On occasion, the Foundation (United Cerebral Palsy Research & Education Foundation) receives requests asking about the use of hyperbaric oxygenation in the treatment of the impairments or disabilities associated with cerebral palsy. Hyperbaria means under increased pressure; hyperbaric oxygenation means oxygen delivered under increased pressure. The following is the response usually provided to those inquiries:

Hyperbaric oxygenation is the term used for a procedure in which a person is placed in an apparatus that delivers under increased atmosphere pressure, additional oxygen to the lungs and its blood vessels. It is usually delivered by placing the person in an enclosed chamber in which the atmosphere pressure is gradually increased, maintained, and then gradually decreased to normal levels. Under increased pressure, oxygen is not only more available to the red blood cells in the blood vessels in the lungs, but oxygen is also dissolved in the fluid (plasma) of the blood. Thus, additional oxygen becomes available to the body's tissues as the oxygen enriched blood circulates.

Hyperbaria was initially used medically in treatment of "the bends", a condition brought on by too rapid decompression when coming too rapidly to the ocean's surface after a "deep" dive or when people were working under increased atmosphere pressure and returned to normal pressure too rapidly (e.g.: escaping from undersea vessels; building tunnels under rivers). With too rapid decompression, nitrogen which was dissolved in the blood formed bubbles and blocked small blood vessels. This blockage often caused pain and sometimes tissue damage ("the bends"). Placing the person in a pressure chamber and increasing the atmospheric pressure forced the nitrogen bubbles back into solution, relieving the blockage. Then by gradually decreasing the pressure, the person can exist in normal atmospheric pressure without danger.

Utilizing the procedure of increasing the atmospheric pressure of inhaled air, it was found that additional oxygen could be incorporated into the circulation -- hyperbaric oxygenation. In addition to the bends, this treatment is used in the treatment of carbon monoxide poisoning and sometimes in the treatment of burns (skin grafts). It is not an innocuous procedure in that too much oxygen can be very harmful and cause essential blood vessels in the brain and heart to constrict. So, the delivery of hyperbaric oxygen has to be done under very carefully controlled conditions.

During the past few years, a few clinicians have explored the use of hyperbaric oxygen in a variety of conditions such as stroke, head injury, spinal cord injury, and multiple sclerosis. At this time, the published scientific literature does not support the use of this technique in any of these conditions. The problem has been the lack of a well designed case series or of a controlled clinical trial evaluating the usefulness of the procedure utilizing a scientifically acceptable protocol. The reports of success are all anecdotal and are impossible to evaluate for reliability or validity. This doesn't mean it has been demonstrated that the procedure doesn't work. There is no acceptable evidence available for either conclusion: it works, it doesn't work.

The same is true in regard to the use of hyperbaric oxygen in the treatment of developmental brain damage such as cerebral palsy or in the treatment of the impairments (e.g.: spasticity) or disabilities (decreased mobility) associated with it. There is no scientifically acceptable evidence available at this time in the literature that demonstrates its clinical usefulness; as above, there is no scientifically acceptable evidence available at this time in the literature demonstrating its lack of usefulness. Individual stories ("anecdotes") tell us very little; they are interesting but not informative.

Comment: There is no biological reason to assume that increased oxygen availability will have any effect on the old lesions in the brain of a person with disabilities due to a developmental brain disorder. Thus, until there is reasonable evidence that this statement is wrong, be cautious about claims to the contrary. The Foundation urges that the clinicians supporting the use of hyperbaric oxygenation launch a well designed clinical trial to evaluate its usefulness in any or all of the following: the acute phase of developmental brain damage; the chronic phase of developmental brain damage; the impairment(s) or disability(ies) associated with developmental brain damage. The initiative for these studies must be theirs; the responsibility is theirs to demonstrate that what they believe is true.

December, 1998