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Using Acute Intermittent Hypoxia as a Therapeutic Intervention for Individuals With Spinal Cord Injury

Posted By Sofia Anastasopoulos and Milap Sandhu

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Midwest Regional Spinal Cord Injury Care System Lab News

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A new and relatively simple approach to improve function in people with some types of tetraplegia is being evaluated at the Shirley Ryan AbilityLab. During this therapy, a person breathes air with of low oxygen through a face mask, similar to being on the top of a high mountain – for about a minute, alternating with normal air. As a result of this treatment, proteins are released within the spinal cord that strengthen the connections between the brain and spinal cord. This treatment temporarily strengthens neural connections, and when combined with rehabilitation, may enhance function.

Known as acute intermittent hypoxia, this approach may increase strength in ankle muscles within a few minutes. Coupling daily intermittent hypoxia with walking training for one week enhanced walking recovery in a recent study, compared to walking training alone. Importantly, no one has been harmed during this study.

In the long term, this treatment could help people with SCI get back into their everyday life...

Dr. Milap Sandhu, PT, PhD

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Although studies have looked at walking, we know little about acute intermittent hypoxia effects on arm and hand function. Dr. Sandhu’s team seeks to learn if – and how – this treatment, either alone or in combination with training, might improve strength and function in the arm and hand. He is conducting a clinical trial which focuses on daily intermittent hypoxia along with various forms of training.

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If Dr. Sandhu’s team is able to demonstrate the effectiveness and safety of intermittent hypoxia combined with intense upper limb training, the next step will be to learn how to use this procedure in clinical settings. The information from his studies will help us understand the effectiveness of intermittent hypoxia and which patients could benefit. We spoke with Dr. Milap Sandhu, the Principal Investigator for this study, and got his take on how he believes this study can benefit people with SCI.

Experiences with Intermittent Hypoxia: A Q&A Session

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Q: Tell me about your experience with Intermittent Hypoxia thus far.

A: Intermittent hypoxia is a unique therapy that is being investigated for improving recovery after spinal cord injury. During this therapy, patients breathe low oxygen air from a face mask for about 60 seconds. This level of low oxygen is similar to being on a tall mountain. 

Low oxygen air helps patients form new proteins that can strengthen the connections between the brain and spinal cord. This process is called “plasticity,” and plays a big part in the success of most rehabilitation therapy. I take great joy in helping to support rehabilitative training with intermittent hypoxia.

Q: How could intermittent hypoxia be used in the future?

A: Intermittent hypoxia therapy is at an early stage of development, but compared with other restorative therapies it is relatively inexpensive and induces rapid spinal cord strengthening. While intermittent hypoxia could eventually be a stand-alone therapy, we believe its ultimate use will involve pairing with rehabilitative training.

This therapy seems to open up a temporary window when individuals are able to generate more strength. Intermittent hypoxia before rehabilitation could improve the benefits of training.

Q: How do you believe that people with SCI can benefit from intermittent hypoxia?

A: In the short term, we will be able to determine the effectiveness of this therapy in a diverse group of patients with SCI. We will gain critical insights into dosage, timing, and other aspects of hypoxia therapy. If we are successful in using hypoxia therapy to boost the benefits of rehabilitation, the next issue will be how to best use this approach in clinical settings.

I hope that this strategy may be used outside of a medical rehabilitation facility, such as in a physical therapy clinic. In the long term, this treatment could help people with SCI get back into their everyday life, as well as improve their sense of autonomy, confidence, and self-esteem.



While intermittent hypoxia is still in development, the use of this therapy with conventional rehabilitation therapy may improve the independence of people with SCI. With Dr Sandhu’s insight and the contributions of people who participate in this study, we hope to create a way to improve therapy that will increase function and overall quality of life.

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