TBI is a significant cause of death and disability. In the USA alone, there were over 64,000 TBI-related deaths in 2020. Unfortunately, (1) in European Union and the UK, the numbers are not much better. With 57,000 deaths a year (2), TBI is one of the biggest health issues on the Old Continent as well. However, research shows that some TBI-related consequences could be successfully treated by hyperbaric oxygen therapies (HBOT).
What happens to your brain during TBI?
Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. A TBI can also occur when an object penetrates the skull. Some of the common causes include:
- motor vehicle crashes
- sports injuries
- child abuse
- blast injuries due to explosions
- firearms or shrapnel injuries
- blunt force trauma (hammer, baseball bat, etc.)
- bone fragment penetrating the skull
A traumatic brain injury can be viewed as a chain of events since it happens in three stages (3)
- The first injury occurs in the seconds after the accident. Usually, the head is rocked, shaken, or squished, causing the brain’s nerves to be twisted, stretched, or torn in the process. Blood vessels in the brain might rupture as well, causing internal bleeding.
- The second injury happens in the minutes and hours after this, depending on when skilled medical intervention occurs. The brain is deprived of oxygen because of something blocking the airways or because the blood flow to the brain is affected. This state is described as cerebral hypoxia and can seriously impact the brain.
- A third injury can occur at any time after the first and second injuries and can cause further complications. Even when the patient seems to recover from the initial TBI, bleeding, bruising, swelling, or blood clots can develop.
How to diagnose TBI and monitor recovery progress?
The symptoms of a TBI can be mild, moderate, or severe. To evaluate the damage, health providers use several diagnostic tools. First, they can ask a patient about their symptoms or perform a neurological exam. Next, they can choose to do imaging tests, such as CT or MRI. Another tool is the Glasgow coma scale which shows a patient’s ability to open their eyes, speak and move. Later, neuropsychological tests can help determine how a patient’s brain functions during and after rehabilitation. Another new and revolutionary test is The RightEye Vision System™ (4) which can evaluate brain function by tracking eye movements. All these methods give doctors a better understanding of the patient’s state, progress and needs, allowing a faster recovery.
Depending on how severe TBI is, different treatment methods are suggested and administered to patients. For example, for mild injuries with a slight concussion, only rest can suffice. In contrast, more serious injuries might require surgery, regular monitoring, checking the levels of oxygen provided to the brain, and long-term rehabilitation. (5) Here are some forms of therapy that are usually employed:
- physical therapy to build physical strength, coordination, and flexibility
- occupational therapy to help patients learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing
- speech therapy to help people with speech and other communication skills and treat swallowing disorders
- psychological counselling to help people learn coping skills, work on relationships, and improve their emotional well-being
- vocational counselling, which focuses on people’s ability to return to work and deal with workplace challenges
- cognitive therapy to improve memory, attention, perception, learning, planning, and judgment
The results are of a patient in the treated group suffering from left hemiparesis due to ischemic stroke that occurred 26 months prior to inclusion in the study. The brain perfusion maps (upper two images) show the infarcted brain (deep blue colour) involving the right antero-postero-lateral frontal, right superior-parietal and right parieto-occipital regions. Curved sagittal view in CT MIP reconstruction of the brain shows the anatomical stroke area (left lower image, V = posterior horn of right ventricle). The peri-infarct region show improved perfusion, as demonstrated by the HBOT image (right upper image). Quantitation of the cerebral blood flow (CBF) change (delta between baseline and HBOT) is demonstrated in the right lower image.
Image source: https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0053716.g006
Principles of HBOT that help the brain
Understanding the basic principles of hyperbaric therapy and its effect on the body can help us determine how HBOT can help people with TBI. As we know, Hyperbaric therapy (HBOT) is a procedure where a person breathes pure oxygen under pressure up to two or more times higher than normal. Under these conditions, the oxygen in our body is dissolved in blood plasma and can thus reach even the most ischemic parts of the body.
- Vasoconstriction that happens during the therapy can help fight unwanted internal bleeding and diminish oedema that often occurs in the first stage of TBI.
- Hyperbaric treatments can fix the tears and injuries of blood vessels and nerves.
- During the second stage of TBI, cerebral hypoxia threatens to impact the patient’s brain function. HBOT helps dissolve oxygen in the blood plasma, sending it to the affected brain in dire need of oxygen because of restricted blood flow or oedemas. Oxygen in the plasma is smaller than the molecules attached to red blood cells and thus able to penetrate the most hypoxic areas in the brain.
According to research, HBOT influences the body cells themselves and the processes inside them. A study from 2019 shows that HBOT helps patients with stroke and TBI on the cellular level by transferring mitochondria from astrocytes to PRNCs reducing cell death. (6)
Clinical trials provide convincing evidence that HBOT can induce cerebral plasticity, leading to repairing chronically impaired brain functions. Apart from that, it can improve the quality of life in post-stroke patients and mTBI patients with prolonged post-concussion syndrome, even years after the brain insult.
Dr Efrati and his team managed to show that patients recovered even from 26 months old brain damage. In any case, the observed reactivation of neuronal activity in the stunned areas implies that increasing the plasma oxygen concentration with hyperbaric oxygenation is a potent means of delivering to the brain sufficient oxygen for tissue repair: HBOT might initiate a cellular and vascular repair mechanism and improve cerebral vascular flow. (7).
AHA Medical Solution
Dr Efrati’s trial, mentioned earlier, was performed with the following HBOT protocol: 40 daily sessions, 5 days/week, 90 minutes each, 100% oxygen at 2ATA.
To replicate this trial’s effects and treat neurological disorders, one needs to rely on top-notch hyperbaric equipment. To provide clinics and medical personnel with a simple yet effective way to help their patients, AHA Hyperbarics provide AHA Medical Solution. It encompasses a portable 2.0 ATA hyperbaric chamber and oxygen delivery system and all accessories needed to provide safe and efficient treatments. AHA Hyperbarics also includes training for hyperbaric chamber operators and medical staff to fully utilize the equipment and offer their patients a well-rounded solution on the road to recovery.