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BRAIN INJURY
Chapter 15 of the HBOT Manual
BRAIN INJURY
Chapter 15 of the HBOT Manual
UNDER CONSTRUCTION
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Hyperbaric Oxygen improves cognitive abilities after brain injury

Texas researchers have found that patients with long-standing but stable traumatic brain injury (TBI) show a general improvement in speech, memory and attention after undergoing a series of hyperbaric oxygen therapy treatments. Dr. Paul Harch and colleagues presented their findings in Seattle at the Undersea and Hyperbaric Medical Society Annual Scientific Meeting.

The researchers enrolled 11 patients from The Transitional Learning Community in Galveston, Texas, who had chronic stable TBI for at least 3 years. Five of the patients initially had 80 sessions in a multichamber hyperbaric oxygen unit.

Each 60-minute session consisted of raising the atmospheric pressure to 1.5 ATA (atmospheres absolute) and administering 100% oxygen through a mask. After a 5-month rest period, the five patients had another 40 hyperbaric sessions. The remaining six patients, serving as controls, did not undergo hyperbaric oxygen therapy.

SPECT imaging showed that no change occurred in the cerebral blood flow of the six control patients during the study period. However, patients who did receive the hyperbaric oxygen therapy showed an increase in penumbral area cerebral blood flow as well as improvements to their speech and memory functions, Dr. Harch said.

The improvements in these patients peaked at 80 hyperbaric oxygen sessions. "Individualized [hyperbaric oxygen therapy] repeats every 1 to 2 weeks appears to maintain improvement," Dr. Harch said.

Dr. Harch told Reuters Health that he has used hyperbaric oxygen therapy sessions to treat individual cases of stroke, cerebral palsy and multi-infarct dementia as well as near-drowning and chronic carbon monoxide poisoning patients. "All these are patients with no other treatment options..." who were treated 1 year after their injuries, Dr. Harch said.

Dr. Harch noted that patients with the least loss of function following injury show the greatest improvement with hyperbaric oxygen therapy. "Hyperbaric oxygen therapy is a nonspecific treatment that seems to be appropriate in many different forms of brain injury," he said.

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From Life Extension Magazine, July 1999

16.Brain injury improves with hyperbaric oxygen

Full source: Presented in Seattle at the Undersea and Hyperbaric Medical
Society 1998 Annual Scientific Meeting

          Patients with long-standing traumatic brain injury show a general improvement of speech, memory and attention after undergoing a series of hyperbaric oxygen therapy treatments. Hyperbaric oxygen therapy is a technique in which patients breathe pure oxygen in a chamber with a higher-than-normal atmospheric pressure. Hyperbaric oxygen therapy is commonly used to treat people suffering from carbon monoxide poisoning or divers with decompression sickness. Initially, five of the 11 patients, at least 3 years post-brain injury had 80 sessions in a hyperbaric unit. After a 5-month rest period, those five patients underwent another 40 hyperbaric sessions. The remaining six patients, serving as controls, did not undergo hyperbaric oxygen therapy. There was no change in the blood flow of the six control patients during the study period. However, patients who did receive the hyperbaric oxygen therapy showed increased blood flow in specific areas of the brain, as well as improvements in speech and memory functions. The improvements in these patients peaked at 80 hyperbaric oxygen sessions, and repeating
the therapy every one to two weeks maintained improvement. The therapy sessions were also used to treat individuals with stroke, cerebral palsy, dementia, near-drowning and chronic carbon monoxide poisoning patients. Those patients were treated a year after the brain injury occurred. The patients had no other treatment options. Patients with the least loss of function following injury showed the greatest improvement with hyperbaric oxygen therapy. According to the researchers, it's not clear why hyperbaric oxygen therapy helped patients. "There is clinical and animal data to suggest that it might help, but the studies are not conclusive," said the president of the Undersea and Hyperbaric Medical Society. It's fertile ground for research.

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RESEARCH

Baromedical Research Institute (BRI) is a not-for-profit research and educational institute dedicated to the study of baromedicine and emergency medicine. The Institute has had long standing ties with Tulane School of Medicine and LSU School of Medicine in New Orleans (1980-present). The Institute houses a large collection of hyperbaric medicine journal articles tended to by a full time librarian. Through ISI or MEDLINE searches, researchers can obtain articles pertinent to their research on short notice with librarian assistance. The Institute sponsors fellowships in research and clinical hyperbaric medicine in affiliation with the LSU School of Medicine. The Institute hosts continuing medical education programs which are ACEP, UHMS, and NBDHMT approved.

The research facility contains multiplace chamber hardware capable of sophisticated invasive physiologic animal monitoring. Current projects include the application of hyperbaric oxygen to advanced trauma, life support, and advanced cardiac life support resuscitative effort. All animal experimentation is approved through either Tulane School of Medicine or LSU School of Medicine Animal Care and Utilization Commitee. The research compound contains a modern AAALAC approved vivarium and ample bench laboratory space and operating room facilities. The Institute supports the salaries of one PhD physiologist on joint staff with Tulane School of Medicine and one MD, PhD neurologist on joint staff with LSU School of Medicine.

    Active emergency physician research staff include:
    Paul Harch, MD
    Larry Weiss, MD, JD
    Jack Simononok, MD
    James Moises, MD
    Larry Roycraft, MD
    Keith Van Meter, MD

    Active support research staff include:
    Stephanie Dudenhoffer (grant submissions, publication compilation, and general secretarial
    services to the institute)
    Anna Guidry (research librarian)
    Shelly Gotlieb, PhD (institute research director)
    Paul Staab, MD, DPharm (research pharmacist and physician)
    Simon Sheps, MD, PhD (research neurologist and physiologist)
    Harvey Swanson, PhD (senior research physiologist)
    Ray Gonzolez, DVM (institute veternarian)
    Fred Kriedt (sponsored PhD candidate in physiologic bio-engineering at Tulane University
    Medical School)
    John Wilson (senior hyperbaric technician)
    Tracy Archebald (hyperbaric technician)
    Brock Chamberlain (hyperbaric technician)
    Ken Savoie (hyperbaric technician)
    Frank Smith (animal caretaker)

          Turning up the Pressure on Brain Injuries

                            Biomedical Inquiry

  The University of Texas Medical Branch at Galveston

                            By: Robert Lucey

                          Spring/Summer 1997

After suffering a head injury in a 1984 car accident, Margaret Reiter lost the use
of her right arm and her ability to read and speak clearly. Eight years later, she
still had not recovered those faculties. After that much time, doctors held out little
hope she would ever do so.

With no medical treatments available for such brain damage, Reiter's only option
seemed to be rehabilitation to learn how to work around her limitations. But then
doctors offered her another alternative: She was invited to join a study exploring
the use of a Hyperbaric chamber to rejuvenate damaged brain tissues.

Hyperbaric chambers were developed to simulate the increased pressure of
underwater conditions to treat divers suffering from decompression sickness, also
known as the bends. That potentially fatal malady occurs when those breathing
compressed air, a combination of oxygen and nitrogen, stay down too long. The
nitrogen dissolved under pressure forms bubbles when the person surfaces and
the pressure is suddenly released, much like the carbon dioxide fizz that happens
when one pops opens a shaken can of soda. The chamber-one of about 300
multi-person chambers in the United States-is used to treat about two dozen
cases of the bends each year by providing a gradual lessening of pressure.

At deep-sea levels of pressure, the chambers triple the amount of oxygen
absorbed by a patient's blood. This ability has led to new uses for the chambers,
including stimulating the recovery of patients with wounds, blood loss, infections,
tumors and cardiovascular diseases.

"Hyperbaric turns the body into a healing machine," says Kevan Corson,
technical director of the Hyperbaric program at the University of Texas Medical
Branch.

Scientists have wondered whether this healing effect could benefit brain tissue.
To answer that question, UTMB researchers took SPECT (single-photon
emission computed tomography) scans of head-injury patients before and after
Hyperbaric treatments. The gamma ray machine uses an X-ray technique to
produce an image of a cross section of brain tissue.

Five residents of Galveston's Transitional Learning Community (TLC) for the
rehabilitation of people with head injuries participated in the six-month study
beginning in May 1996. They received Hyperbaric oxygen therapy, with scans
before and after treatments. Participants went on 80 one-hour "dives" simulating
the pressure under 16 1/2 feet of water.

While the treatment has been used elsewhere, UTMB's study is the first to
attempt to quantitatively measure actual benefits. Researchers hoped to find
increased brain activity using the SPECT scans, but the scans revealed a
previously unknown phenomenon: After a head injury, blood flow to the
uninjured areas of the brain apparently increases. The Hyperbaric treatment
appeared to increase the flow to the injured areas with a corresponding decrease
to the uninjured areas.

"That just blew us away," says Dr. Brent Masel, medical director of TLC. "It's
normalizing the blood flow, which is something we didn't expect."

Researchers in the study theorize that the increased blood flow to the injury helps
oxygenate those cells, possibly rejuvenating them. Masel says it appears that the
oxygen boost prompts the dormant brain cells to restart their metabolic process
by creating the optimum blood-oxygen level for the body to burn simple sugars.

Corson compares it to revitalizing the zone of yellowed tissue lying outside the
black-and-blue center of a bruise.

UTMB and TLC researchers gathered plenty of anecdotal evidence of the
benefits of Hyperbaric treatment to accompany their technical data. Reiter, for
example, says she can now read and speak more clearly. Another patient has had
measurable improvements in his IQ.

"All of the patients who were treated in the chamber have shown improvement,"
Corson says.

Like Reiter, the four other participants sustained their injuries more than two
years before the start of the study, minimizing the possibility that these
improvements were simply spontaneous recovery unrelated to the treatment.

Corson predicts that patients with more recent injuries could benefit from
Hyperbaric treatment just as much as, if not more than, the study participants.
One treated child who was not included in the study because his injury was too
recent has shown some of the most dramatic improvement. Before treatment, he
was curled in a ball, unable to lift his hands or walk without assistance. Now,
after 130 treatments, he feeds himself, mouths words and is regaining his ability
to walk.

But the theory explaining such anecdotal evidence still needs to be proven.

The researchers plan to answer some of the remaining questions in the next phase
of the study. Participants began an additional 40 Hyperbaric dives in March to
determine whether benefits continue with additional treatments. Jon T. Mader,
medical director of UTMB's Hyperbaric facility and chief of the UTMB Marine
Medicine Division, will continue as principal investigator of the study. Funding is
from Galveston's Moody Foundation.