Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Dr. Jim Wright: Hyperbaric oxygen for brain injury


Published on

Dr. Jim Wright (retired USAF Colonel) present his findings on the use of hyperbaric oxygen therapy at the 2011 First Annual Independent Football Veterans Conference in Las Vegas.

Published in: Health & Medicine
  • Be the first to comment

Dr. Jim Wright: Hyperbaric oxygen for brain injury

  1. 1. Hyperbaric Oxygen for Brain Injury James K. Wright, MD, Col, USAF (Ret)
  2. 2. Traumatic Brain Injury in Active Duty and Veterans <ul><li>300,000+ cases from OEF/OIF (19.5%) </li></ul><ul><ul><li>RAND Report 2008 </li></ul></ul><ul><li>300,000+ have PTSD (18.5%) </li></ul><ul><li>TBI makes PTSD more likely </li></ul><ul><li>About 2/3 of PTSD have TBI also </li></ul><ul><li>< ½ get “minimally adequate care” </li></ul>
  3. 3. Example of TBI impact assessment in NFL Player <ul><li>NFL football player with concussion </li></ul><ul><li>Loss of about 2% of the fiber tracts in the region of the corpus callosum. </li></ul>Enlarged Fiber Tract showing fibers from concussive event Courtesy Dr. Walter Schneider, U Pittsburgh Area of Tissue change Fibers passing through areas
  4. 5. 1 st 2 Airmen Treated for TBI <ul><li>2 USAF Airmen </li></ul><ul><li>Previously healthy </li></ul><ul><li>No Hx head injury </li></ul><ul><li>IED 13 Jan 2008 </li></ul><ul><li>In M915 14-ton truck </li></ul><ul><li>Concussive injuries (“bell rung”) </li></ul><ul><li>No LOC </li></ul><ul><li>No Amnesia </li></ul>
  5. 6. Symptoms <ul><li>Immediate </li></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Slight confusion </li></ul></ul><ul><ul><li>Assessed </li></ul></ul><ul><ul><li>Off line for 2-3 days </li></ul></ul><ul><li>Delayed – 3 weeks + </li></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Sleep disturbances </li></ul></ul><ul><ul><li>Headaches </li></ul></ul><ul><ul><li>Memory difficulties </li></ul></ul><ul><ul><li>Cognitive difficulties </li></ul></ul><ul><ul><li>Clumsy </li></ul></ul><ul><li>Threatened with job loss </li></ul>
  6. 7. Results of HBOT for TBI Airman B Airman C Date of IED 13 Jan 2008
  7. 8. Symptom resolution <ul><li>Headaches </li></ul><ul><li>Sleep disturbances </li></ul><ul><li>Fatigue </li></ul><ul><li>Irritability </li></ul><ul><li>Memory loss </li></ul><ul><li>Fine motor reactions </li></ul><ul><li>Cognitive function </li></ul>Time
  8. 9. What HBOT is <ul><li>100% oxygen under pressure </li></ul><ul><li>1.5 – 2/0 ATA for brain injury </li></ul><ul><li>40-80 1 hr treatments </li></ul><ul><li>1-2 HBOT per day </li></ul><ul><li>Used for more than 100 years for brain injury </li></ul>
  9. 10. How it works - 5,769+* ways <ul><li>Upregulates growth factors </li></ul><ul><li>Reduces edema </li></ul><ul><li>Promotes neural pathway growth </li></ul><ul><li>Activates senescent neurons </li></ul><ul><li>Increases neuronal ATP </li></ul><ul><li>Downregulates inflammation </li></ul><ul><li>Reduces reperfusion injury </li></ul>*Rink C, Roy S, Khan M, Ananth P, Kuppusamy P, Sen CK, Khanna S. Oxygen-sensitive outcomes and gene expression in acute ischemic stroke. J Cereb Blood Flow Metab. 2010 Feb 10.
  10. 11. HBOT Indications <ul><ul><li>Air or gas embolism </li></ul></ul><ul><ul><li>Carbon monoxide poisoning </li></ul></ul><ul><ul><li>Gas gangrene </li></ul></ul><ul><ul><li>Traumatic ischemias – crush injury, compartment syndrome </li></ul></ul><ul><ul><li>Decompression sickness </li></ul></ul><ul><ul><li>Arterial insufficiencies </li></ul></ul><ul><ul><li>Severe anemia </li></ul></ul><ul><ul><li>Intracranial abscess </li></ul></ul><ul><ul><li>Necrotizing soft tissue infections </li></ul></ul><ul><ul><li>Refractory osteomyelitis </li></ul></ul><ul><ul><li>Delayed radiation injury </li></ul></ul><ul><ul><li>Compromised flaps and grafts </li></ul></ul><ul><ul><li>Acute thermal burn injury </li></ul></ul><ul><ul><li>Problem wounds </li></ul></ul><ul><ul><li>Retinal ischemic disease </li></ul></ul>HBOT has been used for >100 years to treat brain injury
  11. 12. Casey Owens Video <ul><li>Casey Owens video </li></ul>
  12. 13. NBIRR National Brain Injury rescue and Rehabilitation Project <ul><li>1000 patients with mTBI </li></ul><ul><li>17+ centers </li></ul><ul><li>All receive HBOT </li></ul><ul><li>Early results encouraging </li></ul><ul><li>35 participants treated (Mar 2011) </li></ul><ul><li>All participants have improved </li></ul><ul><li>Most improved in every measure </li></ul><ul><li>Most improved substantially </li></ul><ul><li>No participants worsened </li></ul><ul><li>Results are durable </li></ul>
  13. 14. Results <ul><li>1 st 12 consecutive patients with TBI </li></ul><ul><li>All received HBOT </li></ul><ul><li>All improved in nearly every measure </li></ul><ul><li>Results are % change in ANAM mood scores </li></ul>
  14. 15. ANAM Results <ul><li>1 st 12 consecutive patients with TBI </li></ul><ul><li>All received HBOT </li></ul><ul><li>All improved in nearly every measure </li></ul><ul><li>Results are % improvement in ANAM scores </li></ul>
  15. 16. Comparison to Pre-Injury Status N=4
  16. 17. ANAM Scores pre-injury, post injury, post HBOT 100% 50% 0
  17. 18. Do HBOT recipients get back to normal?
  18. 19. PHQ-9 Test
  19. 20. PHQ-15 Test
  20. 21. What we have learned <ul><li>Every patient with TBI treated with HBOT has improved </li></ul><ul><li>Improvement is durable </li></ul><ul><li>The earlier you treat, the better the result </li></ul><ul><li>More severe TBI requires more HBOT </li></ul><ul><li>HBOT reduces the need for medication </li></ul><ul><li>PTSD associated with TBI (2/3 of military PTSD cases) improves with HBOT </li></ul>
  21. 22. Questions?