The Role of Transcranial Lower Level Laser Therapy in Stroke Rehabilitation Fauziah Nuraini Kurdi RSIA YK Madira Palembang

Background: The Role of Transcranial Lower Level Laser Therapy in Stroke Rehabilitation Fauziah Nuraini Kurdi Dosen Luar Biasa Rehabilitasi Medis FK Unsri Palembang Bagian Rehabilitasi Medis RSIA YK Madira Palembang Background: Low-le el laser thera!" is an irradiation te#hni$ue that has the abilit" to indu#e biologi#al !ro#esses using !hoton energ"% Most e iden#e o& e&&i#a#" is based on the in#rease in energ" state and the a#ti ation o& mito#hondrial !athwa"s% 'he !rimar" e&&e#t o##urs when light is absorbed in #"to#hrome # o(idase a !rotein within the mito#hondria% Low Le el Laser 'hera!" )LLL'* o& the #orre#t wa elength and densit"+ disso#iates ,- allowing o("gen ba#. in+ so A'P is restored and o(idati e stress redu#ed% -n#e normal mito#hondrial &un#tion is restored b" LLL' then #ell metabolism is im!ro es+ and the !atient gets better more $ui#.l"% In the brain+ there is similar e iden#e o& #ellular a#ti it" with laser irradiation using trans#ranial LLL' )/0/ nm* has signi&i#antl" im!ro ed re#o er" a&ter is#hemi# stro.e in rats when the" re#ei ed one treatment 12 hours a&ter sustaining a stro.e% In vivo studies rein&or#ed the e&&i#a#" o& this te#hni$ue &or a better neurologi#al and &un#tional out#ome !ost-stro.e% 'he e iden#e is based on in vivo animal studies o& arious models and one human #lini#al stud"% 'he resear#hers suggested that an underl"ing me#hanism &or the &un#tional bene&it a&ter LLL' in this stud" was !ossible indu#tion o& neurogenesis Objective: 'o .now the role o& trans#ranial lower le el laser thera!" in stro.e rehabilitation Material and methods: Literature re iew in !ublished studies about the role o& trans#ranial lower le el laser thera!" in stro.e rehabilitation. Re iew o& some studies about low le el laser thera!" 3 In the &irst stud" Lam!l et al% wrote that trans#ranial LLL' has been shown to signi&i#antl" im!ro e out#ome in human stro.e !atients+ when a!!lied at 45/ hours !ost-stro.e+ o er the entire sur&a#e o& the head 610 !oints in the 50710 ele#troen#e!halogra!h" )889* s"stem:+ regardless o& stro.e lo#ation% -nl" one LLL' treatment was administered+ and ; da"s later+ there was signi&i#antl" greater im!ro ement in the real- but not in the sham-treated grou! )!<%0;+ ,I= Stro.e Se erit" S#ale*% 'his signi&i#antl" greater im!ro ement was still !resent at >0 da"s !oststro.e+ where ?0@ o& the !atients treated with real LLL' had su##ess&ul out#ome+ ersus onl" ;5@ o& #ontrols% A ,IR )/0/ nm* laser was used+ deli ering 45 Aoule7#m1 o& energ" o er the entire sur&a#e o& the head% In a se#ond stud"+ with the same trans#ranial LLL' !roto#ol+ with an additional B;B a#ute stro.e !atients randomiCed &or real or sham laser+ similar signi&i#ant bene&i#ial results )!<%02* were obser ed &or moderate and moderate-se ere stro.e !atients )but not &or mild or se ere*+ who re#ei ed the real laser !roto#ol % Another stud" b" La!#ha. et al a!!lied in&rared light thera!" to rabbits that su&&ered a#ute emboli# stro.e% Light thera!" was a!!lied trans#raniall" B to 51 hours !ost embol-iCation

with #ontinuous wa e and !ulsed wa es% Beha ior anal"sis was !er&ormed 2/ hours a&ter is#hemi# stro.e% 'he results demonstrated that the !ulsed mode IR light thera!" resulted in signi&i#ant #lini#al im!ro ement when administered B hours &ollowing emboli# stro.es in rabbits -ron et al studied the e&&e#ts o& 9aAs laser irradiation on adenosine tri!hos!hate )A'P* !rodu#tion in normal human neural !rogenitor #ells% 'issue #ultures were treated with the 9aAs laser and A'P le els were determined at 50 minutes !ost laser a!!li#ation% 'he $uantit" o& A'P in the treated #ells was signi&i#antl" higher than the non-treated grou!% 'he a!!li#ation o& laser to normal human neuronal !rogenitor ),=,P* #ells signi&i#antl" in#reases A'P !rodu#tion% 'his ma" e(!lain the bene&i#ial e&&e#ts o& LLL' in stro.ed rats% Conclusion: De #an see &rom the re&eren#ed studies that there are a number o& bene&i#ial neurologi#al e&&e#ts arising &rom the a!!li#ation o& thera!euti# laser and !oint to signi&i#ant im!li#ations &or thera!euti# a!!li#ations in !otentiall" serious neurologi#al #onditions su#h as stro.e% 'hera!euti# laser is a low ris. #lini#al a!!roa#h that #ould bene&it #ountless numbers o& neurologi#al !atients% It is e(!e#ted that as resear#h #ontinues and understanding o& the underl"ing me#hanisms im!ro es+ we will be able to a!!l" laser thera!" more e&&e#ti el" to the neurologi#al !atient% Low-le el laser thera!" is an irradiation te#hni$ue that has the abilit" to indu#e biologi#al !ro#esses using !hoton energ"% Most e iden#e o& e&&i#a#" is based on the in#rease in energ" state and the a#ti ation o& mito#hondrial !athwa"s% 'he !rimar" e&&e#t o##urs when light is absorbed in #"to#hrome # o(idase a !rotein within the mito#hondria% Low Le el Laser 'hera!" )LLL'* o& the #orre#t wa elength and densit"+ disso#iates ,- allowing o("gen ba#. in+ so A'P is restored and o(idati e stress redu#ed% -n#e normal mito#hondrial &un#tion is restored b" LLL' then #ell metabolism is im!ro es+ and the !atient gets better more $ui#.l"% In the brain+ there is similar e iden#e o& #ellular a#ti it" with laser irradiation using trans#ranial LLL' )/0/ nm* has signi&i#antl" im!ro ed re#o er" a&ter is#hemi# stro.e in rats when the" re#ei ed one treatment 12 hours a&ter sustaining a stro.e% In vivo studies rein&or#ed the e&&i#a#" o& this te#hni$ue &or a better neurologi#al and &un#tional out#ome !ost-stro.e% 'he e iden#e is based on in vivo animal studies o& arious models and one human #lini#al stud"% 'he resear#hers suggested that an underl"ing me#hanism &or the &un#tional bene&it a&ter LLL' in this stud" was !ossible indu#tion o& neurogenesis Objective: 'o .now the role o& trans#ranial lower le el laser thera!" in stro.e rehabilitation Material and methods: Literature re iew in !ublished studies about the role o& trans#ranial lower le el laser thera!" in stro.e rehabilitation. Re iew o& some studies about low le el laser thera!" 3 In the &irst stud" Lam!l et al% wrote that trans#ranial LLL' has been shown to signi&i#antl" im!ro e out#ome in human stro.e !atients+ when a!!lied at 45/ hours !ost-stro.e+ o er the entire sur&a#e o& the head 610 !oints in the 50710 ele#troen#e!halogra!h" )889* s"stem:+ regardless o& stro.e lo#ation% -nl" one LLL' treatment was administered+ and ; da"s later+ there was signi&i#antl" greater im!ro ement in the real- but not in the sham-treated grou! )!<%0;+ ,I= Stro.e Se erit" S#ale*% 'his signi&i#antl" greater im!ro ement was still !resent at >0 da"s !oststro.e+ where ?0@ o& the !atients treated with real LLL' had su##ess&ul

out#ome+ ersus onl" ;5@ o& #ontrols% A ,IR )/0/ nm* laser was used+ deli ering 45 Aoule7#m1 o& energ" o er the entire sur&a#e o& the head% In a se#ond stud"+ with the same trans#ranial LLL' !roto#ol+ with an additional B;B a#ute stro.e !atients randomiCed &or real or sham laser+ similar signi&i#ant bene&i#ial results )!<%02* were obser ed &or moderate and moderate-se ere stro.e !atients )but not &or mild or se ere*+ who re#ei ed the real laser !roto#ol % Another stud" b" La!#ha. et al a!!lied in&rared light thera!" to rabbits that su&&ered a#ute emboli# stro.e% Light thera!" was a!!lied trans#raniall" B to 51 hours !ost embol-iCation with #ontinuous wa e and !ulsed wa es% Beha ior anal"sis was !er&ormed 2/ hours a&ter is#hemi# stro.e% 'he results demonstrated that the !ulsed mode IR light thera!" resulted in signi&i#ant #lini#al im!ro ement when administered B hours &ollowing emboli# stro.es in rabbits -ron et al studied the e&&e#ts o& 9aAs laser irradiation on adenosine tri!hos!hate )A'P* !rodu#tion in normal human neural !rogenitor #ells% 'issue #ultures were treated with the 9aAs laser and A'P le els were determined at 50 minutes !ost laser a!!li#ation% 'he $uantit" o& A'P in the treated #ells was signi&i#antl" higher than the non-treated grou!% 'he a!!li#ation o& laser to normal human neuronal !rogenitor ),=,P* #ells signi&i#antl" in#reases A'P !rodu#tion% 'his ma" e(!lain the bene&i#ial e&&e#ts o& LLL' in stro.ed rats% Conclusion: De #an see &rom the re&eren#ed studies that there are a number o& bene&i#ial neurologi#al e&&e#ts arising &rom the a!!li#ation o& thera!euti# laser and !oint to signi&i#ant im!li#ations &or thera!euti# a!!li#ations in !otentiall" serious neurologi#al #onditions su#h as stro.e% 'hera!euti# laser is a low ris. #lini#al a!!roa#h that #ould bene&it #ountless numbers o& neurologi#al !atients% It is e(!e#ted that as resear#h #ontinues and understanding o& the underl"ing me#hanisms im!ro es+ we will be able to a!!l" laser thera!" more e&&e#ti el" to the neurologi#al !atient%
The Role of