2nd International Conference on Hyperbaric Oxygen Therapy and The Brain

P. Longobardi
Institute of Life Science, Scuola Superiore Sant’Anna
2nd level Master Diving & Hyperbaric Medicine
HBOT for Brain Injury & Cerebral
Palsy: Path Diagnostic and
Therapeutic Care (PDTA)
Pasquale Longobardi
Centro iperbarico Ravenna (Italy)
Affiliate Researcher of Life Sciences Institute
School for Advanced Studies S. Anna (Pisa, I)
P. Lega, F. Fontana, G. Gaudenzi, C. Orzincolo,
P. Mengozzi, S. Vignoli, I. Gianstefani, M. Gaudenzi,
R. Cascioli, S. Simoncellli, D. Bandini, K. Hoxha, M.A. Rust
segreteria@iperbaricoravenna.it

P. Longobardi
goal:
the best possible autonomy
Nicolò
Martina
Filippo

P. Longobardi
150 patients
evaluated
81 not eligible
17 HBOT
contro
indications
12 no
consent
to
HBOT
4 other
study
20 other
(logistic,
cost)
28 lost
to
follow
up
69 treated
Patients enrolled
(2011-2015)

P. Longobardi
http://www.mindspect.com/
Imaging
The functional impairment
(fMRI, SPECT, PET, neuro
psychomotor profile) must
be worse than the
anatomical damage (MRI)

P. Longobardi
Martina: cerebral palsy with
dystonia, spastic quadriplegia
• MRI: alteration of the basal ganglia
(globus pallidus, putamen), pre-
Rolandic cortex, cerebral white
matter from hypoxic ischemia.
• SPECT (HMPAO): 2008 severe
perfusion deficit in the basal ganglia
and in the left frontal parietal lobe.
• 2013 regular cerebral perfusion.

P. Longobardi
-
Diagnostic & Therapeutic Path
• Initial assessment of the patient
– Neuropsychiatric evaluation: to evaluate the family or
care-givers expectations and their level of cooperation.
Clarify that the scope is improving patient autonomy.
– functional impairment (Activities of Daily Living_ADLs)
– Hyperbaric medicine evaluation
– Physiatric evaluation to define the neurological
rehabilitation plan
• periodic evaluations (every four months) to
monitor the trajectory of autonomy improvement
respect to what was agreed with the parents

P. Longobardi
-
Neurological Rehabilitation
• Physiatric assessment of the patient:
– Level of cooperation
– Joint passive movements; postural alterations
– Archaic reflex
– Ability of active and passive movements
– Postural reflexes adaptations (head and trunk)
– Ability to execute and maintain postural changes
– Capacity for locomotion / ambulation
– Orthopedic aids or adjuvants
• define of the objectives in the short and long term
• define of the rehabilitation protocol
• Periodic and final evaluation

P. Longobardi
• Physioterapy (during HBOT)
• Clown therapy (during HBOT)
• Osteophaty (SpiroTiger)
• Physioterapy (standard)
• Hydrokinetic
• Speech therapy
• Relational psycotherapy
• Pet therapy
• Equine rehabilitation
Rehabilitation protocol

P. Longobardi
Clown therapy
(during HBOT session)
Carlotta:
Leigh syndrome with
psychomotor regression
(progressive loss of mental
and movement abilities).
Leigh syndrome affect
proteins in_or disrupt
mitochondrial complexes I,
II, IV, or V.

P. Longobardi
Osteopathy & physiotherapy
(during HBOT session)
oxygen

P. Longobardi
ppO2 required for the NO synthesis in the presence of an
"inhibitor"
NOS apparent Michaelis constant (Km) is increased
NOS neuronal ~ 490 mmHg 350 µM
NOS inflammatory ~ 130 mmHg 190 µM
NOS endotelial ~ 38 mmHg 53 µM
HBOT dose: relationship between
ppO2 and NO synthesis
normal NO synthesis occurs when the ppO2
is about ~ 40 mmHg (50 uM)

P. Longobardi
ppO2 and NO synthesis
LIU Li (2001): HBOT 2.0 ATA 30～60 min have the best
effect, increase SOD content and decrease MDA content in
brain tissue in HIBD neonatal rats

P. Longobardi
HBOT improves Neural Stem Cells
SHAM: surgery without
hypoxia
HI CONTROL: carotid
ligation and hypoxia
HI-HBO: carotid ligation and
hypoxia + HBOT (2 ATA/60’)

P. Longobardi
Physiotherapy
strengthening exercises and trunk control
Raffaele (14)
drowning
syndrome

P. Longobardi
Speech therapy
Nicolò, mosaic trisomy 18
• Synthetic Human Growth
Hormone (“HGH”) 0,4
mg per day
• 2012 (after HBOT): high
GH 7,57 µg/L (v.n. 0-1)
with normal IGF1 262
ng/ml (v.n. male < 10 yrs:
64-452 ng/ml)
• HGH was stopped
• Commonly, HGH costs
10,000 to 30,000 USD a
year

P. Longobardi
Hydrokinetic
Raffaele (14): severe outcomes of drowning syndrome

P. Longobardi
Pet therapy
Equine rehabilitation
MartinaRaffaele

P. Longobardi
Unmeet needs
• It is hard to define a Path Diagnostic and
Therapeutic Care (PDTA) focused on the pediatric
neurological patients
• the National Health Service does not pay the cost of
treatments
• parents depend on the support of family and
community
• One parent and relatives often reject the problem and
the other parent has to take care for the assistance

P. Longobardi
Final thoughts
• the trajectory of autonomy
improvement can vary for each child
• it is difficult to design a study to
assess the validity of a PDTA
• the functional assessment scales (as
ADLs) has limited ability to measure
small increments of change
• the Italian Society of Hyperbaric
Medicine (SIMSI) opposes the use of
HBOT in cerebral palsy (risk of being
expelled as a member) diploma as a young
hyperbaric patient

P. Longobardi
Master Med. Subacquea Iperbarica,
Scuola Superiore S. Anna (Pisa)
www.iperbaricoravennablog.it

2nd International Conference on Hyperbaric Oxygen Therapy and The Brain

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