Can Hyperbaric Oxygen Repair the Damaged Brain?

March 18, 2013

In 1662, a British clergyman and physician now known only as Henshaw created the first hyperbaric chamber for therapeutic purposes. While this chamber was merely a sealed room with a system of bellows and valves, Henshaw theorized that the pressure changes he could modulate in his “domicilium” were of a benefit to both acute and chronic illnesses. In the more than three centuries since, hyperbaric oxygen treatments have proven effective for myriad conditions including decompression sickness (the “bends”), carbon monoxide poisoning, burn,s and non-healing wounds. And new research out of Tel Aviv University suggests that hyperbaric oxygen might also promote neuroplasticity—and dramatic improvements in outcomes—after brain damage.

How it works

It is the increased overall pressure found in hyperbaric oxygen chambers that helps reduce the volume of inert gas bubbles to treat conditions like the bends. But another side effect of the pressure change is an increased level of oxygen—the pressure compresses the oxygen molecules, providing an environment that can deliver oxygen to the body at ten times the amount available in normal atmospheric conditions.

“I call it a supernatural treatment,” says George Mychaskiw, chair of the department of anesthesiology at Nemours Children’s Hospital in Florida and an expert in hyperbaric medicine. “Not that it’s magic. But we don’t normally live at two or three atmospheres of pressure. Except for a few bottom-dwelling organisms in the sea, the behavior of oxygen at these difference pressures is outside the normal realm of biology, certainly outside the normal realm of human biology.”

That “supernatural” oxygenation has been shown to help promote healing in different types of wounds. “The tissue around a chronic wound may be getting very little oxygen because there’s very little blood flow to the center of the wound,” says Col. Brian McCrary, an Air Force physician and expert in hyperbaric medicine. “So by increasing the oxygen to the tissues, you help drive healing. Hyperbaric treatment also helps stimulate new blood vessel growth, which drives new capillaries into an area to help get more blood and oxygen into the affected area. And it’s also been shown to reduce inflammation, too.”

The combination of these benefits has led many to hypothesize that hyperbaric oxygen could be a good treatment for brain damage. Mychaskiw has demonstrated exactly that in animal models, yet it has been more difficult to prove in human trials. But Shai Efrati, a neuroscientist at Tel Aviv University's Sackler Faculty of Medicine, recently tested hyperbaric oxygen treatments on seventy-four people who had had strokes and were no longer improving.

Healing after stroke

Efrati and his colleagues had half the study participants undergo hyperbaric oxygen treatment for two hours daily five times a week for a total of forty sessions. The second control group received no treatment for two months, followed by two months of hyperbaric treatments. The researchers found that the patients who received hyperbaric treatment in the first two months showed remarkable clinical improvements including increased sensation, language skills, and movement ability—even if it had been years since the initial damage. Neuroimaging analyses also showed significant increased neural activity in damaged brain areas. The results were published in PLoS ONE earlier this year.

“After a brain injury, you’ll see several types of brain damage. The most severe is necrosis. That tissue is dead and nothing can be done. But surrounding that necrotic tissue, you see areas that still have some metabolic function. Those areas can be improved,” says Efrati. He argues that those cells are compromised, with enough metabolic activity to stay alive but not enough to fire and promote action potentials. The extra oxygen delivered by hyperbaric treatment, over time, helps those cells heal and regain normal metabolic function and firing potential.

Efrati and his team are currently running two similar trials on people with traumatic brain injury and Alzheimer’s.

A question of control

While many agree that Efrati’s data are promising, a prior study run by the U.S. Air Force found no significant differences between hyperbaric oxygen treatment and a sham treatment on patients with mild traumatic brain injury (TBI). Both groups showed significant improvement over the course of the trial. Those results were published in the November 2012 issue of the Journal of Neurotrauma.

“The sham treatment was just air at a slightly increased pressure,” says McCrary. “There are several possible explanations for why there were equivalent improvements but the most likely scenario is a placebo effect or just the effects of the intensive treatment and attention that the patients received over the course of the six-week trial.”  McCrary says that future trials should be able to rule out those scenarios.

Mychaskiw is not surprised by the contradictory results. He argues that it is very difficult to design a good study to test the efficacy of hyperbaric oxygen treatments. “Patients are very aware of their surroundings, so people in any control group have to believe they are receiving some kind of pressure. It’s hard to rule out placebo or just the effect of receiving a treatment, any treatment ,” he says. “But it’s also possible that it’s not the oxygen that has the effect. It’s possible that the pressure itself has a therapeutic effect. There are a lot of factors at play—and it’s a very complicated thing to study.”

The Air Force is completing the analysis on three more trials that will be published later this year, which McCrary hopes will finally provide more definitive answers. But despite the lack of clear-cut clinical results, hyperbaric oxygen is already being used to treat brain damage resulting from conditions ranging from TBI to dementia to autism at specialized clinics across the globe.

“At the end of the day, hyperbaric oxygen is a relatively benign therapy. It’s very hard to hurt someone with hyperbaric oxygen at the pressures that are used,” says Mychaskiw. “And those who are currently using it become very evangelistic about it because they see, at least in their minds, dramatic, clinical improvement. My hope is that future studies will give us a better understanding of how and where and why it works. But we haven’t gotten those answers yet.”


Scientific Conference

Edward Fogarty, MD

8/16/2016 8:06:55 AM

There is a scientific conference in New Orleans regarding HBOT from 9/9-9/11 2016 at the Astor Crowne Plaza. Many but not all of the presentations will have a focus on therapy for neurological injuries. A free Public Day is a part of this conference on Saturday 9/10/16, which will allow interested members of the public to hear some of the successes of hyperbaric medicine. It would be wonderful to have some of the DANA foundation board come to this conference. The conference is sponsored by the IHMF a 501c3 entity, I have recently become the President of this small advocacy group and some of the best and brightest in HBOT will be faculty of this conference, including Dr. Paul Harch and Dr. Keith Van Meter who have had pioneering roles in the observation of healing of the brain from HBOT. One of the most impressive cases of healing is the story of Curt Allen which has been fully documented as a recovery that defies medical logic. Having seen this as a physician a few years ago drew me into helping others in medicine and in the public understand the important use of this modality in recovering people to a more functional life.


Rhonda Rudd

5/5/2016 1:32:39 PM

My daughter was born anoxic 24 years ago. Due to lack of oxygen to her brain she has learning disabilities. Can HBOT reverse the trama to her brain?

HBOT treatment for TBI

Glenn Guidry

4/11/2016 11:41:41 AM

My wife suffered from Hypoglycemic episode on 02-09-16, her glucose level dropped so low that they say she went into cardiac arrest, I am not sure that her heart was just beating so slow that it could not supply enough oxygen needed for her brain, causing hypoxia. My question is do you think HBOT would help her become cognitive again. At present she opens her eyes and squeezes our hands sometimes more than others, but she cannot talk so we really do not know what she is actually understanding.


Rashmi Sirsalewala

4/11/2016 11:41:35 AM

My brother in law 51 year old had cardiac arrest that lead to hypoxic injury. He is in coma for last 49 days and I wanted to understand if HBOT can be really helpful for him to make any improvement? -

HBOT for kid with 45% brain damage

Vamshi Krishna

2/29/2016 10:28:14 AM

Hello My son has a brain damage on the left side which is about 45% and he has serious developmental delays and due to this damage he is not able to concentrate and focus on objects even though he has functioning eyes. Can Hyperbaric Oxygen therapy be of any use in helping him to develop his vision atleast.He is undergoing vision therapy, speech therapy and physiotherapy regularly and he is 17 months old. Need serious advice can someone please help. Regards Vamshi

HBOT for hypoxic brain injury

Ankur jain

12/29/2015 3:21:15 PM

My father 59 year old had cardiac arrest that lead to hypoxic injury. He is in coma for last 49 days and I wanted to understand if HBOT can be really helpful for him to make any improvement?

HBOT heals but requires repeat treatments

Mimi Hanora

11/20/2015 10:23:18 AM

HBOT excellent treatment for stroke But there needs to be on going treatment Every year

HBOT works for Concussion/TBI: Doing nothing doesn't


10/20/2015 8:51:44 PM

Cost effective, immediate and successful treatment of TBI/PTSD/Concussion casualties is ethically available now. The TreatNOW Coalition, as supported by the International Hyperbaric Medical Foundation (IHMF), a 501(c)3 public charity, has built and tested a network among civilian Hyperbaric Oxygen Therapy (HBOT)-capable clinics which have, on a pro bono basis, successfully treated over 460 TBI/PTSD/Concussion Veteran and civilian casualties. We have had dramatic, life-altering success returning each of the fully-treated patients to a quality of life far beyond what they could receive from traditional or DOD medicine. A significant number were returned to active military duty. Under TreatNOW, this scientific work will continue to give hope to the hundreds of thousands of brain-injured patients with Concussion, TBI and/or PTSD: they do not have to settle for a "new normal" along with a life of addictive dependence on prescribed drugs that come with warnings against suicidal risk. This is not the Quality of Life they deserve nor what medicine can provide for them. Army medicine has run trials investigating the use of Hyperbaric Oxygen to treat and help heal TBI. They have shown that HBOT is both safe and effective: "Randomization to the chamber . . . . offered statistical and in some measures clinically significant improvement over local routine TBI care." Also: ".... total scores for [both] groups revealed significant improvement over the course of the study for both the sham-control group .... and the HBO2 group....." Expert outside consultants to DOD declared that "[HBOT] is a healing environment." One of the preeminent researchers in the field has said: "Hyperbaric oxygen is a safe, easily used treatment that, in many cases, has resulted in a dramatic improvement in the symptoms of patients with [TBI]. Every day we are…. gathering more data validating its efficacy.… I feel , as do many of my colleagues, that there is sufficient clinical and research evidence to justify the use of [HBOT] as a standard-of-care treatment for [TBI] that should be reimbursed by CMS and Tricare…. I have no doubt that, over the next several years, [HBOT] will be proven beyond a reasonable doubt to be one of the most effective treatments for [TBI]…. There is a preponderance of evidence now to justify the use and funding for the treatment….” And HBOT works for veterans and retired athletes 40-50 years after their injuries. HBOT WORKS for Concussion/TBI/PTSD....... Doing drugs or doing nothing doesn'

hyperbaric oxygen treatment on brain injurty

kathy buckenmeyer

10/12/2015 7:51:43 AM

I would love to see the answers to the comments posted, especially from Bob Reese. We also live in Ohio and my husband suffered TBI in 2001 from an auto accident. We are looking into starting treatments but with the cost so high we want to research its long term effects


Bob reese

10/7/2015 9:03:58 AM

My son suffered a TBI from an auto accident 19 years ago. Is there a time limit where hbot will no longer be effective, from the time of injury? Are there any place in Ohio to look into hbot?


Tama Babcock

8/25/2015 8:39:16 AM

My son (now 29yrs) was involved in a motorcycle accident Oct 2011, suffered a TBI. He's gone through all the therapy the military and now VA will give him. I'm now looking for something outside of the normal VA therapy and found the HBOT. Hoping it will help him regain some of his mobility on his left side. I'm with a lot of you on this site, it can't hurt to try it.

Direction for TBI HBOT

Howie Samuels

6/1/2015 9:45:29 AM

Had auto accident TBI 34 years ago and have done everything but HBOT to try and lessen my constant head, neck pain and pressure. I live in Chicagoland and can not find HBOT specifically designed for TBI, that my SSDI can afford. Any directional help. I am always suffering, can't drive and very limited lifestyle. Please help!


phillip cleere

2/18/2015 9:14:28 AM

my son did hyperbaric 5 days a week for 6 months , he had been in a coma for 6 weeks in 2009, hospital for the next year, rehab for the follwing year, then we tried hyperbaric the results well life changing



10/20/2014 9:14:41 AM

We have been researching this for two years now. Our daughter suffered a brain injury due to lack of oxygen because of Sudden Cardiac Arrest. They need to make brain injuries one of the prescribed illnesses for hbot so it can be utilized more locally and insurance can cover it.


mark westaway

4/16/2014 9:26:32 AM

In the Air Force study the sham group used standard air (21% oxygen). Under pressure the partial pressures of each gas is still elevated as well as the delivery of oxygen under pressure is no longer simply by the hemoglobin but is now into into solution, that is it is now delivered in the plasma, synovial fluid and other liquid in the body. If you check the Navy dive manual not only do they have hyperbaric treatment tables on oxygen but also on standard air. The sham treatment used in the mentioned Air Force study is not a sham, but a treatment itself.

Hyperbaric Oxygen

Sarah S.

2/5/2014 7:27:21 AM

Hyperbaric Therapy is a wonderful treatment. I have been working with HBOT for 6 years and see amazing results on a daily basis. Sarah S.