Therapeutic Listening

Two separate occupational therapists have told us about Therapeutic Listening and how is might help our son, so we thought we'd look into it. Our son tends to get upset when he hears sudden loud noises like a hair dryer, coffee grinder, vacuum cleaner, etc. What's interesting is that if we tell him about what we're doing or let him touch the item before it makes noise, he's much calmer. At any rate, we're considering finding a Therapeutic Listening trained therapist to work with our son.

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The following information is copied directly from "A brief introduction to Therapeutic Listening":

"Therapeutic Listening coupled with Sensory Integration (SI) tends to speed the emergence of:
- Attention
- Organized behavior
- Self regulation
- Postural control
- Bilateral coordination
- Praxis
- Fine motor control
- Oral motor/articulation
- Social skills
- Communication
- Visual motor integration

What is Therapeutic Listening?

Therapeutic Listening (TL) is an expansion of Sensory Integration. It is an auditory intervention that uses the organized sound patterns inherent in music to impact all levels of the nervous system. Auditory information from Therapeutic Listening CDs provides direct input to both the vestibularand the auditory portions of the vestibular-cochlear continuum. The emphasis of TL is onblending sound intervention strategies with vestibulo-proprioceptive, core development, and breath activities so as to sustain grounding and centering of the body and mind in space and time. Providing these postural, movement, and respiratory activities as part of the TL program is critical. Therapeutic Listening utilizes numerous CDs that vary in musical style, types of filtering, and level of complexity. The music on Therapeutic Listening CDs is electronically altered to elicit the orienting response which sets up the body for sustained attention and active listening."

Chiropractic Care

We've recently started to look into chiropractic care for our son. I've read that chiropractors can sometimes help with posture and neurological function. Our son has had one adjustment several months ago, just before his last month of HBOT. It's something that we've not really had time to pursue until now, and seems to make a lot of sense. Check out the links below for some case studies specific to chiropractic care and cerebral palsy.

Improvement in a Child with Cerebral Palsy Undergoing Subluxation Based Chiropractic Care

Cerebral Palsy Helped With Chiropractic Care, Four Case Studies

2009 H1N1 swine flu vaccine : Q&A

I was browsing through the CDC website to find out more information about the H1N1 vaccine and thought I'd share some direct quotes from the general Q&A on H1N1 vaccine safety, as well as links to other reputable US government sources of information.

General Questions and Answers on 2009 H1N1 Influenza Vaccine Safety
"Will the 2009 H1N1 influenza vaccines be safe?
We expect the 2009 H1N1 influenza vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) will be closely monitoring for any signs that the vaccine is causing unexpected adverse events and we will work with state and local health officials to investigate any unusual events.

Are there some people who should not receive this vaccine?
People who have a severe (life-threatening) allergy to chicken eggs or to any other substance in the vaccine should not be vaccinated.

Will the benefits of the 2009 H1N1 influenza vaccines outweigh the risks? Is this something I should talk to my healthcare provider about?
Currently the 2009 H1N1 influenza virus (sometimes called “swine flu”) virus seems to be causing serious health outcomes for:

1. healthy young people from birth through age 24;
2. pregnant women; and
3. adults 25 to 64 who have underlying medical conditions.

Seasonal influenza vaccines are highly effective in preventing influenza disease. The expectation is that a vaccine against 2009 H1N1 influenza would probably work in a similar fashion to the seasonal influenza vaccines. CDC and FDA believe that the benefits of vaccination with the 2009 H1N1 influenza vaccine will far outweigh the risks.

What is the best source of information for 2009 H1N1 influenza vaccine safety?
In addition to talking openly with your healthcare providers, CDC also encourages you to stay informed by checking the following Web sites often for the most up-to-date news and information: www.cdc.gov/H1N1flu and http://www.flu.gov/."

Edited to add my personal opinion:
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Whether or not to have your child vaccinated for H1N1 is a very personal decision. That said, we are not planning to vaccinate our son due to his egg allergies and the fact the the vaccine has been fast-tracked. Verbiage like "expectation", "would probably" and "unusual events" from the above direct quotes, coupled with the fact that the substances in the vaccine have not been disclosed yet do play a part in our decision. I feel it's important to individually weigh the pros and cons for your child.

H1N1 swine flu and kids with cerebral palsy

I've read some posts on other blogs, including Ellen's post at To The Max, about H1N1 swine flu and concerns of how this may affect kids with epilepsy, cerebral palsy, or other neurodevelopmental conditions in the coming months.

The CDC report states that, of the thirty-six (36) pediatric deaths associated with H1N1 in the US in 2009, twenty-four (24) were kids with high-risk medical conditions. Of this high risk group:
"... 92% had neurodevelopmental conditions (e.g., developmental delay or cerebral palsy), a finding consistent with the results from a study of influenza-associated mortality during the 2003--04 influenza season."

I've read a bunch of information on this topic and found an interesting article linking low vitamin D with increased flu death risk in kids. Here's a quick quote from the article:
"All of these neurological conditions are associated with childhood Vitamin D deficiency. Exacerbating the problem further, many of these kids take anticonvulsant drugs, which lower Vitamin D levels."

I've written about Vitamin D before, and this research only solidifies our decision to continue to test and supplement our sons Vitamin D3 levels.

The Oxygen Paradigm

This is a lecture by Dr. Philip James at the 2001 International Symposium of Hyperbaric Oxygen for the Brain-Injured Child. I think Dr. James gives a good overview of reasons to utilize HBOT for brain injury.

Nutrition

So much of development is tied to proper nutrition.

Our son has food allergies and oral-motor difficulties with solid foods, which makes it difficult to ensure that he's getting all the nutrition he needs. So, we've consulted with a chiropractor nutritionist who suggested a nutrition test called a Pediatric ION (Individual Optimal Nutrition) profile. The test measures essential minerals, vitamins, fatty acids, and amino acids, among other things and recommends supplements based on these test results.

We recently received the test results and will be adjusting his supplements based on his individual needs. I like this because it tells us exactly what his body needs, so we're not supplementing unnecessary items.

Serial Casting

We first heard about serial casting during our son's month of intensive pediatric therapy. His PT told us about children they had worked with who were able to postpone or avoid surgery for muscle tightness using this approach.

Serial Casting - quoted from St. Joseph's Children's Hospital of Tampa

"Serial casting is a noninvasive procedure that helps children and adults improve their range of motion so they can perform daily activities with less difficulty. It is a process in which a well-padded cast is used to immobilize a joint that is lacking full range of motion. The cast will be applied and removed on a weekly basis. Each cast gradually increases the range of motion in the affected joint.

Who benefits from Serial Casting?
Muscle tightness can manifest itself in many ways and for various reasons. Doctors refer patients for serial casting to help improve overall quality of life. Serial casting helps patients who have a variety of disorders including:

• Cerebral palsy
• Spina bifida
• Brain or spinal cord injury
• Congenital abnormalities
• Muscular dystrophy
• Idiopathic toe walking
• Peripheral neuropathy

Why would a physician refer for Serial Casting?

• Serial casting is a non-surgical approach aimed at reducing muscle tightness around a joint that is limiting range of motion and functional mobility.
• Serial casting assists in achieving the optimum alignment of a joint. It also helps prepare a joint for the use of further orthopedic devices such as braces, splints, etc.
• Serial casting may help decrease the chance of a deformity developing and/or progressing due to abnormal weight-bearing.
• Serial casting is a safe and effective way to increase range of motion and improve functional mobility. It may help eliminate, delay, or minimize the need for surgical intervention.

What happens during a Serial Casting session?
Muscle strength and range of motion of the affected joint will be assessed prior to application of the cast. A team of specially trained therapists will apply the cast in the joint’s optimal position and range. Instruction about care of the cast and precautions will be reviewed with the family and patient.

How long will I need to come for cast changes?
Casts will be changed on a weekly basis until a target range-of-motion goal is achieved. Predicting the number of casting sessions is difficult, as each individual responds to the casting procedure at different rates. Typically, the casting procedure is completed in 4-6 weeks.

What happens after the casting is finished?
The physician determines what may be needed in terms of orthotics (braces, splints, etc.) to help maintain the newly gained range of motion.

How does Serial Casting affect the patient and family?
A short accommodation time will be required, as the cast has added weight and the joint is now immobile. A walking cast and cast shoe allow children to walk during the period of casting. Daily routines are not altered significantly and patients can stay very active, participating in school and normal activities. The biggest challenge is keeping the cast dry. Sponge bathing is necessary to avoid getting the cast wet."

Phosphatidylcholine (PC) : PhosChol

Phosphatidylcholine (PC) is a phospholipid and a major source of choline. I found out about a PC supplement, PhosChol, from a fellow parent who has a son diagnosed with Guanidinoacetate methyltrasferase deficiency. You can read more about John at Mommy Klor. After consulting with a doctor, I started giving the supplement to our son on 05/06/09.

It's been about two weeks, and our son seems to be opening and using his hands more than before we started the choline supplement. One of his therapists comment recently that he's using his hands and keeping them open more than before. It's hard to conclusively say that it's only the choline supplement, but his hand improvements seem to correlate with the introduction of PhosChol.

Doctors at the University of Colorado are seeing if choline taken during pregnancy by mothers can prevent mental illness in children. You can read more about their work at Choline Baby.

Botox : FDA instructs manufacturers to add boxed warning about possible negative effects

Botox has been used by doctors in recent years to help manage muscle spasticity. I've heard many success stories and some warnings about using Botox to treat spasticity. I don't have any personal experience with this use of Botox and our son's physiatrist has never mentioned that he would recommend it for our son. I've included links and quotes below from a few sources, including the FDA. Hopefully this FDA warning will help parents make informed decisions about their children's treatment.

Botox helps kids with CP
"...the drug forces the stronger contracting muscles to relax, a condition that lasts for a few months. During that time, physical therapists can work with the child to develop the weaker muscles that control extension. Although it's not appropriate for all children with CP, the treatment may help some move normally."

The Latest on Botox for Cerebral Palsy
"The FDA, which has never approved botulinim toxin for this use, issued instructions to manufacturers to add a boxed warning on labels about possible negative effects."

"Will these precautions make you less likely to seek this treatment for your child? Or have you had such success with it that you're willing to take the risk?"

Follow-up to the February 8, 2008, Early Communication about an Ongoing Safety Review of Botox and Botox Cosmetic (Botulinum toxin Type A) and Myobloc (Botulinum toxin Type B)
"As the result of an ongoing safety review, FDA has notified the manufacturers of licensed botulinum toxin products of the need to strengthen warnings in product labeling, and add a boxed warning, regarding the risk of adverse events when the effects of the toxin spread beyond the site where it was injected."

"Botulinum toxin products have been approved by FDA for one or more of the following uses: temporary improvement in the appearance of glabellar lines (frown lines between the eyebrows), treatment of strabismus (crossed eyes), blepharospasm (abnormal tics and twitches of the eyelids), cervical dystonia (involuntary sustained or repetitive contraction of the neck muscles), and primary axillary hyperhidrosis (severe underarm sweating). For these uses, botulinum toxin is injected into the skin or into muscle tissue."

"In pediatric postmarketing adverse event case reports, botulinum toxin products were mostly used to treat muscle spasticity in cerebral palsy, a use that has not been approved by the FDA. The reported cases of spread of botulinum toxin effect beyond the site of injection were described as botulism, or involved symptoms including difficulty breathing, difficulty swallowing, muscular weakness, drooping eyelids, constipation, aspiration pneumonia, speech disorder, facial drooping, double vision, or respiratory depression. Serious case reports described hospitalizations involving ventilatory support and reports of death."

"...healthcare professionals who use botulinum toxin products should understand that these adverse events have been reported as early as several hours and as late as several weeks after treatment."

Allergan to Resolve Botox Safety Labels
"Most deaths and serious problems were seen in children treated for cerebral palsy-associated limb spasticity, the FDA said."

Blues for Botox? 'Black box' warning, slumping economy, competitors may impact dominance
"Typically reserved for medications associated with serious or life-threatening risks, the "black box" warning is one of the strongest safety actions the agency takes. The FDA noted that problems with botulinum toxin had occurred mainly in patients receiving overdoses for unapproved therapeutic treatments, such as use in limb spasticity in children with cerebral palsy."

Olive Oil

We've been giving our son organic olive oil since he was around one year old, initially to provide him with some healthy calories since he was mainly eating, and continues to mainly eat organic baby food and some pureed table food. Much of the following information is taken from the book Brain-Building Nutrition.

Olive oil is high in the Omega-9 fatty acid oleic acid and rich in antioxidants and phytonutrients. Organic cold-pressed virgin or extra virgin olive oil is preferred. It has also been shown to elevate HDL "good" cholesterol, which might have an important affect on preserving brain function. In terms of overall health value, olive oil is one of the most important.

Fatty acid content:
Omega-6 = 8 percent
Omega-9 = 82 percent

Brain-Building Nutrition: How Dietary Fats and Oils Affect Mental, Physical, and Emotional Intelligence

I just finished reading a book by Michael A Schmidt, PhD on the importance of dietary fats and oils and our intelligence. I thought it was a good read covering the different fats and oils that we consume and how they affect our brain.

The book includes a small section on cerebral palsy. The author writes: "Looking carefully at the fatty acid status of any child with cerebral palsy seems to be an important step in fostering recovery. Supplementation with fatty acids may allow slow restoration of some functions and may lead to an improved quality of life."

Without giving away too much of the book, here are some strategies for healing with fats and oils:

1. Determine the Ideal Omega-3
2. Balance Omega-6 and Omega-3
3. Keep Your Carbohydrates Balanced
4. Eliminate Trans Fatty Acids
5. Eat Brightly Colored Fruits and Vegetables
6. Remember Important Brain Minerals
7. Use Spices That Help to Balance the Messengers and Protect the Brain
8. Include Mitochondrial Nutrients
9. Enrich with the Sulfur-Bearing Nutrients
10. Get Adequate Methyl Donors
11. Get Enough Sleep
12. Exercise

I highly recommend reading this book to better understand the nutritional importance and brain benefits of the right balance of fats and oils.

Brain-Building Nutrition: How Dietary Fats and Oils Affect Mental, Physical, and Emotional Intelligence

Vitamin D

Vitamin D is an important fat-soluble vitamin that promotes bone mineralization, enhances the immune system, and works as a neurohormone to stimulate proper brain development.

Our son has food allergies and we had his vitamin D levels tested the last time he had a blood draw to test for food allergies. Be sure to get a 25(OH)D vitamin D test before starting any oral supplementation. Our sons vitamin D levels were low and we've increased his oral supplementation accordingly. We'll be getting a repeat 25(OH)D test soon and and may supplement less since it's now spring and he'll be getting more vitamin D from sun exposure.

• Vitamin D
• Test Values and Treatment for Vitamin D Deficiency
• The Link Between Autism and Low Levels of Vitamin D
• Vitamin D Council

Deep Pressure and Proprioceptive Technique (DPPT) or the Walbarger Brushing Technique and Joint Compression

Our son doesn't like us to touch his right hand and always makes a "yucky" face with the first bite of every meal. We continue to expose his hands to different textures, which will hopefully help desensitize his hands. He seems to have decreased proprioception in his hands and feet, as well as some tactile sensitivity.

If you're anything like me, you're probably thinking "What is proprioception?". Well, proprioception means "one's own" perception. It is the awareness or sense of one's own limbs in space. I found this information from http://www.wisegeek.com/what-is-proprioception.htm interesting "Without proprioception, we'd need to consciously watch our feet to make sure that we stay upright while walking." Our son does tend to watch his feet while walking.

One technique that may help with these issues is Deep Pressure and Proprioceptive Technique (DPPT) or the Walbarger Brushing Technique and Joint Compression.

** This should only be done with supervision from an Occupational or Physical Therapist. **

The brushing technique was developed by Dr. Patricia Wilbarger. Dr. Wilbarger, is an occupational therapist and clinical psychologist who has been working with sensory processing theories for over 30 years.

"The DPPT uses a specific pattern of stimulation delivered through a specific type of brush and gentle joint compression or “pushing” to send information to the brain in an organized fashion. Simply put, it primes the brain to receive and organize information in an effective and useful way. It is done approximately every two hours for a specified number of days and then according to the needs of the child. Consistency is a critical factor! However, the protocol can be administered in between scheduled sessions, to assisting with transitions between activities, reducing overwhelm reactions, and re- organizing the nervous system after emotional upset.

The brush used for this technique, is a soft plastic surgical brush. This brush has been found to be the most effective in stimulating nerve endings in the skin. The actual brushing is done using a very firm pressure, starting at the arms and working down to the feet, avoiding the chest and stomach. The brushing is slow and purposeful providing “proprioception” (input through muscles and joints.) It is not ‘scrubbing’, and should never be painful, or cause damage to the skin. Children may initially react with crying or other avoidance measures because it is new, and the re-organizing can be disquieting. Generally within a few sessions, it becomes pleasurable and children will often ask for it or do it themselves.

The joint compression is also done in a specific pattern; ten count repetition, using light pressure. Students can be taught to do this themselves, by using an alternative method of ‘wall’ push-ups, and jumping."

Sources: http://www.pbbkids.com/the_wilbarger_brushing_protocol.htm
http://ezinearticles.com/?Tactile-Defensiveness-The-Facts-About-the-Wilbarger-Brushing-Protocol&id=1776984

HBOT on Oprah

The hyperbaric chamber may look high-tech, but the concept is pretty simple.

When you take oxygen and pressurize it in a tube, Dr. Oz says the oxygen is forced into a person's cells. "It gets me to mobilize stem cells from my bone marrow," he says. "It gets those cells moving along so it goes out to heal areas. In some parts of the body, like the brain, where you don't always have a lot of oxygen in the tissues, it might improve memory. It might play a role in making those cells which have energy factories function more efficiently."

Oxygen therapy isn't just for people who want to live longer. It's also speeds up the healing process for wounds and helps repairs broken bones. If you're interested, Dr. Oz encourages you to seek out qualified technicians.

"They should usually be used in a hospital with folks really watching what's happening," he says. "You have to wear 100 percent cotton, because it's oxygen in there, and oxygen's combustible. If you have synthetic fabrics, those fabrics can rub and make a spark."

Source: Oprah.com :: High-Tech Ways to Extend Your Life

HBOT Effective Against Autism

Okay, this information isn't cerebral palsy specific, but I think it's worth mentioning. Both autism and cerebral palsy are based in the brain, so it's great to see a study that scientifically supports HBOT for such diagnoses.

A multicenter, randomoized, double-blind, placebo-controlled study (the strongest kind of research) was published today that shows significant improvements in autistic children after 40 hours of hyperbaric oxygen therapy. The study, A Controlled Trial of the Clinical Effects of Hyperbaric Therapy in Autistic Children, included 62 children with autism between the ages of 2 and 7 years of age who were randomly assigned to 40 hourly treatments of either hyperbaric treatment at 1.3 atmosphere (atm)and 24% oxygen or slightly pressurized room air at 1.03 atm and 21%oxygen.

To quote the study
"Children with autism who received hyperbaric treatment at 1.3 atm and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air."

For more details, please read the study - Hyperbaric treatment for children with autism: a multicenter, randomized, doubleblind, controlled trial

News storied regarding the research study:
Hyperbaric Therapy Called Effective Against Autism
Oxygen therapy benefit in autism

Tomatis

The Tomatis method is suppose to re-educate the way a person listens. It's intensive therapy where children wear head phones and listen to music like Mozart that is filter out except for the high frequencies. Children also listen to their mothers voice after it's been modulated to replicate what the fetus hears in the womb. This is suppose to stimulate the brains desire to communicate. The method is named after Dr. Alfred Tomatis who developed the method. I found a good overview of the method here:

"In 1953, Dr. Alfred Tomatis said "The voice contains only the sounds which the ear hears." This quote basically sums up the process he created to reteach the ear to listen. The program begins with an initial assessment with a consultant to test present and potential hearing. The patient is also evaluated to ensure that auditory stimulation is the appropriate treatment. Then a program is custom made, but it follows a basic pattern. The Electronic Ear is a tape recorder where sound is filtered and frequency can be adjusted. Initially, workouts consist of sessions of listening to very high frequencies that stimulate the pre-natal sounds and reproduce the stages of development from an audial point of view. This training makes it possible to switch ear dominance, reteach the listening process. These passive exercises, which consist of listening to specific frequencies, are gradually combined with active exercises utilizing the voice to maintain the lessons learned. For language learning and transformation of words and pictures, beginning with pre-natal sounds enables a person to learn a language quicker and more efficiently. The first fifteen days usually require about two hours a day. Subsequent sessions are shorter, with up to one or two months between each session."

Some national media interviews can be viewed here.

What is the Tomatis Method?

MEDEK

MEDEK stands for "Metodo Dinamico de Estimulacion Kinesica" or "Dynamic Method for Kinetic Stimulation". It is a therapy that claims to help develop gross motor skills by provoking automatic motor responses.

Cuevas Medek Exercise
The Canadian MEDEK Centre

Promising components developed to protect against cerebral palsy caused by oxygen deprevation at birth

Northwestern University chemists have developed two compounds that have been shown effective in pre-clinical trials in protecting against cerebral palsy due to oxygen deprivation during or shortly after birth.  The press release Stunning Finding: Compounds Protect Against Cerebral Palsy contains all the details, an excerpt of which is below:

"In developing the potential drugs, Silverman and his team were able to produce something that pharmaceutical companies so far have not: highly selective compounds that inhibit the enzyme found in brain cells that produces nitric oxide but that do not affect similar nitric oxide-producing enzymes found in endothelial and macrophage cells."

Scientists have not tested the compounds on humans yet, but the initial animal trials appear promising:

"None of the fetuses born to animals treated with the two compounds died; more than half of those born to untreated animals died. Eighty-three percent of animals treated with one of the compounds were born normal, with no cerebral palsy characteristics. Sixty-nine percent of animals treated with the other compound were born normal."

This research greatly interests me because our son has cerebral palsy caused by a lack of oxygen at birth.  Don't get me wrong, I love my son for who he is, but I am also in support of research that may help to minimize the long-term impacts of infant brain injury.

Omega-3

Since our son has been weaned, we've been supplementing his diet with Omega-3. DHA and EPA are both Omega-3 fatty acids. From what I've read, research has shown that most neurological benefits appear to come from DHA. You can find out more about Omega-3 and it's benefits by reading DHA Supports Brain Development and Protects Neurological Function.

I like the Nordic Naturals brand, specifically their Children's DHA, because it's tested by independent laboratories to have undetectable levels of heavy metals and other environmental contaminants.

Omega Resource Library : Children's Health and Development

Metagenics Ultracare for Kids Medical Food

Our son has allergies to milk and eggs, so Metagenics Ultracare for Kids Medical Food has been a big help to ensure that he's getting the nutrients he needs.  We blend the product with organic rice milk, which he drinks at least twice a day.  "Ultracare for Kids" is rice based, which has worked well for him.  We tried a corn syrup solids based medical food and he seemed to have more digestion issues with corn syrup solids based medical food.

Cool-Cap treatment fosters hope for infants

"Oxygen-deprived newborns now stand a fighting chance against permanent brain damage through innovative technological advances involving controlled-temperature treatment. 

The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital offers a new treatment involving the Olympic Cool-Cap System, which combines a continuous flow of cooling water connected to the cap and an infant’s head, according to a press release. 

“This therapy offers hope for a situation and condition that we previously did not have anything to nto before,” said Dr. Daniel Hirsch, an attending neonatologist in the Neonatal Intensive Care Unit at The Bristol-Myers Squibb Children’s Hospital.

While the cap is connected, the infant has a body temperature three to four degrees below normal, according to the release.

The hospital’s informational fact sheet said that infants who qualify for the treatment are full-term newborns affected by prenatal asphyxia and diagnosed with acute hypoxic-ischemic encephalopathy. 

HIE is a condition in which the infant’s brain does not receive enough oxygen, and it occurs about two to three times per every thousand births, according to the fact sheet. Infants who suffer from this condition endure such long-term damage as cerebral palsy, delayed development, seizures and even death.

“We know that the babies suffering moderate to severe brain injury due to lack of oxygen will do better, not only in the short term but in the long term as well, which has been seen through large group trials,” said Hirsch, an assistant professor of pediatrics at the RWJUH of the University of Medicine and Dentistry of New Jersey.

Babies up to one and a half years old who received the treatement were developing better than those who did not receive the treatment, he said. 

“There are follow up studies in the trial to measure the benefits and effectiveness to persist to even six or seven years in life,” Hirsch said.

A stand-alone unit carefully regulates and monitors the water temperature and the infant’s scalp, abdominal wall and rectal temperatures to about 34 to 35 degrees Celsius, Hirsch said. 

“We will get the brain cool enough to slow down the biochemical reactions that have started secondary due to lack of oxygen to the brain,” Hirsch said.

Applying the Cool-Cap treatment within the first six hours of birth for 72 hours impedes the destructive secondary biochemical reactions in the brain due to HIE, according to the fact sheet.

The cool water circulates through a cap similar to a bathing cap, Hirsch said. A middle layer assures that there is good contact between this cap and the infant, and the final, third cap insulates the infant’s scalp from the surrounding environment.

A large clinical trial showed that the Olympic Cool-Cap System is safe and has prevented or reduced the degree of an infant’s brain injury, which is also supported through findings in animal testing, according to the hospital’s fact sheet.

The Bristol-Myers Squibb Children’s Hospital is a top-rated children’s hospital in the United States and is the first hospital in New Jersey to offer the Cool-Cap treatment, according to the press release. 

“It is another way in which our hospital can continue to stay on the side of cutting edge technology and offer the kids of New Jersey the best of care, opposed to having all these babies to be sent out of state to New York or Pennsylvania,” Hirsch said.

Hirsch expects that other New Jersey hospitals will follow in the footsteps of Bristol-Myers Squibb Children’s Hospital and offer the valuable treatment within the next few months to one or two years.

Hirsch said the hospital staff have all been carefully trained and prepared to use the Olympic Cool-Cap System, and currently the hospital offers the revolutionary treatment to any infant who qualifies."

Source: The Daily Targum

HBOT for veterans with TBI

The video found here is from a Louisiana TV news station interview with Dr. Paul Harch regarding the small ongoing study currently in progress looking into the effects of HBOT on veterans with TBI. Hopefully larger studies focused on HBOT and brain injury will take place. In my opinion, if HBOT can measurably help people with brain injury recover some lost function, it's worth putting time, energy and resources into further research.

Improvement in cerebral palsy cognition by oxygen therapy

A while back I signed up to receive Google Alerts for topics of interest, like "hyperbarics and cerebral palsy" and "alternative therapies for cerebral palsy".  If I find something relevant I try to write about it here.

Our son did 40 sessions of HBOT when he was 12 months old.  It's hard to quantify the results we witnessed, but needless to say we saw positive physical and cognitive changes with HBOT.  We're getting ready for another 40 sessions is a few weeks, coupled with intensive pediatric therapy.

Source: http://www.abilitydisability.com/index.php/2009/02/improvement-in-cerebral-palsy-cognition-by-oxygen-tx/
Study from The Indian Journal of Occupational Therapy

"Adjunctive hyperbaric oxygen therapy significantly improves cognition for children with cerebral palsy, compared with standard therapy alone, according to an open, ongoing, observational study.

All participants significantly improved their physical, speech, and motor
Capabilities after 6 months, compared with baseline. Interim results for 84 children whose parents chose hyperbaric oxygen therapy (HBOT) and 20 children in a non-HBOT group were presented at a symposium on hyperbaric oxygen therapy.

Changes in cognition were distinctive. “Children receiving HBOT showed statistically significant improvements in cognitive-only parameters. This is interesting and what is driving us to go on with this treatment,” said Dr. Arun Mukherjee of Majeedia Hospital, New Delhi, India.

Researchers used a modified 49-item Gross Motor Function Measure to monitor clinical progress at 2-month intervals. In an attempt to assess the effects of hyperbaric oxygenation, researchers focused on 26 cognitive-only items, which are less dependent on therapist input. “This is the closest measure we can get to brain repair,” said Dr. Mukherjee, who is also director of the UDAAN Project for Cerebral Palsy at the Foundation for Spastic and Mentally Handicapped Persons in New Delhi. UDAAN is a Hindi word for flight (of freedom).

Hyperbaric therapy consisted of 100% oxygen delivered at 1.5 atmospheres. Not included in this interim analysis is a recently added third group of patients who receive a low pressure HBOT option (ambient air delivered at 1.3 atmospheres).

Dr. Mukherjee and his associates launched the UDAAN HBOT-Based Multimode Long-Term Observational Study in 2001 to assess the benefits, if any, of adjunctive therapy for children with cerebral palsy. They tried nerve block with Botox and phenol, computer-assisted biofeedback, and pulsed magnetic field therapy. “We were not impressed with their cost-to-benefit ratio as per Indian prices. Hence, we have dropped them.”

Standard therapy consists of special education, occupational therapy, speech therapy and physiotherapy totaling 2 hours daily. After 5 months of HBOT, clinicians administer 60 sessions of electro acupuncture using transcutaneous electrical nerve stimulation (TENS) specifically designed for cerebral palsy. This therapy reduces pain and discomfort of intensive exercises and helps the brain recognize pathways revived by HBOT, Dr. Mukherjee said at the symposium sponsored by the Ocean Hyperbaric Neurology Center in Fort Lauderdale, Fla. “This alerts the brain that these circuits are now working,” he said.

Short-term treatment has limited other pediatric studies of hyperbaric oxygen for cerebral palsy, Dr. Mukherjee said. In the current investigation, it took 6 months before cognitive differences between groups reached statistical significance. He said this suggests the need for a long-term commitment to hyperbaric therapy for cerebral palsy."

ADULT STEM CELL SUCCESS STORIES - 2008 UPDATE: JULY-DECEMBER

http://www.frc.org/insight/adult-stem-cell-success-stories-2008-update-july-december
by David Prentice, PhD, William L. Saunders, JD, Jan Ledochowski, and Lukas Lucenic

Brain Injury
New nerve cells, produced naturally by adult neural stem cells present in the brain, appear to be essential for learning and memory. The old idea that brain cells are not renewed was debunked in the 1990's, when researchers showed that the adult brain continues to make new neurons, a process termed "neurogenesis," throughout life. Now, researchers at Kyoto University in Japan have shown in mice that new brain cells are necessary for learning and for memory. The new research, published in Nature Neuroscience, indicates that neural stem cells in the adult brain continue to produce new brain cells that are important for memory and learning.

The new study supports work published earlier this year showing that new brain cells can affect learning and memory. Last year, research showed that transplanting adult neural stem cells into brain-injured mice could restore some memory. In March 2008, another study showed that injecting human umbilical cord blood stem cells into the brains of aging animals boosted neurogenesis. Another recent study also suggested that stimulating specific molecules in the brain could reactivate adult neural stem cells. Exercise has also been shown to stimulate neurogenesis in the brain.[5]

An Auckland twin who was brain-damaged at birth has become the first New Zealander to undergo experimental treatment in the United States using her own umbilical cord blood. Three months ago, Maia Friedlander, 4, was locked in her own world. Despite six hours of therapy a day for three years, Maia-who was born six weeks premature-struggled to talk, walk properly, or even chew her food without choking. Her twin sister, Ariel, achieved all her developmental milestones about six months early, but Maia did not learn to crawl until she was three. Her father, Daniel, said: "Our lives revolved around her therapy regime but we could not see much improvement."

The breakthrough came in February, when they met American mother Mary Schneider, whose son, Ryan, was the first to undergo cord blood transfusion for his brain injury at Duke University , North Carolina . Five years later, he is developmentally normal. More than 50 other children with brain injuries have been treated through Duke's reinfusion program. In August, Maia and her mother, Jillian, traveled to the U.S., where she received a two-hour infusion of her own cord blood stored by her parents at birth. Within days her concentration and coordination improved. Maia now goes to kindergarten five days a week. "She's like a different child-talking, hugging us, playing . . . She's had a second chance at life and we can now have the family life we'd always dreamed of."[6]

Stroke
Doctors have used a revolutionary stem cell treatment to restore the power of speech for a stroke victim. Walter Bast also regained the use of his right arm after the operation to place a "teabag" of drug-producing adult stem cells in his brain. Speaking a week after the operation-the first of its kind in the world-he said: "I feel like a lucky guy." If further trials confirm the value of the treatment, it could be on the market in as little as five years, providing fresh hope for the 45,000 Britons each year who suffer a hemorrhagic stroke caused by the bursting of a blood vessel in the brain. Currently, the only treatment option is surgery, which has a variable success rate. Half will die within a month and just one in 20 patients will recover to the extent of Mr. Bast, a 49-year-old mechanic. British experts described the operation as "very promising."

The CellBeads treatment is the brainchild of scientists at the British medical technology firm Biocompatibles International, based in Farnham, Surrey , U.K. At its center is a teabag-like sachet filled with tiny capsules, each containing approximately a million stem cells. The stem cells, taken from bone marrow, have been genetically engineered to produce a drug that protects brain cells from dying. This allows the cells to rejuvenate and repair the damage done by the stroke. The stem cells are encapsulated in beads to hide them from the immune system and ensure they are not rejected by the body.[7]

Cerebral Palsy
When Chloe Levine was 9-months-old, her parents noticed she could not hold her bottle with her right hand. That was not her only developmental setback. Chloe, of Pinetop , Arizona , was unable to raise both hands above her head and could not crawl. At 12 months, a CAT scan showed a portion of the left side of Chloe's brain had not developed and contained fluid. Chloe's parents, Ryan and Jenny Levine, took her to a neurologist who diagnosed the toddler with right-side hemiplegic cerebral palsy. "The cerebral palsy had only affected the right side of her body," Jenny Levine said. "The neurologist told us we were looking at 17-18 years of therapy." That was when the Levines heard about an experimental procedure at Duke University in North Carolina , where children with cerebral palsy were infused with their own cord blood stem cells in an effort to heal and repair damaged brain tissue.

The Levines remembered they had banked Chole's cord blood when she was born. "It was a miracle," Dr. Manny Alvarez said on FOX & Friends. "I congratulate you for banking her cord blood. Stem cells are a new field of medicine and they certainly can rejuvenate the tissue." Two months ago, Chloe, 2, received an infusion of her own stem cells and her progress is remarkable, said her father, Ryan. "Her therapist said she's made a 50 percent recovery," he said. "She can walk, run, and do sign language with her right hand."[8]

Spinal Cord Injury
The Australian team at the National Centre for Adult Stem Cell Research, Griffith University , continues to produce exciting results. The latest report published in the journal Brain gives the results of a 3-year clinical trial, using olfactory ensheathing cells (specialized adult cells that surround nerves) from the patients' own noses, transplanted into the damaged spinal cord. The initial one year follow-up has shown no adverse effects from the transplant.

This was a highly controlled trial, with matched control and transplant patients, followed for 3 years. Patients were chosen who might be considered "chronic"-at least 2 years after their spinal cord injury-to control for any spontaneous recovery. The trial was designed to show the safety of the transplant. The transplant was safe by all measures, and one transplanted patient showed improvement over 3 segments in light touch and pin-prick sensitivity. The cells were shown to be quite safe, to take well in the patients, and to safely improve function.[9]

Why does HBOT and intensive pediatric therapy work so well together?

"Plasticity is one of the most important mechanisms of brain repair and involves the redirection and reeducation of neurons to make new pathways to learn and improve both cognitive and motor skills. Following any brain insult there is a period of plasticity while the brain and body compensate and attempt to overcome and rewire their connections to learn to take over the tasks of the damaged neurons. In children, plasticity is ongoing, as the brain is in development and still growing new brain cells. Just as babies need to be taught to walk and talk, newly awakened neurons need to be redirected and retrained. HBOT, the safe, non-invasive use of 100% oxygen under greater than atmospheric pressure, has been clearly proven to reactivate and facilitate dormant, idling, damaged neurons that had been receiving enough oxygen to exist but not enough to function or fire electrically. The reactivation of these cells with HBOT opens up whole new areas of plasticity so that the brain is able to learn or relearn the skills that are necessary for proper function of both the brain, as it relates to cognitive function, and the body as the brain makes new connections for recovery of trunk, limb and muscle movement. New neurons are like newborn babies. They need direction for their optimal growth and development. This is why a multi-disciplinary approach to brain injury in cerebral palsy and the brain injured child is so crucial to the outcome. The sooner the new neurons can be redirected to take on the tasks of the damaged areas the more promising the prognosis. It is the intensive therapy and strength training that redirect the brain cells when they are reactivated by HBOT to form the necessary pathways for functional recovery. The synergy of the two approaches combined demonstrates a good and positive outcome for the child."
-from The Synergy of Body/Brain Repair by Virginia Neubauer

We are planning to complete another 40 sessions of HBOT coupled with intensive physical, occupational, and speech therapy over the course of a very busy month! Our schedule will look something like this:

• HBOT session (60 minutes at 1.5 atmospheres, ~30 minutes to pressurize/depressurize)
• Intensive PT, OT and Speech (4 hours)
• HBOT session (60 minutes at 1.5 atmospheres, ~30 minutes to pressurize/depressurize)

This is 7 hours of therapy every weekday for a month!

It will make for very busy days, but hopefully our son will recover even more function by coupling intensive pediatric therapy with HBOT.

Preterm birth: Magnesium sulphate cuts cerebral palsy risk

"Magnesium sulphate protects very premature babies from cerebral palsy, a new study shows. The findings of this Cochrane Review could help reduce incidence of the disabling condition, which currently affects around one in every 500 newborn babies overall, but up to one-in-ten very premature babies.

The neuroprotective function of magnesium in preterm babies was first suggested in the early nineties. Cochrane Researchers who carried out a systematic review of the available evidence say this role is now established. magnesium sulphate is usually given as a slow infusion through a vein, but can also be given as an injection into the muscle.

"There is now enough evidence to support giving magnesium sulphate to women at risk of very preterm birth as a protective agent against cerebral palsy for their baby," said lead researcher, Lex Doyle, who works at the Department of Obstetrics and Gynaecology at the Royal Women's Hospital and the University of Melbourne in Australia.

Exactly how magnesium protects the brain is not certain, but it is essential for many processes that keep cells working normally, it may protect against harmful molecules that can damage or kill cells, and it improves blood flow under some circumstances.

The researchers reviewed data from five trials of antenatal magnesium sulphate therapy, which together included 6,145 babies. Overall 63 women at risk of very preterm birth had to be given magnesium sulphate to prevent one case of cerebral palsy in the baby.

Side effects of the treatment include flushing, sweating, nausea, vomiting, headaches and palpitations. However, the researchers found no increase in major complications in mothers due to magnesium therapy."

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Contact: Jennifer Beal
wbnewseurope@wiley.com
44-012-437-70633
Wiley-Blackwell
Source:Eurekalert
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How HBOT Helped Sophia

Treating Chronic Neurologic Conditions with Low Pressure HBOT

Linked below are a couple articles that support the use of low pressure HBOT to treat neurologic conditions. The first article is a must read in my opinion for families with children who have CP.

Before I knew much about hyperbarics, I read The Oxygen Revolution and found it to be a well organized text and a good overview of the off-label use of hyperbarics. I also would recommend this book to anyone interested in HBOT.

• Hyperbaric Oxygen Therapy in Cerebral Palsy and Pediatric Neurology: A Scientific Perspective
• Hyperbaric oxygen therapy improves spatial learning and memory in a rat model of chronic traumatic brain injury