Hyperbaric oxygen therapy (HBOT) alleviates chronic neurocognitive symptoms in adults who suffered from mild or moderate traumatic brain injury as children

By John Rosseel. This article was initially published in the 10/23/25 edition of our Concussion Update newsletter; please consider subscribing.

A study by Shlifer et al. found that hyperbaric oxygen therapy (HBOT) can alleviate cognitive symptoms associated with post-concussion syndrome (PCS) in adults who suffered from mild or moderate traumatic brain injury (TBI) and PCS as children and who are still dealing with persisting neurocognitive symptoms. Published by Frontiers in Neurology, the researchers studied 26 patients who were diagnosed with TBI and PCS before the age of 17, had only been diagnosed with that single brain injury, and did not have other, unrelated neurocognitive impairments. 

Before and after receiving HBOT treatment, these patients were tested using computerized neurocognitive assessments to measure their cognitive abilities, including executive function, information processing speed, attention, memory, and motor skills (an online “catch game” with a cognitive aspect). The patients were given this test two months prior to HBOT and one month after their last session. The results showed improvements across all areas tested except for motor skills and were valid for both mild and moderate TBI. These findings held regardless of time elapsed after injury, with a mean of 23.6 years between participants’ injury and receiving HBOT, suggesting HBOT can treat PCS-related neurocognitive impairments even decades after injury. However, the study only evaluated these neurocognitive changes one month after HBOT, so understanding the duration of these improvements necessitates further study. 

These patients received a standardized therapy procedure of 40 HBOT sessions––five per week––at 2 atmospheres of pressure and 100% oxygen for 90 minutes each. The higher pressure and 100% oxygen cause an increase in oxygen levels within the blood, triggering regenerative processes within the brain that manage inflammation, stimulate growth and repair of cells, and cause stem cells to migrate. The researchers argue that these beneficial neurological effects are why patients’ neurocognitive symptoms improved even years after their injury, due to the “[induced] neuroplasticity and recovery of dysfunctional brain regions.”

Shlifer et al. noted several limitations of their study, including its sample size. Since the researchers were highly selective (their exclusion criteria narrowed the participant pool to 26), they argue that the study lost generalizability; they encourage further research using a wider sample size. Patients also reported other health improvements, such as better sleep and mood. However, these were not formally evaluated and therefore not included in the final results. Finally, the study did not include a longer-term follow-up after the first month post-HBOT evaluation, meaning researchers could not determine for how long the patients’ alleviated symptoms continued.