A Study on Hyperbaric Oxygen Therapy in Children with Post-Concussion Syndrome

In a 2022 study in Scientific Reports, researchers at Shamir (Assaf Harofeh) Medical Center and Tel-Aviv University examined the effect of hyperbaric oxygen therapy (HBOT) on children between the ages of 8 and 15 with recent symptoms of persistent post-concussion syndrome (PPCS).
Study participants who received 60 sessions of hyperbaric oxygen therapy showed signs of cognitive and behavioral improvement on many assessments. MRI scans revealed a decrease in diffusivity in several brain areas of importance to cognition, which is a sign of decreased swelling and inflammation.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy involves placing the patient in an environment with greater than normal atmospheric pressure and oxygen content. Hyperbaric treatments cause more blood to reach the organs, including the brain.

The first known implementation of HBOT occurred in 1662 when its developer used it to treat lung problems. The use of HBOT increased in the 19th century when medical practitioners used it to treat lung diseases, such as tuberculosis and other afflictions. HBOT became an effective therapeutic tool in the 20th and 21st centuries when modern HBOT treatment protocols took shape.

In typical HBOT treatments, the patient undergoes daily sessions over a period that varies depending on the patient’s needs. Each session lasts up to two hours. During the session, air pressure increases, and the patient breathes in 100% oxygen instead of the atmospheric mixture of mostly nitrogen and oxygen.

At the end of the session, the pressure gradually decreases over ten minutes to prevent the harmful effects of rapid decompression.

Persistent Post-Concussion Syndrome

Persistent post-concussion syndrome occurs when symptoms last longer than usual (three months to a year or more) after a mild traumatic brain injury (mTBI). The symptoms of a minor TBI include difficulty concentrating, headaches, changes in sleep patterns, sensory issues, and anxiety.
PPCS tends to be more common in older adults, but children can experience PPCS as a result of bicycling, participation in athletic sports, and other activities.

The Study Design and Procedure

The current study was a randomized, double-blind clinical trial that investigated the effects of HBOT relative to sham treatment. The majority of patients in both conditions believed they were in the experimental condition, suggesting that the double-blind protocol achieved its goal of minimizing placebo effects.

The use of multiple measures, including patient behavioral data, parent reports, and neuroimaging, reduces the risk that the study’s overall conclusions are an artifact of any one statistical process or assessment method.

Study Participants

A total of 25 children participated in this study. The experimental group included 15 children, and the control group included ten children.

To be eligible for the study, patients needed to have a Glasgow Coma Scale score of 9 to 15, a mild TBI within the past year but not more recently than six months, and no change in symptoms within the past month. They also needed to show a deficit in at least one cognitive domain based on tests administered during the screening procedure (below).

The design excluded some patients for pragmatic reasons, such as prior HBOT or medical conditions that would contraindicate MRI scanning.

Screening, Baseline, and Post-Treatment Assessments

The study assessed participants’ cognitive abilities and mental functioning using the Neurotrax cognitive battery (for children over age 10), a trail-making test, the WISC-IV, TOMAL (a memory test), and other tests of executive function, learning, attention, and language fluency. Participants also underwent the BESS test to assess their balance and posture stability.

Parents reported data on patients’ symptoms (the British Columbia Post-Concussion Symptom Inventory), quality of life (PedsQL), behavior Health and Behavior Inventory (HBI), and behavioral assessments (Conners 3 and BRIEF).

MRI Scanning

Researchers used a 3 T Magnetic Resonance Imaging (MRI) scanner to assess structural changes in the brain using FLAIR, SWI, and DTI imaging techniques. However, the study’s authors do not mention identifying or localizing specific regions of interest before conducting the study, so the link between HBOT and specific brain regions may await further confirmatory studies.

The Hyperbaric Oxygen Therapy Treatment Sessions

Patients underwent five 60-minute sessions of HBOT per week for 12 weeks in a Starmed-2700 chamber. During the HBOT treatment, the air pressure was 50% greater than normal, and the patients breathed 100% oxygen.

In the sham treatment, air pressure was only 3% above atmospheric pressure in the chamber, and the patients breathed a normal (21%) oxygen concentration. The authors note this as an improvement over previous research that increased the air pressure and oxygen concentration in the “sham” trials.

Effects of Post-Concussion Syndrome Therapy Using Hyperbaric Oxygen

The data suggest wide-ranging, if occasionally sporadic, effects of HBOT therapy on cognition, behavior, physiology, and quality of life.

Additional Read: Effect of HBOT on Cognition, Performance, Proteomics & Telomere Length

Cognitive Changes

The children in the experimental condition showed a significant improvement in cognitive function on the Neurotrax cognitive battery. In contrast, the children in the sham condition showed a slight numerical decrease in cognitive function that did not approach statistical significance. The memory subset of the cognitive assessment showed the most striking improvement.

The WISC-IV results showed an increased digit span and improved performance on the cancellation task. In the cancellation task, the child has to identify the instances of a target in a cluttered visual array. The children who received HBOT also outperformed the sham group in verbal fluency and the 5PT task.

Behavioral Changes

Children in the experimental group improved in the cognitive and somatic sections of the Health and Behavior Inventory. The HBOT and the sham groups reported increased scores on the BC-PSI assessment. In the Conners 3 and BRIEF assessments, children in the HBOT condition showed improvement across many domains.

Participants showed improvement in two of the four subsections of the quality of life assessment: psychosocial health and school functioning.

Changes in Mean Diffusivity on MRI Scans

The diffusion of water through areas of brain tissue, as distinct from normal diffusion of water along axons, is often a sign of swelling or edema. In this study, several brain areas showed a decrease in mean diffusivity for experimental participants compared to the sham participants.

As support for the functional role of changes in diffusivity, the researchers point to a correlation between MD and improved cognitive function. The changes reflect known associations between specific brain regions and cognitive domains. For example, changes in the left insula, an area linked to language functions, correlated with phonemic fluency.

Must Read: The Benefits of HBOT for Post-Traumatic Stress Disorder

Limitations of the Study

The sample size (n = 15) is lower than ideal for this study, and the study’s authors make no mention of correction for multiple comparisons in their statistical analyses. Considering these limitations, the study strongly suggests some improvement following HBOT in crucial cognitive, behavioral, and neurophysiological measures.

General Implications for the Treatment of Persistent Post-Concussion Syndrome

According to the Mayo Clinic, the treatment of post-concussion syndrome addresses the symptoms. Cognitive behavioral therapy (CBT) and medication can address difficulty focusing, anxiety, emotional disturbances, and other cognitive or mental health symptoms.

If patients have changes in posture, coordination, balance, or heart rate following a concussion, a doctor might refer them to an ENT specialist and prescribe physical therapy, such as stretching or exercise on stationary bikes.

Patients often take over-the-counter or prescription pain medication for post-concussion headaches. However, overuse of these medications can worsen symptoms or introduce new side effects.

Patients who experience worsening symptoms, such as severe headaches, should go to the emergency room for immediate treatment. At the ER, doctors might perform a CT scan or MRI of the head to identify or rule out bleeding, strokes, swelling, or other acute problems.

The lack of a single unitary treatment for PCSS means that a whole-body treatment like hyperbaric oxygen therapy has the potential to impact the symptoms of PCSS across multiple domains in ways that complement other forms of post-concussion syndrome therapy.

Hyperbaric oxygen therapy promotes organ functioning, enhances healing processes, and improves patient quality of life. The current study advanced our understanding by using improved experimental controls to identify potential improvements in memory, cognition, behavior, and quality of life in patients with PCSS after hyperbaric oxygen therapy.

Hyperbaric Oxygen Therapy for Post-Concussion Syndrome at NexGen Hyperbaric, LLC

Our dedicated healthcare professionals at NexGen Hyperbaric, LLC, are proud of their exemplary medical service using hyperbaric oxygen therapy for post-concussion syndrome, wound care, and other acute and chronic medical equipment. We use state-of-the-art equipment and prioritize the comfort and safety of our patients.

Our commitment to evidence-based care means we keep the patients, families, and medical practitioners we work with up-to-date on the latest clinical research on the expanding role of hyperbaric oxygen therapy on 21st-century standards of medical care.

Whether you are a healthcare provider looking for more information about hyperbaric oxygen therapy, a patient, or the parent or guardian of a patient in need of hyperbaric oxygen therapy, feel free to call us at 888-567-4302. Ask us about the potential of HBOT to treat chronic conditions, including persistent post-concussion syndrome and other medical conditions.