Katy had been a joyful surprise to her parents right from the start. "We thought we couldn't have children," says Darin Bryant, who lives with his family in Dallas, Texas. Indeed, his wife, Janie, was scheduled for a hysterectomy when they got astonishing news: Janie was pregnant. And so their miracle baby was born, and quickly grew into an open and sweet child. She liked to recite poems, sing songs, and go to McDonalds with her father-until that afternoon in July 1998, when an oncoming van swerved into his lane and hit him and his daughter head-on, shattering Bryant's legs, his face, and his only child's brain.

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In photographs, the car in which Katy's skull was fractured many times over looks as though it's been through a compactor. "They told us she wouldn't live," Bryant says, and then repeats the phrase, as if he'd only just heard the news yesterday. "Absolutely wouldn't live." But live she did, in a manner of speaking. Severe cerebral swelling choked her brain cells and threw her into a coma that would last six months.

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When she finally came home from the hospital, Katlyn was alive, but only barely. Hers would be a life spent essentially unconscious, her doctors told the Bryants. She'd be unable to swallow, control her bladder or bowels, or move her arms or legs except in involuntary spasms and seizures. Her inertia would put her at constant risk for bedsores, and eventually, her arms and legs would shrivel. She'd suffer infections along with circulatory problems that could lead to strokes. And she'd require round-the-dock care just to get from one day to the next.

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"She was on a cooling blanket because she couldn't maintain her temperature," says her father. "She was having five to ten seizures a day and was on multiple medications. She was going downhill, just totally downhill. There was nothing there. There was just no child there."

Unfortunately, doctors can do very little for children like Katlyn Bryant. Physical therapy can keep the muscles from atrophying. Drugs can mitigate spasticity, fight infections, and get the blood flowing back to the brain. But real recovery, real progress, is rare.

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The family settled in for the long haul. Nursing Katlyn became the all-consuming, and increasingly desperate, focus of their lives. Then a call came from Katlyn's Aunt Mary. Turn on Channel 4, she said. It was a show about hyperbaric oxygen therapy (HBOT) for children with cerebral palsy, a motor disorder caused by a brain defect that appears at birth, or shortly thereafter. The Bryants were intrigued: If this mysterious therapy could help other profoundly brain-damaged children, why not Katlyn?

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HBOT, still lodged in the popular consciousness as the bizarre therapy used by Michael Jackson in the 1980s purportedly in a quest for eternal youth, has been making a quiet comeback. It is most often prescribed by doctors to treat radiation damage, help heal wounds, treat carbon monoxide poisoning, and prevent decompression sickness in deep-sea divers. Indeed, medical insurance covers HBOT for these and a few other conditions. But the Bryants quickly discovered that outside the mainstream, promising work is also being done on near-drowning victims along with people suffering from stroke, cerebral palsy, multiple sclerosis, and other types of brain damage.

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At Bay Area Hyperbarics in Mountain View, California, patients are increasingly coming in for what clinic director Lisa St. John calls off-label treatments-those not FDA-approved, covered by insurance for a particular condition, prescribed by mainstream doctors, or supported by definitive research. The list of "off-label" conditions now treated with HBOT is varied and seemingly endless: Lyme disease, migraine headaches, chronic fatigue syndrome, and peripheral neuropathy, or disorders of the nervous system, to name only a few. "People hear about it in waiting rooms and read testimonials on the Internet," says St. John. "Then they come to us."

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Hyperbaric oxygen therapy is based on a pretty simple premise. The air you're breathing as you read this contains about 21 percent oxygen. That oxygen circulates throughout your body via your bloodstream, feeding healthy cells and nourishing your brain. It's an efficient process if everything's in good working order. However, if you're diabetic and have circulatory problems, or your blood has become toxic due to carbon monoxide poisoning or decompression sickness, the system easily breaks down and the oxygen in your body is diluted or blocked. This causes muscles to contract, prevents wounds from healing, and starves brain cells.

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Saturating the body with pure oxygen can address at least some of these problems. Doctors accomplish this by sealing patients in a chamber and turning up the pressure, literally. Under higher than normal (hyper) atmospheric (baric) pressure, the body absorbs oxygen more quickly and thoroughly: Under pressure, oxygen diffuses into plasma, bypassing the red blood cells, the normal path oxygen uses, and then infiltrates more easily into the cells.

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In cases of carbon monoxide poisoning, dean oxygen quickly flushes out the toxic gas. For cases of "the bends," the decompression illness that happens when divers emerge too quickly from the deep, oxygen therapy quickly deflates the troublesome nitrogen bubbles that can collect in the bloodstream. For treating stubborn wounds, particularly those in the extremities where circulation often fails, an onslaught of pure oxygen regenerates moribund cells, encouraging the growth of new ones.

In fact, it was during the treatment of a wounded patient, who also happened to have the degenerative nerve disorder multiple sclerosis, that neurologists Richard Neubauer and Edgar End made an important observation: The patient's MS symptoms-seizures, trembling, and spasticity-abated after each hyperbaric session. That discovery, in the 1960s, launched a new generation of applications for oxygen therapy, many of them pioneered by Neubauer, who works only with patients with brain damage at his clinic in Lauderdale-by-the-sea, Florida. He's considered by many to be the father of neuro-hyperbarics medicine.

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The common denominator for all his patients is a surfeit of dead brain cells killed by a period of oxygen deprivation The reason there's been no cure for such patients is there's no way to bring dead cells back to life. But Neubauer's clinical success has led him to believe some brain cells only appear to be dead. He prefers to think of them as having fallen asleep, the way humans sometimes do when they're not getting enough air. He says HBOT regenerates these dormant, or "idling," brain cells sort of like mouth-to-mouth resuscitation, but at the cellular level.

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To track these dormant cells, Neubauer relies on a type of brain scan that can demonstrate increased cerebral activity after HBOT. In the scans, dead brain cells still appear. But others, which looked dead on previous scans, appear alive and newly infused with blood.

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According to Neubauer, some brain cells are recoverable even 10 or 12 years after an event. "The hyperbarics brings them back," he says. To support his claims, he's published dozens of articles on specific case studies in prestigious journals like the Lancet and the Journal of the American Medical Association.

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Typical of these cases was a seven-year-old with cerebral palsy: He came to Neubauer spastic and in a wheelchair, and after 86 treatments was able to stand by himself and use a walker. Or the severely brain-damaged three-year-old boy who after 31 treatments held a cup for the first time, demonstrated a greater awareness of his surroundings, and reportedly "grabbed at everything."

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But Neubauer is a clinician, not a researcher, and the influential Undersea and Hyperbaric Medical Society (UHMS), the closest thing hyperbarics has to a governing board, remains unmoved by the case studies he has assembled. A private organization, the UHMS distributes information, reviews scientific data, and advises the FDA and Medicare on what conditions to approve for treatment with HBOT. Thus far, the organization doesn't believe it has seen enough evidence to support using the therapy for treatment of neurological problems. Case studies, says the UHMS's Tom Workman, just aren't good enough. "There are success stories enough to tell me something's there," he says, "but so far enthusiasm still rules over scientific fact."

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Still, case studies are giving way to larger clinical trials, though results thus far have been more ambiguous than illuminating. At McGill University in Montreal, in the largest study to date, researchers found that children with cerebral palsy who underwent HBOT showed significant improvements; however, so did patients in the control group, who were given regular oxygen at only slightly elevated pressures.

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The McGill researchers interpreted these results as unsatisfactory, while advocates see them as proof that HBOT works even under mild pressure and with impure air, and contend that it's the pressure that made the difference in the control group. A smaller study at Cornell concluded that for children with cerebral palsy, HBOT mildly "improves motor skills, attention, language, and play."

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But the UHMS has made its position clear: "Since prospective, randomized trials are generally accepted to be the most reliable form of clinical research, the weight of the currently available scientific literature is not felt to support an endorsement of HBOT for chronic brain injury." Until the UHMS is satisfied, using HBOT to treat neurological conditions will remain an unreimbursable, outside-the mainstream option.

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Still, Neubauer is by no means alone in expanding the uses of HBOT. David Perlmutter, a neurologist and medical director of the busy Perlmutter Health Center in Naples, Florida, uses HBOT to treat a range of off-label conditions. Founded in 1998, the center has several thousand patients using its four chambers. Most are seeking to recover from stroke or cerebral palsy, and they view hyperbarics as their best shot at a healthier future. "There's no turning back now," says Perlmutter, noting that the enthusiasm for hyperbarics is growing. "It's not just because of the passion from the doctors using the therapy," he says, "but from the people they've treated."

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Lisa St. John says she was initially reluctant to treat brain conditions, concentrating instead on treating nonhealing diabetic wounds and tissue damaged during radiation therapy. But the force with which the loved ones of brain-damaged patients pleaded for treatment began to break down her resistance.

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"Mothers would call and say, 'Look, there's nothing more I can do for my daughter; you need to help me."' So she relented. And then she began to witness changes. "The kids with brain damage, boy you see it," she says. "When they first come in, they can't walk the 50 feet from the door to the chamber. When they're done (after 35 to 40 treatments), they can run or walk unaided to the end of the room."

The Bryants knew about mainstream medicine's reluctance to treat brain damage with HBOT. But while Katlyn languished, her father pleaded with hyperbaric centers near Dallas. Bryant would tell them, "My God, you've got to help my child, because she's going to die." Still, none were willing to do experimental work on his brain-damaged little girl.

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Then one day Katlyn's mom and her Aunt Mary spotted a collection can on the counter at a local hardware store. It wasn't to "help send a kid to camp," however, but to help send a kid with cerebral palsy to the HBOT center run by Neubauer.

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The women scribbled down the number, and the Bryants made the fateful call. Neubauer quickly convinced them to make the difficult trip from Texas to his Florida clinic. It would be expensive; they'd be paying for the therapy out-of-pocket. But their insurance company had already incurred $4 million in medical expenses, says Bryant, and Katlyn was still in limbo.

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''We loaded up our van, attached a U-Haul trailer with all our medical equipment to the back," he says, "and we took her off to Florida."

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When the Bryants arrived, they quickly took Katy for her first treatment. True to its longtime underwater associations, entry into a hyperbaric chamber is often called a "dive." In fact, a chamber looks remarkably like a submarine, with porthole-like windows and a serene coolness inside its thick iron walls. There's a thin mattress in the chamber, along with some pillows and blankets. Patients can communicate with the outside world through an intercom. Chamber attire is strictly casual: Patients wear cotton pajamas and a clear plastic hood over their head.

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Once a session begins, pure oxygen is pumped into the hood through hoses. The lighting is soft, and the sensation inside as the pressure increases (as one's ears begin to clog) is something akin to what you experience when a plane lands. This is the worst side effect a patient is likely to experience. "If you can fly on a plane," says St. John, "you can take hyperbarics." The usual treatment lasts approximately an hour and a half-enough time to meditate, nap, chat with a technician over the intercom, or watch a video on a small screen visible through a window.

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On the tenth day of Katlyn's treatments with Neubauer, Bryant realized he'd left behind the suction cup he'd relied on daily to clear her oral secretions. He was shocked. Relating the story, he begins to stammer, still trying to find the words to express his amazement at something that happened more than a year ago. "The technicians said, 'You didn't bring it yesterday, either."' Somehow, he'd failed to notice that Katlyn no longer needed help swallowing. After 80 sessions, Katlyn's five to ten daily seizures ceased. In all the Bryants spent two months in South Florida.

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Since then, they've been back five times for booster therapy, and will return for more; the prognosis now is far better than they'd ever expected. “We hope she'll be self-sufficient, able-bodied, and able to complete her education," Neubauer says.

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Bryant himself has gone back for training; he's a hyperbaric technician now, certified to run the chamber himself and hoping to someday install one at home. Having gotten no insurance money for HBOT, the Bryants have paid for Katy's treatments with the help of relatives and funds from a post-accident settlement. Other families of patients in search of hyperbaric oxygen treatments hold fund-raisers, mortgage houses, do whatever it takes to afford the $175 per treatment.

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One year after her first hyperbaric therapy session, Bryant says Katlyn, now age ten, has no lung problems, has suffered no pneumonia, and has been hospitalized only once. She is off all 28 medications she had been taking since the accident, and is – slowly – starting to speak a few words. Her primary care physician is impressed by her progress and has even prescribed more HBOT for her. "She's alert enough to know us," says Bryant. "She smiles, she interacts with us. Before, we were in a downward slide. Finally, we're moving upward again."