Sports Medicine Research: In the Lab & In the Field: More Oxygen Please (Sports Med Res)
Monday, January 6, 2014

More Oxygen Please

Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury - randomized prospective trial

Boussi-Gross RGolan HFishlev GBechor YVolkov OBergan JFriedman MHoofien DShlamkovitch NBen-Jacob EEfrati S. PLoS One. 2013; 8(11):e79995

Take Home Message: Hyperbaric oxygen therapy can improve cognitive function, quality of life, and brain activity among patients with chronic post-concussion syndrome.

The brain consumes 20% of the body’s total oxygen at a healthy state, but after an injury the recovery process requires additional energy. Unfortunately, mild traumatic brain injury (mTBI) results in mild ischemia, tissue hypoxia, and edema, which may cause cognitive impairments. We may be able to use a hyperbaric oxygen therapy to increase the oxygen level in a brain during healing and improve the metabolic environment necessary for recovery; however, we lack enough data to support this treatment decision. Therefore, the authors conducted a randomized clinical trial to investigate if hyperbaric oxygen therapy effects brain activity and cognitive impairments in patients with mTBI and prolonged post-concussion syndrome. The authors randomized 56 patients into 2 groups (32 in a treatment group, 24 in a crossover group). All of the patients suffered an mTBI (38 from motor vehicle accident) and complained of cognitive symptoms 1 to 6 years after the injury. Medical and neuropsychological practitioners, blinded to the treatment groups, evaluated all patients with the Mindstreams testing battery. Additionally, brain activity was evaluated with single photon emission computed tomography, and quality of life was assessed with the EQ-5D. The authors evaluated treatment-group patients after 2 months of hyperbaric oxygen therapy (40 daily sessions, 5 days/week, 60 minutes each, 100% oxygen at 1.5 ATA). Crossover-group patients were evaluated after 2 months of a control period without any treatment and then 2 months after hyperbaric oxygen therapy. The crossover group revealed no improvements following the control period. Following hyperbaric oxygen therapy, both groups improved their cognitive function and quality of life and had elevated brain activity in areas responsible for cognitive function (e.g., mid-frontal area, cingulate gyrus, temporal cortex).

This was the first randomized controlled trial to examine the effectiveness of hyperbaric oxygen therapy to improve brain function among individuals with a history of an mTBI and chronic post-concussion symptoms. The imaging results indicated that the oxygen concentration was sufficient enough to promote cellular and vascular repair to regenerate brain tissue in areas that are typically damaged. However, the therapy itself is very time consuming, and may not be a viable rehabilitation option for some people. Also, none of the patients included in this study suffered an athletically induced mTBI so this therapy may not be beneficial for concussed athletes. Oxygen is fairly affordable, and easy to administer. If oxygen delivery without the hyperbaric chamber would have similar effects this could lead to better concussion rehabilitation programs. It would be interesting to examine if this treatment over a longer period with shorter pressure periods would display similar effects.  In the meantime, this study demonstrates that hyperbaric oxygen therapy has potential for patients with chronic post-concussion symptoms, and hopefully this work will prompt more research on the influence of oxygen levels on a brain after a concussion.

Questions for Discussion: Do you give your athletes oxygen on the sideline after a brain injury? Do you believe hyperbaric oxygen therapy would help in the acute phase following mTBI? Would you use hyperbaric oxygen therapy to treat chronic post-concussion symptoms?

Written by: Jane McDevitt, PhD
Reviewed by: Jeffrey Driban

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Boussi-Gross R, Golan H, Fishlev G, Bechor Y, Volkov O, Bergan J, Friedman M, Hoofien D, Shlamkovitch N, Ben-Jacob E, & Efrati S (2013). Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury - randomized prospective trial. PloS one, 8 (11) PMID: 24260334

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