Abstracts NAALT 2002
Iuliu Hatieganu University of Medicine and Pharmacy, 13 Emil Isac 3400, Cluj-Napoca, ROMANIA
Most surgeons who use laser are generally aware of the risk of eye injury. Appropiate eye protection measures must be used. However, too much eye protection can also prevent safe and proper surgery. At a certain level all laser wavelengths become safe because laser light is not ionizing radiation like X-rays. The greatest risk associated with laser devices is electrical shock. As long as the console`s panels are left in place, there is no significant electrical risk for anyone in the operating room. The laser should never be operated unless all panels are properly in place.
Only factory- trained personnel should open a laser system. Fire is another major concern with lasers. They must never be activated unless directed properly at target tissue. Lasers should always be placed in the standby mode when not actually in use. Drapes surrounding open surgical sites should be covered with moistened towels.
Skin injury is the last risk. If the skin is irradiated with a high energy laser beam (> 1W/mm2) it can result in burns. A longer radiation time with a weaker UV laser light can lead to symptoms comparable to sunburns. Good communication is essential to a safe operating environment. Most accidents resulting from laser devices are attributable to either poor communication or poor training. All communication should be a two-way process. Nothing should ever be assumed. Safety measures for patients and personnel undergoing laser surgery are: hold distance,. wear laser – safety glasses or goggles in laser area, the handpiece or the fiber is not a pointer, if not in use deposit handpiece and fibers safely, do not lase on surgical instruments, do not point on combustible materials and return to Stand-by whenever possible.
LLLT in treating dentinary hypersensibility: a histologic study and clinical application
Aldo Brugnera Jr.*
Ana Eliza Garrini, Antonio Pinheiro, Dilma Helena Souza Campos, Elisângela
Márcia Takamoto, Thereza Christinna Ladalardo
*Professor and Chairman of the Laser Department, School of Dentistry, Universidade Camilo Castelo Branco, São Paulo, SP, Brazil; Researcher of the Endodontic Laboratory – FORP USP, Ribeirão Preto, SP, Brazil; Researcher of the Laser Center , Universidade Federal da Bahia, Salvador, BA, Brazil
Dental hypersensitivity has been studied for several years and it is reported as a striking painful condition that originates from the exposition of dentinal tubuli as a result of the reduction of the thickness of the enamel or cement. Usually the exposed area is subjected to several kinds of stimuli, resulting in a rapid sharp acute pain.
The aim of this study was evaluated the efficiency of LLLT in the treatment of patients with dentinal hypersensitivity. 1102 teeth of 388 patients from the Laser Center of the Camilo Castelo Branco University were treated with LLLT between 1995-2000. 98 males and 290 females aged 30 to 45 years old were treated. For LLLT, a diode laser was used at 780nm, CW, 40mW, elliptical area of the beam 2mm2, exposure time per point 25s. This corresponds to an equivalent dose of 50 J/cm2 at each point (considering the area of the spot). If a 1cm2 area is considered, the total dose per tooth is 4J/cm2.
With the diode laser 830nm ,CW, 50mW, elliptical area o the beam 2mm2, exposure time per point of 20s. This corresponds to an equivalent dose of 50J/cm2 at each point (considering the area of the spot). If a 1cm2 area is considered, the total dose per tooth is 4J/cm2.
The results showed 403 (36.57%) out of 1102 teeth required a single session for complete remission of the symptom. 255 (23.14%) needed two sessions; 182 (16.51 %) three sessions; 107 (9.7%) four sessions; and 59 (5.35%) five sessions. 96 (8.71%) did not respond to LLLT and the patients were re-assessed and treatment changed.
The more affected tooth was the lower premolar (301 – 27.4%), followed by lower molars (163 – 14.8%), upper premolar (149 – 13.5%), lower incisive (148 – 13.4%), upper canine (119 – 10.7%), upper incisive (108 – 9.9%), lower canine (62 – 5.6%), and upper molars (52 – 4.7%).
The result of the present investigation demonstrates indeed that LLLT, when based on the use of correct irradiation parameters, is effective in treating dentinal hypersensitivity as it quickly reduces pain and maintains a prolonged painless status. The authors concluded that the use of LLLT was effective on 91.27% of the cases. Previous studies were carried out by the authors to evaluate histologically the reaction of the dentinal pulp in rats after application of LLLT .The LLLT was shown to be efficient in the stimulation of odontoblast cells, producing reparative dentin and closing dentin tubuli.
KEY WORDS: Dental Hypersensitivity , Laser therapy, LLLT
Cellular Effects Of Low Level Laser Therapy Relevant To The Stimulation Of Tissue Repair
Mary Dyson, PhD FAIUM(Hon) FCSP(Hon)
Visiting Professor, Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, Kansas 66160-7601, USA
Mdyson@kumc.edu
When used appropriately, low level laser therapy can stimulate tissue repair in chronic wounds and in acute wounds that are healing suboptimally. Following an outline of the repair process in skin, the effects of low level laser therapy on the activity of cells involved in this process will be reviewed. Research on keratinocytes, macrophages, mast cells, fibroblasts and endothelial cells has demonstrated stimulation of cell activity, provided that appropriate wavelengths and energy densities are used. The trigger for this appears to be a temporary increase in the permeability of the cell membrane to calcium ions. It is suggested that this may be the mechanism by which low level laser therapy produces its effects at the cellular level. The collective effect of these cellular events is the stimulation of tissue repair.
Laser Photostimulation of Collagenous Tissues Repair Processes in Patients and Experimental Animal Models of Tendon Repair and Diabetic Skin Ulcers.
C. S. Enwemeka, PhD, FACSM, G. K. Reddy, PhD, L. Stehno-Bittel, PhD, J. Thomas, MD
Departments of Physical Therapy & Rehabilitation Sciences and Division of Vascular Surgery
University of Kansas Medical Center, Kansas City, KS, USA
Connective tissues are notorious for their slow rates of healing. As a result, they are often protected in immobilization casts for long periods of time after surgery. The long period of immobilization predisposes a multitude of complications, including muscle atrophy, osteoarthritis, skin necrosis, infection, tendo-cutaneous adhesion, re-rupture, and thrombophlebitis.
If healing can be quickened, then, the duration of cast immobilization can be reduced to minimize the deleterious effects of immobilization. In several experiments, we studied the effects of He-Ne, Ga-As, and Ga-Al-As lasers on tissue repair. Furthermore, we tested the hypothesis that early weight-bearing, ultrasound, He-Ne laser, and Ga-As laser, when used singly or in combination, accelerate the healing process of experimentally tenotomized and repaired rabbit Achilles tendons as evidenced by biochemical, biomechanical, and morphological indices of healing.
Our results demonstrate that:
(1) Laser therapy of appropriate intensity promotes skin and tendon tissue repair processes.
(2) Appropriate doses of each modality, i.e., early weight-bearing, ultrasound, He-Ne and Ga-As laser therapy augment collagen synthesis, modulate maturation of newly synthesized collagen, and overall, enhance the biomechanical characteristics of the repaired tendons.
(3) Combinations of either of the two lasers with early weight-bearing and either ultrasound or electrical stimulation further promote collagen synthesis when compared to early weight-bearing alone.
However, the biomechanical effects measured in tendons receiving the multi-modality therapy were similar, i.e., not better than the earlier single modality trials. In other experiments, we tested the hypotheses that appropriate doses of laser therapy promote tissue repair in a rat model of experimental diabetes, and also in clinical cases of healing-resistant diabetic ulcers.
Our experimental diabetic ulcers healed faster with laser therapy, as did some human cases of diabetic leg ulcers. Our recent meta-analyses of the laser therapy literature corroborate these results, and support the widely held belief that appropriate intensities of laser therapy accelerate healing of collagenous tissues, i.e., skin, bones, tendons, ligaments, and cartilage. These studies and reports will be addressed during this presentation.
Funded by The NIH-NCMRR, The NIDRR, and VA-RR&D.
Summary of Clinical Studies on Low Energy Photon Therapy for Pain and Carpal Tunnel Syndrome Management
N. Filonenko, Ph.D.[1], N. Salansky, Ph.D.1,[2]
PO Box 502, 1057 Steeles Avenue West, Toronto, ON, M2R 3X1, CANADA
E-mal: nsalansky@sprint.ca
Low Energy Photon Therapy (LEPT) is a photo-therapeutic modality for pain relief and soft tissue healing acceleration that involves the irradiation of tissue with monochromatic light at intensities that do not cause thermal changes or ionization in tissues. Clinical studies reflected in this review have been performed in Canadian universities, hospitals and clinics during years 1989-2002. This clinical research has been supported by Canadian granting agencies (NRC and DoD of Canada and others). All studies have been performed using a professional system with different single and cluster multiple-sources probes at wavelengths of 660nm, 830nm, 880nm, and 990nm with a range of frequencies of 1-200 Hz, or continuous wave mode. Since 1989 we created three generations of LEPT clinical protocols (using light emitting diodes) for pain relief and carpal tunnel syndrome management. First generation of LEPT clinical protocols had been tested in several prospective, open protocol clinical and case studies involving over 250 subjects with different musculoskeletal and neuromuscular pathologies. Full resolution or significant improvement of symptoms was achieved in 55-75% of cases depending on the pathology. We conducted a correlation analysis of immediate pain relief (after 1-2 sessions of LEPT) and cumulative pain relief after 10 sessions using the results of these clinical studies. A strong positive correlation was found between immediate and cumulative (after 10 sessions) pain relief. This finding encouraged us to concentrate our effort on the optimization of LEPT protocols for immediate (after 1-2 sessions) pain relief. In early nineties we embarked upon investigation of the most crucial aspects of photon-biotissue interaction and LEPT dosimetry for pain relief and soft tissue healing. As a result of this basic research, we created next generations of integrated LEPT clinical protocols for pain relief and soft tissue healing. These integrated clinical protocols consist from several specific protocols that are applied in physiologically justified sequence one after another. Each specific LEPT protocol is hypothesized to improve a specific for this particular protocol soft tissue pathology, e.g., to relieve muscle spasticity, to increase cellular energy and reduce ischemic pain, to decrease swelling, to reduce pain and inflammation, etc. Integrated LEPT clinical protocols were further optimized in clinical settings (involving over 1500 patients) using biofeedback (surface EMG, Whole Blood Chemiluminescence, Laser Doppler Flowmeter, etc.).
An integrated LEPT clinical protocol efficacy for the recovery of the neck extensor muscle (NEM) strength and sleep improvement in subjects after acute whiplash injury has been tested in a randomized controlled clinical trial involving 54 subjects. By the end of this 8-week clinical trial, statistically and clinically significant improvement in the NEM strength and sleep pattern was observed in the LEPT group as compared to conventional therapy (neck exercises and manipulations) group.
The efficacy of integrated LEPT clinical protocol versus ultrasound and placebo LEPT for pain relief has been tested in a recent controlled, randomized, comparative double blind clinical trial. 75 subjects that suffered subacute (2 weeks-6 months duration) and chronic (>6 months duration) pain in soft tissue surrounding joints were randomly allotted to the following three groups: Group 1 received LEPT; Group 2 received Ultrasound; and Group 3 received placebo LEPT. Each subject received 2 treatments of selected in accordance with the random number modality during three consecutive days. Pain rating by 10-cm visual analog scale (VAS) was taken prior to and after each treatment. All required blindness procedures were strictly followed in this study. Statistical analysis revealed that LEPT had superior (4-fold) efficacy for pain relief as compared to ultrasound, and to placebo. In particular, in a group treated with LEPT mean pain VAS dropped by 40%, while in the ultrasound group a moderate pain reduction of 10% was not statistically significantly different from pain relief in the placebo group (by 14%). Another double blind clinical trial with a similar design on the LEPT efficacy for pain relief in 22 subjects who suffered from acute (<2 weeks duration) and subacute symptoms has been accomplished. LEPT efficacy (pain relief by 53.% after 2 treatments) was found to be superior to ultrasound (by 31.6%) and placebo (by 20%).
A prospective open protocol study on the efficacy of LEPT for symptom relief in patients with carpal tunnel syndrome (CTS) resulted in full resolution of symptoms in 15 out of 21 (71.4%) patients who suffered chronic CTS. The LEPT protocol that was used in this study appeared to be effective for symptom relief, however, it did not produce consistent clinically significant improvement of nerve conduction test. The LEPT protocol had been improved and tested in a recent prospective open protocol clinical trial involving 19 patients with 34 hands affected by CTS. In this study, a normalization of mean median nerve motor distal latency (from 4.68msec, range 4.2-6.0msec to 3.9msec, range 3.5-4.2msec) was observed after a course of LEPT (10-24 sessions). Patients also experienced pain relief by 70% and improvement of night sleep interruption by 79%. The results of the study were found to be statistically significant.
Last several years, we carried on jointly with Canadian hospitals and clinics a series of prospective open protocol studies on the LEPT efficacy for different types. These studies produced consistent statistically significant results of 39-56% of pain relief after 2 LEPT sessions including those patients who did not respond previously to conventional therapies.
We developed integrated LEPT protocol that could be administered immediately after trauma. Timing of LEPT administration after an acute injury appears to be a critical factor affecting the rate of recovery. Anecdotal case studies suggest that early intervention (within 24 hours after the injury) with LEPT could induce pain relief of 50-100% after 2 LEPT treatments. This pain relief is accompanied by inflammation and swelling reduction and improvement of ROM and weight-bearing. If these anecdotal data are proven in a rigorous double blind study, it could change a current paradigm of acute trauma management.
The above body of clinical evidence suggests that LEPT has substantial potential to become an effective treatment modality for pain, acute trauma and carpal tunnel syndrome management.
Low Energy Photon Therapy Efficacy for the Treatment of Wounds and Skin Ulcers
N. Filonenko, Ph.D.[3], N. Salansky, Ph.D.1,[4]
PO Box 502, 1057 Steeles Avenue West, Toronto, ON, M2R 3X1, CANADA
E-mal: nsalansky@sprint.ca
Low Energy Photon Therapy (LEPT) is a photo-therapeutic modality for pain relief and wound healing acceleration that involves the irradiation of tissue with monochromatic light at intensities that do not cause thermal changes or ionization in tissues. Low-energy photons (LEPs) are quanta of monochromatic electromagnetic waves in the visible (400-700nm) and near-infrared (700-1100nm) ranges of wavelengths. Unlike high-energy photons (ultraviolet or X-Ray), LEPs have much less (< 2ev) energy than needed to break chemical bonds or ionize biomolecules. Different monochromatic optical sources (lasers, laser diodes and light emitting diodes) can be used for LEPT depending on the particular application.
Since 1989 we created three generations of LEPT clinical protocols (using light emitting diodes) for wound, burn and skin ulcer healing acceleration. First generation of LEPT clinical protocols had been tested in a prospective, open protocol clinical study and case studies. In a prospective pilot clinical study, seven patients with 11 chronic leg ulcers that had been scheduled for surgical grafts were referred for LEPT to improve ulcer bed. All ulcers in 6 patients completely healed and 2 ulcers in the 7th patient decreased in size by 75%. Surgery was cancelled for all patients.
Next generations of LEPT clinical protocols (using light emitting diodes) for wound, burn and skin ulcer healing acceleration featured improvement of their efficacy, consistency and diversification in regards to the types of wounds treated (decubitus, venous stasis, diabetic, vasculitis, radiation ulcers, etc.). This advancement of LEPT clinical protocols was a result of our basic research on the understanding of photon-tissue interaction and LEPT dosimetry for wound healing and ongoing process of protocol optimization using clinical data. Overall, since 1990, over 200 refractory wounds and skin ulcers of different etiology (decubitus, venous stasis, diabetic, vasculitis, radiation, pyoderma gangrenosum, and others) have been treated using these particular protocols of LEPT with a rate of success (complete closure or healing more than 75% of wound area) exceeding 75%.
In a preparation to a rigorous double blind clinical study, we carried on 2 preliminary clinical trials with a goal to determine sample size, inclusion and exclusion criteria and confirm the consistency of results. First prospective open protocol clinical trial included 9 patients with 15 chronic venous ulcers that were unresponsive to conventional therapies. Out of 15 venous ulcers, 12 (75%) had healed or improved markedly (greater than 75% reduction in pretherapy area of ulcer) by the end of the study. Second clinical trial involved 27 patients with 35 skin ulcers. It was non-randomized, comparative, double blind study. Patients had been treated at their homes by visiting nurses or physiotherapists. There were 3 different locations involved in this study. In the first location patients received LEPT plus dressings, in the second location patients received placebo LEPT plus dressings, and in the third location patients received dressings only. By the end of this 10-week clinical trial, total ulcer area decreased in size by 79.4% in the LEPT group, while it was only a decrease by 31.9% in the placebo group, and by 31.4% in the dressings only group.
A placebo-controlled, randomized, double blind study using LEPT was performed in nine patients with 12 chronic venous ulcers (mean ulcer duration 70.4 weeks). LEPT (real or placebo) was given three times per week during 10 weeks. For the duration of the study the ulcers were cleaned with saline followed by a dry dressing. Statistically significant difference in healing between LEPT and placebo groups was observed early
(at week 3, p<0.0003). At the conclusion of the study, the mean ulcer area in the LEPT group decreased in size by 75.6%, while in the placebo group a decrease in size of only 15.3% was observed. This difference in the ulcer healing was found to be statistically significant (p<0.0002).
In most cases of wounds and skin ulcers treated with LEPT, a substantial pain reduction was observed after first several LEPT sessions. Patients were able to reduce or eliminate their pain medication prior to complete wound healing. In some cases narcotic analgesics were discontinued early during the course of LEPT. A case study on LEPT for large (10-year duration) pyoderma gangrenosum ulcer accompanied by excruciating pain will be reported. 10 daily sessions of LEPT resulted in substantial pain reduction. As a result, the patient was able to discontinue narcotic analgesic Darvocet and controlled his pain with Advil.
In a recent case study LEPT was proven to result in complete healing of a large leg ulcer caused by a genetic disorder of blood clotting. This patient had circulation problems over 50 years (since he was 17), this current ulcer was open for 8 years and gradually increased in size. The patient is in remission over 6 months.
Damiano Fortunaa, Giacomo Rossib, Alessandro Zatic, Mauro Pianad, Cesare Paolinie,
Leonardo Masottif.
Department of Cardio-Thoracic Medicine - University of Pisa (Italy)
Department of Animal Science - University of Camerino (Italy)
Rizzoli Othopedics Institutes of Bologna (Italy)
Medical Center of Vinovo (Torino - Italy)
Deka Mela S.r.l. Laser System (Calenzano – Italy)
Department of Electronic and Telecommunications – University of Florence (Italy)
Objective: to verify the safety and efficacy of Nd:YAG PW laser (1064 nm) in osteoarthritis.
Background data: Low-Level Laser Therapy (LLLT) has been widely tested in arthritis disorders, but there is still some disagreement in the results. In this study we have investigated High-Intensity Laser Therapy (HILT) in an animal model of osteoarthritis.
Materials and methods: degenerative arthritis was induced in 32 heavyweight chickens in growing age by intra-articular inoculation of Freund’s complete adjuvant. Clinical studies were carried out (weight increase and grades of lamenesses), as well as morphological (macroscopic and histological) tests and seroassay (C reactive protein). The laser was evaluated at two different intensities (power density) and with or without an immunostimulant; all irradiated subjects received the same total energy.
Results: The histological findings indicated the laser’s ability to block the degenerative process and promote tissue repair through neochondrogenesis when used at high intensity (w/cm2).
The serological and histological samples showed the anti-inflammatory effect of the laser, which did not seem to be intensity dependent, and highlighted a significant difference between the treated group and Controls.
Conclusions: HILT has proved to be an antagonist against the destructive degenerative process as well as being able to promote neochondrogenesis. Unlike the anti-inflammatory effect, the neochondrogenic effect seemed to be intensity dependent.
Furthermore, at the intensities used, HILT was safe for surface and deep structures.
Keywords: High Intensity Laser Therapy, degenerative arthritis, neochondrogenesis, animal model
[1] Correspondence: dami.fortuna@tiscalinet.it
NSOM/AFM-characterization of cell conductive biomaterials
Central Institute of Biomedical Engineering
Dept. of Biomaterials / ENSOMA-Lab.
University of Ulm, Germany
Ti6Al4V is a much used titanium alloy in orthopaedic and traumatological surgery because it has good mechanical and corrosion properties and shows an enhanced osteoconduction. In the recent literature the influences of surface roughness and chemical surface structure on cell conduction and the interaction between body foreign materials and the body's own tissues are discussed. Here it was demonstrated that a surface structure with a given roughness but with different chemistry resulted in different binding of bone precursor cells to these surfaces. The results from these observations with respect to surface structure may be transferred to degradable biomaterials and thus become relevant for tissue engineering, implantology and photobiology.
Laser Acupuncture to Treat Paralysis in Stroke Patients, CT Scan Lesion Site Study
Margaret Naeser, Ph.D., Lic.Ac., Dipl.Ac. (NCCAOM)
Department of Neurology, Boston University School of Medicine and Neuroimaging/Aphasia Research, V.A. Boston Healthcare System, Boston, MA.
Purpose:
1) To study the effectiveness of low-level laser stimulation of acupuncture points to treat paralysis in stroke patients; 2) To examine the relationship between neuroanatomical lesion sites on CT scan and potential for improvement following laser acupuncture treatments. We have conducted previous research with needle stimulation of acupuncture points in the treatment of paralysis in stroke patients (1-3).
Subjects:
Seven stroke patients participated (ages 48-71 years when entering the study; 5 men, 2 women). Five cases had single left hemisphere stroke; two cases, single right hemisphere stroke. Five patients were treated for residual arm/leg paralysis; they had greatly reduced arm and leg power (and severely reduced or no voluntary isolated finger movement). Two cases were treated only for hand paresis; they had good arm and leg power, but they had mildly reduced isolated finger movement. CT scans were obtained on all patients after at least 3 months poststroke.
Six patients began receiving the laser acupuncture treatments during the chronic phase poststroke (10 months to 6.5 years). These times are beyond the spontaneous recovery period of up to 6 months poststroke (4, 5). One hand paresis case began receiving treatments during the acute phase poststroke (1 month poststroke). Because all patients were beyond the spontaneous recovery period except for one, each patient served as his/her own control. No sham laser treatments were administered. None of the stroke patients was receiving physical therapy or occupational therapy treatments during the course of the laser acupuncture treatments.
Method:
A 20 mW Gallium Aluminum Arsenide (780 nm) near-infrared, diode laser (Uni-laser, Denmark) with 1 mm diameter aperture, was used for 20-40 seconds (51-103 J/cm2) on each acupuncture point. The laser was used for 20 seconds on shallow points (hands and face), and 40 seconds on deeper acupuncture points (arms and legs). The points used on the paralyzed arm included: LI 4 (Hegu), LI 11 (Quchi), LI 15 (Jianyu), TW 5 (Waiguan), TW 9 (Sidu), and three distal Baxie points in the web-spaces between the fingers. The points used on the paralyzed leg included: ST 31 (Biguan), ST 36 (Zusanli), GB 34 (Yanglingquan), GB 39 (Xuanzhong), and LIV 3 (Taichong). Points used on the non-paralyzed side included LI 4 (Hegu) and ST 36 (Zusanli). These points include some of those used in our previous research where needle acupuncture was used to treat paralysis in stroke patients (1-3). If facial paralysis was present, the following points on the paralyzed side were used: ST 4 (Dicang), ST 6 (Jiache), ST 7 (Xiaguan), LI 20 (Yingxiang), and SI 18 Quanliao).
The patients were tested a few days prior to the first laser acupuncture treatment, and within a few days after completing the 20th, 40th and/or 60th laser acupuncture treatment. P.T. and O.T. testers were blinded; testers were part of a needle acupuncture study with real or sham or no acupuncture. Some patients received only 20 or 40 treatments. The number of treatments a patient received (20, 40 or 60) was based solely on patient availability and transportation issues. All patients were offered a maximum of 60 laser treatments. The patients were treated 2 - 3 times per week, for 3 - 4 months.
For patients with arm/leg paralysis, improvement was defined as a minimum increase of at least 10% isolated active range of motion, on at least one arm/leg test, following 20, 40 or 60 laser acupuncture treatments. For the patients treated for hand paresis, improvement was defined as an increase of at least 1 lb., on at least one hand strength test, following 20, 40 or 60 laser acupuncture treatments.
Results:
Overall, 5/7 patients (71.4%) treated with laser acupuncture showed improvement. Four of the six chronic stroke patients (66%) showed improvement. The single acute stroke patient (hand paresis case) also showed improvement.
Three of the five arm/leg cases showed a minimum of at least 10% improvement in isolated active range of motion on knee flexion; knee extension and/or shoulder abduction (range, +11 to +28%; mean, +15.8%, S.D., 7.08).
The two cases with hand paresis each showed improvement in hand strength. For the chronic hand paresis case (33 months poststroke), grip strength, pre- treatment, 62.7 lbs., post- 20 treatments, 68.4 lbs; strength in first 2 fingers opposing thumb (3-Jaw Chuck), pre- 12, post- 18 lbs.; strength in index finger opposing thumb (Tip Pinch), pre- 8, post- 11 lbs; and strength in thumb opposing the lateral surface of index finger (Lateral Pinch) pre- 12, post- 14 lbs. For the acute hand paresis case (starting at 1 month poststroke), grip strength, pre- 32.2, post- 20 Tx.'s, 47.7 lbs.; 3-Jaw Chuck, pre- 0, post- 11.3 lbs.; Tip Pinch, pre- 0, post- 10.7 lbs; Lateral Pinch, pre- 3.7, post- 14.7 lbs.
The five cases who showed improvement following the laser acupuncture treatments
had either no lesion in, or lesion in less than half of the motor pathway areas, including the periventricular white matter (PVWM) area on CT scan. The PVWM area is located adjacent to the body of the lateral ventricle, superior to the posterior limb, internal capsule. The two arm/leg cases who showed no improvement following the laser acupuncture treatments had lesion in more than half of the motor pathway areas, including the PVWM area. These behavioral and neuroanatomical findings are similar to our previous research using needle acupuncture to treat paralysis in stroke patients.
The PVWM area appears to be the most important area to examine on CT scan or MRI scan, in understanding whether a stroke patient is likely to benefit from needle or laser acupuncture to help reduce the severity of paralysis. This area contains many important intra- and inter-hemispheric pathways including, in part: 1) The descending pyramidal fibers from motor cortex, where the pathways for the leg are more medial. 2) The body of the caudate nucleus. 3) The mid-callosal pathways. 4) The medial subcallosal fasciculus containing connections to caudate from supplementary motor area and cingulate gyrus. 5) The occipito-frontal fasciculus. 6) The superior lateral thalamic peduncle which includes projections from dorsomedial nucleus and anterior nucleus to cingulate and projections from the ventrolateral nucleus to motor cortex.
Thus, even within this small PVWM region there are numerous motor systems that might, if incompletely damaged, respond to needle or laser acupuncture. These systems include dorsal striatum, supplementary motor area, or the frontal-striatal-ventrolateral thalamic-frontal loop, as well as the descending pyramidal system.
One patient with severe arm/leg paralysis did have improvement in her facial paralysis with good control of food and liquids in the left side of her mouth for the first time poststroke (4 years poststroke). She also improved in walking, with a “loosening” of the left Achilles tendon.
The author has observed that red-beam laser stimulation (4.59 J/cm2) on the Jing-Well points on the fingers (LU 11, Shaoshang; LI 1, Shangyang; PC 9, Zhongchong; TW 1, Guanchong; HRT 9, Shaochong; SI 1, Shaoze), in combination with the use of a microamps TENS device (MicroStim 100 TENS, Tamarac, FL) placed on the hand (HRT 8, Shaofu; and TW 5; Waiguan), is helpful in treating hand paresis and reducing hand spasticity in stroke patients (6, p. 40, Naeser Laser HAND Treatment Program). This method is also helpful in the prevention/ reduction of contractures of the hand, in patients with severe hand paralysis (personal observation).
Discussion:
The use of low-level laser for long-term treatment is especially desirable for chronic stroke patients with hand paresis. The patient can be trained to treat him/herself at home, using an inexpensive 5mW red-beam diode, laser pointer and a microamps TENS device (MicroStim 100, Tamarac, FL). See Websites listed below.
Acupuncture studies using needle acupuncture have observed the best outcome levels when acupuncture treatments were initiated at less than 3 months poststroke (7, 8), and especially when the acupuncture treatments were initiated at less than 24 hours and 36 hours poststroke (9, 10).
This is the first study to examine the effect of low-level laser therapy on acupuncture points to treat paralysis in stroke patients where lesion location was known for each patient. Results suggest that low-level laser therapy on acupuncture points is effective to help reduce the severity of paralysis in stroke patients, especially those with mild-moderate paralysis. The treatments should be initiated as soon as possible poststroke, even within 24 hours poststroke. A comprehensive rehabilitation program of P.T., O.T. plus needle and/or laser acupuncture is recommended.
References
1. Naeser MA, Alexander MP, Stiassny-Eder D, Galler V, Hobbs J, Bachman D: Real versus sham acupuncture in the treatment of paralysis in acute stroke patients: A CT scan lesion site study. Journal of Neurologic Rehabilitation 1992;6:163-173.
2. Naeser MA, Alexander MP, Stiassny-Eder D, Lannin LN, Bachman D: Acupuncture in the treatment of hand paresis in chronic and acute stroke patients - Improvement observed in all cases. Clinical Rehabilitation 1994; 8:127-141.
3. Naeser MA, Alexander MP, Stiassny-Eder D, Galler V, Hobbs J, Bachman D: Acupuncture in the treatment of paralysis in chronic and acute stroke patients - Improvement correlated with specific CT scan lesion sites. Acupuncture & Electrotherapeutics
4. Bard G, Hirschberg GG: Recovery of voluntary motion in upper extremity following hemiplegia. Arch Phys Med Rehabil 1965; 46:567-572.
5. Sunderland A, Tinson D, Bradley L, Hewer R: Arm function after stroke: An evaluation of grip strength as a measure of recovery and a prognostic indicator. J Neurol, Neurosurg, and Psych 1989; 52:1267-1272.
6. Naeser MA, Wei XB: Laser Acupuncture, An Introductory Textbook for Treatment of Pain, Paralysis, Spasticity and Other Disorders. Boston, Boston Chinese Medicine, 1994, p. 40.
7. Zhang WX, Li SC, Chen GB, Zhang QM, Wang YX, Fang YA. Acupuncture treatment of apoplectic hemiplegia. Journal of Traditional Chinese Medicine 1987;7:157-160.
8. Johansson K, Lindgren I, Widner H, Wiklung I, Johansson BB: Can sensory stimulation improve the functional outcome in stroke patients? Neurol 1993; 43:2189-2192.
9. Li DM, Li WD, Wei LH, Zhao YL, Lu HZ. Clinical observation on acupuncture therapy for cerebral hemorrhage. J. of Traditional Chinese Medicine 1989;9(1):9-13.
10. Hu HH, Chung C, Liu TJ, Chen RC, Chen CH, Chou P, Huang WS, Lin JCT, Tsuei JJ. A randomized controlled trial on the treatment for acute partial ischemic stroke with acupuncture. Neuroepidemiology 1993;12:106-113.
Additional Information:
www.Acupuncture.com/Acup/Naeser.htm and www.Acupuncture.com/Acup/laser.htm
See also: Naeser MA: Neurological Rehabilitation: Acupuncture and Laser Acupuncture to Treat Paralysis in Stroke and Other Paralytic Conditions and Pain in Carpal Tunnel Syndrome. Chapter in National Institutes of Health Consensus Development Conference on Acupuncture sponsored by the Office of Alternative Medicine and the Office of Medical Applications of Research. Bethesda, MD, November 3-5, 1997. pp. 93-109
Abstract based on: Naeser MA, Alexander MP, Stiassny-Eder D, Galler V, Hobbs J, Bachman D, Lannin L: Laser Acupuncture in the Treatment of Paralysis in Stroke Patients: A CT Scan Lesion Site Study. Am J of Acupuncture, 23(1):13-28, 1995:
Robert K. Naviaux, MD, PhD
The Mitochondrial and Metabolic Disease Center, University of California, San Diego, 214 Dickinson St., CTF, Rm. C-103, San Diego, CA 92103-8467.
Email: Naviaux@ucsd.edu.
Mitochondria contain pigments that respond to light. When cells are stressed or injured, mitochondria can shift their metabolism from being energy producers, to being net consumers of ATP. Associated with the injured cell response, mitochondrial oxidative phosphorylation is down-regulated, anaerobic glycolysis is up-regulated, and the transmitochondrial membrane potential (DYm ) is maintained by a reversal in the normal direction of proton pumping through the F0 subunits of the ATP Synthase. Loss of the DYm can be associated with cytochrome c release from mitochondria, activation of caspases, and cell death by apoptosis. One of the light-sensitive molecules in mitochondria is cytochrome aa3, a component of the fourth complex in the mitochondrial electron transport chain, cytochrome c oxidase (COX). The injured cell response to near-infrared light involves several different pathways. The spectral properties of certain mitochondrial cytochromes and the role of mitochondria in models of cell injury and dysfunction will be discussed.
Cellular and Molecular Aspects of Low Energy Laser Enhancement of Cell survival And Angiogenesis
Professor, Department of Zoology, Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv, 69978, Israel
BIOMODULATIVE EFFECTS OF 830nm LASER LIGHT ON THE HEALING OF SURGICAL BONE DEFFECTS
Antonio L B Pinheiro1,3; Francisco de Assis Limeira Jr2; Marleny E. M.M de Gerbi2; Cibelle B. Lopes3, Luciana Maria. P. Ramalho1; Clóvis Marzola4; Sokki Sathaiah3,
André O Soares5; Lívia C B Carvalho5; Helena Cristina A.V Lima5; Thais O. Gonçalves5.
1 Laser Center, School of Dentistry, Federal University of Bahia, Salvador, BA, Brazil
2 PhD Student on Lasers in Dentistry, Federal University of Bahia and Federal University of Paraiba, Salvador, BA, and João Pessoa, PB, Brazil
3 Universidade do Vale do Paraíba – UNIVAP-
Instituto de Pesquisa e Desenvolvimento - IP&D
São José dos Campos – SP, Brazil
4 Bauru School of Dentistry, University of São Paulo, Baurú, SP, Brazil
5 Dental Student, Academic Fellowship by the CNPq, Laser Center, School of Dentistry, Federal University of Bahia, Salvador, BA, Brazil
A major problem on modern Dentistry is the recovery of bone defects caused by trauma, surgical procedures or pathologies. Bone loss may be a result of several pathologies, trauma or a consequence of surgical procedures. This aspect led to extensive studies on the process of bone repair worldwide. Several techniques for the correction of bone defects have been proposed. Several types of biomaterials have been used in order to improve the repair of these defects. Amongst them the use of several types of grafts, membranes and the association of both techniques. These materials are often associated to procedures of BTR. Previous studies have shown positive effects of LLLT on the repair of soft tissue wounds, but there are a few on its effects on bone healing. And its effects on bone are not completely understood.
The aim of the first part of this study was to assess histologically the effect of LLLT (AsGaAl, 830nm, 40mW, CW, f ~0,6mm, 16J/cm2 per session) on the repair of standardized bone defects on the femur of 69 Wistar albinus rat which were grafted either with anorganic bone (Gen-ox®) associated or not to bovine membrane (Gen-derm®) or filled with lyophilized bovine bone (Gen-oxâ, organic matrix) associated or not to GTR (Gen-dermâ). Twelve randomized groups were studied: Group I (Control n = 6); Group II (Experimental Gen-ox® - n=9); Group III (Experimental Gen-ox® + Laser – n=9); Group IV (Experimental Gen-ox® + Gen-derm® - n=9); Group V (Experimental Gen-ox® + Gen-derm® + Laser – n=9); Group VI (Gen-oxâ - 9 animals); Group VII (Gen-oxâ + Laser – 9 animals); Group VIII (Gen-oxâ + Gen-derm - 9 animals); Group IX (Gen-oxâ + Gen-dermâ + Laser – 9 animals). The animals of the experimental groups were irradiated at every 48h during 15 days; the first irradiation was performed immediately after the procedure.
The animals were irradiated transcultaneously in four points around the defect. At each point a dose of 4J/cm2 was given (f~0,6mm, 40mW) and the total dose per session was 16J/cm2. The animals were humanely killed 15, 21 and 30 days after surgery. The specimens were routinely processed to wax, serially cut and stained with H&E and Picro Sirius stains, and analyzed under light microscopy. When the anorganic graft was used, there was evidence of a more advanced repair on the irradiated groups when compared to non-irradiated ones. The repair of irradiated groups was characterized by both increased bone formation and amount of collagen fiber around the graft within the cavity early since the 15th days after surgery.
When the organic graft was used, there was histological evidence of improved amount of collagen fibers at early stages of the bone healing (15 days) and increased amount of well-organized bone trabeculae at the end of the experimental period (30 days) on irradiated animals compared to non -irradiated ones. It is concluded that a positive biomodulative effect on the healing process of the defect associated or not to the use of both organic and inorganic lyophilized bone and biological bovine lyophilized membrane on the femur of the rat. On the second study, near infrared Raman spectroscopy (NIRS) was used to assess the amount of both inorganic and organic components of irradiated and non-irradiated bone around dental implants inserted in to the tibia of the rabbit.
Fourteen male young adults rabbits had an dental implant placed in the tibia of each animal. A Diode (830nm, 21.5J/cm2, 10mW, 6s, f~0,0028cm2) was used in the irradiated group. The irradiation was performed in four points around implants at every 48h, for fifteen days. Raman Spectroscopy was perfomed with an excitation laser with 830nm (Argon laser pumping a Ti: Sapphire laser), power applied at the sample 80mW; spectral recording time 100s. Four points for measurement around the implants at the superior, medium and inferior thirds were measured resulting in 12 readings of each implant and 168 total spectra.
Statistical analysis of the results of the measurements of the concentrations of inorganic and organic components at days 15, 30 and 45 showed that at day 15 there is non significant difference between irradiated and control samples (p > 0,05). Although 30 days after surgery the amount of Inorganic was already significantly higher on irradiated subjects (p < 0,01), at day 45 this difference was much higher (p < 0,001). Regarding the concentration of organic components on irradiated and control samples, significant differences were observed only at day 30 (p < 0,001)
It is concluded that Lasertherapy does improve bone healing and Raman Spectroscopy can safely assess this effect.
Preemptive Analgesia with Low Energy Photon Therapy (LEPT)
Pekka J. Pöntinen, MD, PhD
The objective of preemptive analgesia is to prevent central sensitization from tissue injury during surgery. The clinical trials with prolonged epidural analgesia or opioids administered intravenously or intrathecally as well as local anesthetics have not been very promising. Our earlier clinical trials with transcutaneous electric nerve stimulation (TENS) as premedication and adjuvant during cholecystectomy markedly decreased peri- and postoperative need of analgesics (1). Moreover, the incidence of postoperative nausea and vomiting were remarkable low in TENS group and peristalsis started appr. 15 hrs earlier in TENS stimulated patients. Postoperative pain itself seems to be an important mediator of the tumor-promoting effects of surgery in rats (2). The management of perioperative pain is a critical factor in preventing surgery-induced decreases in host resistance against metastasis (2). Our hypothesis is that preoperative low energy photon therapy (LEPT) applied to the operating field effectively controls peri- and postoperative pain and inflammation. Our pilot series in humans have shown beneficial effects in radical mastectomy with evacuation of axillary lymphnodes, in total colectomy, in gingivectomies, in mandibular cystectomy, in reconstruction of oral cavity and dentistry after radical surgery and radiation therapy for tongue cancer, etc. The main benefits have been: minimal or no oedema at the site of surgery; minimal scar formation/better quality scar; effective postoperative pain control; faster recovery; cost-effectiveness.
References:
1. Kalinowski J, Borzecki M, Pöntinen PJ. Transcutaneous electric nerve stimulation (TENS) as a supplement to standard anaesthesia for cholecystectomia. Scand J Acup & Electrotherapy 1987;2:16-17
2. Page GG, Blakely WP, Ben-Eliyahu S. Evidence that postoperative pain is a mediator of the tumor-promoting effects of surgery in rats. PAIN 2001;90:191-199
Will there be a place for laser therapy in further development of reconstructive and cell tissue-engineering approaches for peripheral nerve, spinal cord and brain tissue repair?
The purpose of these experimental studies is to evaluate the efficacy of low power laser irradiation as a supportive factor for accelerating and enhancing axonal growth and regeneration after reconstructive peripheral nerve and spinal cord procedures. In these procedures regenerative and reparative biotechnological sources were used for the microsurgical reconstruction. These research projects are an interdisciplinary effort of a novel therapeutic strategy where biodegradable nerve tube was used for peripheral nerve reconstruction and composite implants of cultured embryonal nerve cells were applied for transected spinal cord followed by post-operative laser treatment.
In addition, the studies investigate the role of low power laser irradiation in accelerating and enhancing axonal growth in nerve cell culture model and primary repair of injured peripheral nerve. The significance of these approaches will be the provision of new nerve tissue-engineering modality and laser technology for treatment of severe peripheral nerve and spinal cord injury.
Low Energy Photon Therapy Dosimetry
N. Salansky, Ph.D.[6],[7], N. Filonenko, Ph.D.2
PO Box 502, 1057 Steeles Avenue West, Toronto, ON, M2R 3X1, CANADA
E-mal: nsalansky@sprint.ca
A right choice of optical parameters (wavelength, power, energy, power densities etc.) and an appropriate three-dimensional (3D) photon distribution within the target tissue constitute critical factors that determine LEPT efficacy. Depending on the set of optical parameters used it is possible to observe an acceleration, inhibition or no healing effect.
The following are the concepts of Low Energy Photon Therapy (LEPT) dosimetry that being implemented in concert allow substantial effects to be induced by low energy photons:
1. The concept of “optical windows”: the full set of optical parameters (wavelength, wavelength bandwidth, intensity, dose, frequency and pulse duration and duty cycle, beam size and divergence, etc.) and an appropriate 3D photon distribution has to conform to corresponding optical window in order to induce a desired photo-effect. If even one of the optical parameters is out of the optical window ranges, a significant photo-effect could not be induced.
2. An appropriate 3D light distribution has to be provided in the target tissue. LEPT optical parameters that are “seen” by the skin cells have to be specific to the desired biological mechanisms to be activated.
3. Timing and specificity of optical windows to the specific photo-induced mechanisms has to be taken into account for the optimization of LEPs efficacy. In particular, timing and specificity of optical windows for in vitro & in vivo experiments differ substantially for different healing mechanisms (e.g., fibroblast proliferation as opposed to collagen release by fibroblasts) and for different phases of wound healing (the inflammatory as opposed to the repair phase).
Substantial effects or favorable alterations of cellular or tissue processes could be induced by LEPs only using specific sets of optical parameters and an appropriate three-dimensional (3D) photon distribution within the target tissue. We call them “optical windows”. The set of optical parameters that may affect the outcome of LEP-tissue interaction includes wavelength and its bandwidth, optical power and energy densities, beam size and divergence, frequency, pulse duration, duty cycle and peak power, total energy delivered to the body and some others. We are distinguishing incident optical parameters and internal optical parameters. Incident optical parameters are those that are delivered to the skin or wound surface. Internal optical parameters are those that are actually “seen” by the tissue cells. Incident and internal optical windows are approximately the same only for mono-layers of cell cultures.
As a result of photon scattering & absorption in the skin a complex 3D distribution of photons takes place. Internal optical parameters that are “seen” by the skin cells depend on the tissue optical properties: reflection, refraction, scattering, absorption, regular reflectance, epidermal and dermal remittance. Classical approach to photon distribution modeling in the biotissue is based on Monte Carlo (MC) algorithm to obtain solutions of photon transfer equation. For different skin layers (epidermis, dermis, blood plexus, etc.) the optical tissue parameters are experimentally obtained and will be used within the frame of this approach.
The standard MC approach for our purposes is not effective enough. First of all, we need to have the possibility of very fast “in dialog time” of obtaining photon distributions in the tissue for different source parameters. This is important for the optical source design implementation and as a feedback for the optical source optimization. MC modeling does not provide this opportunity.
Last decade, a Neural Network (NN) approach was developed to analyze big volumes of information. This approach was used as a technique for fast multi- parametrical approximation solution. We will demonstrate combined MC modeling with NN approach, for fast 3D photon distribution observation in the tissue in real time. An animated computer simulation of 3D photon distribution in a real time environment (3 minutes) will be shown.
Most importantly, new information obtained from this research may establish a rationale for choosing appropriate parameters for further use in clinical trials, limiting the existing inconsistency and contribute to establish the use of LEPT as an efficacious and cost-effective alternative treatment modality in clinical practice.
Analysis of some published data and their interpretation based on the above dosimetry considerations will be provided.
Treatment Of Chronic Neck And Shoulder Pain With 635 Nm Low Level Laser Therapy. A Randomized, Multi-Center, Double Blind, Clinical Study On 100 Patients.
Background and Objective
The purpose of this clinical study was to determine the effectiveness of the use of the Erchonia ML2000, in providing temporary relief of minor neck and/or shoulder pain of chronic origin by emitting 1 mw of near-infrared light (630nm-640nm) to the affected area(s) for short durations, under randomized, double blind, placebo controlled conditions. This study was approved by an IRB (Institutional Review Board) and was conducted at three clinics.
Methods.
The primary outcome measure was the change in a subject’s self-reported Degree of Pain rating using the Visual Analog Scale (VAS) from immediately prior to the treatment administration to immediately after the treatment administration. The individual subject success criteria was defined as a 30% improvement in Degree of Pain rating on the VAS across the two measurement periods. The overall study success criteria was defined as at least a 30% difference between groups, comparing the proportion of individual success in each group, anticipating that about 50% of subjects in the test group and about 20% of subjects in the placebo group would meet the individual success criteria. A total of 86 subjects completed the study, 43 in each of the test and placebo group. Subjects were randomly assigned to either the test or placebo group. Subjects in the test group received the actual laser procedure using the specified treatment protocol and subjects in the placebo group received a “fake” laser treatment. “Pre- and Post” procedure linear range of motion (ROM) in the right and left sides of the neck/shoulder regions were recorded in degrees on case report forms. A “Chronic” condition was defined as longer than 30 days
Results
65% (28 of 43)of the treated group met the individual subject success criteria which was significantly greater than 11.6% (5 of 43) recorded for the placebo group( p<.0001) The overall study success criteria of 30% was exceeded with the actual difference in the proportion of the individual subject successes between treated and placebo group subjects being 53.5%.
Conclusion
The Erchonia ML2000 low level laser is an effective single treatment option for chronic neck and shoulder pain resulting from Osteoarthritis, Muscle spasms, or cervical/thoracic sprain/strain conditions.
Novel Low Intensity Light Activated Biostimulation Paradigm
Central Institute of Biomedical Engineering
Dept. of Biomaterials / ENSOMA-Lab.
University of Ulm, Germany
E-mail: samoan@gmx.net
Molecular light/cell-interaction mechanisms are crucial for an understanding of low intensity light activated biostimulation (LILAB) methods. The majority of clinically relevant LILAB effects have been performed with lasers – therefore LLLT. Various photobiological models have been proposed for the interpretation of the observed LILAB effects. The most prominent models assume an interaction of the irradiation with specific photoreceptors in mitochondria. Requiring the presence of mitochondria, respectively normal mitochondric concentrations, the models restrict the presumably possible spectrum of clinical indications to biological targets containing mitochondria. The recently observed reaction of nanobacteria to photostimulation indicates that additional light-harvesting mechanisms could exist within the body of humans. Local photostimulation of cell organelles and time-resolved nanoscale imaging of topographic and optical contrast variations at the cellular surface could facilitate our understanding of the photobiological mechanisms directly. Nearfield optical analysis (NOA) suggests itself as a tool to locally irradiate and simultaneously investigate living cells in vitro with nanoscale resolution. First results of NOA in living cells in vitro are presented.
Measurements Needed to Help Assure Comparability of Laser Therapy Application Studies.
Ronald W. Waynant, Ilko K. Ilev, Kimberly R. Byrnes1 and Juanita J. Anders1
Food and Drug Administration, Center for Devices and Radiological Health, HFZ-134, 12725 Twinbrook Parkway, Rockville, MD 20857.; 1Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
Laser therapy has been tried for numerous applications from pain treatment to nerve regeneration as well as many other uses. Numerous sources from lasers to LEDs to filtered tungsten and tungsten halogen bulbs have been tried. The literature reports the results of the studies, many of which are positive, yet nearly as many are negative. In many papers the doses, intensities, wavelengths, etc. have not always been reported nor have the subjects of the irradiation been handled and exposed in the same manner. Cell cultures, various animal models and humans all have been exposed. Laser therapy is available in most areas of the world, but in the United States the FDA has not approved laser therapy of any sort. Laser eye surgery and photodynamic therapy have been approved in the US on an application specific basis for some medical procedures after rigorous testing and review. To help assure that each observer of a particular application provides consistent exposure information, it is necessary that each exposure source be monitored and provide reliable source data. For sources that emit a continuous beam it is necessary to measure its intensity (power/cm2) at the point of tissue exposure, its wavelength, its bandwidth and the time duration of the exposure. If the device provides a pulsed output, it is also necessary to measure the duration of the pulse and the repetition rate in addition. Some experiments may require more information, such as polarization or power variation over the exposure. In many cases the spatial distribution of the energy may not be uniform hence causing the exposure to vary over the area of application. This may need to be taken into account or corrected. This talk will try to make sure that observers are on the same page regarding the sources that they will be using for therapy applications. Methods for measurements of light propagation in tissue will also be discussed.
The Use of NASA Light-Emitting Diode Near-Infrared (IR) Technology for
Harry T. Whelan, M.D.
Medical College of Wisconsin, Milwaukee, Wisconsin & NASA-Marshall Space Flight Center, Huntsville, Alabama, USA
This work is supported and managed through the NASA Marshall Space Flight Center - SBIR Program. Studies on cells exposed to microgravity and hypergravity indicate that human cells need gravity to stimulate growth. As the gravitational force increases ordecreases, the cell function responds in a linear fashion. This poses significant health risks for astronauts in long-term space flight. The application of light therapy with the use of NASA LEDs will significantly improve the medical care that is available to astronauts on long-term space missions. NASA LEDs stimulate the basic energy processes in the mitochondria (energy compartments) of each cell, particularly when near-infrared light is sed to activate the color sensitive chemicals (chromophores, cytochrome systems) inside. Optimal LED wavelengths include 680, 730 and 880 nm and our laboratory has improved the healing of wounds in laboratory animals by using both NASA LED light and hyperbaric oxygen. Furthermore, DNA synthesis in fibroblasts and muscle cells has been quintupled using NASA LED light alone, in a single application combining 680, 730 and 880 nm each at 4 Joules per centimeter squared. Muscle and bone atrophy are well documented in astronauts, and various minor injuries occurring in space have been reported not to heal until landing on Earth. An LED blanket device may be used for the prevention of bone and muscle atrophy in astronauts. The depth of near-infrared light penetration into human tissue has been measured spectroscopically. Spectra taken from the wrist flexor muscles in the forearm and muscles in the calf of the leg demonstrate that most of the light photons at wavelengths between 630-800 nm travel 23 cm through the surface tissue and muscle between input and exit at the photon detector. The light is absorbed by mitochondria where it stimulates energy metabolism in muscle and bone, as well as skin and subcutaneous tissue. Long term space flight, with its many inherent risks, also raises the possibility of astronauts being injured performing their required tasks. The fact that the normal healing process is negatively affected by microgravity requires novel approaches to improve wound healing and tissue growth in space. NASA LED arrays have already flown on Space Shuttle missions for studies of plant growth and the U.S. Food and Drug Administration (FDA) has pproved human trials. The use of light therapy with LEDs can help prevent bone and muscle atrophy as well as increase the rate of wound healing in a microgravity environment, thus reducing the risk of treatable injuries becoming mission catastrophes. Space flight has provided a laboratory for studying wound healing problems due to microgravity, which mimic traumatic wound healing problems here on earth. Improved wound healing may have multiple applications that benefit civilian medical care, military situations and long-term space flight. Enhancing the soldier's tissue responses to injury may lead to battlefield resilience and medical independence. Counter-measures to chemical, biological and radioactive weapons exposures which are based on biostimulation of natural tissue regeneration mechanisms could be more universally safe and effective than conventional drugs and surgical modalities. Regeneration of wounded organs and limbs may also be possible if biostimulation could re-awaken molecular events leading to re-growth of tissue. Near infrared (IR) light has documented benefits promoting wound healing in human and animal studies. Our preliminary results have also demonstrated two to five-fold increases in growth-phase-specific DNA synthesis in normal fibroblasts, muscle cells, osteoblasts, and mucosal epithelial cells in tissue cultures treated with near-IR light. Our animal models treated with near-IR have included wound healing in diabetic mice and ischemic bipedical skin flap in rats. Near-IR induced a thirty percent increase in the rate of wound closure in these animal models. Dose- and time-dependent increases in vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF-2) occurred in animals treated with near-IR. Human studies have included the use of near-IR to prevent ulcerative mucositis resulting from high doses of chemotherapy and radiation. Widely published reports, including those from our laboratory, described accelerated recovery from musculoskeletal injuries, hypoxic-ischemic wounds, burns, lacerations, radiation necrosis, and diabetic ulcers with the use of near-IR. Lasers have some inherent characteristics which make their use in a clinical setting problematic, including limitations in wavelength capabilities and beam width. The combined wavelengths of light optimal for wound healing cannot be efficiently produced, and the size of wounds which may be treated by lasers is limited. Light-emitting diodes (LEDs) developed for NASA manned space flight experiments offer an effective alternative to lasers. These diodes can be made to produce multiple wavelengths, and can be arranged in large, flat arrays allowing treatment of large wounds. We are now investigating new collaborations with the Defense Advanced Research Projects Agency (DARPA) for military applications of LED wound healing technology in military medicine. Several uniquely military situations and indications could be addressed, optimizing near-IR parameters for wound healing via LEDs during extended missions under conditions separated from medical personnel. These include burns, chemical agents, radiation, biological agents and highly infected flesh-eating wounds (with and without extended burns) typical for the hygienic conditions occurring in battle fields, also infectious diseases and external wounds occurring in environments with no solar irradiation, low oxygen and high carbon dioxide (submarines). The dramatic results with use of near-IR LED light to prevent digestive mucosal lesions (mucositis) and pain in cancer patients, after high-dose chemotherapy and radiation, suggest the potential for military use of near-IR light to treat U.S. troops exposed to chemical and radioactive warfare agents in the field. These examples illustrate the many possible military uses for this technology. These life-saving applications require especially accelerated wound healing, rapid reduction of infections and pain modulation. Regeneration of muscles in amphibians has also been produced by near-IR therapy. The potential for regeneration of human tissue also deserves study. Central nervous sytem regeneration would be of particular benefit. Thus far, we have demonstrated that the best results for wound healing occur at wavelengths of 670 nm and 880 nm using 4 to 8 joules/cm2, applied at power densities of approximately 50 mW/cm2. However, studies to determine molecular mechanisms could lead to the optimization for current uses, as well as open up new applications. Despite numerous reports on the benefits of near-IR on wound healing and rehabilitation over the last decade, the basic mechanisms of its action remain poorly understood. Britton Chance's group has reported that about 50% of near-IR light is absorbed by mitochondrial chromophores, such as cytochrome oxidase. However, the underlying cellular and molecular events are still unknown.
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