Cerebral Palsy

Cerebral Palsy is a general term for a group of permanent brain injuries that affect an infant in the womb, during birth, or in the months following birth.

Spasticity may develop months after birth. This is likely caused by affected “capsules” in the middle of the hemispheres of the brain. These critical areas are where the fibers from the controlling nerve cells in the grey matter of the cortex of the brain pass down on their way to the spinal cord. In the spinal cord they interconnect with the nerve cells whose fibers finally activate the muscles of the legs and arms. Although anatomists have called these areas the internal "capsules," they are not encapsulated at all; the boundaries are formed by other zones of the brain.

When an event causes lack of oxygen the blood vessels leak, the tissues become swollen and there may be leakage of blood. The increased fluid content interferes with the transport of oxygen and spasticity develops, almost certainly due to the failure of the coverings of the nerve fibers, the myelin sheaths, to develop, and the evidence has come from MRI.

(Philip James, M.D.)

Persons afflicted with CP may experience motor problems of posture and locomotion, abnormal perception, impairment of sight, hearing, and/or speech, mental retardation and seizures.

Hyperbaric oxygenation is not a cure for cerebral palsy but is used as an adjunct therapy. Any age is a candidate for therapy but children appear to have more physical improvements than adults.

Patients/caregivers report:

· Improved global motor coordination

· Decreased spasticity

· Increased attention

· Increased memory

· Increased comprehension

· Increased reasoning ability

· Increased visual perception

· Increased sphincter control

Suggested treatment schedule:

One to two daily treatments, five days/week for a total of 30-40 treatments is the usual base protocol, with booster sessions as needed. Individual responses vary.

HYPERBARIC OXYGEN THERAPY FOR CEREBRAL PALSY CHILDREN (excerpted)

Philip James MB ChB, DIH, PhD, FPOM. Wolfson Hyperbaric Medicine Unit. The University of Dundee, Ninewalls Medical School, Dundee DD19SY.

Ultrasonic scanning of the brain has shown that the events which cause the development of cerebral palsy almost certainly occur at the time of birth, (1) although it may be many months before spasticity develops. (2)

When an event causes lack of oxygen the blood vessels leak, the tissues become swollen and there may be leakage of blood. The increased water content, termed oedema, interferes with the transport of oxygen. These changes apply to any tissue, but a sufficient quantity of oxygen is vital both to the function and development of the brain.

When the controlling nerve cells in the brain are disconnected from the spinal cord, the signals to the arms and legs cannot pass and the ability to move is lost. Eventually, they send an excess of signals to the muscles, causing the uncontrolled contractions known as spasticity

Children who develop spasticity often appear to develop normally for several months and then lose function gradually. This is almost certainly is due to the failure of the coverings of the nerve fibres, known as myelin sheaths, to develop and the evidence has come from MRI. (2) Myelination normally begins about a month before birth and progresses to completion by the age of two. If there is tissue swelling in the mid-brain the delicate cells that form myelin die and the nerve fibres are left exposed and slowly deteriorate with the development of spasticity.

Loss of function in the brain can be due to tissue swelling, which is reversible, or tissue destruction, which is not. By giving hyperbaric oxygen, areas which are not "dead but sleeping" can be identified through SPECT imaging. Authorities have even stated that the critical parameter is not blood flow it is oxygen delivery. (4)

A course of oxygen therapy sessions at increased pressure have been shown to resolve tissue swelling after the lapse of years. It works by constricting blood vessels and interrupting the vicious cycle where oxygen lack leads to tissue swelling, which then leads to further oxygen deficiency. Also, in children, the brain is still developing and therefore the prospects for improvement are very much greater.

References

1. Pape KE, Wiggleworth JS. Haemorrhage, ischaemia and the perinatal brain. Clinics in developmental medicine. Nos. 69/70 William Heinemann Medical Books, London, 1979

2. Dubowitz LMS, Bydder GM, Mushin J. developmental sequence of periventricular leukomalacia. Arch Dis Child 1985: 60:349-55.

4. Astrup J, Siesjo BK, Symon L Thresholds in cerebral ischemia; the ischemic penumbra. Stroke 1981; 12:723-25.