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Brain injury: Success with transcranial LLLT in Patients with DOC

A New Study from the University Clinic Charité in Berlin/Germany confirms the Success with transcranial LLLT in Patients with DOC (Disorders of Consciousness like after traumatic brain injury and stroke).

he department Neurological Rehabilitation of the university clinic Charité in Berlin/Germany (Prof. Dr. med Stefan Hesse, Dr. Cordula Werner) published their new study on the effects of Near Infrared Lasertherapy (NI-LT) in severe cases of DOC (Disorders of Consciousness). Disorders of consciousness are caused by craniocerebral traumas (traumatic brain injury), hypoxia and stroke.

The goal of neurorehabilitation is the recovery of alertness and awarness. Patients are in a state of unresponsive wakefulness (USW=Unresponsive Wakefulness Syndrome) or in a state of lowered consciousness (Minimally Conscious State). Acinetic mutism due to a frontal cerebral trauma is a third clinical condition. Therapeutic approaches include e.g. multisensory stimulation.

A new approach in neurorehabilitation is the non-invasive stimulation of certain cranial areas with near infrared low level laserlight (transcranial lasertherapy). In the comparative study 8 patients (4 traumatic brain injury, 3 hypoxia, 1 multiple stroke) were treated according the following protocol:

Therapy progression
Lasertherapy over a period of 10 minutes, 5x per week for 4 weeks (20 treatments total)

Laser-Parameter
Wavelength: 785 nm, frequencymode (Nogier E´), 21 laserdiodes, energy flux density: 10 mW/cm2 corresponding 6 Joules per diode over a time period of 10 Minutes)

Laser device
POWERTWIN21, MKW Therapiesysteme

Treatment area
5 areas along a horizontal line at the level of the upper edge of the two fossa sphenoidalis

Treatment technique
The areas were lasered with direct skin contact and two times for one minute each.

The results confirm previous studies on the effectiveness of transcranial lasertherapy with N-IR light:

The r-CRS scale (Coma Recovery Scale) improved significantly as well as the scales of FOUR (measurement of eye movement, of the motor reaction in response to a painful stimulus or a verbal command, of reflexes of the brain stem like pupil reflexes and of breathing) and SMART (Evaluation oft he 5 senses).
The best improvement was achieved in a patient with acinetic mutism after a frontal cerebral lesion. Here also the ADL-capacity – the capability to perform activities of daily life, which is measured by the Barthel-Index – did rise relevantly.

The comparative study compares two approaches: 1) NI-Lasertherapy (NI-LT) and 2) focussed shock wave therapy (F-SWT). Both of them showed significant positive effects, whereas the NI-Lasertherapy scored a little higher (about 15-18% relating to the betterments in all three scales with F-SWT). The single case success concerning competence in every day activities was achieved with NI-LT only.

Considering the great cautiousness, which was exercised in transcranial lasertherapy regarding  the dosage (6J/diode corresponding to 10 mW/cm2) and also regarding the narrow selection of the treatment area (horizontal line at the forehead), the outcomes are very pioneeri t. It could be highly interesting to perform a study with a higher dosage as well with additionally treating the region oft he brain stem.

 

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