Traumatic brain injury (TBI) encompasses a wide range of injuries, neurological problems, and outcomes. On one end of the spectrum is a concussion, which can be mild and short lasting. At the other end of the spectrum, traumatic brain injury can be lethal or leave patients with chronic mental and physical problems. Despite this range of severities, traumatic brain injury is one of the leading causes of disability in the United States, affecting over 13 million people. People who suffer from chronic symptoms related to traumatic brain injury may struggle with chronic seizures, memory problems, concentration problems, agitation, among others. TBI can have profoundly worsened a person’s quality of life and overall well-being.
Unfortunately, little can be done to treat traumatic brain injury directly. Aside from treating symptoms, the main treatment for TBI is to have the patient to rest and avoid stimulation in an effort to give the brain time to heal. Patients can regain some function through intensive work with physical, occupational, speech, and recreational therapist. However, the brain’s ability to heal itself is limited compared to other tissues of the body. In short, the brain has very little capacity to make new brain cells after we are born. So once TBI has occurred, patients either need to depend on other healthy areas of the brain or simply adapt to their circumstances.
Fortunately, researchers are finding ways to improve on nature through hyperbaric oxygen therapy. Drs. Shandley, Wolf and other hyperbaric medicine researchers recruited a group of 28 military veterans who sustained a traumatic brain injury in Iraq or Afghanistan. These individuals had ongoing cognitive problems as a result of their brain injuries. Researchers placed some study participants in 2.4 atm avoid hundred percent oxygen, while the others simply underwent a placebo experience at basically normal pressure and oxygen levels. The two groups underwent 30 exposures each and took a cognitive test before and after these treatments.
Hyperbaric oxygen therapy increased the number of stem cells in the blood of patients with TBI. In other words, hyperbaric oxygen treatment was able to move stem cells from the bone marrow and perhaps other tissues into the bloodstream. At the same time, those treated with hyperbaric oxygen performed better on tests of cognition including ImPACT, BrainCheckers, and PCL-M test. Moreover, no adverse effects of treatment were observed. Taken together, these results suggest 30 sessions of hyperbaric oxygen treatment at 2.4 atm was able to increase stem cells in the blood and improve cognition in US warfighters who suffered traumatic brain injury during combat. These results are encouraging news for the millions of veterans and nonveterans who sustained a traumatic brain injury every year.
Reference: Shandley, S. et al. (2017). Increased circulating stem cells and better cognitive performance in traumatic brain injury subjects following hyperbaric oxygen therapy. Undersea & Hyperbaric Medical Society. 2017 May-Jun;44(3):257-269.
Many US warfighters are left with traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) after suffering blast injury during battle. TBI is one of the leading causes of disability in the United States, and PTSD is rapidly becoming a leading cause of disability among US veterans. PTSD leaves sufferers with flashbacks, severe anxiety, sleep disturbances, mood disorders, and cognitive deficits. Traumatic brain injury, on the other hand, may cause a variety of mental and emotional problems. When these conditions occur in the same patient, it can have devastating effects on quality of life for the veteran’s remaining years.
The main treatment for traumatic brain injury is to simply allow the brain time to heal. Unfortunately, the brain is different than skin or other tissues of the body; it only has limited capacity to heal itself after an injury. The main treatment for PTSD is psychotherapy (talk therapy) and a rather nonspecific collection of medications including antidepressants and antipsychotic drugs. Unfortunately, people with both traumatic brain injury and PTSD are more difficult to treat, and generally, have poorer outcomes.
Researchers at the Veterans Administration studied the effects of hyperbaric oxygen therapy among military veterans with mild to moderate traumatic brain injury and PTSD. In a phase 1 clinical trial, veterans received 40 treatments of hyperbaric oxygen therapy lasting for 60 minutes each. Each treatment was 1.5 times atmospheric pressure or 50% more than they would experience under normal circumstances. Despite this modest dose of hyperbaric oxygen, the benefits to warfighters were remarkable.
After treatment, the veterans had substantial improvements in short-term memory, attention, concentration, and executive function. Shockingly, their IQ increased by nearly 15 points on average. They also enjoyed a substantial reduction in the frequency and severity of headaches. On average, they had a 30% reduction in PTSD symptoms. In fact, nearly 2/3 of trial participants were able to reduce the dose of or stop their PTSD medications.
Study participants also underwent special studies to examine the effects of hyperbaric oxygen therapy on brain tissue and blood flow. Patients treated with hyperbaric oxygen showed substantial increases in brain blood flow and marked increases in the volume of brain tissue. In other words, hyperbaric oxygen therapy was able to accelerate brain healing in this study.
This groundbreaking research has led to the use of hyperbaric oxygen therapy is a treatment for TBI and PTSD in other military personnel and also civilians. As additional clinical trials are published, the hope is that more health insurers, Medicare, and the VA will reimburse patients for this important treatment.
Traumatic brain injury (TBI) is one of the most common causes of disability in the United States, affecting over 13 million citizens. Traumatic brain injury is responsible for over 2 million emergency department visits, over a quarter of 1 million hospitalizations, and nearly 60,000 deaths each year.
Traumatic brain injury harms brain tissue in two phases. The first phase of injury occurs at the time of the traumatic incident. This initial injury may cause small or large areas of the brain to bleed. It may also shear (stretch/tear) nerve cells, making them dysfunctional. The second phase occurs hours or days after the initial injury. The brain is subjected to ongoing damage because of inflammation, cell death, and injury to blood vessels. Many people with TBI are left with lifelong problems with thinking, memory, and behavior.
In both of these phases of injury, one major way to help prevent long-term brain damage is by maintaining adequate blood flow to brain tissue. Unfortunately, once the damage has occurred, it can be a challenge to reverse the damage. Patients usually must endure months or years of physical and occupational therapy to regain what was lost. Moreover, patients often need substantial amounts of psychiatric and psychological support to treat mental health problems.
Fortunately, researchers are using hyperbaric oxygen therapy (HBOT) to improve blood flow to the brain in patients with traumatic brain injury. Hyperbaric oxygen therapy provides patients with pure oxygen (100%) at slightly higher pressures than they would experience normally. It is been used for hundreds of years to treat scuba divers who suffered “the bends” or decompression sickness; however, researchers are finding that hyperbaric oxygen therapy is a “coveted neurotherapeutic method for brain repair.”
To study the effects of hyperbaric oxygen therapy, researchers selected 10 people who had suffered mild traumatic brain injury in the previous 7 to 13 years. Patients all had brain damage that interfered with attention, memory, and thinking abilities.
Even though patients had sustained traumatic brain injury and brain damage a decade earlier, hyperbaric oxygen therapy was able to improve blood flow in the brain. Likewise, the amount of blood detected within the brain significantly increased, suggesting that hyperbaric oxygen therapy actually caused blood vessels in the brain to grow and multiply. Just as impressively, patients with chronic brain damage performed better on tests of cognition (i.e. thinking). They were able to process information more quickly, they had better motor function, and they were able to take in and process information about the world around them more efficiently.
Because people with traumatic brain damage have limited treatment options to improve their situations, these results are incredibly exciting. This was a study on 10 patients and more studies on larger numbers are still needed to build on these findings. Nonetheless, these results are quite encouraging for people with traumatic brain injury and their loved ones.
A technique called hyperbaric oxygen therapy (HBOT) has been shown to help patients with traumatic brain injury (TBI) who are suffering from a chronic neurological injury. HBOT appears to confer its benefits to these patients by increasing the neuroplasticity in the brain – or, in other words, by making it easier for the brain to re-wire itself. When the brain has a higher degree of neuroplasticity, it is easier to recover from neurological injuries because the brain can find ways to re-wire and restore functions that were lost due to damage to brain tissue.
A new study, published in Frontiers in Human Neuroscience, investigated the effects of HBOT on prolonged post-concussion syndrome (PPCS) that occurs as a result of TBI. The researchers used imaging strategies to monitor the brains of 15 patients with PPCS and evaluated the patients with tests of cognition. The researchers gave each patient 60 treatments with HBOT. The treatments were initiated anywhere from 6 months to 27 years after the patients had sustained their injuries.
Using imaging techniques called Dynamic Susceptibility Contrast-Enhanced and Diffusion Tensor Imaging (DTI) MR sequences, the researchers observed that HBOT increased blood flow and volume in the brain and that it led to the generation of new blood vessels. Using various cognitive tests, the researchers also found that HBOT improved memory, information processing speed, and executive functions.
Based on these findings, the researchers concluded that HBOT is beneficial for patients with TBI by inducing neuroplasticity in the brain, improving the integrity of microstructures of both white and gray matter within the brain, and allowing for the regeneration of nerve fibers. Future research will help clarify further benefits of HBOT and how the brain responds to this treatment.
Researchers have recently shown how a specific type of stem cell, called umbilical cord mesenchymal stem cells, can improve the neurological function of patients who have experienced traumatic brain injury (TBI). When TBI occurs, the trauma to the head leads the immune system to send cells to the area of injury. The resulting swelling often overwhelms the site of injury, which can cause significant damage to the tissue as a number of brain cells, or neurons, die. The rationale for using stem cells to treat TBI is therefore that by replacing these lost neurons, the functions that are lost as a result of TBI may be restored.
In the current study, published in the journal Brain Research, scientists studied 40 patients who had experienced TBI. Half the patients were selected to act as a control, receiving no treatment, while the other half was given 4 transplantations of umbilical cord mesenchymal stem cells through the spine. All 40 patients were evaluated both before any treatment was administered, as well as 6 months later. Specifically, each patient underwent the Fugl-Meyer Assessments (FMA), which assesses balance, motor functioning, and sensation, as well as the Functional Independence Measures (FIM), which tests both motor and cognitive functioning.
Though the control group of patients who did not receive any medical intervention did not improve in their FMA and FIM assessments over the 6 month period, the patients who received the stem cell transplants improved on both measures of functioning. In the FMA, improvements were observed in scores for upper extremity and lower extremity motor performance as well as for balance and sensation. In the FIM, a number of scores increased over the 6 month period for the treatment group, including those for self care, mobility, locomotion, communication, and social cognition.
These results demonstrate the great promise of stem cells generally – and of umbilical cord mesenchymal stem cells specifically – for the treatment of symptoms resulting from TBI. Further studies will be needed to help clarify the specific ways that these stem cells may be able to help patients who have suffered a TBI, and studies that involve multiple centers and larger sample sizes of patients are likely to occur in the future to help in the development of relevant treatments.
Both Hyperbaric Oxygen (HBO) treatment and Mesenchymal Stem Cells (MSC‘s) have been used as interventions for patients suffering from Traumatic Brain Injury (TBI). Find out more in this article.
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