TO TREAT A CONCUSSION:  Using Hyperbaric Oxygen to Mitigate the Duration of Symptoms of Acute Concussions  by Robert L. Beckman, PhD

A concussion is a form of traumatic brain injury. It is a wound to the brain. The current medical standard of care for concussions relies on a protocol that essentially recommends rest. It is thought that this resting period will allow the brain to recover. Indeed, it is "common knowledge" that 80-90 percent of concussions "get better" on their own.   While it is true that some or all symptoms will diminish over time, it is equally true that merely waiting for those symptoms to go away is not our best medicine, nor is this good for the wounded brain, either in the short term but especially over time.

In the State of Illinois, each school district must use education materials provided by the Illinois High School Association to educate coaches, student-athletes, and parents/guardians of student-athletes about the nature and risk of concussions and head injuries. This includes advice about continuing play after a concussion or head injury. Concussion Management in Illinois public and private schools is governed by the Youth Sports Concussion Act (Public Act 099-0245). Illinois points school boards to the Centers for Disease Control and Prevention's (CDC) Injury Center (www.cdc.gov/Concussion). Illinois has developed a public health response to concussion. Through their HEADS UP campaign, concussion educational materials are available at no cost for youth sports coaches, school coaches, parents,   and school and health care professionals.

What the CDC does not discuss, let alone the Mayo Clinic, your hospital emergency room, the NCAA, nor your average concussion or TBI clinic, is that a concussion is a wound to the brain that should be treated according to wound healing principles for the brain to heal. There is no disputing the fact that in most of the millions of concussion cases experienced every year, the average person will "recover" within a few weeks and symptoms will abate. In a large fraction of cases, however, those symptoms do not go away and in no case will the brain become "healed" unless steps are taken to address the wound.

We are all becoming familiar with the symptoms of concussions: headaches, confusion, memory loss, nausea, vomiting, dizziness, fatigue, sleepiness, emotional instability. These symptoms are linked to complex pathophysiological processes affecting the brain, induced by biomechanical forces. These forces can lead to brain inflammation and swelling, damage to blood vessels and brain cells, ringing in the ears (tinnitus), visual and balance problems, and a myriad of other overt and/or subtle physical and emotional and functional difficulties.

Some in the worldwide sports community recognize a concussion as an "injury" to the brain, yet nowhere in the gold standard Consensus Statement of the 2017 Concussion in Sport Group (Berlin, 2017) is there mention of a "wound" to the brain. In the eleven major sections of the Statement, only one is devoted to "rehabilitation." It is worth quoting in full: "SRCs (sports-related concussions) can result in diverse symptoms and problems, and can be associated with concurrent injury to the cervical spine and peripheral vestibular system. The literature has not evaluated early interventions, as most individuals recover in 10–14 days. A variety of treatments may be required for ongoing or persistent symptoms and impairments following injury. The data support interventions including psychological, cervical and vestibular rehabilitation. In addition, closely monitored active rehabilitation programs involving controlled sub-symptom-threshold, submaximal exercise have been shown to be safe and may be of benefit in facilitating recovery. A collaborative approach to treatment, including controlled cognitive stress, pharmacological treatment, and school accommodations, may be beneficial. Further research evaluating rest and active treatments should be performed using high-quality designs that account for potential confounding factors, and have matched controls and effect modifiers to best inform clinical practice and facilitate recovery after SRC." 

They note that SRC "is considered to be among the most complex injuries in sports medicine to diagnose, assess and manage." Let us look at how we are now changing that paradigm and the long-standing nonchalance about aggressively intervening in the "concussion cascade" to reverse the damage and wounding made to a major organ of the body: the brain. 

Critical to understanding the work of integrative medicine doctors trained in wound healing are these facts: medicine knows a lot about how to heal wounds. A physical wound to the brain is like a physical wound to any other organ in the body and Hyperbaric Oxygen Therapy has already been approved by the FDA for certain types of wound healing (air embolism; arterial insufficiencies; compromised skin grafts and flaps, acute thermal burns, crush injuries and other acute traumatic injuries that lead to oxygen and blood constriction).

Starting in the fall of 2015, Dr. Daphne Denham's clinic began treating concussions . We know that we can do better than "recognition, rest, and recovery." Simply placing a patient in the Concussion Protocol  is insufficient to promote recovery. Team trainers, doctors, coaches, teachers and families are then responsible for "managing" symptoms and after a while and with the passage of time, these patients are somehow expected to be "better." We now know that we can be far more effective in treating wounds to the brain than waiting for these wounds to heal on their own. Consider the following.

There were tens of thousands of concussions sustained by athletes at all educational levels in 2017. There were 540 concussion evaluations and 281 concussions from the NFL pre-season that occurred until the week before Super Bowl 52. To improve their treatment protocols, the NCAA brought the chief medical officer of a college into the mix, demanding that an additional sign-off was required before returning-to-play. The NFL went as far as placing more NFL- independent certified athletic trainers (ATC spotters) at every game. As recently as December of 2017, the NFL placed a central unaffiliated neurotrauma consultant (UNC) in the league's command center for all games. On ESPN, it was reported that an estimated 400 people were involved in the concussion process, including every team physician, every athletic trainer, every UNC and every booth spotter.  Imagine these 400 people worried about whether or not an athlete had suffered a concussion, but not one of them considering how to undertake healing these wounds to the brain.

A concussion leads to inflammation and cerebral ischemia (deficient supply of blood to the brain that is due to obstruction of the inflow of arterial blood). A host of negative chemical processes begin, along with mitochondrial/cell damage, oxidative damage and apoptosis (cell death). There can be a breakdown of the blood-brain-barrier and brain swelling. Numerous animal studies on concussion and blast injuries confirm that blows to the head are just not good for your brain. (All the discoveries by Dr. Ann McKee and her Chronic Traumatic Encephalopathy (CTE) team in Boston confirm a strong correlation between numerous hits to the head and onset of CTE. At last count (admittedly a contentious statistic, given the selection criteria), she had found CTE in 99% of the brains studied or 110 out of 111 of former NFL players. ) Common sense is slowly causing parents and coaches and trainers and even some medical personnel to pay attention to these correlations. This is one of the primary reasons that word-of-mouth referrals to HBOT-for-Concussions are increasing nationwide. [NOTE: The NHL owners are still not sure what CTE means. Too many of them are ten years behind the NFL in their admission about the dangers posed by hits to the head playing hockey.]

We treat wounds to the brain. Hyperbaric oxygen has been proved to enhance several natural processes related to wound healing: it reduces inflammation, inhibits apoptosis (cell death), reduces Intracranial pressure; and promotes neurogenesis and angiogenesis.  This is significant: HBOT promotes neurogenesis (growth of new neuronic tissue) and angiogenesis (growth of new blood vessels). The combination of oxygen (typically 100% O2) and pressure (varying, depending on the diagnosis) leads to the production of more stem cells available for wound healing as well. All this has been proven by rigorous, scientific studies that have explored the role of oxygen and pressure in the brain healing process.  What is not controversial is that HBOT aids tremendously in wound healing, typically 20-40 percent faster healing than the norm. In the case of acute concussions and within ten days of the injury, Denham demonstrated http://bit.ly/2jwdUwI) that patients (51 out of 52) diagnosed with acute concussions completely resolved her/his symptoms in five or less treatments (average of 2.4 treatments per concussion). Her most recent numbers of success as of February 2018 are 108 successes out of 110 patients diagnosed with acute concussions. 

Readers can learn more about this by viewing a short film entitled "Concussion Help in a Hyperbaric Chamber?": https://tinyurl.com/ybldktqn If brain injury patients (here we are talking primarily of high school athletes playing contact sports like football, hockey, lacrosse and field hockey) can be evaluated and treated over the weekend, we normally find that their symptoms can be resolved because of the wound healing; they can return to school symptom-free on Monday. Much more importantly, however, are the comments from the concussed patients. Time and again, we hear within one or two one-hour treatments that the patient "had no idea how messed up they were." It is as if the fog has cleared as the symptoms resolve. The patient is wounded and brain function, including judgment, are typically impaired. Naturally, athletes want to get back into the game and are not always the best judges of their level of recovery and ability to return to playing football. Objective tests, coupled with subjective measures such as IMPACT , may offer much more insight into the actual functional recovery.  (Practitioners are familiar with athletes and warriors who "game" the computer and paper tests, purposely obtaining low scores on baseline tests so that post-concussion testing fails to demonstrate such a significant departure from "normal.")

To summarize:  We are much smarter in 2018 than we were in the 20th century about the Mechanisms of Action, both stemming from the negative consequences of concussions and about the remarkable wound healing actions of hyperbaric oxygen. The Concussion Protocol must be upgraded to reflect what Dr. Denham and hundreds of other HBOT clinics are demonstrating daily: that wounds to the brain can be successfully treated and helped to heal using HBOT.