Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Thérapie par laser haute intensite (classe 4) : principes, indications, retour d’expérience

842 views

Published on

Thérapie par laser haute intensite (classe 4) : principes, indications, retour d’expérience

Published in: Health & Medicine
  • DOWNLOAD THE BOOK INTO AVAILABLE FORMAT (New Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THE can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THE is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBOOK .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, CookBOOK, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, EBOOK, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THE Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THE the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THE Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Copas Url to Read PDF eBook === http://freeadygiuagdia.ygto.com/2253127361-therapie.html
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/qURD } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/qURD } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download doc Ebook here { https://soo.gd/qURD } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

Thérapie par laser haute intensite (classe 4) : principes, indications, retour d’expérience

  1. 1. THERAPIE PAR LASER HAUTE INTENSITE (CLASSE IV) : Principes, Indications, Retour d’expérience Institut Régional de Médecine du SportDr BERTIN DR BERTIN DR ROUDESLI, DR BEHAGUE, DR MICHAUD, DR VINCENT, DR LEVAVASSEUR, DR CAUCHOIS, DR MARTINET
  2. 2. Principes  Photothérapie :  une molécule absorbe des photons  électrons niveau d’énergie supérieur  repassent brièvement à leur état fondamental  réémission de photons  induction de réactions photochimiques  libération chaleur
  3. 3.  Effet photochimique et photomécanique Principes
  4. 4.  Effet photochimique et photomécanique  Augmentation métabolisme cellulaire (augm. synthèse ATP et conso O²)  Notamment par pompe sodium potassium et action sur mitochondries  Augm. synthèse protéique et donc nombre de mitose  Augmente prolifération ténocytes  stimule synthèse collagène et activité fibroblastique Stimule sécrétion opiacés endogènes Limite conduction message douloureux des fibres nociceptives)) Principes
  5. 5.  Effet photochimique et photomécanique  Augmentation métabolisme cellulaire (augm. synthèse ATP et conso O²)  Notamment par pompe sodium potassium et action sur mitochondries  Augm. synthèse protéique et donc nombre de mitose  Augmente prolifération ténocytes  stimule synthèse collagène et activité fibroblastique Stimule sécrétion opiacés endogènes Limite conduction message douloureux des fibres nociceptives)) Principes
  6. 6.  Effet photochimique et photomécanique  Augmentation métabolisme cellulaire (augm. synthèse ATP et conso O²)  Notamment par pompe sodium potassium et action sur mitochondries  Augm. synthèse protéique et donc nombre de mitose  Augmente prolifération ténocytes  stimule synthèse collagène et activité fibroblastique  Stimule sécrétion opiacés endogènes  Limite conduction message douloureux par les fibres nociceptives Principes
  7. 7.  Réparation tissulaire  Effet antalgique  Modulation réponse inflammatoire  Effet drainant / anti-oedeme Principes
  8. 8.  LLLT : low level laser therapy : début années 60  Limites du LLLT  Peu de profondeur  Difficulté pour obtenir effet photomécanique efficace  ↑ intensité  ↑efficacité (Navràtil, Prochazka)  fin année 90 début HILT : 10 W et plus Principes
  9. 9.  Epicondylite latérale :  Akkurt, 2014, Laser Med Sci :  30 patients, amélioration à court et long terme par HILT  Roberts, 2013, American College of Sports Medecine  Essai randomisé versus placebo16 patients  Amélioration significative à 3, 6 et 12 mois  Syndrome de conflit sous acromial  Santamato, 2009, Physical Therapy  Essai randomisé, HILT versus Ultra-sons, 70 patients  Diminution plus importante de la douleur dans groupe HILT Indications
  10. 10.  Tendinopathie achilléenne :  Prouza, 2015  Essai randomisé versus placebo, 51 patients  Amélioration significative à 4 et 12 semaines  Valent, 2015, Energy for Health  HILT + excentrique versus placebo + excentrique, 20 patients  Amélioration significative et plus rapide pour le groupe HILT  Autres localisations :  Syndrome myofacial, Dundar, 2014, Laser in medical science, Springer  Gonarthrose : 3 groupes, Kheshie, 2014, Laser in medical science, Springer  Lombalgie : Alayat, 2014, Laser in medical science, Springer Indications
  11. 11.  Tendinopathie achilléenne :  Prouza, 2015  Essai randomisé versus placebo, 51 patients  Amélioration significative à 4 et 12 semaines  Valent, 2015, Energy for Health  HILT + excentrique versus placebo + excentrique, 20 patients  Amélioration significative et plus rapide pour le groupe HILT  Autres localisations :  Syndrome myofacial, Dundar, 2014, Laser in medical science, Springer  Gonarthrose : 3 groupes, Kheshie, 2014, Laser in medical science, Springer  Lombalgie : Alayat, 2014, Laser in medical science, Springer Indications
  12. 12. Intérêt Laser CO²  Traitement :  Contre indications :  Antécédent de cicatrice chéloide ou hypertrophique  Traitement photosensibilisant en cours  Radiothérapie, plaie, infection cutanée en cours sur zone à traiter  Indolore  non invasif  Efficace  Peu d’effets indésirables  Rares CI
  13. 13. Protocole Laser CO² IRMSHN  8 séances  2 par semaine  Bilan à M1  EVA Amélioration  A : Groupe "résultat insatisfaisant" : EVA 0 à 29%  B : Groupe "résultat moyennement satisfaisant" : 30 à 49%  C : Groupe "résultat bon ou satisfaisant" : 50 à 79%  D : Groupe "résultat très satisfaisant ou guérison" : 80 à 100%  Inclusion janvier 2015 a septembre 2016
  14. 14. Protocole Laser CO² IRMSHN  Pathologies aigues :  Lésions ligamentaires  Lésions musculaires / musculo–aponévrotiques  Tendinopathies aiguës tous types  Pathologies chroniques :  Séquelles d’entorses  Lésions musculaires fibreuses  Tendinopathies chroniques
  15. 15. Résultats  173 patients inclus  Age : Moy : 49.7 - Med : 49 (22 à 84 ans)  (pas de différence en fonction du sexe) 110 64% 63 36% Hommes Femmes
  16. 16. Résultats 0 10 20 30 40 50 60 Sequelles entorse cheville Tendinopathie poignet Lésion musculaire aigue ou chronique Tendinopathie Genou autre que patellaire Epitrochléite Epaule Tendinopathie ext/flech orteils, tibial… Aponévrosite plantaire Tendinopathie moyen fessier Tendinopathie patellaire Epicondylite latérale Tendinopathie achilléenne
  17. 17. Résultats  Durée évolution :  Moy : 17.8 mois  Med : 12 mois  Min : 0.5  Max : 240 oui 42%non 58% ODC préalable oui 19% non 81% Infiltr préalable
  18. 18. Résultats  Nombre traitements antérieurs :  0 à 5  Moy : 1.98 0 10 20 30 40 50 60 1 2 3 4 5 6 12 43 58 27 13 4 Nbre ttt antérieurs
  19. 19. Résultats 100 50 29 11 31 84 103 127 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Hyperhémie Doppler Fissuration Bursite Ténosynovite
  20. 20. Résultats OUI 40% NON 60% Réveils nocturnes OUI 75% NON 25% Dérouillage matinal
  21. 21. Résultats  EVA Amélioration  Moyenne : 54.6%  Médiane : 62.5% OUI 87% NON 13% 33 38 6 23 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% insatisfaisant moyennement satisfaisant satisaisant et bon tres satisfaisant et guérison
  22. 22. Amélioration en fonction de l’Age Age < 50 Age ≥ 50 Moy 46 62.7 Med 50 75 84 91 16 9 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Age < 50 Age ≥ 50 NON OUI 24 40 39 37 4 832 14 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Age < 50 Age ≥ 50 A B C D
  23. 23. Amélioration en fonction du sexe H F Moy 53 57 Med 60 70 85 90 15 10 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% H F NON OUI 38 25 29 51 6 7 26 17 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% H F A B C D
  24. 24. Amélioration en fonction de la durée d’évolution <12 mois ≥ 12 mois Moy 65 48 Med 80 60 91 88 9 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% < 12 mois ≥ 12 mois NON OUI 46 22 34 46 5 6 15 27 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% < 12 mois ≥ 12 mois A B C D
  25. 25. ≤3 mois > 3 mois Moy 71 54 Med 80 60 95 89 5 11 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ≤ 3mois >3 mois NON OUI 60 28 20 43 7 6 13 23 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ≤ 3mois >3 mois A B C D Amélioration en fonction de la durée d’évolution
  26. 26. Amélioration en fonction du nombre de traitements antérieurs 0 ou 1 ttt 2,3,4 ou 5 ttt Moy 56 53 Med 70 60 85 88 15 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 ou 1 ttt 2,3,4 ou 5 ttt NON OUI 40 25 28 46 8 6 24 22 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0 ou 1 ttt 2,3,4 ou 5 ttt A B C D
  27. 27. Amélioration en fonction de la réalisation antérieure d’ODC ODC Pas d’ODC Moy 53 56 Med 60 70 86 88 14 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ODC Pas d'ODC NON OUI 25 40 46 31 6 7 23 23 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ODC Pas d'ODC A B C D
  28. 28. Amélioration en fonction de la réalisation antérieure d’infiltration Infiltr Pas d’infiltr Moy 40 59 Med 50 70 73 91 27 9 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Infiltr Pas d'Infiltr NON OUI 13 38 44 363 741 18 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Infiltr Pas d'Infiltr A B C D
  29. 29. Amélioration en fonction de la présence d’un dérouillage matinal DM+ DM- Moy 52 60 Med 66 70 89 93 11 7 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% DM+ DM- NON OUI 29 25 38 64 8 4 24 7 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% DM+ DM- A B C D
  30. 30. Amélioration en fonction de la présence de réveils nocturnes RN+ RN- Moy 65 51 Med 70 60 94 86 6 14 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% RN+ RN- NON OUI 38 26 48 41 4 8 10 26 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% RN+ RN- A B C D
  31. 31. Médiane % Gpe C+D % Gpe D Total 62.5 71 33 Age < 50 50 63 24 Age ≥ 50 75 77 40 H 60 67 38 F 70 76 25 < 12 mois 80 80 46 ≥ 12 mois 60 67 22 0 ou 1 ttt 70 68 40 2,3,4 ou 5 ttt 60 72 25 ODC 60 72 25 Pas d'ODC 70 70 40 Infiltr 50 56 13 Pas d'Infiltr 70 75 38 DM+ 60 67 29 DM- 70 89 25 RN+ 70 85 38 RN- 60 66 26
  32. 32. Médiane % Gpe C+D % Gpe D Total 62.5 71 33 Age < 50 50 63 24 Age ≥ 50 75 77 40 H 60 67 38 F 70 76 25 < 12 mois 80 80 46 ≥ 12 mois 60 67 22 0 ou 1 ttt 70 68 40 2,3,4 ou 5 ttt 60 72 25 ODC 60 72 25 Pas d'ODC 70 70 40 Infiltr 50 56 13 Pas d'Infiltr 70 75 38 DM+ 60 67 29 DM- 70 89 25 RN+ 70 85 38 RN- 60 66 26
  33. 33. Médiane % Gpe C+D % Gpe D Total 62.5 71 33 Age < 50 50 63 24 Age ≥ 50 75 77 40 H 60 67 38 F 70 76 25 < 12 mois 80 80 46 ≥ 12 mois 60 67 22 0 ou 1 ttt 70 68 40 2,3,4 ou 5 ttt 60 72 25 ODC 60 72 25 Pas d'ODC 70 70 40 Infiltr 50 56 13 Pas d'Infiltr 70 75 38 DM+ 60 67 29 DM- 70 89 25 RN+ 70 85 38 RN- 60 66 26
  34. 34. Médiane % Gpe C+D % Gpe D Total 62.5 71 33 Age < 50 50 63 24 Age ≥ 50 75 77 40 H 60 67 38 F 70 76 25 < 12 mois 80 80 46 ≥ 12 mois 60 67 22 0 ou 1 ttt 70 68 40 2,3,4 ou 5 ttt 60 72 25 ODC 60 72 25 Pas d'ODC 70 70 40 Infiltr 50 56 13 Pas d'Infiltr 70 75 38 DM+ 60 67 29 DM- 70 89 25 RN+ 70 85 38 RN- 60 66 26
  35. 35. Tendinopathie Achilléenne  EVA Amélioration  Moyenne : 58.8%  Médiane : 70% OUI 89% NON 11% 41 27 11 21 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% insatisfaisant moyennement satisfaisant satisaisant et bon tres satisfaisant et guérison
  36. 36. Epicondylite latérale  EVA Amélioration  Moyenne : 61%  Médiane : 60% OUI 95% NON 5% 26 58 3 13 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% insatisfaisant moyennement satisfaisant satisaisant et bon tres satisfaisant et guérison
  37. 37. Conclusion  Traitement efficace :  Sur des pathologies rebelles  Des indications préférentielles  Place dans l’arsenal thérapeutique du médecin du sport?

×