A Clinical Trial of the Clinical Effects of Hyperbaric Oxygen Therapy in Thai Autistic Children
Condition: Autistic Disorder
MeSH terms: Autistic Disorder
Study type: Interventional
Phase: Phase 1

Summary: 
      Autism is a developmental and behavioral pattern which includes the triad of impairments, 1.
      social interaction 2. social communication 3. imagination. Inevitable difficulties in the
      treatment, managing and handle with autistic children are the main problems. Their memories
      are seemingly in picture or photo records, which are difference from normal population. There
      are many concepts but no concise in causative factors, including useful treatments, useless
      and prolong remaining in many studies.

      HBOT (Hyperbaric Oxygen Therapy) is a quite modern treatment in Thailand for nitrogen
      imbalance (decompression sickness syndrome or Caisson disease). How can we apply it to treat
      the autism? A hypothesis shows evidence that neurons surrounding the permanently damaged
      epicenter of injury can be reactivated with increased oxygen. Oxygen exists in the blood in
      two forms, combined with hemoglobin and dissolved in plasma. More oxygen is transported by
      hemoglobin, but oxygen is delivered to the tissues in dissolved form by the liquid portion of
      blood. HBOT can increase in plasma oxygen to the tissues including the brain. A little change
      in oxygen can make the better improvements in : cognitive ability, socialization, sleep,
      calmness, decreased stimming and language. It can make increased in Glutathione (GSH), and
      Glutathione (GSH) can decreased in oxidative stress with effected to remove metal compounds
      (mercury) to improve the autism.

      This clinical trial study divided into 3 group populations 1. general autism 2.
      post-treatment chiropractic autism 3. medicated autism. This comparative study shows the
      major clinical symptoms before and after the treatment with HBOT. This study results and
      analysis are the most important for our further projects planning.
    

Detailed description: 
      Detailed Description There is a general agreement that early identification of autistic
      spectrum disorders in children and intervention is extremely important.

      We would like to find out beneficial effects for early identification and treatment in the
      autism. Another meaning, it declares that the autism is treatable and can be prevention in
      the early stage of the symptoms. According to many studies, they had shown brain injury could
      be caused by heavy metal effects, chemical poisoning, infection, autoimmune response, poor
      blood flow, lack of oxygen. There are many alternative therapies that were claimed to have
      some effects to make better results in autistic symptoms, but no definite one which could
      absolutely cured to the autism.

      HBOT (Hyperbaric Oxygen Therapy) is a new way in the treatment for decompression sickness
      syndrome (Caisson disease) and it can be applied to intervene or concomitant treatments with
      some symptoms such as diabetic wounds, burnt wounds.

      Vachira Phuket Hospital, HBOT center and child development center was established in 2002.
      This HBOT center is the only one stand-alone center of provincial hospitals in Thailand.
      Enthusiastic questions in our proceedings were how to declare our opportunities to be a
      center in HBOT and child developmental center.

      If HBOT can be an effective method in alternative therapies, we can help our numerous
      autistic children. In our proceeding study we found that HBOT was the least interesting
      method of alternative therapies for the autism in parental opinions. (Figure 1.)

        1. General information, the most of sampling groups (75.68%) are female, 40.54% of
           aged-groups are 30-40 years old, 37.84% of occupations are employee and 32.43% of
           educations are primary school.

        2. Information about opinion of alternative therapies, the most of parents think that the
           music therapy is the best way. The second is Chiropractic and the third is Art therapy
           but Animal therapy with the pony is the least effective way.

      In the topic of the knowledge about Alternative therapies, the most of parents know about
      Chiropractic, Art therapy and Music therapy as sequence. The parents know Hyperbaric Oxygen
      Therapy as the least.

      They interested in Music therapy, Chiropractic and Art therapy as sequence. But they are
      interested in animal therapy with pony and dog as the least. The researchers think that the
      parents' knowledge about each therapy affects their decision making to choose for their
      children. Vachira Phuket Hospital has Hyperbaric oxygen therapy (Chamber) which is the new
      therapy for Autistic children but the parents don't have the knowledge about it. So, the
      researchers wonder how should we give the information to the parents in order to get the most
      benefit from this therapy.

      Figure 1. Autistic parental attitude surveys in effective, knowledge and interesting in
      various therapies at Vachira Phuket Hospital, July 2007

      Whatever it is our opportunities to prove how effective of HBOT in the treatment for autism
      and represent autistic pathology mechanisms in preceding hypotheses.

      Advantages

        1. Administrator's support is provided.

        2. Equipment (HBOT) is in the same place with Development Training Clinic.

        3. Study by professional physicians in various associated experiences and the developmental
           nurse, psychologist who accustom with children and the parents (caretakers).

        4. Convenience in transportation, which is in a small province.

        5. This HBOT is solitary equipment, governed beneath Thailand Ministry of Public Health.

      Disadvantages

        1. Publication in knowledge about HBOT is very low in Thailand.

        2. Harmful may be unknown hidden.

        3. Stigmatization is a delicate point in the parents of these children.

        4. Worrying and guilty feelings are easily occurred in the parents when something may be
           unexpected happening.

        5. A small province liked Phuket may be difficult to find volunteers for research or
           study's enrollment.

        6. Information gathering and assessment processes including scoring forms may be underneath
           standardization and not up-to-date.

      Problems-solving plans

        1. Informed knowledge about HBOT, more and more, to the parents and community.

        2. Pre-treatment evaluation was carefully evaluated according to good clinical practice.

        3. Respected to their honour, patient's right and kept confidential of the volunteers.

        4. Reassured the parents and clarified in details of their concerned issues. Explained the
           strategies explicitly and slowly.

        5. Therefore studied in a small group, closed observation was applied to integrated in
           details for descriptive study in the volunteers.

        6. It could be a pilot study if their any parts of this study were not clearly understood.
           And thereafter, study planning in the future will be done in the advance conforming
           design and methodology following our knowledgeable experiences.
    

Intervention name(s): oxygen (Hyperbaric Oxygen Therapy)
Intervention type(s): Procedure
Intervention description(s): Current Accepted Applications of HBOT (2008) Jan 2003, ANDI International
Air or Gas Embolus
Decompression Illness
Carbon Monoxide poising
Clostridial Myonecrosis (Gas Gangrene)
Necrotizing Fasciitis
Crush Injury (Compartment syndromes)
Selected Problem Wounds
Compromised Skin Flaps or Grafts
Refractory Osteomyelitis
Exceptional Anemia due to Blood loss
Osteoradionecrosis
Thermal Burns and Radiation Tissue Damage
Diabetic Wounds
Intra-Cranial Abscess
Brain Injury and other Head Trauma
Cerebral Palsy
High Altitude Sickness
Lyme disease
Other intervention name(s): HBOT
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment