Treating Veterans with TBI & PTSD

Between 2000 and 2020, more than 430,000 US Service Members have experienced their first lifetime Traumatic Brain Injury (TBI), not including service members who incur subsequent TBI’s(1). TBI’s are classified as mild, moderate, severe, or penetrating. They can occur from a sudden blow or jolt to the head from an impact, blast exposure, and even whiplash. Studies suggest that service members and veterans who have sustained a TBI may still have ongoing symptoms of post-concussive syndrome that go untreated. TBI of any severity can cause symptoms across multiple functional domains, including physical, cognitive, and psychological. 

In addition, among veterans with positive TBI screens, 80% indicate comorbid psychiatric diagnosis and up to half meet criteria for Post-Traumatic Stress Disorder (PTSD)(2). From the Vietnam war to Operation Enduring Freedom, Veterans suffering from PTSD has increased from 15% to 20%. PTSD is a complex psychiatric condition that develops in certain individuals after experiencing a major traumatic event(14). Behavioral symptoms of PTSD include re-experiencing the trauma, avoidance behavior, mood alternation, and hyperarousal(15). 

The negative impact that such symptoms and risks can make on one’s quality of life makes it clear that veterans with PTSD and TBI’s require safe, effective treatment options. Unfortunately, less than half of patients receiving traditional psychosocial treatments gain clinically meaningful improvements, and many continue to have residual symptoms(22-23). Thankfully, there is compelling evidence to suggest that Hyperbaric Oxygen Therapy (HBOT) may significantly reduce the negative symptoms experienced by TBI patients and PTSD patients, even years after the incident.

Extivita Therapies for Veterans Suffering from TBI or PTSD:

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What is Hyperbaric Oxygen Therapy?

HBOT involves sitting in a hyperbaric chamber while breathing 100% medical grade oxygen through a mask or hood. The hyperbaric chamber gradually pressurizes to between 1.5 and 2.5 times the normal atmospheric pressure (referred to as 1.5 ATA and 2.5 ATA). This is equivalent to diving between 16 feet (1.5 ATA) and 50 feet (2.5 ATA) below water.

The majority of HBOT treatments at Extivita are at 2.0 ATA, which is equivalent to 33 feet below surface level. Because oxygen is considered a drug by the FDA, patients must obtain a prescription from a licensed healthcare professional for these therapeutic treatments. The specific pressure is also included in the prescription. Our in-clinic provider can write HBOT prescriptions following your in-person consultation.

 

How does Hyperbaric Oxygen Therapy affect TBI & PTSD?

HBOT has been shown to improve cognitive function and quality of life in patients who experienced a mild TBI(4). Additionally, HBOT results in improved cognitive function (in multiple categories) in the case of moderate and severe TBI. These improvements were correlated with increased activity in the brain regions associated with each cognitive impairment(4).

HBOT also can have positive behavioral and neurochemical effects in patients with PTSD by regulating the immune system. Emerging evidence suggests that patients with PTSD have biological alterations, such as a dysregulated immune system, which results in oxidative stress and inflammation(24,26). In fact, a 2015 meta-analysis of 20 studies found that PTSD is associated with elevated levels of proinflammatory markers in the blood plasma and serum(25,26).

The consequences of oxidative stress and inflammation include accelerated cellular aging as well as increased risk of neurological, cardiovascular, and respiratory diseases. Taken together, the effects of increased disease risk increase the physical and emotional burden of those with PTSD(26). Thankfully, HBOT has been shown to inhibit many of the same proinflammatory cytokines (chemical messengers) that are elevated in PTSD, while also increasing anti-inflammatory/antioxidant gene expression(27). By doing so, HBOT may improve some of the chemical imbalances that can cause serious damage to those with PTSD.

 

Effects of HBOT on the Body:

Grows New Blood Vessels

New Blood Vessel Formation

Hyperbaric oxygen therapy stimulates the formation of new blood vessels, healing injured tissues that were unable to get nutrients and oxygen.
Increases Stem Cell Production

Increased Stem Cell Activity

Hyperbaric oxygen therapy mobilizes stem progenitor cells (SPCs) from the bone marrow, creating the opportunity for tissue regeneration.
Decreases Inflammation

Decreased Inflammation

Hyperbaric oxygen therapy reduces systemic inflammation by increasing anti-inflammatory gene expression and decreasing proinflammatory genes.

Research suggests that increased tissue oxygenation, improved cellular metabolism and mitochondrial function, and improved inflammatory response, to name a few, are responsible for improving the following cognitive impairments(5):

  • Improved Memory (most improvement)
  • Reduced Attention Problems (high improvement)
  • Improved Executive Function
  • Increased Information Processing Speed
  • Improved Motor Skills

Frequently Asked Questions About Hyperbaric Oxygen Therapy

How do I get started with HBOT (new patients)?

Before you come into the clinic, you will need to register as a patient in our patient portal. Here you will enter your medical history and primary reason/s for starting HBOT. After this, you will be able to schedule a consultation with Elena Schertz, FNP. You will be all set to begin treatment following your consultation!

How is HBOT administered? 
All Extivita patients have their very own hood or mask through which 100% medical grade oxygen is administered. These will be provided after your consultation. 
What type of HBOT chambers do we use? 
We have two hard-shell, multi-seat chambers at Extivita. Our biggest chamber can seat up to 12 patients, while our smaller chamber can seat up to 8 patients.  
What can I do while in the HBOT chamber? 
Whether it’s reading, watching a movie, or sleeping, there is plenty to do during your HBOT session. We have a TV in our largest chamber that we play movies on during most treatment sessions. In our smaller chamber, we have tablets that you can use to watch TV, browse the internet, or play games on. You are also more than welcome to bring your own book to read during treatment! 
Will I be by myself during my HBOT session?  

There will be a trained Extivita supervisor with you in all HBOT sessions. While you may be the only patient in the chamber on some days, most sessions will have other patients in the chamber as well. For additional information on how we are keeping our patients safe during COVID-19, click here.

How long does an HBOT session last?  
Most HBOT sessions will last roughly 1 hour and 30 minutes, which includes the time it takes to pressurize the chamber, 1 hour at the prescribed depth, and the time it takes to depressurize the chamber. Certain conditions may require shorter or longer durations at depth.  
How many HBOT sessions are needed to improve PTSD and TBI Symptoms?

This depends on the condition that you are receiving treatment for, as well as how your body responds to HBOT. The antioxidant and anti-inflammatory effects of HBOT can typically be felt within the first few sessions. Benefits for acute injuries and soft-tissue damage can typically be seen 5-10 sessions in, while chronic injuries typically require 10-20 sessions. Many conditions require 20-40 HBOT sessions for full healing effects such as stem cell increase.

For TBI and PTSD patients, an initial HBOT regimen is typically 40 sessions. Symptom improvement is often experienced by patients between 10 and 20 sessions.

Are there any side-effects to HBOT? 

HBOT is generally considered one of the safest therapies in use today. Any serious side effects can be prevented by pre-HBOT screening that all patients receive during their consultation. One side effect that is some people experience is mild ear pain while the chamber pressurizes. However, this can be reduced through proper sinus clearing and it typically goes away as you receive more treatments.

Neurofeedback Therapy in Durham, NC

Neurofeedback for Veterans with PTSD & TBI:

Neurofeedback has been shown to improve many of the cognitive issues that veterans with traumatic brain injuries (TBIs) experience post-injury(6, 7). After a TBI, the brain must form new neural pathways to account for any brain tissue damaged by the TBI. These new connections play a vital role in restoring healthy brain function, and neurofeedback has been shown to help establish and help strengthen such connections(6). Most studies that use neurofeedback to help TBIs train to increase theta and alpha brainwaves in the occipital lobe (towards the back of the head). This has been shown to reduce stress (which has a negative physiological and emotional effect in TBIs), increase relaxation, and improve cognitive measures such as memory and processing speed (6, 7, 8, 9).

Additionally, Neurofeedback therapy has strong potential as an effective, non-invasive therapy for those with PTSD. Individuals with PTSD are believed to have a degree of dysfunction in two important neural networks: the salience network (SN) and the default mode network (DMN) (23-24). Normalizing these networks through neurofeedback has been shown to significantly improve symptoms of PTSD (21-29). To normalize these networks, neurofeedback protocols for PTSD typically focus on reducing theta and high-beta while increasing low-beta activity(27, 30) or decreasing alpha activity(12,13). Both protocols have shown to significantly improve symptoms of PTSD and improve emotional regulation after 20-40 neurofeedback sessions.

Learn More About Neurofeedback

IV Therapy for Veterans with PTSD & TBI:

The combination of the Myer’s cocktail and glutathione IV’s can improve cognitive and motor function following traumatic events and brain injury. A principal issue post-TBI is the degree neuroinflammation, which is directly correlated to the severity of the short-term and long-term consequences of TBI. In TBI patients, the mitochondria in brain cells become damaged, activating immune cells (glia, microglia, and astrocytes). These immune cells release inflammatory cytokines which recruit even more inflammatory cells to the area. This results in brain cell swelling, death, decreased energy production, all of which lead to impaired cognitive and motor function(10).

The Myer’s cocktail can help minimize further cells damage and improve brain health and function for those suffering PTSD, or after a TBI(11, 12). One of the primary issues in PTSD is the repeated pattern of re-experiencing the traumatic event, which results in chronic activation of the body’s stress response(36). Additionally, the sleep disruption, hypervigilance, anger, anxiety and dysphoria that most people with PTSD experience also activate the stress response. The net effect of this is hyperactivation of the stress network which results in oxidative damage(36). The Myer’s Cocktail IV contains Vitamin C and other nutrients which have been shown to counteract increases in stress hormones(37-38).

Glutathione, the master antioxidant, has been used to reduce oxidative stress and enhance cellular detoxification and can be part of a multi-modal therapy in correcting the metabolic crisis in TBI. Research also shows that levels of Glutathione are imbalanced in patients with PTSD(39). Our Glutathione IV can increase Glutathione levels in the body to reduce oxidative stress and enhance cellular detoxification.

Learn More IV Therapy
Nutritional IV Therapy in Durham, NC
Pulsed Electromagnetic Field Therapy (PEMF) in Durham, NC

PEMF Therapy for Veterans with PTSD & TBI:

Pulsed-electromagnetic field therapy (PEMF) results in improved microcirculation, as well as increased oxygen and nutrient delivery to much needed areas of the body. Micro vessels play a significant role in overall course of vascular diseases. Dysfunction to this system has been linked to a multitude of illnesses. The PEMF device has been shown to optimize the microcirculatory system for veterans suffering from TBIs and/or PTSD, increasing perfusion to tissues and organs. When used in conjunction with HBOT, oxygen rich blood can be delivered to these areas, where healing can begin(13).

Additionally, PEMF has been shown to reduce levels of inflammation, which is a primary culprit in PTSD pathology(40, 21). The BEMER also has an accessory called the B-pad which can be utilized to target specific regions for better pain management. In cases of neurological concerns like PTSD, we can even position the B-pad over the individual’s head to maximize PEMF’s therapeutic benefits.

Learn More About PEMF Therapy

News & Research for Veterans with PTSD & TBI:

Executive summary: The Brain Injury and Mechanism of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA) Study.

Aug 3, 2017 | ,

The Brain Injury and Mechanism of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA) study, sponsored by the Department of Defense and held under an investigational new drug application by the Office of the Army Surgeon General, is one of the largest and most complex clinical trials of hyperbaric oxygen (HBO₂) for post-concussive symptoms (PCS) in U.S. military service members.

read more

Hyperbaric oxygen for mild traumatic brain injury: Design and baseline summary.

Aug 3, 2017 | ,

The Brain Injury and Mechanisms of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA) study, sponsored by the Department of Defense, is a randomized double-blind, sham-controlled clinical trial that has a longer duration of follow-up and more comprehensive assessment battery compared to recent HBO₂ studies. BIMA randomized 71 participants from September 2012 to May 2014. Primary results are expected in 2017. Randomized military personnel received hyperbaric oxygen (HBO₂) at 1.5 atmospheres absolute (ATA) or sham chamber sessions at 1.2 ATA, air, for 60 minutes daily for 40 sessions. Outcomes include neuropsychological, neuroimaging, neurological, vestibular, autonomic function, electroencephalography, and visual systems evaluated at baseline, immediately following intervention at 13 weeks and six months with self-report symptom and quality of life questionnaires at 12 months, 24 months and 36 months. Characteristics include: median age 33 years (range 21-53); 99% male; 82% Caucasian; 49% diagnosed post-traumatic stress disorder; 28% with most recent injury three months to one year prior to enrollment; 32% blast injuries; and 73% multiple injuries. This manuscript describes the study design, outcome assessment battery, and baseline characteristics. Independent of a therapeutic role of HBO₂, results of BIMA will aid understanding of mTBI.

read more
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