title: Randomized, Sham-Controlled, Feasibility Trial of Hyperbaric Oxygen for Service Members With Postconcussion Syndrome: Cognitive and Psychomotor Outcomes 1 Week Postintervention.
abstract: Background Mild traumatic brain injury (mTBI) and residual postconcussion syndrome (PCS) are common among combatants of the recent military conflicts in Iraq and Afghanistan. Hyperbaric oxygen (HBO2) is a proposed treatment but has not been rigorously studied for this condition. Objectives In a secondary analysis, examine for possible effects on psychomotor (balance and fine motor) and cognitive performance 1 week after an HBO2 intervention in service members with PCS after mTBI. Methods A randomized, double-blind, sham control, feasibility trial comparing pretreatment and posttreatment was conducted in 60 male active-duty marines with combat-related mTBI and PCS persisting for 3 to 36 months. Participants were randomized to 1 of 3 preassigned oxygen fractions (10.5%, 75%, or 100%) at 2.0 atmospheres absolute (ATA), resulting in respective groups with an oxygen exposure equivalent to (1) breathing surface air (Sham Air), (2) 100% oxygen at 1.5 ATA (1.5 ATAO2), and (3) 100% oxygen at 2.0 ATA (2.0 ATAO2). Over a 10-week period, participants received 40 hyperbaric chamber sessions of 60 minutes each. Outcome measures, including computerized posturography (balance), grooved pegboard (fine motor speed/dexterity), and multiple neuropsychological tests of cognitive performance, were collected preintervention and 1-week postintervention. Results Despite the multiple sensitive cognitive and psychomotor measures analyzed at an unadjusted 5% significance level, this study demonstrated no immediate postintervention beneficial effect of exposure to either 1.5 ATAO2 or 2.0 ATAO2 compared with the Sham Air intervention. Conclusions These results do not support the use of HBO2 to treat cognitive, balance, or fine motor deficits associated with mTBI and PCS.
authors.affiliation: Virginia Commonwealth University, Richmond, VA, USA Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA Richmond Defense and Veterans Brain Injury Center, Richmond, VA, USA wwalker@mcvh-vcu.edu.
authors.forename: William C
authors.initials: WC
authors.lastname: Walker
authors.affiliation: Virginia Commonwealth University, Richmond, VA, USA Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA Richmond Defense and Veterans Brain Injury Center, Richmond, VA, USA.
authors.forename: Laura Manning
authors.initials: LM
authors.lastname: Franke
authors.affiliation: Virginia Commonwealth University, Richmond, VA, USA Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA Department of Veterans Affairs, Washington, DC, USA.
authors.forename: David X
authors.initials: DX
authors.lastname: Cifu
authors.affiliation: Navy Medicine Operational Training Center, Pensacola, FL, USA.
authors.forename: Brett B
authors.initials: BB
authors.lastname: Hart
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D001924:Brain Concussion / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D003071:Cognition / Q000502:physiology*; D004311:Double-Blind Method; D056344:Executive Function / Q000502:physiology; D005240:Feasibility Studies; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008889:Military Personnel; D009483:Neuropsychological Tests; D038223:Post-Concussion Syndrome / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004856:Postural Balance / Q000502:physiology; D011597:Psychomotor Performance / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: cognition disorders; hyperbaric oxygenation; postconcussion syndrome; psychomotor performance; randomized controlled trial; traumatic brain injury