As research and development of curative treatments for Spinal Cord Injuries (SCI) are still in the process of maturing into practical, real-world applications, the treatment for reduction of secondary injuries that follow SCI’s are well documented and applicable. One of such treatments showing promising neuroprotective effects in several experimental studies is the use of Hyperbaric Oxygen Therapy (HBOT). The use of HBOT has been documented to show multiple neuroprotective mechanisms for the prevention of secondary injuries after SCI.
One of the most significant mechanisms involved in secondary injury after SCI is ischemia, which is described as an inadequate blood supply to an organ or part of the body. The Hyperbaric Oxygen Chamber can artificially create an environment that effectively saturates the lungs with 100%+ oxygen and can double and even triple the surrounding environmental pressure. This type of environment allows the lungs to gather significantly more oxygen molecules and circulate them into the bloodstream. For reference, the percentage of oxygen that we breathe in our regular environment varies between 19-22%, which HBOT effectively creates a 5-fold increase in oxygen saturation in the environment. While oxygen availability plays a pivotal role in cell survival following SCI there are also further mechanisms involved in secondary injury mechanics in which HBOT can positively impact. These include decreasing apoptosis, reducing oxidative stress, diminishing inflammation, promoting angiogenesis, reducing spinal cord edema, and increasing autophagy.
Cells that have survived the primary injury from SCI are susceptible to secondary damage particularly in the form of Apoptosis. This process is defined as the death of cells that occurs in a normal and controlled part of an organism’s growth or development, but in individuals who have suffered a SCI this process has been observed to persist for several weeks after SCI. A significant part and influential trait in the ischemic characteristics that present post SCI can be partially attributed to the lack of blood flow to the surrounding extremities. The lack of blood flow in turn reduces the quantity of oxygen and various other nutrients that are delivered to the muscle tissue. This impact creates a starved cell, which begins to weaken and shrink in size.
The end-all be-all way to promote blood flow to the lower extremities is to exercise and use the muscles in the lower body. This obviously poises to be a difficult task when one becomes paralyzed, which is where FES stimulated muscle contraction comes into play. This system that is utilized by healthcare professionals takes advantage of the muscles ability to retain peripheral stimulation which can be mediated by the FES stimulation system. By attaching the FES pads to the quads, gluteals, and hamstrings one can stimulate muscle contraction to assist an individual in accomplishing a sit to stand. This aids the individual greatly as they are in a standing position which promotes bone mineral density but also reduces the impact of muscle atrophy due to an absence of central nervous system stimulation.
Additional ways to promote the level of oxygen in the tissues in the lower extremities is by using a Hyperbaric Oxygen Chamber. As this increases the density of oxygen in the air, it saturates the red blood cells as they bathe in an oxygen rich environment. With the red blood cells fully saturated with oxygen they can travel through the blood vessels and spread the oxygen to ischemic tissues specifically in the lower body. The use of Hyperbaric Oxygen Therapy and exercise are a worthwhile combination for creating a hypertrophic environment, retaining muscle mass and bone mineral density, and promoting the greatest likelihood for nervous system regeneration.
Source: Patel, Nitesh P, and Jason H Huang. “Hyperbaric oxygen therapy of spinal cord injury.” Medical gas research vol. 7,2 133-143. 30 Jun. 2017, doi:10.4103/2045-9912.208520
Blog By Dane Stair, Adaptive Rehabilitative Exercise Specialist