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Laser & Light Therapy. What is Laser Therapy?. L ight A mplification by the S timulated E mission of R adiation Compressed light of a wavelength from the cold, red part of the spectrum of electromagnetic radiation Monochromatic - single wavelength, single color

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what is laser therapy
What is Laser Therapy?
  • Light Amplification by the Stimulated Emission of Radiation
  • Compressed light of a wavelength from the cold, red part of the spectrum of electromagnetic radiation
      • Monochromatic - single wavelength, single color
      • Coherent - travels in straight line
      • Polarized - concentrates its beam in a defined location/spot
history
History
  • Albert Einstein – 1st described this theory that was transformed in to laser therapy
  • By the end of the 60’s, Endre Mester (Hungary) -
    • was reporting on wound healing through laser therapy
  • In early 1960’s, the 1st low level laser was developed.
  • In Feb. 2002, the MicroLight 830 (ML830) received FDA approval for Carpal Tunnel Syndrome Treatment (research treatment)
  • Laser therapy – has been studied in Europe for past 25-30 years; US 15-20 years
what s in a name
Therapeutic Laser

Low Level Laser Therapy

Low Power Laser Therapy

Low Level Laser

Low Power Laser

Low-energy Laser

Soft Laser

Low-reactive-level Laser

Low-intensity-level Laser

Photobiostimulation Laser

Photobiomodulation Laser

Mid-Laser

Medical Laser

Biostimulating Laser

Bioregulating Laser

What’s in a Name?
what does it do
What Does It Do?
  • Laser light waves penetrate the skin with no heating effect, no damage to skin & no side effects.
  • **Laser light directs biostimulative light energy to the body’s cells which convert into chemical energy to promote natural healing & pain relief.
  • Optimizes the immune responses of blood & has anti-inflammatory & immunosuppressive effects.
physiological effects
Physiological Effects
  • Biostimulation – improved metabolism, increase of cell metabolism
    • Increases speed, quality & tensile strength of tissue repair
  • Improved blood circulation & vasodilation
    • Increases blood supply
  • Increases ATP production
  • Analgesic effect
    • Relieves acute/chronic pain
  • Anti-inflammatory & anti-edematous effects
    • Reduces inflammation
physiological effects1
Physiological Effects
  • Stimulation of wound healing
    • Promotes faster wound healing/clot formation
    • Helps generate new & healthy cells & tissue
  • Increase collagen production
    • Develops collagen & muscle tissue
  • Increase macrophage activity
    • Stimulates immune system
  • Alter nerve conduction velocity
    • Stimulates nerve function
tissue cellular response
Tissue & Cellular Response
  • Red light affects all cell types
    • Absorbed by the mitochondrial present in all cells
    • Cytochromes (respiratory chain enzymes) within the mitochondria have been identified as the primary biostimulation chromophores (primary light-absorbing molecules).
    • Since enzymes are catalysts with the capability of processing thousands of substrate molecules, they provide amplification of initiation of a biological response with light.
  • Infrared light is more selective absorbed by specific proteins in the cell membrane & affects permeability directly
tissue cellular response1
Tissue & Cellular Response
  • Cytochromes function to couple the release of energy from cellular metabolites to the formation of high energy phosphate bonds in adenosine triphosphate (ATP)
    • ATP is used to drive cell metabolism (maintain membrane potentials, synthesize proteins & power cell motility & replication).
  • Assuming cytochromes also can absorb energy directly from illumination, it is possible that during LLLT light energy can be transferred to cell metabolism via the synthesis of ATP.
tissue cellular response2
Tissue & Cellular Response
  • Magnitude of tissue’s reaction are based on physical characteristics of:
    • Output wavelength/frequency
    • Density of power
    • Duration of treatment
    • Vascularity of target tissues
  • Direct effect - occurs from absorption of photons
  • Indirect effect – produced by chemical events caused by interaction of photons emitted from laser & the tissues
laser regulation
LASER Regulation
  • LASERs - classified by the FDA’s Center for Devices & Radiological Health based on the Accessible Emission Limit (AEL).
  • Class Levels 1-4
      • 1 = incapable of producing damaging radiation levels (laser printers & CD players)
      • 2 = low-power visible lasers (400-700 nm wavelength, 1 mW)
      • 3 = medium-power lasers - needs eye protection
          • 3a – up to 5 mW
          • 3b** – 5 mw-500 mW
      • 4 = high-power lasers– presents fire hazard (exceeds 500 mW)
laser generators
Laser Generators
  • Components of a generator:
      • Power supply – electrical power supply that can deliver up to 10,000 volts & 100’s amps
      • Lasing medium – gas, solid, liquid
      • Pumping device –
        • high voltage, photoflash lamps, radio-frequency oscillators or other lasers (pumping is used to describe the process of elevating an orbiting electron to a higher, excited energy level)
      • Optical resonant cavity – contains lasing medium
types of lasers
Types of Lasers
  • 4 categories of lasers
    • Crystal & Glass (solid - rod)
      • Synthetic ruby & others (synthetic ensures purity)
    • Gas (chamber) – 1961
      • HeNe, argon, CO2, & others (HeNe under investigation)
    • Semiconductor (diode - channel)- 1962
      • Gallium Arsenide (GaAs under investigation)
    • Liquid (Dye) - Organic dyes as lasing medium
    • Chemical – extremely high powered, frequently used for military purposes
high vs low level lasers
High

Surgical Lasers

Hard Lasers

Thermal

Energy – 3000-10000 mW

Low

Medical Lasers

Soft Lasers

Subthermal

Energy – 1-500 mW

Therapeutic (Cold) lasers produce maximum output of 90 mW or less

600-1000 nm light

High vs. Low Level Lasers
infrared light therapy
Infrared Light Therapy
  • SLD – Super Luminous Diode
    • Brighter
  • LED – Light Emitting Diode
laser light properties
Laser Light Properties
  • Monochromaticity
      • 1 color – 1 wavelength
      • <400 nm
      • Ultraviolet spectrum
  • Coherence
      • Waves same length & traveling in same phase relationship
      • 400-700 nm
      • Visible
  • Collimation
      • Degree to which beam remains parallel with distance
      • 700-10,000 nm
      • Infrared
parameters
Patient

Need medical history & proper diagnosis

Diabetes – may alter clinical efficacy

Medications

Photosensitivity (antibiotics)

Pigmentation

Dark skin absorbs light energy better

Laser

Wavelength

Output power

Average power

Intensity

Dosage

Parameters
parameters wavelength
Parameters - Wavelength
  • Nanometers (nm)
  • Longer wavelength (lower frequency) = greater penetration
  • Not fully determined
  • Wavelength is affected by power
parameters power
Output Power

Watts or milliwatts (W or mW)

Important in categorizing laser for safety

Not adjustable

Power Density (intensity)

W or mW/cm2

Takes into consideration – actual beam diameter If light spread over lager area – lower power density

Beam diameter determines power density

Average Power

Continuous or pulse-train (burst) frequency mode

Knowing average power is important in determining dosage with pulsed laser

If laser is continuous – avg. power = peak output power

If laser is pulsed (burst) then avg. power is = to peak output power X duty cycle

Parameters – Power
parameters energy density
Dosage (D)

Amount of energy applied per unit area

Measured in Joules/square cm (J/cm2)

Joule – unit of energy

1 Joule = 1 W/sec

Dosage is dependent on:

Output of laser in mW

Time of exposure in seconds

Beam surface area of laser in cm2

Various dosage ranges per site (1-9 J/cm2)

Parameters – Energy Density
parameters energy density1
Parameters – Energy Density
  • Recommended Dosage Range
    • Therapeutic response = 0.001-10 J/cm2
    • Minimal window threshold to elicit response
    • Too much – suppressive effect
    • Open wounds – 0.5-1.0 J/cm2
    • Intact skin – 2.0-4.0 J/cm2
    • Average treatment – 6 /cm2
helium neon lasers
Helium Neon Lasers
  • Uses a gas mixture in a pressurized tube
      • Now available in semiconductor laser
  • Emits red light
  • Wavelength: 632.8 nm
  • Power output: 1.0-25.0 mW
  • Energy depth: 6-10 mm
  • The higher the output lasers (even though they are still low power) allow reduced delivery time
indium gallium aluminum phosphide
Indium-Gallium-Aluminum-Phosphide
  • InGaAip
  • Replacing HeNe lasers
  • Semiconductor
  • Wavelength: 630-700 nm
  • Power output: same as HeNe
  • Energy depth: superficial wound care
gallium arsenide
Gallium Arsenide
  • Semiconductor - produces an infrared (invisible) laser
  • Wavelength: 904–910 nm
  • Power output: may produce up to 100 mW
  • Energy depth: 30-50 mm
  • Short pulse-train (burst) duration (100-200 ns)
gallium aluminum arsenide
Gallium Aluminum Arsenide
  • GaAIAs
  • Semiconductor
  • Wavelength: 780-890 nm
  • Power Output: 30-100 mW (up to 1000 mW)
  • Energy Depth:
what does it look like
What Does it Look Like?
  • http://www.laserhealthsystems.com/omegaofferings.htm
  • http://www.thorlaser.com/products/
indications
Indications

Soft tissue injuries

Fractures

Osteoarthritis, Rheumatoid Arthritis

Pain

Wounds & Ulcers

Acupuncture

Indications
contraindications
Contraindications
  • Contraindications
    • Application over eyes
    • Possibly can damage cellular structure or DNA
    • Cancerous growths
    • Pregnancy – over & around uterus
    • Over cardiac region & Vagus nerve
    • Growth plates in children
    • Over & around thyroid gland & endocrine glands
    • Patients who have been pre-treated with one or more photosensitizers
treatment precautions
Treatment Precautions
  • Better to underexpose than to overexpose
  • Avoid direct exposure into eyes (If lasing for extended periods of time, safety glasses are recommended)
  • May experience a syncope episode during treatment during chronic pain, but very rare
  • If icing – use BEFORE phototherapy
    • Enhances light penetration
  • If using heat therapy – use AFTER phototherapy
    • Decreases light penetration
treatment techniques
Treatment Techniques
  • Gridding Technique
      • Divide treatment areas into grids of square centimeters
  • Scanning Technique
      • No contact between laser tip in skin; tip is held 5-10 mm from wound
  • Wanding Technique
      • A grid area is bathed with the laser in an oscillating fashion; distance should be no farther than 1 cm from skin
  • Point Application (Acupuncture point)
treatment techniques1
Simple

For general application, only treatment time & pulse rate vary

Dosage

Most important variable in laser therapy & may be difficult to determine because of the above conditions

Handheld applicator

Tip should be in light contact with skin while laser is engaged for calculated time

Maintain laser perpendicular to treatment surface

Firm contact unless open wound

Clean area prior to treatment

Begin with minimal treatment and gradually increase

Check for pre/post-treatment changes

Ask the patient how they are doing prior to next treatment

May have to adjust dosage

Treatment Techniques
slide36
Dynatron’s Solaris D880 Infrared Therapy
    • 880 nm wavelength – SLD (32 ) (deep)
    • 660 nm – LED (4) (superficial)
    • 10 minute max. treatment or 60 Joules
    • Place probe on treatment area. Maintain constant contact with the skin.
      • Do not bathe the area with the probe.
    • FDA cleared to “provide topical heating for temporary increase in blood circulation, temporary relief of minor muscle & joint aches, pain & stiffness & relaxation of muscles; for muscle spasms & minor pain & stiffness associated with arthritis.”
      • Dynatron Solaris 709
medx laser light therapy
MedX Laser & Light Therapy
  • Laser probe
  • SLD (2)
miscellaneous
Miscellaneous
  • www.geocities.com/altmedd/laser.htm
  • http://laserhealing.net/lowlevel.html
  • Journal of Laser Therapy
    • www.walt.nu/journal.htm