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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
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
**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 antiinflammatory & immunosuppressive effects.
Physiological Effects
Biostimulation improved metabolism, increase of cell metabolism
Increases speed, quality & tensile strength of tissue repair
Physiological Effects
Stimulation of wound healing
Promotes faster wound healing/clot formation Helps generate new & healthy cells & tissue
Infrared light is more selective absorbed by specific proteins in the cell membrane & affects permeability directly
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
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 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
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)
Types of Lasers
4 categories of lasers
Crystal & Glass (solid - rod)
Synthetic ruby & others (synthetic ensures purity)
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
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
Laser
Wavelength Output power Average power Intensity Dosage
Medications
Photosensitivity (antibiotics)
Pigmentation
Dark skin absorbs light energy better
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
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
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
InGaAip Replacing HeNe lasers Semiconductor Wavelength: 630-700 nm Power output: same as HeNe Energy depth: superficial wound care
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)
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
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
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
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
Miscellaneous
www.geocities.com/altmedd/laser.htm
http://laserhealing.net/lowlevel.html