Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.
Issue link: http://todaysveterinarypractice.epubxp.com/i/321264
Today's Veterinary Practice May/June 2014 64 | RECOVERY & REHAB tvpjournal.com management is purely speculative due to lack of studies. Hope- fully, more evidence will become available in the future. HOW IS LASER THERAPY APPLIED? To treat small areas, laser therapy is administered using a hand- held probe with a beam. The probe can be placed in: • Direct contact with the skin, which minimizes reflection of photons (Figure 5) • A noncontact position , in which the probe is held per- pendicular to the treatment area and off the skin (Figure 6). Noncontact is recommended for wound treatment. Dose & Duration Currently, the most efficient way to determine the dose and time is to use available treatment tables 1 (Table). Step-by-Step Application 1 1. Clip the patient's hair, which maximizes the laser's effect be- cause hair absorbs 50% to 90% of the light. 2. Measure the area to be treated. 3. Determine the treatment dose; in areas of darker skin, the dose should be increased by 25%. 4. Determine the total joules (J/cm 2 ) and treatment time needed. For example: If treating an area of 57 cm 2 (size of a playing card) with 10 J/cm 2 , the total treatment is 600 J. If using a 10-W laser, the treatment time is 60 seconds. 5. Place safety goggles prior to using the laser: all personnel in the room should wear protective eye gear, and the patient's eyes should also be protected. 6. The laser should be pointed perpendicular to the treat- ment area. 7. Apply the laser treatment, moving slowly, over the area by using an overlapping grid technique to ensure the entire area is treated. Precautions Precautions with laser therapy generally involve protecting the eyes during treatment. Since the light is coherent, a small amount focused on the retina may cause permanent damage. Fortunately, visible light will gener- ate a blink reflex to help protect the user; however, infrared lights are not visible so a blink reflex will not occur. SUMMARY In general, laser therapy is an emerging tech- nique that appears to at least have subjective benefits. Potential areas where laser therapy can be incorporated are in wound healing, pain management, and rehabilitation for various conditions (eg, OA). As has been emphasized, evidence-based, peer-reviewed studies are lacking. The author encourages readers to pursue well-controlled studies that help document a proven benefit, along with appropriate doses and conditions that can be treated. n TABLE. Laser Therapy Treatment Guidelines TREATMENT PURPOSE RECOMMENDED THERAPY (once daily unless noted otherwise) Analgesia for Pain Associated with Joints • 4–6 J/cm 2 for acute pain • 4–8 J/cm 2 for chronic pain Analgesia for Pain Associated with Muscles • 2–4 J/cm 2 for acute pain • 4–8 J/cm 2 for chronic pain Anti-inflammatory Therapy • 1–6 J/cm 2 for acute inflammation • 4–8 J/cm 2 for chronic inflammation Open Wound Therapy • 2–6 J/cm 2 for acute wounds for 7–10 days • 2–8 J/cm 2 for chronic wounds once daily Osteoarthritis Therapy • 8–10 J/cm 2 ; treat along the joint lines (Refer elsewhere for treatment of particular joints 1 ) Postoperative Wound Therapy • 1–3 J/cm 2 once daily Adapted from Millis dL, Saunders dG. Laser therapy in canine rehabilitation. in Millis dL, Levine d (eds): Canine Rehabilitation and Physical Therapy, 2nd ed. Philadelphia: elsevier, 2014. Figure 5. Note the perpendicular placement of the probe on the skin, which minimizes reflection of the laser. Courtesy ruby Lynn Carter, LvT, CCrT, Mississippi State University Figure 6. Application of the laser directly to the skin to avoid scatter of the photons. Note, when treating open wounds, the laser should not be placed directly into the wound. Courtesy ruby Lynn Carter, LvT, CCrT, Mississippi State University TVP_2014_0506_RecovRehab_LaserTherapy.indd 64 5/23/2014 6:02:12 PM