EFFICACY OF LOW LEVEL LASER THERAPY FOR SYMPATHETIC REFLEX DYSTROPHY SYNDROME IN GERIATRIC PATIENTS

抄録

Sympathetic reflex dystrophy (SRD) is a frequent occurrence in geriatric hemiplegic patients, but the pathogenic factors (involvement of the peripheral and/or central nervous systems) of the disease are not yet clearly defined and are still a matter of debate. Many different diseases may produce SRD; this may frequently occur in hemiplegic patients so that elderly people cannot undergo rehabilitative kinetic therapy after a stroke, due to osteoarticular pain and dystrophic diseases. The aim of the present work is to analyze the effect of laser therapy at different wavelengths and doses (i.e. HeNe and CO₂ laser at low and high energy densities), in order to identify the technical conditions yielding the maximum treatment effectiveness in the protocol of rehabilitation of hemiplegic patients suffering from SRD. The method adopted by our Institute to establish the clinical diagnosis of each patient is based on the creation of a card in which the personal data; clinical diagnosis; medical history; the physical therapist’s evaluation; the radiologist's report; and the clinician’s assessment are recorded. The treatment was carried out by sweeping the laser beam over the area of articulation of the shoulder (area size ≅ 10 x 15 cm) and on the hand (area size ≅ 10 x 10 cm). Since the physical parameters of laser therapy for the treatment of this disease in hemiplegic patients have not yet been established, our trial was performed either with defocused CO₂ laser or with the HeNe laser at a range of increasing doses (energy density) in order to identify the laser parameters yielding the maximum effectiveness for the treatment. Therapy was performed daily (5 treatments/week), either with the CO₂ laser (energy densities ranging from 137 to 290 J/cm²) or with the HeNe laser (energy densities ranging from 0.229 to 0.311 J/cm²). At the time of writing there are 140 patients who have completed the therapy regimen with completed record cards. The results are still preliminary, due to the as yet unbalanced numbers of patients admitted to the different treatments, but a statistically significant difference was observed in the effect of HeNe and CO₂ laser (p < 0.026). In addition, a significant difference was found between the effects of low and high doses of CO₂ laser (p < 0.024) and between the results of treatments based on low dose CO₂ laser and high dose HeNe laser (p < 0.006).