Category Archives: Treatments and Therapies

Hyperbaric Oxygen Therapy: Does it Work?

By John Lehman

Hyperbaric Oxygen Therapy (HBOT) is commonly used to treat scuba divers with the bends, but recently, the therapy has been used to treat certain types of cerebral palsy, as well. Opinions vary as to whether or not HBOT is an effective treatment for children with cerebral palsy. Some research has shown improvements in motor, verbal and visual skills. However, others feel there isn’t enough conclusive data to recommend it to people with cerebral palsy. We’ll review both sides of the argument to help you decide if HBOT is the right treatment for your child.

What is Hyperbaric Oxygen Therapy?

When using HBOT, the patient enters a specialized room or a glass chamber designed for manipulating air pressure. The procedure is painless and patients can wear comfortable clothes, listen to the radio, read or watch television while inside the room. The average session lasts roughly an hour, including decompression once the session has finished.

Once the patient is inside, the room is sealed and the air pressure within is raised to a point where the patient is breathing 100 percent oxygen. In comparison, the air you are breathing right now contains approximately 20 percent oxygen. Increasing the air pressure in this way allows for the lungs to take in three times as much oxygen as they normally would. With more oxygen intake within the body, damaged or disabled cells can be regenerated and potentially given a second chance to become functional again.

Are There Any Risks?

As with any medical procedure, risks do exist when using HBOT. Patients undergoing HBOT may experience barotrauma, a form of ear damage related to changes in pressure. The medical practitioner on site should be able to advise you on how to reduce health issues related to compression and decompression, which should prevent this from occurring. Other issues associated with HBOT include oxygen toxicity, headaches or fatigue. Thankfully, these risks are not very common.

Does it Really Work?

HBOT is a controversial treatment for those with cerebral palsy. Within the last decade, many studies have been conducted and results have varied. In 1999, a study was published by researchers at McGill University to test the effectiveness of HBOT in children with cerebral palsy. The study took 25 children with cerebral palsy, who each underwent 20 sessions of HBOT over a month-long period. Follow-up tests concluded that 67 percent of the children showed improvement in movement and a reduction in muscle spasticity.

However, a study from Canada in the late 1980’s was met with skepticism. The study gathered 473 children afflicted with spastic cerebral palsy and administered 20 one-hour sessions of the therapy to 230 children within the group. Upon reevaluation after six months, roughly 75% of the treated children had improved balance and a lowered frequency of convulsions.

The controversy stems from the remaining 243 children who were grouped into a placebo study. Unlike standard placebo studies, these 243 children were treated with a reduced version of HBOT, using 1.3 atmospheres of pressure as opposed to the 1.7 atmospheres of pressure used for the original 230. This has led some researchers to claim that the study did not use a true placebo. An article written by Pierre Marois provides further details regarding this controversy.

Even today, research is ongoing in regards to the effectiveness of HBOT for cerebral palsy. While more studies are published demonstrating improvement in the quality of life for those treated, others point out that the treatment does not cure cerebral palsy and that the effects of HBOT are not permanent. HBOT can also be a costly procedure and, therefore, may not be available for all families whose children have cerebral palsy. In any case, it’s best to speak to your child’s doctor about HBOT to see if the treatment is worth trying for your child.

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Further Reading:

FDA Consumer Updates Hyperbaric Oxygen Therapy: Don’t Be Misled

Hyperbaric Oxygen Therapy – Medscape

PubMed 2012  Effects of Hyperbaric Oxygen on Motor Function of Children with Cerebral Palsy

Electrical Muscle Stimulation Treatments for Cerebral Palsy

By John Lehman

Electrical Muscle Stimulation (EMS) refers to a group of treatments that make use of electrical current to stimulate nerve endings, with the aim of reverting damage to the patient’s nervous system. Children suffering from cerebral palsy often have issues with movement and muscle spasticity, and EMS has proven to be effective at treating these issues, improving their overall quality of life. Combined with physical therapy, research has shown that EMS can increase walking speed, reduce muscle spasticity and improve overall motor function.

Types of Electrical Muscle Stimulation

EMS can be broken down into two main categories:

  • Neuromuscular Electrical Stimulation (NMES) – Also known as Therapeutic Electrical Stimulation (TES) or Functional Electrical Stimulation (FES). This form of the treatment is usually provided by a medical practitioner. Unlike Threshold Electrical Stimulation, NMES uses a higher voltage in shorter increments, with the aim of stimulating muscles to contract.
  • Threshold Electrical Stimulation – This treatment differentiates itself from NMES, as it does not induce muscle contractions. Instead, a lower voltage is used over a long period of time. Patients can purchase devices for this treatment without a prescription and use it at home, typically while sleeping.

How EMS Works

Whether treating cerebral palsy or other motor dysfunctions, EMS follows the same procedure. First, electrodes are placed on the skin near muscles that have atrophy or are weaker than their counterparts. These electrodes are attached to a small electric generator, operated by patient (or in this case, the parent), or by a medical practitioner.

As mentioned before, Threshold Electrical Stimulation is usually performed at home, with the parent sending minor amounts of electric current through the electrodes over the course of several hours. With NMES, the patient is subjected to a slightly higher level of current, which coerces the muscle to contract. In either case, the electric current is mild and should not cause any pain or discomfort for your child.

How Effective is EMS?

Although doctors can usually agree on the benefits of EMS, many find that the therapy is unnecessary or unreliable since it does not produce permanent results. EMS typically needs to be conducted over a long period of time, as a single session of EMS will only temporarily improve motor function in the patient. Marked improvement is usually seen after the patient has undergone treatment between one to three months, with 2-hour sessions every day. Any prolonged breaks from the treatment may result in your child’s spasticity returning to an abnormal state. Because of this, many patients undergo the treatment throughout their life.

Although research is promising regarding the use of EMS for cerebral palsy patients, most research suggests that it is supplementary to standard treatments. Typically, EMS is combined with exercise or some other form of physical activity, depending on the child’s muscle condition. Some studies suggest that EMS alone can be used to treat smaller muscle groups, such as forearms or wrists. For larger muscle groups, such as leg muscles, EMS would be combined with another form of physical therapy.

Nevertheless, research is ongoing as to whether EMS can stand alone as an effective treatment for cerebral palsy and issues with motor skills. Ask your child’s doctor about EMS and whether it could help your child’s spasticity.

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Psychotherapy for Children Diagnosed with Cerebral Palsy

By Drew Dillard

The causes of cerebral palsy (CP) are both many and unknown, and no two people diagnosed with CP endure identical situations. However, at one point or another, nearly all people with cerebral palsy will face emotional and psychological challenges regarding the limitations CP has placed upon them. Let’s explore the types of psychotherapy available and how they might benefit your child.

Psychotherapy

Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a patient in an effort to improve that person’s sense of well-being, coping skills, communication skills and general disposition in the navigation of life’s challenges. It is different from therapeutic disciplines such as physical, speech & language, music & dance, occupational and play therapy, but is an important part of the overall care plan for your CP child.

Behavioral Therapy

Behavioral therapy uses psychological techniques that encourage the mastery of tasks. It is rooted in the belief that responses to emotional challenges and negative behaviors are learned and can therefore ne changed through therapy. Children do not yet possess the cognitive ability to process all that goes on with their thoughts and emotions, much less the ability to clearly communicate them. Psychotherapists are trained in identifying troubling situations, helping that child explore the thoughts, emotions and beliefs surrounding that situation, then helping the them acquire skills that will allow them to respond in a more effective and beneficial manner.

The activities used in behavioral therapy vary greatly depending on the abilities of the child and the problem behavior being addressed. Activities can be designed to teach completing tasks, managing emotions, resolving conflicts, delaying gratification and any number of other basic life skills. Behavioral therapy can help alleviate depression, mood swings, sadness, loss, anger and frustration by allowing previous negative outcomes to be replaced with a more positive perspective.

Counseling or Talk Therapy

As they get older, children with cerebral palsy will likely feel ostracized by peers, isolated from friendships, embarrassed by body image and/or frustrated with treatment goals. This may be a good time to introduce them to “counseling” or “talk therapy,” where they can talk about the things that are bothering them and learn to put them in perspective. It differs from behavioral therapy in that the goals are more along the lines of learning to accept and embrace one’s individuality rather than of raw behavior modification.

Even the most “normal” young person faces daily psychological and emotional challenges. Your hopes for your child at this age won’t differ much from that of any other parent. You want your child to cultivate a healthy attitude toward his or her challenges and to acquire the basic tools that will carry them into adulthood.  Many adolescents and teens see therapists to help process these complicated years. The right therapist can work wonders.

Social and Group Therapy

Individuals with physical or cognitive limitations often face real, and sometimes self-imposed, challenges in building relationships. Difficulties in communicating, fitting in or feeling accepted can lead to delays in social, emotional and even physical development.

Social therapy, introduced in the late 1970’s, helps children learn and embrace strategies that will help them develop friendships as they grow older by participating in group therapeutic settings. This decreases their sense of loneliness, isolation and stress. Social therapy focuses on the health and welfare of the individual as an integral part of a group dynamic. This relational approach helps children integrate into society and understand their role within.

Children with Mild Cerebral Palsy

Mild forms of cerebral palsy are often more difficult to detect and diagnose. Sometimes this leads to missed opportunities to introduce early-intervention corrective treatments, including those of a psychological nature. Undiagnosed abnormalities are often more emotionally troubling than diagnosed ones. If a child’s family and doctors don’t know what’s going on, it can be frustrating and confusing for the child.

A child that only exhibits minor physical impediments, such as issues of balance and coordination, may be completely normal in every other way. This can easily affect the child’s self-esteem. Also, children with minor physical or intellectual limitations are actually more likely to be teased and bullied for it than a child with an overt disability. Likewise, recent studies have shown that children with even minor learning disabilities benefit as much from treating the emotional component of the condition as with remediation of the learning disability itself.

It Takes a Village

It is important that parents and caregivers remain fully involved in the child’s therapies, especially with pre-teens. Caregivers need to understand and practice the positive behavior modifications learned in therapy to be able to recognize attention disorders, identify stressors, prevent meltdowns and minimize triggers all in an effort to reinforce a child’s progress.

Parents, caregivers and children with CP can all benefit from the positive interactions achieved with psychotherapy to compassionately, respectfully and appropriately interact with each other in a stable, secure and happy environment.

Resources

American Academy of  Pediatric Neuropsychology

Mayo Clinic Cognitive Behavioral therapy

Neuropsychology Frequently Asked Questions

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