PBM Therapy in Medicine and Healthcare
Dr Tiina Karu (left), renowned PhD researcher and cytobiologist in the field of photochemistry and photobiology, presented to Tina Czech the Director and senior technical consultant of the Australian Institute of Laser Therapy (AILT) with her latest autographed book “Ten Lectures on the Basic Science of Laser Phototherapy”
The Australian Institute of Laser Therapy (AILT) was officially opened in the city of Melbourne on the 9th December 1997 by Secretary General of the World Association of Laser Therapy (WALT)
UPDATE FROM THE DIRECTOR
A lot has changed since 1990, when I was first introduced to laser therapy in Guys Hospital in London by Dr Mary Dyson, who was Head of the Tissue Repair Research Unit at the time. Mary was investigating the bioeffects of laser light, in relation to the mechanisms which control the response of living tissue to injury and what influences laser light may have on healing processes and the quality of tissue repair.
Research into photomodulated phenomena continued to be conducted worldwide in both in vitro and in vivo experiments and published in the first journal representing photobiomodulation research which was named ‘Laser Therapy’ and was the official journal for the International Laser Therapy Association (ILTA). Eventually in 1994 ILTA amalgamated with the International Society for Low Power Laser Applications in Medicine (ISLPLAM) and became the World Association for Laser Therapy (WALT) to represent this emerging field in phototherapy called low level or low intensity laser therapy (LLLT, LILT)), which was distinct from the photothermal activation by high level lasers used in surgery. As LLLT laser devices improved and effective treatment methodology continued to be developed, light-based technology expanded and so did the clinical applications of laser and non-laser light. Consequently, the term low level laser therapy was no longer applicable and the term PhotoBioModulation Therapy (PBMT) was agreed upon and with this progression the ‘Laser Therapy’ journal was renamed the journal for ‘Photobiomodulation, Photomedicine, and Laser Surgery’ and is now available in 170 countries.
More recent research investigating the biological effects of visible Blue light in the 400nm-470nm wavelengths has demonstrated decreasing viability and colony numbers of several antibiotic resistant bacterial species, including methicillin-resistant staphylococcus aureus (MRSA). Resolution of bacterial infection in acute and chronic wounds is complicated by the growing resistance to antibiotic treatment, which is further compromised by the wound surface biofilm. The potential of blue light to eradicate Pseudomonas aeruginosa infections, which are notoriously resistant to various classes of antibiotics, offers a new treatment strategy that relies on photochemically induced reactions that are non-toxic to the skin or patient. This Gram-negative pathogen is usually found in hospitals and plays a crucial role in hospital-acquired infections, as it can rapidly colonise on any surface that contains water and has complex biofilm forming capabilities (Rossilini et al 2014.,Amin et al 2016).
The bacteria-eradicating effects of blue light in the 415nm +- 10nm range using specific treatment parameters which could offer an alternative, risk- free treatment for infected tissues (Lanzafame et al 2013) and anti-microbial effects of blue light have been 40-100 times more potent when applied in pulse mode (Enwemeka CS. et al 2020).
Sensitivity of viruses to photodynamic procedures using light and a photosensitiser chemical was reported back in the 1930’s (Perdrau J.R., Todd C. 1933) and photodynamic inactivation (PDI) has been mainly focused on viral lesions e.g. Herpes Simplex, but considerable progress has been made with viral disinfection of blood products, in vitro against the immunodeficiency viruses (HIV) and hepatitis viruses (Sloand E.M., Pitt E. Klein H.G. 1995., Mannucci P.M. 1992., Klien H.G. 1994)., human parvovirus B19 (Azzi A. et al1993)., cytomegalovirus (Klien H.G. 1994)., and human T-cell lymphotrophic virus type I and Type II (Klien H.G. 1994).
It is reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the disease COVID-19 (Booth TF, Kournikakis B, Bastien N, et al 2005 ) and that similar symptoms and genetic material to SARS-CoV-2 has been found in breath samples and on throat and nasal swabs of COVID-19 patients. Furthermore, air samples, surface swabs of furniture and ceiling vents that were taken from COVID-19 treatment rooms also contained SARS-CoV-2 genomic material (Guo Z, Wang Z, Zhang S. et al 2020), indicating that airborne contaminants are projected into the external environment during sneezing and coughing and breathing, which can survive for several hours at room temperature and particularly in dark environments (Pyankov OV. et al 2018), and other conditions such as temperature and humidity and sunlight may also affect the rate of decay of infectious viruses in aerosols projected from the upper respiratory tract. In another more recent study investigating the effect of relative humidity and simulated levels of sunlight equal to light levels in winter, early autumn and summer on concentrated SARS-CoV-2 viral suspensions, which that were diluted in a simulated saliva or culture medium, showed mean decay rates of the virus equal to a 90% loss in 19 minutes and 8 minutes respectively, whilst the mean decay rate of the SARS-CoV-2 virus without simulated sunlight took longer and was equal to a 90% loss in 286 minutes (Shuit M, Gardner S, Wood S. et al 2020). Research reports exist of the germicidal effects of UVC 252nm ultraviolet light and on airborne viral aerosols (Walker CM, Ko G. 2007), however the application of simulated sunlight in the UVA 315-400nm and UVB 280-315nm part of the electromagnetic spectrum had not been examined yet and this first study using simulated sunlight on SARS-CoV-2 indicates that these wavelengths may reduce the risk of aerosol transmission of respiratory viral disease within internal medical and hospital environments, as well as the workplace environment. PBMT has previously been used in combination with the recommended medical treatment for a range of respiratory diseases i.e. asthma, pneumonia and chronic obstructive pulmonary disease to improve and accelerate healing processes (Derbenev VA, Mikhailov VA, Denisov IN.1999,2000 ., de Brito AA, da Silveira EC, Rigonato-Oliveira NC. et al 2020., Fekrazad R. 2020).
Electromagnetic waves, which exist in the external environment, as well as the internal biological environment of both humans and animals, have the potential for electromagnetic frequency interactions that can activate or stimulate living cells e.g. influx of Ca2+ gated channels (Grassi et al 2004). The discovery of the genetic code and its relation to the flow of information from DNA to proteins indicates that complex biological systems can process information and maintain biological coherence at multiple scales (Robert, 2012). DNA in cells is capable of receiving photons via light waves and phonons via sound waves and so may act as a resonator, thereby attracting electromagnetic energy and communicating via different frequencies to other parts of the cell and other cells (Huelga and Pieno,2013., Rieper E. et al 2010).
Biological environments possess a complex spectral structure and short-lived frequencies that originate from embedded molecules and proteins that can interact electronically to enable rapid transport and molecular recognition or long -lived quantum coherence (Chin AW. et al 2012).
Light consists of photons that have no mass but behave as particles and waves of energy that possess electrical and magnetic properties. Once photons are transmitted through the skin surface, they are transferred to a photoacceptor molecule that absorbs them. The first photoacceptor is the terminal enzyme cytochrome c oxidase which activates the first primary reaction to light in the red to near infra-red region and is located inside the cell mitochondria within the electron transport chain and is responsible for photobiomodulation to begin in the first place and instigates the creation of a chemical form of energy called Adenosine Triphosphate (ATP) which is essential for cells to function normally and regenerate.
Light activates cellular metabolism, as well as other redox changes and further modulates biochemical reactions via a cascade of events called the photosignal transduction and amplification chain and a common step in pharmacological reactions is a change in the redox state of the cell, irrespective of the cell type or its specialisation.(Karu 1988., Young et al 1990., Kondrasha 1970., Karu, T. 2007., 2011).
Dr Raphael Nogier from France at 9th International Symposium on Auriculotherapy in Singapore with AILT clinical instructor Adam Canning, who specialises in laser auriculotherapy and PBM therapy at the Wellness Clinic in Latrobe Health centre in Geelong Vic, Australia
Copyright © Tina H.E. Czech 2021
ABOUT THE DIRECTOR – Tina Czech
Tina Czech has been involved in laser phototherapy at a clinical and educational level for the past 30 years and during that time she has learnt that successful treatment relied on more than just a dose of light energy. Effective treatment outcomes are also influenced by treatment methodologies and the severity of the tissue degeneration or injury, which can be further complicated by infection or other underlying pathology’s that need to be taken into account when devising a treatment plan for each individual person. In the early 1990’s very little was known about the capabilities of laser technology or the surgical and clinical applications that were soon to become possible. Even less was known about non-thermal, low level laser therapy (LLLT), which at that time was mainly used for spot stimulation of acupuncture points using very low 5 or 10 milliwatt powered laser pens in place of metal acupuncture needles.
Tina first began using laser phototherapy in her own clinic in 1992 after she had returned from a visit to Guys Hospital research unit in London and during the next 4 years she gained over 8,000 hours of practical experience and know-how in applying both high level thermal laser therapy ( HLLT) for removal of benign skin lesions, vascular telangiectasia and skin photorejuvenation, in conjunction with low level non-thermal laser therapy (LLLT) for treatment of inflammatory dermatological conditions, burn injuries and scarring, as well as post- surgically on wounds, grafts and skin flaps, following the removal of skin cancers.
Over time Tina became more and more involved in treating tissue injuries resulting from accidents and soon became aware of the vast capabilities that LLLT had to offer as a general tissue repair and post- operative therapy, especially after orthopaedic surgery, when pain levels are extremely high and especially for chronic non-healing wounds and pain syndromes and she did not witness any adverse side -effects from treatment with LLLT.
So in 1997 Tina founded the Australian Institute of Laser Therapy (AILT) which was the first government registered training organization in Australia for the dissemination of scientific information relating to HLLT and LLLT laser phototherapy and their clinical applications and she became the founding President of the Australian Medical and Clinical Laser Association (AMCLA)and held that position for the next 4 years.
During her 24 years in clinical practice she also completed over 3,000 hours of operating room experience and in addition to her clinical work she was a sessional lecturer at both university and TAFE and also conducted practical workshops and lectures in clinical phototherapy throughout South -East Asia from 1995 to 2010 on a regular basis.
Tina has been fortunate to have worked alongside many of Australia’s most reputable dermatologists and plastic, reconstructive and cosmetic surgeons during her lengthy career and has been mentored by world experts in the field of phototherapy and photomedicine and now intends to complete her higher PhD degree by research, within the next 6 years.
Her continuing dedication to the sharing of knowledge and her broad clinical experience has been instrumental in expanding the clinical application of LLLT therapy (now know, as PBMT i.e. photobiomodulating therapy) into many areas of healthcare in Australia and her professional connections worldwide, continue to keep her up to date with the most advanced laser technology and phototherapy methodologies, as it becomes available .
Research & Studies
Health Sci. C. D.T., Grad. Dip. Clin. Nutr., Grad. Cert Clin L. D. S. R.,
Grad. Cert. Clin L.M.P.W.H., Dip. A.E.T., Cert. IV. W.T.A.
Tina Czech has studied in the United Kingdom, USA and Germany and authored several government accredited post graduate courses, which included an introductory science course in laser and intense pulsed light phototherapy and laser safety certificate course, approved by Australian Radiation Health Departments, for licensing. Her other accredited courses include a Graduate Certificate course in the clinical application of class 4 and class 3 laser for dermatology and scar repair and another in clinical application of low level laser therapy for musculoskeletal conditions, pain relief and wound healing, which she conducted at national level for 5 years, after establishing the Australian Institute of Laser Therapy as a government registered training organization (RTO).
In 2008 Tina was invited to join the research team at the Royal District Nursing Service Helen Macpherson Smith Institute of Community Health, in Melbourne and was the educator and supervisor for laser phototherapy in the first Australian Proof of Concept clinical study on the effects of low intensity laser therapy for relief of wound pain. Tina continues to develop customised courses for various fields of healthcare for both class 4 and class 3 laser and now acts as a private consultant for the integration of PBM therapy and photomedicine into medical and hospital practice, as well as an advisor to new laser PBMT research projects.
Member: World Association for Laser Therapy (WALT)
Member: American Society for Photobiology (ASP)
Member: Wounds Australia
Photobiology is an area of science that examines the chemical and physical changes induced by non-ionizing radiation and light in humans, plants, animals and micro-organisms, as well as the emission of light by biological systems. This involves the use of scientific tools to study the effects of different wavelengths on different molecules and the physical interactions of light with matter, including the vibration and rotation of molecules.
Photochemistry is a branch of chemistry that studies chemical reactions that occur due to absorption of light in the ultraviolet 100- 400nm, visible light 400-750nm and infra-red 750-2500nm part of the electromagnetic spectrum. Following absorption of a photon of light a chemical change can occur in the absorbing molecule e.g. Vitamin D synthesis in the skin after exposure to UV light.
Photobiomodulation instigates photochemical processes within humans and animals that can assist in restoring and maintaining homeokinetics and homeostasis within the biological system, following absorption of visible light and near infra- red wavelengths through the skin surface and this is known as PBM Therapy, previously called Low Level Laser Therapy LLLT.
WOUNDS Virtual Conference 4 -6 MAY 2021
Connect, Collaborate, Innovate
The Wounds Australia National Conference
Concurrent 2: Chronic Wound Infection
Tuesday, May 4th, 2021
1:45pm – 3:00pm
RESEARCH Oral Presentation – Tina Czech
Photobiomodulation effects of Blue light 405nm to 470nm on pathogenic microbes and biofilms
My pursuit of the best and most current knowledge in integrative Laser PBM Therapy(PBMT) and photomedicine as well as the most precise and potent laser systems available, led me to the Australian Institute of Laser Therapy (AILT) and Tina Czech who provided both. My personal experience with Induction and Masters level training with AILT opened a world of ground breaking multi-disciplinary practice with great possibilities and my interest to help a close family member with laser PBM therapy (PBMT) quickly expanded to my clinic patients, where results were promising and at the time, nothing short of incredible. I have been integrating laser PBMT and Osteopathic practice over the past 18 months using the RJ Physiolaser Olympic multiplatform PBM system and have been astounded by the treatment results so far. Not only have my ‘high’ expectations been breached, the possibility of greater heights for clinical success has been galvanised and made real by the treatment results I have obtained so far and would not have been possible without the support from Tina Czech and the highly experienced clinical consultants at AILT.
I first integrated laser technology into the Coonabarabran Medical Centre back in 2005 after attending the Laser Induction course and hands-on practical training at the Australian Institute of Laser Therapy in Melbourne. Since then my nurses have also completed that same course, in order to assist me with the increase in patient demand for non- thermal laser PBM Therapy and this demand was largely due to patient word of mouth communication amongst our regional country community. Being in a north western NSW farming area, we have a high level of musculoskeletal complaints as well as injuries, coupled with acute and chronic pain, which we find PBMT highly effective for, as well as Diabetic leg ulcers and non -healing amputations and wounds and dermatological conditions. I utilise a variety of lasers from the RJ Laser range because of the diverse pre-programmed treatment menus, easy touch-screen operation and very fast treatment times that save me valuable time and effort in an already busy medical practice. I provide non-needle acupuncture, localised anatomical treatment and recently introduced non-invasive systemic PBM treatment, which we have found very beneficial for relieving anxiety and depression.
As a family doctor, I would be faced several times a day with patients who are suffering from chronic pain, which may not have been the main reason for their visits to me and I usually prescribed pain killers to provide temporary pain relief, knowing these may carry side-effects and do not address the underlying cause of the problem. Patients had often failed to get relief from other modes of physical therapy and I would feel helpless at not being able to offer definitive management of their pain stemming from injury or inflammation. After completing comprehensive and government approved training in laser photobiomodulation therapy (PBMT) and choosing what I considered to be the best laser equipment I could find from the Australian Institute of Laser Therapy, I began introducing this support therapy to some of my patients, who had very limited benefits from other clinical therapy modalities and a plethora of pain medications over the years. Initially I was surprised and delighted with the results and quickly began to accept that the speedy resolution of their symptoms, was not just a random effect, but a repeatable and effective one and without any unwanted side-effects. My clinical experiences since I introduced PBMT into my family medical practice has led me to believe that this modality is the way forward in managing chronic pain, pain medication addiction and associated mental health issues, just as it has proven to be in other countries around the world for the past 2 decades.
I purchased 2 lasers from the RJ Laser range for my hand therapy practice from the Australian Institute of Laser Therapy 18 months ago. Of all the modalities I have used in the past and currently still use, PBM therapy at this advanced level is by far the most versatile and effective management for a broad range of clinical applications, from acute trauma, post-operative management to chronic pain conditions. The analgesic and anti-inflammatory benefits are outstanding reducing the need for medication and in particular has offered a treatment option, for those slow to heal tendinopathies and ligament injuries and has accelerated healing timeframes. Tina Czech has been very responsive to our clinical queries and supporting us as we continue to successfully integrate PBM therapy into our routine rehabilitation.
I first integrated non-thermal, low level laser therapy, into my clinical practice with the RJ laser PBM equipment some 6 years ago and our clients were mainly sporting professionals and young recreational sports enthusiasts affected by physical trauma. Since then we have outgrown our clinic space and located to larger premises and continued to increase our range of RJ laser equipment because of it’s advanced German technology and ever increasing range of treatment options, in keeping with the latest scientific research in the field of photobiomodulation. Our scope of treatment has now expanded to include pre and post- operative therapy and rehabilitation, as well as, but not limited to; lumbago, sciatica, frozen shoulder, whiplash, chronic headache and neck pain, with an ever increasing focus on chronic pain and inflammation and in particular osteoarthritis and the advanced laser phototherapy education provided by the Australian Institute of Laser Therapy has been there right from the start and continues to provide that professional ongoing technical and clinical support.
At Roseville Wellness Group, Sydney, NSW we have found PBM to be very helpful for our patients. The many applications range from the usual musculoskeletal conditions (such as degenerative spine to acute trauma) to acupuncture approaches to healing and general wellbeing maintenance. We have found PBM is the only visibly effective treatment for lymphatic and G-lymphatic drainage. Good lymphatic and G-lymphatic flow as part of general wellbeing has become more prominent in clinical care today. Our PBM laser team (Jo, Tash, Deirdre and myself) have thoroughly enjoyed looking after the patients over the last two years and helping them achieve a better quality of life.
It may be time for clinical studies on PBM in patient care.