APPLICATION

OF
LOW LEVEL LASER THERAPY IN
REHABILITATION MEDICINE

Nury
Nusdwinuringtyas

Definition
Rehabilitation
PM &R
Its primary goal is the
patient attaining the
fullest physical,
psychological,
social,
vocational,avocatio
nal, and
educational potential
consistent with
physiologic or
anatomic impairment
and environmental
limitations

Has been defined as

the development of
the individual to the
fullest physical,
psychological,
social,
vocational,avocatio
nal and educational
potential consistent
with his or her
physiologic or
anatomic impairment
and environmental
limitation

International Classification of
Functioning, Disability and Health
(ICF)
Health condition disorder or
disease

Body function and

body structure

Activity

Environment factor

Participation

Personal factor

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

ysical agents: devices and application in: Physical medicine and Rehabilitation s

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

What forms of heat and cold

therapy are available
Is produced by relative
heat
cold
absence of thermal
Superficial and deep
energy
Superficial agents e.g
Because of lack of
heat lamp, heat the skin
energy , only
and subcutaneus tissues
superficial agents
Deep heating agents e.g
such as ice can be
US, short waves , also
used
known as diathermies,
Conversive cooling is
heat more deeply and
therefore not possible,
can rise temperatures
and cooling therapies
for therapeutic levels at
must rely on
depths of 3.5 7 cm.
conduction and
Physical agents: devices and application
in: Physical medicine and
convection

General goals of heat therapy and

cryotherapy
Heat therapy
1. Analgesia
2. Muscle spasm
relaxation
3. Hyperemia
4. Increased collagen
extensibility
5. Acceleration of
metabolic process

Cryotherapy

1.
2.
3.
4.
5.

Analgesia
Muscle spasm
Inflammation
Spasticity
Slowing of metabolic
activity

sical agents: devices and application in: Physical medicine and Rehabilitation sec

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 biostimulation.

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 antiinflammatory 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

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 joules
Energy = 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 sec
Mean 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 ones 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 ones eyes
3. The best protection for eye is the
safety goggles

Myth & facts

ENDOLASER 476

LASER beserta perlengkapannya

1. Set button
2,3. Up and Down button
4. Start/stop button
5. Set button
6,7. Up and Down button
8. Start /Stop button of 830nm
9. Output Power LED
10. Treatment time LED
11. Output power LED
12. Frequency LED
13. Treatment time LED

Improvement
1. Subjectively ( pain )
2. Objectively :
By Inspection
By Palpation
By Function

Carpal tunnel
syndrome

Visual Analog Scale (VAS) :

daily evaluation on samples

Rheumatoid arthritis

Frozen shoulder

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

Tendon
rupture

Stroke

Problem :
Hemiparese- left side
Shoulder hand syndrome
right side (?)
injury
ILIB and probe
Problem hearing
impairment
day 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

Dysphagia

A boy 14 y.o
Para parese (?)
Survive from
leukemia 2 years
ILIB
24 Mei
2008

Scanner
-Back slapt
-Strengthening
-Home scholling

13 November 2008

Diabetic foot

Herpetic neuralgia

OA Genu

Trauma

Back pain

Thank