Fetal Alcohol Spectrum Disorder (FASD) describes a wide range of adverse physical, behavioral and cognitive effects resulting from prenatal alcohol exposure (PAE) during embryonic and fetal development. A number of clinical studies have presented evidence regarding the physiological effects of HBOT on metabolically dysfunctional brain regions that might be related to FASD. The aim of the study is to compare the effect of HBOT vs. neurocognitive training on neurobehavioral function in FASD.
Fetal Alcohol Spectrum Disorder (FASD) describes a wide range of adverse physical, behavioral and cognitive effects resulting from prenatal alcohol exposure (PAE) during embryonic and fetal development. Currently individuals afflicted by FASD are treated symptomatically for ADHD and different forms of disruptive behavior. However, these approaches have not succeeded in improving the long-term clinical outcome \[1\]. A number of clinical studies have presented evidence regarding the physiological effects of hyperbaric oxygen therapy (HBOT) on metabolically dysfunctional brain regions that might be related to FASD \[2-5\]. Case studies conducted using HBOT suggested a potential safe and efficient treatment for FESD \[6-7\]. The aim of the study is to compare the effect of HBOT vs. neurocognitive training on neurobehavioral function in FASD. The study is designed as a prospective randomized, two active arm trial. After enrolment, eligible participants will be randomized with equal probability into one of two arms: HBOT or cognitive training arm. The evaluation procedure will be performed twice, at baseline and 1-3 weeks after the last treatment session, and includes cognitive tests, FASD relegated questionnaires, and anatomical and functional brain imaging (MRI and SPECT). The study is designed as an intention to treat trial, and thus, patients will be included in the analysis if they completed at least one HBOT/cognitive training session, and attained post treatment study analysis. The HBOT protocol will be administrated in a multi-place chamber. The protocol comprised of 60 daily sessions, 5 sessions per week within a three month period. Each session includes breathing 100% oxygen by mask at 2ATA for 90 minutes with 5-minute air breaks every 20 minutes. The cognitive training protocol contains a neuropsychologist guided BrainHQ training program. This is a 3 months program that includes 30 minutes sessions at least 3 times per week.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
36
Each session will include exposure of 90 minutes to 100% at 2 ATA, with 5 minutes air breaks every 20 minutes
Neuropsychologist guided BrainHQ training
Assaf-Harofeh Medical Center
Ẕerifin, Israel
Cognitive health assessment (NeuroTrax)
Memory, attention and information process will be evaluated using the NeuroTrax computerized cognitive evaluation battery.
Time frame: baseline, 3 months
Executive functions and self-regulation in everyday environment
Evaluated using the Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) self-reported questionnaire
Time frame: baseline, 3 months
Brain perfusion
Cerebral blood volume and flow will be measured using perfusion MRI protocol Dynamic susceptibility contrast (DSC).
Time frame: baseline, 3 months
Brain microstructure - (MD)
Mean diffusivity (MD) will be evaluated using diffusion tensor imaging (DTI) MRI protocol.
Time frame: baseline, 3 months
Brain microstructure - (FA)
Fractional anisotropy (FA) will be evaluated using diffusion tensor imaging (DTI) MRI protocol.
Time frame: baseline, 3 months
Brain function imaging
Resting state fMRI (rsfMRI), and task based fmri will evaluate brain function during a working memory task.
Time frame: baseline, 3 months
Metabolic Brain function imaging
Brain Single photon emission computed tomography (SPECT) will be conducted using Tc-99m-ECD.
Time frame: baseline, 3 months
Depression anxiety and stress
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Evaluated using the Depression Anxiety Stress Scale Test (DASS 21) self-report instrument.
Time frame: baseline, 3 months, 6 months
Interpersonal Reactive Index (IRI)
The IRI questionnaire will be used to evaluate cognitive and affective aspects of empathic abilities.
Time frame: baseline, 3 months, 6 months
Difficulties in Emotion Regulation Scale (DERS)
The DERS questionnaire is a multidimensional self-report measure of emotion regulation
Time frame: baseline, 3 months, 6 months
Mental Health Continuum (MHC-SF)
The MHC-SF questionnaire will be used to assess three components of well-being: emotional, social, and psychological and conduct categorical diagnosis of positive mental health.
Time frame: baseline, 3 months, 6 months