The document discusses the use of hyperbaric oxygen therapy (HBOT) for treating traumatic brain injury (TBI) in active duty military personnel and veterans, highlighting the prevalence of TBI and PTSD in this population. It presents case studies showing significant improvement in symptoms like headaches and cognitive function after HBOT treatment, emphasizing that early intervention yields better outcomes. Additionally, the document notes that HBOT has been used for over 100 years, has shown durable results, and may reduce the need for medication related to TBI and PTSD.

1. Hyperbaric Oxygen for Brain Injury James K. Wright, MD, Col, USAF (Ret)

2. Traumatic Brain Injury in Active Duty and Veterans 300,000+ cases from OEF/OIF (19.5%) RAND Report 2008 300,000+ have PTSD (18.5%) TBI makes PTSD more likely About 2/3 of PTSD have TBI also < ½ get “minimally adequate care”

3. Example of TBI impact assessment in NFL Player NFL football player with concussion Loss of about 2% of the fiber tracts in the region of the corpus callosum. Enlarged Fiber Tract showing fibers from concussive event Courtesy Dr. Walter Schneider, U Pittsburgh Area of Tissue change Fibers passing through areas

5. 1 st 2 Airmen Treated for TBI 2 USAF Airmen Previously healthy No Hx head injury IED 13 Jan 2008 In M915 14-ton truck Concussive injuries (“bell rung”) No LOC No Amnesia

6. Symptoms Immediate Headache Slight confusion Assessed Off line for 2-3 days Delayed – 3 weeks + Irritability Sleep disturbances Headaches Memory difficulties Cognitive difficulties Clumsy Threatened with job loss

7. Results of HBOT for TBI Airman B Airman C Date of IED 13 Jan 2008

8. Symptom resolution Headaches Sleep disturbances Fatigue Irritability Memory loss Fine motor reactions Cognitive function Time

9. What HBOT is 100% oxygen under pressure 1.5 – 2/0 ATA for brain injury 40-80 1 hr treatments 1-2 HBOT per day Used for more than 100 years for brain injury

10. How it works - 5,769+* ways Upregulates growth factors Reduces edema Promotes neural pathway growth Activates senescent neurons Increases neuronal ATP Downregulates inflammation Reduces reperfusion injury *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.

11. HBOT Indications Air or gas embolism Carbon monoxide poisoning Gas gangrene Traumatic ischemias – crush injury, compartment syndrome Decompression sickness Arterial insufficiencies Severe anemia Intracranial abscess Necrotizing soft tissue infections Refractory osteomyelitis Delayed radiation injury Compromised flaps and grafts Acute thermal burn injury Problem wounds Retinal ischemic disease HBOT has been used for >100 years to treat brain injury

12. Casey Owens Video Casey Owens video

13. NBIRR National Brain Injury rescue and Rehabilitation Project 1000 patients with mTBI 17+ centers All receive HBOT Early results encouraging 35 participants treated (Mar 2011) All participants have improved Most improved in every measure Most improved substantially No participants worsened Results are durable

14. Results 1 st 12 consecutive patients with TBI All received HBOT All improved in nearly every measure Results are % change in ANAM mood scores

15. ANAM Results 1 st 12 consecutive patients with TBI All received HBOT All improved in nearly every measure Results are % improvement in ANAM scores

16. Comparison to Pre-Injury Status N=4

17. ANAM Scores pre-injury, post injury, post HBOT 100% 50% 0

18. Do HBOT recipients get back to normal?

19. PHQ-9 Test

20. PHQ-15 Test

21. What we have learned Every patient with TBI treated with HBOT has improved Improvement is durable The earlier you treat, the better the result More severe TBI requires more HBOT HBOT reduces the need for medication PTSD associated with TBI (2/3 of military PTSD cases) improves with HBOT

22. Questions?