The Treatment of Children with Cerebral Palsy using Low Level Laser Therapy (LLLT)

Introduction

Cerebral palsy (CP) is a disease that affects musculoskeletal system, and it occurs in early childhood. The disease is characterized by a permanent damage to the brain due to some insult that leads to a permanent movement disorder. Many treatment modalities are being utilized to improve the condition, and one of the emerging treatment options is phototherapy.

Phototherapy is being used to treat different orthopaedic diseases since 1991. The process involved focusing the light of different wavelengths on the acupuncture and the nerve block points at places where impaired muscle tone, known as myotonia, was present. The phototherapy used in this case was low level laser therapy (LLLT), near-infrared ray therapy and LED therapy. The treatment was seen to decrease myotonia for 23 hours to 1 day, and the response varied from patient to patient depending upon the severity of myotonia and patient’s sensitivity to phototherapy. The use of low level laser therapy (LLLT) proved to increase the efficacy of treatment. These principles are now being applied to treat the patients with cerebral palsy (CP).

How does Low Level Laser Therapy Work?

There are many mechanisms by which low level laser therapy (LLLT) helps improve the patient. Many researches have been carried out, and the list below mentions their finding of the mechanism of action of laser therapy.

• The most widely observed effect of this therapy is the rise in local temperature that leads to increase in the blood flow due to the dilatation of the blood vessels. A study observed up to 9 degree Celsius rise, but the body temperature remained within the normal range. Moreover, another test, doppler USG, was performed to observe the rise in the blood flow in the common carotid artery that went up from an average of 23.5% to 74%. A similar rise in flow was also observed on the non-irradiated side.
• Increased signals produced by sympathetic nervous system increase the tone of the muscles. Laser therapy suppresses the excitation of this system.
• This therapy also decreases the concentration of free calcium ions in the smooth muscles of the blood vessels which further helps them dilate.
• It causes depolarization of the nerve fibers by opening sodium channels that leads to the generation of action potential and improves movement.

Also, low level laser therapy (LLLT) has seen to improve sleep patterns and increase the temperature in extremities.

The Efficacy of Low Light Laser Therapy (LLLT) as a Supplementary Treatment

LLLT provides a temporary but immediate relief from increased muscle tone or muscle spasticity. It a simple procedure that does not take long and has proved to be very efficacious for spastic type cerebral palsy.

• A study performed gross motor function measure (GMFM) on the patients who had undergone laser therapy along with functional training. Results showed that LLLT greatly enhanced the results in the irradiated areas as compared to the sites which were not irradiated and only intensive training was performed.
• The mothers of CP children also noticed an improvement and more than 90% said that they were satisfied with this treatment modality.

So, both physicians and mothers noticed a visible improvement after low level laser therapy (LLLT). This therapy acts as a trigger to improve the imbalance of antagonist muscles, and hence, plays a good role as a supplementary therapy in addition to functional training.

Complications of Laser Therapy

No serious complications of low level laser therapy (LLLT) have been noticed yet. In severe encephalopathy i.e. brain involvement and where autonomic temperature regulation is defected, temperature rise has been noticed in a few patients.

This procedure is pain free. One major precaution is to ensure that eyeball is not directly irradiated as it can lead to complications.

Other Uses of Low Light Laser Therapy (LLLT) in Muscle and Bone Diseases

Low light laser therapy (LLLT) can be used various musculoskeletal disorders.

• Suppression of muscle tone in athetotic cerebral palsy, a type of cerebral palsy
• Suppression of femoral head deformation
• Decrease in the therapeutic period in Perthes disease, a disease that affects hips in children
• To treat congenital hip displacement
• To improve muscle function by decreasing myotonia
• To treat bed sores
• To treat clubfoot

There have also been some implications of LLLT in the treatment of interactable osteoporosis which occurs in cerebral palsy and is characterized by bone fractures. This therapy improves bone density, bone age and raises the level of insulin-like growth factor (IGF) which causes bone growth.

Conclusion

Low light laser therapy (LLLT) has been useful in the treatment of many musculoskeletal disorders and has a great role in the treatment of cerebral palsy without any adverse effects. The treatment time is short and the results of it are immediate in reducing muscle tone. However, it is a temporary treatment and does not help in situations where there is an irreversible joint contracture. It is a very efficient supplementary treatment for cerebral palsy patient going through intensive functional training.

Reference

Asagai Y (2016) 24 Years’ Experience of Low Level Laser Therapy (LLLT) for Children with Cerebral Palsy. Int J Phys Med Rehabil 4:320. doi: 10.4172/2329-9096.1000320