Transcript specific protocols

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INDEX
HILTERAPIA
•Introduction
•Tecnology
•Application modality
•Protocols
•3D videos
•Nd-YAG wavelengths and emissions
•Hilterapia : technical characteristics
•Hilterapia : laser-tissue interaction
•Hilterapia : indications, contraindications and warnings
•Clinical Evidences
•The material of support for Hilterapia®
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INTRODUCTION
HILTERAPIA®
High Intensity Laser Therapy
 It’s a therapy that is revolutionizing the therapeutic approach
of Orthopaedics, chiropractors, physiotherapists,
sport medicine doctors opening new horizons
 In 2003 the HILT ® patent has been achieved in USA,
both as a technological innovation and a therapeutic approach.
 In 2005 HILT ® devices have been approved by the FDA
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Our Goal
Our aim was to conceive a non-invasive and non-painful therapy able to induce not only
antalgic , anti-inflammatory and anti-oedema effects, but also a reparative and
regenerative action on deep structures.
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Expectations
 Achievement of therapeutic results in short treatment times and with long lasting
benefits to the patients
 Analgesic effect and fast recovery just from the first session
 Contemporary resolution of the causes of the pathology and of the associated symptoms
 Deep effective action
 Wide treatment volume
 Controlled delivery of energy
 High safety in operation
 Respect of the thermal relaxation time of tissues
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TECHNOLOGY
HILTERAPIA®
can be performed with 2 devices:
 SH1 (1 kW)– Pain management
SH1
 HIRO 3.0 (3 kW)– Pain management
Reparative/regenerative therapy
Standard handpiece
supplied with
SH1 and HIRO 3.0
DJD handpiece
supplied with
HIRO 3.0
HIRO 3.0
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APPLICATION MODALITY
 Delivery modes
• Fixed points (spots):
static handpiece, i.e. located on the areas
to be treated (trigger points)
• Manual scanning:
- Fast scan: 10 cm/1 s
- Slow scan: 10 cm/3 s
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APPLICATION MODALITY
 Delivery modes
Global approach: in order to make the most
of Hilterapia® effects, we suggest a global
approach . Treatment is performed not only
on the tissues in the affected area, but also
on all muscle groups and trigger points that
are involved in the pathology, directly or
indirectly .
Total energy is partitioned in this way:
60% on muscolar areas
40% on pathology site and irradiation
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APPLICATION MODALITY
 Delivery modes
• Scans can be longitudinal or transversal
(single or, preferably, associated) to the
anatomical structure to be treated, ideally
following a straight lines path.
It is very important to correctly position
the patient during treatment, in order to
utilize the most accessible optical path.
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APPLICATION MODALITY
 Delivery modes
• Sessions planned for Hilterapia are
normally 8-15, performed daily or every
other day. Each session lasts between 10
and 20 minutes, with a total energy of
1000 to 4000 J.
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PROTOCOLS
 Treatment protocol
• Standard protocol
• Specific protocols
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STANDARD HILTERAPIA® PROTOCOL
It guarantees good results in all pathologies and clinical stages, thanks to the use of
particular pre-set fluences and frequences which give an analgesic and anti-inflammatory
effect. It comprises three phases:
• INITIAL PHASE: fast manual scanning
• INTERMEDIATE PHASE: trigger points treatment
• FINAL PHASE: slow manual scanning
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STANDARD PROTOCOL
Initial phase:
• 3 sub-phases (steps) with increasing fluences and decreasing
frequencies. The highest number of anatomic structures, both
superficial and deep, are reached with an homogeneous distribution
of energy.
• Speed scanning:
- transfer of energy in depth
- prevalence of photomechanical effect on photothermal
effect (cold treatment)
- heating is dissipated through convection
TRANSMISSION IS PREVALENT ON ABSORPTION
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STANDARD PROTOCOL
Intermediate phase:
• It is applied in presence of painful trigger points.
• This phase includes 4 sequential steps with increasing fluences
and fixed frequencies, until each area has reached a pain
reduction of about 80%.
• The handpiece is located directly on each painful point for a
maximal time of 7 seconds.
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STANDARD PROTOCOL
Final phase:
• 3 sub-phases (steps) with increasing fluences and decreasing
frequencies. The highest number of anatomic structures, both
superficial and deep, is reached, with an homogeneous distribution
of energy.
• Slow scanning:
- The heating is dissipated through conduction
- Higher photothermal effect with hyperemia
- Higher accumulation of energy
ABSORPTION IS PREVALENT ON TRANSMISSION
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SPECIFIC HILTERAPIA® PROTOCOLS
The specific protocols are an optimization of the standard protocol according to the
pathology, the clinical situation and the type of patient. They may be composed by 3 phases
or by a single phase. The parameters (fluence, frequency and total energy) are specifically
set.
Besides the protocols proposed for each joint, more protocols have been specified for
gonarthrosis, muscular pathologies, oedemas.
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SPECIFIC PROTOCOLS
The proposed values are related to a normotype patient and phototype I,II e III.
• In a patient with scarce adipose tissue and/or muscular mass the total energy must be
reduced by 20%.
• In a patient with abundant adipose tissue and/or muscular mass the total energy must be
increased by 20%.
• In a patient of IV, V e VI photoype it could be necessary to reduce fluence, frequency and
total energy by 10-20%. In any case the parameters have to be tested on patient before the
treatment.
PHOTOTYPE
HAIR
COMPLEXION
TENDENCY TO
ERYTHEMA
TAN
I
Red
Whitish
Constant +++
Always present
No
II
III
IV
V
VI
Fair
Brown
Dark brown
Black
Black
Fair
Fair
Olive
Olive
Black
Constant ++
Frequent
Rare
Exceptional
Not
Slightly tanned
Light tanned
Dark
Very dark
Black
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SPECIFIC PROTOCOLS
Gonarthrosis: there is a specific protocol for degenerative chondropathies and gonarthrosis,
both for the way it is performed and for the frequency of the sessions. In particular, it
includes two cycles of 15 daily sessions, with a pause of 3 months between them, during
which the patient is advised to take hyaluronic acid supplements (by mouth or by
infiltrations). During each session the maximal possible fluences and frequencies will be
used with a slow scanning mode according to 6 optical windows, using DJD handpiece:
• Anteromedial and lateral with patient in supine position and knee flexed at 90°
• Posteromedial and lateral with patient in prone position and extended knee
• Medial and lateral patellar (extended knee and patellar balancing)
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SPECIFIC PROTOCOLS
According to the gonarthrosis protocol 500 joule for each optical window are supplied, for a
total of 3000 joule for each session. For each optical window is suggested a single phase
with maximal fluences and frequencies and slow scannnig (parameters can vary depending
on patient sex, phototype and individual tolerance).
Gonarthrosis
Modality
6 optical windows
Slow
Scanning
Fluence
(mJ/cm2)
1430-1780
Frequency
Hz (level)
25-30
(Level 11-9)
Total
Energy (J)
3000
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The DJD handpiece
A cavity with the shape of a bell
and an internal side gold-plate
for increasing the reflection power
Reduced blood sprinkling
for the light pressure
of the handpiece
on the skin
Quartz window
for permitting to
exert a light
pressure during
the treatment
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SPECIFIC PROTOCOLS
Contusions and Muscular lesions: Contusions and muscular lesions must be treated with
variable parameters according to the clinical phase. In acute phase (lasting 3-7 days) a
unique phase have to be performed with 3 steps at medium/low fluences and frequencies,
because the precocious heat could cause dangerous complications like fibrosis and
calcifications. In sub-acute and chronic phase a unique phase have to be performed with
medium/high fluences and frequencies to stimulate the tissue to regenerate.
Contusions and muscular lesions
Modality
Fluence
(mJ/cm2)
Frequency
Hz (level)
Total
Energy(J)
Acute phase
Fast scanning
Step 1: 360
Step 2: 510
Step 3: 610
Step 1: 18 (7)
Step 2: 15 (4)
Step 3: 10 (1)
900
Sub-acute and chronic
phase
Slow scanning
Step 1: 810
Step 2: 970
Step 3: 1070
Step 1: 30 (11)
Step 2: 25 (10)
Step 3: 20 (9)
1500
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SPECIFIC PROTOCOLS
Muscular contractures: Muscular contractures take benefit from heat, therefore have to be
treated precociously with rather high energy. Also in this case a unique phase has to be
made, with slow scanning, composed by 3 steps at increasing fluences and decreasing
frequencies. Total energy 1000-1500 J.
Muscular Contractures
Modality
Fluence
(mJ/cm2)
Frequence
Hz (level)
Total
Energy(J)
Slow scanning
Step 1: 710
Step 2: 810
Step 3: 970
Step 1: 30 (11)
Step 2: 25 (10)
Step 3: 20 (9)
1000-1500
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SPECIFIC PROTOCOLS
Oedema and swelling (effusion): Oedema and post-traumatic effusion must be treated with
compressing bendage and cryotherapy for at least 48-72 hours. Hilterapia® is suggested
starting from the second day (during the first 24 hours the induced vasodilatation could
worsen the effusion) with a specific protocol. A unique phase is suggested, with slow
manual scanning composed by 3 steps with increasing fluences and decreasing frequencies.
The treatment has to be performed first on the area with oedema and then on the
lymphatic system, with centripetal scanning (for instance the saphenous veins), to help the
drainage of effusion.
Oedema and swelling
Modality
Slow scanning
Fluence
(mJ/cm2)
Frequency
(Hz)
Total
Energy(J)
Step 1: 970
Step 2: 1070
Step 3: 1170
Step 1: 30 (11)
Step 2: 25 (10)
Step 3: 20 (9)
3000
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