APPLICATION OF

LOW LEVEL LASER THERAPY IN REHABILITATION MEDICINE

Nury Nusdwinuringtyas

Definition PM &R

Its primary goal is the patient attaining the fullest physical, psychological, social, vocational,avocational, and educational potential consistent with physiologic or anatomic impairment and environmental limitations

Rehabilitation

Has been defined as the development of the individual to the fullest physical,

psychological, social, vocational,avocational and educational potential consistent with his or her physiologic or anatomic impairment and environmental limitation

International Classification of Functioning, Disability and Health (ICF)

Activity ParticipationBody function and body structure

Environment factor Personal factor

Health condition disorder or disease

Treatment technique and special equipment

Therapeutic exercise Physical agent modality- heat - cold - cold laser - manipulation, traction, and massage Protheses Orthoses Wheelchair Drugs

modality

• Is a physical agent that uses physical forces to accomplish a therapeutic goal.

• Any physical phenomenon: pressure, heat, cold, electricity, sound, light.

• Are seldom used in isolation. Are almost always adjunct to a comprehensive therapy program that may also involve: exercise, streching, education

Physical agents: devices and application in: Physical medicine and Rehabilitation secrets

How do physical agents heat or cool tissue

1. Conduction is defined as the transfer of heat between two bodies n contact at different temperatures. Examples include hot packs and paraffin baths

2. Convection also involves contact between two objects at different temperatures but also requires that one flow past the other. This flow maximizes the temperature gradient between the objects e,g a whirpool bath, so more intense heating and cooling are possible that by conduction alone

3. Conversion utilies the conversion of another form of energy to heat. Heat lamps, radio waves, and ultrasound (US), for example, rely on the conversion of infrared light and sound to treat.

Physical agents: devices and application in: Physical medicine and Rehabilitation secrets

What forms of heat and cold therapy are available

heat• Superficial and deep• Superficial agents e.g heat

lamp, heat the skin and subcutaneus tissues

• Deep heating agents e.g US, short waves , also known as diathermies, heat more deeply and can rise temperatures for therapeutic levels at depths of 3.5 – 7 cm.

cold• Is produced by relative

absence of thermal energy• Because of lack of energy ,

only superficial agents such as ice can be used

• Conversive cooling is therefore not possible, and cooling therapies must rely on conduction and convection

Physical agents: devices and application in: Physical medicine and Rehabilitation secrets

General goals of heat therapy and cryotherapy

Heat therapy1. Analgesia2. Muscle “spasm” relaxation3. Hyperemia4. Increased collagen

extensibility5. Acceleration of metabolic

process

Cryotherapy

1. Analgesia2. Muscle “spasm”3. Inflammation4. Spasticity5. Slowing of metabolic

activity

Physical agents: devices and application in: Physical medicine and Rehabilitation secrets

The History of Laser Therapy

• The word "laser" is an acronym for Light Amplification by the Stimulated Emission of Radiation. The theory was first described by Albert Einstein (1879-1955) who paved the way for the development of the therapeutic laser.

The History of Laser Therapy

• The first low-level therapeutic laser was developed in 1962. By the end of the 1960's, Endre Mester in Hungary was reporting an improved healing of wounds through low-level laser radiation. Since then, scientists and doctors around the world have been using laser light to treat conditions that can affect all age groups.

High Power vs. Low Power Medical Lasers

• There are two types of medical laser: high power and low power. High power lasers are used to cut through tissue. Low-level lasers, on the other hand, are used to stimulate tissue repair through a process of bio-stimulation.

How Does Low Level Laser Therapy Work?

• Low-level lasers supply energy to the body in the form of non-thermal photons of light. Light is transmitted through the skin's layers (the dermis, epidermis and the subcutaneous tissue or tissue fat under the skin) at all wavelengths in the visible range. However, light waves in the near infrared ranges penetrate the deepest of all light waves in the visible spectrum.

How Does Low Level Laser Therapy Work?

• When low level laser light waves penetrate deeply into the skin, they optimize the immune responses of our blood. This has both anti-inflammatory and immunosuppressive effects. It is a scientific fact that light transmitted to the blood in this way has positive effective throughout the whole body, supplying vital oxygen and energy to every cell.

LASERS WAVELENGTHS

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Low Level Laser Therapy

• Location : directing red & near infra red light• Benefit : stimulate cellular function

- improving healing - reducing pain - reducing bacterial count

• Uses : cold (subthermal) laser light therapy• Energy output is low enough so that the temperature

of the treated tissue does not rise above 36.5 o C (normal body temperature)

• Energy range : 1 – 500 mW

HeNe & GaAlAs are the most common types for oral & wound healing.

GaAs laser :best for treating deeper problem (joint injuries, vertebra and muscles)

GaAlAs : - superficial tendons - muscle attachment

Many acute and chronic conditions can be improved or eliminated with laser use, including:

• * Pain Relief* Wound Healing* Arthritis* Migraine headaches* Lower back pain* Repetitive Stress Injuries (RSI)* Carpal Tunnel Syndrome (CTS)* Tendonitis* Fibromyalgia* Sprains and strains* Post-operative pain

• Tennis Elbow* Golfer's Elbow* TMJ* Soft tissue injuries* Post-operative wounds* Swelling* Burns* Pressure sores* Herpes simplex* Acne

DOSAGE & TREATMENT GUIDE

Ranging from 0,5-10 joulesEnergy = mean output (watts)x time (seconds)i.e. 1 J = 1 mW x 1000 sec 1 J = 10 mW x 100 sec

1 J = 30 mW x 33 secMean output 30 mW, treatment time 20 sec – 5

Safety Precautions:

1. Do not stare directly at laser rays

2. Do not point laser rays directly on to one’s eyes

3. The best protection for eye is the safety goggles

Tissue Reaction

• No matter what dosage are used, the treated tissue will be affected

• The patient will not notice the tissue reaction• Tissue reaction has to be fairly great before

the patient notice

Treatment Reaction

• When sufficient energy has been delivered to cause a noticeable tisssue reaction

• A dosage should be sufficient to cause a treatment reaction

Minimal Reaction Dose (MRD)

• If we take treatment time into consideration, + the possibility of causing an unpleasantly strong treatment reaction optimum dosage as being the lowest dosage that cause a treatment reaction

• One, should attempt to attain this MRD each time a treatment is administered

Safety Precautions:

1. Do not stare directly at laser rays

2. Do not point laser rays directly on to one’s eyes

3. The best protection for eye is the safety goggles

Myth & facts

ENDOLASER 476

LASER beserta perlengkapannya

1. Set button2,3. Up and Down button4. Start/stop button 5. Set button6,7. Up and Down button 8. Start /Stop button of 830nm9. Output Power LED10.Treatment time LED11. Output power LED12.Frequency LED13.Treatment time LED

Improvement

1. Subjectively ( pain )

2. Objectively :By InspectionBy PalpationBy Function

Carpal tunnel syndrome

Visual Analog Scale (VAS) : daily evaluation on samples

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1 2 3 4 5 6 7 8 9 1011121314

Control

Experimental

p

There is a decrease of pain on MCP joint by using low level LASER, isometric enhancement training on muscles of the hand, and drugsThere is an improvement of LGS MCP by using low level LASER, isometric enhancement training on muscles of the hand, and drugs

• There is a significant difference on the decline of pain in frozen shoulder case before and after low level LASER therapy dan shoulder joint training

• There is a significant difference on the incline of LGS in frozen shoulder case before and after low level LASER therapy and shoulder joint training

Frozen shoulder

Rheumatoid arthritis

Tendon rupture

Problem” hearing impairmentday 1: ILIB 30 mint; ear probe 30 min

day 2 : ILIB 40 min; ear probe 30 min

day 3 ILIB 50 min; ear probe 30 min

day 4 ILIB 60 min; ear probe 30 min

Plus neurotropic agent

StrokeProblem :Hemiparese- left side

Shoulder hand syndrome – right side (?)

injuryILIB and probe

Dysphagia

13 November 2008

24 Mei 2008

A boy 14 y.o

Para parese (?)Survive from leukemia – 2 years

ILIB

Scanner

-Back slapt-Strengthening

-Home scholling

Diabetic foot

Herpetic neuralgia

OA Genu

Trauma

Back pain

Thank you