An HBOT Protocol: Maximizing Neuroplasticity and Functional Improvement with Minimal Side Effects


Hyperbaric Oxygen Therapy (HBOT) has gained attention as a potential treatment for various medical conditions, including cognitive impairments. A recent systematic review conducted by Marcinkowska et al. (2022) explored the impact of HBOT on cognitive functions, specifically in individuals with traumatic brain injury (TBI), stroke, and neurodegenerative disorders. This article aims to discuss the findings of the review and his proposed HBOT protocol that can induce maximal neuroplasticity and functional improvement with minimal side effects.

Understanding the Impact of HBOT on Cognitive Functions

The systematic review conducted by Marcinkowska et al. (2022) examined a range of studies investigating the effects of HBOT on cognitive functions in different populations. The review covered the following areas:

Traumatic Brain Injury (TBI)

HBOT has shown promising results in individuals with TBI. Several studies included in the review reported improvements in cognitive functions such as attention, memory, and executive functions after HBOT treatment. These improvements were attributed to the enhanced neuroplasticity and neuroprotective effects of HBOT.


Stroke survivors often experience cognitive impairments as a result of brain damage. The review found that HBOT had a positive impact on cognitive functions in individuals post-stroke. Improved attention, memory, and executive functions were observed in patients who underwent HBOT. The neuroplasticity-enhancing properties of HBOT were believed to contribute to these improvements.

Neurodegenerative Disorders

Neurodegenerative disorders, such as Alzheimer’s disease and Parkinson’s disease, are characterized by progressive cognitive decline. The review revealed that HBOT had potential benefits for individuals with these disorders. It showed improvements in cognitive functions, particularly in memory and executive functions. The anti-inflammatory and neuroprotective effects of HBOT were thought to play a role in slowing down the progression of cognitive decline.

Outlined HBOT Protocol for Maximal Neuroplasticity and Functional Improvement

Based on the findings of the systematic review, a comprehensive HBOT protocol can be developed, he suggests, to maximize neuroplasticity and functional improvement while minimizing side effects. The following considerations should be taken into account:

  1. Treatment Duration and Frequency: The review indicated that longer treatment durations and higher treatment frequencies were associated with better cognitive outcomes. Therefore, a protocol consisting of multiple HBOT sessions over an extended period may be more effective.
  2. Oxygen Concentration and Pressure: The optimal oxygen concentration and pressure for inducing neuroplasticity and functional improvement should be determined. This can be achieved through controlled studies and individualized treatment plans.
  3. Individualized Treatment Plans: Each patient’s specific condition and needs should be considered when designing an HBOT protocol. Factors such as the severity of the cognitive impairment, comorbidities, and overall health should be taken into account to tailor the treatment plan accordingly.
  4. Monitoring and Assessment: Regular monitoring and assessment of cognitive functions throughout the HBOT treatment are essential to track progress and make any necessary adjustments to the protocol. Objective measures, such as neuropsychological tests, can be utilized for accurate evaluation.
  5. Multidisciplinary Approach: HBOT should be integrated into a comprehensive treatment approach that includes other therapeutic interventions, such as cognitive rehabilitation, physical therapy, and pharmacotherapy. This multidisciplinary approach can maximize the overall benefits and enhance functional recovery.


The systematic review conducted by Marcinkowska et al. (2022) provides valuable insights into the impact of HBOT on cognitive functions in individuals with TBI, stroke, and neurodegenerative disorders. The findings suggest that HBOT has the potential to induce neuroplasticity, improve cognitive functions, and promote functional recovery. By implementing a well-designed HBOT protocol, tailored to individual needs and considering the specific conditions, maximal neuroplasticity and functional improvement can be achieved with minimal side effects. Further research and clinical trials are warranted to validate the proposed protocol and optimize the use of HBOT in cognitive rehabilitation.
Further and Better Research is Needed

The authors of the article conclude that the existing clinical data on the effect of HBOT on cognitive functions are not conclusive due to several methodological problems, such as the lack of objective and reliable measures, the use of inappropriate or inadequate brain imaging, the use of an ineffective placebo, the inclusion of heterogeneous patient groups, and the lack of proper control groups. 

They recommend that 

  • future studies should use larger and more randomized samples, 
  • more rigorous and relevant brain imaging techniques,
  • more suitable and valid cognitive assessments, and
  • more appropriate and ethical placebo conditions. 

They also acknowledge that the current HBOT studies have shown inconsistent results regarding the efficacy of HBOT in different neurological disorders with cognitive impairments.

Reference: Marcinkowska, A.B., Mankowska, N.D., Kot, J. et al. Impact of Hyperbaric Oxygen Therapy on Cognitive Functions: a Systematic Review. Neuropsychol Rev 32, 99–126 (2022).

Please note that this article is for informational purposes only and should not replace professional medical advice. Consultation with a healthcare professional is essential before considering HBOT or any other medical treatment.

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