In December, Josh Cooley could not walk across a room without help or start a conversation — lingering effects of a serious brain injury the Marine reservist suffered in 2005 in Iraq.
But by March, he was doing those things and more. "He can shower standing up," said his mother, Christine Cooley. "You don't know how important that is."
She attributes her son's progress to the 40 treatments he received inside a hyperbaric oxygen chamber. His doctor, Palm Harbor neurologist Allan Spiegel, says the exposure to 100 percent oxygen under increased atmospheric pressure promotes the growth of blood vessels and also helps reduce swelling and inflammation in the brain.
"It's helped tremendously," Cooley, 33, of Brooksville, said in a slow, soft tone during a recent visit to Spiegel's clinic on U.S. 19.
Now, through a pair of studies, doctors across the country hope to learn more about the potential of hyperbaric treatment for people like Cooley.
One study, headed by Dr. Paul Harch, a clinical associate professor at Louisiana State University and a leading expert in the field, will soon be recruiting as many as 1,000 people — veterans and civilians alike — with varying degrees of traumatic brain injury, or TBI, to receive treatments at clinics across the country, including Spiegel's.
And the U.S. military plans to begin clinical trials next year on about 300 service members with mild to moderate TBI.
They shouldn't be hard to find. A 2008 report from the nonprofit RAND Center for Military Health Policy Research estimated that more than 300,000 military personnel deployed in Iraq and Afghanistan since 2001 reported probable TBI, a number that has likely grown with the wars continuing two years later. And the Centers for Disease Control and Prevention estimates that 1.5 Americans survive a traumatic brain injury each year.
Harch said he has seen its positive effects for many years and hopes his forthcoming study will go a long way toward pushing it to the forefront of TBI treatment.
But he knows it will continue to be an uphill climb. The Food and Drug Administration has not approved hyperbaric oxygen therapy to treat brain injuries. The therapy carries some risks, such as seizures. And there isn't large-scale data to show it works.
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Hyperbaric oxygen therapy has been around for centuries, using sealed chambers of various shapes and sizes. But it has had a relatively low profile as a medical treatment, occasionally thrust into the public spotlight by the likes of the late eccentric pop star Michael Jackson, who reportedly slept in a hyperbaric chamber because he believed it would slow the effects of aging.
But it has a proven track record as an effective treatment for a number of illnesses. Currently, the FDA has approved it to treat about 15 conditions, including carbon monoxide poisoning, diabetic wounds, gangrene and soft tissue infections. Medicare covers hyperbaric oxygen therapy for many of the FDA-approved uses.
Treatment for brain injuries is one of several "off-label" uses that aren't typically covered by insurance or backed by the mainstream medical community. Other off-label uses include treatment for cerebral palsy, stroke, Lyme disease and autism.
Harch said the use of hyperbaric oxygen therapy for brain injuries dates back about 40 years. Though he admits no one really knows the exact mechanisms at work, he points to a number of successes, including his 2007 study published in the journal Brain Research that showed the therapy improved learning and memory, while increasing blood vessel density, in the damaged brains of rats.
Further evidence comes from his recent pilot study, which involved 15 veterans who suffered blast-induced TBI. The study, which is nearing completion, found that the veterans showed significant improvements after undergoing 40 one-hour hyperbaric oxygen treatments in a one-month period. They showed a 15-point average increase in IQ, a reduction in depression and improvements in headaches, sleep disturbances and post-traumatic stress disorder.
Harch presented the findings last month to the International Brain Injury Association and hopes to have the study published when its complete.
"We wanted to get this out there," said Harch, who called TBI the "most pressing health problem in the U.S. military."
"It's the most significant injury in terms of the toll it has taken," he said.
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Typically, TBI is treated with a combination of physical therapy and medications that can include atypical antipsychotics and antidepressants, said Jay Rosenberg, a San Diego neurologist and member of the American Academy of Neurology.
Rosenberg, who heard Harch's presentation in Washington last month, described hyperbaric oxygen therapy as "a hot, hot topic."
"I was impressed with the potential for this," Rosenberg said.
But, he added, much work needs to be done before it gains mainstream acceptance or FDA approval, or both.
"The problem is, we don't have good data," he said. "The medical community is evidence-based, and they're skeptical."
Some have noted the treatment's cost as a barrier. The therapy can run between $200 to $500 per treatment in clinics, and as much as $1,500 per treatment in a hospital.
There are also side effects, such as a very small risk of seizure. But Rosenberg doesn't think that's as much of an issue as the treatment's cost and questions about its effectiveness.
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For Christine Cooley, it was a matter of making life better for her son, who has undergone several surgeries and years of physical therapy since the 2005 roadside bomb exploded in Iraq and sent shrapnel through his brain.
She credits the hyperbaric oxygen treatments for his improved strength, particularly in his left arm and leg, and better conversational skills.
"I saw changes the first week of treatments," she said. "He started to express what he was thinking, without me having to initiate it."
Asked about Cooley's prognosis with continued therapy, Spiegel said "we don't know."
"He's improved so much, so fast that I wouldn't put an end point on it," he said.
But Cooley knows what he wants.
"To go back to work," he said with a smile.
Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.