Hyperbaric Oxygen Therapy To Improve Decreased Oxygen Supply To The Human Brain

Autism is a neurodevelopmental disorder marked by impairments in communication, social interaction, and restricted/repetitive patterns of behavior or activities. The symptoms are easily detected during the early developmental period of a child causing impairment in occupational and social aspects essential for various normal daily functions.

Autism is caused by genetic and environmental risk factors such as high consumption of drug and alcohol, history of autism in immediate family members, prenatal and postnatal factors, and exposure to metal, arsenic, and toxin. Each individual displays different symptoms varying in severity. Cerebral inflammation, oxidative stress, and immune dysfunction are few of the other conditions associated with autism.

A range of therapies (speech therapy, pet therapy, art therapy, occupational therapy, physiotherapy, etc.) and medical management have been proposed to treat symptoms of autism. Hyperbaric oxygen therapy for autism (HBOT) is an alternative treatment recommended for treating autism symptoms. Is HBOT safe for children?

HBOT Treatment

Hyperbaric oxygen therapy is recommended for individuals with autism and also for those who have reduced oxygen supply to their brains. For autism, there is an increased demand for evidence‐based treatments. No therapies can completely treat individuals on the spectrum. Hyperbaric oxygen therapy for autism can help in reducing the biochemical dysfunction and symptoms of autism.

For HBOT, the individuals are provided with a higher concentration of oxygen, delivered through tubes or in a chamber with atmospheric pressure higher than sea level. Inhalation of oxygen at ‘above-atmospheric level’ results in increased oxygen delivery to the brain.

For treatment, the therapists measure the inflammation and oxidative stress level, in children with autism, before and after hyperbaric oxygen therapy. Hyperbaric oxygen therapy for autism has no/minimal adverse effects on people.



Hyperbaric oxygen treatment has proved effective in:

  • Managing the core symptoms of autism including repetitive behaviour and social communication problems
  • Diminishes the challenging behaviours
  • Provides relief from stress, depression, and anxiety

Thus, the goal of hyperbaric oxygen therapy is to provide an adequate supply of oxygen to the brain, ease inflammation and to manage autism symptoms. It helps in improving eye contact, communication, social skills, and level of perception.

Side Effects

Fatigue, claustrophobia, and headaches are side effects linked with hyperbaric oxygen treatment. In rare cases, temporary short-sightedness and sinus are also detected. It is therefore advisable to consult a trained therapist with experience in treating people with hyperbaric oxygen treatment.

Many children reportedly showed improvements in measures of behaviour such as stress and anxiety.

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Developing Essential Skills With Speech And Art Therapy

Individuals with autism have different challenges in areas such as communication, behaviour, and social skills. They find difficulty in initiating a meaningful conversation and inability to decipher facial expressions. They find difficulty in making friends and understand social cues. Some people with autism may not talk at all, and others may talk very well, at times even knowing what they say.

Children as well as adults with autism have restricted interest and indulge in repetitive action and speech. Some of them can memorize their favourite ad or song which they repeat fluently. They have the tendency to get attached to certain objects or activities and show interest in music or a television show.

Sudden changes in their schedule are something that they react aggressively.

Diagnosing Autism

Diagnosing autism is done by a professional team of doctors, neurologists, speech-language pathologists, and psychologists. An audiologist also does tests to assure that the individual does not have hearing loss.

Most of the individuals with autism face social-communication challenges due to inadequate vocabulary. With speech therapy for autism, the therapists can figure out the best treatment options to ease the challenges and severity of speech/communication disorders.

Treatments For Communication Disorder

Autism cannot be completely cured. Early intervention programs or therapies are preferred for a quick and pleasant result. Through speech therapy for autism, the therapists help to build communication and social skills in sessions conducted in groups or at home or school. Group sessions allow individuals to practice skills together and experience pleasant interaction and bonding.

Role of Speech Therapists

Once autism is diagnosed, speech therapists employ various techniques to improve communication and speech skills. This helps in enhancing the quality of life in individuals with autism.

Some of these techniques include:

  • Apps and electronic ‘talkers’
  • Picture exchange communication systems that use picture cards to help a child learn to communicate
  • Massaging the lips and facial muscles to improve articulation of speech
  • Encouraging the individuals to speak (in shrieks or hoarse voice) in a composed sing-song manner. This helps in releasing the built-in stress

The goals of speech therapy for autism include helping to:

  • Understand and develop both verbal and nonverbal communication
  • Articulate words well
  • Indulge in a two-way conversation
  • Communicate without prompts from others
  • Know where to use words such as please, thank you, good morning and sorry
  • Enjoy playing and interacting

Early identification and intervention during childhood stage, improves the ability to grasp spoken language and learn communication skills.

Art Therapy Treatment For Autism

People with verbal or non-verbal limitations show great skills in other areas. If exposed to the use of artistic media, such as a canvas, paint, pencil, and brush, it helps in building a wide range of skills. They feel more comfortable expressing their feelings and desires more effectively than in a spoken language form. Art therapy for autism offers an opportunity for therapists to build a wide range of skills when working one-on-one with individuals.

Thus, art therapy for autism is a useful tool for helping children release their inbuilt emotions through strokes, lines, and colours.

 What art therapy does for individuals?

Art therapy for autism opens various opportunities for individuals with artistic flair and an opportunity to bond with other participants. Some of the other benefits include:

  • Enhanced imagination power and the capability to think symbolically
  • The ability to recognize facial expressions
  • Improvement in managing sensory issues such as accepting the texture or the stickiness of paints, coping with the scratching sound made by the pencil or brush
  • Improved fine motor skills

Speech and language therapists are qualified people having a specific experience working with individuals with autism. To find a speech therapist near your vicinity online, click here

The Early Signs Of Autism

Children with autism exhibit developmental differences in their behaviour, social and language skills as they reach their second birthday. Some of them sit, crawl or walk on time, but changes in the progress in their language, body gestures and avoidance of eye contact often go unnoticed by parents. Along with these early signs of autism in children, they display other behavioural differences such as loss of interest while interacting with peers.

Identifying The Signs Of Autism

Children on the spectrum lack in social, communication, and behavioural skills. Some of the symptoms of autism or differences in their conduct that need immediate attention are:

1. Social Differences 

  • Make little or no eye contact when addressed
  • Fail to decipher facial expressions and gestures
  • Do not point out objects of personal interest
  • Do not show appropriate facial expressions
  • Show concern or empathy for others
  • Prefer to stay alone even when in a group
  • Uninterested in making friends

2. Communication Differences 

Some of the early signs of autism in children that indicate a lack of communication skills are:

  • Do share things such as toy and games with others
  • Do not speak single word/words, even when they complete16 months of age
  • Imitate or repeat exactly what they hear or see (parroting or echoing) without understanding the meaning
  • Do not respond when called by name
  • Show no desire to communicate or take part in a conversation
  • Do not indulge in ‘pretend play’ using toys to represent people around them
  • Some children have a good rote memory for numbers and can easily memorize songs or advertisements aired on radio or TV

Some of the children go into regression and lose their language and other social milestones, between the ages of 15 and 24 months, if not treated.

3. Behavioural Differences – Repetitive, Compulsive or Obsessive Behaviors

Obsessive and repetitive behaviour disorder is considered an anxiety disorder that individuals with autism experience through repetitive thought and action. Some of the behavioural disorders that differ from person to person are:

  • Rocking, hand-flapping, finger-flicking, walking on toes, jumping or twirling
  • Prefers a fixed routine. The slightest change or transition can upset them easily
  • Obsessed with parts of their toys (wheels of a car, neck or limbs of a doll) rather than the whole toy
  • Do not feel pain when hurt
  • Children with autism are sensitive to touch, sound, light, smell, and sound

There is no cure for autism. Still, various interventions help in diminishing the dire symptoms. For treating symptoms of autism such as social, behavioural and communication (verbal/non-verbal) skills, successful approaches and trained therapists are required. Therapies like occupational therapy, applied behavioural analysis, speech therapy, and art therapy are some of the main tools for building lost skills.

Medical Management – Relief From Recurring Symptoms

Some of the medical conditions in people with autism can be treated with medicine. This medical management of autism can improve their health and quality of life.  

A clinical approach for autism includes the confirmation of autism diagnosis and the intensity level of core behavioural symptoms. The behavioural symptoms need several treatment options, including therapies that include occupational therapy. This therapy improves fine motor skills, self-help abilities, and also treat various sensory issues (touch, vision, noise). 

Gastrointestinal conditions, epilepsy and sleep problems occur more frequently in children with autism. Medical management for autism is a symptomatic approach aimed at treating the underlying core symptoms. Several medicines benefit children on the autism spectrum when other options fail. They do not treat autism completely, but offer relief from recurring symptoms. 

Medication Options 

There are medications for treating antipsychotic conditions, attention deficit hyperactivity disorder (ADHD) symptoms, and also antidepressants and anti-psychotic conditions. They do benefit the children but fail to treat the developmental syndrome of autism. 

Antidepressant and Anxiety Medication

Children with autism are challenged by anxiety or obsessive behaviours. These behaviours include the impulse to evade or run away from new situations, the fear of separation, and obsessive/neurotic behaviour that can cause a huge problem in their daily life. Anxiety in children is similar to ‘black-and-white’ thinking that can trigger self-injury, explosive temper and violent behaviours. They also develop depression, which may worsen if not treated with the right medication prescribed by a physician.

For antidepressant and anxiety symptoms, the prescribed medications are Selective Serotonin Reuptake Inhibitors (SSRIs) that include Citalopram, Escitalopram, Fluvoxamine, Fluoxetine, and Sertraline. These medications have been approved for children with autism. They help in easing obsessive thought, anxiety, and compulsive behaviours. Parents must closely monitor signs of side effects.

Antipsychotic Medicines

Medications like Risperdal or Aripiprazole are approved as the best way to manage bad temper. The doctors also prescribe these atypical anti-psychotics drugs to improve aggression and mood swings in children with autism. These antipsychotics are also beneficial in improving anxiety.

Along with potential benefits it also comes with the risk of side effects which include a threat of developing diabetes and weight gain among others. Blood sugar and weight must be regularly monitored in children consuming these medicines.

Thus, medical management of autism may benefit children with autism. The medicine not only treats a few autism traits, but also offers relief from common recurring symptoms. Parents need to decide which medications would be beneficial for a child’s life. Appropriate medications allow children to move forward in their lives.

Improvement In Sensory Profile Post Sensory Integration Therapy For Autism

Sensory processing dysfunction is a known symptom of autism. Individuals are either over or under-sensitive to the five senses – light, sound, smell, taste, and touch. Their hyper or hypo reaction to the sensory input make them react indifferently to pain, extreme temperature, adverse response to sounds, smell, specific textures, visual lights, etc.  

Sensory Processing Dysfunction 

Children with autism, apart from facing challenges in other areas, are sensitive towards noise, light, and touch. This sensory dysfunction in children interferes with their ability to perform many ordinary actions in their daily life. They appear to avoid the screeching sounds made by the chalk when rubbed on the board or evade wearing a shirt of a particular colour. They may at times injure themselves and not even be aware of the pain and body harm. This sensory processing dysfunction can be managed with sensory integration therapy.

The Sensory Inputs

Some of the sensory inputs seen in children with autism are:

Visual Input

  • Look beyond a person’s face
  • Bump into people or things as they misjudge spatial relationships
  • Inability to locate a toy from a cluster

 Auditory Inputs

  • Runaway from loud noise
  • Cover ears in an area where there are many people
  • Prefer either very loud music or none at all 
  • Scared of the noise made by the toilet flush

  Touch or Physical Input

  • Cringe when being picked up or petted
  • Do not react to pain caused by a fall or a cut
  • Avoid getting hands or feet messy 
  • Avoid touching certain textures 
  • Touch everything when walking
  • Do not react to extreme cold or hot surface 

    Taste and Smell 

  • Love eating only certain dishes
  • Smell everything that they touch
  • Hate strong smell
  • Breathe through the mouth instead of their nose

   Proprioceptive Input (the sense that allows the body to know where it is in space)

  • Walk touching walls
  • Fall or crashes into things
  • Walk with a stiff and uncoordinated gait
  • Crack knuckles
  • Apply pressure when writing

Vestibular Input (the inability to handle movement)

  • They are either ‘thrill-seekers’ or hesitant to take risks
  • Have extreme loose or tense grip on objects
  • Loose balance when climbing stairs
  • Cannot coordinate the movements of the eyes

Sensory  Ingegration Therapy For Autism

Sensory integration therapy for autism is based on whether the child is over-or under-stimulated by the environment. The therapy aims to help the brain to process sensory information. 

The purpose of the therapy is to help the child overcome the challenges through playful activities (play therapy, drama therapy, occupational therapy). This will make the child want to participate because the activities are engaging and full of fun.


Sensory integration therapy for autism is offered by trained therapists. They plan differently for each child according to their deficits.

Therapy to solve sensory issues involve activities that play an important role in organizing the sensory system. It delivers auditory, tactile, vestibular, and proprioceptive inputs. Specially designed recreational equipment is included to provide the needed relief.

  • Swinging in a hammock (feel the motion in space)
  • Music (sound)
  • Playing in boxes filled with sand or pebbles (touch)
  • Crawling through tunnels 
  • Hitting a swinging object (eye-hand coordination)
  • Balancing on a plank (poise/stability)

Sensory integration therapy stimulates the brain and improves the sensory processing systems. It also improves the child’s behaviour and maximizes his/her functional ability to perform daily activities. A significant improvement is observed in children in domains including cognitive, communication, motor skills, aggressiveness, and in their occupational performances.

Intervention Program: A Treatment for Autism Spectrum Disorder

Children diagnosed with autism spectrum disorder (ASD) show problems related to social, communication and behavior deficits. Known as a spectrum disorder, individuals with autism have either mild or severe symptoms. The type of treatment they receive depends on their individual needs. 

Early diagnosis coupled with effective intervention is vital for achieving the best possible future for children with autism. Diagnosis of ASD is possible from as young as six months and before the age of 3.  

Treatment Options For Managing The Symptoms

Different treatment options for autism spectrum disorder are applied to improve their social, speech and behavior deficits in individuals. These treatments depend on his/her individual needs, but the goal is to reduce the symptoms and enhance development.

The most effective treatment options for autism spectrum disorder are applied behavioral analysis (ABA), speech therapy, occupational therapy, physiotherapy, art therapy, medical management, etc. At times, a prescribed medication and diet plan also helps in managing their conditions. Intervention program works to minimize the impact of ASD symptoms and to maximize the functional and quality of life of individuals. 

Speech Therapy

Individuals with autism spectrum disorder have deficits in verbal and non-verbal communication. They also have trouble producing speech sounds, and their language, if present, is hard to understand. Speech therapy done under the guidance of a speech-language therapist helps individuals to express their needs or wants. Electronic talkers, picture communication programs, massaging lips or facial muscles to improve the articulation of speech are some of the useful tools implied by the therapist to improve communication abilities.

The speech therapy sessions assist the participants to understand both verbal and nonverbal cues such as tone of voice, facial expressions, and body language. The speech therapist work with family members, caregivers, and teachers to promote communication skill in the natural setting at home and school.

Occupational Therapy (OT)

The goal of occupational therapy is to improve social interaction, behavior, and to help the child lead an independent life.

Occupational therapy is useful in treating sensory integration issues related to autism. It refines the fine motor skills to help individuals in tying shoelaces, buttoning the shirt, combing hair, writing and cutting with scissors. It improves their quality of life and the capability to participate in day-to-day activities. Each occupational therapy program is based on goals to improve sensory integration, fine motor issues, enhance social behavior and independence.

Physical Therapy 

Apart from behavioral, sensory and communication difficulties, individuals with autism spectrum disorder also experience difficulties with motor skills. Physical therapy is one of the best treatment options for autism spectrum disorder to improve gross motor skills. It improves the muscle tone of the individuals and their ability to participate in activities (balancing, hopping, skipping or riding a bike) with more refined and sophisticated body control.  

The various treatments or therapies for autism are effective when integrated into the individual’s early intervention programs.

Chelation Therapy and Autism

Autism is a spectrum of disorders characterized by complications concerning social interaction, communication, and repetitive behaviors. The cause of this disorder is linked to gene mutation and the environmental conditions that include increased levels of toxic metals that clog the arteries and preventing the flow of fresh blood. Evacuation of these metals from the body by the use of therapeutic chelating agents may improve the symptoms of autism. These agents are injected into the bloodstream where they work to remove toxic metals from the body and easing the signs of autism.

Approval from a registered neurosurgeon is essential for chelation therapy autism treatment. Inappropriate way of infusion and incorrect dosage volume of chelation agents can incur serious side effects such as kidney damage.

Chelation Treatment

For chelation therapy for autism, the surgeons use chelating agents that include synthetic amino acid also known as ethylene diamine tetra-acetic acid (EDTA), Dimercaptosuccinic acid (DMSA), and 2-3- dimercaptopropane-1- sulfonate (DMPS. These agents are infused orally, through the skin or by an intravenous (IV) drip. In the bloodstream they bind with the molecules of harmful metals, eliminating them via urine. Post chelation therapy autism symptoms show improvement as healthy blood flow in the arteries is restored. 

Chelation Therapy For Autism Is Used For –

The chelation treatment is advisable for:

  • Treating arteries blockages by removing metal deposits and plaques effectively.
  • Treating painful leg cramps (claudication) caused due to narrowed arteries (arteriosclerosis) 
  • Treating and improving symptoms of neurodegenerative conditions such as autism

It is advisable to opt for chelation therapy under the guidance of a specialized doctor having the needed experience in treating individuals with autism. Before treatment, thorough diagnosis and blood tests are mandatory to detect the volume of toxic metals in the bloodstream. Regular monitoring of the person’s health condition must be maintained to detect even the slightest possibility of side effects and reactions after the therapy.

Chelation therapy for autism aims at flushing out levels of heavy metals like mercury and lead from the body. The individuals, who underwent the therapy, need to follow the doctor’s advice and take the prescribed medication regular until their urine levels are stabilized back to normal. 

How Does Assistive Technology Assist People With Communication Need?

The frustration of not able to communicate or express their wants can have a negative effect on individuals with autism. They may tend to stay aloof, throw tantrum and indulge in negative behavior

For autism, assistive technology can benefit individuals (of all age groups) in promoting communication and social interactions. Assistive technology refers to hand-held gadgets such as Tablets and iPhones which are light in weight and easy to handle. The touch screen and layout help to slide or tap instead of typing. These modified or customized assistive technology for autism helps in improving the functional capabilities and communication of individuals with others. It helps them to become independent by working on their challenges and improving undeveloped skills. 

 What is Assistive Technology?

Assistive technology for autism refers to a modified or customized device with assistive technology service, employed to increase or improve the functional skills of individuals with autism. As children with autism understand visual information better than audio information, assistive technology devices provide needed information through visual (pictures and videos). Therefore, ‘low’ tech to ‘high’ tech technology is incorporated to improve the functional abilities and skills of children with autism.

Various assistive devices are used to improve:

  • The overall understanding of their environment
  • Their expressive social interaction and communication skills 
  • The attention span
  • Their academic skills and performance
  • The self-help skills for improved overall daily functioning 

How does assistive technology help in managing communication skills? 

Communication Skills

People with autism experience a wide range of communication difficulties. Those who are totally non-verbal may face difficulty in understanding cues or the topic of the running conversation.


Mobile devices and tablets provide excellent solutions for people looking for assistive technology to help them with speech or language production. These small-sized portable electronic devices come with pre-recorded digitized speech output, instant messaging systems, images, and videos to help with communication.

A device with picture-cards collections including related words can be helpful for people struggling with a communication disorder or for those who have an issue with word-recall. For example, to express that he/she is ‘hungry’, the person can point at a related image to display his/her feeling.

Thus assistive technology assists those with communication problems through a device. People with autism can convey messages and attract attention using sound (tapping, banging, clapping, or cooing). Many of these communication devices are programmable, adjustable and are recommended for homes, classrooms, and public places.

Some Of The Signs Of Autism Seen In Children

Autism or autism spectrum disorder is a complex neurodevelopment disorder that is marked by social, behavior and communication difficulties in children. Being overly focused on certain objects, avoiding eye contact, and failing to involve babbling at a certain age are few of the signs of autism in children. Sometimes, they may appear to develop normally till reach age three, then become indifferent towards social engagement.

Sometimes, children with autism may sit attain their motor milestones (sitting, crawling, walking) at the right time, but may have developmental differences in their social and communication skills. They may show delays in spoken language and social interaction with their peers. Thus, children with autism have differences in their behavior, social, and communication skills when compared with those who are not on the spectrum.

Social Skills

Children with autism have problems with their social skills do not know how to engage with others and prefer to be alone. Some of the socially linked symptoms of autism seen in kids may include the following:

  • Avoid or make little eye contact
  • Do not reply to their name 
  • Show no emotion or facial expressions
  • Do not point out to objects of interest
  • Unable to understand the feelings of others by their tone or facial expressions
  • Have no concern or sympathy for others
  • Unable to make friends 

Communication Skills

Not every child with autism has a speech issue. Their ability to communicate depends on intellectual and social development. Children with autism are self-absorbed in their thoughts and unable to successfully communicate with others. As they have difficulty in language skills and understanding, they find it hard to interact verbally and also non-verbally through hand gestures, the nuances of vocal tones, and facial expressions. Some of the signs of autism in children with communication difficulties are:

  • Delayed language skills 
  • Repeat what they hear without understanding 
  • Speak in a robotic or a singsong voice
  • Use mixed-up pronouns ‘you’ for self and ‘I’ for others 
  • Cannot initiate a conversation  
  • Do not pretend play
  • May remember dialogues and songs or can speak on a specific topic without understanding the meaning 
  • Unable to stay on a topic when answering questions
  • Cannot identify a sarcasm from a joke

Behavioral Disorders

 Disruptive behaviors, such as aggression, are seen in children with autism. Some of the challenging symptoms of autism that involve behavioral issues in children are:

  • Repetitive actions (stereotypic behavior) such as rocking, spinning, or flapping hands 
  • Prefer to stick to a fixed routine and become aggressive due to instant changes
  • Being obsessed with particular activities or certain parts of the toys
  • Maybe over-sensitive or under-sensitive to touch, sound, smells, lights, and touch
  • Hurt themselves (headbanging) without exhibiting pain

 If a child shows signs and symptoms of autism, remember that a consultation with a pediatrician can make a big difference!

Hyperbaric Oxygen Therapy For Autism

Autism is associated with difficulties in communication, social, and restricted or repetitive behaviors in individuals. High pressure or hyperbaric oxygen therapy for autism is a proposed treatment to treat these symptoms in children and adults.

Children with autism struggle with neurological issues such as epilepsy, sleep disturbances, motor deficits, sensory disorder, etc. The objectives of hyperbaric oxygen therapy for autism are:

  • To improve the core symptoms including communication and social issues, and repetitive behavior.
  • Improve depression and anxiety

 What Is Hyperbaric Oxygen Therapy For Autism

Individuals with autism have a weak immune system, neuroinflammation, gastrointestinal inflammation, oxidative stress, hypoperfusion and various neurotransmitter disorders which are correlated with autistic symptoms. Cerebral hypoperfusion is linked with stereotyped behavior, impairment in communication and also with repetition of physical movements or sounds. 

Hyperbaric oxygen therapy treats these autism-related issues by providing adequate oxygen supply to the brain and preventing further brain-cell damage. This therapy also acts as an antibiotic to decrease the abnormal pathogens in the gut often found in children with autism. Thus, hyperbaric oxygen therapy for autism controls the immune system and reduces inflammation in the brain and the gastrointestinal tract.

 Hyperbaric oxygen therapy for autism compensates for declined oxygenated blood flow to the brain by increasing the oxygen content in brain cells and body tissues. During hyperbaric oxygen treatment, the individual receives a few sessions of hyperbaric oxygen treatment. The therapist delivers a dose of high concentration of oxygen at an atmospheric pressure which is 1.5 times more than the normal pressure. The individual inhales the pure oxygen in a sealed chamber. 

The therapy is also recommended for conditions such as carbon monoxide poisoning.

Possible Side Effects and Complications

During hyperbaric oxygen treatment, the individual is placed in an enclosed chamber, breathe oxygen while the pressure is increased slowly. Due to the increased pressure, he/she may experience discomfort, ear pain or an exploding sensation in ears.

Possible side effects include: 

  • Fatigue and light-headedness
  • Rupture of the middle ear
  • Sinus damage
  • Fluctuations in vision resulting in near-sightedness
  • Oxygen poisoning results in fluid accumulation in the lungs causing lung failure or seizures

The healthcare providers or therapists consider the health problems and age criteria of the individual to reduce the risk of complications. They take short breaks during the therapy to prevent the tissues from absorbing excess oxygen.

The therapy may last from a few minutes or as long as 2 hours (as prescribed), after which the pressure is returned to its normal level. 


The best way to avoid complications during hyperbaric oxygen therapy is by hiring the services of a certified, trained and experienced therapists.