Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a controlled environment where the atmospheric pressure is increased. This medical treatment is typically administered in a specialized chamber designed to deliver oxygen at pressures greater than normal sea-level pressure. This article explores the application of HBOT specifically for concussions, examining its underlying mechanisms, current scientific evidence, and the practical aspects of receiving the therapy.
How Hyperbaric Oxygen Therapy Works
During HBOT, patients breathe 100% oxygen while the chamber pressure is raised, often to 1.5 to 3 times normal atmospheric pressure (ATA). This elevated pressure allows significantly more oxygen to dissolve directly into the blood plasma, rather than being solely carried by red blood cells. Under hyperbaric conditions, the amount of dissolved oxygen can increase by 7 to 15 times, depending on the pressure.
This increased oxygen saturation in the blood allows oxygen to reach areas of the brain and other tissues that might be deprived due to injury or swelling. After a concussion, brain tissue can experience reduced blood flow and oxygen supply, a condition known as hypoxia. HBOT helps to reduce inflammation and swelling in injured tissues.
The therapy also promotes various healing processes. It can stimulate the production of new blood vessels (angiogenesis) and nerve cells (neurogenesis), which are crucial for tissue repair and regeneration. HBOT may enhance the body’s natural immune response and facilitate the removal of cellular waste products.
Current Scientific Understanding
The current scientific understanding of HBOT for concussion and post-concussion syndrome is still developing, with mixed results. Some research indicates that HBOT may offer benefits, particularly for individuals with persistent post-concussion symptoms. For instance, a systematic review suggested that 40 sessions of HBOT at 1.5 ATA could significantly improve symptoms and cognitive function in patients with mild traumatic brain injury and persistent post-concussion syndrome. Studies from 2013 and 2017 have also reported improvements in cognitive function, quality of life, and reduced symptoms like headaches and anxiety in veterans with post-concussion syndrome after multiple HBOT sessions.
Despite these promising findings, not all studies have demonstrated a clear benefit over sham treatments or standard care. Some randomized controlled trials, particularly those for acute mild traumatic brain injury, have shown no significant differences between HBOT and sham groups in outcomes. This has led to skepticism within the medical community, as the long-term efficacy and universally accepted protocols are still under investigation.
Major medical organizations do not universally accept HBOT as a standard treatment for concussion. The U.S. Food and Drug Administration (FDA) has not cleared or approved HBOT specifically for traumatic brain injury. This is due to the need for more large-scale clinical trials to establish its effectiveness and optimal treatment parameters.
Receiving Hyperbaric Oxygen Therapy
There are two main types of chambers: monoplace chambers, which accommodate one patient, and multiplace chambers, which can treat several patients simultaneously. Inside the chamber, patients typically lie down and breathe 100% oxygen through a mask or hood.
During a session, usually lasting 60 to 90 minutes, patients may experience pressure in their ears, similar to an airplane. This pressure change is managed by swallowing or yawning to equalize the pressure. Treatment protocols for concussion often involve 20 to 40 sessions, administered once or twice daily, five days a week.
HBOT carries potential side effects and risks, including ear barotrauma (discomfort or injury to the ear from pressure changes) and temporary changes in vision like nearsightedness. Rarely, oxygen toxicity can occur, which might affect the lungs or central nervous system. Claustrophobia can also be a concern for some individuals in the enclosed chamber. For concussions, HBOT is often considered an off-label use. A thorough medical consultation with a neurologist or concussion specialist is necessary to determine if it is a suitable option.