The Effect of Hyperbaric Oxygen Therapy on Patients Suffering From Neurologic Deficiency Due Traumatic Brain Injury

INTRODUCTION Traumatic brain injuries (TBI) are a major cause of morbidity and mortality worldwide. Due to improvements in emergency medical care, transportation and specialized trauma facilities, the number of people surviving TBI with impairment has significantly increased in recent years. The long term cognitive sequelae, which are often not visible persist far beyond the resolution of the obvious physical disabilities. This combined with the relatively low awareness of the general public has designated TBI as the "silent epidemic" (TBI CDC 2006). Hyperbaric oxygen therapy (HBOT) has been suggested as a possible treatment modality for these cases and preliminary studies are promising.

The purpose of this study is to evaluate the effectiveness of HBOT in the treatment of chronic mild traumatic brain injuries (mTBI). Sequential SPECT scans of the brain and neurocognitive testing will be used to evaluate cerebral blood flow (CBF) response, cognitive and functional improvement following treatment.

Traumatic brain injuries (TBI) Traumatic brain injuries are a major cause of morbidity and mortality leading to major long term consequences on both a personal and national level with an estimated 5.3 million Americans suffering from permanent TBI related disabilities (24).The prevalence of traumatic brain injury in the United States is estimated to be approximately 1.5 million individuals per year (24,25). This however does not include those individuals who did not receive care in a facility included in national surveillance systems or received no medical care at all and thus probably significantly underestimates the actual number of TBI victims. The 2006 NIH consensus states a prevalence of 2.5 - 6 million people per year suffer form TBI(23).

Due to improvements in emergency medical care, transportation and specialized trauma facilities, the number of people surviving TBI with impairment has significantly increased in recent years. The long term consequences of TBI are vast, affecting a large number of people with a substantial effect on the patients themselves, their families and society as a whole. These injuries also impart a significant economic burden on those involved, both personally and as a society. Approximately 80,000 - 90,000 individuals suffer from long term disabilities annually, and the estimated costs including both direct medical care and indirect expenses such as lost earning potential were over 60 million dollars in 2001 in the US (28).

The long term sequelae of TBI may include impairment of the individuals physical, cognitive and psychosocial functioning. The neurological consequences are numerous and complex affecting various sites and functions. Sensory, motor and autonomic systems may all be affected and symptoms may include headaches, seizures, visual defects, movement disorders and sleep disorders. The cognitive consequences likewise are broad and varied. Amongst the symptoms most commonly noted are memory deficits and problems with attention and concentration. There may be impaired executive function, problem solving abilities and language difficulties as well as problems with planning, information processing, judgment and insight. While some of these symptoms may be apparent immediately after the injury, others may present days, weeks or months after the initial trauma(Kushner,24). Moreover, there can be vast fluctuations and changes in the severity and presentation over time.