Laser Light Therapy What is Laser Therapy Light

Laser & Light 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 • Albert Einstein – 1 st 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 1 st low level laser was developed. • In Feb. 2002, the Micro. Light 830 (ML 830) 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 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 antiinflammatory & immunosuppressive 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 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 • 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 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.

Mitochondria

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 • 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 m. W) • 3 = medium-power lasers - needs eye protection • 3 a – up to 5 m. W • 3 b** – 5 mw-500 m. W • 4 = high-power lasers– presents fire hazard (exceeds 500 m. W)

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 • 4 categories of lasers – Crystal & Glass (solid - rod) • Synthetic ruby & others (synthetic ensures purity) – Gas (chamber) – 1961 • He. Ne, argon, CO 2, & others (He. Ne under investigation) – Semiconductor (diode - channel) - 1962 • Gallium Arsenide (Ga. As under investigation) – Liquid (Dye) - Organic dyes as lasing medium – Chemical – extremely high powered, frequently used for military purposes

High vs. Low Level Lasers • High • Low – – – – – Surgical Lasers Hard Lasers Thermal Energy – 3000 -10000 m. W Medical Lasers Soft Lasers Subthermal Energy – 1 -500 m. W Therapeutic (Cold) lasers produce maximum output of 90 m. W or less – 600 -1000 nm light

Infrared Light Therapy • SLD – Super Luminous Diode – Brighter • LED – Light Emitting Diode

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 - 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 m. W) – Important in categorizing laser for safety – Not adjustable • Power Density (intensity) – W or m. W/cm 2 – 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 – Energy Density • Dosage (D) • Amount of energy applied per unit area • Measured in Joules/square cm (J/cm 2) – Joule – unit of energy – 1 Joule = 1 W/sec • Dosage is dependent on: – Output of laser in m. W – Time of exposure in seconds – Beam surface area of laser in cm 2 • Various dosage ranges per site (1 -9 J/cm 2)

Parameters – Energy Density • Recommended Dosage Range – Therapeutic response = 0. 001 -10 J/cm 2 – Minimal window threshold to elicit response – Too much – suppressive effect – Open wounds – 0. 5 -1. 0 J/cm 2 – Intact skin – 2. 0 -4. 0 J/cm 2 – Average treatment – 6 /cm 2

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 m. W 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 • • • In. Ga. Aip Replacing He. Ne lasers Semiconductor Wavelength: 630 -700 nm Power output: same as He. Ne Energy depth: superficial wound care

Gallium Arsenide • Semiconductor - produces an infrared (invisible) laser • Wavelength: 904– 910 nm • Power output: may produce up to 100 m. W • Energy depth: 30 -50 mm • Short pulse-train (burst) duration (100 -200 ns)

Gallium Aluminum Arsenide • • • Ga. AIAs Semiconductor Wavelength: 780 -890 nm Power Output: 30 -100 m. W (up to 1000 m. W) Energy Depth:

What Does it Look Like? • http: //www. laserhealthsystems. com/omegao fferings. htm • http: //www. thorlaser. com/products/

Indications • Indications – – – Soft tissue injuries Fractures Osteoarthritis, Rheumatoid Arthritis Pain Wounds & Ulcers Acupuncture

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 • 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 • 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 Techniques • 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

• Dynatron’s Solaris D 880 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 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

Med. X Laser & Light Therapy • Laser probe • SLD (2)

Miscellaneous • www. geocities. com/altmedd/laser. htm • http: //laserhealing. net/lowlevel. html • Journal of Laser Therapy – www. walt. nu/journal. htm