Low Level Laser Therapy 2024 PDF

LOW LEVEL LASER THERAPY Introduction Brightness LASER LLLTT. Monochromaticity Directionality. 4- Coherence  Characteristics of Laser beam 1. Directionality:An ordinary source of light emits light waves in all the directions and is highl...

LOW LEVEL LASER THERAPY Introduction Brightness LASER LLLTT. Monochromaticity Directionality. 4- Coherence  Characteristics of Laser beam 1. Directionality:An ordinary source of light emits light waves in all the directions and is highly divergent. But the divergence or angular spread of a laser is very small. 2. Monochromaticity: It means that all the laser rays have same wavelength and frequency when they are emitted from the same source. 3. Brightness: A laser beam has brightness many times in magnitude greater than that of conventional sources due to high directional property of laser beam.  4. Coherence:Two or more light waves are said to be coherent if they bear a constant phase relation among themselves. Coherence can be classified into two ways: a) temporal coherence wave containing only a single frequency is perfectly correlated CONT. with itself at all time delays. On the other hand a wave whose phase drifts quickly will have a short coherence time. b) spatial coherence. The spatial coherence is the phase relationship between the radiation field at different points in space. Therapeutic LASER Temporal and spatial coherence are essential concepts in the functionality of therapeutic lasers, particularly in medical applications. Let's break down these terms in the context of therapeutic laser use:  Temporal coherence refers to the ability of a light source to maintain a consistent phase relationship over time. This characteristic is critical for: Laser Efficiency: High temporal coherence Temporal allows lasers to produce a coherent light Coherence beam that can maintain its intensity and direction over longer distances. Interference Effects: In therapeutic applications, temporal coherence can enhance the effectiveness of treatments through interference patterns, which can help stimulate healing processes at the cellular level.  Spatial coherence, on the other hand, indicates how uniform the phase of the light wave is across different points in space. This coherence is significant for: Beam Quality: High spatial coherence leads Spatial to a well-collimated and focused beam that can penetrate tissue more effectively. This is Coherence particularly important in therapies aimed at targeting specific areas without affecting surrounding tissues. Depth of Penetration: In therapeutic lasers, spatial coherence can affect how well light penetrates through various layers of tissues, making it critical for the effectiveness of treatments in deeper areas.  In the context of therapeutic uses, lasers with high temporal and spatial coherence are often employed in: Therapeutic Pain Management: Lasers can stimulate healing and reduce inflammation. Applications Wound Healing: Focused laser treatment can enhance cellular repair and promote faster healing. Tissue Regeneration: They can encourage the proliferation of cells involved in tissue repair.  The mechanical structure contains the lasing media and incorporating a pair of parallel reflecting surfaces or mirrors in which photons of light produced by the medium are allowed to be PRODUCTION reflected back and forth between the mirrors to produce an intense photon resonance. OF LASER BEAM As one of the reflecting mirrors is not as pure mirror thus does not reflect 100% of the light striking its surface, some of the radiation is allowed to pass through as the output of the device. PRODUCTION OF LASER BEAM Laser production: (a) (b) Absorption Spontaneous (c) emission: Stimulated Incident photon(p) is Excited emission: Epidemiology absorbed by electron drops to lower Incident photon resting resting level interacts with already electron(e), (E1) emitting excited electron to which moves to produce two single photon higher level(E3). identical photons (p). (p1& p2) Steps of laser production BENEFITES OF lllT  Semiconductor diode lasers based upon the gallium arsenide (Ga-As) or gallium aluminum arsenide (Ga-Al-As). Semiconductor laser diodes can give either a continuous or TYPES OF a pulsed output. LASER(cont.) Due to the small size semiconductor lasers can be applied directly to the tissues in a hand held applicator. Infrared radiation will penetrate > 2mm before losing 37% of its intensity.  1- Helium neon laser was the first laser system to be used in clinical and research applications. Helium neon laser give radiation in the red visible region at 632.8 TYPES OF nm. The output is highly collimated laser beam LASER about 1 mm to less than 1cm. Helium neon laser pose a greater ocular hazard, so the eyes must be protected during application. Helium neon laser penetrates 0.5 - 1mm before losing 37% of its intensity  Lasers with wavelength is the near infrared such as 904 nm are chosen to treat subcutaneous structures whereas skin lesions or Infrared superficial wounds surfaces are LASER appropriately treated by one of the He Ne lasers which will be absorbed largely in the skin.  Therapeutic laser-tissue interaction is essentially ATHERMIC. The main type of Laser tissue reaction with tissue during laser therapy interaction would appear to be PHOTOCHEMICAL. The absorption of the incident photons by irradiated tissue produce chemical rather than thermal energy.  It stated that the absorption of laser light take place in tissues chromophores (photoacceptores). The These chromophores may be enzymes, a membrane molecule, or any other cellular photochemica or extracellular substances, thereby l theory producing a stimulation of cell activity. Activation of these chromophores by laser light is thought to be responsible for laser biostimulation effect. Therapeutic LASER Once Laser is directed at the tissue, it may be reflected, transmitted, scattered and absorbed in proportion that depends on The angle of incidence The wavelength of the radiation The nature of the tissues irradiated  THERAPEUTIC EFFECTS OF LASER Stimulation of Tissues Healing The photobiostimulation of the healing processes remains the basic indication for the use of low intensity laser therapy, including wound healing , soft tissues healing and nervous tissue regeneration. Both types of laser were found to be successful in promotion of healing with preference of using He Ne laser in superficial lesion and IR laser in more deep lesions  Mechanisms of action Anti-inflammatory effect and improved immune response. Acceleration of the inflammatory phase of wound healing by increasing the levels of prostaglandin. Stimulation of DNA synthesis. Stimulation of collagen production by fibroblasts. Stimulate angiogenesis and revascularization.  Pain Control Laser has been used successfully for its analgesic effect in various types of acute and chronic pain as musculoskeletal pain, sport injuries, and post-operative pain as well as neurogenic and neuropathic pain.  Mechanism of action Increase pain thresholds Alteration of nerve conduction velocity neuropharmcological effect by alteration of level of endogenous opoid. increase release and metabolism of serotonin. INDICATIONS 1- Non infected and infected skin wound and ulcers 2- Acute and chronic inflammation of musculoskeletal system as osteoarthritis and rheumatoid arthritis. 3- Acute and chronic soft tissues injuries, 4- Acute and chronic sprain and strain 5- Non-united fracture 6- Neurogenic pain such as, trigeminal neuralgia, post-herpetic neuralgia. 7- Trigger point and acupuncture point stimulation.  Calculation of the laser dose The incident dose is measured as either POWER DENSITY or ENERGY DENSITY. Power density is given in watts per centimeter squared (W/cm2). It is usually in the region of 50 W/ cm2 or less. Power density (W/cm2) = mean power (W) Surface area(cm2) Energy density given in joules per centimeter squared (J/cm2). Energy density (J/cm2) = mean power (W) X time(min) Surface area(cm2)  There is wide variation in the recommendations for the optimal energy for different conditions the usual ranges are from 1 to 10 J/cm2, but doses as low as 0.5 J/cm2 and up to 32 J/cm2 have been suggested. Higher doses are usually recommended for subcutaneous tissues. The most commonly used range for the dose is from 0.5 : 4 J/cm2. CLINICAL APPLICATION OF LASER Treatment parameters The parameters which describe laser therapy are Type and wavelength of laser Power in watts (W) Mode either continuous or pulsed.  Technique of application Laser is applied using two main techniques: 1- Contact technique This technique For the optimum laser treatment using diode systems (hand held probe) the tip of the probe is held perpendicular in contact of the skin. This technique allow deeper penetration of laser and maximize the power density on the target tissues as reflection is minimized.  2- Non-contact technique This technique is used in treatment of open wounds. The distance between the laser probe and wound bed should be 0.5-1 cm. The probe also should be held perpendicular to the site of radiation Non-contact and contact technique  Types of application 1-Point application It is used to irradiate localized painful spot. Using hand held probe, one can use contact and non-contact technique. It is commonly used in treatment of localized painful site, trigger points, and acupuncture points.  2-Scanning application Scanner technique is used for treatment of large area specially in wound healing. It is scanning device which has been offered with some laser equipment usually in conjunction with He-Ne units. This technique the laser beam is automatically scanned across a predefined area. Automatic scanning allow easy uniform simple application of laser treatment over large area instead of using manual scanning Manual scanning  manual scanning Usually used in case of wound healing. When the laser machine is not offered with automatic scanners, manual scanning is applied using single hand held probe (non contact). This technique is achieved by the motion of the operator’s hand. Considerable care is required to ensure that a reasonably uniform dosage is delivered to all wound area.  3- Gridding A more practical and less time consuming alterantive method to manual scanning for treating wounds. For this the area of the wound bed is visualized as being covered with a gridwork of squares measuring 1cm X 1 cm. Apply to each square is systematically treated with a single diode probe. Treatment of wound by gridding  Laser treatment of wounds The technique used in treatment of wounds consists of two parts – CONTACT TECHNIQUE : is used to treat a series of points around the whole wound margin about 1 cm from the edge of the wound at a dosage of 0.5-4 J/cm2. laser treatment about 2 cm intervals around the edge of the wound, with alternation of the position of the points between treatment sessions. This technique aim to accelerate margination & wound closure in addition to promotion of blood flow to wound and angiogenesis.  Technique of application According to the patients tolerance, contact and non contact technique could be used. If the treatment over painful or trigger points non-contact technique is used specially in acute conditions. Usually point application is utilized using hand held probe. Another technique is using combined scanning and point application specially if the laser unit has scanners. The treated area is scanned first then the trigger points are treated with the probe using point application. This method is used when a large inflamed area is treated and in addition there is trigger points within the treated zone.  Laser type Infrared laser is preferred for its deeper penetration than helium neon laser. HE NE LASER Laser treatment of wounds  2- SCANNING AND GRIDING TECHNIQUES (non- contact): for wound bed treatment using a dose of 1-2 J/cm2. scanning may be automatic or manual according to the laser unit available. Laser type Both types of laser (He Ne & IR lasers) are effective  Duration and frequency of treatment The duration of treatment is determined according to the power of the laser unit. For example if the laser unit has 30 mW power to irradiate each cm2 with 1.5 J/cm2 each square is irradiated for 50sec. Laser treatment is given once daily or at alternate days  Laser treatment for pain control Points of application Directly over the site of lesion or pain Trigger points Nerve roots and superficial nerve trunks Acupuncture points. Dose: usually use higher doses because the target treated tissue is deeply situate usually 1-3 J/point Thank you ‫قسم العلوم األساسيه‬ ‫امتحان شفوي وعملي‬ ‫المستوي الثاني‬ A case of marathon runner female 25 years old suffer from low back pain with Rt posterior pain in thigh. 1. Differentiate between effect of infrared and short wave and explain the best modality and technique for pervious case? 2. Enumerate functions of skin? 3. Apply erythema test Patient 35 years old suffer from pain in posterior aspect of neck with free radiological examination and spasm in paravertebral neck muscles. 1. Describe the causes of pain in pervious case and in case of chronic spasm describe best method to control it? 2. Apply us application in case of Cervical Pain. 3. Describe recent uses of shock wave. ‫قسم العلوم األساسيه‬ ‫امتحان شفوي وعملي‬ ‫المستوي الثاني‬ A case of MILITARY OFFICER 25 years old suspected to gun shoot in his back at level of T2 result in loss of touch and temperature in right leg as well as septic wound at bullet site. 1. Apply the best electrotherapy modality and explain your reason? 2. Enumerate effects of magnetic therapy in a case of wound healing 3. Mention tract affected in such case.  Introduction Comorbidities and Risk Factors Comorbidities OA CV DM COPD * Understanding these comorbidities is crucial for optimizing surgical planning and managing perioperative complications. Epidemiology Risk Factors obesity Smoking family certain history occupations * Addressing these risk factors may help prevent or delay the need for surgery. Bank outline Artificial Intelligence outline  SURGICAL APPROACH Theory Total hip arthroplasty  Lateral Anterior Theory Posterior & posterolateral Hardinge smith peterson approach approach Anterolateral SURGICAL APPROACH kocher langenbeck watson jones  Precautions Associated With Total Hip Arthroplasty Surgical Approaches Theory Posterior/ posterolateral Anterior/ Anterolateral / lateral Avoid hip flexion > 90° & Abd & IR beyond neutral Avoid hip extension & Add & ER beyond neutral Do not cross the leg Do not cross the leg Avoid sitting in low, soft chairs During early ambulation, step to, rather than past, the operated hip to avoid hyperextension Use a raised toilet seat If a trochanteric osteotomy was done, do not perform active hip abduction for at least 6 to 8 Avoid bending the trunk over the legs weeks or until approved by the surgeon. Avoid sitting in low, soft chairs > 90° when rising Toe touch weight bearing for 6 to 8 weeks or up to from or sitting down in a chair or dressing or 12 weeks to allow for bone healing to occur undressing Avoid activities that involve rotating the trunk away Avoid activities that involve rotating the trunk the operated extremity toward the operated extremity Sleep in supine position with an abduction pillow; Sleep in supine position with an abduction pillow; avoid sleeping or resting in a side-lying position avoid sleeping or resting in a side-lying position Theory Here Idea! Overall Incidence The average reported dislocation rate after THA varies widely depending on several factors, including the study population, follow-up period, and surgical Epidemiology approach. Estimated range: 0.2% to 10% per year. Most studies report incidences between 1% and 3%. Theory Here Idea! Timing of Majority of dislocationsDislocation (50-60%) occur within the first 3 months after surgery. Recurrence rates are also significant, with studies Epidemiology reporting 57% of patients experiencing recurrent dislocations after an initial episode. Theory Here Idea! Risk factors Surgical factors: Surgical approach (posterior approach carries the highest risk), implant design, component positioning, surgeon experience, and soft Epidemiology tissue management. Patient factors: Age (younger and older patients are at higher risk), gender (females have higher risk), pre- existing hip instability, neuromuscular disorders, cognitive impairment, and patient compliance with post- operative precautions. Theory Here Idea! Dislocation Rates by Surgical Approach Posterior approach: 2.3% - 3.23% Lateral transgluteal approach: 0.55% Anterolateral approach: 2.18% Epidemiology Bank outline 3d Glasses outline Reality Imaginary Design Reality 3 DIMENSIONS SENSORS ANGULA SENSORS MAGNETIC SENSORS VIBRATION SENSORS HEART RATE SENSOR Reality involved into the mechanical structure and linked to a mobile application Reality involved into the mechanical structure and linked to a mobile application  User Interface Reality Bank outline 3d Glasses outline Buddha Silhouette outline  ANY Expectatio Suggestions n