HYPERBARIC OXYGEN AND CEREBRAL PALSY
Pierre Marois, M.D., F.R.C.P., Hospital Maire Enfant, Quebec, Canada
The Use of Hyperbaric Oxygen Therapy in Children with Cerebral Palsy:
A Pilot Study – Preliminary Results
Background and Purpose: Hyperbaric Oxygen (HBO) therapy, a procedure in which 100% oxygen is inspired at pressures greater than atmospheric pressure, has been shown to be effective in treating a multitude of conditions. Its beneficial use in children with cerebral palsy has to date, been purely anecdotal. The purpose of this study was to objectively evaluate the effects of HBO therapy in children with cerebral palsy.
Subjects and Methods: 25 subjects (10 girls & 15 boys, mean age + 5.6 years, range = 3.1 – 8.2 years) with a functional diagnosis of spastic diplegia were recruited to participate in this study. All subjects received 20 one hour HBO treatments, which were administered at a pressure of 1.75 atmospheres. Subjects were evaluated pre- and post- treatment by the same evaluators (physician, physical and occupational therapist). Each subject underwent 2 post-treatment evaluations, the first within 2 weeks post-treatment and the second at 3 months post-treatment. The evaluations consisted of the following elements: An evaluation of gross motor function using the Gross Motor Function Measure (GMFM); an evaluation of fine motor function using the Jebsen Test for hand function; an evaluation of spasticity using the modified Ashworth Scale (evaluation completed by both the physical therapist and the physician); and an evaluation of reflexes. Subsequently, the parents were contacted by telephone to respond to a therapist directed questionnaire. All measures were compared pre- and post-treatment using the Wilcoxon matched pairs signed rank test done non parametric measures at level of p<0.05 and p<0.01.
Results: At the time of this publication the results for the 3-month post-evaluation were not available. Therefore, the results presented here are for the comparison between the pre- and post-treatment (2 weeks) evaluations only. All results reported here are at the p<0.05 level of significance unless otherwise specified. Statistically significant changes pre- and post-treatment were measured for the following tests: The GMFM was significantly improved for Items B,D and Item E (p<0.001); the Jebsen Test was significant for card turning, lifting objects, and stacking checkers; Spasticity was decreased in the hip adductors, hamstrings and ankle plantarflexores (p<0.01) for the evaluation conducted by the physician, and was significantly reduced in the quadriceps (as measured by the physical therapist); The questionnaire revealed significant improvement for walking and sitting (p<0.01) as well as for knee walking.
Conclusions and Discussion: This study has demonstrated that HBO therapy improves function in children with spastic diplegia. At the present time we cannot confirm the long term effects of this treatment as the 3-month post-treatment evaluations have not yet been completed. Given the limits of the present pilot study (small sample size, no control group, minimal number of treatments), these results must be interpreted with caution and further research is needed to ascertain the true potential of the treatment for children with cerebral palsy. In fact, a double-blinded randomized study is currently being planned to commence in the spring of 1999.