What is a Stroke?
Strokes, also called cerebrovascular accidents (CVAs), occur when brain tissues stop functioning, as normal blood circulation and oxygenation within the brain stops. This can happen as a result of blood clots or cerebral hemorrhaging. When strokes occur, brain neurons quickly die as the oxygen supplying them gets cut off. (Hyperbaric oxygen therapy is effective because it vastly increases oxygen supply to body fluids and tissues, helping to repair and regenerate them.)
Stroke victims can suffer various disabilities, depending on which area of the brain has been starved of oxygen. Common symptoms include numbness or weakness in the face, arms and legs. A stroke victim’s limbs may become rigid or spastic. He or she may get double vision or find that balance is impaired. Some people lose their ability to swallow, speak or comprehend. Victims may also experience memory loss, difficulty thinking, and profound mood and personality changes.
Doctor’s don’t always know the cause of strokes, but here are the three classic types:
- Ischemic Strokes (Clots) are caused when blood vessels supplying blood to the brain get narrowed or blocked by fatty deposits (plaque) lining the inner vessel walls. We call the condition atherosclerosis, and it causes around 87 percent of all strokes. Ischemic strokes can take two forms:
- Cerebral thrombosis, referring to a blood clot (or thrombus) that develops at the place where the vessel is clogged.
- Cerebral embolism, referring to blood clots that form in another location of the circulatory system, often within the heart or the large arteries in the neck and upper chest. These clots break loose and enter the bloodstream. Then they travel through the brain blood vessels until they reach blood vessels that are too small to permit them through.
- Hemorrhagic strokes (bleeds) result when compromised blood vessels (aneurysms or arteriovenous malformations) rupture and leak blood into the surrounding brain. The accumulating blood presses against surrounding brain tissues, destroying brain tissue around the hemorrhage site. These strokes account for around 13 percent all stroke cases.
- Transient Ischemic Attacks (TIAs), often referred to as mini-strokes, should more accurately be called warning strokes. Like larger ischemic strokes, they are caused by clots, but a TIA blockage is only temporary. The symptoms usually come on quickly and last one to five minutes at most. Victims may feel numbness or weakness in the face, arm or leg. Their speech may be slurred or they can temporarily lose the ability to speak. TIAs normally cause no permanent
brain injury, though they shouldn’t be taken lightly. About one third of those having TIA will go on to have a stroke within a year. Recognizing TIA symptoms and getting to a hospital quickly can help doctors determine why the TIA occurred and provide treatment to prevent a more serious stroke from occurring. For prior stroke victims, TIA symptoms can indicate that current treatments are not working properly.
When people suffer strokes, brain tissues die. Neither HBOT nor any other known treatment can revive this localized area of brain tissue. However, HBOT can create significant improvements in the penumbra, the area between damaged brain tissue and the part of the brain that remains intact. The penumbra contains idle or dormant brain cells that are still alive, though they’ve temporarily lost their ability to function because the oxygen they require has been cut off. Hyperbaric oxygen treatment effectively bathes this dormant region with oxygen, providing vital nutrients to the area. If this should awakenpenumbra cells, brain and body function will also improve.
Researchers now understand that the brain has plasticity. This means when one brain portion dies, another brain part can learn to take over its functions. Hyperbaric oxygen treatments help to engage circuits on the uninjured side of the brain. In the best case scenario, function will later switch back to undamaged regions on the side of the brain that previously experienced the stroke. In fact, treatment in a hyperbaric oxygen chamber can boost brain repair years after a stroke has occurred!
In 2013, Dr. Shai Efrati of Tel Aviv University’s Sackler Faculty of Medicine and fellow researchers showed conclusively in a randomized trial study that high oxygen levels can reinvigorate dormant neurons. The study’s participants included 74 patients between six months and three years’ post-stroke, whose condition was no longer improving. These were divided into two groups – one that got HBOT from the beginning of the study, and the second that got no treatment for two months, then received a two-month period of HBOT treatment. Researchers used a combination of CT scans to identify dead tissue areas and SPECT scans to measure the metabolic activity level of neurons that surrounded damaged brain areas.
Brain imaging showed significantly increased neuronal activity after a two-month period of HBOT treatments for two hours five times weekly, compared to control periods of non-treatment. Patients saw dramatic improvements that included reversing paralysis, increased sensation and a renewed ability to use language. And although the study focused just on patients up to three years’ post stroke, similar improvements have been seen in patients whose brain injury occurred up to 20 years before!
How does HBOT therapy help in Brain Recovery?
HBOT works by improving blood flow to a stroke patient’s damaged brain tissues. The area of dead brain tissue resulting from a lack of blood supply is known as an infarct. The ability of a stroke victim to recover using HBOT (or any other medical treatment) will depend on several factors: the infarct’s size and location and the condition of the penumbra. Severe brain infarctions cause swelling that also intensifies pressure on the remaining viable brain tissue.
Hyperbaric oxygen therapy floods blood plasma, lymph fluids and cerebrospinal fluid (the clear, watery fluid that fills the brain and spine) with pure oxygen at higher than normal atmospheric pressures. The body receives 1,500 to 2,000 times the O2 concentration it would when a person breathes in normal room air. This brings down brain swelling and provides crucial nutrients to oxygen-starved brain matter, muscle and bone. In many cases, with a series of HBOT treatments, stroke victims’ function is improved or restored. Dormant cells in the penumbra become re-activated, and new capillaries also form in the area. These capillaries increase both blood flow and nutrients and carry away cellular waste.
How Successful Is HBOT in Recovering Brain Function?
In one study, researchers gave 122 stroke victims HBOT sessions. Sixteen patients were treated with HBOT within four hours of suffering the stroke. Seventy-nine patients received the therapy anywhere from five months to 10 years after their initial strokes. This is far beyond the amount of time we might expect stroke-related symptoms to improve on their own. Many of these 79 patients had gone through occupational and physical therapy, but they still had significant impairments. Following hyperbaric oxygen therapy, 62 percent of the 79 patients said they experienced an improved quality of life. Of 59 patients who had previously been confined to a bed or a wheelchair, 27 began to walk again –independently or with the assistance of a cane or walker.
Report data showed that patients who received HBOT spent, on average, 177 days hospitalized. That represents just three-fifths of the time it took for patients treated using more traditional therapies. And each HBOT patient was able to return home immediately following treatment, while many of the conventionally-treated patients required further rehab at a facility.
In general, stroke victims are able to achieve 95% of their potential improvement within six months of suffering the initial stroke, with the remaining 5% occurring by the end of the first year. No stroke treatment, including HBOT, can restore dead brain tissues. But as we discussed in the previous section, hyperbaric oxygen therapy can often reactivate cells in the penumbra (the area between dead tissues and the non-impacted brain) in order to kick start brain function. As the 2013 Efrati study demonstrates conclusively, HBOT also boosts the formation of new neural pathways.
Post Stroke Treatment Center
At the National Hyperbaric Oxygen Therapy Center, we offer treatments to supplement HBOT. These include prescription meds to decrease limb spasms, Fotox injections to reduce spasticity, and other medications to lessen the chance for a further stroke, such as Plavix, Aggrenox, Ticlid, Cumadin and aspirin. We also offer Physical Therapy to supplement HBOT’s effects. Orthopedists prescribe physical therapy to restore muscular strength and joint motion following a bone break or fracture. Similarly, stroke patients require both HBOT and physical therapy to regain strength and mobility, as well as to stabilize weakened limbs.
Celebrating Each Small Improvement
During hyperbaric oxygen therapy at our Post Stroke Treatment Center, we frequently see patients progress from being confined to a wheelchair to walking with assistance. Some progress from walkers to canes – or even now walk completely unassisted. Other patients find their slurred speech improves so much that they’re able to resume gainful employment. We celebrate each victory as we watch patients’self-esteem, dignity and economic stability return. As part of a versatile treatment approach, hyperbaric oxygen therapy can restore purpose and function to stroke victims’ lives. And that’s very important, both for them and for us!
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