APLIKASI TERAPI LASER DALAM

BIDANG KEDOKTERAN FISIK DAN

REHABILITASI
(Rehabilitasi Medik)
Dr. Ibrahim Agung, Sp.KFR
Divisi Muskuloskeletal – Departemen Rehabilitasi Medik, RSUPN dr. Cipto Mangunkusumo

dr. Ibrahim Agung, Sp. KFR
E-mail: ibrahim.kfr@gmail.com

Education:
• 2017 International Fellowship of Physical Medicine and Rehabilitation at Chang Gung Memorial Hospital,
Linkou, (Republic of China) Taiwan
• 2013-2017 Physical Medicine and Rehabilitation Specialist at Medical Faculty; University of Indonesia
• 2010 Medical Doctor at Medical Faculty; University of Indonesia

Professional Experience:
• Physical Medicine and Rehabilitation Specialist at dr. Cipto Mangunkusumo General Hospital
• Physical Medicine and Rehabilitation Specialist at Medistra Hospital – Jakarta

Studies and Pubilcations:

• Agung I, Murdana N, Purba H, Fuady A. Perbandingan Efektivitas Terapi Laser Tenaga Rendah dengan Terapi
Dry Needling pada Penderita Sindroma Nyeri Miofasial Otot Upper Trapezius: Studi Intervensi. Universitas
Indonesia. Jakarta: 2017.
• Agung I. Direct effect of High-Intensity Laser Therapy for Myofascial Pain Syndrome of The Upper Trapezius
Muscles: An Interventional Study. Universitas Indonesia. Jakarta: 2016.
CAHAYA adalah suatu bentuk energi elektromagnetik yang
memiliki panjang gelombang antara 100 hingga 10.000
nanometer (nm = 10-9) dalam suatu rentang spectrum.
Elektromagnetik cahaya Terlihat dari 400 (ungu) sampai 700 nm
(merah)

BIOPHOTON ADALAH CAHAYA YANG MEMILIKI

KOHERENSI DARI SEL -- > ENERGI SEL -- >
SEMUA SISTEM KEHIDUPAN.
W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed
 ADA 2 JALAN CAHAYA DAPAT DIHASILKAN
● SPONTANEUS EMISSION
● STIMULATED EMISSION

LASER
LIGHT AMPLIFICATION OF STIMULATED OF RADIATION
(THEODORE MAIMAN 1960)

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

 HOW STIMULATED EMISSION
ACCOURS

●IN STIMULATED EMISSION , TWO PHOTONS

ARE EMITTED WHEN A PHOTON COLLIDES
EXCITED ATOM

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003
 A LASER IS AN AMPLIFIER OF LIGHT

STIMULATED EMISSION
THREE COMPONENTS OF ANY LASER ARE :
1.ENERGY SOURCES
2.AMPLIFYING MEDIUM
3.A PAIR OF MIRRORS

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003
tiga sifat
Coherence
membedakan
laser dari à Gelombang cahaya berada dalam satu fase.
sumber
cahaya pijar
dan neon:

Monochromaticity
àLASER adalah salah satu dari sedikit sumber cahaya yang
memproduksi panjang gelombang spesifik ..

Collimation
à Sinar laser adalah cahaya yang teratur, dimana
terjadi divergensi yang minimal dari foton.
W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed
 Laser equipment commonly is grouped into
four FDA classes :
Class II Class III Class IV
Class I
(low power) (moderate risk) (high risk)
• Lasers are • Lasers are • Lasers can cause • lasers present a
considered hazardous only retinal injury. high risk of
nonhazardous if a viewer • Operator and injury and can
to the body. stares patient are cause
• All invisible continuously required to combustion of
lasers with into the source. wear protective flammable
average power • Visible lasers eyewear. materials
outputs of 1 that emit up to • Diffuse
mW or less. 1 mW average reflections that
These include power, such as may harm the
the GaAs lasers the HeNe laser. eyes and cause
(820 to 910 nm). serious skin
injury from
direct exposure.
 Type of Laser
depending on the intensity of energy they deliver

• Dikenal sebagai "hot laser” karena panas yang

ditimbulkannya.
High-power • Digunakan diberbagai tindakan medis termasuk saat
lasers pembedahan untuk memotong dan menghentikan
perdarahan, ophthalmologi, dermatologi, onkologi
dan vaskular..
• > 500 miliwatts (laser kelas 4)

Tidak untuk menghasilkan panas karena diproduksi

secara fotokimia.
Low-power digunakan untuk menyembuhkan luka,
management nyeri, pengobatan pada trauma
lasers tendon dan ligamen, arthritis, mengurangi edema,
trauma jaringan lunak, perawatan luka bakar dan
W.E. Prentice,Therapeutic menghambat scaring.
Modalities in Rehabilitation, 4th 1 miliwatt – 500mili watts( laser kelas 2&3)
Ed
 PANJANG GELOMBANG LASER
Cahaya yang digunakan mempunyai spektrum yang
sempit yaitu pada spektrum merah (red) dan near
infrared (600-1000nm), dengan power density
(irradiance) antara 1mw-5W/cm2.
Pada bidang rehabilitasi medis digunakan
radiasi dengan panjang gelombang 630-
1100nm.

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

 JENIS JENIS LASER
• 1 Gallium Arsenid Laser
• 2 Gallium-Aluminum-Arsenid Laser
(GaAlAs)
• 3 Helium Neon Laser

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

 Depth of Penetration
depends on the type of laser energy delivered

HeNe laser GaAs Laser

• Absorption of HeNe laser • The GaAs directly absorbed

energy occurs rapidly in the
superficial structures,
especially in the first 2-5
mm of soft tissue.
• An indirect effect on tissues
up to 8-10 mm.
in tissues at depths of 1-2
cm and has an indirect
effect up to 5 cm.
• This laser has better
potential for the treatment
of deeper soft tissue
injuries, such as strains,
sprains, and contusions.
 CARA KERJA LASER
• Cara kerja low laser ini dengan menghasilkan
reaksi photochemical (fotokimia) dan
mempunyai efek termal yang minimal

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

Emisi spontan dari sinar. (A) atom dikelilingi
oleh electron, (B) penggunaan elektrikal dan
electron berpindah ke tingkatan lintasan yang
lebih tinggi, (C) electron turun kembali dan
mengemisikan panjang gelombang foton yang
sama
W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed
 TEKNIK PENGGUNAAN LASER

Terdapat tiga teknik cara

penggunaan laser yaitu gridding,
scanning, dan wanding.

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

CONTINOUS AND INTERRUPTED PULSED
 Hal yang perlu diperhatikan dalam
penentuan dosis :
1. Reaksi jaringan

2. Reaksi pengobatan

3. Minimal reaction dose

 Efek laser
1. Mengurangi nyeri
2. Menyebabkan vasodilatasi
3. Memodulasi inflamasi
4. Mengubah kecepatan konduksi saraf dan regenerasi
5. Menstimulasi proses regenerasi jaringan
6. Meningkatkan produksi adenosine triphosphate (ATP)
7. Meningkatkan produksi kolagen
8. Menghambat pertumbuhan bakteri
9. Menstimulasi serotonin dan endorfin à efek relaksasi
dan sedasi

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

 Precaution condition in laser therapy

1. Vision —>Protect your patients vision your

own
2. Thyroid treatment —> decrease the level of
mRNA
3. Steroids —> Block the effect of therapeutic
lasers
4. Tatto and dark hair —> cause localized
heating of tissue
5. Pain respon
6. Children —> Epiphyseal plate

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003
 KONTRAINDIKASI
1. Penyinaran langsung ke mata.

2. Kehamilan. Pada wanita hamil laser dapat diberikan di daerah

mana saja kecuali pada daerah abdomen dan uterus.
3. Keganasan (Malignancy)

4. Dalam 4- 6 bulan setelah radioterapi

5. Daerah yang yang mengalami perdarahan, karena akan

menyebabkan vasodilatasi dan mungkin meningkatkan
perdarahan.

6. Daerah tiroid dan kelenjar endokrin lain

PENGGUNAAN LASER
SEBAGAI TERAPI
MODALITAS
Clinical Application for Laser

Wound
healing

Tensile strength
Immunologic response Pain
reducti
Inflammation on
Scar tissue

Bone
respon
se

W.E. Prentice,Therapeutic Modalities in Rehabilitation, 4th Ed

 MYOFASCIAL PAIN SYNDROME

1. Agung I, Murdana N, Purba H, Fuady A. Perbandingan Efektivitas Terapi Laser Tenaga Rendah dengan Terapi Dry Needling pada Penderita
Sindroma Nyeri Miofasial Otot Upper Trapezius: Studi Intervensi. Universitas Indonesia. Jakarta: 2017.
2. Agung I, Murdana N, Purba H. Relationship between Body Mass Index and Pain Threshold in Myofascial Pain Syndrome Patients: A Cross-
sectional Study. Universitas Indonesia. Jakarta: 2017.
3. Agung I. Direct effect of High-Intensity Laser Therapy for Myofascial Pain Syndrome of The Upper Trapezius Muscles: An Interventional Study.
Universitas Indonesia. Jakarta: 2016.
4. Agung I, Murdana N. Comparison of Skin Resistance between Myofascial Trigger Points (MTPs) with Normal Tissue on Upper Trapezius
Muscles. Universitas Indonesia. Jakarta: 2014.
 BACK PAIN
• Laser therapy restores blood flow to the
muscle, relaxing them and relieving the
stagnation and ischemic which cause most
back pain

GaAas is effective in chronic low back pain

(a double blind with trial

Laser surgmed Prof soriano,argentina)

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003
 HEEL SPURS
• LASER THERAPY WITH HIGH DOSE
EXTREMELY EFFECTIVE FOR THIS CASE

• SCHEDULE TREATMENT : TWICE WEEKLY (4 WEEKS)

• DOSE : 30-80J / Cm2 or more

Jennifer A Blahnik, O.M.D,d, LASER THERAPY A CLINICAL MANUAL, Healing light seminars,inc 2003
 KNEE PAIN
• LASER THERAPY STIMULATE THE
PRODUCTION OF CARTILAGE AND
RELIEVES INFLAMATION AND PAIN

THE EFFECT OF LLLT THERAPY ON OSTEOARTHRITIS OF THE KNEE

(Basirnia A,Sadeghipoor G.,Esmaeeli Djavid et al)
TREAT ON 20 PATIENTS (20-40 YEARS) TREAT BY LASER WITH DEVICE pulsed diode
laser (810nm , once a day, 5 days )

Outcome : Pain relief and improve functional ability

 NEUROPATHYIC PAIN
• LASER THERAPY AS a MODALITY IN THE
TREATMENT OF INCOMPLETE PHERIPHERAL
NERVE INJURY
(Prospective clinical double blind plasebo-controlled randomized study )
S.Rochkin, M.Alon,M.nissan, department of neurosurgery, neurologi,
rehabilitation, physiotherapy, Tel aviv,Israel)

Result : LASER THERAPY , A NON INVASIVE LOW CHOST METHOD,

MAY BE USEFUl IN IMPROVING THE FUNCTIONAL RECOVERY OF
PATIENT SUFFERING FROM INCOMPLETE PERIPHERAL NERVE AND
BRACHIAL PLEXUS INJURY
 WOUNDS / BURNS
• Thought a visible, red laser is the best choice when
avaiable, GaAIAs works very well for wounds.

Dose : 4J/cm2 in contact peripher

0,5-1J/cm2 in over the wound

(Simunovic z , ivankovich a.d,depolo.wound healing on human body with use

LLLT-treat of operated sport and traffic accident injuries :
a randomized clinical study on 74 patients with control group)

Result : pain relief and functional recovery was significantly

improved in the laser group
 Take home massages
• Terapi laser merupakan pilihan utama terapi non
invasif pada berbagai kasus
neuromusculoskeletal

• Terapi laser memiliki efek mengurangi nyeri,

antiinflamasi dan menstimulasi regenerasi

• Terapi laser yang dikombinasikan dengan terapi

lain (exercise, manual therapy) sangat
direkomendasikan, untuk memberikan hasil yang
terbaik bagi pasien
TERIMA KASIH