1
Q
Therapeutic LASER
A
- Light Amplification by Stimulated Emission of Radiation
~ Cold laser because of the low power
used (<500 mW)
~ Emits photons into the tissues
> Individual parts of a light wave
> Zero mass
> No electric charge
2
Q
Characteristics of LASER Light: Coherence
A
Photons emitted from a specific medium have some spacing relationships within the light wave
3
Q
Characteristics of LASER Light: Monochromatic
A
- Emitted light waves from a specific medium have a single defined wavelength
~ Emits light that’s only one color
> Ambient light is composed of
many wavelengths and colors
4
Q
Characteristics of LASER Light: Collimated
A
The light from a laser emerges in an extremely thin beam with very little divergence
5
Q
Class 3 LASER
A
- Due to low power, class 3 lasers don’t heat up tissues
~ Low Level Laser
~ Cold laser
~ Soft laser
> Pts. may perceive an increase in
temperature due to potential
increased circulation
6
Q
Effects of LASER Tx: Photomodulation
A
- Light modifies biological processes by interacting with cellular photoreceptors
~ Effects determined by the amount of
energy/photons absorbed
> More photons = more effects
7
Q
Effects of LASER Tx: Wound/Tissue Healing
A
- Most evidence comes from wound healing studies.
~ Increases number and/or activity of
fibroblasts.
~ Speeds conversion of fibroblasts to
myofibroblasts.
> Myofibroblasts help contract
wound margins.
8
Q
Effects of LASER Tx: Pain
A
- Evidence that laser decreases pain, but no clear mechanism identified
~ Healing
~ Inhibition of nociceptor.
9
Q
Class 4 LASER
A
- Uses increased power (>500 mW)
- Heats superficial tissues
~ All effects of heat are in play
~ Uncertainty exists relative to
photomodulation effects - Can burn pt.
10
Q
Arndt-Schultz Law
A
- There’s an amount of energy that’s optimal
- Less than that will cause no effects and greater levels will be detrimental to tissues
- At a certain point Tx is no longer beneficial
11
Q
Dosage of Laser Tx
A
- Theoretically dosage should match the condition
~ Need enough photons in the area to
make a change - Power output of the units is often fixed so the way to alter dosage is by manipulating the Tx time
12
Q
LASER Indications
A
- Any condition that requires healing
- Pain
13
Q
LASER Contraindications
A
- Cancer
- Directly over eyes
14
Q
Bottom Line of LASER?
A
- If light doesn’t penetrate the desired tissues, there will be no beneficial effects
- Depth of penetration is a function of wavelength color
~ 600-1000 nm typically used
15
Q
Monochromatic Infrared Energy (MIRE)
A
- Application of near infrared light energy to the tissues.
~ Infrared
> Light energy that can not be seen.
> Produces heat energy.
> Ex. Heat from a fire or light bulb.
~ Near Infrared
> Light energy that can be seen.
> Does produce heat, but very little.
16
Q
Effects of MIRE
A
- Appears to increase fibroblast activity
- Appears to increase nitric oxide levels in the tissues treated
17
Q
Effects of MIRE: Nitric Oxide Function
A
- Acts as a vasodilator = increased circulation
~ Nitric Oxide is produced by many
tissues including blood vessels
> Production of nitric oxide causes
smooth muscle to relax
18
Q
MIRE Indications
A
- Sub Acute/Chronic conditions
- Any condition where increased circulation is needed
~ Wounds
~ Fracture
~ Diabetes - Pain
- Spasm
19
Q
MIRE Contraindications
A
Acute conditions
20
Q
Longwave US
A
- Application of long wave length ultrasound = low frequency ultrasound.
- Typical US Frequencies
~ 1 MHz = 1000 kHz
~ 3 MHz = 3000 kHz - Longwave Ultrasound Frequency
~ Very low
> .045 MHz = 45 kHz
• much deeper & much
more divergence
21
Q
Longwave US Characteristics: Frequency and Intensity
A
- Frequency
~ As frequency increases:
> Depth Decreases - due to
greater absorption of
superficial tissues.
> Divergence Decreases - Intensity
~ Very low
> Measured in milliwatts mW.
> Ex: 60 mW/cm2 = 06 W/cm2 - Does not heat up tissues
22
Q
Longwave US Effects
A
- Increases Cell Membrane Permeability
- Stimulates Fibroblast Activity
- Stimulates WBC Activity
- Stimulates Osteoblast Activity
23
Q
Microcurrent Electrical Stimulation
A
- Current applied at an intensity below sensory or motor levels (pt. doesn’t feel anything)
~ Current parameters are extremely
variable between manuracturers.
~ 1/1000 the amperage of TENS, but
much longer pulse duration.
~ Effects are not well understood.
> Some studies do show
improvement, but not greater
than other available modalities.
• Improvement shown in
studies using electrodes
implanted in the tissues.
• Improvement shown with
DC variety with negative pole.
24
Q
Microcurrent Electrical Stimulation: Theory/Effect of Injury
A
- Tissue trauma increases the cells resistance to electrical current.
- The body’s intrinsic bioelectrical currents take the path of least resistance around the site of trauma.
~ Results in diminished bioelectrical
activity within the site disrupting cell
homeostasis
25
Microcurrent Electrical Stimulation: Thoery/Effect of Current
- Microcurrent re-establishes the body’s electrical balance and restores normal levels of resistance
- Restores Homeostasis
~ Allows cell's ATP supply to be
restored so cells can properly
function and heal area.
> Low intensity electrical current
has been shown to increase
ATP opposed to higher
intensities which have been
shown to decrease ATP.
26
InterX
Delivers pulsed AC while measuring resistance in tissues to direct practitioner to specific area for treatment.
27
Compex
Delivers AC. Presets deliver waveforms that are effective for sensory input (TENS) and muscle contraction (NMES)
28
Hivamat
Deep tissue oscillation due to a pulsed electrostatic field.
