*

Dr. Azza Attia

Patient and skin preparation:
 Remove the clothes on the treated body area.

 Normal skin: Cleanse the exposed skin with rubbing alcohol to remove
dirties or dead tissues. Shave excessive hair if necessary.

 Wounded skin: Wash and debride the wound. Wear protective gears like
goggles, mask, gown, and gloves to Prevent contamination.

 Put the patient in comfortable body position.

 Patient instructions
 Inform the patient that he or she may feel nothing during
treatment

 Patient and therapist must wear protective glasses or

goggles, which filter the wavelengths emitted by the laser
device during therapy.
5. Laser selection
Infrared-light diode
Red-light gaseous
or semiconductor
(HeNe)
(GaAs,GaAlAs)

Absorption by
melanin and more less
haemoglobin

Scattering
“depending on more less
wavelength”

Penetration
“depending on
wavelength, tissue
less more
contact and
compression”
6. Mode of delivery

Continuous Pulsed

recommended effective with

for acute pain chronic pain and
and fresh long-standing
wounds open wounds

applied at a
range of 4-10
pulses / second

power reduced
to almost its
half
Probe type

Probe type

Single
Cluster
(wand)

*selection is based on the size of the treatment

surface area
*larger surface area require cluster probe in order to
minimize the number of application
8. Application methods

Application methods

Stationary Gridding Scanning

 Stationary method Gridding method Scanning method

The applicator Cover area with grid mapping of - Scanning of the entire
equal size squares measuring 1 cm treatment area
makes contact or
X 1 cm - use cluster probe
non-contact with
the skin and is kept -Each cm2 corresponds to one point. - contact or non-
contact application
in place for the -manually move from one point to - Used in large body
entire irradiating the next over the treatment area
area
duration or -The grid can be made with plastic Circular or longitudinal
treatment. sheet and a pen. directions
for tender point - Use single probe, point by point
application application
use single probe
- Used in small body area
- Non contact application
Techniques of application:
*Contact: making a light contact between the tip of
the probe and the skin surface.
* Intact skin → contact technique is the application of
choice
* Reflection is minimal so more light energy is delivered to
the target tissue.
* The probe held perpendicular to the skin surface.

*Non-contact: keeping a distance “no more than 0.5-1

cm” between the probe tip and the skin surface.
* The probe held perpendicular to the skin surface.
* Recommended when patients cannot tolerate the pressure
exerted by the laser probe and in a cases of open wounds.
End of the treatment:
- Always inspect the exposed skin surface.
- If contact technique used, wipe the probe tip using rubbing alcohol swap to clean
it.

Frequency of treatment sessions:

* Daily treatment for 2 weeks or treatment every other day for 3-4 weeks
is recommended.

* The total treatment time/session when using scanning

technique

* The total treatment for the small area is from 5-10 minutes
* The total treatment for the large area from 12-15 minutes
 Open wound

Stage 1 Stage 2
Around the
edges of the Wound bed
wound

Use non-
Use contact
contact
technique
technique
 Stage 1, treatment of wound margins

* Use single probe, point by point

method
* Apply treatment around the
circumference of wound at
approximately 1-2 cm from its
edges.
* Points of application should be no
more than 2-3 cm apart.
* Apply the treatment with firm
pressure to the intact skin, within
the patient’s tolerance.
* The initial dosage is 0.5 – 1
J/point (approximately 4-8 J/cm2)
 Stage 2, treatment of wound bed

* Use single probe or

cluster, scanning or
gridding methods
* Non contact
* Probe is moved slowly
over the area of the
lesion, while
maintaining the head
at a distance of no
more than 1 cm from
the wound bed
* Girding methods:
energy density 1.5 –
2.5 J/cm2 in each
irradiated grid square
*Treatment should be carried out only after the wound
has been cleaned.
*If the wound is fresh, the continuous mode is utilized
while with old wounds; the pulsed mode is more
effective.
*In the early stages laser may be used twice per day to
minimize patient suffering and to maximize the
potential benefit.
*If there is improvement; the treatment frequency
reduced to alternative days or several days per week
*World Association for PhotobiomoduLation
Therapy (WALT)

*https://waltpbm.org/documentation-
links/recommendations/