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Laser Phototherapy

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  • 1. The Quality SystemISO 9001:2008 &ISO 13485:2003This is certified and checkedyearlyby the German mdc GmbH,StuttgartAll products are CE compliant.
  • 2. Definition of LPTLPT is the abbreviation for Laser Photo Therapy,which means the treatment of symptoms like pain,inflammation or wound healing with non-thermallaser radiaion, LPT is used in various fields like:Pain / inflammation: Wound healing: - Arthrosis - Burns - Epicondylitis - Scars / Keloids - Carpal Tunnel Syndrom - Ulcus cruris - Diabetic footSport Injuries: Others: - Luxation - Tinnitus - Distortion - Acne - Fracture - Facial Paresis - Shoulder-Arm-Syndrom - Zoster
  • 3. Example on tissue regenerationAfter 2 weeks
  • 4. Accelerated wound healing
  • 5. History of LPTIn 1963 Endre Mester performed the first trreatmentof lasers on mice. He found a stimulation of hairgrowth on the treated spots.*In later studies he found also an increasedepithelization of wounds.*** Endre Mester, B.Szende u.a.: The effect of laser beams onthe growth of hair in mice. In: Radiobiol Radiother. 9/1968,S.621-626** Endre Mester: Laser - induced stimulation of thevascularisation of the healing wound. In: Separat.Exp.30/1974, S.341-345
  • 6. Scientific EvidenceIs there scientific evidence for LPT?The answer is clearly: YES - More than 3000 scientifical and clinicalpublications listed in PubMed* - More than 160 randomized placebo controlleddouble blind studies*** **: December 2011
  • 7. Different laser types used in medicineDifferent lasers for different indications:Tatoo & hair removal – 694 nm Ruby laser (crystal)‫‏‬Hair removal, bone cutting – 755 Alexandrite (crystal)‫‏‬Tumor coagulation – 1064 nm NdYAG (crystal)‫‏‬Kidney stone treatment – tunable (liquid dye laser)‫‏‬Eye surgery – 193 nm, 248 nm, 308 nm Excimer laser (gas)‫‏‬Dermatology – 10.600 nm CO2 laser (gas)‫‏‬ Biostimulation: LaserCat / PalmLaser / SilkLite HeNe: 633 nm red (gas)‫‏‬ InGaAlP: 630 nm – 685 nm red (semiconductor, diode)‫‏‬ GaAlAs: 780-820-870 nm IR (semiconductor, diode)‫‏‬ GaAs: 904, 905 nm IR (semiconductor, diode)‫‏‬
  • 8. Laser Light and BiophotonsA laser emits a special sort of light which ismonochromatic(only one colour ==> highest power intensity)and• coherent(all waves oscillate parallel to each other)‫‏‬Biophotons of the body emit alsocoherent light* Wave peaks and wave troughs are parallel to each other * Prof. Dr. Fritz-Albert Popp, Int. Institute for Biophysics, Neuss www.biophotonen-online.de
  • 9. The meaning of coherency Non-coherent light Coherent light
  • 10. UV – Visible - IR
  • 11. UV – Visible - IR
  • 12. Wavelength dependent treatment depth
  • 13. Spectrum and Penetration depthSpectrum of radiation * ** Visible light UV light IR light x-rays Thermal radiation Cosmic radiation TV RadioMedSolution LPT devices: •‫‏‬Wavelength:‫‏‬combination‫‏‬of‫‏‬ red* & infrared**Red: for indications on the surfaceinfrared: for deep laying indications
  • 14. Treatment depth versus treatment time
  • 15. The ATP synthesisATP (Adenosine-Tri-Phosphate): themolecular energy for each cell of the bodyand the skin.It is built in the mitochondria, the powerstation in each cell. The light is absorbedby components of the cellular respiratorychain namely cytochrome c oxidase (COX).If there is too less ATP available, the cell Mitochondriacannot follow its functions 100%LaserCat & PalmLaser bring energy to themitochondria where it is used to producemore ATP - which means new energy forthe cell.Regeneration of the cell, the tissue and thebody can be seen already after a fewtreatments.
  • 16. Biochemical effects• LPT increases the ATP synthesis min 150 %==> biostimulation / regeneration of tissue==> reduction of inflammation==> relief of pain•‫‏‬LPT‫‏‬stimulates‫‏‬the‫‏‬collagen‫‏‬production‫‏>==‏‬improved‫‏‬tissue‫‏‬regeneration•‫‏‬LPT‫‏‬supports‫‏‬the‫‏‬blood‫‏‬flow,‫‏‬lymphatic‫‏‬flow‫‏‬and‫‏‬metabolism‫‏>==‏‬more‫‏‬nutrients,‫‏‬more‫‏‬oxygen,‫‏‬more blood cells are available for an increased healing and regeneration, swellings are reduced•‫‏‬LPT‫‏‬stimulates‫‏‬the‫‏‬RNA-, DNA- & protein synthesis ==> improved cell regeneration
  • 17. Enhancement of ATP production
  • 18. Arndt-Schultz-LawBiphasic dose response in measured difference in integrated areaunder the curve of time course of wound size compared to notreatment control, with a clear maximum seen at 2 J/cm2, and the highdose of 50 J/cm2 gave a worsening of the wound healing time*Dose Response. 2009; 7(4): 358–383.Published online 2009 September 1. doi: 10.2203/dose-response.09-027.Hamblin, PMCID: PMC2790317Biphasic Dose Response in Low Level Light TherapyYing-Ying Huang, Aaron C.-H. Chen, James D. Carroll, Michael R.
  • 19. Pain versus timePain Time
  • 20. Effects on wound healing - Enhanced DNA and RNA synthesis * - Stimulation of mitosis ** - Accelerated tissue regeneration **** M.Dyson, S.Young: Effect of laser therapy on wound contraction and cellularity an mice. In:Lasers Med.Sci. 1/1982, S.125-130* Tiina Karu: Molecular mechanism of the therapeutic effect of low-intensity laser irradiation. In:Lasers Life Sci. 2/1988, S.53-74* V.Manteifel u.a.: Activation of transcription in lymphocytes after exposure to a He-Ne laser. In:Mol.Biol. 24/1990, S.860-867*,G.Danhof: Biological effects of the laser beam. In: Lasers in Medicine and Dentistry. Zagreb2000, S.127-152** Tiina Karu: Mechanisms of Low-Power Laser Light Action on cellular Level In: Lasers inMedicine and Dentistry.Zagreb 2000, S.97-125** O.A. Tiphlova und Tiina Karu: Role of primary photoacceptors in low-power lasereffects:action of He-Ne Laser radiation on bacteriophage T4 - Escheria coli interaction. In:Lasers Surg.Med. 9/1989, S.67-69*** N.Ben-Dov. u.a.: Low-energy laser irradiation affect satellite cellproliferation anddifferentiation in vitro. In: Biochem.Biophys.Acta. 3/1999, S.372-380*** A.Mester u.a.: Open wound healing - bed sores, ulcus cruris, burns - with systemic effects ofLLLT. In: Lasers in Medicine and Dentistry. Zagreb 2000*** V.d.Veen, P.Lievens: Low level laser therapy (LLLT): the influence on the proliferation offibroblasts and the Influence on the regeneration process of lymphatic, muscular and cartilagetissue. In: Lasers in Medicine and Dentistry. Zagreb 2000, S.187-217
  • 21. Application in Medicine - examplesDermatology / General Medicine Dental Medicineplastic surgery Acute injuries Acid & Grinding Trauma Abrasions Arthrosis Aphtae Acute injuries Gout Dentitio difficilis Allergies Neuralgiform pain Extraction wounds Burns Panarteriitis Lockjaw Decubiti Tinnitus Nausea Fresh scars & keloids Trigeminusneuralgi Paradontosis Hematoma after surgery a Stomatitis Wounds Temporomandibular- jaw Herpes Zoster, H. painLabialis Orthopaedics Dental root hyper- Post surgical pain Carpal Tunnel Syndrome sensibilities Ulcus Cruris Distortion Urticaria Epicondylitis Wounds Fibromyalgia Ischialgia Lumbago Muscular Induration Post surgical pain Shoulder-Arm-Syndrome
  • 22. Contraindications / Precautions Patientes with cardiac pacemaker in the area of the thorax Pregnant women in the area of the abdomen Patients with cancer Skin diseases without diagnose Epilepsy patientsno radiation on: Open eyes Thyroid gland Solar Plexus Childs epiphysis Open fontanel of infants
  • 23. Side effectsThe Laser Photo Therapy has only very few side effects:The treatment effect can be:• A little tingeling in the treated area• A warm feeling in the treated area (blood flow!)‫‏‬• A higher sensitivity in open wounds• If too much energy is used, a surpressing effect can take placeFurther there can be• Some tiredness• Increased sweating
  • 24. Why should I start using LPT – New Paradigma Very broad indication range of LPT & No or negligible side effects ->Trade off between beneficial effect and side effects always in favour of treatment -> Therapy possible without secure diagnosis
  • 25. Safety considerationsEye protectionParallel laser beams are of great danger for theeyes. The beam can be focused by the eyes anddamage the retina irreparable ! (Class 3b & 4lasers)‫‏‬Laser light which is coming through the closedeyes is not dangerous as the light is not focused, itis diffuse.PalmLaser are class 1M lasers and emit adivergent beam, which becomes only danger, bylooking into it directly for more than 100 seconds.A divergent beam can not be re-focused by theeyes. Therefore PalmLaser are much safer thanclass 3b lasers.There are no precaution actions necessary for aclass 1M laser.
  • 26. Specification of PalmLaser PalmLaser: combination of cw lasers red & IR Laser 1Power Red laser 650 nm, 20 mWin mW cw = continuous wave Time in nsec Laser 2Powerin mW IR laser 785 nm, 80 mW cw = continuous wave Time in nsec
  • 27. PL - Safety Laserclass 1M:  No protection goggle  No laser safety course  No special precautions required
  • 28. PalmLaser •If the red battery control LED lights up, PalmLaser needs to be charged. There are approx 5 minutes left to finish the treatment. •During charging PalmLaser, a green LED lights up till the charging process is finished. Charging time - approx. 3 h Treatment time - approx. 1 h
  • 29. PL & PL professional - accessoriesPalmLaser / PalmLaser professional comes with the followingaccessory:•PalmLaser•Operation manual•Battery charger•Case•Accumulators (inside PalmLaser)‫‏‬
  • 30. PL & PL professional - Application•‫‏‬Muscle-lesions •‫‏‬Arthrosis•‫‏‬Edema •‫‏‬Rheumatoid arthritis•‫‏‬Swellings •‫‏‬Myalgia•‫‏‬Bursitis •‫‏‬Decubitus ulcers, Pressure sores•‫‏‬Tendinopathies •‫‏‬Circulatory disorder•‫‏‬Tenosynovitis •‫‏‬Diabetic foot•‫‏‬Distortions, contusions, sprains •‫‏‬Ulcus cruris, Leg ulcers•‫‏‬Capsulo-ligamentar lesions •‫‏‬Back pain•‫‏‬Abrasions •‫‏‬Shoulder-arm-syndrome, Frozen•‫‏‬Fractures shoulder•‫‏‬Iliotibial‫‏‬band‫‏‬syndrome‫(‏‬runner‘s‫‏‬ •‫‏‬Tension, stiffnessknee) •‫‏‬Carpal-tunnel-syndrome•‫‏‬Traumas •‫‏‬Fall-related injuries
  • 31. Application CTS Knee ShoulderHead
  • 32. Application
  • 33. Application
  • 34. Application
  • 35. PalmLaser– Application Dr. RarreckThe application is aseasy as with LaserCat.After adjusting the timedue to therecommendations in themanualOr against ownexperience, the diffusor Dr. Rarreck, FC Schalke 04can be set on the skinandThe treatment can bestarted.The diffusor shall stayin contact with the skinto avoid too muchloss by reflections.Exception: open Jörg Blüthmann, Physiotherapistwounds. Hertha BSC BerlinPalmLaser shall bemoved slowly over the
  • 36. PL– Application Schalke 04
  • 37. PL – Application Schalke 04
  • 38. PL– Application Schalke 04
  • 39. Self-Treatment
  • 40. Veterinary use
  • 41. Advantages of LPT with LaserCat &PalmLaser Easy operation Two wavelength in one machine Class 1M laser Pre-set program in LaserCat Mobile use with PalmLaser & SilkLite No protection goggle needed No harm to the skin/tissue, no heat For acute & chronic diseases
  • 42. Advantages for the doctor´s practice using LPT•‫‏‬Highly‫‏‬profitable‫‏‬already‫‏‬with‫ 3-2‏‬patientsPalmLaser delivers highly effective laser- phototherapy and represents a lucrativeproposition to professionals. Performing regular therapy sessions on 2 -3 patients permonth breaks the threshold of profitability.•‫‏‬Patient‫‏‬loyalty‫‏‬and‫‏‬acquisition‫‏‬toolOffering and delivering effective and safe innovative therapies elevates the image ofthe practice, leading to long term patient loyalty and patient recommendation basedincrease in popularity.•‫‏‬Using‫‏‬your‫‏‬assistant‫‏‬to‫‏‬the‫‏‬full‫‏‬potentialPalmLaser treatment is easy to perform and can be delegated to less qualified, but welltrained‫‏‬assistants,‫‏‬thus‫‏‬freeing‫‏‬the‫‏‬valuable‫‏‬doctor‘s‫‏‬time‫‏‬for‫‏‬other‫‏‬duties‫‏‬and‫‏‬tasks.The assistants can dedicate more time to the patients, thoroughly explaining the thera-py and providing as much personal care and attention as the patients desire.Further the motivation and qualification of the assistant will increase.•‫‏‬Enhancing‫‏‬your‫‏‬therapy‫‏‬systemsAbility to perform laser-phototherapy guarantees a real USP advantage for your practice.Despite its proven efficacy and safety, laser-phototherapy is not yet widely spreaddue to the past difficulties with early lasers (i.e. complexity, size and high costs).PalmLaser from MedSolution provides a practical and affordable solution to the pro-blems of the past, making laser-phototherapy accessible, affordable and well withinyour reach!As a part of modern therapeutic approach PalmLaser is an effective and safe therapeu-tic solution to many health problems.
  • 43. Advantages for the patient using LPT•‫‏‬Highly‫‏‬efficientPalmLaser delivers highly powerful and potent laser therapy for acute or chronic medicalconditions. PalmLaser supports an array of healing processes at cellular level and signifi-cantly accelerates regeneration. Pain and inflammation reduce swiftly.•‫‏‬No‫‏‬side‫‏‬effects‫ –‏‬highly efficient treatment methodToday‘s patient is well informed and demands interventions that are effective,safe andwithout side effects or treatment related harms. Therapy with PalmLaser is safe and pain-less. Side effects have never been noted. PalmLaser is a stand alone therapeutic modalityor can be used in synergy with other therapies, such as physiotherapy or prescriptionmedicines. In some conditions, PalmLaser can entirely replace or largely reduce the needfor other therapeutic interventions.•‫‏‬Fast‫‏‬recoveryLaser-phototherapy helps athletes to return to training or competition faster or withoutexcessively long delay. Portability of PalmLaser allows the treatment to commenceimmediately after the trauma has occurred – The immediate post trauma application oflaser therapy is the most effective way of dealing with injuries for optimum healing andfast recovery.•‫‏‬Premium‫‏‬therapy‫‏‬for‫‏‬supporting‫‏‬the‫‏‬somatic‫‏‬self-healing mechanismsLaser-phototherapy is a natural and modern therapy that is recognised and appreciatedby many people. Older and the elderly patients in particular value the features and thebenefits of laser-phototherapy. Laser-phototherapy is effective, yet gentle and non-trau-matising. It activates self healing, regeneration and restoration. Improvements achievedwith PalmLaser phototherapy can be life changing and giving new leases to
  • 44. Example – diabetic foot ulcerLaserWorld Guest Editorial, Nr 13 - 2000.The mangement of diabetic neuropathiculceration by HeNe laser.The following photo sequence has been contributed by Dr.Ali Abaci, TurkeyThe main effects of the LLLT helps the patient in terms of-> skin regeneration-> wound healing-> blood circulationTreatment parameters for the diabetic neuropathic ulceration are given below : He-Ne Laser,wavelength 632 nm. Continuous Wave Beam Area(cm2)= Diameter(cm)2 x 0.7854 = (3.1 x 3.1)x 0.7854 = 7.547 cm2 Laser Output Power = 5 mW= 0.005 W Laser Output Power(W) PowerDensity(W/cm2)= Beam Area(cm2) 0.005 == 0.0006625 W/cm2 7.547 Energy Density(J/cm2)=Power Density(W/cm2) x Time(sec) = 0.0006625 x 600 = 0.3975 J/cm2 = ~ 0.4 J/cm2.Treatments were given once a day, 5 days a week, totally for 4 weeks
  • 45. Example – Diabetic Foot Surgery I Chief Surgeon & SAFDAP: Dr. Abdulazizi Al-Qannass Podiatry Surgery Team – Riyadhh: SAFDAP Assistant Ms. Jazwa Al-Otaibi Mr. Matthew Mallon Mr. Mumdoh MnwarCase: 42 old Male, sufferingfrom Obesity and DiabeticType II. Come to the clinicwith highly affected toe in theright foot, amputation neededfor the fifth toe. Onmedication Hypo Glacimic,after amputation started onInsulin.Foot after fourth sessionwith PalmLaser:Pus from tunnel woundDry tissue and dark colorWound is closing
  • 46. Example – Diabetic Foot Surgery II The after amputation wound was under treatment with antibiotic for 3 months, wound did not heal and foot skin color was dark and did not get well, the patient was under stress and pain.Low Level Laser Therapy wasdecided to be applied byPalmLaser, 5min, eachsession, day after day,3sessions per week. The timeframe of treatment set to 30Days.Foot afer 13 sessions withPL:Tissue and skin heal fromnecrotic stage.Wound completely heal frominfection and wound is closewith no pain.Foot tissue and bloodcirculation are back tonormal.