oxygen treatment (HBO2) improves the cognitive status of children with cerebral palsy (CP). Of 111 children diagnosed with CP (aged 4 to 12 years), only 75 were suitable for neuropsychological testing, assessing attention, working memory, processing speed, and psychosocial functioning. The children received 40 sessions of HBO2 or sham treatment over a 2-month period. Children in the active treatment group were exposed for 1 hour to 100% oxygen at 1.75 atmospheres absolute (ATA), whereas those in the sham group received only air at 1.3 ATA. Children in both groups showed better self-control and significant improvements in auditory attention and visual working memory compared with the baseline. However, no statistical difference was found between the two treatments. Furthermore, the sham group improved significantly on eight dimensions of the Conners' Parent Rating Scale, whereas the active treatment group improved only on one dimension. Most of these positive changes persisted for 3 months. No improvements were observed in either group for verbal span, visual attention, or processing speed.
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