HBOT Effects on First Responders' Cognition and Well-Being

This prospective, single-arm study will examine changes in cognitive functioning and post-concussive symptoms following hyperbaric oxygen therapy (HBOT) in approximately 54 current or former first responders with a history of traumatic brain injury (TBI). Secondary outcomes include symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety, as well as quality of life. After providing informed consent, participants will undergo medical and behavioral health screening to determine eligibility for HBOT. Eligible participants will complete baseline cognitive testing and questionnaires measuring post-concussive symptoms, psychological symptoms, and quality of life. These assessments will be repeated after treatment. Participants will receive 40 HBOT sessions in a multiplace chamber at 2.0 atmospheres absolute (ATA). Each session will include two 30-minute periods of breathing 100% oxygen separated by a 5-minute air break. Sessions will take place twice daily, Monday through Friday, with at least four hours between sessions. A physician will prescribe and oversee treatment, and trained hyperbaric personnel will operate the chamber and monitor participants. Changes between baseline and post-treatment assessments will be analyzed within participants. The study will also explore whether demographic or clinical characteristics are associated with the magnitude of change. All participants will receive HBOT; there is no randomized or untreated comparison group. As a result, the study can describe changes observed following treatment but cannot establish that HBOT caused those changes.