The Role of Transcranial Lower Level Laser Therapy in Stroke Rehabilitation

Fauziah Nuraini KurdiRSIA YK Madira Palembang

Background:

The Role of Transcranial Lower Level Laser Therapy in Stroke Rehabilitation

Fauziah Nuraini KurdiDosen Luar Biasa Rehabilitasi Medis FK Unsri PalembangBagian Rehabilitasi Medis RSIA YK Madira Palembang

Background: Low-level laser therapy is an irradiation technique that has the ability to induce biological processes using photon energy. Most evidence of efficacy is based on the increase in energy state and the activation of mitochondrial pathways. The primary effect occurs when light is absorbed in cytochrome c oxidase a protein within the mitochondria. Low Level Laser Therapy (LLLT) of the correct wavelength and density, dissociates NO allowing oxygen back in, so ATP is restored and oxidative stress reduced. Once normal mitochondrial function is restored by LLLT then cell metabolism is improves, and the patient gets better more quickly. In the brain, there is similar evidence of cellular activity with laser irradiation using transcranial LLLT (808 nm) has significantly improved recovery after ischemic stroke in rats when they received one treatment 24 hours after sustaining a stroke. In vivo studies reinforced the efficacy of this technique for a better neurological and functional outcome post-stroke. The evidence is based on in vivo animal studies of various models and one human clinical study. The researchers suggested that an underlying mechanism for the functional benefit after LLLT in this study was possible induction of neurogenesisObjective: To know the role of transcranial lower level laser therapy in stroke rehabilitationMaterial and methods: Literature review in published studies about the role of transcranial lower level laser therapy in stroke rehabilitation.Review of some studies about low level laser therapy :In the first study Lampl et al. wrote that transcranial LLLT has been shown to significantly improve outcome in human stroke patients, when applied at ~18 hours post-stroke, over the entire surface of the head [20 points in the 10/20 electroencephalography (EEG) system], regardless of stroke location. Only one LLLT treatment was administered, and 5 days later, there was significantly greater improvement in the real- but not in the sham-treated group (p<.05, NIH Stroke Severity Scale). This significantly greater improvement was still present at 90 days poststroke, where 70% of the patients treated with real LLLT had successful outcome, versus only 51% of controls. A NIR (808 nm) laser was used, delivering ~1 Joule/cm2 of energy over the entire surface of the head. In a second study, with the same transcranial LLLT protocol, with an additional 656 acute stroke patients randomized for real or sham laser, similar significant beneficial results (p<.04) were observed for moderate and moderate-severe stroke patients (but not for mild or severe), who received the real laser protocol .

Another study by Lapchak et al applied infrared light therapy to rabbits that suffered acute embolic stroke. Light therapy was applied transcranially 6 to 12 hours post embol-ization

with continuous wave and pulsed waves. Behavior analysis was performed 48 hours after ischemic stroke. The results demonstrated that the pulsed mode IR light therapy resulted in significant clinical improvement when administered 6 hours following embolic strokes in rabbits

Oron et al studied the effects of GaAs laser irradiation on adenosine triphosphate (ATP) production in normal human neural progenitor cells. Tissue cultures were treated with the GaAs laser and ATP levels were determined at 10 minutes post laser application. The quantity of ATP in the treated cells was significantly higher than the non-treated group. The application of laser to normal human neuronal progenitor (NHNP) cells significantly increases ATP production. This may explain the beneficial effects of LLLT in stroked rats.

Conclusion:

We can see from the referenced studies that there are a number of beneficial neurological effects arising from the application of therapeutic laser and point to significant implications for therapeutic applications in potentially serious neurological conditions such as stroke. Therapeutic laser is a low risk clinical approach that could benefit countless numbers of neurological patients. It is expected that as research continues and understanding of the underlying mechanisms improves, we will be able to apply laser therapy more effectively to the neurological patient.

Low-level laser therapy is an irradiation technique that has the ability to induce biological processes using photon energy. Most evidence of efficacy is based on the increase in energy state and the activation of mitochondrial pathways. The primary effect occurs when light is absorbed in cytochrome c oxidase a protein within the mitochondria. Low Level Laser Therapy (LLLT) of the correct wavelength and density, dissociates NO allowing oxygen back in, so ATP is restored and oxidative stress reduced. Once normal mitochondrial function is restored by LLLT then cell metabolism is improves, and the patient gets better more quickly. In the brain, there is similar evidence of cellular activity with laser irradiation using transcranial LLLT (808 nm) has significantly improved recovery after ischemic stroke in rats when they received one treatment 24 hours after sustaining a stroke. In vivo studies reinforced the efficacy of this technique for a better neurological and functional outcome post-stroke. The evidence is based on in vivo animal studies of various models and one human clinical study. The researchers suggested that an underlying mechanism for the functional benefit after LLLT in this study was possible induction of neurogenesisObjective: To know the role of transcranial lower level laser therapy in stroke rehabilitationMaterial and methods: Literature review in published studies about the role of transcranial lower level laser therapy in stroke rehabilitation.Review of some studies about low level laser therapy :In the first study Lampl et al. wrote that transcranial LLLT has been shown to significantly improve outcome in human stroke patients, when applied at ~18 hours post-stroke, over the entire surface of the head [20 points in the 10/20 electroencephalography (EEG) system], regardless of stroke location. Only one LLLT treatment was administered, and 5 days later, there was significantly greater improvement in the real- but not in the sham-treated group (p<.05, NIH Stroke Severity Scale). This significantly greater improvement was still present at 90 days poststroke, where 70% of the patients treated with real LLLT had successful

outcome, versus only 51% of controls. A NIR (808 nm) laser was used, delivering ~1 Joule/cm2 of energy over the entire surface of the head. In a second study, with the same transcranial LLLT protocol, with an additional 656 acute stroke patients randomized for real or sham laser, similar significant beneficial results (p<.04) were observed for moderate and moderate-severe stroke patients (but not for mild or severe), who received the real laser protocol .

Another study by Lapchak et al applied infrared light therapy to rabbits that suffered acute embolic stroke. Light therapy was applied transcranially 6 to 12 hours post embol-ization with continuous wave and pulsed waves. Behavior analysis was performed 48 hours after ischemic stroke. The results demonstrated that the pulsed mode IR light therapy resulted in significant clinical improvement when administered 6 hours following embolic strokes in rabbits

Oron et al studied the effects of GaAs laser irradiation on adenosine triphosphate (ATP) production in normal human neural progenitor cells. Tissue cultures were treated with the GaAs laser and ATP levels were determined at 10 minutes post laser application. The quantity of ATP in the treated cells was significantly higher than the non-treated group. The application of laser to normal human neuronal progenitor (NHNP) cells significantly increases ATP production. This may explain the beneficial effects of LLLT in stroked rats.

Conclusion:

We can see from the referenced studies that there are a number of beneficial neurological effects arising from the application of therapeutic laser and point to significant implications for therapeutic applications in potentially serious neurological conditions such as stroke. Therapeutic laser is a low risk clinical approach that could benefit countless numbers of neurological patients. It is expected that as research continues and understanding of the underlying mechanisms improves, we will be able to apply laser therapy more effectively to the neurological patient.

The Role of