Introduction to New High Power High Dose Class IV Laser
Therapy
Slide 2
HPLT was first introduced to the medical field in 2002 by then
CEO of Avicenna Laser Technology, Inc, Bruce R. Coren, DVM, MS. The
company invented and developed the first High Power Therapeutic
Laser to receive FDA clearance in 2003.
Slide 3
Technological Medical Advancements is a spin off from Avicenna
and was founded not only to advance the field of Laser Medicine but
also to bring other innovative medical devices to the market
place.TMA Technological Medical Advancements is a spin off from
Avicenna and was founded not only to advance the field of Laser
Medicine but also to bring other innovative medical devices to the
market place. TMA offers the most powerful laser platforms in the
world and thus allowing physician's of all medical disciplines the
capability to heal injuries previously refractive to traditional
medical care.TMA offers the most powerful laser platforms in the
world and thus allowing physician's of all medical disciplines the
capability to heal injuries previously refractive to traditional
medical care.
Slide 4
The TMA laser was designed from the ground up to be a
therapeutic medical laser.
Slide 5
It was developed using research by our own biomedical engineers
and clinicians as well as collaboration with a major medical school
and university optics department.
Slide 6
We investigated important criteria such as wavelength, power
and power density, optics and beam delivery in order to afford the
greatest penetration and delivery of a therapeutic dose capable of
stimulating tissue healing in deep seated pathologies.
Slide 7
Light Light Amplification by Amplification by Stimulated
Stimulated Emission of Emission of Radiation Radiation
Slide 8
It could well stand for Latest Advance For Surgeon to Enhance
Revenue
Slide 9
Are used to cut, coagulate, and evaporate tissues. This type of
laser replaces the scalpel blade.
Slide 10
The TMA Laser is the only laser available on the market that
was designed to accomplish both surgical and therapeutic
procedures.
Slide 11
Therapeutic Lasers are used for the stimulation of cell
function. The biological effect is photochemical not thermal, as is
the case with surgical lasers.
Slide 12
Surgical lasers collimate high amounts of laser energy into a
beam of high intensity resulting in tissue destruction
Slide 13
High Power Therapeutic Lasers take a high amount of laser
energy but instead of beam collimation you get beam divergence
resulting in tissue stimulation
Slide 14
Veterinarians - Equine and Small Animal Human - Physical
Medicine and Rehab - Pain Management - Orthopedists, Neurologists,
- Family Practice
Slide 15
Chiropractors and Physical Therapists Podiatrists, Naturopaths
and DOMs MLB, NBA, NFL College Sports Teams Medical and Veterinary
Colleges United States Military VA Hospitals
Slide 16
Laser therapy aims to bio-stimulate injured and dysfunctional
tissues. Clinical studies and trials of Class III & IV laser
technology indicate the following beneficial effects of light
therapy on tissues and cells.
Slide 17
Chromophores are components of molecules which absorb
light.
Slide 18
The stimulation of chromophores on mitochondrial membranes
incites the production of ATP. Leading to a biological cascade of
events.
Slide 19
Increased Growth factor response within cells and tissue as a
result of increased ATP and protein synthesis. Accelerated cell
reproduction and growth leading to faster repair of damaged
tissues.
Slide 20
Increased metabolic activity- via increase in enzyme outputs,
oxygen and nutrient availability. Stem cell activation
Slide 21
Faster Wound Healing - Laser significantly increases fibroblast
and collagen production which are essential for tissue repair.
Improved Vascular Activity - Increased capillary production leads
to faster wound closure..
Slide 22
Greater Tensile Strength - Surgical repaired wounds heal with
greater tensile strength, including skin, tendon, ligament and
fascia. Scar Tissue Reduction - Wounds heal with less scar tissue
formation.
Slide 23
WOUND DAY 1 WOUND DAY 7 SID TX 4 WATTS-3000 JOULES
Slide 24
PRE-LASER AND AFTER TWO MONTHS OF TRADITIONAL THERAPY AFTER TWO
5 MINUTE LASER THERAPY TREATMENTS AT 7.5 WATTS
Slide 25
Strengthening the immune system response via increasing levels
of lymphocyte activity and through a newly researched mechanism
termed photo-modulation of blood.
Slide 26
Stabilization of cellular membrane Lubart R, Friedman H, and
Lavie R. Photobiostimulation as a function of different
wavelengths. The Journal of Laser Therapy. Vol 12. World
Association of Laser Therapy. 2000. Karu T. et al. Changes in
absorbance on monolayer of living cells induced by laser
irradiation. IEEE Journal of Selected Topics in Quantum
Electronics. IEEE Lasers and Electro-Optical Society. December
2001. 7(6):982. De Castro E Silva Jr. O, et al. Laser enhancement
in hepatic regeneration for partially hepatectomized rats. Lasers
in Surgery and Medicine. 2001. 29(1):73-77
Slide 27
Acceleration of leukocytic activity Increased Prostaglandin
synthesis Reduction in Interleukin 1(IL-1). Enhanced lymphocyte
response Increased angiogenesis Temperature modulation
Slide 28
Laser Therapy Cytochrome ActivationRos Production Cell Membrane
Changes Proton Gradient Change Ca, Na, K Ion Changes ATP
IncreaseVasodilationPG SynthesisIL-1 Decrease Increased Leukocyte
Activity Enhanced Lymphocyte Response Temperature Modulation
AngiogenesisSOD Production
Improved Vascular Activity Increased Metabolic Activity
Improved Nerve Function Immunoregulation Trigger Point Resolution
Acupuncture Pt. Stimulation
Slide 31
Improved Vascular Activity Increased Metabolic Activity
Improved Nerve Function Immunoregulation Trigger Point Resolution
Acupuncture Pt. Stimulation
Slide 32
Decreased inflammation of disc, nerve roots and the cauda
equine Increase microcirculation of spinal structures Accelerate
healing of annular defects Decreased formation of abnormal/non
functional scar tissue
Slide 33
Decreased scar tissue and non-osseous hypertrophic changes
Reduce pain associated with PRP prolotherapy injection Decrease or
even eliminate need for epidurals
Slide 34
Decreased inflammation of nerve tissue Accelerated Reinervation
of nerve fibers Increase blood flow and microcirculation of tissue
structures
Slide 35
Accelerate healing of open wounds Decreased formation of
abnormal non- functional scar tissue Increase synovial fluid and
cartilage production
Slide 36
Increase collagen and fibroblast production Increase
osteoblastic activity and fracture healing Decreased bony edema
osteochondral bone bruise
Slide 37
Safety Training begins with YOU! Class IV Laser Beams can cause
damage to the eyes Safety Glasses must be worn by everyone in the
treatment area AKA Nominal Hazard Zone (NHZ)
Slide 38
Safety protocols must ensure sufficient precautions are taken
to protect the health and safety of employees and patients. Use of
safety goggles to prevent retinal exposure is paramount.
Slide 39
Laser safety eyewear is not a primary mode of protection They
do not replace proper laser safety education, training, and careful
clinical practice.
Slide 40
Fluorescein angiography of retina after laser irradiation
Lesion
Medical Instruments (Reflex Hammers, Stethoscope) Jewelry
(Rings, Watches, Earrings) Treatment Table Mirrors, Door Knobs and
other Fixtures
Slide 44
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Reflect Absorb Transmit Scatter
Slide 48
Slide 49
Class 1 Lasers Laser Printers Compact Disc Players
Slide 50
Class 2 Lasers
Slide 51
Class 3a Lasers Office Depot Laser Pointers
Slide 52
Class 3b Lasers LLLT
Slide 53
Class 4 Lasers Surgical LasersTherapeutic Lasers
Slide 54
Pregnant Females Epiphyseal Lines In Children Pacemaker
Thyroid, Gonads, & Testicles Light Sensitive Medications
Corticosteroids Intolerance Eyes Carcinoma Hemorrhage
Immuno-Suppressant Drugs Sympathetic Ganglia, The Vagus Nerves
& Cardiac Region In Patients With Heart Disease
Slide 55
Although all therapeutic lasers bio- stimulate tissue, that is
where the similarities end. Laser Therapy is all about
Physics!
Slide 56
Therapy lasers are classified based on their power output Class
IIIa = lasers 1 to 5mw of power (laser pointers) Class IIIb =
lasers 6 to 500mw in power
Slide 57
Class IV = lasers above 500mw of power TMA Laser Platforms =
1,000 60,000 mw maximum continuous wave output
Slide 58
What we would like to do is find a volunteer with knee pain to
demonstrate the efficacy of high dose laser therapy While we finish
the lecture we will treat the patient and have him/her give you
feed back as to how the pain level and range of motion have
changed.
Slide 59
Laser Therapy 101 Rule #1: You Cannot Treat a Target That You
Cannot Reach.
Slide 60
X-Ray Physics = Laser Physics Rule # 2
Slide 61
Laser Therapy 101 Rule #3: Overstimulation With Laser Energy
Only Exists in a Petrie Dish
Slide 62
Laser Therapy 101 Rule #4: Understimulation and Lack of
Penetration are the #1 Reasons for Poor Clinical Outcomes!
Slide 63
The therapeutic dosage of laser energy is measured in Joules
Dosage is a function of the lasers power output For every one watt
of continuous laser power output, one joule of laser energy is
delivered per second of time
Slide 64
For a pulsed laser the energy delivery depends on the duty
cycle. Duty cycle tells us what percentage of time the laser is on
or actively firing. If the duty cycle is 50% then the laser at 1
watt only delivers 0.5 Joules / Second. For any given time period a
continuous wave laser delivers twice as much energy than laser with
a 50% duty cycle
Slide 65
The shorter the wavelength, the more readily the energy is
absorbed in the body. The higher the wavelength, the deeper the
penetration of photon energy.
Slide 66
980 nm: Low melanin, low water, low hemoglobin absorption thus
an optimal wavelength to choose when designing a therapy laser for
stimulating tissue at greater depths of penetration.
Slide 67
Slide 68
65% of laser energy is absorbed in the skin and subcutaneous
tissue layers with the following having a high affinity for
absorption: Hemoglobin in blood Melanin in skin, hair, moles, etc.
Water (present in all biological tissue)
Slide 69
As light energy hits the surface of the skin and subsequent
deeper layers, some of it is scattered and some of it is absorbed
and some is reflected At each tissue interface less energy is
available to pass further through to the next layer because of the
effects of absorption, reflectance and transmission
Slide 70
Laser Energy is just another form of energy on the
electromagnetic spectrum. Depth of penetration is determined by
wavelength and energy density. Just like with x-rays when deeper
penetration is required, more energy must be delivered to reach the
target tissues.
Slide 71
Prime Determinants of Laser Penetration and Concomitant Tissue
Stimulation are: Power measured in Watts or milliwatts
Slide 72
Wavelength measured in nanometers Power Density measured in mw
/ cm2 Frequency continuous wave versus pulsing
Slide 73
Since approximately 65% of the energy delivered is lost in the
epidermis If you dont start with enough energy on the skin, there
will not be enough to stimulate cell healing in deeper tissues
Slide 74
If you do not have sustained power density over a long enough
period of time treatments may be ineffective
Slide 75
A laser with two or more wavelengths only has the ability to
penetrate as deep as each individual wavelengths allows Most class
iv lasers that pulse or have a high duty cycle coupled with
multiple wavelengths of energy emission will not penetrate as deep
as CW lasers of a single wavelength or lasers that can pulse but
still maintain a high average power output
Slide 76
Continuous wave lasers = 100% duty cycle, laser is always
delivering energy which is needed to overcome absorption in the
superficial layers Newer generation of TMA lasers can now pulse yet
still maintain a high average power output allowing for greater
tissue saturation with less thermal effects
Slide 77
Dual wavelength lasers only penetrate as deep as each
wavelength individually. Penetration is not additive. There is no
validated clinical benefit to this scenario. It is more of a
marketing
Slide 78
For purposes of penetration it is more advantageous to have one
wavelength of greater power that stimulates cell metabolism and
tissue regeneration at all tissues densities in its pathway
Slide 79
Throughout our 13 years of clinical experience using a 980nm
treatment beam, we have experienced stellar results with both
superficial and deep pathologies. We still feel once you are
treating within the infrared spectrum, power, power density and
dosage are the key to better clinical outcomes.
Slide 80
In order to achieve penetration one must create significant
energy density to overcome absorption in the superficial layers of
the skin. With low power or pulsed lasers it is like pouring small
amounts of water onto a large sponge (the dermis and subcutaneous
tissues) and expecting the water to leak through.
Slide 81
In order to do so you must saturate the superficial layers of
the sponge- with enough water-energy to soak the sponge-superficial
tissue structures So as you pour more water-energy over the sponge
it will start to penetrate or leak through.
Slide 82
This it what is needed to penetrate and why it is important to
deliver a high amount of laser energy/dosage on the skin Especially
if you want to reach deep seated pathologies.
Slide 83
49-73 mw/cm 2 for cell stimulation 1 EFFECTS OF INFRARED LASER
EXPOSURE IN A CELLULAR MODEL OF WOUND HEALING Mark D. Skopin and
Scott C. Molitor, Department of Bioengineering, University of
Toledo, Toledo OH This study shows an optimal wavelength (980 nm)
and power density range for wound healing and tissue
stimulation
Slide 84
Tissue LayerMax Power (mw/cm2) Epidermis206 Dermis Layer182
Dermis Plexus Super.135 2nd Dermis Layer115 Dermis Plexus Prof.93
Muscle Tissue9.7 Power Setting 5 Watts, 3.0cm spot size, 980nm This
is a snapshot in time. Calculated using computer models by U of
Toledo.
Slide 85
Translation As laser light or energy penetrates through the
body more and more energy is absorbed so by the time you start
reaching deeper structures there is not enough therapeutic energy
to cause adequate tissue stimulation Thus the reason why low power
lasers as well as pulsing lasers cannot effectively treat deep
seated pathologies.
Slide 86
Duty Cycle 100% Laser is firing continuously Duty Cycle 50%
Laser is firing 50% of the time. This will not only cut energy
delivery but it will also affect ability to penetrate.
Slide 87
Pulsing Lasers that pulse also do not emit continuous energy
Lasers that can operate at 100% continuous wave output or pulse the
laser energy while still maintaining a high average power output is
key to treating deep seated pathologies and better clinical
outcomes.
Slide 88
With a high power output the laser beam can easily penetrate
deeper joints especially when compared to a class iii laser which
at best only offers superficial penetration.
Slide 89
Under penetration - The typical low level or cold laser or weak
or pulsed class iv laser does not concentrate the laser energy
sufficiently to allow for adequate penetration
Slide 90
Under-dosage The typical low level or cold laser or weak or
pulsed class iv laser does not deliver enough energy to adequately
stimulate deep seated inflammatory conditions
Slide 91
TMA protocols are successful because they call for delivery of
significantly larger amounts of therapeutic energy than industry
standard protocols.
Slide 92
TMAs goal has always been to build the most efficacious laser
available to deliver the best outcomes. Our lasers are built from
the ground up and are designed to get patients who have failed
traditional therapy better
Slide 93
Many other lasers are built based on economic factors or from
taking laser from other markets like dentistry and converting them
into weak class iv lasers There are no shortcuts to treating deep
seated pathologies and one must deliver the correct dosage of laser
energy in order to get the best outcomes.
Slide 94
Higher the power output of laser energy The Greater The
Penetration and Dosage The Faster the Therapeutic Outcome
Slide 95
The Quicker the Patient Returns to Normal This is the main
reasons we keep advancing our technology and developing more
powerful lasers.
Slide 96
More power equates to deeper penetration, faster delivery of
the proper therapeutic dosage, and ultimately better outcomes A 30
watt laser will not only penetrate deeper, it will put more
therapeutic energy to the target pathology It will do this 3X
faster than a 10 watt laser and 5X faster than a 12 watt laser with
a duty cycle of 50%
Slide 97
Small Joint 25-50 lb. Pet = 6,000 Joules Small Joint 50-100 lb.
Pet = 9,000 Joules Large Joint - 25-50 lb. Pet = 9,000 Joules
Slide 98
Large Joint- 50-100 lb. Pet 12-15,000 Joules Equine Dosages are
typically Double the Small Animal Dosage for Large Joints Even more
for back pathologies
Slide 99
The effects of HPLT can easily be documented Clinicians can
measure results using outcome assessment tools: Pressure Algometer
Inclinometer, Goniometer Thermal Imaging and Doppler Studies VAS,
PDQ Pain Disability Questionnaire
Slide 100
Slide 101
LASER BRAND (In watts) MDO(1) DUTY CYCLE (2) MPTD(3) JPM(4)
CPW(5) WARRANTY TMA - Diowave 60 60 100 60 w 3600 $834 3 yr TMA -
Diowave 30 30 100 30 w 1800 $1,167 3 yr TMA - Diowave 15 15 100 15
w 900 $1,600 3 yr TMA - Diowave 10 10 100 10 w 600 $1,500 3 yr
Litecure 15 7.5 100 7.5 w 900 $1,800 2 yr Litecure 10 5 100 5.0 w
600 $1,750 2 yr Klaser 12 6 50 3.0 w 360 $3,667 2 yr Klaser cube 15
5 50 2.5 w 450 $3,600 2 yr Cutting Edge 1.1 0.5 75