In the past several decades, Dr. Paul Harch, MD has helped to further develop and standardize the protocols for HBOT’s use for the treatment of TBI.  The primary protocol has been to treat the TBI patient (mild, moderate, severe) with the same 40 treatment protocol at 1.5 ATA for 1 hour at depth. Nonmedical home chambers have been scorned and discounted as having any value. This one-size fits all approach has been adopted and utilized by HBOT clinics around the US, which positive success for the patients treated, but limited by the scope of patients that can devote the time (6-8 weeks) and financial resources ($5000-8000) to commit to this protocol. And, in fact, HBOT alone, even over 40 treatments, may not resolve the long-term post-concussion sequela experienced by TBI patients. Finally, most insurance plans and government organizations balk at the idea of paying for this type of long-term therapy for TBI patients. This battle between science and the business of treating TBI by medical insurers and other third parties has led to a stalemate and ultimately, the a failure for any practitioners to incorporate even shorter bursts of HBOT or home HBOT chambers into their treatment of TBI. 

At TBI Therapy, we have sought to change the fundamentalist protocol of 40 HBOT treatments for all but the most severe TBI patients. We allow the patients to utilize their own home HBOT chambers at 1.3-1.4 ATA before coming to get medical HBOT treatments at 1.5-2.0 ATA. TBI Therapy has developed 3-10 day programs for patients with their own chambers (or milder brain injuries or who have already completed 40 HBOT treatments) that incorporate all of the discussed modalities of therapy including HBOT, cranial osteopathy, nasal specific, intranasal therapies, ketogenic nutrition, IV nutrition, and binaural rhythms.  Every patient who utilizes this multi-modal TBI Therapy treatment gains some form of benefit, even with just a small number of HBOT sessions. Patients report sleeping well, having more mental energy, more clarity, more physical energy, and improved memories.  

It is theorized that multi-modal therapy for TBI (including antioxidant IV nutrition and IN glutathione) also allows patients to sustain deeper dives beyond 1.5 ATA. Part of the rationale for keeping patients at 1.5 ATA is the fact that the patients may suffer from more oxidative stress with higher pressures. As one would do with an athlete, using appropriate nutrition can protect against this oxidative stress and improve the overall benefit of HBOT therapies for the TBI patient.

Also, thinking of HBOT as akin to athletic training for the brain injured patient, it has been found that “altobaric training” may be more effective than monobaric training.  Altobaric training means that the patient is not simply kept at 1.5 ATA (or any consistent pressure) for more than a short amount of time (10 minutes or less) so that the body and brain have to adapt to changing pressures. This is kind of like interval training for an athlete. A typical altobaric HBOT protocol might include spending 10 minutes at each depth: 1.4, 1.6, 1.8, 2.0, 1.8, 1.6, 1.4 ATA over a 1.25 hour session. Some studies suggest a continued variation in pressure.^[1] 

Other protocols and adaptations include hypoxic training before going into the HBOT chamber. Dr. Adam Breiner reports that he has patients exercise on a bicycle for 15 minutes before getting into the chamber using a mask that makes the patient breathe air with less oxygen.^[2] Dr. John Hughes, DO reports that simply having the TBI patient hold his or her breath for a minute while in the chamber is effective. Even elevating the lower extremities to improve CBF to the brain can be an effective way to help some patients.

^[1] https://www.ncbi.nlm.nih.gov/pubmed/11434218

^[2] Hypoxico is a great resource for getting a hypoxic chamber or mask to help patients gain the maximum benefit of HBOT.  http://www.hypoxico.com/  Note: TBI patients may only be able to handle a certain amount of hypoxic stress so gauge your treatments accordingly.