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;

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

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).

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?

by: Jane McDevitt, PhD
by: Jeffrey Driban


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