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Friday, April 27, 2007
To Whom It May Concern,
I have known, admired and collaborated with Ray Cralle for the past twenty-five years*. Ray is one of the finest and most competent physical therapists in the traditional realm of the field as well as being one of the most innovative, imaginative and forward thinking, particularly in the treatment of brain injury. His techniques have revolutionized the neurorehabilitation of thousands of our patients treated concomitantly with hyperbaric oxygen and his unique and standard modalities of physical / occupational therapy and neurocognitive stimulation.
I have specialized in the treatment of brain injury with hyperbaric oxygen for the past 35 years. I recognized early in my research that a multi-disciplinary approach to brain repair was essential and that as brain cells were recovered with hyperbaric oxygen they must still be redirected to form new myoneural pathways. In both the acute and chronic brain injury, one of the most important mechanisms of recovery is plasticity: the reeducation of neurons and neuronal connections to improve both cognitive and motor skills. Following any brain injury there is an inherent period of plasticity while the brain and body compensate and attempt to overcome and rewire their connections to learn to take over the tasks of the damaged brain cells. Hyperbaric oxygen, by significantly increasing oxygenation and reestablishing blood flow to the injured brain enhances plasticity in the acute phase and reawakens this natural repair mechanism in chronic brain injury.
Hyperbaric oxygen is a simple concept that obeys all of the gas laws of physics. It involves the administration of 100% oxygen at greater than atmospheric pressure in a specialized hyperbaric chamber. Under normal pressure, oxygen is only transported throughout the body by the hemoglobin or red blood cells. Therefore, any area of the body that is receiving little or no blood flow is hence receiving little or no oxygen. This can have devastating effects, especially to the brain, which although comprising only 2% of the body’s weight, requires 20% of the total body’s oxygen consumption. When 100% oxygen is delivered under increased pressure, the inhaled oxygen is perfused through the lungs and by virtue of the pressure phenomena is dissolved into all body fluids including a 2000% potential increase in plasma oxygenation. More importantly it is also dissolved into lymph, intracellular fluid and cerebrospinal fluid, which surrounds and nourishes the brain and the central nervous system. This oxygen can now reach brain cells, bone and tissue which are inaccessible to red blood cells, enhance white blood cell function and promote the formation of new capillary and peripheral blood vessels.
In almost all brain injuries, irrespective of cause (traumatic, vascular or ischemic), there may be areas of irreparable damage. Because the blood flow, and thereby oxygen, and glucose are not perfused from these damaged cells to the cells surrounding them, it causes these cells to swell and become non-functional reducing blood flow and glucose to the cells surrounding them. This is a vicious devastation that has been likened to the epicenter and periphery of an atomic bomb blast; the further away from the center of the insult the more there is a possibility that some of these cells may be recoverable. These areas of the brain are well known as the ischemic penumbra which is comprised of brain cells that are receiving just enough oxygen and glucose to survive but not to fire electrically or to function. Often these penumbral zones are far greater in volume than the actual area(s) of permanent damage. It is these marginal, dormant cells that can be reactivated by increased oxygenation in a hyperbaric chamber.
The synergy of brain / body repair now becomes essential. Not only can the brain repair the body but the body can facilitate the reparation of the brain through physical and sensory input by systematically teaching the central nervous system and the brain to learn new or better ways to move, balance and coordinate. It challenges the brain to form new networks, bypassing damaged cells to compensate, coordinate and accommodate new physical skills. This stimulus also activates the function of the dormant damaged cells, as it increases blood flow and oxygenation throughout the body, thus provoking further brain function.
In 25 years of business, personal and professional experience with Ray Cralle, I can honestly say that he is one of the most honorable men I have ever encountered. His desire now to expand his practice to incorporate hyperbaric oxygen to treat one of the most neglected populations of our patients, those with brain injury, is beyond commendable. These are the patients who have been told that given the standard medical paradigm, nothing can be done. In fact, research into the field of neurorehabilitation in chronic brain injury is almost non-existent. Of particular relevance is the treatment of cerebral palsy and the brain injured child, wherein the synergy of hyperbaric oxygen and physical / sensory neurorehabilitation often has a very profound effect. In these children, when the brain is still in development and the natural mechanism of plasticity is ongoing, the combination of increased oxygenation, new capillary formation to the brain and Ray’s innovative techniques of therapy, we are seeing children who may likely have required some level of supportive care all of their lives become fully physically functional cognitive young men and women.
It is with great enthusiasm that I welcome Ray Cralle to join me in furthering the highly promising field of hyperbaric oxygen for neurologic injury. His talents and insights will have a major impact on the lives and well being of many patients and families.
Sincerely,
R.A. Neubauer, M.D.
Richard A. Neubauer, M.D.
Medical Director, Ocean Hyperbaric Neurologic Center
*His mother, Ruth, was a patient of mine and an amazing woman; one of the first female physical therapists in the United States at a time when a professional woman was a rarity. Obviously, great talent runs in the family.
April 23, 2007
To Whom It May Concern:
We have been blessed with angels in our life and one of them is Mr. Raymond H. Cralle. We heard about Mr. Cralle through the parents of a near drowning boy in Maryland on August 2005, and started therapies on September 6, 2005. After 6 years of trying to find help for our son, Rafael A. Cruz, finally we met Mr. Cralle.
Our son, Rafael, was a healthy 22 months old boy who enjoyed playing with his brother and sisters and was very talented with the drums; till an accident happened on May 18, 1999. Rafael fell in a swimming pool and near drowned. As a result of this accident Rafael was diagnosed with severe brain damage due to lack of oxygen and the doctors said he will stay in a persistent vegetative state. We never accepted this diagnosis and tried to find alternatives for our son. We have tried different approaches: natural medicine, hyperbaric oxygen, mineral therapy, and a program for parents to help their children with exercises and stimulation.
Rafael never had so many improvements until he started physical therapy with Mr. Cralle. By the time Rafael started Mr. Cralle therapies, Rafy had a dislocated hip, severe scoliosis and was severely spastic. It was very hard to position him on the bed because of the “C” shape of his back, it was hard to change his diaper, his arms and hands were so tight and his legs were overextended, in general he was fighting his own body. After the first therapy we noticed the changes in his tone, he wasn’t that stiff anymore, and during the months that followed he kept getting better and better.
But there was a problem, we couldn’t afford to pay for more therapies, the last one that we paid for was on March 2006. Thanks to the generosity and dedication of Mr. Cralle, Rafael continues to receive therapies at no charge. Rafael now a 9 1⁄2 year old is able to control switch activated communication devices, he is aware, his back is straight, he is not stiff anymore, he bends his knees, tracks with his eyes, and is not fighting his own body.
God bless Mr. Cralle, for contributing to Rafael’s Miracle in Progress.
Sincerely, Nanette and Miguel
Proud Parents of Rafael Angel
"Before Lauren came down to Florida to work with Ray Cralle, she had lost a lot of her abilities due to growth spurts and increased spasticity. We were only able to spend one week on our initial visit to see Ray. In that limited time, we were amazed at the progress we saw with Lauren. The biggest improvement has been Lauren regaining her flexibilty with her legs. We are now able to carry her on our waist again, whereas for the past year, she was so tight that this type of straddling wasn't even possible for her to do. Lauren really enjoyed working with Ray. She has said that he has helped her hip feel better, and she can't wait to go back and work with him again."
In June 1997, our son Jacob suffered a near-drowning accident at the age of 16 months. Due to this accident, Jacob is severely brain damaged. He has lost the ability to walk, talk and eat. We were not sure how much he could see. The doctors told us this is the worst they had ever seen. Although I believe they did the best they knew how, they gave us little hope. We brought Jake home and did our best to keep him comfortable. This was a momentous job, as his brain was always sending the wrong messages to his body, making him stiff as a board, making it very difficult to take care of his daily needs.
About three years after Jake’s accident we were at a follow-up appointment with the rehabilitation team. They were impressed that his skin looked nice and he didn’t have any bedsores. They said I was doing a great job and to take him home. When I left that appointment, I rode home thinking, “This can’t be it. There must be more. Someone needs to tell me what to do next to make his life better.”
I began researching therapies. I found Hyperbaric Oxygen. We started treatments and Jake became much more calm, relaxing his spastic muscles, became much more alert, and started swallowing. I took him off most of his medications.
I heard Mr Cralle’ speak at two conferences I attended. What he said made sense to me. Some of the traditional things we were doing (like drugs, pumps, and braces) began to not make much sense. Mr Cralle’ began working with Jake in 2002. Jake has scoliosis which the orthopedic doctor said would never improve and we could only hope to keep it from getting worse. It continued to get worse and the doctor wanted to do surgery to put rods in his back. It would be a two part surgery, once from the front and then later from the back. Mr. Cralle’ worked on Jake’s back and the curvature has decreased enabling us to avoid this seriously involved and risky surgery. Jake’s decreased curvature remains flexible, not fixed, thanks to Mr. Cralle’s myofascial work.
I believe surgeons recommend surgery because that is what they know. Through Mr. Cralle’ I have learned that sometimes there are other ways. If I can keep Jake from suffering the trauma of surgery, avoiding the side effects of surgery, suffering through a lengthy recovery time where we may loose what we have gained or having a surgery where nerves are cut permanently and can not be reversed, then I truly feel I am doing what is best for my son.
Jake has surpassed what the doctors expected of him and is now a happy boy. Jake has a long way to go but has come so far for a boy who was going to be a “vegetable”. His body is relaxed and so flexible. He smiles a lot now and laughs out loud. He enjoys riddles and rhymes. He is moving his mouth more and I am able to feed him a little bit orally. He vocalizes more and seams to be speaking to us in his own language. His breathing has improved and he has not had to be hospitalized in years. His vision has improved and we can now teach him what things are by showing him pictures.
Mr. Cralle’ is an extremely gifted and talented therapist. He has a great knowledge of neurology. He knows why the problem with your child’s spastic muscles is not in their arms and legs but in their brains and treats your child accordingly. Ray Cralle’s amazing work gives my family hope that Jake’s future will be the best it can be and that it will NOT be the grim prognosis we initially received.
Donna and Doug
Upperco, MD
Our 16 year old, Justin, was born with a neurological disorder that resulted from a genetic defect. He has multiple problems due mostly to abnormal muscle tone that has increased through the years. He had become “trapped” in his tight deformed little body, unable to walk or talk due to the spasticity of his muscles. In September of 2006, my husband and I talked to some people who, for the first time, gave us some hope that Justin could be helped. We were directed to Cralle Physical Therapy Center in Delray Beach, Fl. a long way from our home in Colorado. It was hard for us to believe that anything or anyone could help Justin, but we had to try it.
We found Ray Cralle and his staff to be very gracious and professional. After 5 weeks of intensive therapy, plus the benefit of nutritional supplement, we have seen some wonderful changes in Justin. His head and neck, once “stuck” on the left side, is now flexible and he is able to turn his head to the front and even to the right side at times. He is able to relax his body and is helping to have better arm movements. Overall, he is more alert and more aware of the world around him.
We plan to bring Justin back in a few months for more therapy, but also to benefit from the new hyperbaric oxygen therapy unit that is being installed at the Center.
Thanks to all of you who have made Justin’s life better and given us hope to look for even more changes in the future.
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