slide5

Stem Cells Therapy in Delhi, India

A stem cell can be defined as the cell from the embryo, also called as the master cell or the first cell of the body. These master cells have the capacity to multiple or renew themselves to form more than 200 specialized cell types.

When a stem cell divides, it either has the potential to remain a stem cell or become another cell type with a specialized function, for example, pancreas cells, blood cells, and cartilage cells. Under specific physiologic and experimental conditions, these cell types can be induced to become tissue or organ-specific cells.

Stem cells can be obtained from the human embryo in the early stages of development. Another source is from fetal tissues obtained from terminated pregnancies. For adult patients, stem cells can be obtained from bone marrow and the adipose tissue. Compared to the human embryo, bone marrow has a much limited capacity to multiply in various body cells. However, as the human bone marrow is regenerated every 3 months by the human body, it can be the best choice for stem cells. Another reliable source is the fat deposition in our body, which have a lot of stored stem cells that take care of any skin damage.

stem1

As stem cells are the basic cells of our body, they can develop or differentiate into any cell type. These developed cells migrate to the injured organs of our body and transform themselves into new tissue cells that can replace the damaged cells in the organ. If the disease is in an advanced state, an additional supply of stem cells can provide faster and powerful healing.

Stem cells using bone marrow has been used to treat cancer patients with conditions such as leukaemia and lymphoma for the last 30 years.

Stem cell therapy has also been used in the treatment of critical diseases including:

  • Brain stroke
  • Spinal cord injury
  • Cerebral Palsy
  • Parkinson’s disease
  • Alzheimer’s disease
  • Muscular Dystrophy
  • Motor Neuron disease
  • Kidney failure
  • Rheumatoid Arthritis
  • Liver disease
  • Blindness and visual impairment
  • HIV/ AIDS.

Stem cells provide the following characteristics, making them effective in medical treatments:

  • They can divide infinitely without losing any of their genetic traits.
  • They undergo the process of self-renewal by producing copies of themselves over and over again, throughout the life of the organism.
  • They can maintain their number with each additional division.
  • They can divide and differentiate themselves into more specialized cell types. Stem cells from different tissues and in different stages of development can vary in the number and type of cells they produce.

There is widespread opposition to the use of the human embryo as the source of stem cells. The controversy is largely regarding the technique used to derive the embryonic stem cell lines, which requires the destruction of the blastocyst. Besides this, stem cells derived from the human embryo have ethical issues and carry the risk of tumour development.The guidelines set by the National Institute of Health in 2009 determine that stem cells can be derived from the embryo created only by invitro fertilization, when the embryo is no longer needed. In India, embryonic stem cell is still under clinical research. According to the Indian Council of Medical Research (ICMR), embryonic stem cells cannot be used in clinical therapies until it is approved by regulatory authorities like the DCGI.

Stem cells therapy in India is definitely safer than other invasive forms of treatment such as organ transplants and surgery. As stem cells are derived from your own body, they are safer and readily accepted by one’s own body for the regeneration of damaged cells, without any severe medical complications. Additionally, stem cells are similar to other cells of your body, hence they are processed faster and do not cause any unfavourable body reaction.

Mesenchymal stem cells (MSCs) are multipotent stromal cells that can differentiate into a variety of cell types, including osteoblasts (or bone cells), chondrocytes (or cartilage cells), myocytes (or muscle cells) and adipocytes (or fat cells).

The Adipose tissue is one of the richest source of MSCs. The quantity of stem cells in 1 gm of body fat is around 500 times that in 1 gm of bone marrow. Another rich source of MSCs is the developing tooth bud of the mandibular 3rd molar. These stem cells eventually progress to form the enamel, dentin, blood vessels, and dental pulp.

Human MSCs have the natural ability to transform into numerous type of cells that can:

  • Reduce inflammation.
  • Prevent the death of cells.
  • Form new blood vessels.
  • Direct the immune system of the human body in effective healing.

In general terms, most physicians and patients believe that stem cell therapy in India is the future of medicine. Worldwide advancement in stem cell research has been geared towards improving the effectiveness of stem cells in speedy and safe treatment of most diseases.According to Roger Pedersen, Professor of Regenerative medicine and Director of the Anne McLaren Laboratory for Regenerative Medicine at the University of Cambridge, we are fast moving into a world where stem cell therapy will replace the use of treatment drugs.

What do we mean by Autism Spectrum Disorders?

AUTISM is a severely incapacitating lifelong developmental disability that typically appears during the first 3 years of life.

Children are born apparently normal, but then begin to deteriorate by age of 1 to 3 years

• Always presents before 36 months of age,

• These children may have some speech developmental and social interactive regression, usually around 18 months of age.

The diagnosis of childhood autism must meet the specific DSM IV criteria and will therefore present with poor eye contact, pervasive ignoring, language delay, and other features.

• Per definition, these children will have a severe impairment in speech, communication, or social interaction.

• Many of them will be completely non-verbal and “in their own world.”

What triggers Autism Spectrum Disorders?

A huge number of metabolic susceptibilities for abnormal physiology caused by an unimaginable number of permutation and combination of more than 50 genetic defects identified so far.During life, when the child is exposed to a triggering factor for a particular susceptibility, then he/she manifests the typical abnormal physiological manifestations that are some of the hall-marks of Autism Spectrum Disorder.

What is the effect of Toxin Exposure for causing Autism?

One 2005 study by the Environmental Working Group (EWG.org July 14, 2005 ) found that blood samples from newborns contained an average of 287 toxins.

Of these,

• 180 are known to cause cancer in humans or animals;

• 217 are toxic to your brain and nervous system; and

• 208 have been found to cause birth defects or abnormal development in animal tests.

Clearly, nothing good can come from exposure to so many toxic compounds.

Who are the latest culprits for Harming Brain?

From Harvard School of Public Health and the Icahn School of Medicine at Mount Sinai

One dozen common chemicals (listed below) known to disrupt brain development and cause brain damage, neurological abnormalities, reduced IQ, and aggressiveness in children. (Lancet Neurology March 2014:13(3); 330-338)

• Lead, Methyl-mercury, Polychlorinated biphenyls (PCBs), Arsenic, Toluene (finger nail polish etc), DDT, Manganese, Tetrachlorethylene (dry cleaning), Chlorpyrifos, Fluoride, Polybrominated diphenyl ethers (used as flame retardant in upholstry, PCs, etc), Ethanol.

If Autism is genetic how do we treat it?

A genetic defect causes changes in normal body biochemistry causing symptoms and signs typical for a disease.

For example:

• Hereditary Diabetes: incurable but we can manage it with proper diet, proper lifestyle, and anti-diabetic drugs and adjuvants.

• Hereditary high blood pressure: incurable but we can manage it with proper diet, lifestyle, and blood pressure controlling drugs.

• Eye power defect: incurable but we can manage it with proper eye examination and use of glasses with power as advised by the optician.

It is the same with Autism.

• Many (but not all) manifestations of abnormal behavior have an abnormal physiology, metabolism, or abnormal level of an essential vitamin or mineral or other vital body chemical as the causative factor. It is often possible to identify them and control them.

What is GFCF Diet?

A diet free from Gluten (protein in wheat, barley, rye, oats) and Casein (Animal source milk protein)

Two causes of intolerance to Gluten and Casein:

• Allergy to gluten and / or casein

• Leaky gut absorbs the two proteins when they have been digested only up to the Polypeptide stage. This chemical structurally resembles the Encephalin chemical released by the brain when we are happy or have done our regular exercise or when there is injury pain. The “kick” is similar to opium intake.
Hence, by taking milk or wheat etc, the child shows effects of opium / morphine intake with its bizarre behavior.

A balanced, nutrient rich GFCF diet weans the child away from this intoxicant in 6 to 8 weeks.

What are the means of managing Autism?

managing-autism

Who needs brain repair Therapies?

Those who show typical and specific low oxygenation levels (Blotchy red or Blue color) in specific parts of the brain as seen in almost all cases of Autism, using 3-D CT-SPECT Fusion Scans of brain.SPECTS in three Autism cases.

How many will respond?

There is no cure for Autism.

Bigoted opinion advocating any one single mode of therapy at the expense of all other therapies, is fit for the nearest gutter.

YOUR CHILD IS VERY PRECIOUS.

He/she needs whatever will help him/her improve the quality of his/her life to the highest level possible using modern science, to become a useful as well as an earning member of society in future.

 


slide3
Need based medical care of a person needing rehabilitation services

Consists of Clinical Assessment and its evaluation, if required supplemented by CT-SPECT Fusion Scan of brain or equivalent, to delineate areas of brain dysfunction requiring management and repair.

Instruct Therapists on neural damages identified, so that they may choose specific need based neuro-rehabilitation strategies accordingly.

Makes medical diagnoses of complications for taking care of, e.g. malnutrition, micronutrient deficiencies, epilepsy, deformities, hypothyroidism, diabetes, etc.

 

Where needed, advise electro diagnostic approach

In selected cases, based on clinical assessment and investigations, have detailed discussion of all pros and cons of modern and/or experimental interventional therapies like HBOT, Biomedical approach, • surgical correction of deformities and spasticity, and Regenerative Medical Therapies

Make it clear to the attendants and patient that a variable degree of disability WILL persist, but, with proper holistic Neuro-Rehabilitation and need based medical interventions, quality of life may be enhanced significantly in most but not all cases.

 

Team Approach

Familiarity and regular use of established scales for measurement of disabilities

Regular follow up for years if needed

Awareness that holistic Neuro-Rehab is the foundation of all management strategies

The patient’s physical, functional, emotional, and psychosocial well-being must always be considered in totality for effective treatment.

 

Detailed medical history taking: why/how the mishap occurred, followed by Biomedical, Genetic and/or Health tests as per individual case needs

Discuss with group members to decide the final management, orthotic aids, further tests, etc.

In patient is not responding to any approved and established therapy, and is only being given palliative tonics, etc, only then consider using Experimental Therapies if they fit Helsinki Protocol Para 35 guides.- Here, approach must be as in a clinical trial, with all its safeguards, detailed record keeping, full information to patient or guardian. A 2 year follow up is recommended.

Musculoskeletal care:- Different forms of arthritis: Osteo-, Rheumatoid, Traumatic, Ankylosing, Fibromyositis, Low Back Pain, etc.Sports injuries:- Examples: Achilles Tendonitis, Iliotibial Band Syndrome, Turf Toe, Medial & Lateral Epicondylitis, Tenosynovitis, Rotator Cuff Pathology, Acromioclavicular Separation, Biceps Tendonitis, Stress Fractures, Concussion, etc.

Neurorehabilitation:- Cerebral palsy, Traumatic Bain Injury, Autism Spectrum, Stroke, Spinal Cord Injury, Muscular Dystrophy, Parkinsonism, Multiple Sclerosis, Motor Nuron Disorders, etcPain medicine:- Different Neuralgias, Chronic Fibro-myossitis, Cancer Pain Management, Regional Pain Syndrome, Back Pain, Degenerative Arthritis, Carpal Tunnel Syndrome, Tennis Elbow, etc.

Cerebral Palsy

Autism Spectrum Disorder:-Aspergers, Autism, PDD, PDD-NOS, Rett, TBI-induced autistic features, Mental Impairment (Fragile-X, Tuberous Sclerosis, Down, etc)

Post traumatic cognitive impairment, eg. After accident, war injuries,

Brain damage with cognitive impairment after stroke, cardio-respiratory failure and other forms of Hypoxic Ischemic Encephalopathy (HIE)


All forms of impairment of-Cognition, especially its regression for no cause-Psycho-social behavior,-Communication skills- Attention deficit• Hyperactivity

• Bizarre behavior as in Autism Spectrum, Depression, criminal tendencies, Schizophrenia,

• Mental Impairment

Contrary to popular opinion, a Speech Therapists’ work is not limited to speech only.

He provides all necessary Physical and Special Education Therapies to functions related to the area from throat to nose.

Sucking

Swallowing

Blowing

Chewing

Phonation

Soft palate control

Hard palate control

Breathing control

Communication, language and speech development

Dietician-Balanced, hypo-allergenic need based diet avoiding foods that are prohibited in a particular situation / disease.

Vascular Surgeon-Specific target organ based administration of a drug

Geneticist

• Diagnosis of obscure genetic disorders by tests

Orthopedician

• Surgical correction of deformities and spasticity

• Neurologist / Neurosurgeon

Brain pathology management by surgery or medication especially in cases Hydrocephalus, brain trauma, tumors and abscesses, epilepsy, etc-Pediatrician

Manage pediatric complications in childhood disprders

Internal Medicine Specialist (Physician)

Group Leader, who can consolidate everyone’s opinion, and then lay down the ultimate holistic approach to be followed in a particular case and be the main handler.

HBOT: Hyperbaric Oxygen Therapy has stood the test of time over 3 decades and is now recognized and approved therapy for well over a dozen indications by US FDA & its European counterparts.

Cerebral Palsy in children: likely to be officially approved soon

Autism: reports of many small trials encouraging but more data needed from large scale long follow up trials for its final official approval.

Stem Cell Therapy: Adult Human Stromal Stem Cells are recommended to be in Clinical Trial Phase as of early 2014.-Autologous stem cells somewhat closer to approval. Good for acquired pathologies, but prolonged relief in genetic disorders questionable as the very stem cells used are defective, coming from the patient only.

• Allogenic Stem Cells from unrelated healthy donors might be better for genetic disorders. Recommended to be used in Phase II and Phase III Clinical Trials only.

 


slider11-1

 

What is HBO Therapy?

Hyperbaric Oxygen (HBO) Therapy (or HBOT) is a medical therapeutic process, which enhances the natural healing of the human body through inhalation of 100% oxygen in a closed chamber with controlled atmospheric pressure. A hyperbaric chamber Is used to administer the HBO therapy using which the patient breathes 100% oxygen.In HBOT, the ambient pressure of the body chamber is kept greater than the atmospheric pressure at sea level. This reduces the harmful effects of systemic gas bubbles by reducing their physical size and improving the conditions for eliminating the bubbles and excessive dissolved gases.

How does HBOT work?

The patient is kept in a transparent monoplace or multiplace chamber. A monoplace chamber is used to treat a single patient and is surrounded with 100% oxygen. A multiplace chamber is designed to fit several patients at the same time, and the oxygen is delivered using a mask or hood to the patient, who can either sit or lie in this chamber.

In a normal human body, only the red blood corpuscles perform the task of circulating oxygen throughout the body cells. Using HBOT, oxygen gets dissolved in multiple body parts including the body fluids, plasma, and the central nervous system fluids. This improves the circulation of healthy oxygen to body areas where the circulation is limited or damaged, thus enhancing the natural healing process of the body.

An increased supply of oxygen produces the following benefits:

  • Shrinking of the blood vessels, thus reducing the amount of edema.
  • Restores normal cell growth.
  • Rebuilds the skin, bone, and muscle.
  • Healing of the capillaries
  • Reduction in the fluid leakage
  • Enhances the ability of the white blood corpuscles to destroy harmful bacteria.
  • Growth of new blood vessels

Is it safe? What about the bends?

In general terms, HBOT is as safe as any other medical treatment. HBO therapy can only be prescribed by a physician and is performed under strict medical supervision. Depending on the patient’s medical condition, the risks, if any, are discussed with the patient before the signing of the consent form.Some side effects of this treatment can be sinuses and barotrauma caused to the ears due to change in the chamber pressure. To minimize these risks, patients are advised to clean their ears during the compression.Minor and temporary changes in the patient’s vision can be another side effect. This can be due to the swelling of the lens. This side effect usually lasts for about 8 weeks after completion of the therapy. A rare side effect is oxygen toxicity caused by use of excessive oxygen supply at high pressures.

Can the parent accompany the child into the chamber?

For children with neurological conditions like autism, HBO therapy has been used under the doctor’s supervision in recent years. Parents can accompany their autistic child into the chamber after getting the required clearance from the authorized doctors.

Are there any restrictions on who can take part in the therapy?

Patients who have consumed the following drugs for treatment recently should not undergo the HBO therapy:

  • Doxorubicin (or Adriamycin), a chemotherapeutic drug that can cause cytotoxicity during HBO therapy.
  • Cisplatin, another chemotherapeutic drug.
  • Disulfiram (or Antabuse), used in the treatment of alcoholism.
  • Mafenide acetate (or Sulfamylon), which suppresses bacterial infections in burn wounds.

Patients with a history of the following conditions, must be consulted by specialist before any HBO therapy:

  • Cardiac heart conditions
  • Upper respiratory infections, as this condition can lead to ear or sinus problems during therapy.
  • High fever, in which case the fever must be lowered before the therapy.
  • Emphysema, which can lead to pneumothorax during HBO therapy.
  • Previously undergone chest surgeries.
  • Malignant diseases such as cancer, as cancer cells can thrive in oxygen-rich blood flows.
  • Barotrauma in the middle ear.

What can’t be taken in?

Patients can only wear 100% cotton clothing (including undergarments) into the chamber. Cosmetics, perfumes, hair conditioners, deodorants, wigs, or jewellery are not permitted inside the chamber. For safety measures, items such as cigarettes, matches, lighters, cell phones, and other metallic objects are not permitted.Patients are also advised to stop consuming alcohol or carbonated drinks for 4 hours prior to the therapy. They also have to give up smoking or any tobacco products during the treatment, as this can interfere with the body’s ability to circulate oxygen.

What can be taken in?

Due to the oxygen-rich setting of the HBOT chamber, the only thing that you are permitted to carry in is drinking water in spill-proof containers. For child patients, most of the chambers are equipped with entertainment systems for watching movies or videos to keep them from getting bored.

How long does each session take?

Each treatment session takes approximately 1.5 to 2 hours to complete. Additionally, the time to pressurize and depressurize the treatment chamber is around 10 to 15 minutes each.The number of sessions can vary between 20 to 40, depending on the diagnosis or the condition. Decompression sickness can be treated with 1 or 2 visits to your clinic. Damage due to radiation or bacterial infections can require 30 or more visits.

Therapeutic Effects of HBO Therapy

Hyperbaric Oxygen Treatment in India can be used to treat all conditions and diseases that can be cured by the use of increased oxygen supply to the affected tissues.The following medical conditions that are covered by medi-claim or health insurance in India can be treated by HBOT:

  • Air or gas embolism
  • Poisoning from carbon monoxide
  • Central retinal artery occlusion
  • Intracranial abscess
  • Sickness due to decompression
  • Diabetes
  • Diabetic foot wounds
  • Anaemia or excess blood loss
  • Gas gangrene
  • Thermal burns
  • Osteoradionecrosis and Radiation Tissue Damage
  • Osteomyelitis (Refractory)
  • Skin grafts and flaps
  • Mucormycosis
  • Spinal cord injury
  • Radiation tissue damage

HBOT can also be effective in the following conditions, which are not covered under any health insurance in India:

  • Autism
  • Cerebral Palsy
  • Migraine
  • Multiple Sclerosis
  • Sport injuries
  • Brain trauma injury
  • Depression

Hyperbaric Oxygen therapy in India

There are a number of established hyperbaric oxygen therapy centres operating now in India. Based in Delhi, Clinicounselors provides an established team of doctors and medical counsellors attached to a wide range of hospitals.  This team is best qualified to recommend to their patients the best suited treatment options including Hyperbaric Oxygen therapy and Stem cell therapy. The medical professionals in Clinicounselors are also particularly focussed on recommending the right hyperbaric oxygen therapy for autism cases in India.


slide4

Muscular Dystrophy Treatment in India

What Is Muscular Dystrophy ?

Muscular Dystrophy (MD) a genetic (inherited) disorder of muscles. Muscular dystrophy causes the muscles in the body to become very weak. The muscles break down and are replaced with fatty deposits over time.
Some forms of Muscular Dystrophy are seen in infancy or childhood, while others may not appear until middle age or later.
About 1 out of every 3,500 to 5000 boys is born with Muscular Dystrophy.Other health problems commonly associated with muscular dystrophy are:
Heart muscle problem or Cardiomyopathy

Scoliosis – a lateral or sideways, curvature and rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side Obesity

Definition of Gene :

Every cell in any living being has a nucleus built up of numerous pieces of information. These particles are called genes, and comprise a set of instructions that determine what the organism is like, its appearance, how it survives, and how it behaves in its environment. Many genes make a chromosome. Many chromosomes make a nucleus, one of which governs each cell in a body.

What is called Genetic or Inherited Disorders :

A Genetic or Inherited Disorders is an illness caused by abnormalities in Genes or Chromosomes. Variations within the DNA sequence of a particular Gene affect its function, and may cause or predispose an individual a particular disease which transmitted with the generations.

Different type of Muscular Dystrophy :

Duchenne’s Muscular Dystrophy (DMD)

Becker’s Muscular Dystrophy (BMD)

Emery- Dreifuss Dystrophy (EDD)

Facioscapulohumeral Dystrophy (FHD)

Scapuloperoneal Syndrome

Oculopharyngeal Dystrophy

Congenital Muscular Dystrophies

Kearns-Sayre Syndrome

Myotonic Dystrophy

Limb-Girdle Muscular Dystrophies (LGMD)

Duchenne’s Muscular Dystrophy (DMD) :

Duchenne muscular dystrophy is caused by an X-linked recessive gene. “X-linked” means that the gene causing the trait or the disorder is located on the X chromosome. Genes on the X chromosome can be recessive or dominant, and their expression in females and males is not the same because the genes on the Y chromosome do not exactly pair up with the genes on the X. X-linked recessive genes are expressed in females only if there are two copies of the gene (one on each X chromosome). However, for males there only needs to be one copy of an X-linked recessive gene in order for the trait or disorder to be expressed. For example, a woman can carry a recessive gene on one of the X chromosomes unknowingly, and pass it on to a son, who will express the trait or disease.

Symptoms of DMD :

a) Symptoms usually appear in male children before age 6 and may be visible in early infancy

b) Early signs may include enlargement of calf and deltoid muscles, low endurance, and difficulties in standing unaided or inability to ascend staircases

c) Gower’s manoeuvre (See next slide)

d) Contractures of hip, knees & ankles become severe when relatively untreated child spends much of the day in wheelchair

e) Hips & Knees are locked at 90 degrees & feet turn downward & inward in an exaggerated position of equinovarus

f) With development of severe scoliosis, resp fn becomes compromised

g) Cardiac inv : degeneration & fibrosis of posterolateral wall of lt.ventricle

h) Mental impairment is common. IQ is 1 SD below the mean

Gower’s Maneuver:

banner

Diagnosis of DMD :

a) Heart testing – electrocardiography (ECG)

b) Muscles charting to diagnose activity and efficiency of the muscles

c) Mutation analysis of DNA testing (Genetic Tests: Exon skipping) and Muscle Biopsy for Dystrophin level from peripheral blood leukocytes which confirms the deletion of dystrophin gene

d) 30 % of pts in whom deletion is not found , Muscle Biopsy is required to establish absence of dystrophin

e) Creatine phosphokinase (CPK) a simple blood test. When the total CPK level is very high, it usually means there has been injury or stress to muscle tissues

f) Western blot analysis of muscle biopsy to find reduced amount or abnormal size of dystrophin

g) Electromyography (EMG) nerve testing

Treatment options for DMD :

a) Physical Therapy : aim : to keep joints as loose as possible. Commenced at 3-4 yrs of age , when parents are taught to stretch child’s heel cords, hip flexors, iliotibial bands on daily basis

b) Night splints can be considered

c) Bracing : appropriate use of bracing – delay child’s progression to wheelchair by approx 2yrs

d) Surgery : Reconstructive surgery of the leg often accompanies bracing. The purpose : to keep leg extended & prevent contractures of iliotibial bands & hip flexors

e) Percutaneous tenotomies of Achilles tendon, knee flexors, hip flexors and iliotibial bands

f) Pharmacological : Prednisolone improves muscle strength & Deflazacort-Synthetic Steroid

Why Stem Cell therapy may be an option for Muscular Dystrophy Treatment in India?

There are half a dozen drugs in clinical trial Stage II or Stage III. This means that they are still a few years away from commercial availability. Today’s DMD patient must survive in at least moderate severity stage but not sever state in order to qualify for the use of future drugs. To enable as many DMD patient as possible to remain in treatable stage the only option left is Stem Cell therapy. They may be experimental and clinical study stage but they may offer benefit within three months at an affordable cost compare to what the new therapies will cost. The main stem-cell-based approaches currently being investigated are:

Producing healthy muscle fibres: Clinicians hope that if stem cells without the genetic defect that causes DMD can be delivered to patients’ muscles, they may generate working muscle fibres to replace the patient’s damaged ones.

Reducing inflammation: In muscular dystrophy damaged muscles become very inflamed. This inflammation speeds up muscle degeneration. Clinicians believe certain types of stem cells may release chemicals that reduce inflammation, slowing the progress of the disease.

Muscular Dystrophy Treatment

Counseling
Assessment and Muscle charting
Genetic Diagnostic
Physiotherapy
Assistive devices
SCT Regenerative Medical Intervention(Experimental)
Research work (Clinical Case Studies)


slide12

Cerebral Palsy Treatment in India

What is Cerebral Palsy

Cerebral Palsy (CP) is a Neurodevelopmental Disorder affecting about 1 to 4 children per 1000 new born, characterized by abnormal low or high muscle tone along with inadequate control over muscles, associated with variable disability in Cognitive abilities, hearing and sight, and sometimes autism like behavior. There has been no change with modern medical advances in reducing the incidence of CP but with Cerebral Palsy Treatment in India has seen advances. Earlier, CP was thought to be mainly due to poor obstetric care and management, but epidemiological studies have refuted this.

Main Causes

Brain damage before, during or within 2 years of child birth causes CP

Maternal infection, diabetes, high blood pressure, Hypothyroidism

Birth trauma or asphyxia

Post-partum brain trauma or severe infection.

Disturbance or inadequacy of Umbilical Blood Supply

Other Causes

Multiple gestation,

Prematurity,

Low birth weight,

Genetic (?) thrombophilic disorders

Fetal inflammatory response to viral or bacterial infections during pregnancy

Intrauterine abnormal fetal cytokine responses, etc.

  • Gibson, Catherine S et al, Obstetrical & Gynecological Survey:2003; 58(3): 209-220

 

 Is Genetics involved?

There is increasing evidence that Genetics is not entirely to be ruled out in cases of CP, as some reports show.

Child homozygous for the thrombophilic factor-V Leiden (fVL) mutation develop hereditary clotting tendency in many organs including brain. This may cause CP.

  • KH Harum et al, Developmental Medicine & Child Neurology, 1999, 41(11): 777-780

Argininemia is a treatable genetic cause of progressive spastic diplegia simulating cerebral palsy

  • AN Prasad et al, J Child Neurol August 1997 vol. 12no. 5 301-309

High quality Brain MRI may show important diagnostic clues in distinguishing genetic-metabolic disorders from other causes. Hypoxic-ischemic encephalopathy at the end of a term gestation, produces a characteristic pattern of hyper intense signal and atrophy in the putamen and thalamus.

 

Signal abnormalities & atrophy of brain parts in the putamen, globus pallidus, or caudate can point to genetic-metabolic diseases, including disorders of mitochondrial and organic acid metabolism.

  • AH Hoon et al, J Pediatr 1997;131:240-5)

 

Comprehensive Assessment for CP

Assessment should be comprehensive considering the total child and his normal environment. It includes the following, in a child-specific need

Gross motor function

Fine motor and hand function

Postural reactions

Handwriting assessments

Cognitive and perceptual assessment

Play assessment

Social skills assessment

It is not out of place to remind that CP is not just a Motor Associated Problem. It is associated with:

Speech Impairment –    in about 25%

Visual Impairment –       in about 25%

Mental Retardation –     in > 25%

Sensory Dysfunction –   in about 2%

Neurological association with function

Part of Brain  Function regulated Age
1: medulla moving arms and legs birth
2: pons cross-pattern crawling 3m
3: midbrain creeping 6m
4: cortex walking with arms in a primary balance 12m
5: cortex walking free from primary balance 18m
6: cortex: crosspattern running 36m
7: cortex: using a leg in a skilled role, consistent with the dominant hemisphere 72m

Scales for Examination and Assessment of Disability

There are many types of measurement scales used to assess the ability of the child on various parameters, not all perfect, especially those for Special Education and Speech, since:

The child may understand but be unable to perform

The child may be able to perform only if he/she could understand

A variable degree of dysfunction and inadequacy of both.

However, the following scales are often used by specialty centers

Muscles tone (on Modified Ashworth’s scale)

Deep tendon reflexes / Primitive reflexes

Ankle / Patellar clonus

Tightness / Contracture/ Deformities

Voluntary motor control

Balance / Equilibrium

Hand functions

  • Pre –writing skills

GMFCS
(Gross Motor Functional Classification System)

  • This is a classification System for classifying disability as per age into five classes, from 5 as severest form to 1 as mildest form.
  • Therapy induced change by even one level to higher level (= lesser number) is significant

GMFM
(Gross Motor Functional measurement)

GMFM done on 88 parameters shows motor abilities in five domains in lower limbs:

  1. Lying & Rolling
  2. Sitting
  3. Crawling & Kneeling
  4. Standing
  5. Walking ,Running & Jumping

GMFM done on 66 specific parameters gives an overall score of serial changes in lower limb action.

QUEST
(Quality of Upper Extremity Skills test)

  • Givew results similar to GMFM, but for upper extremity.
    1. Shoulder items
    2. Elbow items
    3. Wrist items
    4. Finger Movements
    5. Grasps

Other common tests

  • REEL for Speech, Language & Communication ability, and BASIC MR, FAB, ADOS, RUTH-GRIFFITH, etc. give an idea about Special Educational parameters. However, they are not mathematical like GMFM & QUEST.

Management

HOME BASED THERAPY PROGRAM

Positioning

Weight Bearing (if needed)

Active ROM exercises of all joints 5 times each joint

ADL & Hand Function to eat properly, hold and release properly, dress and undress properly, signal for or independently perform toilet needs

Standard Rehabilitation Therapy

Physiotherapy for strengthening the body and mobilizing bones and joints

Occupational Therapy to teach the body proper way to function and work

Speech, including Oro-motor Therapy to exercise all structures of breathing, eating and phonation. It includes sucking, chewing, swallowing, saliva drooling control, soft and hard palate control, solid and liquid ingestion, and THEN speech development

Special Education to increase the ability of the child become self-reliant, and a useful member of family, society and country, ability dependent education, coaching Activities of Daily Living (ADL), Potty training, dressing and undressing hand function, eating, etc.

Psychological Counselling and guidance to both the child and parents.

  • Make the parents realize that they have a very important role to play TOGETHER to give their child the best fighting chance in life.
  • That Rehab must continue till bone growth stops (M-21, F-18)

 

Established or Off-label Experimental Early Medical Intervention Therapies

Botox injections give 4 to 6 months of relief from spasticity, and then may need to be repeated or supplanted by Tendon Lengthening Surgery.

  • No cognitive or communication improvement

Acupuncture/Acupressure

  • Gives some improvement in motor control. It is cost-effective when done by a TRAINED therapist. However, it also only provides muscle relief for the duration of therapy.

Selective Dorsal Rhiozotomy Surgery is a skilled brain operation to permanently cut some of the fibers that are causing spasticity, to reduce the symptom on a long term basis. However, here also, no other brain function is improved.

Corrective Surgery is done to lengthen contracted muscles when all other means have failed to straighten the limb, in order to protect damage to the articular surface of bones at the affected joint. Combined with proper Physical Therapies, it is a highly successful surgery to restore gait and movement in intractable contracture. This is different from Polio deformity correction surgery where total correction is done. In CP, doing that would lead to unstable floppy joint function. Correct degree of release is a matter of careful judgment based on experience.

Bramhi, an ancient Indian Ayurvedic / Unani plant extract formulation restores brain dysfunction and damage to an extent, including cognitive ability. However, the preparation needs a very careful manufacturing protocol to ensure a purified standardized extract with correct ratios of specific adjuvant plant extracts as per ancient literature, to achieve the desired potency and efficacy.

Hyperbaric Oxygen Therapy (HBOT) uses Henry’s Law of Physics that stipulates that the solubility of gas in water increases with pressure. The patient with hypoxic or severely inflamed tissues anywhere in the body, including brain is put inside a pressure chamber which is inflated to achieve a pressure of 11 to 16 feet of water (1.3 ATA to 1.5 ATA) and made to breathe ambient air or variable concentration of oxygen as per need. The damaged but not dead tissues get the lifesaving oxygen to revive back into function. The benefits of HBOT can be summarized as follows:

  • Enhances microcirculation and increases new blood vessel formation
  • Marx, RE. Am J Surg, 11/90; 160: 519-24
  • Manson, PN. Surg Forum, 1980; 31: 564-66
  • Improves ischemic tissue oxygen capacitance
    • Siddiqui, A. Plast Reconstr Surg, 1997; 99: 148-55
  • Reduces inflammation and edema
  • Mobilizes Bone Marrow Stem Cells
    • Thom, SR. Am J Physiol Heart Circ Physiol, 2006;290:1378-86.
  • Speeds rate of wound/damage repair
  • Stimulates hibernating / dormant resident stem cells into activity to initiate auto-repair
  • Enhances Neuro-Plasticity and normalizes of metabolic apoptosis & DNA signaling
    • P Harch, Neural Repair & Neuro Rehabilitation Conf. (NR2CON), Ind. Inst. of Technology; Delhi; Sept. 2007
  • Increased Fibroblast Proliferation
    • Hehenberger, K. Wound Rep Regen, 1997; 5: 147-50
  • Increases Bone Mineral Density & Healing
    • Ueng, SWN. J of Trauma; Injury , Infection & Critical Care, 1998; 44(4): 676-81
  • Increases Epithelialization
    • Uhl, E. Plast Reconstr Surg, 1994; 93: 835
    • Manson, PN. Surg Forum, 1980; 31: 564-66

Stem cell Therapy

  • Stem cells are the remnant colony of the original germ cells that gave rise to the person. Hence they are called Master Cells of the body. Undifferentiated cells that have the ability to divide & differentiate into many other cell types. They are distinguished from other cell types by two important characters
  1. Capable of renewing themselves through cell division, sometimes after long periods of inactivity.
  2. Can be induced to become tissue or organ specific cells with special functions, like cartilage, liver tissue, heart muscle, pancreatic tissue, nerve tissue, blood cells etc.
    • Embryonic Stem Cells are obtained by killing a fetus and obtaining stem cells from its various tissues. It is associated with many legal, religious, moral and ethical issues, hence generally looked down upon. They can make a very wide variety of tissues.
    • Stem cells obtained from an adult or a child after birth, hence more acceptable. They are called “Adult stem cells”. They have limited functionality, meaning specific stem cell types can only mature into a selected number of tissue types.
    • Mechanism of Action: Different source and different types of stem cells exhibit the following benefits:
      • Glial derived neurotrophic factor (GDNF) release can rescue neurons from a lack of oxygen and help repair of brain white matter
      • Specific types of stem cells enhance the release of Neurotrophin 3 (NT-3) Nerve Growth Factor (NGF) and Brain Derived Neurotrophic Factor (BDNF) to stimulate growth of new neurons.
      • Stem cells support existing injured neurons by attaching to them. This type of “cell fusion” may be more efficient than creating new neurons in cases where neurons may have hundreds of synapses already established
      • Stem cells stimulate VEGF (Vascular Endothelial Growth Factor) release that promotes growth of new neurons to repair and replace injured brain tissue.
      • Some types of stem cells have been found to give rise to a small percentage of neurons that can repair the gray matter of the brain and spinal cord.
    • Help balance the immune system and autoimmune disorders.
    • Relax the artery walls which promotes improved blood flow.
    • Safety of adult stem cells has not been questioned seriously so far in spite of many decades of use (in marrow replacement therapy for blood cancer). However, the use of embryonic stem cells has been noted to cause tumor growth after 4 to 6 years in a very small number of patients.
    • Intensive Standard Therapies THROUGHOUT is mandatory for optimum benefit.
    • Follow up to show efficacy requires 2 monthly checkup for at least 2 years, with the first few months under close supervision of the medical institution.

Repetitive Transcranial Magnetic Stimulation Therapy (rTMS).

    • rTMS uses an electromagnetic coil to give stimulation in a pulsed manner to specific affected parts of brain.
    • The intensity and duration of stimulation, number of pulses per sitting, number of sittings and duration of time in-between one round, is still under investigation.
    • rTMS reduces muscle spasticity and may have a slight beneficial effect on Cognitive skills as well.

 


slide7

Autism Treatment in India

What is Autism ?

Autism is a complex mental developmental disability that affects an individual in the areas of social interaction and communication. Autism is a spectrum disorder that affects each individual differently and to varying degrees of severity.Autism tends to occur more frequently than expected among individuals who have certain medical conditions, including Fragile X syndrome, tuberous sclerosis, congenital rubella syndrome, & untreated phenylketonuria

Childhood Autism

Children born apparently normal, but then begin to deteriorate by age of 1 to 2

These children may have some speech developmental and social interactive regression, usually around 18 months of age.

The diagnosis of childhood autism must meet the specific DSM IV criteria and will therefore present with poor eye contact, pervasive ignoring, language delay, and other featuresbut today our scientist find the autism treatment in India.

As per definition, these children will have a severe impairment in speech, communication, or social interaction. Many of them will be completely non-verbal & “in their own world.”

A brief Flow Chart of causes Autism

chart1

A brief Flow Chart of causes Autism Contd…….

 

chart2

 

Can autism be reliably diagnosed before 36 months of age?

No biological markers so screening focus on behavior

Problems with eye contact

Joint attention

Pretend play

Imitation

Nonverbal communication

Delayed language development

Orienting to one’s name

Measurable by 18 months of age.

Current screening methods may make it difficult to identify children with milder variants of autism, those without mental retardation or language delay, such as verbal individuals with high-functioning autism and Asperger’s disorder, or older children, adolescents, and young adults.

Earliest Suspicion when CURE possible

Lack of acquisition of the following milestones within known accepted and established ranges is considered abnormal:

no babbling by 12 months

no gesturing (e.g., pointing, waving bye-bye) by 12 months

no single words by 16 months

no 2-word spontaneous (not just echolalic) phrases by 24 months
any loss of any language or social skills at any age

Diagnostic Tools we plan to use

Checklist for Autism in Toddlers (CHAT-23) for 18-month-old infants

Pictorial CHAT, to be filled in by parents

Childhood Autism Rating Scale (15 Point)

Form E2 of Autism Research Institute

Patient Rating Scales

Strategies for management/Treatment

Cerebral Hypoperfusion:

HBOT

Neuro-inflammation and GI Inflammation:

GFCF Diet and allergy/infection control

Neurotransmitter Abnormalities:

Micronutrient support & MB12

Mitochondrial Dysfunction:

HBOT & MB12

Immune Dysfunction:

HBOT

Oxidative Stress:

MB12, Selenium, Vit. A, C, E, Se, Glutahione

Autism Treatment

Counseling
Assessment and Diagnostic
Biomedical Therapy
ADLD Training
Assistive devices
Workshops for patients and parents
MB12 Treatment
Hyperbaric Oxygen Therapies
SCT Regenerative Medical Intervention (Experimental)


slide

Stroke Treatment in India

Stroke

  What is it? • Sudden disruption of blood flow in one or more parts of brain causing loss of function of that area.Causes:

• Bursting of a blood vessel or its blockage due to local or migrating blood clot.

• Unless treated vigorously and immediately, the outcome may be fatal.

Outcome

• The cells in the brain may quickly begin to die. The result can be serious disability or death.

Types

TIA: Transient Ischemic Attack• Temporary loss of function of brain due to sudden blood flow disruption caused by arterial spasm (as due to tobacco use) or minor clot that the body manages to dissolve and wash away.Stroke: Thrombotic and Embolic/Hemorrhagic types

• Gradually progressive loss of power & sensations in one half of body over a day or two, due to development of Thrombus (clot) over a fatty deposit on the vessel wall.

• Sudden loss of power & sensation due to migrating clot (Embolus) blocking a blood vessel or rupture of an artery at a vulnerable spot (aneurysm / ballooning of an artery)

Features

Loss of power in one or more parts of body on the side opposite to that affected in brain. Muscles may be floppy when the lesion is fresh, but soon spasticity develops in the affected side. Tickling the sole of the affected foot causes the big toe to go up (Babinski sign).

Sensory and involuntary muscle function loss.

Investigation

Clinical assessments of neurological deficits & dysfunctionsMRI Scan (top) to show anatomical extent of stroke injurySingle Photon Emission CT (SPECT: Bottom image) to show functional status of injured brain

• Blue/black: dead area;

• Green: badly damaged, difficult to revive

• Yellow damaged but revivable;

• Red: normal tissue)

Electro Encephalograph (EEG) if there is epileptic fits.

Immediate Management

Regulate blood pressureDrugs to reduce brain swellingDrugs to enhance metabolic activity in brain to help it recover faster

Drugs to prevent blood clotting (as that is the commonest cause of stroke)

Strict control of lipids, blood sugar and diet.

Nursing care to prevent bed sore and help in toilet

Physical Therapies to preserve muscle tone, function and power

Specialized Management

Clot busting infusionsBlocking aneurysmsRemoval of fatty deposits (plaques) if artery is approachable.

Control of heart rhythm, as abnormal rhythm promotes clot formation.

Blood vessel wall anti-inflammatory agents like Statins

Specialized therapies like rTMS, Pulsed Magnetic Field Therapy, Gyrosonics, etc. may sometimes work

New Experimental Therapy

Hyperbaric Oxygen Therapy, at a pressure and oxygen level to suit the severity and extent of lesion as per SPECT Scan, for 90 minutes per session, for a number of sessions equal or greater than 40, as per clinician’s judgment.• There are a lot of Inclusion and Exclusion Criteria that must be fulfilled before HBOT is attempted, that too, under expert guidance under an expert in this mode of therapy.Regenerative Medical Therapies are under Experimental Clinical Trial stage.

 

Stroke Treatment in India

Counseling
Diagnostic and assessment
Physiotherapy
Need based rehabilitation
Pharmacological Intervention
Surgery to remove blood clots
Surgery to repair blood vessels
Surgery to remove plaque from the carotid artery
Carotid angioplasty and stenting
Coiling aneurysms
Hyperbaric Oxygen Therapy
SCT Regenerative Medical Intervention (Experimental) & Clinical case studies

 


slide17

Trauma to the brain can cause damage and loss of viable brain tissues. This is referred to as TBI or Traumatic Brain Injury.

TBI is brain damage caused by concussion, pressure or direct projectile injury to the brain tissue.

It may be caused by a variety of reasons

• Vehicular accident

• Severe fall

• Mugging, boxing, sports trauma, murder attempt.

• War injury (bomb blast), gun shot wound, etc.

• Wrongly applied forceps for obstructed delivery.

Injury to brain inside part of skull traumatized

Injury also to brain on opposite side of brain due to soft brain hitting opposite side hard skull cavity due to counter shock.

Central core of injury has dead or near dead brain unlikely to be revived as of today.

Surrounding it is a wide zone of injury, hypoxia, inflammation and function loss: Penumbra.

This penumbra is capable of being revived.

avatares-del-equipo-de-negocios_23-2147506107

The color code is given as a bar on the left:

White to red: normal

Yellow to green: low blood perfusion

Blue to black: very low blood perfusion or dead unrevivable brain

tbi3

Dizziness Stupor Coma depending on severity and site of lesions
Loss of function of affected brain:

• Memory, intelligence, socializing skills

• Emotion, behavior, speech, vision

• Sensory loss of one or more types

• Motor loss: both voluntary and involuntary

• Psychological disturbances: anxiety, depression and even criminal tendencies.

History of Trauma

Scales of assessment, as per individual need:

• Glasgow Coma scale

• Modified Ashworth Scale for muscle tone

• Walking time

• Various types of Psychological & Cognitive scales

Brain Scans: CT, MRI, SPECT, PET, etc

OR

Specialized: 3-D CT-SPECT Fusion Scan, DSI, fMRI

• EEG

Need based life support

Need based drugs like Mannitol, citicholine, steroids, anti-epileptics, muscle relaxants, vasoprotective agents, memantadine, etc.

Rehabilitation esp. Physical, Psychological

HBOT

Regenerative Therapies

Traumatic Treatment

Counseling
Diagnostic and assessment
Physiotherapy
Need based rehabilitation
Pharmacological Intervention
Craniotomy
Decompressive craniectomy
Tracheotomy
Percutaneous Endoscopic Gastrostomy Tube (PEG)
Hyperbaric Oxygen Therapy
SCT Regenerative Medical Intervention (Experimental) & Clinical case studies