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February 14, 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.


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.

Hyperbaric therapy is perhaps the safest procedure in medicine at the pressures used to treat brain injuries and children on the spectrum.

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. There chambers that are small one person monoplace devices all the way up to submarine sized 30 person multiplace chambers. The hard-shell chambers can be compressed with 100% oxygen or room air, but if they are compressed with room air, as all multiplace chambers are, there are oxygen hoods or masks given to the patient(s) so they can breathe in the enriched oxygen.

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 can have oxygen pumped into the chamber by an FDA licensed oxygen concentrator, 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.

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.

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. 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.

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.

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.

What chamber is the right chamber?

As I have already pointed out there are many shapes and sizes, but not all portable chambers are equal. There are some very cheaply made chambers on the market and so a parent is best served by a manufacture that has the best guarantee, the best system for fixing a chamber should something go wrong, and has a long track record in the USA of selling their chambers from the same location. In other words, an established company that stands behind their product is best and what is not best is looking for the best price. There is only one company I know of that will both rent chambers and buy back their chambers to refurbish them and sell them at a reduced price – there is only one chamber manufacture in the USA that sells a portable chamber that is Pressure Vessel Certified – that is the only company I would obtain a chamber from.

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.

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 from 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.)

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.

What if I want to buy or lease a hyperbaric chamber for in home use?

Should parents and treating physicians recommend additional hyperbaric treatments utilizing a home unit IHA will refund a partial credit towards the purchase or a unit. The partial credit is available when patients visit an IHA center only.

The IHA member benefit (i.e. if you go to an IHA center and receive in patient HBOT services, you can apply a “credit” to a purchase of a chamber – if you choose to purchase.)

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.

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]

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