Treatment of mild traumatic brain injury with hyperbaric oxygen

50 Pages·2009·2.66 MB·English

UHM 2009, Vol. 36, No. 6 – Treatment of mild traumatic brain injury with hyperbaric oxygen
Case report: Treatment of mild traumatic brain injury
with hyperbaric oxygen
CoLoneL JAMeS K. WrIGHT1, eDDIe ZAnT2, KeVIn GrooM3, roBerT e. SCHLeGeL4,
KIrBy GILLILAnD4
1720th Special Tactics Group, Hurlburt Field, Florida, USA; 2Hyperbaric Medicine Inc., Fort Walton
Beach, Florida, USA; 3The Anchor Clinic, Destin, Florida, USA; 4Center for the Study of Human
Operator Performance, The University of Oklahoma, Norman, Oklahoma, USA
AbSTrACT
Two United States Air Force Airmen were injured in a roadside improvised explosive device (IeD)
blast in Iraq in January 2008. Both airmen suffered concussive injuries and developed irritability, sleep
disturbances, headaches, memory difficulties and cognitive difficulties as symptoms of mild traumatic
brain injury (mTBI). Six months after injury, repeat Automated neuropsychological Assessment Metrics
(AnAM) testing showed deterioration, when compared to pre-injury baseline AnAM assessment, in all
measured areas (simple reaction time, procedural reaction time, code substitution learning, code
substitution delayed, mathematical processing, and matching to sample).
The airmen were treated with hyperbaric oxygen in treatments of 100% oxygen for one hour at 1.5
atmospheres absolute, resulting in rapid improvement of headaches and sleep disturbances,
improvement in all symptoms and resolution of most symptoms. repeat AnAM testing after completion
of the hyperbaric treatments — nine months after initial injury — showed improvement in all areas,
with most measures improving to pre-injury baseline levels. The airmen received no other treatment
besides medical monitoring. Repeat neuropsychologic testing confirmed the improvement. We conclude
that the improvement in symptoms and AnAM performance is most likely attributable to HBo treatment.
INTrOduCTION 1) any period of loss of or a decreased level of
Traumatic brain injury has been called one of the consciousness lasting less than 30 minutes;
signature injuries of operations enduring Freedom 2) any loss of memory for events immediately
and Iraqi Freedom. The rAnD report documented before or after the injury lasting less than
a 19% self-reported incidence of probable TBI 24 hours after the event;
among returning service members, with 3) any alteration in mental state at the time of
320,000 probable TBI cases. Most of these cases the injury such as confusion, disorientation,
(80%) are considered mild traumatic brain injury, or slowed thinking lasting less than 24 hours
or mTBI (1). after the event;
on a per-case basis, one-year costs for mTBI were 4) transient neurological deficits (e.g., weakness,
estimated at $27,259 to $32,759 in 2007 (2). The loss of balance, change in vision, praxis,
lifetime costs of even mild TBI impairment in young paresis or plegia, sensory loss, aphasia); and
service members can be deemed incalculable (3). 5) normal intracranial imaging.
Mild TBI is usually characterized by a concussive Findings may be transitory, and late sequelae that
event that causes a brief period of unconsciousness are not explainable by other means may qualify
(lasting less than 30 minutes) or a period of confusion an individual for the diagnosis of mTBI. Patients
or amnesia lasting less than 24 hours. The Department with more than one of these findings may be
of Defense has developed criteria for the diagnosis assigned a higher level of TBI (4).
of mTBI, which must include one of the following:
Copyright © 2009 Undersea and Hyperbaric Medical Society, Inc. 391
UHM 2009, Vol. 36, No. 6 – Treatment of mild traumatic brain injury with hyperbaric oxygen
Since the symptoms of mTBI may develop The detonation occurred on the passenger
gradually, are often subtle, and can be confused with side of the vehicle, nearer to where Airman B was
other illness such as post traumatic stress disorder, sitting. The vehicle was damaged, and Airmen B
mTBI may be unrecognized and undiagnosed (5). and C sustained concussive injuries with a sense of
A concussive injury causes diffuse axonal injury, being dazed for several minutes. There was no
structural neuronal damage and diffuse neuronal known direct blow to the head for either occupant or
dysfunction (6). loss of consciousness, although both occupants had
The symptoms of mTBI are variable and may tinnitus. Airman B, who was approximately 3 feet
include headache, irritability, impulsivity, anger, closer to the blast, suffered immediately from a severe
cognitive impairment, memory difficulty, loss of headache. Airman C continued to drive the damaged
executive function, and vestibular and sleep vehicle for several minutes and had no immediate
disturbances (7). electroencephalogram and sleep symptoms other than being slightly dazed; however,
studies are usually normal. Most individuals with he developed a mild headache some hours later.
mTBI recover in three to 12 months, especially Later in the day, Airmen B and C reported to
those who are young (8). However, some victims do the medical clinic, where no additional injuries
not recover, or recover slowly; they are at risk for were found. They were given acetaminophen
future injury and deterioration of brain function (9). for their headaches and placed on light duty.
Mild TBI usually resolves without treatment Two weeks later their symptoms had largely
within months, although approximately 20% of resolved, and they were returned to full duty.
patients with mild TBI continue to have lingering Three weeks post-injury both airmen noted the
symptoms for one year or longer after injury return of headaches, with difficulty sleeping. Airman
(1,10). Poor scores on neuropsychological testing B expressed his headache severity as 5-6 and Airman
months after injury have been correlated with C as 4-5 (on a scale of 1-10, with 10 being the most
poorer outcomes and unresolved symptoms (11). severe pain imaginable) with headaches occurring
Patients with several post-concussive symptoms daily and lasting for several hours. Both individuals
are unlikely to improve after one year, in spite of had difficulty falling and remaining asleep, and
traditional therapy (12). Treatment of mild TBI they reported sleep duration of three to six hours
has included rest and observation, education, per night. Additionally both individuals felt they
cognitive rehabilitation and phamacotherapy (13). were quick to anger and stayed angry from trivial
Pharmacologic treatment may be required for provocations for several hours. Lack of attention to
control of disabling symptoms of headache, detail, forgetfulness, and fatigue were also reported
irritability, depression, and anger (14). Because by both airmen. These latter symptoms began
of the efficacy of hyperbaric oxygen (HBO) in insidiously about three weeks after injury,
treating brain dysfunction from decompression progressed for about two months and remained
sickness and carbon monoxide injuries, as well constant for the next four months, until
as anecdotal reports of its efficacy in treating treatment with HBo was administered.
concussive injuries, we felt HBo might prove Upon arrival at their home base, the airmen
of use in treating two airmen injured in a blast. presented to the clinic complaining of headaches,
fatigue, lapses in memory, irritability and sleep
CASE rEpOrT
disturbances. neurological exams were normal,
In January 2008 Airman B, a 23-year-old although the airmen appeared tired. Computerized
male vehicle operator, was a convoy lead vehicle tomography of the brain, eeGs and sleep studies
commander sitting in the passenger seat of an were normal.
M915 14-ton truck. Airman C, a 22-year-old male on initial deployment both airmen had
vehicle operator, was driving the vehicle that was received the Automated neuropsychological
attacked with an improvised explosive device (IeD). Assessment Metrics test (AnAM) on 11 november
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UHM 2009, Vol. 36, No. 6 – Treatment of mild traumatic brain injury with hyperbaric oxygen
2007, two months prior to injury. This test was Initially, treatment of the headaches with
repeated on 21 July 2008, six months after injury. ibuprofen and butalbital-aspirin-caffeine capsules
The repeat AnAM testing showed marked (Fiorinal®) was tried, but these drugs were
declines from the pre-injury baseline in several ineffective in relieving the pain. The airmen
areas of measurement (Figures 1A and 1B, Page 394). were placed on limited duty and daytime work only.
Airman B presented a statistically significant As the airmen had experienced at least one of
change in Simple reaction Time and Matching the symptoms of mTBI after the blast (confusion,
to Sample tests, with declines in all other areas. alteration of mental state) and their symptoms
Detailed neuropsychological testing of Airman had no other reasonable explanation, they were
B at six months post-injury and prior to HBo given the diagnosis of mTBI in accordance
therapy revealed a diffuse or scattered pattern of with the Department of Defense criteria (4).
deficits. Although his IQ score was within the Because the two airmen had shown no improve-
average range, his neuropsychological functioning ment in their symptoms for seven months and were
on a summary measure (repeatable Battery for having difficulty performing their occupations, it
the Assessment of neuropsychological Status – was decided to begin hyperbaric oxygen treatment.
rBAnS Form A) (15) was at just the 7th percentile. Treatment with HBo was begun eight months
Moreover, Airman B showed marked attention post-initial injury. The treatment protocol was
dysfunction for both auditory and visual material; 100% oxygen for one hour at 1.5 atmospheres
cognitive processing speed was slowed and absolute. Treatments were given five days per week.
subjectively observed in casual conversation with Clinical improvement was rapid. Airman C
the patient. He showed difficulty in repeating reported that his headaches vanished by the fifth
sentences and digit sequences as well as treatment and did not return, and that he was able to
learning digit sequences over repeated trials. sleep seven to eight hours per night uninterrupted.
Airman B also demonstrated problems in both Airman B reported that his headaches weakened to
verbal learning and visual memory. His reading speed 3-4 on a pain scale of 1-10, lasted only one to two
was slowed, fingertip-tapping speed was slowed in hours instead of the previous eight to 10 hours,
both hands, and clerical speed for coding tasks was and that he was able to sleep eight to nine
mildly impaired. He showed difficulty for rhythm hours per night uninterrupted.
perception and visual-motor integration for copying Both airmen reported that they felt more mentally
geometric designs. His reaction time was slowed on alert and were less prone to forgetting, although
a computerized measure of attention. reading level they still did not feel “normal.” At the completion
for sight words remained at the college level, but of the 40-treatment protocol, Airman C felt that his
written arithmetic was at just the sixth-grade level. symptoms had ostensibly resolved, and Airman B
Airman C presented statistically significant felt that he was much improved, notwithstanding
and drastic changes in both Simple reaction Time some lingering irritability and forgetfulness.
modules (at the beginning and end of the bat- repeat AnAM testing showed improvement
tery), along with declines in all other areas except in essentially all areas for both airmen. Airman
Mathematical Processing. Detailed neuropsycho- C’s AnAM scores returned to pre-injury baseline
logical testing of Airman C at the levels, and Airman B’s AnAM scores returned to
same time — prior to HBo therapy — was pre-injury levels, with no statistically significant
largely within normal limits notwithstanding differences in any of the tested domains
problems for inconsistent attention and upper- (Figures 1A and 1B, Page 394, and Figures 2A
right extremity dysfunction for grip strength and and 2B, Pages 395-396).
somatomotor integration. His rBAnS (Form A) total repeat detailed neuropsychological testing of
score was at the 50th percentile, average range. Airman B showed improvement on some but not all
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UHM 2009, Vol. 36, No. 6 – Treatment of mild traumatic brain injury with hyperbaric oxygen
areas of cognitive functioning after HBo therapy at post-HBo treatment was deemed satisfactory to
(cid:11)(cid:20)(cid:22)(cid:25)(cid:21)(cid:17)(cid:1) (cid:9)(cid:26)(cid:24)(cid:15)(cid:17)(cid:16)(cid:29)(cid:26)(cid:13)(cid:21)(cid:1) (cid:2)(cid:24)(cid:16)(cid:17)(cid:1) (cid:2)(cid:24)(cid:16)(cid:17)(cid:1) (cid:6)(cid:13)(cid:28)(cid:19)(cid:17)(cid:22)(cid:13)(cid:28)(cid:20)
10 months post-injury. His rBAnS (Form B) total continue his job duties without special monitoring.
(cid:10)(cid:17)(cid:13)(cid:15)(cid:28)(cid:20)(cid:24)(cid:23)(cid:1) (cid:10)(cid:17)(cid:13)(cid:15)(cid:28)(cid:20)(cid:24)(cid:23)(cid:1) (cid:11)(cid:29)(cid:14)(cid:27)(cid:28)(cid:20)(cid:28)(cid:29)(cid:28)(cid:20)(cid:24) (cid:11)(cid:29)(cid:14)(cid:27)(cid:28)(cid:20)(cid:28)(cid:29)(cid:28)(cid:20)(cid:24) (cid:15)(cid:13)(cid:21)(cid:1) (cid:6)(cid:13)(cid:28)(cid:15)(cid:19)(cid:20)(cid:23)(cid:18)(cid:1)
score was at the 12th percentile. For a patient with repeat neuropsychological testing of Airman
mild to moderate(cid:12) (cid:20)T(cid:22)B(cid:17)I, his s(cid:12)c(cid:20)(cid:22)or(cid:17)es im(cid:23)(cid:1)p(cid:5)r(cid:17)o(cid:13)v(cid:26)(cid:23)ed(cid:20)(cid:23) (cid:18)fa(cid:23)st(cid:1)e(cid:1)(cid:3)r (cid:17)(cid:21)(cid:13)(cid:31)(cid:17)C(cid:16) w(cid:9)a(cid:26)(cid:24)s (cid:15)(cid:17)g(cid:27)e(cid:27)n(cid:20)(cid:23)e(cid:18)ral(cid:28)ly(cid:24) (cid:1)(cid:27)c(cid:13)o(cid:22)n(cid:25)si(cid:21)(cid:17)stent with his pre-treatment
th(cid:36)a(cid:36)n(cid:32)(cid:7) w(cid:24)o(cid:30)(cid:32)u(cid:35)l(cid:42)d be exp(cid:44)e(cid:35)cted throu(cid:39)g(cid:35)h spontan(cid:36)e(cid:44)ous brain (cid:42) test sco(cid:41)r(cid:42)es. Areas (cid:40)o(cid:43)f subtle improvement such as
he(cid:37)a(cid:36)l(cid:32)in(cid:4)(cid:29)g(cid:21) (cid:32)(cid:35)a(cid:43)lone duri(cid:40)n(cid:43)g this tim(cid:38)e interval.(cid:44) Areas of (cid:36) motor a(cid:37)b(cid:44)ilities in t(cid:41)he dominant right hand, written
ob(cid:44)j(cid:32)e(cid:8)ct(cid:15)i(cid:28)v(cid:32)(cid:35)e(cid:43) improve(cid:43)m(cid:39)ent includ(cid:39)e(cid:42)d visuoco(cid:36)(cid:36)nstructive (cid:36)(cid:41) arithme(cid:42)ti(cid:35)c and v(cid:38)e(cid:38)rbal fl uency were observed.
ab(cid:36)i(cid:41)li(cid:32)t(cid:4)i(cid:13)e(cid:23)s(cid:32),(cid:35) fi(cid:44) ngertip-t(cid:44)a(cid:40)pping spee(cid:43)d(cid:44) and verba(cid:39)l(cid:43) learning/(cid:36)(cid:40) His rB(cid:42)(cid:38)AnS B (cid:38)t(cid:35)otal score was at the 47th
memory for word lists. His cognitive abilities status percentile, which was not a signifcant change
from pre-treatment testing.
FigUre 1A — Airman B ANAM Scores
(cid:36)(cid:35)(cid:35)
(cid:43)(cid:35)
(cid:41)(cid:35)
(cid:36)(cid:36)(cid:32)(cid:7)(cid:24)(cid:30)(cid:32)(cid:35)(cid:42)
(cid:39)(cid:35) (cid:37)(cid:36)(cid:32)(cid:4)(cid:29)(cid:21)(cid:32)(cid:35)(cid:43)
(cid:11)(cid:20)(cid:22)(cid:25)(cid:21)(cid:17)(cid:1) (cid:9)(cid:26)(cid:24)(cid:15)(cid:17)(cid:16)(cid:29)(cid:26)(cid:13)(cid:21)(cid:1) (cid:2)(cid:24)(cid:16)(cid:17)(cid:1) (cid:2)(cid:24)(cid:16)(cid:17)(cid:1) (cid:6)(cid:13)(cid:28)(cid:19)(cid:17)(cid:22)(cid:13)(cid:28)(cid:20)
(cid:44)(cid:32)(cid:8)(cid:15)(cid:28)(cid:32)(cid:35)(cid:43)
(cid:37)(cid:35) (cid:10)(cid:17)(cid:13)(cid:15)(cid:28)(cid:20)(cid:24)(cid:23)(cid:1) (cid:10)(cid:17)(cid:13)(cid:15)(cid:28)(cid:20)(cid:24)(cid:23)(cid:1) (cid:11)(cid:29)(cid:14)(cid:27)(cid:28)(cid:20)(cid:28)(cid:29)(cid:28)(cid:20)(cid:24) (cid:11)(cid:29)(cid:14)(cid:27)(cid:28)(cid:20)(cid:28)(cid:29)(cid:28)(cid:20)(cid:24) (cid:15)(cid:13)(cid:21)(cid:1) (cid:6)(cid:13)(cid:28)(cid:15)(cid:19)(cid:20)(cid:23)(cid:18)(cid:1)
(cid:36)(cid:41)(cid:32)(cid:4)(cid:13)(cid:23)(cid:32)(cid:35)(cid:44)
(cid:12)(cid:20)(cid:22)(cid:17) (cid:12)(cid:20)(cid:22)(cid:17) (cid:23)(cid:1)(cid:5)(cid:17)(cid:13)(cid:26)(cid:23)(cid:20)(cid:23)(cid:18) (cid:23)(cid:1)(cid:1)(cid:3)(cid:17)(cid:21)(cid:13)(cid:31)(cid:17)(cid:16) (cid:9)(cid:26)(cid:24)(cid:15)(cid:17)(cid:27)(cid:27)(cid:20)(cid:23)(cid:18) (cid:28)(cid:24)(cid:1)(cid:27)(cid:13)(cid:22)(cid:25)(cid:21)(cid:17)
(cid:35)
(cid:36)(cid:36)(cid:32)(cid:7)(cid:24)(cid:30)(cid:32)(cid:35)(cid:42) (cid:44)(cid:35) (cid:42)(cid:37) (cid:44)(cid:42) (cid:43)(cid:44) (cid:43)(cid:40) (cid:43)(cid:39)
(cid:37)(cid:36)(cid:32)(cid:4)(cid:29)(cid:21)(cid:32)(cid:35)(cid:43) S(cid:11)i(cid:20)m(cid:22)p(cid:25)le(cid:21)(cid:17) (cid:38) (cid:9)P(cid:26)r(cid:24)o(cid:15)c(cid:17)e(cid:16)d(cid:29)ur(cid:26)(cid:40)a(cid:13)l(cid:21) C(cid:2)o(cid:42)(cid:24)d(cid:16)(cid:42)e(cid:17) (cid:42)(cid:38)(cid:2)C(cid:24)o(cid:16)d(cid:17)e (cid:43)(cid:40)(cid:6)M(cid:13)a(cid:28)t(cid:19)h(cid:17)e(cid:22)m(cid:13)a(cid:28)ti(cid:20)c(cid:15)(cid:40)a(cid:13)(cid:38)l(cid:21) (cid:6)M(cid:13)(cid:28)a(cid:15)t(cid:19)c(cid:20)h(cid:23)in(cid:18)g(cid:1)(cid:28)(cid:24)
R(cid:10)(cid:17)e(cid:13)a(cid:15)c(cid:28)ti(cid:20)o(cid:24)n(cid:23) T(cid:1)(cid:12)im(cid:20)(cid:22)e(cid:17) (cid:10)R(cid:17)e(cid:13)a(cid:15)c(cid:28)t(cid:20)i(cid:24)o(cid:23)n (cid:1)T(cid:12)i(cid:20)m(cid:22)e(cid:17) S(cid:11)(cid:29)u(cid:14)bs(cid:27)(cid:28)ti(cid:20)t(cid:28)u(cid:29)ti(cid:28)o(cid:20)(cid:24)n(cid:23) (cid:11)(cid:29)S(cid:14)u(cid:27)b(cid:28)s(cid:20)t(cid:28)i(cid:29)tu(cid:28)t(cid:20)i(cid:24)o(cid:23)n(cid:1) (cid:9)P(cid:26)r(cid:24)o(cid:15)c(cid:17)e(cid:27)s(cid:27)s(cid:20)i(cid:23)n(cid:18)g to(cid:27) (cid:13)S(cid:22)am(cid:25)(cid:21)p(cid:17)le
(cid:44)(cid:32)(cid:8)(cid:15)(cid:28)(cid:32)(cid:35)(cid:43) (cid:44)(cid:42) (cid:42)(cid:37) (cid:44)(cid:38) (cid:44)(cid:37) (cid:43)(cid:40) (cid:42)(cid:38)
Learning Delayed
(cid:5)(cid:17)(cid:13)(cid:26)(cid:23)(cid:20)(cid:23)(cid:18) (cid:3)(cid:17)(cid:21)(cid:13)(cid:31)(cid:17)(cid:16)
FigUre 1B — Airman C ANAM Scores
(cid:36)(cid:35)(cid:35)
(cid:43)(cid:35)
(cid:41)(cid:35)
(cid:36)(cid:36)(cid:32)(cid:7)(cid:24)(cid:30)(cid:32)(cid:35)(cid:42)
(cid:39)(cid:35)
(cid:37)(cid:36)(cid:32)(cid:4)(cid:29)(cid:21)(cid:32)(cid:35)(cid:43)
(cid:44)(cid:32)(cid:8)(cid:15)(cid:28)(cid:32)(cid:35)(cid:43)
(cid:37)(cid:35)
(cid:35)
(cid:11)(cid:20)(cid:22)(cid:25)S(cid:21)(cid:17)im(cid:1)(cid:10)p(cid:17)l(cid:13)e(cid:15)(cid:28)(cid:20)(cid:24)(cid:23) (cid:9)P(cid:26)r(cid:24)o(cid:15)c(cid:17)e(cid:16)d(cid:29)u(cid:26)r(cid:13)a(cid:21)l C(cid:2)(cid:24)od(cid:16)e(cid:17) (cid:2)C(cid:24)o(cid:16)de(cid:17) (cid:6)M(cid:13)a(cid:28)th(cid:19)e(cid:17)m(cid:22)a(cid:13)t(cid:28)ic(cid:20)(cid:15)a(cid:13)l(cid:21) (cid:6)M(cid:13)a(cid:28)(cid:15)tc(cid:19)h(cid:20)(cid:23)in(cid:18)g(cid:1)(cid:28)(cid:24)
Reac(cid:12)t(cid:20)io(cid:22)n(cid:17) Time (cid:10)R(cid:17)e(cid:13)a(cid:15)c(cid:28)t(cid:20)i(cid:24)o(cid:23)n(cid:1) (cid:12)T(cid:20)i(cid:22)me(cid:17) (cid:11)S(cid:29)u(cid:14)b(cid:27)s(cid:28)t(cid:20)i(cid:28)t(cid:29)ut(cid:28)i(cid:20)o(cid:24)n(cid:23) (cid:11)S(cid:29)u(cid:14)b(cid:27)s(cid:28)(cid:20)t(cid:28)it(cid:29)u(cid:28)t(cid:20)i(cid:24)on(cid:23) (cid:1) P(cid:9)r(cid:26)o(cid:24)c(cid:15)e(cid:17)s(cid:27)s(cid:27)i(cid:20)n(cid:23)g(cid:18) to(cid:27) S(cid:13)(cid:22)am(cid:25)p(cid:21)(cid:17)le
Learning Delayed
(cid:5)(cid:17)(cid:13)(cid:26)(cid:23)(cid:20)(cid:23)(cid:18) (cid:3)(cid:17)(cid:21)(cid:13)(cid:31)(cid:17)(cid:16)
Throughput scores are presented as the percentile of the comparison group of military members without TBI.
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(cid:1)
FigUre 2A — Airman B ANAM Scores
(cid:1)
Airman C was essentially well. Based on showed improvement in all measures at or exceeding
these results, it was decided to return Airman his pre-injury state, except for matching to sample,
C to full duty, while Airman B continued hyperbaric which was improved markedly from the injury
treatment for another 40 treatments following state (Figures 1A and 2A, Page 394 and above).
the original treatment protocol. Airman B reported that he had made continued
repeat AnAM testing on Airman B at the improvement in cognitive function, felt much more
conclusion of the second set of 40 HBo treatments alert and had returned to his pre-injury functional
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FigUre 2B — Airman C ANAM Scores
(cid:1)
state. He reported that he was experiencing eight hippocampal neuronal cell loss after brain
hours of uninterrupted sleep per night, and that his injury (18).
headaches had diminished to about one per week. HBo promotes neural stem cell activation
He also noted the pain intensity had further and growth (19, 20), and this effect is seen in the
decreased to 2-3 on a scale of 1-10, and that hypoxic-damaged brain (21). HBo also alleviates
the headaches lasted two to three hours versus hypoxic-induced myelin damage, up-regulates
the original eight to 10 hours’ duration. HIF-1 alpha-enhancing neuronal tolerance to
hypoxia, and increases cellular ATP levels and
dISCuSSION cognitive recovery after concussive injury (22).
Hyperbaric oxygen treatment has several effects Balance beam scores in rats with cerebral
that may be beneficial in treating brain injury. In contusions were improved after treatment with
animal models, HBo has been shown to enhance HBo (23). In a rat model of chronic TBI, HBo
mitochondrial recovery and to reduce apoptosis improved spatial learning and increased vascular
in hypoxic nerve cells (16,17). The HBo-induced density in the injured hippocampus (24).
improvement in mitochondrial function appears to Controlled human studies of the efficacy of
facilitate improved cognitive recovery and reduced HBo after brain injury have been few. In a study
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of moderate and severe TBI using the Glasgow CONCluSIONS
Coma Scale and Glasgow outcome Scale as Several aspects of these two cases demonstrate
measures of efficacy, an HBO-treated patient the efficacy of HBO for the airmen treated. Although
showed improvement over controls (25). HBo has both airmen had stable symptoms of mTBI/post-
been shown to be clinically effective in mediating concussive syndrome that had not improved for
the effects of brain injury (26). While the exact seven months, substantive improvement was
mechanism is unknown, HBo is thought to restore achieved within 10 days of HBo treatment. The
neural pathways damaged in TBI with supporting headaches and sleep disturbances improved
evidence supplied from SPeCT brain imaging (27). rapidly, while the irritability, cognitive defects
AnAM is a library of more than 30 computer- and memory difficulties improved more slowly.
based test modules designed for a wide variety of Fortunately, both airmen had taken the AnAM
clinical and research applications and is the direct and presented objective demonstration of their
outgrowth of more than 20 years of computer-based deficits from TBI and their improvements after HBO
test development across all service branches within treatment. Both airmen, who were injured by the
the Department of Defense (28). AnAM4™ is a same blast sitting side by side, had similar symptom
neurocognitive assessment tool that can be used to complexes of TBI and improved at similar rates after
identify changes in a service member’s cognitive initiation of HBo treatment. neither airman had any
function and mood state as a result of some other form of treatment for TBI. It seems unlikely to
debilitating event. the authors that any explanation other than the HBo
The AnAM4™ TBI-MIL test battery used treatments can be offered for their improvements.
in this case report has been tailored to provide
n
an instrument that is sensitive to cognitive
changes that often accompany mTBI. The battery The views in this article are those of the authors and do
consists of a set of assessment modules that gather not reflect the official policy of the Department of the Air
Force, the Department of Defense or the U.S. Government.
data on mood, processing speed (reaction time),
working memory, short-term memory, spatial
pattern recognition/memory and other cognitive
rEFErENCES
functions. The test is designed for repeated testing
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