Concussion & Mild TBI
Recent years have brought an increased focus to concussions and other traumatic brain injuries in the United States.1 Signs of a concussion include slow response times, irritability, low energy. These symptoms may resolve on their own but can persist and evolve into long-lasting cognitive, behavioral, and communicative disabilities.2 However, advances in medical research suggest hyperbaric oxygen therapy (HBOT) has the potential to slow or reverse concussion symptoms.
Hyperbaric oxygen therapy works to reduce or eliminate concussion symptoms by infusing blood with higher than average levels of oxygen.3 Extra oxygen boosts mitochondria activity and energizes growth of new blood vessels in the brain.4 Scientists have linked increased mitochondrial activity to healing in various tissues throughout the body.4
HBOT Research Shows Improvement to:
- Headaches caused by damaged nerve fibers
- Memory loss (most improvement)
- Difficulty problem-solving
- Anxiety/depression
- Shortened attention span (significant improvement)
- Slowed reaction time
Concussion & Mild TBI
Recent years have brought an increased focus to concussions and other traumatic brain injuries in the United States.1 Signs of a concussion include slow response times, irritability, low energy. These symptoms may resolve on their own but can persist and evolve into long-lasting cognitive, behavioral, and communicative disabilities.2 However, advances in medical research suggest hyperbaric oxygen therapy (HBOT) has the potential to slow or reverse concussion symptoms.
Hyperbaric oxygen therapy works to reduce or eliminate concussion symptoms by infusing blood with higher than average levels of oxygen.3 Extra oxygen boosts mitochondria activity and energizes growth of new blood vessels in the brain.4 Scientists have linked increased mitochondrial activity to healing in various tissues throughout the body.4
HBOT Research Shows Improvement to:
- Headaches caused by damaged nerve fibers
- Memory loss (most improvement)
- Difficulty problem-solving
- Anxiety/depression
- Shortened attention span (significant improvement)
- Slowed reaction time
Benefits of HBOT for Concussion / Mild TBI:

Increases Amount of Oxygen in the Blood
Stimulates development of new blood vessels from pre-existing vessels as well as the natural development of new blood vessels.

Reduces Inflammation & Swelling
Suppresses the cellular activity of the immune system which triggers swelling when an injury or damage to the body occurs. While this reaction is meant to start healing and protect from injury it can result in secondary injury, pain, and prolonged recovery time.

Preserves, Repairs, & Enhances Cellular Functions
Boosts cellular metabolism, promotes rapid cell reproduction, and enhances collagen synthesis. Collagen is a protein in connective tissues like skin.

Accelerates Wound Healing
Increases production of nitric oxide in the bone marrow and microvasculature (smaller blood vessels). Stimulates stem cells from the bone marrow, accelerating wound healing. Dilation of smaller blood vessels enhances blood flow to areas of local tissue damage, hypoxia, and ischemia.
Key Research on Hyperbaric Oxygen Treatment for Concussion
Recent News on Hyberbaric Oxygen Treatment for Concussion
Howard Stern – How Joe Namath Reversed His Own Brain Damage Caused by Football
The former N.Y. Jets quarterback opens up to Howard Stern in an interview about using a hyperbaric oxygen therapy chamber to reverse damage to his brain and why he wouldn’t want his son to play football.
Hall-of-famer says treatment is curing disabling effects of concussions
From CINCINNATI (WKRC) – by Duane Pohlman National Football League (NFL) statistics reveal its players suffered nearly 2,000 concussions from 2012 to 2019. Even with new concussion protocols designed to protect today’s players from further damage,…
A breakthrough that may reverse concussion damage
CINCINNATI (WKRC) – As the NFL gets ready to crown a new champion, concussions remain a focus of football. While the league has done much to protect today’s players, some of the greatest players to ever take the field say they struggle with damage…
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Additional Research
The National Brain Injury Rescue and Rehabilitation Study – a multicenter observational study of hyperbaric oxygen for mild traumatic brain injury with post-concussive symptoms
The National Brain Injury Rescue and Rehabilitation Project was established as a preliminary study to test the safety and practicality of multi-center hyperbaric oxygen administration for the post-concussive symptoms of chronic mild traumatic brain injury as a precursor to a pivotal, independent, multi-center, controlled clinical trial. This report presents the results for 32 subjects who completed a preliminary trial of hyperbaric oxygen several years before the passage of the 21 st Century Cures Act. This study anticipated the Act and its reassessment of clinical research. Subjects received 40-82 one-hour treatments at 1.5 atmospheres absolute 100% oxygen. Outcome measures included repeated self-assessment measures and automated neurocognitive tests. The subjects demonstrated improvement in 21 of 25 neurocognitive test measures observed. The objective neurocognitive test components showed improvement in 13 of 17 measures. Earlier administration of hyperbaric oxygen post injury, younger age at the time of injury and hyperbaric oxygen administration, military status, and increased number of hyperbaric oxygen administrations were characteristics associated with improved outcomes. There were no adverse events. Hyperbaric oxygen was found to be safe, inexpensive and worthy of clinical application in the 21 st Century model of facile data collection provided by recent research regulatory shifts in medicine. The study was approved by the ethics review committee of the Western Institutional Review Board (WIRB; Protocol #20090761).
Erratum: Effect of hyperbaric oxygenation therapy on post-concussion syndrome.
The present review evaluated the effect of hyperbaric oxygenation (HBO) therapy on post-concussion syndrome (PCS). Searches for publications from the earliest date possible up until the first week of 2016 were conducted using the electronic databases Cochrane, EBSCOhost, Embase, Ovid MEDLINE, PubMed and Web of Science. Additional trials were identified through reference list scanning. Randomized controlled trials assessing the effectiveness of HBO therapy in PCS were selected and tested for eligibility for inclusion in the present review.
Effect of hyperbaric oxygen therapy on chronic neurocognitive deficits of post-traumatic brain injury patients: retrospective analysis.
The aim of the study is to evaluate the effect of hyperbaric oxygen therapy (HBOT) in participants suffering from chronic neurological deficits due to traumatic brain injury (TBI) of all severities in the largest cohort evaluated so far with objective cognitive function tests and metabolic brain imaging. A retrospective analysis was conducted of 154 patients suffering from chronic neurocognitive damage due to TBI, who had undergone computerised cognitive evaluations pre-HBOT and post-HBOT treatment. The average age was 42.7-14.6 years, and 58.4% were men. All patients had documented TBI 0.3-33 years (mean 4.6-5.8, median 2.75 years) prior to HBOT. HBOT was associated with significant improvement in all of the cognitive domains, with a mean change in global cognitive scores of 4.6-8.5 (p<0.00001).
Evidence brief: hyperbaric oxygen therapy (HBOT) for traumatic brain injury and/or post-traumatic stress disorder.
This report is a product of the VA Evidence-based Synthesis Program. The purpose is to provide “timely and accurate syntheses of targeted healthcare topics. to improve the health and healthcare of Veterans”. The authors have made a comprehensive search and analysis of the literature and make recommendations to assist clinicians in dealing with veterans suffering from either traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD). The report is timely and of great potential impact given the vigorous and lengthy debate among hyperbaric physicians and lay people determined to find an answer for the large numbers of veterans deeply affected with some combination of PTSD and post-concussion dysfunction.
HYPERBARIC OXYGEN THERAPY- BASICS AND NEW APPLICATIONS
Hyperbaric oxygen therapy (HBOT) serves as primary or adjunctive therapy for a diverse range of medical conditions. The indication for HBOT can be related to either pressure (decompression sickness or air emboli) or tissue hypoxia. It is now realized, that the combined action of hyperoxia and hyperbaric pressure, leads to significant improvement in tissue oxygenation while targeting both oxygen and pressure sensitive genes, resulting in improved mitochondrial metabolism with anti-apoptotic and anti-inflammatory effects. Clinical studies published in recent year’s present convincing evidence that HBOT can be the coveted neurotherapeutic method for brain repair. Here we discuss the multi-faceted role of HBOT in wound care in general and in neurotherapeutics in detail.
The protection effect and mechanism of hyperbaric oxygen therapy in rat brain with traumatic injury.
To investigate the effect of hyperbaric oxygen therapy (HBOT) on traumatic brain injury (TBI) outcome. The modified Marmarou’s weight drop device was used to generate non-lethal moderate TBI rat model, and further developed in vitro astrocytes culturing system. Then, we analyzed the expression changes of interested genes and protein by quantitative PCR and western blot. Multiple HBO treatments significantly reduced the expression of apoptosis promoting genes, such as c-fos, c-jun, Bax and weakened the activation of Caspase-3 in model rats. On the contrary, HBOT alleviated the decrease of anti-apoptosis gene Bcl-2 and promoted the expression of neurotrophic factors (NTFs), such as NGF, BDNF, GDNF and NT-3 in vivo. As a consequent, the neuropathogenesis was remarkably relied with HBOT.
Case control study: hyperbaric oxygen treatment of mild traumatic brain injury persistent post-concussion syndrome and post-traumatic stress disorder.
Mild traumatic brain injury (TBI) persistent post-concussion syndrome (PPCS) and post-traumatic stress disorder (PTSD) are epidemic in United States Iraq and Afghanistan War veterans. Treatment of the combined diagnoses is limited. The aim of this study is to assess safety, feasibility, and effectiveness of hyperbaric oxygen treatments (HBOT) for mild TBI PPCS and PTSD. Thirty military subjects aged 18-65 with PPCS with or without PTSD and from one or more blast-induced mild-moderate traumatic brain injuries that were a minimum of 1 year old and occurred after 9/11/2001 were studied. The measures included symptom lists, physical exam, neuropsychological and psychological testing on 29 subjects (1 dropout) and SPECT brain imaging pre and post HBOT.
Increased circulating stem cells and better cognitive performance in traumatic brain injury subjects following hyperbaric oxygen therapy.
Traumatic brain injury (TBI) may cause persistent cognitive dysfunction. A pilot clinical study was performed to determine if hyperbaric oxygen (HBO₂) treatment improves cognitive performance. It was hypothesized that stem cells, mobilized by HBO₂ treatment, are recruited to repair damaged neuronal tissue. This hypothesis was tested by measuring the relative abundance of stem cells in peripheral blood and cognitive performance during this clinical trial. The subject population consisted of 28 subjects with persistent cognitive impairment caused by mild to moderate TBI suffered during military deployment to Iraq or Afghanistan. Fluorescence-activated cell sorting (FACS) analysis was performed for stem cell markers in peripheral blood and correlated with variables resulting from standard tests of cognitive performance and post-traumatic stress disorder: ImPACT, BrainCheckers and PCL-M test results. HBO₂ treatment correlated with stem cell mobilization as well as increased cognitive performance. Together these results support the hypothesis that stem cell mobilization may be required for cognitive improvement in this population.
Hyperbaric oxygen for mild traumatic brain injury: Design and baseline summary.
The Brain Injury and Mechanisms of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA) study, sponsored by the Department of Defense, is a randomized double-blind, sham-controlled clinical trial that has a longer duration of follow-up and more comprehensive assessment battery compared to recent HBO₂ studies. BIMA randomized 71 participants from September 2012 to May 2014. Primary results are expected in 2017. Randomized military personnel received hyperbaric oxygen (HBO₂) at 1.5 atmospheres absolute (ATA) or sham chamber sessions at 1.2 ATA, air, for 60 minutes daily for 40 sessions. Outcomes include neuropsychological, neuroimaging, neurological, vestibular, autonomic function, electroencephalography, and visual systems evaluated at baseline, immediately following intervention at 13 weeks and six months with self-report symptom and quality of life questionnaires at 12 months, 24 months and 36 months. Characteristics include: median age 33 years (range 21-53); 99% male; 82% Caucasian; 49% diagnosed post-traumatic stress disorder; 28% with most recent injury three months to one year prior to enrollment; 32% blast injuries; and 73% multiple injuries. This manuscript describes the study design, outcome assessment battery, and baseline characteristics. Independent of a therapeutic role of HBO₂, results of BIMA will aid understanding of mTBI.
Review of recent non-hyperbaric oxygen interventions for mild traumatic brain injury.
Traumatic brain injury (TBI) affects 3.2 to 5.3 million persons in the United States (U.S.), and the impact in the U.S. military is proportionally higher. Consensus is lacking regarding an accepted outcome to measure the effectiveness of interventions to improve the symptoms associated with TBI, and no standard-of-care treatment exists for mild TBI (mTBI). A recent literature review evaluated hyperbaric oxygen therapy (HBO₂) interventions, and findings were mixed. We conducted a systematic review of non-HBO₂ mTBI interventional trials published in 2005-2015 in military and civilian populations. A total of 154 abstracts, seven randomized controlled trials (RCTs) and five pilot studies were reviewed. RCTs were evaluated using Consolidated Standards of Reporting Trials criteria. Results indicated that studies published within the period of review were small pilot studies for rehabilitation therapy and motion capture or virtual reality gaming interventions. Neuropsychological assessments were commonly specified outcomes, and most studies included a combination of symptom and neuropsychological assessments. Findings indicated a lack of large-scale, well-controlled trials to address the symptoms and sequelae of this condition, but results of small exploratory studies show evidence of potentially promising interventions.
References
- Our Mission. (n.d.). Retrieved March 27, 2018, from https://concussion.weillcornell.org/about-us/our-mission
- Hu, Q., Manaenko, A., Xu, T., Guo, Z., Tang, J., & Zhang, J. H. (2016). Hyperbaric oxygen therapy for traumatic brain injury: bench-to-bedside. Medical Gas Research, 6(2), 102.
- Tal, S., Hadanny, A., Sasson, E., Suzin, G., & Efrati, S. (2017). Hyperbaric oxygen therapy can induce angiogenesis and regeneration of nerve fibers in traumatic brain injury patients. Frontiers in Human Neuroscience, 11, 508.
- Keilman, J. (2012, November 14). Concussions: What happens and how the brain heals. Retrieved March 29, 2018, from http://articles.chicagotribune.com/2012-11-14/news/ct-met-concussions-1114-20121114_1_concussion-program-david-hovda-cells
- Stoller, K. P. (2011). Hyperbaric oxygen therapy (1.5 ATA) in treating sports related TBI/CTE: two case reports. Medical Gas Research, 1(1), 17.
- 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):e79995
- Shandley, S., Wolf, E. G., Schubert-Kappan, C. M., Baugh, L. M., Richards, M. F., Prye, J., & Kalns, J. (2017). Increased circulating stem cells and better cognitive performance in traumatic brain injury subjects following hyperbaric oxygen therapy. Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc, 44(3), 257-269.
- Wang, F., Wang, Y., Sun, T., & Yu, H. L. (2016). Hyperbaric oxygen therapy for the treatment of traumatic brain injury: a meta-analysis. Neurological Sciences, 37(5), 693-701.
- Tal, S., Hadanny, A., Sasson, E., Suzin, G., & Efrati, S. (2017). Hyperbaric oxygen therapy can induce angiogenesis and regeneration of nerve fibers in traumatic brain injury patients. Frontiers in Human Neuroscience, 11, 508.