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7. Main principles of MIL- therapy treatment techniques.

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MIL-therapy methods have to take into consideration the whole complex of medication in every particular case. So, patients have to be examined by the physician every day to register positive (or negative) changes in their state, to have consultations with other specialists (if necessary), to make regular lab investigations (blood, urine, ECG, USI, FEGDS, etc.) for the correction of medicamentous and physiotherapeutic doses. MIL-therapy appears to be the most resultative in functionally reversible phases of the disease; though, lately, new techniques have found their application in more severe cases and in more marked pathological changes.

Physiotherapeutic procedures exhaust, to some extent, organism's adaptative mechanisms because these procedures cause some expenditure of energetic resources. So, MIL-therapy is not recommended in the complex treatment with several procedures prescribed which may totally exhaust organism reactive abilities. Not more than two physiotherapeutic procedures, including balneo-treatment, are possible during one day. In this case a light-curing procedure (local impact on a pathological focus) should precede the other physiotherapeutic procedure (which may have an impact on the whole organism). MIL-therapy may be combined with massage and curative physical culture in patients having no tendency to disease exacerbation and to neuro-vegetative lability; as well as it is not indicated to patients with a severely expressed pain syndrome. In the combination with the two other physiotherapeutical procedures laser session is performed 15-30 min (and more) before the massage or physical culture. The effect of increasing ion permeability of skin under MIL-impact optimises the effects of drug-induced electrophoresis and phonophoresis. These procedures are performed one after the other ( without any time interval). But MIL-therapy precedes the electrophoresis and phonophoresis (at the same area). It is not recommended to perform MIL-therapy on the same day with X-ray and radio-isotope investigations.

MIL-therapy combined with drug therapy increases effectiveness of the latter one, especially in severe and complex cases. The effectiveness of treatment is also increased by subcunateous laser radiation of blood (SLRB). Recovery period is shorter and has better results when MIL-therapy is combined with phitotherapy, diet, drug therapy, massage and curative physical culture.

A common (optimal) principle for treating patients with different pathological processes is the following: MIL-therapy is performed by courses usually consisting of 7-8 daily sessions (procedures) up to 12 per each course (or the first 5 procedures are performed daily, the others - every other day); duration of the procedure more than 10 min is not reasonable; chronic diseases are treated longer - 2-3 courses with 8-10 daily procedures per each course and 2-3-week intervals between the courses; after that there is a six- month interval and the course treatment is started again .

MIL-therapy is administered with care to sensitive, emotionally excitable and labile patients, as well as to children before 12. When prescribing MIL-therapy to these patients exposure time should be decreased by twice.

Usually, pain syndrome decreases and patient’s condition improves after 2-3 MIL-therapy sessions.

One can regulate average output power of laser radiation by changing LILR frequency, thus regulating the energy dose. The higher is the frequency, the higher is the dose that objects receives and, visa versa , the lower is the frequency, the lower is the dose (during the same time unit). Besides, LILR frequency from 100 up to 1000 Hz considerably affects the speed of different biochemical reactions in the organism.

In acute pathological processes accompanied by pain syndromes (acute radiculitis, neuralgia, etc.) it is recommended to perform MIL-therapy with frequency 1500, 5000 Hz. The following rule should be observed: the more acute is the process and the stronger is the pain, the higher is the impulse frequency and the longer is exposure to the lesion (up to 5-6 min). Normally, these parameters of treatment are applied on the first day to control the acute pain. When pain is not severe, as well as in chronic disorders with trophic disturbances ( the course treatment is performed ) frequency 50, 80, 150, 600 Hz is recommended.

For laser stimulation of the nerve-muscular apparatus having damage of skeleton muscles (reduction of tone, atrophy or paresis and paralysis) impulse frequency is chosen depending on damage severity: in severe cases - low (20-80 Hz), in mild cases - higher (80-150 Hz).

In the acute stage (inflammatory processes) LT is used in pulsed regime and with low doses (for instance, to perform the irradiation without lightguides) using mostly a segmentary-reflex approach. In subacute period LT is administered more widely, in low doses. Pulsed laser irradiation combined with CMF is applied topically to the diseased area. The intensity of light-curing irradiation increases in chronic stages ( as described above).

Some patients have increased sensitivity to LT, individual responses to MIL-therapy are possible. Hypersensitivity could hardly be estimated as the complication to LT because such individuals quite often demonstrate hypersensitivity to many other inductors (for instance, to drugs, magnetic field, electric procedures). This reaction is observed rarely. It usually develops within some hours or on the first day and has different manifestations. More commonly patients may have drowsiness or irritation and causeless anxiety, slight and short dizziness, not sharply marked intermittent headache, common muscular tenderness, feeling of weakness or weariness, psychological discomfort. Different patients reveal one or more signs; duration of these adverse-effects lasts several minutes, rarely 1-3 hours. These reactions disappear spontaneously and do not need any special care. But if the patients still demonstrates unfavourable reactions to LT despite the changes in treatment parameters, MIL-therapy should be discontinued.

Even more rarely vegeto-vascular reactions of two types develop: 1) BP elevation, painfulness in joints; 2) some BP decrease, pale skin, chills, weakness. Normally, these reactions occur in such patients during other procedures too (for instance, during blood sampling from a finger).

The first reaction usually develops in 1-2 hours after the session and can last from several minutes up to 5-8 hours. In such a case the patient is prescribed rest or application of proper hypotensive drugs, analgetics, tranquilizers. These conditions are of no danger and need no cancellation of LT. Reactions of the second type develops within the first 3-5 min after LT beginning. Medicative measures are the same as in other similar conditions, i.e. ammonia, cardio- or vascular drugs, horizontal position with elevated extremities, etc. MIL-therapy is not cancelled but the correction of doses and regime has to be done (shorter sessions, less irradiation power, another approach, combination of acting factors, observation of the prescribed regime: sufficient sleep, rest, proper nutrition).

Therapeutic effect in MIL-therapy is achieved in different ways: directly to the target tissue (wound, ulcer) or through healthy skin and mucous (subcutaneously, transdermally on the zone of the projection of organs, blood vessels -SLRB, nervous bundles; via an intra-cavital approach when special optic lightguides are used). There is a contact way when the terminal is in contact with the irradiated surface and a distant way (or non-contact) when the terminal and irradiated surface have some space in between (Fig.1). The lightguide terminal is placed stationary on the object ( a stable method) or it moves above the focus ( a labile method).

Fig.1 Distant (А) and contact (B) approach in MIL-therapy

Blood and fat are the basic substances absorbing IR radiation. In contact approach when laser slightly compresses tissues ( thus arresting superficial blood circulation and reducing fat layer thickness) the depth of IR light penetration is increased by almost 3 times in comparison to a distant approach. So, under close contact LILR reaches all dermal and subdermal nervous and vascular plexuses, superficial muscle layers and capsules of the majority of joints. Due to the simultaneous stimulation of the correspondent structures in the vegetative and somatic nervous system ( so - called, a space summation of irritation) we have a complete range of organism responses.

The non-contact (distant) method has its own advantages. On one hand, lightguide sterilization is not necessary. On the other hand, distant lightguide positioning allows to perform stable and labile ways of treatment. However, such lightguide placement brings a considerable radiation loss (30-40%) because of the reflection from the object surface. A final decision what approach to use is a choice of a doctor and therapeutic tactics.

Pediatrics. Because of age specificity it is advisable to apply MIL-therapy in children mostly using the distant method (stable or labile, a distance from the terminal to the body surface is 0,5-1 cm) and observing some definite parameters presented in Table 2.

Table 2. Parameters of MIL-therapy in pediatrics
Age LED radiation power, mWt
New-borns, aborted, weakened 12-15 (+CMF)
Children from 3 up to 7-10 years 25-30(+CMF+LILR)
Children from 7 up to 12-14 years 40-45(+CMF+LILR)

Note: CMF induction, pulse power of IR LILR for this apparatus are constant values.

MIL-therapy techniques described below ( namely, areas of irradiation) used in traumatic injuries, surgical or internal disorders are applicable in pediatrics as well . However, the procedure duration should not exceed 4-5 min.