Hyperbaric Oxygen Therapy Providers and Treatment Centers …

Additional Information and Resources on Hyperbaric Oxygen Therapy For the Treatment of Autism, Cerebral Palsy And Other Neurological and Developmental Disorders Or "Off-Label" Conditions and Diseases Introduction to the Use of Hyperbaric Oxygen Therapy for Neurological and Developmental Disorders

[Request to Dr. James Neubrander to author this section is pending] [Example:] Hyperbaric oxygen therapy is classically defined as the inhalation of 100% oxygen at greater than 1 atmosphere absolute (ATA) in a pressurized chamber. This definition is now popularly defined as the inhalation of varying degrees of oxygen at greater than 1 atmosphere absolute (ATA) in a pressurized chamber. You will hear many terms used interchangeably by lay people and professionals alike: hyperbaric oxygen therapy (HBOT), mild hyperbaric oxygen therapy (mHBOT), hyperbaric therapy (HBT), hyperbaric oxygen (HBO), hyperbaric air therapy (HBAT), hyperbaric enriched air therapy (HBEAT), etc. However, the most common way the term is used by the autism community is to just say "HBOT". Then most parents will state what they are doing, e.g. "we're using 1.5, 1.75, or 2.0 atmospheres in a hard chamber with 100% oxygen, or we're using a soft chamber (also referred to as a mild chamber) at 1.3 atmospheres 'with or without a mask' to which 'concentrated oxygen' is be supplied at concentrations varying from 24% to 70%." Conventional wisdom states that unless one receives HBOT in a hard chamber with 100% oxygen at atmospheric pressures greater than 1.5 ATA, little or no benefit will be seen.

However, as history has shown repeatedly throughout the years, convention is only convention until challenged, proven wrong, and then changed. Such is the case with HBOT and autism. Based on the published studies by Dr. Rossignol, the early work of Dr. Buckley and Dr. Kartzinel, and the tremendous number of children that have been treated by physicians such as Dr. Bradstreet, Dr. Feingold, Dr. Freedenfeld, Dr. Stoller and myself, and a growing number of other physicians who are now using HBOT routinely in their offices, there remains no doubt that HBOT works and that it works well for children with autism. There is also no doubt that it works well at low pressures with varying degrees of oxygen concentrations as well as at varying degrees of high pressures with 100% oxygen.

The reason I recommend HBOT for all my patients is because there is scientific evidence that pressure, independent of the concentration of oxygen, decreases inflammation and that any concentration of oxygen under any increased amount of pressure will allow more oxygen to dissolve into the extracellular fluids of the body: plasma, lymph, cerebrospinal fluid, and interstitial fluid. Because dissolved oxygen is not confined to a hemoglobin molecule, it can go wherever "body water goes" and therefore reach 'deeper tissues' more easily and more consistently than ever before Because no test is able to predict which child may and which child may not respond to extra pressure and/or extra oxygen (in contrast to excessive oxygen), I let nature take its course and prescribe a clinical trial of HBOT for all my children Though I let "nature take its course", I would not consider prescribing or administering HBOT to children with autism unless there was good scientific evidence to support its use. Fortunately such evidence does exist, the body of which continues to accumulate, and the mechanisms of action by which HBOT may work for children with autism, as described below, may already be outdated by the time you read this.

A few of the multiple mechanisms demonstrating how HBOT may work for children with autism was originally and thoroughly researched over many months time by Dr. Rossignol. These mechanisms are shown below along with a couple others that have been suggested They include:

[Request to Dr. Paul Harch to author this section is pending] [Example:] Modern technology has been a positive factor in the treatment of cerebral palsy and other forms of traumatic brain injury. Specifically, SPECT imaging, or what is commonly termed the SPECT scan, is helping to identify those parts of the brain that are in a dormant state due to a lack of oxygen. As Dr. Philip James of the Wolfson Hyperbaric Medicine Unit at the University of Dundee in Scotland has stated, "Loss of function in the brain can be either due to tissue swelling, which is reversible, or tissue destruction, which is not." When we combine what Dr. James said with what the SPECT scan can do, it is clear that the SPECT scan can help us identify those parts of the brain that stand a chance of being revived.

SPECT stands for Single Photon Emission Computed Tomography. The SPECT scan can give a clear picture of which parts of the brain are awake and working, which parts are dormant and sleeping, and which parts are lifeless and permanently damaged. This is of particular significance when considering HBO therapy because, to be blunt, the SPECT scan has the ability to indicate if HBO therapy is working or not by monitoring the change in brain tissue blood flow.

Some brain cells become dormant due to a lack of oxygen, which can be caused by reduced blood flow. Swelling can cause reduced blood flow. HBO therapy has been shown to reduce the swelling of brain tissue by constricting blood vessels. Also, HBO therapy dramatically increases the amount of oxygen at the cellular level, which, it is believed, may revive dormant, oxygen starved areas of the brain. The ability to perform a SPECT scan before and after a course of HBO therapy can help identify those parts of the brain affected by the therapy. The SPECT scan will identify those areas of the brain that have reacted in a positive manner to an increase in oxygen, indicating the potential for recovery.

[From the original article by Dr. Lewis Mehl-Madrona] [Excerpt:] The logic for using hyperbaric oxygen treatment for developmental disorders relates to the auto-immune and/or viral theory of these conditions. Hyperbaric oxygen has been studied for auto-immune disorders and found to be helpful. Encephalitis, in this theory, is thought to be part of developmental disorders. The encephalitis can be initiated by viral infection, by exposure to vaccines, and/or by other auto-immune processes (the result of exposure to abnormal opioid-like substances from the opioid excess hypothesis, for example).

This article contains the following sections:

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D . Rossignol , L . Rossignol Medical Hypotheses ,Volume 67 ,Issue 2 ,Pages 216 - 228

Abstract

Autism is a neurodevelopmental disorder that currently affects as many as 1 out of 166 children in the United States. Recent research has discovered that some autistic individuals have decreased cerebral perfusion, evidence of neuroinflammation, and increased markers of oxidative stress. Multiple independent single photon emission computed tomography (SPECT) and positron emission tomography (PET) research studies have revealed hypoperfusion to several areas of the autistic brain, most notably the temporal regions and areas specifically related to language comprehension and auditory processing. Several studies show that diminished blood flow to these areas correlates with many of the clinical features associated with autism including repetitive, self-stimulatory and stereotypical behaviors, and impairments in communication, sensory perception, and social interaction. Hyperbaric oxygen therapy (HBOT) has been used with clinical success in several cerebral hypoperfusion syndromes including cerebral palsy, fetal alcohol syndrome, closed head injury, and stroke. HBOT can compensate for decreased blood flow by increasing the oxygen content of plasma and body tissues and can even normalize oxygen levels in ischemic tissue. In addition, animal studies have shown that HBOT has potent anti-inflammatory effects and reduces oxidative stress. Furthermore, recent evidence demonstrates that HBOT mobilizes stem cells from human bone marrow, which may aid recovery in neurodegenerative diseases. Based upon these findings, it is hypothesized that HBOT will improve symptoms in autistic individuals. A retrospective case series is presented that supports this hypothesis.

M.Markley, Ph.D., CHT

Summary

In more than 7,000 facilities worldwide, hyperbaric oxygen therapy (HBOT) has been used for decades to heal serious infections, non-healing wounds, and to treat divers with the bends. An increasing number of these hyperbaric medical centers are also successfully treating neurological injuries and disease such as autism. Recent studies have suggested that a common link among children with autism is chronic inflammation of areas of the brain and gut, and that the anti-inflammatory effects of HBOT may make it one of the safest and most effective ways to help resolve the debilitating effects of autism.

This study evaluated the effects of 20 hours of hyperbaric oxygen therapy on the functional outcomes of twenty children (4 females and 16 males) ranging in ages from three to seven years, each with a clinically proven diagnosis of autism, and living in Hawaii. Pre-HBOT baseline and post-HBOT follow up evaluations were performed by experienced autism testing clinicians in the community, independent of the treating facility. Testing outcomes proved statistically significant clinical improvements in 100% of the children in one or more of the following areas: Communications, Social Interaction, Imagination/ Creativity, Stereotyped Behaviors and Global Assessment of Functioning (GAF) scores.

Daniel A. Rossignol, Lanier W. Rossignol, S. Jill James, Stepan Melnyk and Elizabeth Mumper BMC Pediatrics, Volume 7, November 2007

Abstract

Recently, hyperbaric oxygen therapy (HBOT) has increased in popularity as a treatment for autism. Numerous studies document oxidative stress and inflammation in individuals with autism; both of these conditions have demonstrated improvement with HBOT, along with enhancement of neurological function and cognitive performance. In this study, children with autism were treated with HBOT at atmospheric pressures and oxygen concentrations in current use for this condition. Changes in markers of oxidative stress and inflammation were measured. The children were evaluated to determine clinical effects and safety.

Eighteen children with autism, ages 316 years, underwent 40 hyperbaric sessions of 45 minutes duration each at either 1.5 atmospheres (atm) and 100% oxygen, or at 1.3 atm and 24% oxygen. Measurements of C-reactive protein (CRP) and markers of oxidative stress, including plasma oxidized glutathione (GSSG), were assessed by fasting blood draws collected before and after the 40 treatments. Changes in clinical symptoms, as rated by parents, were also assessed. The children were closely monitored for potential adverse effects.

At the endpoint of 40 hyperbaric sessions, neither group demonstrated statistically significant changes in mean plasma GSSG levels, indicating intracellular oxidative stress appears unaffected by either regimen. A trend towards improvement in mean CRP was present in both groups; the largest improvements were observed in children with initially higher elevations in CRP. When all 18 children were pooled, a significant improvement in CRP was found (p = 0.021). Pre- and post-parental observations indicated statistically significant improvements in both groups, including motivation, speech, and cognitive awareness (p < 0.05). No major adverse events were observed.

In this prospective pilot study of children with autism, HBOT at a maximum pressure of 1.5 atm with up to 100% oxygen was safe and well tolerated. HBOT did not appreciably worsen oxidative stress and significantly decreased inflammation as measured by CRP levels. Parental observations support anecdotal accounts of improvement in several domains of autism. However, since this was an open-label study, definitive statements regarding the efficacy of HBOT for the treatment of individuals with autism must await results from double-blind, controlled trials.

NooriS.Al-Waili, GlennJ.Butler, JorgeBeale, MahdiS.Abdullah, R.W.BillHamilton, BokeY.Lee, PaulLucus, MichaelW.Allen, RichardL.Petrillo, ZevCarrey and MichaelFinkelstein Advances in Therapy, Volume 22, Number 6 / November, 2005

Abstract

Hyperbaric oxygen (HBO) therapy has been used to treat patients with numerous disorders, including stroke. This treatment has been shown to decrease cerebral edema, normalize water content in the brain, decrease the severity of brain infarction, and maintain blood-brain barrier integrity. In addition, HBO therapy attenuates motor deficits, decreases the risks of sequelae, and prevents recurrent cerebral circulatory disorders, thereby leading to improved outcomes and survival. Hyperbaric oxygen also accelerates the regression of atherosclerotic lesions, promotes antioxidant defenses, and suppresses the proliferation of macrophages and foam cells in atherosclerotic lesions. Although no medical treatment is available for patients with cerebral palsy, in some studies, HBO therapy has improved the function of damaged cells, attenuated the effects of hypoxia on the neonatal brain, enhanced gross motor function and fine motor control, and alleviated spasticity. In the treatment of patients with migraine, HBO therapy has been shown to reduce intracranial pressure significantly and abort acute attacks of migraine, reduce migraine headache pain, and prevent cluster headache. In studies that investigated the effects of HBO therapy on the damaged brain, the treatment was found to inhibit neuronal death, arrest the progression of radiation-induced neurologic necrosis, improve blood flow in regions affected by chronic neurologic disease as well as aerobic metabolism in brain injury, and accelerate the resolution of clinical symptoms. Hyperbaric oxygen has also been reported to accelerate neurologic recovery after spinal cord injury by ameliorating mitochondrial dysfunction in the motor cortex and spinal cord, arresting the spread of hemorrhage, reversing hypoxia, and reducing edema. HBO has enhanced wound healing in patients with chronic osteomyelitis. The results of HBO therapy in the treatment of patients with stroke, atherosclerosis, cerebral palsy, intracranial pressure, headache, and brain and spinal cord injury are promising and warrant further investigation.

By R.A. Neubauer, M.D., J.Orient, M.D., & M. Hall-Dickenson B.Sc.

Introduction

One thousand cases of hyperbaric oxygenation therapy for acute stroke with intervention ranging from four hours to one week are in the literature. Work observation by Ingvar and Lassen published the first report on the treatment of four stroke patients with hyperbaric oxygenation. The overall results showed a regression of EEG changes during treatment with hyperbaric oxygenation. Hayeman and Saltzman published 22 of cases with some excellent results. Nighogossian performed a double blind study utilizing a time factor of entry up to 24 hours. Anderson in a control study showed that with a late entry the tendency toward poor results occurred with the hyperbaric oxygenation. The Russians have done extensive work. A critical time factor of four hours and a specific protocol for hyperbaric oxygenation in the acute stroke were published in 1980.

Conclusions

Because of certain rapid physiological effects of hyperbaric oxygenation, it may perhaps be a treatment of choice.

Paul G. Harch, M.D. The Second International Conference on Hyperbaric Oxygen Therapy and the Brain Injured Child

Introduction

The concept of dosage of hyperbaric oxygen therapy (HBOT) derives from the definition of HBOT as a drug. Using the broad definition of HBOT by Harch and Neubauer, HBOT is the use of greater than ambient pressure oxygen as a drug to treat basic pathophysiologic processes/states and their diseases. Drug dosage of HBOT, therefore, is a function of baseline or reference ambient pressure, depth of pressurization, duration, frequency, air breaks, surface interval, number of treatments, idiosyncratic genetic patient factors, and time to intervention in the disease process which determines the pathological targets. All of these factors cause HBOT to be a narrow-window drug in chronic brain injury similar to digoxin and coumadin: too little maybe ineffective and too much can be toxic. In addition, oxygen is a respiratory metabolite: ;too little has serious metabolic consequences and too much can cause metabolic fatigue. Determining the proper dosage in a given patient with a specific or multiple diseases can be difficult. Ultimately, one wants the best dosage that improves the patient while doing the least harm.

Excerpt

HBOT has both acute and chronic effects. This paper will address only the chronic effects. Chronic effects of HBOT include fibroblast stimulation, collagen deposition, anglogenesis, epithelialization, and bone remodeling. This is most evident in shallow perfusion gradient wounds such as the classic homogenous wound of external beam radiation. In this animal and human model, Marx (3) has shown that intermittent exposure to HBOT induces the aforementioned chronic trophic effects to cause wound healing. The final level of tissue oxygenation after HBOT is approximately 80% of normal tissue, but the effect is durable for years. The unproven mechanism of the effect is thought to be secondary to transient elevation of tissue oxygen levels that results in a steep oxygen gradient that causes anglogenesis. Since 1995 this effect has been better characterized as signal induction where the drug HBOT, by elevation of tissue oxygen pressures, alone or in combination with other factors, signals the DNA to begin transcription of various gene sequences to mRNA (4,5,6). The mRNA is translated to proteins which cause trophic tissue changes, i.e., wound healing. These mechanisms are thought to be responsible for the HBOT-induced wound healing that is seen in a large variety of chronic non-healing wounds, such as arterial insufficiency, venous insufficiency, diabetic, radiation, sickle cell, vasculitic, and other ulcers.

R. A. Neubauer, M.D.

Summary

Cerebral Palsy is a term that encompasses many etiological factors in children diagnosed in utero to age fourteen. Problems may present in utero, peri-natal, and post-natal. Infections, traumatic brain injury, near-drowning, and strokes in children suffering from neurological problems come under the heading of Cerebral Palsy. Hyperbaric oxygenation not only relieves hypoxia but also jumpstarts the brain to much better organization and function. In the very young, it produces a better internal milieu for the growth of new brain tissue. Compelling studies around the world were presented at a conference in Boca Raton, July of 1966. This is well known therapy for the neonates in China, Russia, and South America. In certain of these areas, hypoxic or neurologic involved infants are taken from the delivery room to the hyperbaric chamber. The clinical effects are remarkable.

Richard A. Neubauer and Philip James Ocean Hyperbaric Center, Lauderdale by the Sea, FL, USA | Wolson Hyperbaric Medicine Unit, Ninewells Hospital, Dundee, Scotland, UK

Introduction

Oxygenation is the most critical function of blood flow and a sudden reduction in oxygen availability is an inevitable consequence of severe ischemia. The resulting cascade of events may result in the failure of membrane integrity of some cells and necrosis, but in the surrounding zone of tissue, less affected by hypoxia, cells survive to form the ischemic penumbra. The timing of these events is uncertain, but sufficient oxygen is available to these cells to maintain membrane ion pump mechanisms, but not enough for them to generate action potentials and therefore function as neurons. The existence of such areas has been suspected for some time based upon the nature of clinical recovery, but has now been demonstrated by SPECT imaging with a high plasma oxygen concentration under hyperbaric conditions as a tracer. A course of hyperbaric oxygen therapy frequently results in a permanent improvement in both flow and metabolism. These changes apparently represent a reversal of the changes that render neurones dormant and the activity of cells, previously undetectable by standard electrophysiological methods, can now be demonstrated. Three patients are presented in whom recoverable brain tissue has been identified using SPECT imaging and increased cerebral oxygenation under hyperbaric conditions. Improved perfusion from reoxygenation has correlated with clinical evidence of benefit especially with continued therapy. [Neurol Res 1998; 20 (Suppl 1): 533-536]

Richard A. Neubauer, M.D. 3rd EPNS Congress, European Paediatric Neurology Society, Nice, France, November 7-10, 1999. Published By Monduzi Editore, International Proceedings Division: 283-289.

Excerpt from Results and Conclusions

In all cases, cerebral palsy has an etiologic episode which is ultimately hypoxic ischemic. Unfortunately, preemies and hypoxic infants are not given large doses of surface oxygen because of the fear of retrolental fibroplasia. Hyperbaric oxygenation has no such side effect. Recent uncovered data showed that the oxygen was not the cause, but the withdrawal from the oxygen environment. Resubmersion into the oxygen completely cured the retrolental fibroplasia.

There are multiple conditions causing the problems in utero, at birth or immediately post partum such as premature placental separation, amniotic fluid embolus, trauma and stroke at birth, cord around the neck, meningitis, peritonitis, and shaken baby syndrome, etc. In Russia and South America, many neonates have been taken from the delivery room into the hyperbaric chamber.

With newer methods such as ultrasound, SPECT (single photon emission computed tomography), PET (positron emission tomography) and fMRI (functional magnetic resonance imaging), devastating problems may be easily identified prior to development of clinical symptoms and this is the time for intervention with hyperbaric oxygenation.

Carole Snchal, Ph.D.; Serge Larive, Ph.D.; Engelbert Richard; Pierre Marois, M.D. Journal of American Physicians and Surgeons Volume 12, Number 4, Winter 2007

Abstract

Hyperbaric oxygenation therapy (HBOT) has shown promise in clinical trials and is sought by many parents of children with cerebral palsy (CP). There is unusual resistance to expanding the indications for this modality, which is the only treatment available for certain conditions, such as decompression sickness and air embolism, and which is effective in a number of others related to wound healing. 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. Further systematic research is needed, but in the meantime children should not be denied access to HBOT.

Rationale

CP is most often caused by an ischemic/hypoxic injury during the perinatal period. While hypoxia may cause cell death, there may sometimes be a zone called the "ischemic penumbra," in which brain cells receive just enough oxygen to survive, but not enough to function normally. Since that discovery, many have asked the question: to what extent can HBOT reactivate damaged neurons? It is generally admitted that the cells to which the blood flow is dramatically reduced for 10 minutes or so (less than 10 ml of blood per 100 g of brain tissue per minute) undergo necrosis and form the core of a lesion. With less severe hypoxia, some researchers believe that cells can survive for a long time in an "idling" state, and might be reactivated if blood flow is restored. Those who observed a decrease in spasticity and functional improvements with HBOT hypothesized that neurons might be viable but inactive much longer than previously believed.

Conclusions

Previous studies of HBOT in CP have shown noteworthy favorable results, but to produce conclusive evidence, additional, more systematic trials are needed. Much is at stake. Improvement in the function, independence, and comfort of persons with a severely disabling neurologic condition could lead to significant improvements in health and quality of life as well as to significant cost savings in the long term. While other treatment modalities are paid for by government programs, parents must bear the cost of HBOT as the controversies continue. In the meantime, given the very low risk of adverse effects and the promising results, children should be allowed access to HBOT.

Zarabeth L. Golden;Richard Neubauer;Charles J. Golden;Lorie Greene;Julie Marsh; April Mleko International Journal of Neuroscience, Volume 112, Issue 2 February 2002 , pages 119 - 131

Abstract

While no research study has yet [2002, ed.] demonstrated convincing evidence for the efficacy of Hyperbaric Oxygen Therapy (HBOT) in patients with chronic neurological disorders (CND), anecdotal studies have been supportive of its use in improving healing of the damaged brain. The current study hypothesized that individuals with CND show increases in cerebral blood flow and metabolism as measured by Single Positron Emission Computed Tomography (SPECT) in the cerebral hemispheres, but not on measures of cerebellar and pons blood flow; and younger patients show more improvement than older patients. The study used archival data to compare 25 older and 25 younger subjects who were given SPECT scans pretherapy, midtherapy, and posttherapy. ANOVAs using the SPECT scans as a within subjects variable and age as a between subjects variable confirmed the hypothesis that the cerebral measures all changed but that the cerebellar and pons measures did not. Post-hoc t-tests confirmed that there was improvement in blood flow from the beginning to the end of the study. An age effect was found on only two of the five measures; however, there were no interactions. Analysis by post-hoc t-tests showed that the younger group had higher blood flows, but not more improvement than the older group. The results provided the first statistical research data to show the effectiveness of HBOT in improving blood flow in CND. These results indicate that HBOT can be an effective part of the treatment for such clients. The implications of these findings and future research directions were discussed.

W. P. Fife, Ph.D. and R. A. Neubauer, M.D.

Purpose

It is the purpose of this paper to demonstrate the positive effects of hyperbaric oxygenation on severe encephalopathy occurring in Lyme Disease as a synergistic treatment with antibiotics.

Conclusion

In the series treated at the Ocean Hyperbaric Center results of SPECT imaging gave documentation that hyperbaric oxygenation was a valid treatment of Lyme Disease. This tended to document the work done by Dr. Fife. Because of the difficulty in actual diagnosis it would be suggested that all patients with possible Lyme Disease should have a SPECT or functional brain imaging. Although these cognitive modes and other anomalies may accompany many other diseases, these changes can also come in Lyme Disease and probably respond to hyperbaric oxygenation irrespective of the cause. The serologic diagnosis is mandatory for Lyme. Although difficult to document the positive effects, the long-term results of Dr. Fife's protocol has established this as a treatment of choice. It was the use of his protocol that resulted in the positive changes in Lyme encephalopathy which paralleled the clinical improvement. Frequently the diagnosis can be made only by an astute physician.

Morton Walker, D.P.M. Alternative & Complementary Therapies - January/February 1996

Excerpts

Six years after his stroke occurred, Mr. Phosfeld was given access to two major medical advances, one diagnostic advance that determined the viability of his ischemic penumbra and the other a therapeutic advance that nourished that penumbra with oxygenation. These procedures allowed him to overcome his residual stroke symptoms (sequelae). More effective for visualizing the internal functional structures of the brain than either computed tomography (CT) or magnetic resonance imaging (MRI) is single photon emission computed tomography (SPECT), with the addition of a special radiotracer element, technetium-99 mHMPAO [Tc-99m, dl-hexamethyl-propyleneamine oxime], commercially known as Ceretec (Amersham Co., Arlington Heights, Illinois). Together, SPECT and the tracer allow for observing both local and global evolutionary changes in the brain following stroke most accurately.

The damage to neurons that accompanies ischemia is repairable if associated hypoxia is corrected within a reasonable period of time. Because blood flow to the ischemic area cannot be restored immediately, the only way to get oxygen into the ischemic tissues is by increasing the rate and distance of oxygen diffusion through the marginal trickle of blood flow. HBO provides the means for increasing the amount of oxygen carried by the trickling capillaries. Oxygen delivered under pressure from a hyperbaric chamber nourishes the tissues even when there is an absence of red blood cells.

Treatment with HBO also has numerous other attributes for the stroke-impaired individual that cannot be duplicated by any other known drug. For brain pathophysiologies, oxygen under pressure:

S. E. Gottlieb and R. A. Neubauer Journal of Hyperbaric Medicine, Vol 3, No. 3, 1988

Excerpt

A review of the current hypotheses in the etiology and pathogenesis of multiple sclerosis (MS) is presented together with the implications for therapy. A new hypothesis as to etiology is presented. Special emphasis is placed on the controversy surrounding the use of hyperbaric oxygen in a critical analysis of the published double-blind studies and related discussions. Emphasis placed on the predominant infective and autoimmune hypotheses cannot be supported, either from the pathology of the disease or by the response to treatment. It is concluded that the evidence of beneficial effects of hyperbaric oxygen therapy, despite the use of patients with advanced disease in trials, is very impressive, especially in chronic progressive disease. It is also concluded that there is need for further research and that such studies should examine the effects of hyperbaric oxygenation alone, and in combination with other therapeutic agents, in individual patients with the methods of real-time investigation now available. Meanwhile, based on comparative efficacy and safety, hyperbaric oxygenation is recommended for treating early stages of MS, especially for treating cerebellar and bowel-bladder disorders.

Hyperbaric Center of Alabama 3401 Independence Drive, Suite #121 Birmingham, AL 35209 Phone: 205-912-8282 Fax: 205-912-8286

Patients receiving hyperbaric oxygen therapy enter a monoplace (one-person) clear acrylic chamber where they breathe 100% oxygen delivered to the chamber under increased atmospheric pressure. Typically, treatments last one to two hours during which time patients relax, watch television, or sleep, while they are carefully monitored by highly trained technicians.

The Hyperbaric Center of Alabama is a state-of-the-art hyperbaric oxygen facility. We utilize two Sechrist hyperbaric chambersthe most technologically advanced monoplace chambers available. Treatments are administered by our staff of highly trained, courteous technicians under the direction of Woodie Fritz, M.D., board certified in family practice with more than 26 years of experience.

Birmingham Hyperbaric Oxygen Therapy 200 Riverhills Business Park, Suite 260 Birmingham, AL 35242 Phone: 205-980-0123 Fax: 205-980-1120

Currently the indications for hyperbaric oxygen are expanding. There is much research being done on the effects of HBOT on neurodevelopmental disorders but it is currently believed to be a successful and promising treatment option. Many different medical problems can show benefits with hyperbarics and specifically children with autism, cerebral palsy, near-drowning, carbon monoxide poisoning, and other anoxic insults can show tremendous improvements in function and cognitive processes. There are many other problems treated with HBOT and more information regarding these can be found on the website for the International Hyperbaric Association.

We provide hyperbaric treatments to children with neurodevelopmental delays. These treatments are specified by the childs primary physician, but can be administered with multiple different profiles. The most common profile for autism is a 1 hour treatment at 1.5 ATA, 100% oxygen, repeated either once or twice per day. To receive 100% oxygen the child must wear a hood that is cut to fit around the neck. Some children have trouble with the change in pressure and can have discomfort in their ears. For this reason the hoods are not placed until the chamber reaches final pressure, so that clients can drink water, chew gum, and pinch their noses as needed to help equalize middle ear pressure. A DVD player is available to watch videos while in the tank and this greatly increases tolerance of the treatments.

Pressurization and Depressurization are best tolerated when the rate of change is kept at around 1psi per minute. This adds approximately 15 minutes to the treatment time at 1.5 ATA. These treatments can be repeated twice per day but with a three to four hour break in between. An adult caregiver in good health must dive with the child at each session. If you are interested in receiving treatments please contact our office as soon as possible, as there may be short wait for availability.

Hyperbaric Oxygen Therapy of Arizona 12802 N. Cave Creek Road Phoenix, Arizona 85022 Phone: 602-996-8327 Toll Free: 877-996-8327 Fax: 602-996-3348

When red blood cells deliver only a limited supply of oxygen to tissue cells, negative physiological changes occur. Injuries, infections and diseases can cause a drop in tissue oxygen level to almost zero. World wide research confirms that breathing 100% oxygen under pressure forces the oxygen to reach those tissues and body systems affected by injury, infection, or disease and accelerates the body's healing process. Statistics from Hyperbaric Oxygenation demonstrate tremendous improvements in hundreds of conditions such as slow healing wounds, migraines, brain injuries, chronic fatigue, spider bites, and even Cerebral Palsy.

At Hyperbaric Oxygen Therapy of Arizona, we have a large, six person walk-in chamber in which one sits comfortably, breathing 100% oxygen through a mask or hood, while the chamber is safely pressurized with filtered whole air. You sit or recline in the pressurized chamber, possibly with one or more people, while you breathe 100% oxygen through a mask or head tent, or hood. You can often watch TV or read or sleep. Dr. Reach works with several M.D.'s, D.O.'s, N.M.D.'s, and Homeopaths as well as through a few patient advocate groups. We will always work with your Doctor. We believe in informed consent and patient and family rights.

NorthStar Neurology & Hyperbaric Oxygen Therapy 7598 N LaCholla Blvd. Tucson, AZ 85741 Phone: 520-229-2122 Fax: 520-797-5555

Any United States soldiers that sustained traumatic brain injury or spinal cord injury in service to our country in Iraq or Afghanistan will be treated without charge.

Beverly Hills Center For Hyperbarics 1125 S. Beverly Drive, Suite 405 Beverly Hills, CA 90035 Phone: 310-551-1375

The Beverly Hills Center for Hyperbaric Medicine is nationally recognized for its expert clinical care in the area of Hyperbaric Medicine. Many other facilities follow medical protocols developed here. Although our physicians are also on the staff at UCLA and Cedars-Sinai Medical Center, The Beverly Hills Center for Hyperbaric Medicine is the first independent facility in the Los Angeles area and the only independent hyperbaric treatment center that is accredited by the Undersea and Hyperbaric Medical Society and also the only independent facility to meet hospital based hyperbaric unit standards. Dr. Ralph Potkin, our Medical Director is one of the pioneers of the freestanding concept.

We are able to provide the highest quality HBO therapy to our patients while emphasizing personalized patient care- all this in a private medical office. This gives you, our patients, ease of access, convenience and above all complete confidentiality during your treatments. All this is provided to you at a cost far below most other units. We are available to serve you on a flexible schedule -24 hours a day- weekends and holidays as needed.

Healing Chambers of America - San Diego Center for Hyperbaric Therapy Gateway Medical Center 995 Gateway Center Way, Suite 108, Suite 208 San Diego, CA 92102 Phone: 619-263 0067 Toll Free: 888-691-1482 Fax: 619-263 0340

Healing Chambers International is a guild of Centers with the Mission to make Hyperbaric Oxygen Therapy (HBOT) available and affordable to all persons who need it. We are expanding our affiliated out-patient Centers around the world to ensure that specialist physicians can, if they choose, prescribe HBOT as an adjunct to their usual response to disease and trauma, having full confidence that their orders will be carried out to the high standards of any hospital.

Our affiliated Centers all havephysicians in daily attendance and we have 24/7 access to our eminent Scientific Advisory Board for specialist advice on the ever-widening groups of maladies that physicians are now referring their patients for HBOT. We can proudly claim that our physicians and staff are the most senior and experienced in HBOT. We provide hospital standard hyperbaric oxygen therapy (HBOT) at affordable prices, utilizing the collective knowledge of an elite group of HBOT medical specialists who are part of our Scientific Advisory Board, and in particular, the experience of Dr. Frederick Cramer who acts as their Medical Mentor in Hyperbaric Medicine.

Our Centers' goal is to achieve optimum recovery for patients with the least amount of HBOT treatment sessions. Our patients do not just pay for a "block" of slots of HBOT at one of our Centers. We will be here for consultations/adjustments to aid in healing throughout the process and, if needed, afterwards it is a relationship.

San Diego Hyperbaric and Wound Care and Pain Treatment Center Gateway Medical Center 995 Gateway Center Way, Suite 208 San Diego, CA 92102 Phone: 619-263 0067 Toll Free: 888-691-1482 Fax: 619-263 0340

Our Medical Director, Dr. Brenton Wynn, is Board Certified in Pain Medicine, Physical Medicine and Rehabilitation, plus Hyperbaric Medicine certifications with special application to Chronic Wound Care. Our large San Diego Center is located on the second floor of Gateway Medical Center. Just minutes from down town San Diego. Parking is abundant and free with easy ambulance access.

San Diego Hyperbaric and Wound Care Center is an independent clinic, owned and operated by Southern California Institute for Problem Wounds, Inc. Note: This Center does not treat emergency care patients. If you are suffering from a serious or fresh traumatic wounding injury, call 911.

San Diego Center for Hyperbaric Therapy 5038 Ruffner Street, Suite C San Diego, CA 92111 Phone: 858-268-4268 Fax: 858-268-4265

The HBOT procedure transports oxygen through out the body tissues and increases the oxygen entering the blood stream. By increasing the oxygen under controlled pressure the oxygen can reach tissue, bone, plasma, the central nervous system and the lymph that are not normally accessible to the red blood cells.

HBOT has a positive effect on the immune system due to the increased efficiency of the white blood cells, which fights infection and kills bacteria. HBOT increases the effectiveness of the red blood cells to carry the oxygen to parts of the body that would not normally be reached. The air we normally breathe at sea level contains 21% oxygen, 78% Nitrogen and 1% of other gases. But, HBOT contains 100% oxygen which prompts healing and growth of new blood vessels, decreases swelling and inflammation, deactivates and clears toxins, metabolic waste and improves the healing rate and ability to fight infection.

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Hyperbaric Oxygen Therapy Providers and Treatment Centers ...