SLIDE 1 Changes in Tissue Water and Indentation Resistance of Lymphedematous Limbs Accompanying Low Level Laser Therapy (LLLT)
Harvey N. Mayrovitz, PhD College of Medical Sciences Nova Southeastern University Suzanne Davey, OTR/L, CLT-LANA Healing Hands of Lymphatics
SLIDE 2
Does LLLT acutely affect tissue hardness and/or water content?
SLIDE 3 Does LLLT acutely affect tissue hardness and/or water content?
Ann Attendee Aki Australia ? Finland NLN 2008 – San Diego
SLIDE 4 Pre-LLLT Tx Post – LLLT Tx Post – MLD Tx
5 min LLLT 51.2 ± 1.5 min
Does LLLT acutely affect tissue hardness and/or water content?
1 2 3
Patients studied had clinically identified lymphedema and fibrosis (37 Arms 36 Legs) M L D
SLIDE 5 Pre-LLLT Tx Post – LLLT Tx Post – MLD Tx
5 min LLLT 51.2 ± 1.5 min
Measurements
- Girth Tape measure
- Tissue Water
Tissue Dielectric Constant (TDC)
Resistance Force for a fixed indentation
Does LLLT acutely affect tissue hardness and/or water content?
1 2 3
Patients studied had clinically identified lymphedema and fibrosis (37 Arms 36 Legs) M L D
SLIDE 6
Five treatment sites marked with template
Legs: Lymphedema due to Varied Etiologies Males: 18 Females: 18
Control Site LLLT Tx 1 min/site
SLIDE 7
Arms: All Breast Cancer Treatment-Related Lymphedema All Unilateral N=37
SLIDE 8
Arms: All Breast Cancer Treatment-Related Lymphedema All Unilateral N=37
SLIDE 9
Girth
Measured with fixed tension
SLIDE 10
Tissue Dielectric Constant (TDC)
TDC ~ % H2O 100% ≈ 78
SLIDE 11
Force Indentation 2, 3 & 4 mm
Tissue Resistance (Force-Indentation)
SLIDE 12
LLLT 1 min @ each site
SLIDE 13
Pre-Treatment Comparisons Affected vs. Control Arms 37 Legs 36
Results
SLIDE 14 10 20 30 40 50
Affected Control
Limb Girth
P < 0.001 P < 0.001
GIRTH TH (cm) Arms Legs gs
Girth
Affected > Contralateral
SLIDE 15 10 20 30 40 50 60
Affected Control
Tissue Water
P < 0.001 P < 0.001
Arms Legs gs TDC
Tissue Dielectric Constant (TDC)
Affected > Contralateral
SLIDE 16 100 200 300 400 500
Affected Control
Tissue Force
P < 0.001 P < 0.01
FORCE E (gm @ 4 mm) Arms Legs gs
Force Indentation
Tissue Resistance (Force-Indentation)
Affected > Contralateral
SLIDE 17
LLLT Treatment Effects Pre - Tx Post - Tx Pre - Tx Post - MLD
Results
SLIDE 18 50 100 150 200 250 300 350 2 3 4
Pre-LLLT Tx Post-LLLt Tx Post-MLD Tx
P<0.01 P<0.001 P<0.001
P<0.001 P<0.001 P<0.01
Tissue Force - Arms
Indentation Depth (mm)
FORCE (gm )
PRE-TX PST-TX PST-MLD L L L T MLD
SLIDE 19 50 100 150 200 250 300 350 400 450 2 3 4
Pre-LLLT Tx Post-LLLT Tx Post-MLD Tx
Tissue Force - Legs
FORCE (gm )
Indentation Depth (mm)
P<0.001 P<0.001
P<0.05
P<0.001
P<0.05 P<0.05
PRE-TX PST-TX PST-MLD L L L T MLD
SLIDE 20 30 35 40 45 50
Pre-LLLT Tx Post-LLLT Tx Post-MLD Tx
Tissue Water
TDC
P<0.001 P<0.001 NS P<0.05
Arms Legs
PRE-TX PST-TX PST-MLD LLLT MLD
SLIDE 21
Active LLLT Treatment Vs. Sham Treatment N= 17 Legs
Results
SLIDE 22 20 25 30 35 40 45
Pre-LLLT Tx Post-LLLT Tx
FORCE
(x10-1)
TDC
Active vs. Sham
Force @ 4 mm or TDC
Active Sham Active ve Sham
P<0.001 P<0.001 P<0.05 P<0.05
Legs gs N=17
SLIDE 23 5 10 15 20 25 30
Active Sham
Active ve Sham
P<0.001 P<0.001
FORCE TDC % Decrease
Active ve Sham
Active vs. Sham
Legs gs N=17
SLIDE 24 Summary
- Rapid acute reduction in local tissue water
and hardness with 5 minute treatment
- Occurs with active LLLT & with SHAM but
greater reductions with ACTIVE
- Tissue water & hardness trend back toward
pre-tx levels by the end of an MLD session
- Specific role & mechanism of low level laser
light in observed changes is not yet known
SLIDE 25
