functional medicine and nutritional genomics - American Association ...

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS
improvement and that clinical improvements may
precede any measurable SPECT changes. They
also note that the patient’s second series of 60
treatments not only re-instated the previous gains
from one year prior, but yielded greater benefits
than those initial 20 treatments. Gains were seen
in gait velocity, working memory, language, and
the processing speed of information. This supports
other author’s suggestion that there is neural
tissue around the area of damage that may be
idle, yet viable, for several years after the initial
neurological insult.(19)
Similar results were also found by Golden et al.
who studied both children and adults with chronic
brain injury who had gone one year without
clinical progress despite multimodal treatment.
Patients who had previously decided to use HBOT
were enrolled into HBO therapy programs, however
the report did not indicate the specific HBOT
protocols used. Outcome of HBO participants was
measured with validated neuropsychological
measures assessing a broad range of cognitive,
social, and motor function (Vineland assessment).
The results suggested that non-responders and
responders existed within the treatment groups.
Furthermore, the number of total treatments, not
the treatment time period, was most suggestive of
benefit. SPECT imaging was performed on these
subjects as well. SPECT changes did not progress
as quickly as cognitive changes progressed. The
authors believed their results were ‚strongly
supportive‛ for HBOT in the treatment of chronic
brain injury and that SPECT changes may not be
a reliable correlate of clinical improvement.(20)
Even comatose patients may benefit from HBOT.
Liu et al. found improvement in cerebral perfusion
by SPECT and Glascow Coma Score in a
prospective trial of comatose patients undergoing
median nerve stimulation with or without (control
group)HBOT. Control patients showed no
measurable improvement while 6 of 12 patients in
the HBOT group emerged from coma, none of the
HBO group needed assisted ventilation, and only
one still needed nasogastric tube feeding at one
year.(21)
148
HBOT may have benefits from a neuropyschologic
standpoint, as studies suggest beneficial effects on
behavior and mood after HBOT. This could
change the perspective on future HBOT research,
allowing us to understand the role of HBOT in
improving more subtle aspects of neurocognitive
function. Improvements at this level are clinically
measured in terms of enhanced mood and
cognitive function. Most previous HBOT work has
focused on the measurement of grossly observable
changes (motor function,etc.), the measurement of
metabolic changes that would validate improvement
in ischemia, or objective measures of improved
brain function (SPECT, EEG). These modalities
of evaluation may not be accurate surrogates to
determine an HBOT benefit as cognitive function
may not be easily measured by physiologic or
electrophysiologic changes.
HBOT may provide clinical benefit in traumatic
brain injury in the acute and chronic injury
settings. It appears to offer neuroprotective benefits
in acute TBI as well as long-term beneficial
effects during recovery from a brain insult. The
clinical benefits of HBOT in TBI is being actively
explored in the literature. HBO therapy may work
by improving oxygen delivery to metabolically
inactive, yet viable tissue, reducing inflammation,
aborting apoptosis, improving cerebral metabolism,
and enhancing brain plasticity. HBOT likely has
application to specific types of injury at specific
times. More studies will be necessary to
differentiate responder and non-responder types.
HBOT has a very safe side effect profile and
therefore, aside from cost, has little down side.
Few good medical treatments exist for TBI;
therefore, HBOT should continue to be researched
to determine its full application and utility in the
treatment of various forms of TBI.
Summary
Hyperbaric oxygen therapy is approved for the
treatment of wounds and burns, decompression
illness, and gas poisoning. Based largely on
animal studies, its mechanism of action is likely
based in its ability to reduce inflammation through
its immune dampening effects. HBOT increases the
2012