1. LASER Evidence Based Research

2. The term laser is an acronym for “light amplification by stimulated emission of radiation.” Lasers by definition generate a monochromatic beam of electromagnetic radiation

4. Uses in different fields Ophthalmology Dermatology Otolaryngology Neurology Orthopedics General surgery Most recently physical medicine and rehabilitation

5. Spontaneous Emission

6. Stimulated Emission

7. Population Inversion

8. Laser production

9. Guess who?????

10. Physiological effects Photochemical activation of enzymes that catalyze the processing of molecular substrates ATP synthesis (possible effect on the oxidative phosphorylative component of the mitochondrial membrane) Activation of calcium (Ca++) at the cell membrane level Absorbing structures for the low-level laser wavelengths are hemoproteins Tissue penetration of laser energy used in LLLT can be in the order of 5 to 10 mm

11. Ongoing Research Multiple-wavelength, low-intensity laser radiation (MWLILR) V efficient

13. Types of lasers

14. Types and clinical application Thermal or “hot” lasers Carbon dioxide (CO 2 ), holmium Power laser (range in wavelength from 10,600 nm (mid-infrared) to 1064 nm (near infrared). Tissue responses to thermal lasers are: – Elevation of temperature, – Dehydration of tissue, – Coagulation of protein, – Thermolysis – Evaporation

15. low power, or cold, lasers Lasers with power levels of 60 mW or less Produce little to no thermal response. The effects of low-powered lasers (photobiostimulation) are a direct result of radiant energy

16. “Gridding” Technique A continuous series of vertical and horizontal strokes with the laser applicator over the length and width of a designated area grid should have a surface area ranging between 1 to 1 1/2 cm2

17. “Surround” Technique The operator may stimulate the tissue at the periphery of the wound. Eschar

18. “Scanning” Technique Mimics gridding with the exception of the aperture being held less than 1 cm above the site

19. Wanding Technique Similar to scanning in that it does not contact the skin. However, the irradiating pattern is oscillatory rather than the spray like pattern used when scanning.

20. Indications for the Use of Lasers Wound Healing Bone Regeneration and Fracture Healing Herpes Simplex Wounds Tendinopathies Epicondylitis Carpal Tunnel Syndrome Arthritis

21. Contraindications and Precautions for Lasers Epilepsy, Fever, malignancy, areas of decreased sensation, or Infected tissue. Anatomically, the gonads, epiphyseal Plates of children, sympathetic ganglia, vagus nerve, and mediastinum should be avoided. During Pregnancy, over the open fontanelles of children, over Cancerous lesions, over the cornea, over Endocrine Glands, and over hemorrhaging lesions.