Aquanautics for Spinal Cord Injury: Undersea and Hyperbaric Research Project

SCI Aquanauts Unite. Veteran SCI divers exploring buoyancy control in the pool at Emerald Coast SCUBAin Destin, FL. Photo ©2024 by Romona Robbins

At the cutting edge of rehabilitation and human exploration, our Spinal Cord Injury Undersea and Hyperbaric Research Project (SCIUHRP) aims to bring the world of aquanautics to US Veterans and other individuals with chronic spinal cord injuries (SCI). By pushing the boundaries of undersea (SCUBA) and hyperbaric approaches to healing, this project offers innovative pathways to recovery, improving the health, quality of life, and independence of those with chronic SCI.

Our Mission: Turning Divers into AquanautsAt the heart of this project is a powerful mission funded by the Combat Wounded Veteran Challenge: to allow veterans and individuals with SCI experience life as aquanauts “explorers of the underwater world” while simultaneously benefiting from cutting-edge rehabilitation approaches. Through innovative undersea and hyperbaric techniques, we aim to unlock new healing possibilities for those with chronic SCI.

SCUBA diving offers more than adventure; it offers therapeutic benefits. We are exploring whether the unique conditions of underwater pressure combined with enhanced oxygen environments similar to hyperbaric oxygen therapy can reduce inflammation and support recovery in SCI patients. This initiative blends science, exploration, and hope, offering an opportunity for a better quality of life to those who have been deeply impacted by spinal cord injury.

The Challenge: Diving into the Unknown

The success of this project was made possible by collaboration with several partners who helped push the limits of undersea exploration for our spinal cord-injured, wounded veterans.We worked closely with Craig Hartzel lof Azimuth, Incorporated, leveraging their Diver6 system for tracking the GPS positions and dive performance of each diver in real time. Additionally, we recorded physiological data and dive logs using Garmin Mk2i and Mk3i watches, capturing vital metrics to monitor the safety and well-being of our divers. We were fortunate to work alongside the dedicated team at Emerald Coast Scuba in Destin, Florida, where our participants trained in their pool before heading out to sea. Our open water dives were supported Emerald Coast staff and dive pros aboard the Aquanaut, a historic boat featured in the movie Jaws 2. We had Dr. James Wright, a physician with extensive experience in hyperbaric medicine meet with us to

discuss scientific, medical, and technical aspects of HBOT for TBI, PTSD, and SCI. Bert McCasland served as our DSO and we were further supported by experienced physician dive instructors and wilderness medicine experts Drs. Brian Pinkston and Cheryl Lowry. We had further support from experienced DM's Michael Jackson and Hamilton Kinard. Logistics were supported by the CWVC VP of Research, Mr. Reid Carlock. 

Image Caption Veteran SCI diver Brian Schiefer cruising on hisDPV through a bait ball being eaten by large amberjacks at theOld Destin Bridge Span dive site near Destin, FL. Photo ©2024 by Romona Robbins.

This groundbreaking initiative was proudly sponsored by the Combat Wounded Veteran Challenge, an organization committed to empowering wounded veterans through adventurous rehabilitation and research projects. All divers involved were disabled veterans with chronic spinal cord injuries, and their courage and determination fueled the success of this first phase of the project. Bringing their special operations backgrounds and attitudes, they worked as true pioneers to establish a framework and approaches to SCI rehabilitation that will end up benefiting many. Mr. Brian Schiefer provided the original inspiration for the project and together we began laying the foundation for the SCI Research arm of CWVC several years ago working from Key West, FL. The entire team's collective expertise and dedication made it possible to turn this long-standing dream into a reality.

Image CaptionVeteran SCI diver Derek Herrera floating about 3 ATA below the surface on EAN/Nitrox (30% O2). Photo ©2024 by Romona Robbins.

Physiological Insights: Healing Beneath the Surface

Throughout our dives, we monitored several key physiological markers, including heart rate (HR), gas consumption, heart rate variability (HRV), and oxygen partial pressure (PO2). These markers provide insights into how the body responds to diving, especially under increased pressure and enriched oxygen environments.

Image CaptionVeteran SCI divers George Vera and Derek Herrera breathing from a spare Nitrox bottle on an anchor line supported by Drs. Brian Pinkston and Jamie Tyler to increase bottom time and 30% O2 consumption at 3 ATA. Photo ©2024 by Romona Robbins.

The data revealed compelling trends. As depth and pressure increased, we observed a decrease in heart rate, likely driven by the mammalian diving reflex, a natural physiological response to conserve oxygen during diving. Additionally, PO2 levels increased with depth, as expected, due to the enriched oxygen and increasing ambient pressure. This aligns with our hypothesis that enriched oxygen may play a role in improving physiological recovery during dives.

Image CaptionThe plot shows heart rate data captured using Garmin Mk's across 22 dives by 3 SCI veterans. The data illustrate how HR changes as a function of depth (in feet), absolute pressure (ATA), and partial oxygen pressure (PO2) using Nitrox (30% O2).

BRAIN Buds: Supporting Relaxation and Recovery

In addition to SCUBA, the group was introduced to BRAIN Buds, an auricular vagus nerve stimulation device. This innovative technology helps induce relaxation and aids in stress management. BRAIN Buds produce physiological effects similar to the mammalian diving reflex, a response seen during SCUBA diving that helps to reduce stress and lower heart rate. By stimulating the vagus nerve, BRAIN Buds help induce a state of calm and relaxation, making them a natural complement to SCUBA diving. Using BRAIN Buds during rest and recovery periods could further enhance stress management, allowing divers to maximize the therapeutic benefits of their underwater experiences. This synergy between SCUBA and auricular vagus nerve stimulation is an exciting new approach for enhancingre habilitation and recovery in SCI patients.

Training Outcomes: Certifications and Success

A key objective of the project was to certify our participants in. specialized diving techniques. Through their hard work and dedication our divers achieved NAUI Worldwide Enriched Air Nitrox (EAN) certification and PADI Full Face Mask diving certification. These certifications provide not only a sense of personal accomplishment but also essential safety benefits for future dives. The full face mask certification, in particular, enhances underwater communication, a critical element of safety for spinal cord-injured divers.

Image Caption Veteran SCI divers Brent South and Brian Schiefer with Jamie Tyler and Hamilton Kinard working on skills training during full face masks dive in Destin, FL.

Next Steps: Advancing Research and Pushing Boundaries

The next phase of our research is set to break new ground. We will focus on using full face masks on spinal cord-injured divers breathing air with different O2 concentrations across depths while keeping the partial pressure of oxygen (PO2) below 1.4 ATA as we aim to minimize the risks of oxygen toxicity and seizure susceptibility while continuing to explore the therapeutic benefits of enriched oxygen in a controlled undersea environment. Additionally, we plan to track cytokine levels in the blood during these therapy sessions, which will allow us to directly measure changes in inflammation and healing markers. This will further solidify our understanding of the therapeutic potential of SCUBA diving for SCI rehabilitation.

Conclusion: Aquanautics as a Path to Recovery 

The Spinal Cord Injury Undersea and Hyperbaric Research Project is more than a SCUBA challenge, it’s a mission to push the boundaries of rehabilitation and recovery. By turning individuals with spinal cord injuries into aquanauts, we are opening new frontiers in both exploration and healing.

Image Caption Veteran SCI diver Redzuan Razak enjoying his time at depth on 30% O2. Photo ©2024 by Romona Robbins

The physiological data we gathered such as the decrease in heart rate with increasing depth and the enhanced oxygen exposure supports the idea that SCUBA diving could offer benefits similar to hyperbaric oxygen therapy. As we continue to explore the potential of undersea environments for rehabilitation, we remain committed to pushing the boundaries of what’s possible for SCI recovery. Aquanautics for SCI represents the intersection of adventure, healing, and innovation. We are excited to continue this work, advancing undersea and hyperbaric therapies to improve the lives and rehabilitation outcomes of individuals with chronic spinal cord injuries.

Please reach out to me if you would like to learn more about what we are doing or how you can help.