25.02.2016
The Department NEUROLOGICAL REHABILITATION of the University Hospital Charité (Prof. Dr. Stefan Hesse, Dr. Cordula Werner) in Berlin, Germany has published its study on the effects of laser therapy in severe cases of DOC (Disorders Of Conciousness).
Disturbances of consciousness are mostly caused by craniocerebral trauma, hypoxia and stroke.
The aim of neurorehabilitation is to promote and restore alertness and awareness. The patients are in a state in which they are awake but not responsive (USW=Unresponsive Wakefulness Syndrome) or in a state of minimal consciousness (Minimally Conscious State). Acinetic mutism due to frontal cerebral trauma is a third clinical manifestation. Therapeutic approaches include, for example, sensory stimulation procedures.
A new approach to neurorehabilitation is the non-invasive stimulation of certain cranial areas with near infrared laser light (transcranial laser therapy).
In the comparative study of the Charité 8 patients (4 with craniocerebral trauma, 3 with hypoxia and 1 after multiple stroke) were treated according to the following protocol:
Course of therapy
Laser therapy over 10 minutes, 5x per week for 4 weeks (20 sessions total)
Laser parameters
wavelength: 785 nm, frequency mode (Nogier E´), 21 laser diodes, energetic flux density 10 mW/cm2 corresponding to 6 joules per diode over a period of 10 minutes)
Laser device
POWERTWIN21, MKW Therapy Systems
Treatment area
5 areas on a horizontal line at the level of the upper cuneiform bone edges (Fossa sphenoidalis)
Treatment technique
All areas were irradiated with direct skin contact twice for one minute each.
The results confirm previous studies on the effectiveness of transcranial laser therapy with N-IR light:
The r-CRS scale (Coma Recovery Score) improved significantly, as did the FOUR scales (measurement of eye movement, motor response to a painful stimulus or verbal command, brain stem reflexes such as pupil reflexes and respiration) and SMART (evaluation of 5 sensory skills: taste, sight, hearing, touch and smell).
The best improvement was achieved in a patient with akinetic mutism due to frontal cerebral damage. In her case, the so-called ADL competence - the ability to Activities of Daily Life, which is measured with the so-called Barthel index - was relevantly increased.
The study compared the effectiveness of transcranial NI laser therapy (NI-LT) with focused shock wave therapy (F-SWT). Both procedures yielded significant results, with transcranial laser therapy slightly better (by about 15-18% related to the improvements in the 3 scales of focused shock wave therapy). The single-case success in the ability to perform everyday activities occurred only after transcranial laser therapy.
In view of the very great caution exercised in the study both in the dosage of transcranial laser therapy (6J/diode, 10 mW/cm2) and in the irradiation area (stripes along the edges of the cuneiform bone, i.e. only frontal irradiation of the forehead), the results are very promising. A study with a higher dosage and the additional treatment of the brain stem region could be very interesting.
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