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Hyperbaric Oxygen Therapy

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Sumaia Muradagha

on 26 November 2014

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Transcript of Hyperbaric Oxygen Therapy

HBOT being used as a form of treatment
Granpeesheh et al., 2009
Neuroinflammation & Blood Flow
So you can imagine if you're doing speech therapy, or what ever therapy you're doing to try to improve speech, but you're not getting adequate blood flow to certain areas of the brain, you may not have an optimal outcome.
.... and Autism?
The Theory Behind HBOT & ASD
Research that Challenges
Lerman et al., 2008
Multiple baseline design
Across 3 participants (Children w/ASD)
1.3 atm; 88% oxygen
Measured:
engagement in tasks
spontaneous communication
problem behavior
"No consistent response to treatment was observed" (Granpeesheh et al, p. 269, 2009)

Rossignol et al., 2009
Their earlier study ended with
So they conducted a double blind, placebo-controlled study
40 HBOT sessions
Group 1: 1.3 atm; 24% oxygen
Group 2: 1.03 atm; regular air
Results
only
compared within-group changes and "significant changes" were found in the treatment group
However, when comparing the placebo/control group to the treatment group, no differences were found.
Data and statistics in this study was manipulated in a way to show a difference
See page 269
(Granpeesheh et al., 2009)
$1.25
Wednesday, November 19, 2014
Vol XCIII, No. 311
Origins
What is Hyperbaric Oxygen Therapy?
Daniel Rossignol, MD
Research that Supports
Hyperbaric Oxygen Therapy
HBOT involves breathing oxygen in a pressurized chamber in which the atmospheric pressure is raised up to three times higher than normal. Under these conditions, your lungs can gather up to three times more oxygen that would be possible breathing oxygen at normal air pressure
FDA Consumer Health Information/ U.S Food and Drug Administration, August 2013
1878
1879
1930's
1662
1662

- The first hyperbaric chamber was created
- Henshaw; British physician
- Discovered that chronic illnesses improved with increased pressures
1930's
The Military
- Looking for ways to treat deep sea divers that had decompression sickness.
- Began research and testing on hyperbaric chamber effectiveness
1878
- Paul Bert; French physiologist
- Found a link between decompression sickness and nitrogen bubbles. Decompression sickness could be reversed with recompression
1879
- Fontaine; French surgeon.
- Built a mobile pressurized operation room
- Deeper anesthesia, increased oxygenation
1928
- Dr. Orville Cunningham; a professor in anesthesia
- Made a "Steel Ball Hospital" next to his medical clinic
- The structure/hospital could reach 3 atmospheres of pressure.
- This hospital was closed in 1930 because of lack of scientific evidence
- Deconstructed during WW II for scraps

1928
1955
- Churchill Davis; physician
- Studied the effectiveness of using hyperoxia [excess of oxygen] to increase the effectiveness of radiation for cancer patients
1976
- UHMS; Undersea and Hyperbaric Medical Society
- Created a committee to "oversee" the ethical use of hyperbaric oxygen treatment
1955
1976
Approved uses of Hyperbaric Oxygen Therapy are for the following:
Air or Gas Embolism
Carbon Monoxide Poisoning
Cyanide poisoning
Crush Injury, Compartment Syndrome
Decompression Sickness
Enhancement of Healing in Selected Problem Wounds
Exceptional Blood Loss (Anemia)
Intercranial Abcess
Necrotizing Soft Tissue Infections
Osteomyelitis (Refractory)
Delayed Radiation Injury )Soft Tissue and Bone Necrosis)
Skin Grafts and Flaps
Thermal Burns
Since then, the use of hyperbaric oxygen therapy has been used for the following diseases and conditions:
AIDS/HIV
Alzheimer's Disease
Asthma
Autism
Bell's Palsy
Brown Recluse Spider Bites
Cerebral Palsy
Chronic Fatigue Syndrome
Depression
Heart Disease
Hepatitis
Lyme Disease
Macular Degeneration
Migraine
Multiple Sclerosis
Myocardial Infarction
Near Drowning
Parkinson's Disease
Reflex Sypathetic Dystrophy (RSD) Syndrome
Spinal Cord Injury
Sports Injury
Stroke
Portable Chamber
Monoplace Chambers
Multiplace Chambers
Treats multiple people at the same time
via mask
100% oxygen
Up to 6 atmospheres of pressure
Compresses one person at a time
100% oxygen
Newer chambers are "duoplace," and can fit two people
Recently, the manufacturing of home chambers has become a trend
Prices range from $5000-$30,000
Types
of
Chambers
Daniel Rossignol, MD
- Children with ASD have less blood flow to the brain
- fMRI scans show less brain function in individuals with ASD
- individuals with ASD have higher rates of neuroinflammation
* A lot of these differences have been noted to be statistically significant - not clinically significant
-statistics is tricky

HBOT is supposed to "treat" all of these symptoms.
By increasing blood flow and decreasing inflammation, ASD should be "solved"
Rossignol & Rossignol, 2006
Uncontrolled, within group design
6 participants
40 HBOT sessions
1.3 atm; 28-30% pressure
Results were
statistically
significant

Rossignol, 2007
18 children (ASD)
40 hyperbaric sessions, 45 minutes each
Group 1 received 1.3 ATM + 25% oxygen
Group 2 received 1.5 ATM + 100% oxygen
No differences between the two groups were found.

Granpeesheh et al., 2009
Randomized (coin toss), double-blind, placebo-controlled
Participants were:
Diagnosed with Autism according to the DSM IV criteria
2-14 years of age (mean age was 6.18)
Primary spoken language was English
Absence of any medical conditions that could possibly effect treatment or contradict it (e.g. seizures)
Caregiver agreement not to introduce or alter any treatments during the study
Participants
were placed in two groups, a placebo/control group (16), and a group receiving HBOT therapy (18).
Both groups: 80, 1 hour sessions.
Number of sessions per week varied between 6-10 per week, but all participants have to finish 80 sessions within 15 weeks or less.
Double blind, so both participants, and adults from both groups were not told (kept blind) to the study details.

Old studies of HBOT showed improvement in people with neurological disorders (e.g. CP)
Replicated, controlled, double blind studies were not able to replicated the results
People with ASD have:
Neuroinflammation
Decreased blood flow to the brain

Findings of these studies have been proved unreliable
See Granpeesheh, p.269, 2009)

Risks & Dangers
Small mistakes could lead to tragic results, including death
Has not been approved by the FDA for ASD treatment
80 documented deaths linked to HBOT


Risks
Temporary nearsightedness (myopia) caused by increased blood oxygen levels
Middle ear and inner ear injuries, including leaking fluid and eardrum rupture, due to increased air pressure
Organ damage caused by air pressure changes (barotrauma)
Seizures as a result of too much oxygen (oxygen toxicity) in your central nervous system
Mayo Clinic
FDA issues warning
Most places falsely advertise the effectiveness of HBOT for many diseases and disorders.
This is part of a letter the FDA (Food and Drug administration in the US) sent to a manufacturer of hyperbaric chambers.

















The letter also mentioned many infractions in assessing the quality of treatments, and found many mistakes in conducting therapy sessions and even problems with adequate installation of the devices!!
Food and Drug Administration
Locally
Who Implements this therapy?
Richmond
Hyperbaric Health Centre
Unit 4 - 12180, Horseshoe Way, Richmond, B.C. Canada V7A 4V5
http://www.richmond-hyperbaric.com/home.html

HOC Hyperbaric Care Centers
695-Alpha Street,
Victoria
, B.C. Canada V8Z 1B5
http://www.hyperbaric-care.com/index.htm
Coquitlam
Location
112 - 250 Schoolhouse Street, Coquitlam, BC, Canada V3K 6V7
http://www.hyperbaric-care.com/hyperbaric_coquitlam.htm
A
Vancouver
location coming soon

SFU
Daryll Frost donated $500,000 to support autism research at SFU.
The news article also provided false information about the implementation of HBOT.

Many more locations across Canada
Globally
USA
http://www.healing-arts.org/children/hyperbaricoxygentherapy_hbot.htm













An "encyclopedia"
Underlined states have HBOT centers
Almost all states have a minimum of 10 centers

Problems:
- No control groups
- No placebos
- Conflict of interest (International Hyperbarics Association funded this study and reimbursed the researchers.
- Researcher has previous findings (and findings since this study) that are non-science based and are based on disproved theories (mercury, vaccinations etc.)

In conclusion the authors say, “Definitive statements regarding the efficacy of HBOT for the treatment of children with autism must await results from future double-blind, controlled trials.”

NO
Conclusions...
"There is no reason to suspect that autism has anything to do with decreased oxygen tension"

There are no studies proving its effectiveness
Invasive treatment, will mostly be used on children
Even UHMS (Undersea and Hyperbaric Medical Society) does not approve HBOT as an autism treatment
References...
Dunleavy, Daniel and Thyer, Bruce A. (2014) "Is Hyperbaric Oxygen Therapy an Effective Treatment for Autism? A Review,"
Journal of Adolescent and Family Health
: Vol. 6: Iss. 1, Article 5. Retrieved from http://scholar.utc.edu/jafh/vol6/iss1/5
Granpeesheh, D., Tarbox, J., Dixon, D., Wilke, A., Allen, M., & Bradstreet, J. (2009). Randomized trail of hyperbaric oxygen therapy for children with autism.
Research in Autism Spectrum Disorders
, 4(2), 268-275. Retrieved from http://www.autismtruths.org/pdf/Randomized Trial of Hyperbaric Oxygen Therapy For Children with Autism.pdf
Hyperbaric oxygen therapy. (2014, November, 1). Retrieved from http://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/basics/risks/prc-20019167
Hyperbaric Oxygen Therapy: Don't Be Misled. (2013, August 22). Retrieved from http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364687.htm
Rossignol, D. (2011, April, 23). Dan Rossignol, MD - Hyperbaric Oxygen Therapy and Autism [video file]. Retrieved from www.youtube.com/watch?v=RYyrhlc3who
History of Hyperbaric Oxygen Therapy - Hyperbaric Oxygen Therapy, Overview. (2014). Retrieved from http://www.hyperbaricoxygentherapies.com/history-of-hyperbaric-oxygen-therapy/
U.S. Food and Drug Administration. (2014, November 1). Retrieved from http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364687.htm
(Rossignol, 2011)
Hyperbaric Oxygen Therapy Overview, 2014
(Hyperbaric Oxygen Therapy: Don't Be Misled, 2013)
Assessments
- Variety of assessments: ADOS, BRIEF, PPVT-III, SRS, VABS, VMI-5 (pre and post treatment)
- ABC, CGI, RBS (weekly)
Good because many of these tools are not meant to be used alone, or are meant to be used as diagnostic tools. Altogether, they form a much more accurate result.
Observers were kept blind to the purpose of the study
. They were asked to take partial interval data on
toy play, hyperactivity, appropriate vocalizations, vocal stereotypy, physical stereotypy, and challenging behaviors (such as aggression, self-injury, and property destruction).

Interobserver agreement was collected for
30%
of observations, with a range of 30.4-45.5%. The
mean IOA for each participant was above 80%
with a range of 81.8% to 100%
Results:
Other than the assessment tools, participants were also measured on behaviors that are symptomatic of autism, such as social reciprocity, communicative approach, and repetitive behaviors.
There were “no significant differences between the HBOT and placebo groups…on any of the outcome measures”
This leads to the conclusion that HBOT did not produce any therapeutic effects or changes for the children in the study.
Therefore, not an effective, recommended treatment.
Dunleavy & Thyer, 2014
- Review of 8 studies regarding ASD and HBOT.
- Included the Granpesheeh, Lerman, and Rossignol studies
Results
were that 4 of the studies showed no effectiveness, and 4 showed that HBOT could alleviate some symptoms of ASD (not cure it).
- However, the strongest studies (with control groups, and proper analysis), have shown no effectiveness.
Full transcript