1. Light Modalities Chapter 19

2. Description Light modalities are found on the electromagnetic spectrum –Most abundant form of energy in the universe Drying superficial tissues or via superficial photochemical effects Some mild superficial thermal effects

3. Types of Therapeutic Lamps Infrared –Superficial dry heat Ultraviolet –Heats the bodys tissues for either tissue destruction or therapeutic effects Visible –Combination of ultraviolet and infrared known as Lasers

4. Infrared Lamp Used to dry seeping open wounds or sedate superficial sensory nerves Radiant modality: An electrical current passes through a carbon or tungsten filament –Intensity controlled by adjusting current flow or distance between lamp and tissue –Constant temperature, increased risk of burns –Heating skin depends on the amount of radiation absorbed Pigmented, darker skin will absorb more energy and will heat more rapidly than lighter skin

5. Types of Infrared Lamps Near-Infrared –Luminous Infrared Lamp –Wavelength: 780 to 1,500 nm (closest to visible light) –Thermal Effects: 5 to 10 mm deep –Energy formed by carbon and tungsten filament Light bulb Some energy is reflected by the surface of the skin

6. Types of Infrared Lamps Far-Infrared –Nonluminous Infrared Radiation –Wavelength: 1,500 to 12,500 nm –Thermal Effects: < 2mm Less penetrating than Near-Infrared –Skin feels warmer –Energy formed by metal coil i.e. electric stove or space heater Invisible to human eye

7. Effects of Infrared Lamps Constant, dry heat to assist with superficial tissue –Dermatological conditions –Increase cell metabolism –Blood flow –Muscle Relaxation Contraindications –Any conditions in which other forms of superficial heat are contraindicated

8. Clinical Applications Turn On and warm if necessary Treatment Duration: 20 to 30 minutes Intensity: adjust wattage or distance of lamp –Luminous = 24 inches –NonLuminous = 32 inches –Inverse Square Law –Cosine Law Clean sweat and dirt, remove jewelry, and fit infrared goggles (if applicable) for patient

9. Ultraviolet Therapy Used to produce photochemical reactions in the skin Wavelength: 180 to 400 nm 3 UV bands (A, B, and C) produce unique effects

10. Types of UV UV-A –AKA: near UV –Effects: Erythema without pigmentation UV-B –AKA: middle UV –Effects: Erythema without pigmentation, formation of vit D, skin tanning (blister/burn) UV-C –AKA: far UV –Kills bacteria, formation of vit D, skin tanning

11. Types of UV Lamps Hot UV Lamps –Low Volt (30-110V) High-Amp (5A) –Electrical current passes through tube, argon gas heats, vaporizing and polarizing mercury to produce UV light in ALL 3 bands and visible violet light Cold UV Lamps –High Volt (3000V) Low-Amp (15mA) –Energy is cooler than Hot and produce UV-C

12. Biophysical Effects Energy absorbed at a depth between 0.20 to 0.22 mm Damages cell proteins, DNA, & RNA to initiate local inflammatory responses Effects: –Vitamin D synthesis –Enhances melanin production –Thickens epidermis –Superficial vasodilatation –Bactericide

13. Effects of UV Lamps Wound Healing –Activates inflammatory response –Use: Cold Lamps at intensity of E 3 Treat Skin Disorders –i.e. psoriasis –Exfoliates tissue and damage DNA that produces the excess skin growth associated with psoriasis –Use: UV-B

14. UV Contraindications Sunlight sensitivity Fair skin (precaution) Medications or food that increase sunlight sensitivity Hyperthyroidism

15. UV Dosage Determined by Minimal Erythema Dose –Least amount of UV exposure time to produce redness within 1-6 hrs and disappear within 24 hours Hot Lamps –Determined by each patient and each lamp –Standard distance = 30 in., not closer than 15 in. Cold Lamps –Standard MED value –12-15 seconds at a distance = 1 in.

16. Determining MED for UV Lamp Cardboard Test Strips 1. 6 different shapes cut out 2. Use to cover shapes UV Lamp 30 in. away Exposes 1 cut out, open the shutters for 30- sec., expose the 2 nd cut out and leave the 1 st uncover for the 30-sec. Repeat the steps above for the remaining 4 cut outs, but expose them at 15-sec intervals Instruct patient to check area every hour and record changes

17. UV Treatment Dosage SED –No erythema MED –Smallest dose that produces erythema within 1-6 hr E 1 –Erythema lasts for 1-3 days, some scaling of skin present, approximately 2.5x MED E 2 –Erythema with edema, peeling, and pigmentation, approximately 5x MED E 3 –Severe erythema and burning, blistering, peeling, edema, approximately, 10x MED

18. Clinical Application Calculate treatment dose and duration Clean area and remove jewelry Cover skin not being treated (sunscreen if applicable) Fit UV-resistant goggles to patient and clinician Position lamp at right angle using the correct distance and duration for each type of lamp Clean machine and check periodically for maintenance of bulbs

19. Adjusting the Treatment Dose Biophysical changes occur with light exposure causing changes in treatment Duration –30 to 50% increase for each subsequent treatment –If 3 to 5 minutes, then distance is reduced –5 to 10 sec is decreased when missing a treatment Be aware of patients skin color and the lamps distance, duration, and angle

20. Therapeutic Lasers L=Light A=Amplification by S=Stimulated E=Emission of R=Radiation Classified by the FDAs Center for Devices and Radiological Health

21. Types of Lasers High-Power Laser –Hot Laser –Effect: Causes thermal changes in tissues (cause tissues to be destroyed, evaporated, or dehydrated) –Uses: Surgery Capsular shrinkage Wrinkle and tattoo removal Low-Power Laser –Cold Laser –Effect Causes photochemical changes in tissue –Uses: Wound healing Arthritis Burn care

22. Production of Laser Energy Lasers are referred to by the type of active medium (gas, liquid, solid) –HeNe: visible red light penetrating 0.8 to 15mm –GaAs: invisible penetrating up to 2 cm Energy is introduced into the active medium An orbiting electron briefly elevates into a higher or excited state The electron spontaneously returns and releases another photon

23. Effects of Lasers Photons are absorbed by tissues to alter molecular-level activity Theorized to affect pain-producing tissue (muscle spasm), by increasing ATP synthesis that increases cell metabolism and encourages the release of free radicals

24. Wound Healing Superficial wounds –Ulcers, surgical insicison, burns Lasers alter cell membrane permeability and increase in fibroblast, lymphocyte, and macrophage activity occurs Blood and lymph improve to promote the growth of granulation tissue Increase collagen and tensile strength of healing wounds

25. Pain Reduction Decrease acute and chronic pain Reduce the rate and velocity of sensory nerve impulses –Similar to cryotherapy but without thermal changes

26. Fracture Healing May enhance fracture healing and bone remodeling by increasing capillary formation, calcium deposition, increase callus formation, and reducing hematomas Photons striking the tissue create acoustic waves that affect bone healing similar to ultrasonic bone growth stimulators

27. Clinical Application Because of the investigational status of therapeutic lasers, the clinical application is not described.