Traumatic brain injury is characterized by altered consciousness or loss of consciousness with varying severities of injury (mild, moderate, or severe) that are proportional to the force of injury and cause anywhere from temporary neurologic dysfunction to death. Up to 55% of all mild TBI patients develop the persistent post-concussion syndrome characterized by cognitive symptoms, headache, irritability, sleep disruption, fatigue, dizziness, depression, anxiety, apathy, and change in personality.

HBOT is the only therapy that directly treats the underlying disease processes of TBI (decreased oxygen, decreased blood flow, swelling of the brain, constriction of blood vessels, acidosis, anaerobic metabolism). HBOT has been shown in multiple studies to have the greatest reduction in mortality of any therapy.

One to three sessions of HBOT in the acute period can decrease the mortality by 50-60% There is very little published experience of HBOT in mild TBI, but in Dr. Harch’s career he has treated many patients within the first week after concussion/mild TBI. With mild TBI after just a few treatments, many patients experience near complete or complete relief of symptoms. For patients with the persistent post-concussion syndrome, HBOT is the most effective therapy known. HBOT is effective in relieving symptoms brain related combat injuries and can create a reduction in suicide ideation in veterans.

There are a wide range of benefits, but the treatment of hbot have resulted in patients generally experiencing partial or complete reversal of the neurologicaldeficit. The most important factor in HBOT treatment of stroke has been the proper dosing of HBOT, based on the type of stroke, and time of intervention. While the best results are derived from early application of HBOT, most patients don’t get HBOT until years after their stroke.

Even in these chronic cases, which comprise the bulk of stroke patients can still experience improvement in their motor, sensory, cognitive, gait, balance, and other symptoms. One of the most comprehensive reviews of HBOT in stroke is presented by Dr. Jain in the Textbook of Hyperbaric Medicine. The net result of all studies and the treatment of over 2000 stroke patients is a beneficial effect of HBOT on all phases of stroke.

Autism or Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental disorders that are defined by behavioral observations and are characterized by impairments in communication and social interaction along with restrictive and repetitive behaviors. ASD includes autistic disorder, Asperger syndrome, and pervasive developmental disorder-not otherwise specified (PDD-NOS). An estimated 1 out of 110 individuals in the United States is currently affected with an ASD.

Recently, hyperbaric oxygen therapy (HBOT) has increased in popularity as a treatment for autism. Numerous studies document oxidative stress and inflammation in individuals with autism; both of these conditions have demonstrated improvement with HBOT, along with enhancement of neurological function and cognitive performance. Children with autism were treated with HBOT at atmospheric pressures and oxygen concentrations in current use for this condition. Changes in markers of oxidative stress and inflammation were measured. The children were evaluated to determine clinical effects and safety.

Pre- and post-parental observations indicated statistically significant improvements in both groups, including motivation, speech, and cognitive awareness. No major adverse events were observed.

It has been demonstrated that the majority of patients affected by ASD (Autism Spectrum Disorder) have high levels of inflammation, compromised blood flow and low oxygen delivery to certain parts of the body. HBOT has been shown in clinical data to help decrease inflammation and reintroduce oxygen and blood flow to affected areas, including affected regions in the brain. This has demonstrated to help improve overall functioning, receptive language, speech and eye contact scores. Additionally, it has been shown to help decrease irritability, hyperactivity and inflammatory markers including TNF-alpha and C-reactive protein levels.

Completing a minimum of 40 hours of therapy within 30 days is the most highly recommended protocol for HBOT, regardless of the pressure. This recommendation parallels clinical data and directly correlates to the best results that have been seen and recorded.

HBOT works in MS by repairing the wounds to the nerve fibers and inhibiting inflammation.      Benefits from HBOToften include increased mobility, reduced fatigue, and improved equilibratory coordination. Urinary symptoms also improve, as well as nystagmus and spasticity. The most rigorous study ever performed using HBOT-treatment of MS was published in one of the most prestigious medical journals, the New England Journal of Medicine, in 1983.

The study showed a statistically significant improvement in HBOT-treated MS patients compared to the control group. Patients experienced increased mobility, reduced fatigability, and improved equilibratory coordination, along with improved urinary symptoms, improvements in nystagmus (rapid beating of the eyes), and improvements in spasticity. At the one year follow-up, deterioration occurred in 12% of the HBOT group vs. 55% of the control group. In other words, HBOT had a sustained effect and prevented further deterioration.

When ten to fourteen year follow-up studies were performed on MS patients in England receiving long-term treatment (one treatment every 2-4 weeks) patients demonstrate maintenance and even improvement in neurological function.

Cerebral palsy (CP) refers to varying degrees of permanent and non-progressive neurological disorders resulting from a brain injury at some point during development, as well as brain damage occuring at any time between fetal development and into infancy.  Symptoms include developmental delays, motor problems (including speech/chewing/swallowing), irritability, muscle spasms, seizures, cognitive problems and hearing/vision problems.

In some instances, HBOT has shown to have positive effects on gross motor function, attention, memory, speech, and functional skills.  In another instance,  60 sessions of HBOT improved one child's CP symtpoms significantly to the point where he was able to walk (with very little assistance).  In yet another case, a child diagnosed with CP was able to regain his vision, attain a significant degree of control over his motor functioning, and an overall improvement in quality of life.

Reports of positive improvements are largely anecdotal.  With children who have CP, HBOT is typically used in conjunction with other forms of treatment modalities (speech therapy, occupational therapy, etc).  According to one study, the optimal candidate for hyperbaric oxygen is a patient with unrecovered brain injury where tissue hypoxia is the limiting factor for the regeneration processes.  In this patient, HBO2 may induce neuroplasticity in the stunned regions where there is a brain anatomy/physiology (e.g., SPECT/CT) mismatch.

HBOT has emerged as an effective treatment for some patients who previously had little hope of recovering from late side effects of radiotherapy. HBOT increases the amount of oxygen in the blood by exposing patients to pure oxygen within a sealed chamber set at pressures greater than the ambient atmosphere, with results that can be measured using a transcutaneous partial pressure oxygen (TCPO2) monitor before and after treatment. Experts believe HBOT helps patients by stimulating growth of new blood vessels following radiation-induced damage.

HBOT has shown to be effective in the treatment of late radiation tissue injury (LRTI) - otherwise referred to as late effects of radiation therapy (LERT), or Delayed Radiation Injury (DRI).  Radiotherapy treatment for cancers is common and may result in the destruction of tissue blood supply; therefore, the tissue becomes hypoxic, hypovascular, and hypocellular.

HBOT works to improve both oxygen and blood supply to the damaged tissue, and can also be used both before and after surgery in cases where the likelihood of osteoradionecrosis (ORN) is high.  Regardless of the type of cancer being treated with radiotherapy, radionecrosis and DRI are possible - depending on dose and sensitivity - and can be treated effectively with HBOT.

Thermal burns are common in the United States, and approximately 2 million people are injured every year, with about 155 per million patients needing admission to a hospital, and 6500 cases resulting in death. Burns are complex and dynamic injuries that cause profound activation of platelets and white cells, destruction of the microvasculature by coagulation or thrombosis, and accumulation of edema.

Medical treatment of burns is critical, especially when they are a second degree or worse and when a substantial amount of body surface area is affected. There are multiple factors to why thermal burns are difficult to treat, and hyperbaric oxygen therapy (HBO) may be used as part of the treatment regimen to reduce healing time and improve outcomes.

Hyperbaric oxygen (HBO) is also used to treat carbon monoxide poisoning and smoke inhalation injuries. Given within the first 48 to 72 hours of a burn injury, HBO therapy increases the oxygen saturation in the body, which speeds up the recovery process. Hyperbaric oxygen is also a valuable treatment for patients with chronic wounds, damaged soft tissues, and certain life-threatening conditions.

When it comes to the treatment of PTSD, the majority of the focus centers around combat veterans who frequently exhibit symptoms suggestive of mild traumatic brain injury (mTBI) even though they have not been diagnosed with a TBI.

The acute damage frequently results in chronic psychological and neurological symptoms that can be difficult to treat, including headaches, memory and attention deficits, and mood swings. Post-traumatic stress disorder (PTSD), an anxiety disorder caused by a stressful event and the subsequent memories of it, has been diagnosed in a proportion of TBI patients.

In one study, participants suffering from chronic neurological deficits due to traumatic brain injury (TBI) were treated with 40–70 daily hyperbaric sessions, 5 days a week. Each session consisted of 60/90minutes of exposure to 100% oxygen at 1.5/2 ATA.  HBOT was associated with significant cognitive improvements. The clinical improvements were well correlated with increased activity in the relevant brain areas.  The most striking changes observed in brain single photon emission computed tomography images were in the anterior cingulate and the postcentral cortex, in the prefrontal areas and in the temporal areas

Globally, every 30 seconds, a lower limb is lost, which is a major sequela of diabetes. The incidence rate of DFU in diabetes patient is 2%, (9.26 million) and this risk increases 17–60% with a previous history of DFU in next three years; also, among them, half (4.63 million) of diabetes patients undergo lower limb amputation at some stage of their life. Additionally, 28–51% DFU patients after the first amputation will have a higher probability of the second amputation in within five years. Furthermore, a higher rate (28–77%) of mortality was reported between 90 days to 5 years of post-amputation in diabetic patients as well as reduction of survival rate at five-years were up to 55%, 34.4% after minor and major amputations respectively in diabetes patients with DFU.

When it comes to diabetic wounds in the lower extremeties, hyperbaric oxygen therapy has proven to be significantly effective as an adjunctive therapy in the treatment of ulcers and various wounds that have failed an adequate course of standard wound therapy.  Another study found that HBOT for diabetic foot ulcers (DBU) was significantly effective in the complete healing of the foot ulcer, as well as reduction of major amputation.

Diabetic foot ulcer is a pathological condition that arises from diabetes and represents a major health problem throughout the world, and is defined as a foot affected by ulceration that is associated with neuropathy and peripheral arterial disease of the lower limb in a person with diabetes.  HBOT can prove effective as an adjunct therapy due to it's effects on improving wound tissue hypoxia, enhancing perfusion, reducing edema, downregulating inflammatory cytokines, promoting fibroblast proliferation, collagen production, and angiogenesis.