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SEMINAR ON LOW LEVEL LASERTHERAPY FOR
BEAS HOSPITAL, EDITED BY JAN TUNER, DEVELOPED AND
PRESENTED BY MALINI CHAUDHRI. UNDE...
LOW LEVEL LASER THERAPY FOR
HOSPITALS
MALINI CHAUDHRI. Ph.D. Dr.Ac
WALT, ISLSM
ISLA, EMLA
NAALT, LASER ANNALS,
Swedish Med...
INTEGRATIVE MEDICINE. SUPPORT WITHOUT
DRUGS
TOPICS OF DISCUSSION
LLLT APPLICATIONS TO
SUPPORT ALL DEPARTMENTS
IN A HOSPITA...
MECHANISMS
OF LLLT. LAWS OF
PHOTOCHEMISTRY
.
Delete text and place photo
here.
Delete text and place photo
here.
ABSORPTIO...
Das wavelength diagram of different light sources
J. Tuner, L. Hode: Laser Therapy
LASER EFFECTS AND SAFETY
• Photo thermal effects. Involve significant increase of
temperature in tissue (5 -10 C),and remo...
PHOTOCHEMISTRY
photo absorption -
photo action -
I I I
Wound healing Relief of inflammation neurogenic pain
Tissue repair ...
NOTES ON EFFECTS OF LLLT
• Photoacceptors (Cytochrome c oxidase) can absorb low level lasers
irradiation and transfer it i...
What are the progressed physiological effects
of laser light?
• - Proliferation on immune cells leads to the combat of inf...
• LASER DOSE SELECTIONS ARE BASED
ON THE ARNDT SCHULTZ LAW
• LOWER DOSES ARE BIOSTIMULATORY
• HIGHER DOSES ARE INHIBITORY
...
WOUND HEALING
Lasers in the visible red spectrum
are preferred for wound healing(or
LEDS)
Helium Neon 634.8nm,
670nm, 780n...
Mechanisms of wound healing
• LLLT is beneficial for wounds of various etiologies and affects every molecule
involved. Thi...
Oral Mucositis. Patients undergoing
chemotherapy need LLLT
Photo: R-J Bensadoun, Nice
A Stye. The following
day after HE NE laser
Photos courtesy Jan Tuner
TECHNIQUES FOR
WOUND HEALING
Apply a probe to points in contact
mode along the periphery of the
wound to stimulate contrac...
PAIN MANAGEMENT
• Pain management involves the use of lasers from the
634nm to 950nm.
• The IR lasers may be Superpulsed, ...
APPROACHES
Laser
irradiation/
scanning.
Trigger
point release
Laser
acupuncture
Laser
auricular
acupuncture
Interstitial
l...
MECHANISMS TO TREAT PAIN WITH LLLT
• a possible stabilization of nerve cell membranes, probably due to the more stable con...
PAIN MANAGEMENT
• evidences exist on the treatments effects of low level lasers on the
synthesis, release and metabolism o...
20
LYMPHEDEMA
LLLT has been noticed to reduce histamine release and
accumulated lymph edema even at Stage 3.
This applicat...
21
TREATING PAIN THROUGH
TRIGGER POINTS IN
ORTHOPEDIC CONDITIONS
Sports injuries, surgeries, visceral organ
diseases and orth...
Trigger Point therapy is an essential
technique used in Physical therapy
to manage pain.
There is a large database of
rese...
CHUKUKA
ENWEMEKA. WALT
EDITOR
Manual on WALT doses
and trigger points is
published online based on
meta-analysis of scient...
muscle or area no of joules
points
Biceps humeri 1-2 8
Supraspinatus 2-3 10
• Minimum 5 Joules per point
Infraspinatus 2-3...
LASER
ACUPUNCTURE
26
27
-LAP must be differentiated from needle
acupuncture.
-LAP treats single command points, wheras
acupuncture approaches a...
LASER AURICULAR
ACUPUNCTURE.
LASER FREQUENCIES.
28
NOGIER FREQUENCIES AND
CORRESPONDENCES
• Frequencies Body Ear (external face)
• A Orifices: mouth, eyes, nostrils, navel, ...
Frequencies and Value (Hz)
• A 292 E 4672
• B 584 F 73
• C 1168 G 146
• D 2336
• Definition of frequencies by Drs Paul and...
EXTRA. RUBACH. MECHANISMS OF PAIN
CONTROL OF ACUPUNCTURE
31
EXTRA. RUBACH. EMBRYONIC ORIGIN
32
33
EXTRA.
RUBACH
34
AXEL RUBACH. EXTRA. BK PRINCIPLES OF EAR
ACUPUNCTURE
EXTRA. RUBACH
35
36
Extra. RUBACH
• ENSURE THAT YOU ARE CERTIFIED
OR TRAINED TO APPLY LASER FOR
A SPECIFIC PROTOCOL
• MANAGE APPLICATIONs THAT ARE
DIAGNOSIS...
KEEP YOUR
PRACTISE
SAFE.
WEAR
PROTECTIVE
GOGGLES
AND PUT UP
SAFETY
SIGNS
38
• READ YOUR LASER
MANUAL
• FOLLOW SAFETY
GUIDE...
RECENT CONCERNS
In a recent editorial published by Tina
Karu in Photomedicine and Laser
surgery, she has communicated that...
Laser blood irradiation in biological cancer therapy
EXTRA
WEBER
41
MALINI CHAUDHRI THANKS ISTE AND JAN TUNER
AND THE BEAS HOSPITAL MANAGEMENT FOR
THEIR SUPPORT
42
LINKS
www.laserannals.com
www.walt.nu
www.laser.nu
www.centerforwellness.net
With European
medical Laser
Assoc.
EMLA pa...
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Continuing Medical Education Seminar. Low Level Laser in Complementary and Alternative Medicine in hospitals

A collaborated CME seminar on LLLT for hospitals.

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Continuing Medical Education Seminar. Low Level Laser in Complementary and Alternative Medicine in hospitals

  1. 1. SEMINAR ON LOW LEVEL LASERTHERAPY FOR BEAS HOSPITAL, EDITED BY JAN TUNER, DEVELOPED AND PRESENTED BY MALINI CHAUDHRI. UNDER THE AUSPICES OF PUNJAB MEDICAL COUNCIL 1
  2. 2. LOW LEVEL LASER THERAPY FOR HOSPITALS MALINI CHAUDHRI. Ph.D. Dr.Ac WALT, ISLSM ISLA, EMLA NAALT, LASER ANNALS, Swedish Medical Laser Society. Has worked with Photomedicine since 1994 with Alma Ata (Hong Kong, Colombo,) Japan, USA, Czech Republic, and Sweden. Sponsored to USA in 2003. Based in R&D from India. Published scientific papers and developed a course, edited by Jan Tuner, Editor of Laser Annals. Specializes in Laser Acupuncture and Physio, technical training , therapy and research. Delete text and place photo here. 2
  3. 3. INTEGRATIVE MEDICINE. SUPPORT WITHOUT DRUGS TOPICS OF DISCUSSION LLLT APPLICATIONS TO SUPPORT ALL DEPARTMENTS IN A HOSPITAL WOUND HEALING PAIN MANAGEMENT INFLAMMATION AND EDEMA MUSCULOSKELETAL DISORDERS LASER ACUPUNCTURE Review: PDT AND SYSTEMIC THERAPY Delete text and place photo here. 3
  4. 4. MECHANISMS OF LLLT. LAWS OF PHOTOCHEMISTRY . Delete text and place photo here. Delete text and place photo here. ABSORPTION SPECTRA. For a photo reaction to take place there must be a photoacceptor. This is mainly cytochrome c oxidase in the mitochondria. Chromophores receiving light molecules that are active in photochemistry are melanin and haemoglobin. ACTION SPECTRA Depends on the nature of the photostimulation. Wavelengths from 600nm to 950 nm are considered therapeutic. Coherent laser light involves photo excitation in the mitochondria that is conveyed to the nucleus. Increased ATP and DNA synthesis provides scope for reversing disease and targeting gene therapy. All cells having mitochondria respond to LLLT. Recent research has shown the infinite possibilities of the mitochondria to expand and generate photo pathways for added photo chemistry Photo of Malini Chaudhri giving laseracupuncture to Jan Tuner in WALT, Japan 4
  5. 5. Das wavelength diagram of different light sources J. Tuner, L. Hode: Laser Therapy
  6. 6. LASER EFFECTS AND SAFETY • Photo thermal effects. Involve significant increase of temperature in tissue (5 -10 C),and remodelling. CO2, ND Yag. Hair removal lasers, surgical lasers etc. Class 4 laser • Photo mechanical effects. This develops a steeper gradient during exposure. Q switch. Removing tattoos. Class 4 laser • Photochemistry. No significant thermal effects. LLLT. Class 3 laser 6
  7. 7. PHOTOCHEMISTRY photo absorption - photo action - I I I Wound healing Relief of inflammation neurogenic pain Tissue repair pain,edema, acute injuries, acupuncture Prevention of tissue chronic diseases death Cellular photoacceptor in mitochondria Low level laser wavelength 600nm- 950nm IIIIIIII 7
  8. 8. NOTES ON EFFECTS OF LLLT • Photoacceptors (Cytochrome c oxidase) can absorb low level lasers irradiation and transfer it inside mitochondria in order to provide cell energy (ATP) which is the product cytochrome c oxidase in the respiratory chain of the mitochondria. The stimulation of ATP synthesis results in increased cell activity. These changes influences macrophages, fibroblasts, endothelial cells, mast cells, bradykinin and nerve conduction speed. • Biomodulatory effects of LLLT comprise the following: • Macrophages, lymphocytes, fibroblasts, endothelial cells and keratinocytes proliferation; increase ATP synthesis and cell respiration, growth factors and • other cytokines release, change of fibroblasts to myofibroblasts; change in inflammatory mediators level (histamine and prostaglandins); increase in oxygen transport and improve in glucose consumption; changes in cell membrane potential and permeability, • sodium/potassium pump excitation and more calcium removal; vasodilation and angiogenesis (improve in tissue nutrition); collagen synthesis. 8
  9. 9. What are the progressed physiological effects of laser light? • - Proliferation on immune cells leads to the combat of inflammations and an accelerated • healing of wound as well as an increased endorphin disbursement, increase of the ATP • production and increased nervous cell potential. • - Increased leukocyte phagocytosis, boosted neovascularisation, increased collagen • formation and protein biosynthesis. It also leads to an improved cell respiration and • stabilization of the membrane potential. • - Enhancement of the proton gradient via the mitochondria membrane, generation of an • increased potential difference with increased phosphorisation of ATP (increase of 150%). • - No modification of intact cells. • - Energetic build-up of sick cells. • - Energy is to a large extent (more than 40%) used for ATP synthesis, in order to increase the • pump activity for maintaining the membrane potential. • - Membrane stabilization leads to blocking of impulses, reducing the transmissions of pain • sensations. • - The cell’s calcium content is regulated (diminished ATP synthesis leads to a an overflow of • the cell with calcium and activation of proteinasis, resulting in the death of the cell, the • necrosis). • - In the pre-necrotic state, cells suffer from acute lack of energy with sodium and calcium • streaming in, which can only be removed with the utmost pump activity. This pump activity • can only be enhanced by radiant energy. 9
  10. 10. • LASER DOSE SELECTIONS ARE BASED ON THE ARNDT SCHULTZ LAW • LOWER DOSES ARE BIOSTIMULATORY • HIGHER DOSES ARE INHIBITORY • LEDS ARE IN WIDESPREAD USE. HOWEVER THEY ARE NOT BASED ON COHERENT LIGHT AND GENERATE • SUPERFICIAL EFFECTS SUITABLE FOR HEALING WOUNDS • IN LASERS Areas of high difference in light intensity levels form • SPECKLES. Local differences in intensity create temperature and pressure gradients across cell membranes which enhances permeability of the membrane so that photons may be active deeper. • 10
  11. 11. WOUND HEALING Lasers in the visible red spectrum are preferred for wound healing(or LEDS) Helium Neon 634.8nm, 670nm, 780nm in Continuous wave. LEDS. PDT Supports dramatic healing of Bedsores Open wounds Allergic or contact dermatitis Infectious and ulcerating wounds Diabetic ulcers Surgical wounds Acne Burns Delete text and place photo here. Delete text and place photo here. 11
  12. 12. Mechanisms of wound healing • LLLT is beneficial for wounds of various etiologies and affects every molecule involved. This includes • Increased ATP levels • Promotion and proliferation of migration of keratinocytes, endothelial cell and fibroblasts. • Secretion of growth factor from macrophages • Increasing collagen synthesis • Increasing phagocytic and bactericidal activities of inflammatory cells. • Modulation and regulation of secretion of chemokines and cytokines • These support the 3 stages of wound healing, • 1) Inflammation (immune cells migrate to the wound and close it to promote healing) • 2) Proliferation(new granulation tissue is produced to fill in the gaps with more collagen production and increased epithelialization • 3) maturation( with wound closure keratins undergo stratification and differentiation to restore the barrier without which wounds become chronic) 12
  13. 13. Oral Mucositis. Patients undergoing chemotherapy need LLLT Photo: R-J Bensadoun, Nice
  14. 14. A Stye. The following day after HE NE laser Photos courtesy Jan Tuner
  15. 15. TECHNIQUES FOR WOUND HEALING Apply a probe to points in contact mode along the periphery of the wound to stimulate contraction. Incase of scanner apply over the wound at .5 cm distance from skin Along the open area use the techniques drawn on the left or apply along the surface of the wound as a grid as below. Dose. 2-6J/sq cm :::::::::::: :::::::::::: :::::::::::: Delete text and place photo here. Delete text and place photo here. These applications improve the effects of laser therapy on wound healing with lasers in the visible spectrum Recommendations are from Tuner Hode
  16. 16. PAIN MANAGEMENT • Pain management involves the use of lasers from the 634nm to 950nm. • The IR lasers may be Superpulsed, SP, (difficult to calculate joules) and achieve a deep tissue response • Recent literature favors Continuous wave, CW, laser for technical control of dosimetry and for progressive photochemical effects during a laser session and management of cummulative effects as per FDA requirements. • In pain management, Professor Pontinen, has established a Pontinen Principle, which emphasizes the ethical responsibilty and capacity to treat pain in a single session of lasertherapy by maximizing the laser dosage and palpating the pain points to assess improvement. 16
  17. 17. APPROACHES Laser irradiation/ scanning. Trigger point release Laser acupuncture Laser auricular acupuncture Interstitial laser treatment Increases synthesis of endorphins and bradykinin, decreased activity of C fibers, reduction of serotonin and nociceptors. Increased pain threshold Relaxes muscles bands and reduces referred pain based on treatment of hyper-irritable points located in muscles that are shortened This is an approach through the CNS to activate acupuncture pathways and create homeostasis This is a photo pathway through the auricular nerves to stimulate a somatotopic representation of the human fetus in the ear, with respect to embryonic tissue This is an invasive procedure in which a 5 mw laser fiber needle penetrates deep into the skin to deliver photons in a injured musculosketal condition 17
  18. 18. MECHANISMS TO TREAT PAIN WITH LLLT • a possible stabilization of nerve cell membranes, probably due to the more stable conformation of the lipid bilayers induced by LPT, and the associated integral proteins of the nerve cell membrane, the enhanced redox systems of the cell and an increase in ATP production have also been shown to restore neuronal membranes and decrease pain transmission. • - Reduction of Inflammation and edema (-releasing of inflammatory cytokines like prostaglandin E2 and plasminogen activator could be reduced- less inflammatory cells were present in irradiated samples- • - Reduction of inflammatory cell migration, • - Reduction of edema and inflammatory cytokines like TNF-α, interleukins 1 and 6 • - The laser acts by inhibiting cyclooxygenase, • - Interrupting the conversion of arachido prostaglandin and also increases the production of B- endorphin. • . • In addition to these, analgesic effects of lasers can be explained by the increase synthesis of endorphin and bradykinin which results in decreased activity of C fibers and change in pain threshold, and also in reduction of serotonin and suppression of nociceptors 18
  19. 19. PAIN MANAGEMENT • evidences exist on the treatments effects of low level lasers on the synthesis, release and metabolism of various chemical nervous mediators like • serotonin and acetylcholine in central nervous system, and • histamine and prostaglandin in peripheral nerves. The • increase in production of endorphin, the reduction of C fibers activity, the decrease of bradykinin and the change in pain threshold can also explain the effects of low level lasers on pain • The anti inflammatory effects of LLLT can be due to the augmentation of phagocytosis and increase of number and diameter of lymphatic vessels, decrease in permeability of blood vessels, repair of capillary flow and reduction of edema 19
  20. 20. 20 LYMPHEDEMA LLLT has been noticed to reduce histamine release and accumulated lymph edema even at Stage 3. This application is useful for lymphedema of patients who have surgically removed nodes, or after chemotherapy -It is not proven in conditions that are genetic. - In treatment of wounds and sports injuries, the lymph pathways have to be cleared through laser application techniques that are specific. This involves irradiating nodes, applying a technique called ‘woodpecker, and managing a dose that regenerates lymph vessels if needed. As with injured skin, injured lymph vessels may also be repaired with laser.
  21. 21. 21
  22. 22. TREATING PAIN THROUGH TRIGGER POINTS IN ORTHOPEDIC CONDITIONS Sports injuries, surgeries, visceral organ diseases and orthopedic conditions including spinal curvature, Spondylosis, lumbago etc, will require an approach with laser to treat trigger points. Pontinens Principle should be applied to maximize the dose till the painful trigger point is removed. The therapist may palpate the tender point to assess pain score, and determine effects before and after lllt. Also manage referred pain 22
  23. 23. Trigger Point therapy is an essential technique used in Physical therapy to manage pain. There is a large database of research from World Association of Laser therapy on precise dosimetry for each condition and muscle or tendon group. The therapist must be acquainted with 1) the laser wavelength, 2) anatomy of muscle and 3) location of trigger point 4) Recommended dosimetry in joules Photo is of sternal division trigger points and referred pain in the eyes and face 23
  24. 24. CHUKUKA ENWEMEKA. WALT EDITOR Manual on WALT doses and trigger points is published online based on meta-analysis of scientific data http://se-led-belt.com/wp- content/uploads/2012/10/Li ght_Therapy_by_Chukuka_ Enwemeka_PhD.pdf. 24
  25. 25. muscle or area no of joules points Biceps humeri 1-2 8 Supraspinatus 2-3 10 • Minimum 5 Joules per point Infraspinatus 2-3 10 Minimum 5 Joules per point Cervical spine 2-4 15 • Minimum 6 Joules per point Lumbar spine 2-4 40 • Minimum 8 Joules per point Hip 2-4 40 • Minimum 8 Joules per point Knee medial 3-6 20 • Minimum 5 Joules per point RECOMMENDED DOSES FROM WALT Using 780nm to 830nm single lllt probes in Physical therapy Chronic and acute conditions must be differentiated Stages of healing must be differentiated Local and referred pain musat be differentiated 25
  26. 26. LASER ACUPUNCTURE 26
  27. 27. 27 -LAP must be differentiated from needle acupuncture. -LAP treats single command points, wheras acupuncture approaches a yin and yang points related to 5 element disorders. -LAP must be differentiated from Trigger points which treat the fascia and PNS. LAP treats the CNS and may speed up treatment effects. -Refer to Laser acupuncture trial on women golfers, published in Laser World.
  28. 28. LASER AURICULAR ACUPUNCTURE. LASER FREQUENCIES. 28
  29. 29. NOGIER FREQUENCIES AND CORRESPONDENCES • Frequencies Body Ear (external face) • A Orifices: mouth, eyes, nostrils, navel, anus and genitals Internal face of tragus, auricular meatus • B Trunk: face and back Concha • C Limbs: arms and legs Anthelix andhelix root • D Median line front and back, trunk and head Pre-tragus area • E Skull, neck and vertebral column Descending part of helix • F Face except nose and forehead Isthmus • G Forehead (projection of frontal lobes) Lobule 29
  30. 30. Frequencies and Value (Hz) • A 292 E 4672 • B 584 F 73 • C 1168 G 146 • D 2336 • Definition of frequencies by Drs Paul and Raphaël Nogier: Extract from "The man in the ear", Maisonneuve, 1979, 255 p. • The "A" frequency is associated, in the animal kingdom, with non-organized, embryonic structures. It is the frequency of the primitive living being; it is in sympathy with the cell in the crude, undifferentiated state. This frequency, the most archaic, can also be considered to be the most anarchic. • The more elaborate "B" frequency is specific to the nutritional visceral system and is related to the primitive gastrointestinal apparatus. • The "C" frequency indicates motor elements of the body. It reflects movement, the limbs, the renal system, the genital tract. • The "D" frequency leads us to a higher level of organization, as it introduces the concept of symmetry, by selectively affecting certain unpaired organs, presenting the characteristic of being solitary, but anatomically symmetrical; for example the corpus callosum or the white commissure, two symmetrical cerebral structures, situated between the right hemisphere and the left hemisphere [...] • The "E" frequency is that of the spinal cord and central nervous system, which perceives and communicates between functional units situated at different levels. • The "F" frequency represents subcortical cerebral regions. These structures are found in the brain of higher animals, dogs, for example. • The "G" frequency resonates with the most elaborate structures of the body, those of the cerebral cortex, the typically human part of the brain, which gives man the capacity to think, create and imagine. • 30
  31. 31. EXTRA. RUBACH. MECHANISMS OF PAIN CONTROL OF ACUPUNCTURE 31
  32. 32. EXTRA. RUBACH. EMBRYONIC ORIGIN 32
  33. 33. 33 EXTRA. RUBACH
  34. 34. 34 AXEL RUBACH. EXTRA. BK PRINCIPLES OF EAR ACUPUNCTURE
  35. 35. EXTRA. RUBACH 35
  36. 36. 36 Extra. RUBACH
  37. 37. • ENSURE THAT YOU ARE CERTIFIED OR TRAINED TO APPLY LASER FOR A SPECIFIC PROTOCOL • MANAGE APPLICATIONs THAT ARE DIAGNOSIS SPECIFIC : WHERE THE PROTOCOL IS DESIGNED • ENSURE THAT YOU BELONG TO A LEGITIMATE AUTHORITY FOR INSTRUCTION • DO NOT MAKE CLAIMS OR PROMISE TO CURE • DOCUMENT ALL PROCEDURES AND RECORDS • MANAGE ORGANIZATIONAL SKILLS • MANAGE COMMUNICATION SKILLS TO INFORM THE CLIENT • STAY UPDATED IN RESEARCH AND SCIENTIFIC LITERATURE FDA. APPROVAL FOR PRACTISE 37
  38. 38. KEEP YOUR PRACTISE SAFE. WEAR PROTECTIVE GOGGLES AND PUT UP SAFETY SIGNS 38 • READ YOUR LASER MANUAL • FOLLOW SAFETY GUIDELINES • ENSURE THAT YOUR LASER IS CERTIFIED • FOLLOW OSHA AND ANSI SAFETY GUIDELINES FOR LASERTHERAPY
  39. 39. RECENT CONCERNS In a recent editorial published by Tina Karu in Photomedicine and Laser surgery, she has communicated that the time has come to consider LLLT a drug based equivalent. She has been accountable in presenting the large and specific database of scientific achievements in all fields in 40 years. 39
  40. 40. Laser blood irradiation in biological cancer therapy EXTRA WEBER
  41. 41. 41 MALINI CHAUDHRI THANKS ISTE AND JAN TUNER AND THE BEAS HOSPITAL MANAGEMENT FOR THEIR SUPPORT
  42. 42. 42 LINKS www.laserannals.com www.walt.nu www.laser.nu www.centerforwellness.net With European medical Laser Assoc. EMLA parliament

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