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Brain Injury & Recovery of Function with Reference to Hyperbaric Oxygen
Excerpt from Dr. Philip James MD. Scotland
After brain injury, many blood capillaries around the are of cell death become torn. The blood plasma then leaks out causing swelling in the surrounding brain tissue, squeezing it like a sponge and so reducing blood flow and therefore nutritional supply. Without this essential nutrition, the brain's electrical activity becomes diminished and signals can not be effectively rerouted. Unfortunately the tiny tubules leading to the capillaries also become so constricted that the red blood cells can not get through to heal the torn capillary walls. Hyperbaric Oxygen treatment is the giving of oxygen under increased atmospheric pressure, (i.e. above the one atmosphere at which we all live) which dramatically increases the oxygen carried in the blood plasma. The treatment is carried out in a Hyperbaric Oxygen Chamber.
In this way, oxygen becomes available to heal the capillary walls, so preventing plasma leakage and reducing swelling. As the swelling decreases, normal blood flow is restored to the surrounding tissue and the cells electrical activity recommences.
1. The complex and almost continuous electrical activity of the brain is so discreet that we are unaware that it is the mechanism behind communication and thus intellectual and motor function.
2. Brain injury can lead to a blockage of the electrical pathways.
3. Depending on the location of the injury, the brain's attempts to re-route through blocked pathways may cause frustrated discharges of activity known as seizures.
What Causes the Blockage ?
SPECT scans (computerized brain mapping) show that not only does brain injury produce cell death, but also it reduces essential blood flow to a wider area of brain tissue surrounding the dead cells, where signal re-routing might be expected to take place.
How does this happen ?
1. After brain injury many blood capillaries around the area of cell death become torn open.
2. The liquid part of the blood (the plasma) then leaks out causing a swelling which may be very extensive.
3. This reduces cerebral blood flow in the affected area.
4. Reduction in blood flow means a reduction of essential nutrition (most vitally oxygen), and a build up of waste products from local biochemical reactions (eg lactate and calcium), which shut down normal cell function and further block pathways.
Why doesn't Capillary Healing happen ?
1. If the capillaries are to heal they desperately need oxygen.
2. Unfortunately, the tiny tubules leading to the torn capillaries become constricted because of the damage.
3. This means that the red blood cells needed to bring the healing oxygen are too big to get through and simply get stuck in the pipes.
What does Hyperbaric Oxygen Therapy do ?
1. It is a scientific fact that, whereas we all live under atmospheric pressure (ie one atmosphere), gases dissolve increasingly into liquids as atmospheric pressure increases.
2. This can be seen each time you release bubbles by unscrewing a bottle of fizzy drink, as the pressure is reduced more bubbles seem to appear from the water.
3. Although blood plasma is normally quite low in oxygen, on high pressure days people usually feel more energetic because a little more oxygen has been dissolved in the blood plasma. Conversely, many people feel their complaints are worse on a low pressure day.
4. If additional oxygen is urgently needed to restore torn tissue, increasing the dose may be paralleled to increasing the dose of vitamins, minerals or amino-acids by food supplementation or by giving an artificially engineered 'normal' dose of insulin to a diabetic.
5. It is impossible to absorb the extra oxygen by breathing it in at normal atmospheric pressure because insufficient can be dissolved in the blood plasma at only one atmosphere.
6. Thus, in order to improve cerebral blood flow, the brain injured individual needs to sit or lie comfortably in a pressurized chamber breathing oxygen through a mask (or a lightweight transparent hood).
7. The ideal pressure for the compressed air in the chamber, and the oxygen breathed, is 1.75 atmospheres - that is 3/4 of an atmosphere above the one atmosphere at which we all live - the equivalent of 24ft of sea water - a relatively shallow depth.
8. As oxygen delivered in this way is breathed the blood plasma becomes oxygen rich.
9. It is thus able to carry the healing oxygen through the constricted capillary tubules to the torn capillary walls which will then begin to heal.
10. As the capillaries heal, their torn walls close and plasma leakage into the surrounding brain tissue stops.
11. Tissue swelling is reduced even more efficiently because oxygen has a slightly constricting effect on blood capillaries.
12. Thus, when blood plasma is oxygen rich, there is also less fluid to contribute to the swelling traveling through the torn capillaries as well as more oxygen to heal them.
13. The swelling gradually goes down and normal blood supply is slowly restored to the previously waterlogged brain.
14. Normal blood supply restores essential nutrition and the washing away of waste products so that the brain's electrical potential for sending normal signals can be restored.
Wherever the injury is in the brain, and whatever diversity of symptoms it produces, the same patterns of problem arise, and the same approach to healing is possible using hyperbaric oxygen therapy.
1. Qibio W & Hongiun et al.: Treatment of Children's Epilepsy by Hyperbaric Oxygenation: Analysis of 100 cases. Proceedings of the 11th International Congress on Hyperbaric Medicine 1995, p79-81.
2. Neubauer RA, Gottlieb SF, & Kangan RL: `Enhancing Idling Neurons',The Lancet, 3 March 1990, p542.
3. Neubauer RA, Gottlieb SF & Miale A: Identification of Hypometabolic Areas in the Brain using Brain Imaging and Hyperbaric Oxygen, Clinical Nuclear Medicine Vol.17, June 1992 p477-481.
4. Sukoff M & Raguix R: Hyperbaric Oxygenation for the Treatment of Acute Cerebral Edema Neurosurgery, Vol.10 no.1.
5. Machado JJ: Clinically observed Reduction of Spasticity in Patients with Neurological Diseases and Children with CP from Hyperbaric Oxygen Therapy. "Centro Bradileiro de Medicina Hyperbarica", San Paulo, Brazil, 1984.
Hyperbaric Oxygen Study Shows Potential Benefit for Patients With Traumatic Brain Injury (2010)
MINNEAPOLIS, Jan. 4 /PRNewswire-USNewswire/ -- A 5-year study of patients with severe traumatic brain injury conducted at Hennepin County Medical Center in Minneapolis shows significant benefit of hyperbaric
oxygen therapy to improve brain metabolism and its ability to recover from injury. The results were recently published in the Journal of Neurosurgery <http://thejns.org/doi/pdf/10.3171/2009.7.JNS09363>.
Every year, more than 1.4 million Americans sustain a traumatic brain injury (TBI) - the leading cause of death and disability in children and young adults. Those who survive often face months or even years of therapy, and sometimes the damage to the brain is irreversible. Decreased utilization of oxygenated blood to brain tissue immediately after the injury is often to blame.
Cells need oxygen to fuel metabolism for cellular growth and repair. Healthy brains produce their own energy to maintain brain tissue and keep the rest of the body doing what it's supposed to do. That includes automatic processes like breathing and circulation, as well as voluntary actions like walking and talking. After a traumatic brain injury, the brain itself needs care. Barriers to blood flow can be compromised from the impact of the injury itself, and then when the brain swells inside the skull, a secondary injury can occur that causes even more brain damage.
"There's a direct correlation between clinical outcome and the degree to which the brain's metabolism is restored," explains one of the study's authors, neurosurgeon Gaylan Rockswold, MD. "In previous research we learned that the brain's energy production is improved and maintained with hyperbaric oxygen treatment, but this study confirms that hyperbaric oxygen treatment has a major impact in terms of /increased
Within 24 hours after injury, eligible patients for the study were randomized into three groups: One group received "normobaric" treatment: oxygen delivered at the patient's bedside; another group received hyperbaric treatment in Hennepin County Medical Center's hyperbaric oxygen chamber; and a third (control) group did not receive additional
oxygen therapy. All groups received the intensive standard of care for brain injury consistent with good clinical practice. The patients who received higher levels of oxygen (hyperoxia) via the hyperbaric oxygen chamber were found to have a marked increase in positive brain metabolism when compared to the normobaric and control group.
"Our goal was to evaluate the brain's metabolism and intracranial pressure, and whether or not too much oxygen posed a concern with hyperbaric oxygen treatment in these patients," said Dr. Rockswold. "The results indicate that hyperbaric oxygen treatment was found to significantly enhance the brain's energy production and reduce
intracranial pressure without any toxic effects on the brain or lungs from too much oxygen."
This research provides important preliminary data for a National Institutes of Health (NIH) supported multicenter trial. NIH trials directly assess the ability to improve clinical outcomes, which is the final step needed to change standard clinical processes. Currently standard clinical practice does not include hyperbaric oxygen for traumatic brain injury/. /
"TBI is not only devastating for the patient, it's also heart wrenching for his or her family. We couldn't be more pleased about the impact this study will have for patients with traumatic brain injury."
The Traumatic Brain Injury Center at Hennepin County Medical Center offers comprehensive, multidisciplinary patient care education and research to serve people who have sustained a traumatic brain injury. Providing a full range of state-of-the-art medical and rehabilitative services, HCMC's expertise spans the entire continuum of care for adult and pediatric TBI patients, from prevention to emergency care, neurosurgery, critical care, rehabilitation and the Mild to Moderate Traumatic Brain Injury Clinic.