2. Dr Ibrahim Aplikasi Terapi Laser dalam bidang RehabilitasiCARA KERJA LASER •Cara kerjalow laser inidenganmenghasilkan reaksiphotochemical (fotokimia) dan mempunyaiefektermalyang

APLIKASI TERAPI LASER DALAM BIDANG KEDOKTERAN FISIK DAN

REHABILITASI (Rehabilitasi Medik)

Dr. Ibrahim Agung, Sp.KFR

Divisi Muskuloskeletal – Departemen Rehabilitasi Medik, RSUPN dr. Cipto Mangunkusumo

dr. Ibrahim Agung, Sp. KFR

E-mail: ibrahim.kfr@gmail.com

Education:• 2017 International Fellowship of Physical Medicine and Rehabilitation at Chang Gung Memorial Hospital,

Linkou, (Republic of China) Taiwan

• 2013-2017 Physical Medicine and Rehabilitation Specialist at Medical Faculty; University of Indonesia

• 2010 Medical Doctor at Medical Faculty; University of Indonesia

Professional Experience:• Physical Medicine and Rehabilitation Specialist at dr. Cipto Mangunkusumo General Hospital

• Physical Medicine and Rehabilitation Specialist at Medistra Hospital – Jakarta

Studies and Pubilcations:• Agung I, Murdana N, Purba H, Fuady A. Perbandingan Efektivitas Terapi Laser Tenaga Rendah dengan Terapi

Dry Needling pada Penderita Sindroma Nyeri Miofasial Otot Upper Trapezius: Studi Intervensi. Universitas

Indonesia. Jakarta: 2017.

• Agung I. Direct effect of High-Intensity Laser Therapy for Myofascial Pain Syndrome of The Upper Trapezius Muscles: An Interventional Study. Universitas Indonesia. Jakarta: 2016.

BIOPHOTON ADALAH CAHAYA YANG MEMILIKI KOHERENSI DARI SEL -- > ENERGI SEL -- > SEMUA SISTEM KEHIDUPAN.

CAHAYA adalah suatu bentuk energi elektromagnetik yang memiliki panjang gelombang antara 100 hingga 10.000 nanometer (nm = 10-9) dalam suatu rentang spectrum. Elektromagnetik cahaya Terlihat dari 400 (ungu) sampai 700 nm (merah)

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

ADA 2 JALAN CAHAYA DAPAT DIHASILKAN● SPONTANEUS EMISSION● STIMULATED EMISSION

LASER LIGHT AMPLIFICATION OF STIMULATED OF RADIATION

(THEODORE MAIMAN 1960)

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

HOW STIMULATED EMISSION ACCOURS

●IN STIMULATED EMISSION , TWO PHOTONS ARE EMITTED WHEN A PHOTON COLLIDES EXCITED ATOM

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003

A LASER IS AN AMPLIFIER OF LIGHT

STIMULATED EMISSION

THREE COMPONENTS OF ANY LASER ARE :1.ENERGY SOURCES

2.AMPLIFYING MEDIUM3.A PAIR OF MIRRORS

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003

tiga sifatmembedakanlaser darisumbercahaya pijardan neon:

Coherenceà Gelombang cahaya berada dalam satu fase.

MonochromaticityàLASER adalah salah satu dari sedikit sumber cahaya yang memproduksi panjang gelombang spesifik ..

Collimationà Sinar laser adalah cahaya yang teratur, dimanaterjadi divergensi yang minimal dari foton.

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

Laser equipment commonly is grouped into four FDA classes :

Class I

• Lasers are considered nonhazardous to the body.

• All invisible lasers with average power outputs of 1 mW or less. These include the GaAs lasers (820 to 910 nm).

Class II (low power)

• Lasers are hazardous only if a viewer stares continuously into the source.

• Visible lasers that emit up to 1 mW average power, such as the HeNe laser.

Class III(moderate risk)

• Lasers can cause retinal injury.

• Operator and patient are required to wear protective eyewear.

Class IV(high risk)

• lasers present a high risk of injury and can cause combustion of flammable materials

• Diffuse reflections that may harm the eyes and cause serious skin injury from direct exposure.

Type of Laserdepending on the intensity of energy they deliver

• Dikenal sebagai "hot laser” karena panas yang ditimbulkannya.

• Digunakan diberbagai tindakan medis termasuk saatpembedahan untuk memotong dan menghentikanperdarahan, ophthalmologi, dermatologi, onkologidan vaskular..

• > 500 miliwatts (laser kelas 4)

High-power lasers

Tidak untuk menghasilkan panas karena diproduksisecara fotokimia.digunakan untuk menyembuhkan luka,

management nyeri, pengobatan pada trauma tendon dan ligamen, arthritis, mengurangi edema, trauma jaringan lunak, perawatan luka bakar danmenghambat scaring.1 miliwatt – 500mili watts( laser kelas 2&3)

Low-power lasers

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

PANJANG GELOMBANG LASER

Cahaya yang digunakan mempunyai spektrum yang sempit yaitu pada spektrum merah (red) dan near infrared (600-1000nm), dengan power density (irradiance) antara 1mw-5W/cm2.

Pada bidang rehabilitasi medis digunakanradiasi dengan panjang gelombang 630-1100nm.

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

JENIS JENIS LASER

• 1 Gallium Arsenid Laser • 2 Gallium-Aluminum-Arsenid Laser

(GaAlAs) • 3 Helium Neon Laser

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

Depth of Penetrationdepends on the type of laser energy delivered

HeNe laser

• Absorption of HeNe laser energy occurs rapidly in the

superficial structures, especially in the first 2-5

mm of soft tissue.• An indirect effect on tissues

up to 8-10 mm.

GaAs Laser

• The GaAs directly absorbed in tissues at depths of 1-2

cm and has an indirect effect up to 5 cm.

• This laser has better potential for the treatment

of deeper soft tissue injuries, such as strains, sprains, and contusions.

CARA KERJA LASER

• Cara kerja low laser ini dengan menghasilkanreaksi photochemical (fotokimia) danmempunyai efek termal yang minimal

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

Emisi spontan dari sinar. (A) atom dikelilingioleh electron, (B) penggunaan elektrikal danelectron berpindah ke tingkatan lintasan yang lebih tinggi, (C) electron turun kembali danmengemisikan panjang gelombang foton yang sama

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

TEKNIK PENGGUNAAN LASER

Terdapat tiga teknik carapenggunaan laser yaitu gridding, scanning, dan wanding.

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

CONTINOUS AND INTERRUPTED PULSED

Hal yang perlu diperhatikan dalampenentuan dosis :

1. Reaksi jaringan

2. Reaksi pengobatan

3. Minimal reaction dose

Efek laser1. Mengurangi nyeri2. Menyebabkan vasodilatasi3. Memodulasi inflamasi4. Mengubah kecepatan konduksi saraf dan regenerasi5. Menstimulasi proses regenerasi jaringan6. Meningkatkan produksi adenosine triphosphate (ATP)7. Meningkatkan produksi kolagen8. Menghambat pertumbuhan bakteri9. Menstimulasi serotonin dan endorfin à efek relaksasi

dan sedasi

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

Precaution condition in laser therapy

1. Vision —>Protect your patients vision your own

2. Thyroid treatment —> decrease the level of mRNA

3. Steroids —> Block the effect of therapeutic lasers

4. Tatto and dark hair —> cause localized heating of tissue

5. Pain respon6. Children —> Epiphyseal plate

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003

KONTRAINDIKASI

1. Penyinaran langsung ke mata.

2. Kehamilan. Pada wanita hamil laser dapat diberikan di daerahmana saja kecuali pada daerah abdomen dan uterus.

3. Keganasan (Malignancy)

4. Dalam 4- 6 bulan setelah radioterapi

5. Daerah yang yang mengalami perdarahan, karena akanmenyebabkan vasodilatasi dan mungkin meningkatkanperdarahan.

6. Daerah tiroid dan kelenjar endokrin lain

PENGGUNAAN LASER SEBAGAI TERAPI

MODALITAS

Clinical Application for Laser

Wound healing

Pain reducti

on

Tensile strengthImmunologic response

InflammationScar tissue

Bone respon

se

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

MYOFASCIAL PAIN SYNDROME

1. Agung I, Murdana N, Purba H, Fuady A. Perbandingan Efektivitas Terapi Laser Tenaga Rendah dengan Terapi Dry Needling pada PenderitaSindroma Nyeri Miofasial Otot Upper Trapezius: Studi Intervensi. Universitas Indonesia. Jakarta: 2017.2. Agung I, Murdana N, Purba H. Relationship between Body Mass Index and Pain Threshold in Myofascial Pain Syndrome Patients: A Cross-sectional Study. Universitas Indonesia. Jakarta: 2017.3. Agung I. Direct effect of High-Intensity Laser Therapy for Myofascial Pain Syndrome of The Upper Trapezius Muscles: An Interventional Study. Universitas Indonesia. Jakarta: 2016.4. Agung I, Murdana N. Comparison of Skin Resistance between Myofascial Trigger Points (MTPs) with Normal Tissue on Upper Trapezius Muscles. Universitas Indonesia. Jakarta: 2014.

BACK PAIN• Laser therapy restores blood flow to the

muscle, relaxing them and relieving thestagnation and ischemic which cause mostback pain

GaAas is effective in chronic low back pain

(a double blind with trialLaser surgmed Prof soriano,argentina)

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003

HEEL SPURS

• LASER THERAPY WITH HIGH DOSE

EXTREMELY EFFECTIVE FOR THIS CASE

• SCHEDULE TREATMENT : TWICE WEEKLY (4 WEEKS)

• DOSE : 30-80J / Cm2 or more

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003

KNEE PAIN

• LASER THERAPY STIMULATE THE PRODUCTION OF CARTILAGE AND RELIEVES INFLAMATION AND PAIN

THE EFFECT OF LLLT THERAPY ON OSTEOARTHRITIS OF THE KNEE(Basirnia A,Sadeghipoor G.,Esmaeeli Djavid et al)TREAT ON 20 PATIENTS (20-40 YEARS) TREAT BY LASER WITH DEVICE pulsed diode laser (810nm , once a day, 5 days )

Outcome : Pain relief and improve functional ability

NEUROPATHYIC PAIN• LASER THERAPY AS a MODALITY IN THE

TREATMENT OF INCOMPLETE PHERIPHERAL NERVE INJURY

(Prospective clinical double blind plasebo-controlled randomized study ) S.Rochkin, M.Alon,M.nissan, department of neurosurgery, neurologi, rehabilitation, physiotherapy, Tel aviv,Israel)

Result : LASER THERAPY , A NON INVASIVE LOW CHOST METHOD, MAY BE USEFUl IN IMPROVING THE FUNCTIONAL RECOVERY OF PATIENT SUFFERING FROM INCOMPLETE PERIPHERAL NERVE AND BRACHIAL PLEXUS INJURY

WOUNDS / BURNS• Thought a visible, red laser is the best choice when

avaiable, GaAIAs works very well for wounds.

Dose : 4J/cm2 in contact peripher0,5-1J/cm2 in over the wound

(Simunovic z , ivankovich a.d,depolo.wound healing on human body with use LLLT-treat of operated sport and traffic accident injuries :a randomized clinical study on 74 patients with control group)

Result : pain relief and functional recovery was significantly improved in the laser group

Take home massages• Terapi laser merupakan pilihan utama terapi non

invasif pada berbagai kasusneuromusculoskeletal

• Terapi laser memiliki efek mengurangi nyeri, antiinflamasi dan menstimulasi regenerasi

• Terapi laser yang dikombinasikan dengan terapilain (exercise, manual therapy) sangatdirekomendasikan, untuk memberikan hasil yang terbaik bagi pasien

TERIMA KASIH