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Hyperbaric Oxygen Therapy for Cerebral Palsy: Definition and Principles

  • Jenny L. Wilson
  • Barry RussmanEmail author
Living reference work entry

Abstract

Hyperbaric oxygen therapy involves the inhalation of 100% oxygen inside a hyperbaric chamber pressurized to greater than 1 atmosphere (atm), which is atmospheric pressure at sea level. While there are a number of indications cleared by the FDA for hyperbaric oxygen therapy, it has been used off-label for patients with cerebral palsy, based on the theory that dormant neurons may respond to the treatment. Treatment approaches are not standardized, though generally children have been given a total of 20–40 sessions of 1 h each, with hyperbaric oxygen at 1.5–1.7 atm. While observational and nonrandomized studies suggested potential efficacy of hyperbaric oxygen therapy in children with cerebral palsy, most commonly on gross motor function, randomized controlled trials showed hyperbaric oxygen therapy not to be superior to placebo/sham treatments. These trials have provoked controversy because of the choice of control groups. Middle ear complications are common, though more serious complications including seizures and pulmonary complications are less common. Current data are insufficient to support the use of hyperbaric oxygen therapy in children with cerebral palsy.

Keywords

Cerebral palsy Hyperbaric oxygen Hyperbaric therapy 

References

  1. Astrup J, Siesjo BK, Symon L (1981) Thresholds in cerebral ischemia - the ischemic penumbra. Stroke 12:723–725CrossRefGoogle Scholar
  2. Bell E, Wallace T, Chouinard I, Shevell M, Racine E (2011) Responding to requests of families for unproven interventions in neurodevelopmental disorders: hyperbaric oxygen “treatment” and stem cell “therapy” in cerebral palsy. Dev Disabil Res Rev 17:19–26.  https://doi.org/10.1002/ddrr.134CrossRefPubMedGoogle Scholar
  3. Beynon C, Sun L, Marti HH, Heiland S, Veltkamp R (2007) Delayed hyperbaric oxygenation is more effective than early prolonged normobaric hyperoxia in experimental focal cerebral ischemia. Neurosci Lett 425:141–145.  https://doi.org/10.1016/j.neulet.2007.07.009CrossRefPubMedGoogle Scholar
  4. Bohannon RW, Smith MB (1987) Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67:206–207CrossRefGoogle Scholar
  5. Calvert JW, Zhang JH (2007) Oxygen treatment restores energy status following experimental neonatal hypoxia-ischemia. Pediat Crit Care Med 8:165–173.  https://doi.org/10.1097/01.pcc.0000257113.75488.84CrossRefGoogle Scholar
  6. Collet JP et al (2001) Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP research group. Lancet 357:582–586CrossRefGoogle Scholar
  7. Efrati S, Ben-Jacob E (2014) How and why hyperbaric oxygen therapy can bring new hope for children suffering from cerebral palsy--an editorial perspective. Undersea Hyperb Med 41:71–76PubMedGoogle Scholar
  8. Efrati S et al (2013) Hyperbaric oxygen induces late neuroplasticity in post stroke patients--randomized, prospective trial. PLoS One 8:e53716.  https://doi.org/10.1371/journal.pone.0053716CrossRefPubMedPubMedCentralGoogle Scholar
  9. EP K (1999) The multiplace chamber. In: Kindwall E, Whelan HT (eds) Hyperbaric medicine practice, 2nd edn. Best Publishing, FlagstaffGoogle Scholar
  10. Essex C (2003) Hyperbaric oxygen and cerebral palsy: no proven benefit and potentially harmful. Dev Med Child Neurol 45:213–215CrossRefGoogle Scholar
  11. Evanger K, Haugen OH, Irgens A, Aanderud L, Thorsen E (2004) Ocular refractive changes in patients receiving hyperbaric oxygen administered by oronasal mask or hood. Acta Ophthalmol Scand 82:449–453.  https://doi.org/10.1111/j.1395-3907.2004.00290.xCrossRefPubMedGoogle Scholar
  12. Feldman AB, Haley SM, Coryell J (1990) Concurrent and construct validity of the Pediatric evaluation of disability inventory. Phys Ther 70:602–610CrossRefGoogle Scholar
  13. Grim PS, Gottlieb LJ, Boddie A, Batson E (1990) Hyperbaric oxygen therapy. JAMA 263:2216–2220CrossRefGoogle Scholar
  14. Gunther A, Kuppers-Tiedt L, Schneider PM, Kunert I, Berrouschot J, Schneider D, Rossner S (2005) Reduced infarct volume and differential effects on glial cell activation after hyperbaric oxygen treatment in rat permanent focal cerebral ischaemia. Eur J Neurosci 21:3189–3194.  https://doi.org/10.1111/j.1460-9568.2005.04151.xCrossRefPubMedGoogle Scholar
  15. Hadanny A et al (2015) Hyperbaric oxygen can induce neuroplasticity and improve cognitive functions of patients suffering from anoxic brain damage. Restor Neurol Neurosci 33:471–486.  https://doi.org/10.3233/rnn-150517CrossRefPubMedPubMedCentralGoogle Scholar
  16. Hampson N, Atik D (2003) Central nervous system oxygen toxicity during routine hyperbaric oxygen therapy. Undersea Hyperb Med 30:147–153PubMedGoogle Scholar
  17. Harch PG The dosage of hyperbaric oxygen in chronic brain injury.. In: Proceedings of the 2nd International Symposium on Hyperbaric Oxygenation in Cerebral Palsy and the Brain-injured Child 2002. p 31Google Scholar
  18. Harch, P. Harch hyperbaric oxygen therapy. HBOT in Cerebral Palsy and Pediatric Peurology: a scientific perspective. 6/3/11. http://www.hbot.com/blog/infinitee/harch-hbot-cerebral-palsy-and-pediatric-neurology-scientific-perspective. Accessed 20 Aug 2017
  19. Hardy P et al (2002) Neuropsychological effects of hyperbaric oxygen therapy in cerebral palsy. Dev Med Child Neurol 44:436–446CrossRefGoogle Scholar
  20. Heyboer M 3rd, Sharma D, Santiago W, McCulloch N (2017) Hyperbaric oxygen therapy: side effects defined and quantified. Adv Wound Care 6:210–224.  https://doi.org/10.1089/wound.2016.0718CrossRefGoogle Scholar
  21. Hyperbaric oxygen therapy: its use and appropriateness. Dallas, TX: Office of Inspector General, Department of Health and Human Services (2000) Department of health and human services. Office of Inspector General, DallasGoogle Scholar
  22. Jadhav V, Ostrowski RP, Tong W, Matus B, Jesunathadas R, Zhang JH (2009) Cyclo-oxygenase-2 mediates hyperbaric oxygen preconditioning-induced neuroprotection in the mouse model of surgical brain injury. Stroke 40:3139–3142.  https://doi.org/10.1161/strokeaha.109.549774CrossRefPubMedPubMedCentralGoogle Scholar
  23. Jain KK (2009) Textbook of hyperbaric medicine. Hogrefe and Huber Publishers, Cambridge, MAGoogle Scholar
  24. Jain KK (2016) The use of HBO in treating neurological disorders. In: Jain KK (ed) Textbook of hyperbaric medicine, 6th edn. Springer, ChamGoogle Scholar
  25. Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, Howard LA (1969) An objective and standardized test of hand function. Arch Phys Med Rehabil 50:311–319PubMedGoogle Scholar
  26. Lacey DJ, Stolfi A, Pilati LE (2012) Effects of hyperbaric oxygen on motor function in children with cerebral palsy. Ann Neurol 72:695–703.  https://doi.org/10.1002/ana.23681CrossRefPubMedGoogle Scholar
  27. Leach RM, Rees PJ, Wilmshurst P (1998) Hyperbaric oxygen therapy. BMJ 317:1140–1143CrossRefGoogle Scholar
  28. Lin KC, Niu KC, Tsai KJ, Kuo JR, Wang LC, Chio CC, Chang CP (2012) Attenuating inflammation but stimulating both angiogenesis and neurogenesis using hyperbaric oxygen in rats with traumatic brain injury. J Trauma Acute Care Surg 72:650–659.  https://doi.org/10.1097/TA.0b013e31823c575fCrossRefPubMedGoogle Scholar
  29. Long Y, Tan J, Nie Y, Lu Y, Mei X, Tu C (2017) Hyperbaric oxygen therapy is safe and effective for the treatment of sleep disorders in children with cerebral palsy. Neurol Res 39:239–247.  https://doi.org/10.1080/01616412.2016.1275454CrossRefPubMedGoogle Scholar
  30. Lou M, Eschenfelder CC, Herdegen T, Brecht S, Deuschl G (2004) Therapeutic window for use of hyperbaric oxygenation in focal transient ischemia in rats. Stroke 35:578–583.  https://doi.org/10.1161/01.str.0000111599.77426.a0CrossRefPubMedGoogle Scholar
  31. Machado J (1989) Clinically observed reduction of spasticity in patients with neurological diseases and in children with cerebral palsy from hyperbaric oxygen therapy. In: Proceedings of “New Horizons in Hyperbaric Medicine”. American College of Hyperbaric Medicine, OrlandoGoogle Scholar
  32. Marois P (2013) Hyperbaric oxygen treatment. Ann Neurol 74:149.  https://doi.org/10.1002/ana.23888CrossRefPubMedGoogle Scholar
  33. Marois P, Vanasse M (2003) Hyperbaric oxygen therapy and cerebral palsy. Dev Med Child Neurol 45:646–647. author reply 647-648CrossRefGoogle Scholar
  34. McDonagh M, Carson S, Ash J, Russman BS, Stavri PZ, Krages KP, Helfand M (2003) Hyperbaric oxygen therapy for brain injury, cerebral palsy, and stroke. Evid Rep Technol Assess (Summ), Sep;(85):1–6Google Scholar
  35. Miljkovic-Lolic M, Silbergleit R, Fiskum G, Rosenthal RE (2003) Neuroprotective effects of hyperbaric oxygen treatment in experimental focal cerebral ischemia are associated with reduced brain leukocyte myeloperoxidase activity. Brain Res 971:90–94CrossRefGoogle Scholar
  36. Montgomery D et al (1999) Effects of hyperbaric oxygen therapy on children with spastic diplegic cerebral palsy: a pilot project. Undersea Hyperb Med 26:235–242PubMedGoogle Scholar
  37. Mukherjee A et al (2014) Intensive rehabilitation combined with HBO2 therapy in children with cerebral palsy: a controlled longitudinal study. Undersea Hyperb Med 41:77–85PubMedGoogle Scholar
  38. Muller-Bolla M, Collet JP, Ducruet T, Robinson A (2006) Side effects of hyperbaric oxygen therapy in children with cerebral palsy. Undersea Hyperb Med 33:237–244PubMedGoogle Scholar
  39. Murphy DG, Sloan EP, Hart RG, Narasimhan K, Barreca RS (1991) Tension pneumothorax associated with hyperbaric oxygen therapy. Am J Emerg Med 9:176–179CrossRefGoogle Scholar
  40. Neubauer RA (2001) Hyperbaric oxygenation for cerebral palsy. Lancet (London, England) 357:2052. author reply 2053CrossRefGoogle Scholar
  41. Neubauer RA, Gottlieb SF, Kagan RL (1990) Enhancing “idling” neurons. Lancet (London, England) 335:542CrossRefGoogle Scholar
  42. Neubauer RA, Gottlieb SF, Miale A Jr (1992) Identification of hypometabolic areas in the brain using brain imaging and hyperbaric oxygen. Clin Nucl Med 17:477–481CrossRefGoogle Scholar
  43. Neubauer RA, James P (1998) Cerebral oxygenation and the recoverable brain. Neurol Res 20(Suppl 1):S33–S36CrossRefGoogle Scholar
  44. Novak I, Badawi N (2012) Last breath: effectiveness of hyperbaric oxygen treatment for cerebral palsy. Ann Neurol 72:633–634.  https://doi.org/10.1002/ana.23760CrossRefPubMedGoogle Scholar
  45. Novak I, Badawi N (2013) Reply: to PMID 23280788. Ann Neurol 74:149–150.  https://doi.org/10.1002/ana.23887CrossRefPubMedGoogle Scholar
  46. Nuthall G, Seear M, Lepawsky M, Wensley D, Skippen P, Hukin J (2000) Hyperbaric oxygen therapy for cerebral palsy: two complications of treatment. Pediatrics 106:E80CrossRefGoogle Scholar
  47. Perez-Gaxiola G (2013) hyperbaric oxygen did not improve symptoms in children with cerebral palsy. Arch Dis Child Educ Pract Ed 98:198.  https://doi.org/10.1136/archdischild-2013-304080CrossRefPubMedGoogle Scholar
  48. Rosenthal RE, Silbergleit R, Hof PR, Haywood Y, Fiskum G (2003) Hyperbaric oxygen reduces neuronal death and improves neurological outcome after canine cardiac arrest. Stroke 34:1311–1316.  https://doi.org/10.1161/01.str.0000066868.95807.91CrossRefPubMedGoogle Scholar
  49. Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S (1989) The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 31:341–352CrossRefGoogle Scholar
  50. Senechal C, Larivee S, Richard E, Marois P (2007) Hyperbaric oxygenation therapy in the treatment of cerebral palsy: a review and comparison to currently accepted therapies. J Am Phys Surg 12:109–113Google Scholar
  51. Sheffield PJ, Desautels DA (1997) Hyperbaric and hypobaric chamber fires: a 73-year analysis. Undersea Hyperb Med 24:153–164PubMedGoogle Scholar
  52. Sheridan RL, Shank ES (1999) Hyperbaric oxygen treatment: a brief overview of a controversial topic. J Trauma 47:426–435CrossRefGoogle Scholar
  53. Simini B (1997) Milan fire fuels concerns over hyperbaric oxygen facilities. Lancet 350:1375.  https://doi.org/10.1016/S0140-6736(05)65155-0CrossRefGoogle Scholar
  54. Singh S, Gambert SR (2014) Hyperbaric oxygen therapy: a brief history and review of its benefits and indications for the older adult patient. Anna Long Term Care 22:37–42Google Scholar
  55. Singhal AB, Dijkhuizen RM, Rosen BR, Lo EH (2002) Normobaric hyperoxia reduces MRI diffusion abnormalities and infarct size in experimental stroke. Neurology 58:945–952CrossRefGoogle Scholar
  56. Tibbles PM, Edelsberg JS (1996) Hyperbaric-oxygen therapy. N Engl J Med 334:1642–1648.  https://doi.org/10.1056/nejm199606203342506CrossRefPubMedGoogle Scholar
  57. Undersea and Hyperbaric Medical Society. www.uhms.org. Accessed 17 July 2017
  58. Vlodavsky E, Palzur E, Soustiel JF (2006) Hyperbaric oxygen therapy reduces neuroinflammation and expression of matrix metalloproteinase-9 in the rat model of traumatic brain injury. Neuropathol Appl Neurobiol 32:40–50.  https://doi.org/10.1111/j.1365-2990.2005.00698.xCrossRefPubMedGoogle Scholar
  59. Waalkes P, Fitzpatrick, D., Stankus, S., Topolski, R. (2002) Adjunctive HBO Treatment of Children with Cerebral Anoxic Injury Army Medical Department Journal Apr-June:13–21Google Scholar
  60. Weisleder P (2010) Unethical prescriptions: alternative therapies for children with cerebral palsy. Clin Pediatr 49:7–11.  https://doi.org/10.1177/0009922809340438CrossRefGoogle Scholar
  61. Xiong L, Zhu Z, Dong H, Hu W, Hou L, Chen S (2000) Hyperbaric oxygen preconditioning induces neuroprotection against ischemia in transient not permanent middle cerebral artery occlusion rat model. Chin Med J 113:836–839PubMedGoogle Scholar
  62. Yildiz S, Aktas S, Cimsit M, Ay H, Togrol E (2004) Seizure incidence in 80,000 patient treatments with hyperbaric oxygen. Aviat Space Environ Med 75:992–994PubMedGoogle Scholar
  63. Yin W, Badr AE, Mychaskiw G, Zhang JH (2002) Down regulation of COX-2 is involved in hyperbaric oxygen treatment in a rat transient focal cerebral ischemia model. Brain Res 926:165–171CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Shriners Hospitals for ChildrenPortlandUSA
  2. 2.Pediatric NeurologyOregon Health and Science UniversityPortlandUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

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