Laser

1
Laser Light Therapy
2
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

3
(No Transcript)
4
History

• Albert Einstein 1st described this theory that
  was transformed in to laser therapy
• By the end of the 60s, Endre Mester (Hungary) -
• was reporting on wound healing through laser
  therapy
• In early 1960s, 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

5
Whats 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

6
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 bodys cells which convert into chemical
  energy to promote natural healing pain relief.
• Optimizes the immune responses of blood has
  anti-inflammatory immunosuppressive effects.

7
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

8
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

9
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

10
(No Transcript)
11
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.

12
Mitochondria
13
(No Transcript)
14
Tissue Cellular Response

• Magnitude of tissues 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

15
LASER Regulation

• LASERs - classified by the FDAs 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)

16
Laser Generators

• Components of a generator
• Power supply electrical power supply that can
  deliver up to 10,000 volts 100s 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

17
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

18
High vs. Low Level Lasers

• 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
• Surgical Lasers
• Hard Lasers
• Thermal
• Energy 3000-10000 mW

19
Infrared Light Therapy

• SLD Super Luminous Diode
• Brighter
• LED Light Emitting Diode

20
Laser Light Properties

• Monochromaticity
• 1 color 1 wavelength
• lt400 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

21
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

22
Parameters - Wavelength

• Nanometers (nm)
• Longer wavelength (lower frequency) greater
  penetration
• Not fully determined
• Wavelength is affected by power

23
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

24
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)

25
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

26
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

27
Indium-Gallium-Aluminum-Phosphide

• InGaAip
• Replacing HeNe lasers
• Semiconductor
• Wavelength 630-700 nm
• Power output same as HeNe
• Energy depth superficial wound care

28
Gallium Arsenide

• Semiconductor - produces an infrared (invisible)
  laser
• Wavelength 904910 nm
• Power output may produce up to 100 mW
• Energy depth 30-50 mm
• Short pulse-train (burst) duration (100-200 ns)

29
Gallium Aluminum Arsenide

• GaAIAs
• Semiconductor
• Wavelength 780-890 nm
• Power Output 30-100 mW (up to 1000 mW)
• Energy Depth

30
What Does it Look Like?

• http//www.laserhealthsystems.com/omegaofferings.h
  tm
• http//www.thorlaser.com/products/

31
Indications

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

32
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

33
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

34
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)

35
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

36

• Dynatrons 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

37
MedX Laser Light Therapy

• Laser probe
• SLD (2)

38
Miscellaneous

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