A Primer of Hyperbaric Therapy for Parents

by Dr. Alan Kadish NMD

I chose to utilize Dr. Stoller’s take on hyperbaric oxygen (below) as it’s well done and gives a good layperson overview. In bold print are my many comments and additions.

Hyperbaric therapy has gone viral and many more publications are now in print and on the web. the explosion of consistent findings worldwide validates its potential. It’s sad to report that the so-called “off -label” moniker remains present even after multiple congressional hearings with tons of excellent scientific and multiple validated studies including one of our focus points those who have experienced a stroke. Curiously many post-stroke individuals testified and yet her we are in almost 2017, without insurance reimbursement.

It’s sad to report that the so-called “off -label” moniker remains present even after multiple congressional hearings with tons of excellent scientific and multiple validated studies, including one of our focus points, those who have experienced a stroke. Curiously many post-stroke individuals testified and yet here we are, in almost 2017, without insurance reimbursement.

On the bright side, there have been so many new advances in both HBOT therapy, supplements, and other additional therapies, for stroke and concussion patients  as well as those with other disabilities, that we can now improve many of their outcomes substantially.

We are excited to offer a truly remarkable therapy, comfortably and with the full support of the scientific community and many of your practitioners. If you have the need or want for this therapy and your physician is not knowledgeable, please contact our office and we would be happy to engage them in a dialogue.

Interestingly, if you choose a health savings account style of medical insurance (HSA), you can use it for reimbursement of the therapy, even off label. (always check with the new updates)

February 14th, 2013
A Primer of Hyperbaric Therapy for Parents
By K Paul Stoller, MD, FACHM, Chief of Hyperbaric Medicine Amen Clinics
Adjunct Assistant Professor, AT Still University School of Medicine
Since 2004, Hyperbaric Oxygen has been a frequent topic discussed at autism conferences and physician education events. This document outlines the treatment, research, and information for parents.

Overview

Hyperbaric Oxygen Therapy (HBOT) works as its name implies – hyper (more of) and baric (pressure) and in fact that is how it works. It is the increased pressure of the gas we breathe everyday that can actually signal the DNA in our cells to perform healing tasks that the body normally can’t do.

Ground zero for this activity is the mitochondria, which are the little organelles inside of our cells that convert oxygen and sugar into the gasoline the cells run on (ATP) – this is called cellular respiration. It doesn’t take much to knock mitochondria off-line and then that cell can’t perform the job it was assigned. So, be it oxygen deprivation, external toxic exposure, or a hyper-immune reaction to an infection or a vaccine the mitochondria will be damaged.

We know how Hyperbaric therapy works – it works by reviving the little mitochondria and actually causes mitochondrial biogenesis, so that if you need more mitochondria in your neurons more of them will form. It is interesting to note that the reason the ketogenic diet helps patients with certain types of neurological problems is that ketone bodies help support mitochondrial function. My opinion is that hyperbaric therapy is the most effective way to do this. It is that simple – this is not rocket science, but it is non-invasive brain repair.

As long as supportive biomedical interventions are taking place at the same time, be that detoxification, the appropriate diet for that child (GF/SF/CF, the SC diet or the GAPS diet, etc.), the appropriate supplements are on board, (folinic acid, B12, ALA, glutathione, etc.), foods the child is allergic to are eliminated and any infectious issues are being dealt with (such as yeast, viral load, Lyme, Mycobacterium, etc.) then hyperbaric therapy can commence. Hyperbaric therapy is not a substitute for a comprehensive bio-medical intervention strategy, and again alone it is not a cure, but it can be an important addition to the overall treatment plan. (We always use a comprehensive bio-medical approach to be certain that you’re receiving the most effective treatments. This means using the proper evaluation tools and therapies specifically for what you need.)

Hyperbaric therapy is perhaps the safest procedure in medicine at the pressures used to treat brain injuries and children on the spectrum. (We have seen consistently that by the 2nd or 3rd dive the children are sleeping throughout the therapy)

What are Hyperbaric Chambers?

There are many types of hyperbaric chambers in all shapes and sizes, but they are not all equal. The term “hard-shell” chamber refers to chambers made of steel and acrylic that can achieve pressures equal to three atmospheres and beyond.  (Ours is a large hard-shell unit) There chambers that are small one person monoplace devices all the way up to submarine sized 30 person, >multi-place chambers. The hard-shell chambers can be compressed with 100% oxygen or room air, but if they are compressed with room air, as all multi-place chambers are, there are oxygen hoods or masks given to the patient(s) so they can breathe in the enriched oxygen. (We use a large 42″ chamber that can easily accommodate 2 people)

The “soft-shell” or portable chambers come in all sizes as well, but the largest of the group are approximately seven feet long and 33 inch in diameter. They only inflate to 1.3 atmospheres (under current FDA regulations), which is about 12 feet of seawater pressure (the pressure you would feel if you were swimming 12 feet below the surface of the water). Soft-shell chambers are not legal for having additional oxygen pumped into the chamber, by either an FDA licensed oxygen concentrator or tank, but even 1.3 atmospheres of compressed room air will increase the partial pressure of oxygen by almost 50%. Oxygen concentrators will increase the oxygen level but this varies based on if the patient wears or does not wear a mask. (We don’t recommend these units for three principle reasons, One they are small and most patient’s experience claustrophobia and two they are plastic and we don’t want you breathing endocrine disrupting chemicals when for an hour under pressure. If there were no other option, they might be a potential. Three, we have also found faster responses, at 1.5 ATA, which is not available in a soft chamber.)

Which pressure is best and is more oxygen better?

There is a therapeutic window that most brain injuries respond to and that is 1.3 to 2.0 atmospheres. There are always exceptions and special cases, but pressures between 1.3 and 1.5 atmospheres seems to be the sweet spot for the utilization of glucose by the brain and so this is a target pressure for many protocols that treat brain injuries.

More pressure and more oxygen are not better. The pressurized air (which contains more oxygen because of the increased pressure) or 100% pressurized oxygen act as signaling agents to as many as 8000 genes. The mitochondria have their own DNA and this is where the action takes place to bring back the energy levels of injured or poisoned brain cells. More genes are actually signaled at 1.5 atmospheres than at higher pressures.

How does one get treated?

Hyperbaric treatment facilities that are not connected to hospital operations almost always treat conditions that have yet to be approved by the FDA – so-called “off-label” conditions. These free-standing centers are few and often far between, and since the brain injury protocol requires daily treatments for months; both treatment cost and distance to the nearest clinic become critical matters. (We have arrangments with the local hotels, for out of area patients and also can arrange for convenient timing to make the therapy easier.) 

Optimally, you will want your child to be treated at a clinic that has experience treating children with brain injuries and where there is a physician with experience in treating children on the spectrum. That is the best case scenario, but that situation is not widely available. (We have been using our ch=amber for ASD and PPD patients since 2010 and have been treating using the biomedical approach for ASD/PPD for ~28+ years). The second best option is to start off at such a center and then rent a portable chamber or buy one, as most do who start off renting a chamber.(see above comments regarding the soft chambers)

Portable chambers go to 1.3 atmospheres and are not allowed to be inflated with oxygen; although they can have oxygen pumped in at 10 liters per minute by and FDA licensed oxygen concentrator. Not every child will be a responder at the low pressure, but most will respond. For the vast majority of affected children, the best case and even the second best case options are not practical, which makes having a portable/soft chamber at home the only real treatment option.

How many treatments are required?

Hyperbaric oxygen therapy is prescribed by a physician based on that patient’s need. Typically for Autism Spectrum issues combined with other co-morbid medical conditions therapies are typically prescribed in 1 hour increments once full pressure is obtained. Treatment length varies by case. Typically treatments are between 20 – 80 separate appointments. Hyperbaric oxygen therapies are more efficacious to be performed in sequential days. (We have found the sweet spot is typically between 20-40 treatments and they can be done up to twice per day or with a cycle of 5 days per week, with 2 days off)

Doctors will work with patients to evaluate individual needs and come up with a treatment plan. Each treatment plan varies. This therapy could be prescribed in groups. For example, a doctor may prescribe three separate 20 treatment sessions as part of a treatment plan. Please check with your doctor for additional details.

But isn’t hyperbaric therapy controversial?

Indeed it is but the controversy is political, not scientific. When Canadian (Quebec) parents petitioned their reluctant government to fund a study examining the use of hyperbaric oxygen to treat children with cerebral palsy, the government put in place a man who designed the study to confuse. He removed the control group and only looked at two treatment arms: 1) children receiving hyperbaric oxygen at 1.75 atmospheres; 2) children receiving hyperbaric air at 1.3 atmospheres.
The results of the study showed that Gross Motor Function improved 15 times greater with treatment than with previous therapies – both groups of children. Eighty percent of the children involved in this Canadian study (Lancet 2002), and there were 110 children, improved including improvement in cognition, speech and other outcome measures. So, what did the amoral< representative of the Canadian government do who was sent in to obfuscate the results of the study? He called the 1.3 atmosphere group a placebo group (he did this in French only – in English he called it a sham treatment) and then he announced hyperbaric therapy didn’t work because the treatment group’s results were no different than the placebo group.

Since few physicians and scientists know anything about hyperbaric medicine, there was no one around to point out that 1.3 atmospheres is hardly a placebo when it increases the partial pressure of oxygen by almost 50%. But they knew that – this was all about making sure the government didn’t have to pay for this therapy for handicapped children and it has worked to this day. Children with CP can not receive hyperbaric therapy from most 3rd party payers in part because of the propaganda surrounding this ten-year-old study.

The truth is that 10 times more progress was made during the two months of hyperbaric therapy (while all other therapies were ceased) than during the three months of follow-up with OT/PT restarted.(Can you imagine the real cost savings let alone the difference in the youngsters and their caregivers ?)

In 2005, I published an article in the journal PEDIATRICS showing that hyperbaric oxygen therapy could reverse the brain damage caused by Fetal Alcohol Syndrome (FAS). That article was met with resounding silence. FAS is the most common form of non-hereditary mental retardation and is considered to be incurable and untreatable.
Below are functional brain images of what hyperbaric oxygen can do for a child on the spectrum before and after treatment.

This is a functional brain scan called a SPECT scan. You are looking at the front of the brain. Before hyperbaric oxygen was administered there is little to no activity in the temporal lobes and lack of blood flow to the prefrontal cortex. After treatment, the horns of the temporal lobes can be seen now and the deficits in the prefrontal cortex are filling in. (The scans were done by Paul Harch, MD, Director of the LSU Hyperbaric Medicine Fellowship and were submitted into the Congressional record.) ( As an update there have been more recent congressional hearing and we are awaiting the word on stroke utilization)


Should I ask my doctor about clinic treatments or in home ?

Many MAPS Doctors and the International Hyperbaric Association (IHA) recommend the first hyperbaric oxygen treatments occur in person, with a supervising physician, trained medical staff at 100% oxygen.

Read updated studies and research information.
For additional providers – please visit www.hbotproviders.com
It is recommended family’s consult their doctor (MAPS doctors, especially) for recommended HBOT providers. Having knowledge about working with children on the autism spectrum is important. ( Dr. Kadish is  a MAPS certified level 2 physician and keeps current with both the literature and the scientific changes in the field.  Please see the constantly updated news articles in this field on the blog site or sign up and get regular updates to your inbox)

A Final Note

Hyperbaric therapy requires a physician’s prescription to utilize a hard shell chamber or to buy a portable or to receive therapy at a hyperbaric clinic. The child must be able to equalize the pressure in the middle ear by swallowing, even at the low 1.3 pressure level.

Studies about Hyperbaric oxygen and autism:

1. Hyperbaric treatment for children with autism: A multicenter, randomized, double-blind, controlled trial. Rossignol DA, Rossignol LW, Smith S, Schneider C, Logerquist S, Usman A, Neubrander J, Madren EM, Hintz G, Grushkin B, Mumper EA. BMC Pediatr. 2009 Mar 13;9:21. PMID: 19284641

[PubMed – indexed for MEDLINE]
2. Hyperbaric oxygen therapy in Thai autistic children. Chungpaibulpatana J, Sumpatanarax T, Thadakul N, Chantharatreerat C, Konkaew M, Aroonlimsawas M. J Med Assoc Thai. 2008 Aug;91(8):1232-8. PMID: 18788696 [PubMed – indexed for MEDLINE]
3. A review of recent reports on autism: 1000 studies published in 2007. Hughes JR. Epilepsy Behav. 2008 Oct;13(3):425-37. Epub 2008 Jul 31. Review. PMID: 18627794 [PubMed – indexed for MEDLINE]
4. The effects of hyperbaric oxygen therapy on oxidative stress, inflammation, and symptoms in children with autism: an open-label pilot study. Rossignol DA, Rossignol LW, James SJ, Melnyk S, Mumper E. BMC Pediatr. 2007 Nov 16;7:36. PMID: 18005455 [PubMed – indexed for MEDLINE]
5. Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism. Rossignol DA. Med Hypotheses. 2007;68(6):1208-27. Epub 2006 Dec 4. PMID: 17141962 [PubMed – indexed for MEDLINE]