Longitudinal study of hyperbaric oxygen intervention on balance and affective symptoms in military service members with persistent post-concussive symptoms

Article type: Research Article

Authors: Meehan, Anna^{a; *} | Hebert, Donald^b | Deru, Kayla^c | Weaver, Lindell K.^{c; d}

Affiliations: [a] Lovelace Biomedical Research, Albuquerque, New Mexico, USA | [b] Emmes, Rockville, MD, USA | [c] Division of Hyperbaric Medicine Intermountain Medical Center, Murray, UT, and Intermountain LDS Hospital, Salt Lake City, UT, USA | [d] Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA

Correspondence: [*] Corresponding author: Anna Meehan, AuD, CCC-A 12034 Upper Preston Rd SE, Issaquah, WA 98027, USA. Tel.: +1 724 713 2639; E-mail: [email protected].

Abstract: BACKGROUND:Dizziness and imbalance are common after mild traumatic brain injury (mTBI). Hyperbaric oxygen (HBO2) has been proposed for persistent post-concussive symptoms after mTBI, but its effect on vestibular function is unknown. OBJECTIVE:To describe balance function in military service-members before and after intervention, and to explore the influence of post-traumatic stress disorder (PTSD), anxiety, and depression on vestibular outcomes. METHODS:Seventy-one participants with mTBI and seventy-five healthy adults without brain injury were enrolled (NCT01611194 and NCT01925963). mTBI participants were randomized to 40 HBO2 sessions or 40 sham chamber sessions over 12 weeks. Normative controls received no intervention. Balance and neuropsychological function were measured at baseline, 13 weeks, and 6 months. RESULTS:The mTBI cohort performed worse than healthy controls on balance and gait measures and reported more affective symptoms. Some within-group improvements were noted at 13 weeks and 6 months. Significant between-intervention differences on balance measures were minimal but effects on postural control generally favored HBO2. Those with affective symptoms, particularly PTSD, had the most improvement in postural control and otolith function following 13 weeks of HBO2. CONCLUSION:HBO2 may influence balance function after mTBI, particularly in those with affective symptoms.

Keywords: Mild traumatic brain injury, persistent post-concussive symptoms, hyperbaric oxygen, computerized dynamic posturography, vestibular evoked myogenic potentials, anxiety, post-traumatic stress, depression

DOI: 10.3233/VES-180671

Journal: Journal of Vestibular Research, vol. 29, no. 4, pp. 205-219, 2019