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LIGHT THERAPY USING POLARIZED, POLYCHROMATIC, LOW ENERGY LIGHT: CLINICAL APPLICATIONS

LIGHT THERAPY USING POLARIZED, POLYCHROMATIC, LOW ENERGY LIGHT: CLINICAL APPLICATIONS. CONTENTS. INTRODUCTION TO LIGHT THERAPY CHARACTERISTICS OF EMITTED LIGHT TARGET AREAS THERAPEUTIC EFFECTS CLINICAL APPLICATIONS LIGHT THERAPY SYSTEM. INTRODUCTION TO LIGHT THERAPY.

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LIGHT THERAPY USING POLARIZED, POLYCHROMATIC, LOW ENERGY LIGHT: CLINICAL APPLICATIONS

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  1. LIGHT THERAPY USING POLARIZED, POLYCHROMATIC, LOW ENERGY LIGHT: CLINICAL APPLICATIONS

  2. CONTENTS INTRODUCTION TO LIGHT THERAPY CHARACTERISTICS OF EMITTED LIGHT TARGET AREAS THERAPEUTIC EFFECTS CLINICAL APPLICATIONS LIGHT THERAPY SYSTEM

  3. INTRODUCTION TO LIGHT THERAPY

  4. Light is a form of energy Light has wave-like properties Light is part of the electromagnetic spectrum This is a range of types of radiation from low energy radio waves to high energy gamma rays Electromagneticspectrum Energy Wavelength Radio waves Microwaves Infra-red radiation Ultraviolet radiation X-rays Gamma-rays Visible light WHAT IS LIGHT?

  5. LIGHT THERAPY: HISTORY • Light has been used to treat various medical conditions since ancient times • Modern light therapy was pioneered by Niels Ryberg Finsen*, a Danish physician • Recent developments in light therapy have used low-power lasers & other sources of polarized light * Nobel Prize winner (Medicine) 1903

  6. CHARACTERISTICS OF EMITED LIGHT

  7. The light emitted by this light therapy system has specific characteristics CHARACTERISTICS OF EMITTED LIGHT Polarized Light waves move in parallel Polychromatic Light emitted from visible & part of infra-red regions of the spectrum Incoherent Light waves are ‘out-of-phase’ Low energy Optimal tissue penetration with minimal heat effects

  8. Non-polarized light waves move (oscillate) in all directions (planes) Polarized light waves are restricted to oscillate in parallel planes POLARIZED LIGHT • Highly efficient polarization process used (degree of polarization ~95%) • Achieved using a system of multi-layered mirrors Non-polarized Polarized

  9. Light emitted contains a range of wavelengths (480nm  3400nm) This includes visible light & part of the infra-red region 480nm BIOPTRON light 3400nm POLYCHROMATIC LIGHT No ultraviolet radiation is emitted   safety

  10. Light waves emitted by this system are not synchronized, i.e. theyare ‘out-of-phase’ INCOHERENT LIGHT BIOPTRON Light • Unlike laser light in which all the light waves are synchronized Laser light

  11. LOW ENERGY LIGHT • Light waves emitted have low energy density* • This provides optimal tissue penetration with minimal heating effect HEAT MINIMAL HEAT High energy Low energy *Energy density ~ 2.4 Joules/cm2 per minute *Power density ~ 40 mW/cm2

  12. LIGHT CHARACTERISTICS: BENEFITS • This combination of light characteristics confers several benefits; Optimal tissue penetration Minimal heating effects No damage to the skin or underlying tissue No known side effects

  13. TARGET AREA

  14. LIGHT PENETRATION INTO TISSUES • When the light therapy device is held over the skin, energy from emitted light penetrates the underlying tissues • This produces a biological response (called ‘photo-biostimulation’) • Different wavelengths of light can affect different tissues • Both visible light & infra-red radiation have been reported to stimulate changes at the cellular level

  15. 1.0 LIGHT PENETRATION INTO TISSUES Wavelength λ [nm] 280-320 320-400 400-470 470-550 550-600 600-650 >1350 650-1000 0 Epidermis 0.5 Dermis ~ ~ Subcutaneous tissue 3.0 Cross-section of human skin & underlying tissues UV Visible Infra-red Penetration depth mm (approx.) BIOPTRON Light

  16. POSSIBLE CELULAR TARGETS Basic science 1 • The exact mechanism of action of photo-biostimulation is still under investigation • Proposed targets within the cell include • Cell membrane • Acting on polar heads of phospholipid bi-layer1 • Acting on calcium channels2 • Mitochondria3 • Changes to the local peripheral blood supply may also be involved4 1Karu T. Health Physics 1989; 56: 691-704 2Smith KC. Laser Therapy 1991; 3: 19-24 3Kertesz I. Optics & Laser Technology 1982; 16: 31-32 4Medenica L. J. Wound Care 2003;12: 37-40

  17. Human cell Cell membrane Mitochondrion POSSIBLE CELULAR TARGETS OF LIGHT THERAPY

  18. EFFECTS ON CELL MEMBRANE Basic science 2 Membrane protein • Light therapy may cause structural changes in the cell membrane & alter lipid-protein interactions1 • This could reduce the activation energy required for certain enzymatic reactions1 • Infra-red radiation has been shown to stimulate the cell membrane, probably via activation of Ca2+ channels2 Lipid bilayer; Head Tail Inside cell Structural changes in cell membrane Alteration in lipid-protein interactions Decreased activation energy for enzyme reactions 1Kertesz I. Optics & Laser Technology 1982; 16: 31-32 2Smith KC. Laser Therapy 1991; 3: 19-24

  19. EFFECTS ON MITOCHONDRIA Basic science • Absorption of visible light energy by the mitochondria is postulated to activate a chain of molecular events1 • This results in an increase in available cell energy & the activation of nucleic acid synthesis (DNA & RNA) • This is essential for repairing tissue damage Outer membrane Inner membrane Respiratory chain reactions ADP ATP ATP synthase  Cell energy  Nucleic acid synthesis, etc. 1Karu T. Health Physics 1989; 56: 691-704

  20. OTHER TARGETS • Light therapy also causes dilatation of blood vessels in the area treated1 • This has several beneficial effects; Improved local blood flow Increased delivery of oxygen Increased delivery of nutrients Promotion of healing 1Lievens P. Laser 1988; 1: 6-12

  21. OTHER TARGETS • Light therapy may also improve the drainage of extra-cellular fluid into lymphatic vessels • This reduces edema (tissue swelling) • Reduction of edema helps to decrease pain & improve mobility of the affected area (e.g. a swollen joint)

  22. TARGET PROCESS Click on box to launch animation

  23. THERAPEUTIC EFFECTS

  24. THERAPEUTIC EFFECTS • The main therapeutic effects of polarized light therapy are Stimulation of tissue repair Stimulation of body defense mechanisms Reduction of pain sensation

  25. STIMULATION OF TISSUE REPAIR Basic science 4 Clinical data • Light therapy has a stimulatory effect on healing • Stimulation of cell proliferation • Enhanced collagen synthesis • Release of growth factors • Acceleration of wound closure • Improved quality of scar tissue • Demonstrated by in vitro & in vivo data1-4 • Findings confirmed by clinical studies5-8 1Mester E. Lasers Surg. Med. 1985; 5: 31-39 2Kertesz I. Optics & Laser Technology 1982; 16: 31-32 3Kubasova T. Photochem. Photobiol. 1988; 48: 505-509 4Bolton P. Laser Therapy 1992; 4: 33-37 5Depuyt K. Abstract 10th Annual EURAPS Meeting, 1999 6Medenica L. J. Wound Care 2003;12: 37-40 7Monstrey S. Br. J. Plastic Surg. 2002; 55: 420-426 8Iordanou P. Int. J. Nurs. Pract. 2002; 8: 49-55

  26. STIMULATION OF TISSUE REPAIR WITH LIGHT THERAPY

  27. STIMULATION OF BODY DEFENSE MECHANISMS • Light therapy may promote non-specific cellular immune responses1 • Activation of neutrophil granulocytes • Activation of monocytes / macrophages • Stimulation of natural killer cells • These activities have general bactericidal & anti-tumor effects Basic science 5 1Samoilova KA. Proc. Low-Power Light Biol. Syst. 1998; IV: 90-103

  28. STIMULATION OF NON-SPECIFIC IMMUNE REACTIONS WITH LIGHT THERAPY Red blood cell White blood cells Neutrophil granulocyte Monocyte / macrophage Natural killer cell

  29. REDUCTION OF PAIN SENSATION Basic science 6 Clinical data • Light therapy may influence pain sensation in several ways1-4 • Improved local blood flow • Reduction in muscle spasm • Reduction of inflammation • Induction of natural pain-killing chemicals • Reduction of pain transmission by direct action on peripheral nerves 1Konstantinovic L. Vojnosanit Pregl 1989; 46: 441-448 2Sakurai Y. Eur. J. Oral Science 2000; 108: 29-34 3Walker JB. Neurosci. Lett. 1983; 4: 297-303 4Tam G. J. Clin. Laser Med. Surg. 1999; 17: 29-33

  30. REDUCTION OF PAIN SENSATION WITH LIGHT THERAPY Cell damage Muscle spasm Tissue ischemia Release of pain & inflammatory mediators Light therapy: potential effects Stimulation of pain receptors & nerve pathways Sensation of pain

  31. CLINICAL APPLICATIONS OF LIGHT THERAPY

  32. CLINICAL APPLICATIONS • WOUND HEALING • Treatment of burns • Treatment of skin ulcers (ulcus cruris, decubitus) • Treatment of post-operative wounds • Treatment of traumatic injuries • PAIN THERAPY • Treatment of musculoskeletal pain in rheumatology, physiotherapy and sports medicine

  33. CLINICAL APPLICATIONS Light therapy can be used in many clinical fields Dermatology Rheumatology Care of the elderly Light therapy Physical therapy Pain management Occupational therapy Surgery Sports medicine

  34. PAIN THERAPY in rheumatology: osteoarthritis, rheumatoid arthritis (chronic), arthroses in physiotherapy: low back pain, shoulder and neck pain, carpal tunnel syndrome, scar tissue, musculoskeletal injuries in sports medicine: soft tissue injuries of muscles, tendons & ligaments like muscle spasm, sprains, strains, tendonitis, ligament and muscle tears, dislocations, contusions, tennis elbow

  35. PAIN MANAGEMENT: MUSCULOSKELETAL PAIN Example: Lower back pain Treatment with BIOPTRON 2

  36. PAIN MANAGEMENT: REHABILITATION Light therapy can be applied to various parts of the body BIOPTRON Compact III BIOPTRON 2 BIOPTRON Pro 1

  37. PAIN THERAPY • Rheumatology: Arthritis • ‘Arthritis’ is the inflammation of a joint • Main symptoms include – • Pain, swelling, stiffness & loss of function in the affected joint(s) • Huge costs to society – • Major cause of disability & poor quality of life • Treatment costs + loss of earnings (time off work &/or unemployment; billions per year) • There are many different types of arthritis, including – • Osteoarthritis • Rheumatoid arthritis

  38. Articular cartilage Synovial membrane Ligament Synovial fluid Bone Basic anatomy #1: A joint Articular cartilage – acts as a shock absorber, protects bone Synovial membrane – lines joint & secretes lubricant (synovial fluid)

  39. PAIN THERAPY • Osteoarthritis • Commonest joint disorder worldwide • Frequency increases with age • Present in most all people aged >60 years • Degenerative joint disease • Caused by wearing away of protective cartilage lining the joints • Risk factors: excess weight, injury to bone/joint, manual occupations, sports Affects hip, knee, elbow, joints in hand/foot

  40. PAIN THERAPY • Osteoarthritis • Disease affecting synovial joints • Characterised by loss of articular cartilage with accompanying periarticular bone response • Diagnosis based upon symptoms + x-ray appearance + pathological joint changes • Main signs: microfractures, bone cysts, osteophyte formation & narrowing of joint space • Variable rate of disease progression; symptoms flare up & remit

  41. PAIN THERAPY • Rheumatoid arthritis • Occurs in 0.5-3% of population • Usual age of onset 30-50 years old, although can occur at any age • Immune disorder affecting joints (& other parts of the body) • Caused by inflammation of the synovial membrane lining the joints • Risk factors: female gender, family history, certain immunological/genetic characteristics Affects small joints in hands/feet, knee, elbow, shoulder, neck

  42. PAIN THERAPY • Rheumatoid arthritis • Chronic, progressive, systemic inflammatory disorder of unknown cause • Characterised by inflammatory synovitis; ‘pannus’ blocks nutrient supply to underlying articular cartilage • Diagnosis based upon history + x-ray changes + blood tests • Rheumatoid factor present in ~70% cases; associated with greater disease severity • Non-articular disease affects lungs, blood vessels & heart, nerves, eyes, kidneys, etc.

  43. PAIN THERAPY • BIOPTRON Light Therapy may help to reduce the symptoms of arthritis

  44. skin subcutaneous tissue muscle tendons ligaments (bone*) Basic anatomy: Soft tissues Tendon – connects a muscle to a bone Ligament – connects a bone to another bone (*not a soft tissue)

  45. PAIN THERAPY • Sports medicine: Sprains & strains • Strain: injury to a muscle or tendon • Sprain: injury to a ligament • Both are caused by overstretching or tearing • Symptoms: pain, swelling, loss of movement,  bruising • Sprains commonly involve ankle, knee & wrist • Strains commonly affect upper arm, elbow, thigh, ankle, groin & abdomen • Risk factors: playing sports, gardening, lifting heavy objects, etc

  46. PAIN THERAPY • Sports medicine: Dislocations Dislocation: Displacement of bones at a joint • Caused by forces pulling a bone into an abnormal position, or by violent muscle contractions • Symptoms: pain, swelling, loss of movement,  fracture,  joint damage • Commonly affects shoulder, thumb/finger, jaw • Risk factors: any violent collision (car crash, falling, contact sport), electrocution

  47. PAIN THERAPY • Sports medicine: Contusions • Contusion: Bleeding into the tissue beneath the skin surface (bruise) • Caused by blunt trauma to the body • Pressure of impact ruptures small blood vessels, causing blood to pool around the injured area • Symptoms: swelling, pain • Risk factors: playing contact sports (martial arts, football, boxing, etc.)

  48. PAIN THERAPY • Sports medicine: Tendinitis & tenosynovitis • Tendinitis: Inflammation around a tendon • Tenosynovitis: Inflammation around a tendon sheath • Caused by overuse or overloading of the tendon (e.g. tennis elbow) • Symptoms: pain, stiffness, weakness, loss of movement • Risk factors: playing sports (patellar tendon, Achilles tendon), repetitive hand movements - typing, packing, sewing (tendons in wrist/hand)

  49. PAIN THERAPY • BIOPTRON Light Therapy may help to reduce the symptoms of sports injuries

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