Hyperbaric oxygen therapy for mild traumatic brain injury persistent postconcussion syndrome: a randomized controlled trial

Paul G Harch, Susan R Andrews, Cara J Rowe, Johannes R Lischka, Mark H Townsend, Qingzhao Yu, Donald E Mercante, Paul G Harch, Susan R Andrews, Cara J Rowe, Johannes R Lischka, Mark H Townsend, Qingzhao Yu, Donald E Mercante

Abstract

Persistent postconcussion syndrome (PPCS) after mild traumatic brain injury (mTBI) is a significant public health and military problem for which there is limited treatment evidence. The aim of this study was to determine whether forty 150 kPa hyperbaric oxygen therapies (HBOTs) can improve symptoms and cognitive function in subjects with the PPCS of mTBI, using a randomized controlled crossover design with 2-month follow-up. Sixty-three civilian and military subjects with mTBI/PPCS were randomized to either 40 HBOTs at 150 kPa/60 minutes, once daily, 5 days per week in 8 weeks or an equivalent no-treatment control period. The Control Group was then crossed over to HBOT. Subjects underwent symptom, neuropsychological, and psychological testing, before and after treatment or control with retesting 2 months after the 40th HBOT. Fifty subjects completed the protocol with primary outcome testing. HBOT subjects experienced significant improvements in Neurobehavioral Symptom Inventory, Memory Index, Automated Neuropsychological Assessment Metrics, Hamilton Depression Scale, Hamilton Anxiety Scale, Post-Traumatic Stress Disorder Checklist, Pittsburgh Sleep Quality Index, and Quality Of Life after Brain Injury compared to the Control Group. After crossing over to HBOT the Control Group experienced near-identical significant improvements. Further improvements were experienced by both groups during the 2-month follow-up period. These data indicate that 40 HBOTs at 150 kPa/60 minutes demonstrated statistically significant improvements in postconcussion and Post-Traumatic Stress Disorder symptoms, memory, cognitive functions, depression, anxiety, sleep, and quality of life in civilian and military subjects with mTBI/PPCS compared to controls. Improvements persisted at least 2 months after the 40th HBOT. The study was registered on ClinicalTrials.gov (NCT02089594) on March 18, 2014 and with the U.S. Food and Drug Administration under Investigational New Drug #113823. The Institutional Review Boards of the United States Army Medical Research and Materiel Command Office of Research Protections Human Research Protection Office and the Louisiana State University School of Medicine (approval No. 7381) approved the study on May 13, 2014 and December 20, 2013, respectively.

Keywords: chronic brain injury; hyperbaric oxygen therapy; neurobehavioral symptom inventory; neuropsychological testing; neurorehabilitation; persistent postconcussion syndrome; post-traumatic stress disorder; randomized controlled trial; symptoms; traumatic brain injury.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Study flow chart. Note: HBOT: Hyperbaric oxygen therapy; T1–4: test points 1–4.
Figure 2
Figure 2
CONsolidated Standards Of Reporting Trials (CONSORT) diagram. Note: HBOT: hyperbaric oxygen therapy.
Figure 3
Figure 3
Change in the Neurobehavioral Symptom Inventory (NSI) and Working Memory Index for the Control Group vs. Treatment Group and the proportionate domain changes for NSI in the Treatment Group. Note: (A) Change in primary outcome measures (post-HBOT minus pre-HBOT or post-control minus pre-control). N = 23 for Treatment Group and 27 for Control Group. (B) Treatment Group domain contributions to total NSI score pre- and post-HBOT. The components of the NSI are the somatic-vestibular (S-V), affective (A) and cognitive (Cog).
Figure 4
Figure 4
Symptom trajectories of total persistent postconcussion syndrome symptom scores during and post-treatment or control. Note: NSI: Neurobehavioral Symptom Inventory; ImPACT: Immediate Post-Concussion Assessment and Cognitive Testing; COG: Control Group; TG: Treatment Group. ImPACT data were from Wolf et al.

References

    1. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013. MMWR Surveill Summ. 2017;66:1–16.
    1. Centers for Disease Control and Prevention. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Vol 45. Centers for Disease Control and Prevention. Atlanta, GA, USA: 2003.
    1. Zogg CK, Haring RS, Xu L, et al. Patient Presentations in outpatient settings: epidemiology of adult head trauma treated outside of hospital emergency departments. Epidemiology. 2018;29:885–894.
    1. Zogg CK, Haring RS, Xu L, et al. The Epidemiology of pediatric head injury treated outside of hospital emergency departments. Epidemiology. 2018;29:269–279.
    1. McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild traumatic brain injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One. 2017;12:e0174847.
    1. Hiploylee C, Dufort PA, Davis HS, et al. Longitudinal study of postconcussion syndrome: not everyone recovers. J Neurotrauma. 2017;34:1511–1523.
    1. Congress of the United States, Congressional Budget Office. A CBO study: The Veterans Health Administration's treatment of PTSD and traumatic brain injury among recent combat veterans. [Last accessed January 5, 2020]. .
    1. Cooper DB, Bunner AE, Kennedy JE, et al. Treatment of persistent post-concussive symptoms after mild traumatic brain injury: a systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans. Brain Imaging Behav. 2015;9:403–420.
    1. Diaz-Arrastia R, Kochanek PM, Bergold P, et al. Pharmacotherapy of traumatic brain injury: state of the science and the road forward: report of the Department of Defense Neurotrauma Pharmacology Workgroup. J Neurotrauma. 2014;31:135–158.
    1. Wallace EJ, Mathias JL, Ward L. Diffusion tensor imaging changes following mild, moderate and severe adult traumatic brain injury: a meta-analysis. Brain Imaging Behav. 2018;12:1607–1621.
    1. Harch PG. Hyperbaric oxygen therapy for post-concussion syndrome: contradictory conclusions from a study mischaracterized as sham-controlled. J Neurotrauma. 2013;30:1995–1999.
    1. Harch PG. Hyperbaric oxygen in chronic traumatic brain injury: oxygen, pressure, and gene therapy. Med Gas Res. 2015;5:9.
    1. Harch PG. Textbook of Hyperbaric Medicine. Cham: Springer International Publishing; 2017. HBO therapy in global cerebral ischemia/anoxia and coma; pp. 269–319.
    1. Undersea and Hyperbaric Medical Society, Hyperbaric Oxygen Committee. Hyperbaric Oxygen Therapy indications: The Hyperbaric Oxygen Therapy Committee Report. Best Publishing Company; 2014.
    1. Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) Hyperbaric Oxygen Therapy (20.29). National Coverage Determinations (NCD) Manual, Publication Number 100-3, Chapter 1, Part 1, Section 2029 effective date June 19, 2006. [Last accessed February 23, 2020]. .
    1. Jain KK. Worldwide overview of hyperbaric medicine, Chapter 49. In: Jain KK, editor. Textbook of Hyperbaric Medicine. 6th ed. Cham: Springer; 2017. pp. 609–614.
    1. Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017;47:24–32.
    1. Takahashi H, Yagi H. Hyperbaric Medicine in Japan, Chapter 42. In: Jain KK, editor. Textbook of Hyperbaric Medicine. 5th ed. Gottingen, Germany: Hogrefe and Huber Publishers; 2009. pp. 495–498.
    1. Harch PG. Hyperbaric oxygen therapy in the treatment of chronic traumatic brain injury: from Louisiana boxers to US veterans, an American Chronology. Wound Care Hyperbaric Med. 2010;1:26–34.
    1. Harch P, Gottlieb S, Van Meter K, Staab P. HMPAO SPECT brain imaging and low pressure hbot in the diagnosis and treatment of chronic traumatic, ischemic, hypoxic and anoxic encephalopathies. Undersea Hyperb Med. 1994;21:S30.
    1. Harch PG, Kriedt C, Van Meter KW, Sutherland RJ. Hyperbaric oxygen therapy improves spatial learning and memory in a rat model of chronic traumatic brain injury. Brain Res. 2007;1174:120–129.
    1. Harch PG, Fogarty EF, Staab PK, Van Meter K. Low pressure hyperbaric oxygen therapy and SPECT brain imaging in the treatment of blast-induced chronic traumatic brain injury (post-concussion syndrome) and post traumatic stress disorder: a case report. Cases J. 2009;2:6538–6538.
    1. Harch PG, Andrews SR, Fogarty EF, et al. A phase I study of low-pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder. J Neurotrauma. 2012;29:168–185.
    1. Harch PG, Andrews SR, Fogarty EF, Lucarini J, Van Meter KW. Case control study: hyperbaric oxygen treatment of mild traumatic brain injury persistent post-concussion syndrome and post-traumatic stress disorder. Med Gas Res. 2017;7:156–174.
    1. Wolf G, Cifu D, Baugh L, Carne W, Profenna L. The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury. J Neurotrauma. 2012;29:2606–2612.
    1. Boussi-Gross R, Golan H, Fishlev G, et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury - randomized prospective trial. PLoS One. 2013;8:e79995.
    1. Cifu DX, Hart BB, West SL, Walker W, Carne W. The effect of hyperbaric oxygen on persistent postconcussion symptoms. J Head Trauma Rehabil. 2014;29:11–20.
    1. Miller RS, Weaver LK, Bahraini N, et al. Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial. JAMA Intern Med. 2015;175:43–52.
    1. Weaver LK, Wilson SH, Lindblad AS, et al. Hyperbaric oxygen for post-concussive symptoms in United States military service members: a randomized clinical trial. Undersea Hyperb Med. 2018;45:129–156.
    1. Harch PG, Van Meter KW, Neubauer RA, Gottlieb SF. Use of HMPAO SPECT for Assessment of Response to HBO in Ischemic/Hypoxic Encephalopathies, Appendix. In: Jain KK, editor. Textbook of Hyperbaric Medicine. 2nd ed. Seattle, WA, USA: Hogrefe and Huber Publishers; 1996. pp. 480–491.
    1. Harch PG, Neubauer RA. Hyperbaric oxygen therapy in global cerebral ischemia/anoxia and coma, Chapter 18. In: Jain KK, editor. Textbook of Hyperbaric Medicine. 3rd Revised Edition. Seattle, WA, USA: Hogrefe and Huber Publishers; 1999. pp. 319–345.
    1. Harch PG, Neubauer RA. Hyperbaric oxygen therapy in global cerebral ischemia/anoxia and coma, Chapter 18. In: Jain KK, editor. Textbook of Hyperbaric Medicine. 3rd Revised Edition. Seattle, WA, USA: Hogrefe and Huber Publishers; 2004. pp. 223–261.
    1. Harch PG, Neubauer RA. Hyperbaric oxygen therapy in global cerebral ischemia/anoxia and coma, Chapter 19. In: Jain KK, editor. Textbook of Hyperbaric Medicine. 5th Revised Edition. Seattle, WA, USA: Hogrefe and Huber Publishers; 2009. pp. 235–274.
    1. Harch PG, Neubauer RA, Uszler JM, James PB. Appendix: Diagnostic imaging and HBO therapy, Chapter 44. In: Jain KK, editor. Textbook of Hyperbaric Medicine. 5th Revised Edition. Seattle, WA, USA: Hogrefe and Huber Publishers; 2009. pp. 505–519.
    1. Neubauer RA, Gottlieb SF, Pevsner NH. Hyperbaric oxygen for treatment of closed head injury. South Med J. 1994;87:933–936.
    1. Golden ZL, Neubauer R, Golden CJ, Greene L, Marsh J, Mleko A. Improvement in cerebral metabolism in chronic brain injury after hyperbaric oxygen therapy. Int J Neurosci. 2002;112:119–131.
    1. Golden Z, Golden CJ, Neubauer RA. Improving neuropsychological function after chronic brain injury with hyperbaric oxygen. Disabil Rehabil. 2006;28:1379–1386.
    1. Churchill S, Weaver LK, Deru K, et al. A prospective trial of hyperbaric oxygen for chronic sequelae after brain injury (HYBOBI) Undersea Hyperb Med. 2013;40:165–193.
    1. Wright JK, Zant E, Groom K, Schlegel RE, Gilliland K. Case report: Treatment of mild traumatic brain injury with hyperbaric oxygen. Undersea Hyperb Med. 2009;36:391–399.
    1. Mozayeni BR, Duncan W, Zant E, Love TL, Beckman RL, Stoller KP. The National Brain Injury Rescue and Rehabilitation Study - a multicenter observational study of hyperbaric oxygen for mild traumatic brain injury with post-concussive symptoms. Med Gas Res. 2019;9:1–12.
    1. Shytle RD, Eve DJ, Kim SH, Spiegel A, Sanberg PR, Borlongan CV. Retrospective case series of traumatic brain injury and post-traumatic stress disorder treated with hyperbaric oxygen therapy. Cell Transplant. 2019;28:885–892.
    1. Figueroa XA, Wright JK. Hyperbaric oxygen: B-level evidence in mild traumatic brain injury clinical trials. Neurology. 2016;87:1400–1406.
    1. Hadanny A, Efrati S. Treatment of persistent post-concussion syndrome due to mild traumatic brain injury: current status and future directions. Expert Rev Neurother. 2016;16:875–887.
    1. Marois P, Mukherjee A, Ballaz L. Hyperbaric oxygen treatment for persistent postconcussion symptoms--a placebo effect. JAMA Intern Med. 2015;175:1239–1240.
    1. Mychaskiw G, 2nd, Stephens PL. Hyperbaric oxygen, mild traumatic brain injury, and study design: an elusive target. J Neurotrauma. 2013;30:1681–1682.
    1. Mychaskiw G. Known knowns, known unknowns and unknown unknowns: the science and the passion of HBO2 therapy and traumatic brain injury: an editorial perspective. Undersea Hyperb Med. 2013;40:371–372.
    1. Hu Q, Manaenko A, Guo Z, Huang L, Tang J, Zhang JH. Hyperbaric oxygen therapy for post concussion symptoms: issues may affect the results. Med Gas Res. 2015;5:10.
    1. Weaver LK, Cifu D, Hart B, Wolf G, Miller S. Hyperbaric oxygen for post-concussion syndrome: design of Department of Defense clinical trials. Undersea Hyperb Med. 2012;39:807–814.
    1. Mitchell SJ, Bennett MH. Unestablished indications for hyperbaric oxygen therapy. Diving Hyperb Med. 2014;44:228–234.
    1. Macdonald AG, Fraser PJ. The transduction of very small hydrostatic pressures. Comp Biochem Physiol A Mol Integr Physiol. 1999;122:13–36.
    1. Merriam-Webster. Sham. [Last accessed January 5, 2020]. .
    1. Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J Head Trauma Rehabil. 1993;8:86–87.
    1. Bigler ED. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc. 2008;14:1–22.
    1. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revised. Washington, D.C: American Psychiatric Association; 2000.
    1. King PR, Donnelly KT, Donnelly JP, et al. Psychometric study of the neurobehavioral symptom inventory. J Rehabil Res Dev. 2012;49:879–888.
    1. Cicerone KD, Kalmar K. Persistent postconcussion syndrome: the structure of subjective complaints after mild traumatic brain injury. J Head Trauma Rehabil. 1995;10:1–17.
    1. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358:453–463.
    1. Theeler B, Lucas S, Riechers RG, 2nd, Ruff RL. Post-traumatic headaches in civilians and military personnel: a comparative, clinical review. Headache. 2013;53:881–900.
    1. Theeler BJ, Flynn FG, Erickson JC. Chronic daily headache in U.S. soldiers after concussion. Headache. 2012;52:732–738.
    1. Michigan alcohol screening test, Revised. [Last accessed January 5, 2020]. .
    1. Gavin DR, Ross HE, Skinner HA. Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. Br J Addict. 1989;84:301–307.
    1. Post-traumatic stress disorder checklist-military and civilian. [Last accessed January 5, 2020]. .
    1. Corrigan JD, Bogner J. Initial reliability and validity of the Ohio State University TBI Identification Method. J Head Trauma Rehabil. 2007;22:318–329.
    1. Blake DD, Weathers FW, Nagy LM, et al. The development of a Clinician-Administered PTSD Scale. J Traum Stress. 1995;8:75–90.
    1. Tombaugh TN. Test of memory malingering: TOMM. New York: Multi-Health Systems, Inc; 1996.
    1. Lesak M, Howieson D, Loring D. Neuropsychological Assessment. 4th ed. New York: Oxford University Press; 2004. pp. 365–367,776.
    1. Wechsler D. Wechsler Test of Adult Reading (WTAR)-Manual. San Antonio, TX, USA: The Psychological Corporation; 2001.
    1. Hedlund JL, Vieweg BW. The Hamilton rating scale for depression: a comprehensive review. J Operat Psychiatry. 1979;10:149–165.
    1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50–55.
    1. Wechsler adult intelligence scale-IV. [Last accessed January 5, 2020]. .
    1. Wechsler abbreviated scale of intelligence. [Last accessed January 5, 2020]. .
    1. Wechsler Memory Scale-IV. [Last accessed January 5, 2020]. .
    1. Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. 4 ed. New York: Oxford University Press; 2004. pp. 422–429.
    1. Sivan AB. Benton Visual Retention Test. 5th ed. San Antonio: The Psychological Corporation; 1992.
    1. Golden C. Stroop color and word test. [Last accessed January 5, 2020]. .
    1. Spreen O, Strauss E. A compendium of neuropsychological tests: Administration, norms and commentary. 2nd ed. New York: Oxford University Press; 1998.
    1. Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. Fourth Edition. New York: Oxford University Press; 2004. pp. 520–521.
    1. Vincent AS, Roebuck-Spencer TM, Cox-Fuenzalida LE, Block C, Scott JG, Kane R. Validation of ANAM for cognitive screening in a mixed clinical sample. Appl Neuropsychol Adult. 2018;25:366–375.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.
    1. Quality of Life After Brain Injury (QOLIBRI) [Last accessed January 5, 2020]. .
    1. Heaton R, Miller SW, Taylor MJ, Grant-Isibor I. Lutz, FL, USA: Psychological Assessment Resources; 2004. Revised comprehensive norms for an expanded Halstead-Reitan Battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults.
    1. Soble JR, Silva MA, Vanderploeg RD, et al. Normative Data for the Neurobehavioral Symptom Inventory (NSI) and post-concussion symptom profiles among TBI, PTSD, and nonclinical samples. Clin Neuropsychol. 2014;28:614–632.
    1. Wilde EA, Whiteneck GG, Bogner J, et al. Recommendations for the use of common outcome measures in traumatic brain injury research. Arch Phys Med Rehabil. 2010;91:1650–1660.e17.
    1. Dretsch M, Bleiberg J, Williams K, et al. Three scoring approaches to the neurobehavioral symptom inventory for measuring clinical change in service members receiving intensive treatment for combat-related mTBI. J Head Trauma Rehabil. 2016;31:23–29.
    1. McAllister TW. Neurobiological consequences of traumatic brain injury. Dialogues Clin Neurosci. 2011;13:287–300.
    1. Basso MR, Carona FD, Lowery N, Axelrod BN. Practice effects on the WAIS-III across 3- and 6-month intervals. Clin Neuropsychol. 2002;16:57–63.
    1. Tukey JW. Comparing individual means in the analysis of variance. Biometrics. 1949;5:99–114.
    1. Belanger HG, Lange RT, Bailie J, et al. Interpreting change on the neurobehavioral symptom inventory and the PTSD checklist in military personnel. Clin Neuropsychol. 2016;30:1063–1073.
    1. Harch PG. The dosage of hyperbaric oxygen in chronic brain injury. In: Joiner JT, editor. The Proceedings of the 2nd International Symposium on Hyperbaric Oxygenation for Cerebral palsy and the Brain-Injured Child. Flagstaff, AZ, USA: Best Publishing Co; 2002. pp. 31–56.
    1. Scorza K, McCarthy W, Miller R, Carne W, Wolf G. Orlando, FL, USA: Undersea and Hyperbaric Medical Society Annual Meeting; 2013. Hyperbaric oxygen effects on PTSD and mTBI symptoms: a subset analysis.
    1. Polinder S, Cnossen MC, Real RGL, et al. A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Front Neurol. 2018;9:1113–1113.
    1. Kraus MF, Susmaras T, Caughlin BP, Walker CJ, Sweeney JA, Little DM. White matter integrity and cognition in chronic traumatic brain injury: a diffusion tensor imaging study. Brain. 2007;130:2508–2519.
    1. Lipton ML, Gulko E, Zimmerman ME, et al. Diffusion-tensor imaging implicates prefrontal axonal injury in executive function impairment following very mild traumatic brain injury. Radiology. 2009;252:816–824.
    1. Roth TL, Nayak D, Atanasijevic T, Koretsky AP, Latour LL, McGavern DB. Transcranial amelioration of inflammation and cell death after brain injury. Nature. 2014;505:223–228.
    1. Korn A, Golan H, Melamed I, Pascual-Marqui R, Friedman A. Focal cortical dysfunction and blood-brain barrier disruption in patients with Postconcussion syndrome. J Clin Neurophysiol. 2005;22:1–9.
    1. Wortzel HS, Arciniegas DB, Anderson CA, Vanderploeg RD, Brenner LA. A phase I study of low-pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder: a neuropsychiatric perspective. J Neurotrauma. 2012;29:2421–2430.
    1. Ferdosi H, Schwab KA, Metti A, et al. Trajectory of postconcussive symptoms 12 months after deployment in soldiers with and without mild traumatic brain injury: warrior strong study. Am J Epidemiol. 2019;188:77–86.
    1. Walker JM, Mulatya C, Hebert D, Wilson SH, Lindblad AS, Weaver LK. Sleep assessment in a randomized trial of hyperbaric oxygen in U.S. service members with post concussive mild traumatic brain injury compared to normal controls. Sleep Med. 2018;51:66–79.
    1. Ewing R, McCarthy D, Gronwall D, Wrightson P. Persisting effects of minor head injury observable during hypoxic stress. J Clin Exp Neuropsych. 1980;2:147–155.
    1. Siddiqui A, Davidson JD, Mustoe TA. Ischemic tissue oxygen capacitance after hyperbaric oxygen therapy: a new physiologic concept. Plast Reconstr Surg. 1997;99:148–155.
    1. Godman CA, Chheda KP, Hightower LE, Perdrizet G, Shin DG, Giardina C. Hyperbaric oxygen induces a cytoprotective and angiogenic response in human microvascular endothelial cells. Cell Stress Chaperones. 2010;15:431–442.
    1. Chen Y, Nadi NS, Chavko M, Auker CR, McCarron RM. Microarray analysis of gene expression in rat cortical neurons exposed to hyperbaric air and oxygen. Neurochem Res. 2009;34:1047–1056.
    1. Oh S, Lee E, Lee J, Lim Y, Kim J, Woo S. Comparison of the effects of 40% oxygen and two atmospheric absolute air pressure conditions on stress-induced premature senescence of normal human diploid fibroblasts. Cell Stress Chaperones. 2008;13:447–458.
    1. Kendall AC, Whatmore JL, Harries LW, Winyard PG, Eggleton P, Smerdon GR. Different oxygen treatment pressures alter inflammatory gene expression in human endothelial cells. Undersea Hyperb Med. 2013;40:115–123.
    1. Marx RE, Johnson RP. Problem wounds in oral and maxillofacial surgery: the role of hyperbaric oxygen, Chapter 4. In: Davis JC, Hunt TK, editors. Problem Wounds: The Role of Oxygen. New York: Elsevier Science Publishing Co; 1988. pp. 65–123.
    1. Brismar K, Lind F, Kratz G. Dose-dependent hyperbaric oxygen stimulation of human fibroblast proliferation. Wound Repair Regen. 1997;5:147–150.
    1. Marx RE, Ehler WJ, Tayapongsak P, Pierce LW. Relationship of oxygen dose to angiogenesis induction in irradiated tissue. Am J Surg. 1990;160:519–524.
    1. Manson PN, Im MJ, Myers RAM, Hoopes JE. Improved capillaries by hyperbaric-oxygen in skin flaps. Surg Forum. 1980;31:564–566.
    1. Uhl E, Sirsjö A, Haapaniemi T, Nilsson G, Nylander G. Hyperbaric oxygen improves wound healing in normal and ischemic skin tissue. Plast Reconstr Surg. 1994;93:835–841.
    1. Ueng SW, Lee SS, Lin SS, et al. Bone healing of tibial lengthening is enhanced by hyperbaric oxygen therapy: a study of bone mineral density and torsional strength on rabbits. J Trauma. 1998;44:676–681.
    1. Tal S, Hadanny A, Sasson E, Suzin G, Efrati S. Hyperbaric oxygen therapy can induce angiogenesis and regeneration of nerve fibers in traumatic brain injury patients. Front Hum Neurosci. 2017;11:508.
    1. Belanger HG, Vanderploeg RD. The neuropsychological impact of sports-related concussion: a meta-analysis. J Int Neuropsychol Soc. 2005;11:345–357.
    1. Belanger HG, Curtiss G, Demery JA, Lebowitz BK, Vanderploeg RD. Factors moderating neuropsychological outcomes following mild traumatic brain injury: a meta-analysis. J Int Neuropsychol Soc. 2005;11:215–227.
    1. Walker WC, Franke LM, Cifu DX, Hart BB. Randomized, sham-controlled, feasibility trial of hyperbaric oxygen for service members with postconcussion syndrome: cognitive and psychomotor outcomes 1 week postintervention. Neurorehab Neural Repair. 2014;28:420–432.
    1. Cifu DX, Walker WC, West SL, et al. Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes. Ann Neurol. 2014;75:277–286.
    1. Quitkin FM. Placebos, drug effects, and study design: a clinician’s guide. Am J Psychiatry. 1999;156:829–836.
    1. Holbach KH, Caroli A, Wassmann H. Cerebral energy metabolism in patients with brain lesions of normo- and hyperbaric oxygen pressures. J Neurol. 1977;217:17–30.

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