The Role of Hyperbaric Oxygen Therapy (HBOT) in the Management of Cerebral Palsy (CP)

Cerebral palsy (CP) is a neuromuscular disorder comprising non-progressive yet transformative motor impairment syndromes evidenced by lesions and anomalies to the brain in its initial stages of development. The motor deficit that mainly manifests itself around 1-3 years of age results from an abnormality of the part of the brain that serves motor function. Spastic cerebral palsy is the most common form of the condition, accounting for about three-quarters of all cases of cerebral palsy. Each aetiology of the disorder manifests through different signs and symptoms. The disorder occurs in children and is quite common in live births. In most instances, cerebral palsy results from an injury/trauma on the developing brain tissues, which affects several cognitive abilities. The damaged brain tissues could manifest through conditions such as asphyxia, intracranial haemorrhage and meningitis. Some of the challenges that individuals with cerebral palsy face include learning difficulties, reduced vision, seizures, and dysfunction of the muscles of the mouth, tongue, limbs and joints. The patients face difficulty while grasping onto something, overextending or flexing their fingers, and responding fast enough, especially with their affected limbs. In most cases, the hands are affected by the disorder more than any other organ. The most explored forms of management of the non-treatable disorder include pharmacology, physiotherapy, speech therapy, occupational therapy, surgery, selective rhizotomy and hyperbaric oxygen therapy (HBOT). 

Mechanism of Action

In the management of cerebral palsy (CP), hyperbaric oxygen therapy gives rise to physiological changes that result in lesser severity and better recovery from the condition. With CP, the brain cells receive just enough oxygen to survive but not enough to function normally. HBOT reverses this action by activating damaged neurons. With increased blood flow, they can transmit information after having been inactive for quite a while. The unused neurons in the brain tissues start functioning, leading to extensive clinical and cognitive development. Oxygen also initiates the healing process of the injured brain tissues, which ultimately leads to cerebral palsy. Most children born with the condition have their brain tissue injured before, during and shortly after birth (the perinatal period). 

With increased oxygen gradients, intracranial pressure and cerebrospinal fluid pressure are reduced by a considerable proportion. Also, metabolic activity in the grey matter of the brain is increased. The brain tissues that were initially dealing with reduced oxygen pressure are replenished. All brain tissues get to benefit from maximum blood circulation. Since the brain is the body's powerhouse, it can send better signals to all parts of the body, including increased oxygen diffusion into all body fluids. Once the cerebrospinal fluid is restocked with optimal oxygen levels, it is better positioned to aid in restoring damaged brain tissue that could be recovered; the brain tissues in this state are whole but not functional. The increased oxygen concentration also addresses blood plasma leakage into the surrounding brain tissues. Once the swelling on the brain tissues, associated with leaked blood plasma, has ceased, microcirculation is boosted, and those with cerebral palsy can experience lesser involuntary and abnormal muscle contractions. Also, their cognitive functions are improved, the most significant being sight, hearing, alertness, coordination, movement, and speech. 

References

Khalil, M., Ghafar, M. A., Abdelraouf, O. R., Mohamed, M. E., Harraz, E. M., Dawood, R. S., & Abouelkheir, R. a. A. (2023). Long-Term Effect of hyperbaric oxygen therapy on GAIT and functional balance skills in cerebral palsy Children—A randomized clinical Trial. Children (Basel), 10(2), 394. https://doi.org/10.3390/children10020394

Laureau, J., Pons, C., Letellier, G., & Gross, R. (2022). Hyperbaric oxygen in children with cerebral palsy: A systematic review of effectiveness and safety. PLOS ONE, 17(10), e0276126. https://doi.org/10.1371/journal.pone.0276126