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

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.

Hyperbaric Oxygen Therapy Combined with Immunosuppression for Acute Macular Neuroretinopathy in Systemic Lupus Erythematosus.

PURPOSE: To describe the use of hyperbaric oxygen therapy (HBOT) in conjunction with immunosuppression for acute macular neuroretinopathy (AMN) in systemic lupus erythematosus (SLE). METHODS: Two known cases of SLE presented to us with blurred vision and paracentral scotomas due to AMN. Both cases reported worsening of their conditions despite the initiation of high-dose steroid therapy. HBOT was added on as a treatment modality to address vaso-occlusive ischemic injury. RESULTS: Both patients underwent a total of twelve cycles of HBOT. Functional and anatomical improvements were noted immediately after the initiation of therapy and were maintained over more than one year of follow-up. No significant retinal thinning was noted on optical coherence tomography on disease resolution, as has been noted previously. Visual field scotoma showed a complete resolution. CONCLUSION: Our cases suggest that HBOT may have a role in aiding functional and anatomical recovery in AMN associated with SLE.

Use of hyperbaric oxygen in traumatic brain injury: retrospective analysis of data of 20 patients treated at a tertiary care centre.

Traumatic brain injury (TBI) related impact results in a permanent need for help in performing daily activities. Standard treatment consists of removing the cause, restore perfusion, support metabolic requirement and limit inflammatory and oxidative damage. Hyperbaric oxygen therapy (HBOT) is one such newer promising treatment that enhances neurological recovery to some extent. HBOT is intermittent inhalation of 100% oxygen at greater than normal atmospheric pressure and is internationally accepted for its role in well-defined indications. It is hypothesised that HBO has a role in reviving 'idling neurons', also called the ischemic penumbra defined as area of reduced cerebral blood flow, abolished synaptic activity but preserved structural integrity. We carried out a retrospective analysis of medical records of 20 patients of TBI who had been treated with HBOT in addition to standard management. These were placed in Group A (test group) and received at least 30 sessions of HBO along with standard treatment. The patients were assessed along the Disability Rating Scale (DRS), Glasgow coma scale (GCS) and Rancho Los Amigos Scale (RLAS). Another 20 patients of TBI, matched in age and severity of brain injury, who received standard treatment but not HBOT, were selected as the control group (Group B). Assessment on the DRS showed maximum improvement in patients with scores of 22-24 (vegetative state).The percentage of patients in the test group fell from 45% to 5% whereas only 20% patients in Group B had similar progress. After the treatment, a significantly higher proportion of HBOT treated subjects showed a good response in cognitive functions, as measured by RLA. In group A, 90% patients had a score of ≤ 3 and in Group B 95% had a similar score, which improved to ≥ 3 in 60% patients versus 30% patients respectively. In both groups maximum patients are in 1-6 months post-injury category and within the groups this category showed the greatest recovery, with a greater improvement in the test group as compared to control group.

A retrospective study of outcomes in subjects of head and neck cancer treated with hyperbaric oxygen therapy for radiation induced osteoradionecrosis of mandible at a tertiary care centre: an Indian experience.

Osteoradionecrosis (ORN) of the mandible is a rare complication of radiation therapy for head and neck cancer. It manifests as an area of exposed necrotic bone failing to heal for at least 3 months. Our study aims to determine the effectiveness of HBO in management of radiation induced mandibular ORN. A retrospective study of 33 subjects of mandibular ORN treated with HBOT during period 2009-2011 was carried out. The mean patient age was 60 years (range 41-80).They were treated in a multiplace hyperbaric chamber at 2.4 ATA, for 90 min once a day for up to 30 sessions. Pre and post treatment improvement in relation to symptoms, healing of intraoral wound and overall wellbeing were evaluated. Out of 33 Subjects, 48 % (n = 16) cases showed complete healing of wound, 18 % (n = 6) had marked healing, slight healing in 24 % (n = 8) cases and 9 % (n = 3) cases had no change in healing. 70 % (23 of 33) cases had significant reduction in pain, 62 % (18 of 29) cases had improved jaw opening, 41 % (11 of 27) cases and 71 % (20 of 28) cases showed improvement in ability to talk and mouth dryness respectively. Overall 85 % (28 of 30) cases showed improvement. Our clinical experience supports the efficacy of HBO treatment for radiation induced mandibular ORN and we recommend additional multicentric, prospective studies to be carried out defining the role of HBOT using at least 30 sessions in such cases.