Thankyou for your inquiry regarding your child suffering global development delay and autistic traits.
Would you kindly email several pictures of your child standing. Does he/she have motor cortex issues? Can he/she walk and run without loss of balance? Does he/she have speech delay, visual disturbances? Often these kids are described as the ‘lights are on but no-one is home’!
Many children with mild forms of cerebral palsy including development delay syndrome and autistic traits suffered issues during birthing. Did any issues arise during the various stages of pregnancy? Did you have any birthing difficulties? What were the APGAR scores? Did he/she react to subsequent inoculations i.e. prolonged fever, feeding or gut issues? Has your specialists recommended an MRI investigation? Unfortunately MRIs for a child require a general anaesthetic!
Many children with development delay have ‘normal’ 1.5 Tesla MRIs of the brain when examined. In many children with ‘hypoxic (inadequate Oxygen) brain involvement’ the 1.5T MRI is often read as ‘normal’ and genetic issues are often flagged as a ‘possible cause’ rather than a hypoxic related injury. Please refer to the last page – Hypoxic Induced Periventricular Leukomalacia (PVL). You may also elect to Google search this topic.
The standard 1.5T MRI is limited when compared to the new emerging functional BOLD 3.5T MRI which is more advanced. Functional BOLD measures Blood Oxygen Level Dependency (fMRI). Regions of the brain that are compromised demonstrate ‘diminished metabolic activity as a consequence of hypoxia due to ischemia’ (lack of normal developing capillary dynamics).
Simply stated a 1.5T MRI is likened to a ‘helicopter view of the city’ identifying the various building structures – if the building is grossly damaged then the 1.5T MRI will confirm i.e. complex issues including cerebral palsy, stroke, drowning etc. Functional BOLD MRI measures not only structure but ‘pedestrian flow’ (functionality) within the building. Often the building appears normal however fMRI is more diagnostic of hypoxic induced metabolic damage which is correlated in children suffering development delay and autism.
The evidence supporting the use of Hyperbaric Oxygenation in the treatment and management of cerebral palsy, autism, development delays, drowning etc are based on Functional BOLD MRI outcomes.
Hyperbaric Oxygenation impacts functional changes by stimulating new capillary networks into hypoxic regions whilst activating neuronal response improving functionality and the process of neuroplasticity (ability of the brain to salvage back what has been damaged).
Hyperbaric Oxygenation (HBOT) in the treatment of patients with cerebral stroke, brain trauma and neurologic disease
Adv Ther. 2005 Nov-Dec;22(6):659-78. J Spinal Cord Med. 2006 ;29:15-6; Life Support Technologies, Inc., and NewTechnologies, Inc., The Mount Vernon Hospital, Westchester Medical Center, New York Medical College, New York, USA.
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 defences, 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 haemorrhage, 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.
Typically many of the children that we take on suffer complex issues – cerebral palsy, near drowning, infantile stroke, autism, development delay etc. The issue is not simply placing the child into a hyperbaric chamber and instantly observing improvement. Many require the catalyst effects of HBOT combined with other therapies including LOKOMAT (Robotic Gait Assisted Walking) to promote motor organisation and continue the process of neuroplasticity. Typically blocks of intensive therapies are required to continue to drive functional changes.
Many children are physically developed for their age but the child’s brain with respect; is very infantile given specific processes have not been developed as per a normal child. Hypoxia affects normal brain development. The damaged brain effectively walls-off normal development and remains in a very low metabolic state. The central nervous system develops function through interaction. The more accurate the intervention - the greater the acquired functionality. Again reason for short blocks of saturation and functional training.
Activities that we take for granted shape our nervous system (through out life) developing healthy skills and mental function that ensures a healthy developing child. A normal child learns to walk by not falling over!
When the brain suffers ‘hypoxic injury’ the normal development and the ability to develop (or maintain) normal skills become replaced by abnormal signals leading to disabilities (acquired behaviour) the brain recognizes as ‘normal’. The child’s developing nervous systems thinks that exactly how he or she is developing is ‘normal’. Again similar paradigm in adults with neurodegenerative disability - normal function being replaced by acquired dysfunction. This ‘acquired’ skill also applies to addictions and other mental health issues. Refer to the ‘Mental Health’ section at HyperMED.
These abnormal signals need to be corrected through functional re-organization. A very good book on this subject is by Dr Doidge ‘The brain that changes itself’. Doidge’s book can be purchased at Dimmocks for around $38.
The brain has the capacity to re-learn improving functionality which then drives mental and cognition development. All over the world ‘task specific training’ is emerging in the field of neurorehabilitation. The more accurate and more repetitive the specific action the greater the representation becomes in the brain which then drives mental function. Neurorehabilitation is about accuracy and repetition. Simply stated we learn not to fall by walking and certainly for disabled patients our body and nervous system was not designed to ‘sit’ in a wheel chair! This level of acquired disability causes a cascade of secondary complications including circulatory problems, osteoporosis, diabetic complications, mental health issues etc.
If your child has motor cortex and cerebellum issues (balance and coordination) in conjunction with Hyperbaric Oxygenation we also recommend the LOKOMAT (Gait Assisted) training. The motor cortex and cerebellum are important parts of the brain that drives development and cognition and the capacity towards ‘neuroplasticity’.
LOKOMAT (Robotic Gait Assisted Walking)
LOKOMAT treadmill training is recommended if the child has motor cortex and cerebellum issues – for this reason we would like to review several photographs our your child prior to making a more specific recommendation.
LOKOMAT is not only used to improve walking skills but drives motor cortex and cerebellum responses which then drives other regions of brain that are immature and underdeveloped resulting in improved skills and cognition. Bottom-line development of the child’s brain goes hand in hand with skills and patterning acquired thru motor cortex and cerebellum activation. The more accurate and repeated the activity the better the projected outcome.
The ability to walk is a complex motor activation pattern organized hierarchically, with the uppermost level (initiation of the movement) mediated through the primary cortex in the brain and the lowest levels (organization and execution of the movement) mediated through the spinal motor neurons. Hypoxic injury at ‘any’ level directly affects the ability to walk – the ability to generate the correct movement and the execution of that movement.
Innate pattern generators in the spine produce the newborn stepping. During the first year of development the ‘corticospinal tracts’ grow which transforms this innate ability towards a normal stepping. Children with disability do not ‘learn’ this function properly and adult patients suffering neurodegenerative disorders progressively loose this ability and have to re-train and re-learn to walk! If you don’t use it – you loose it.
Studies on spinalized cats (cats with their spinal cord completely severed) demonstrated that treadmill walk was possible suggesting evidence of a central gait pattern generators in the spinal cord that could initiate walking. Therefore central nervous system lesions (cerebral palsy child due to hypoxic injury) in a developing brain produce different symptoms: High tone or low tone (or combination), paralysis, spasticity etc which induce inactivity and loss of function. This inability to realize a movement combined with the neuroplasticity of the central nervous system may induce a secondary functional incapacity called the “learning non use”.
The LOKOMAT specifically stimulates ‘corticospinal tracts’ within the spinal cord stimulating both the motor cortex and cerebellum regions of the brain. This neurologic cycle of repetition drives ‘neuroplasticity’ replacing poorly defined circuits with more appropriate responses which strengthen over time. However without the available fuel (Oxygen) and the appropriate stimulation development remains quarantined and prospects poor.
Whole Body Vibration
In addition to HBOT and LOKOMAT we also recommend the use of ‘whole body vibration’ which also provides very strong proprioceptive stimulation (afferentation) into the motor cortex and cerebellum parts of the brain. The unit we have at the clinic is a Power Plate however we recommend most parents an inexpressive unit called ‘Crazy Fit Massage’ or purchase a similar vibration platform via www.deluxeproducts.com.au or www.oo.com.au for home use.
An excellent section can be reviewed under ‘Advanced Vibration Training’ on the HyperMED website.
Median Nerve Stimulation
Median Nerve Stimulation is applied to the child during sleep. MNS stimulates the process of neuroplasticity and impacts the speech centres of the brain!
Please watch the National Geographic documentary (video link) under the Median Nerve Stimulation section on the HyperMED website. You can also copy and paste the link below into the Google search bar.
National Geographic Documentary (VIDEO) - Professor Ed Cooper - Median Nerve Stimulation
What is TENS - Median Nerve Stimulation (MNS)?
Recent studies demonstrate TENS (TransElectrical Nerve Stimulation) electrical stimulation to the median nerve.
Increases cerebral blood flow – measured by SPECT scans and fMRI
Hastens awakening from coma
Improves speech
Increases cerebral activity
Facilitates neural responses in damaged cortex
Improves vigilance, motor and emotional responses, and
Elevates cerebral spinal fluid catecholamine (especially dopamine, which is involved in maintenance of consciousness and motor control)
MNS brings new input to the ascending reticular activating system (ARAS) via the spinoreticular component of the median nerve synapsing with the neurons of the ARAS. Therefore, another means to maintain wakefulness activating neuroplasticity responses!
The median nerve serves as a peripheral gateway (window) to the central nervous system. This is reflected in the fact that the sensory distribution of the hand has a large cortical representation in the brain. MNS seems to activate the entire central nervous system. It is proposed that this peripheral stimulus goes to the ARAS, which further connects with the intra laminar nuclei of the thalamus and then stimulates the cortical layer; the locus coeruleus (releasing norepineprine), and the forebrain basal nucleus of Meynert (releasing acetylcholine) and is also involved in cortical layer I, enhancing arousal.
Better speech appears to be the result of Broca’s motor speech planning area, in the left frontotemporal region, being stimulated. Position emission tomography (PET) of this region became more active when a subject moves, or even contemplates moving his hand, a process mimicked by stimulation of the right median nerve.
Test results showed improvement in 42.9% of the patients documented by improvement in EEG. All had 20% increases in cerebral blood flow as measured by SPECT, and a more active metabolism of catecholamines.
In these studies the median nerve was stimulated for ‘six’ hours daily. However we recommend using MNS at least 3-4 times per week for up to 45-60 minutes at a time. The stimulator used in these original studies was a device that produced a constant wave form. We suggest the use of a different stimulator that constantly changes the wave form; thereby, increasing brain awareness by ruling out accommodation and allowing a shorter treatment time.
"Waking Up" the Brain
Traumatic brain injury, stroke, drowning, autism, cerebral palsy and virtually all neurodegenerative conditions are directly influenced by hypoxia (lack of Oxygen) causing decreased brain activity (non functional neurons) and a coma like state. Complex neurovascular injury will result in a coma-like state due to hypoxia; recovery and normal development are directly affected. Median Nerve Stimulation facilitates ‘neuroplasticity’ and should be part of the rehabilitation process stimulating these patients to "wake up."
Why Electrical Stimulation Might Work
Electrical stimulation has been used in medicine for treating pain, spinal cord injuries, dementia states and even Alzheimer's disease. Generally, there is a low-flow current applied through electrodes into the area of injury i.e. low back pain or tennis elbow. Studies have shown that patients with brain and spinal injuries also show improvement from the use of electrical stimulation. It is thought that the electricity travels up into the brain and "wakes up" various areas along the way.
Attaching the Stimulator to the Right Arm
The median nerve of the right arm was chosen as the way to deliver stimulation for several reasons. The arm is controlled by quite a large portion of the brain. So, by using the arm, we can reach a major part of the brain. In addition, the nerve of the right arm leads into the left side of the brain, where most people control their speech and language.
Electrical treatment of reduced consciousness: Experience with coma and Alzheimer’s disease
E. B. Cooper, E. J. A. Scherder, and J. B. Cooper.
The right median nerve can be stimulated electrically to help arouse the central nervous system for persons with reduced levels of consciousness. The mechanisms of central action include increased cerebral blood flow and raised levels of dopamine. There is 11 years of experience in the USA of using nerve stimulation for acute coma after traumatic brain injury. There is a much longer period of experience by neurosurgeons in Japan with implanted electrodes on the cervical spinal cord for persons in the persistent vegetative state (PVS). But the use of right median nerve electrical stimulation (RMNS) for patients in the subacute and chronic phases of coma is relatively new. Surface electrical stimulation to treat anoxic brain injury as well as traumatic brain injury is evolving. Novel applications of electrical stimulation in Amsterdam have produced cognitive behavioural effects in persons with early and mid-stage Alzheimer’s disease employing transcutaneous electrical nerve stimulation (TENS). Improvements in short-term memory and speech fluency have also been noted. Regardless of the aetiology of the coma or reduced level of awareness, electrical stimulation may serve as a catalyst to enhance central nervous system functions. It remains for the standard treatments and modalities to retrain the injured brain emerging from reduced levels of consciousness.
Stem Cells
Many parents raise the issue of using stem cells. Again stem cells are not a magic bullet. Introduced stem cells do not automatically become a 6-year old or for that matter a 54-year suffering brain or spinal cord damage. However the stem cells will act as a catalyst in the right environment. In addition all foreign stem cells are ultimately rejected by the body. We advise caution – please refer to the Google News section at HyperMED and click on Stem Cells for further reading and review.
Hyperbaric Oxygenation mobilizes and elevates the patient’s OWN circulating stem cells.
American Journal Physiology - Heart and Circulatory Physiology (Nov 05)] reports a single 2-hour exposure to HBOT at 2 ATA doubles circulating CD34+ progenitor stem cells (primordial cells targeted to salvage and restore damaged structures); and at approx. 40-hours HBOT: CD34+ cells increases eight fold (800%). This is exactly the reason for providing blocks of intensive HBOT to promote deep neurovascular responses promoting neural stem cell activity.
Hyperbaric acts as a 'catalyst' promoting functional immune responses by correcting hypoxia in damaged tissue structures. Hyperbaric results in increased blood flow by fostering the formation of ‘new capillary dynamics’ into damaged regions of the body. Hyperbaric mobilizes and elevates the patients own target specific ‘neural stem’ cells. Hyperbaric accelerates neuroplasticity - activating damaged and dormant nerve cells.
Hyperbaric provides the available fuel and acts as a catalyst to the underlying central issue (hypoxia). LOKOMAT (Robotic Gait Assisted Walking) and other forms of intensive physical therapy are based on the principle of neuroplasticity - the ability of the neurons in the nervous system to develop new connections and ‘learn’ new functions.
This combined Hyperbaric Oxygenation, LOKOMAT (Robotic Gait Assisted Walking), Whole Body Vibration, Median Nerve Stimulation approach ‘awakens’ dormant neural pathways and provides accurate neurological repetition enhancing and re-training connections and pathways in the brain and spinal cord. This is the basis of our HyperMED protocols for treating children with various forms of brain injuries including development delay and autism.
Typically most parents attend with their child for an initial intensive block of saturation. Every child varies; most require an initial base line saturation of between 60-80 hours of HBOT. However children with complex issues may require literally several hundred hours to commence some form of functional change.
Ideally an initial 2-3 weeks is recommended with between 2-4 hours HBOT each day attending. HBOT can be provided initially in 2-hour blocks with a 1-hour break between. Within a 3-week period typically around 60+ HBOT hours can be gained initially.
After the initial block parents then return within several weeks for 2-days back to back (Melbourne based parents) or alternatively short 1-2 week blocks for interstate patients approximately 4-6 weeks later.
A parent is required to go in the chamber with the child – we have a multitude of children DVDs however we recommend that you also bring your child's favourite DVDs to hopefully make the time pass quickly.
When you are ready – please complete the on-line Patient Application and Consent Forms which also has the current Fees and Charges.
Our staff will then contact you direct to confirm your application details, your desired dates you would like to attend and confirm the appropriate schedule. If you have additional questions please email me direct at info@hypermed.com.au
Regards,
Malcolm R. Hooper
Director HyperMED
