Stroke recovery is often viewed through the lens of physical rehabilitation, but for many survivors, the hidden challenge is cognitive impairment.

Difficulties with memory, attention, concentration, planning and problem-solving can significantly impact independence, return to work, and overall quality of life.

A newly published 2026 randomised controlled trial from China provides encouraging evidence that combining Hyperbaric Oxygen Therapy (HBOT) with Computerised Cognitive Training (CCT) produces greater improvements in cognition and day-to-day function than either therapy alone.

Understanding Post-Stroke Cognitive Impairement

Up to half of stroke survivors experience some degree of cognitive impairment following their stroke.  

While physical rehabilitation often receives the greatest attention, cognitive recovery is equally important for regaining independence.

Traditional rehabilitation can help, but researchers continue to investigate ways to improve the brain's ability to heal and reorganise itself after injury.

About the Study

Researchers from Shandong University and collaborating hospitals enrolled 116 patients with post-stroke cognitive impairment, including both ischaemic and haemorrhagic stroke survivors.

Participants were randomly assigned to one of the four groups:

• Standard medical care alone

• Hyperbaric Oxygen Therapy plus standard care

• Computerised Cognitive Training plus standard care

• Hyperbaric Oxygen Therapy combined with Computerised Cognitive Training plus standard care

Each participant completed 20 treatment sessions over four weeks at 1.8 ata for 100 mins.  Researchers measured cognitive performance using the Mini-Mental State Examination (MMSE), independence in daily living using the Barthel Index, and changes in brain connectivity using near-infrared spectroscopy (fNIRS).

What Did They Find?

The group receiving both HBOT and cognitive training consistently achieved the greatest improvements.

Compared with the other three groups, participants receiving the combined treatment demonstrated significantly greater improvements in:

• Overall cognitive performance

• Orientation

• Attention and concentration

• Memory and recall

• Visuospatial abilities

• Functional independence in everyday activities such as dressing, bathing, and mobility

These changes were not simply statistical - they represent changes that can make a meaningful difference to daily life.

What Happened in the Brain?

One of the most interesting aspects of this study was the use of functional brain imaging.

Researchers found increased communication between regions of the prefrontal cortex involved in executive function and higher-level thinking.  Importantly, the degree of improvement in this brain connectivity correlated with improvements in cognitive test scores.

This suggests that clinical improvements were accompanied by measurable changes in brain network function, providing insight into how recovery may be occurring.

Why Might HBOT Enhance Cognitive Training?

Hyperbaric Oxygen Therapy increases the amount of oxygen dissolved within the blood plasma, allowing oxygen to reach injured brain tissue more effectively.

Research over the past two decades suggests HBOT helps create an environment that supports:

• Neuroplasticity

• Angiogenesis (formation of new blood vessels)

• Reduced inflammation

• Improved mitochondrial energy production

• Enhanced tissue repair

Computerised cognitive training, meanwhile, repeatedly challenges specific brain networks responsible for memory, attention and executive function.

Together, these therapies may work synergistically - HBOT helping optimise the brain's biological capacity for repair, while cognitive training provides the stimulus that encourages those repaired networks to strengthen and reorganise.

This proposed mechanism aligns with the findings of the study, although further research is needed to fully understand how the two therapies interact.

What Does This Mean for Stroke Recovery?

The findings in this study add to a growing body of evidence supporting the use of HBOT as an important treatment in neurological rehabilitation.

Rather than viewing rehabilitation as either physical or cognitive, this research highlights the value of addressing both the biological recovery of the brain and the active retraining of cognitive function.

Recovery after stroke is often measured in months and years - not weeks - and interventions that support the brain's ability to continue adapting may offer valuable opportunities for improving long-term outcomes.

The Takeaway

This 2026 randomised controlled trial demonstrated that combining Hyperbaric Oxygen Therapy with computerised cognitive training resulted in greater improvements in cognitive function and independence than either therapy alone.

As research into HBOT continues to evolve, studies such as this help build our understanding of how oxygen therapy compliments and significantly improves established rehabilitation programmes to support brain recovery after stroke.

At Hyperbaric Health, Auckland New Zealand, we continue to follow emerging evidence closely as the scientific understanding of HBOT expands.  While HBOT is not a cure for stroke, it is showing meaningful results is it's ability to support the brain's natural capacity for repair and recovery.

Reference - Liu J, Han T, Yan C, et al Hyperbaric oxygen therapy combined with computerised cognitive training improves global cognition and functional independence post-stroke: a randomised controlled trial. Journal of NeuroEngineering and Rehabilitation.  2026; 23:192

- Samantha Winters