Brain injury and stroke
Hyperbaric Oxygen Therapy in Post Stroke Recovery
Stroke
may occur due to reduction in the blood flow and oxygen transport to
the brain after arterial occlusion (thrombus or embolus), arterial
spasm, vessels rupture (aneurysm, hypertension), changes in blood
viscosity, consequence of diabetes, or result of smoking, alcohol or
obesity.
Manifestations of stroke depending on the
location of the neural damage could be: paralysis (hemiplegia or
paraplegia), paresis, spasticity, flaccidity or muscle weakness,
walking and balance impairment, intellectual and cognitive impairment
(thinking understanding), speech impairment, memory disturbance
(“vascular dementia”), sensitivity impairment, bladder and bowel
dysfunction, sexual deficit.
Clinical application of hyperbaric
oxygen (HBO) therapy in stroke has been widely used on experimental
basis in acute stage as well as in the chronic stage - post stroke
rehabilitation.
The benefit of HBO therapy in acute
stage of stroke is due to the following:
- HBO prevents further brain damage by improving cerebral
oxygenation and relieving brain edema and neuronal swelling
- HBO prevents further blood clotting by reducing blood
viscosity and platelet aggregation
- HBO reduces mortality rate in those who survive stroke to
below 20%
The benefit of HBO in rehabilitation in a chronic stage of stroke is
due to the following:
- HBO reduces chance of stroke recurrences
- HBO relieves muscle spasticity and increases muscle strength
- HBO improves mobility and fine motor function
- HBO improves walking and balance
- HBO increases exercise capacity
- HBO improves sensitivity
- HBO improves mental function including speech and memory
- HBO improves visual acuity
- HBO improves bowel and bladder control and reduces sexual
deficit
The
reports of successful HBO therapy in chronic stroke have been mainly
due to the possibility of oxygenation of the areas surrounding dead
neuronal areas, which are anatomically intact but non-functional and
have been dormant due to the initial lack of oxygen. These parts of
brain called “ischemic penumbra” could possibly be reviewed with HBO,
which would in turn initiate self-repair and establishment of lost
connection due to the stroke. This would mean better mental and bodily
functions.
References:
- Jain K: Textbook of Hyperbaric Medicine, 2nd ed.
Hogrefe and Huber Publishers, Inc., 1996, Chap. 17: Role of hyperbaric
oxygenation in management of stroke, Chap. 19: Hyperbaric
oxygen
therapy in neurosurgery.
- Akimov GA et al: Assessment of the
efficiency of hyperbaric oxygen therapy in early forms of
cerebrovascular disorders, Neurosci Behav Phys, 15:13-16, 1985.
- Nighoghossian
N, Trouillas P, Adeleine P, Salord F: Hyperbaric oxygen in the
treatment of acute ischemic stroke. A double- blind pilot study,
Stroke, Aug; 26(8):1369-72, 1995.
- Veltkamp R, Toole
JF: Hyperbaric oxygen-a neuroprotective adjuvant for hyperacute
ischemic stroke? J Neurol Sci, Sep, 1; 150(1):1-2, 1997.
- Watanabe
M, Kanaya H, Fuchizawa K, Onodera H, Suzuki H.: Experimental study on
compressed air therapy on cerebral edema, Jap. J. Hyperbaric Medicine
5: 23, 1970
- Marroni A: Hyperbaric oxygen therapy at 1.5 or 2.0
ATA as an adjunct to the rehabilitation of stabilized stroke patients.
A controlled study, 9th International Congress on Hyperbaric Medicine,
Sydney, Australia: March 1-4, pp: 161-167, 1987
- Steenblock D: Review of Hyperbaric Oxygen for Stroke
Rehabilitation, Explore, Volume 7, Number 5, 1996/97
- Sukoff MH, Ragatz RE: Hyperbaric oxygenation for the
Treatment of Acute Cerebral Edema, Neurosurgery, 10:29-38, 1982
- Holbach KH et al: Reversibility of the chronic post-stroke
state, Stroke , 7 (3) 296-300, 1976
- Holbach
KH et al: Differentiation between reversible and ireversible
post-stroke changes in brain tissue: Its relevance for cerebraovascular
surgery, Surg Neurol, 7: 325-331, 1977.
- Neubauer RR: Hyperbaric
Oxygen and Imaging Techniques in Diagnosis and Therapy of Stroke. Does
the Ischemic Penumbra alter the outcome in Stroke?, International
Symposium: Neuropsychomotor, Neuropharmacological, Psychosocial and
Ethical Aspects, Oct. 7-11,1992 Siracusa, Italy. pp 1-9.
- Neubauer
RR: Hyperbaric Oxygenation in acute stroke- 4 hour window, EUBS, 26th
Annual meeting, Malta, Sep 14-18, pp:43-4650, 2000.
- Neubauer RR:
World Federation of Neurology proposed pilot study of hyperbaric
treatment of acute ischemic thrombotic stroke , EUBS, 25th Annual
meeting, Haifaand Eilat, Israel, Aug 28 -Sep 2, pp:48-51, 1999.
- Li
W: Cerebral thrombosis treated by hyperbaric oxygenation, 9th
International Congress on Hyperbaric Medicine, Sydney, Australia, March
1-4, pp 153-154, 1987.
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