1. 2 index hilterapia introduction tecnology application modality protocols 3d videos nd-yag...
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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 The material of support for HilterapiaHilterapia®®
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
HILTERAPIA®HILTERAPIA®High Intensity Laser TherapyHigh Intensity Laser Therapy
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INTRODUCTIONINTRODUCTION
Our GoalOur 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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ExpectationsExpectations
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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HILTERAPIAHILTERAPIA® ® can be performed with 2 devices:
SH1 (1 kW)– Pain managementSH1 (1 kW)– Pain management
HIRO 3.0 (3 kW)– Pain managementHIRO 3.0 (3 kW)– Pain management
Reparative/regenerative therapyReparative/regenerative therapy
Standard handpiecesupplied with
SH1 and HIRO 3.0
DJD handpiecesupplied with
HIRO 3.0HIRO 3.0
SH1
TECHNOLOGYTECHNOLOGY
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Delivery modesDelivery modes • Fixed points (spots): Fixed points (spots):
static handpiece, i.e. located on the areas
to be treated (trigger points)
• Manual scanning: Manual scanning:
- Fast scan: 10 cm/1 s
- Slow scan: 10 cm/3 s
APPLICATION MODALITY
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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
Delivery modesDelivery modes
APPLICATION MODALITY
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• 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.
Delivery modesDelivery modes
APPLICATION MODALITY
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• 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.
Delivery modesDelivery modes
APPLICATION MODALITY
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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
STANDARD HILTERAPIASTANDARD HILTERAPIA® ® PROTOCOLPROTOCOL
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TRANSMISSION IS PREVALENT ON ABSORPTIONTRANSMISSION IS PREVALENT ON ABSORPTION
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
STANDARD PROTOCOLSTANDARD PROTOCOL
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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.
STANDARD PROTOCOLSTANDARD PROTOCOL
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ABSORPTION IS PREVALENT ON TRANSMISSIONABSORPTION IS PREVALENT ON TRANSMISSION
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
STANDARD PROTOCOLSTANDARD PROTOCOL
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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.
SPECIFIC HILTERAPIASPECIFIC HILTERAPIA® ® PROTOCOLSPROTOCOLS
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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.
PHOTOTYPEPHOTOTYPE HAIRHAIR COMPLEXIONCOMPLEXION TENDENCY TO TENDENCY TO ERYTHEMAERYTHEMA TANTAN
II RedRed WhitishWhitish Constant +++Constant +++Always presentAlways present NoNo
IIII FairFair FairFair Constant ++Constant ++ Slightly tannedSlightly tannedIIIIII BrownBrown FairFair FrequentFrequent Light tannedLight tannedIVIV Dark brownDark brown OliveOlive RareRare DarkDarkVV BlackBlack OliveOlive ExceptionalExceptional Very darkVery darkVIVI BlackBlack BlackBlack NotNot BlackBlack
SPECIFIC PROTOCOLSSPECIFIC PROTOCOLS
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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)
SPECIFIC PROTOCOLSSPECIFIC PROTOCOLS
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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).
SPECIFIC PROTOCOLSSPECIFIC PROTOCOLS
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The DJD handpiece
A cavity with the shape of a belland an internal side gold-platefor increasing the reflection power
Reduced blood sprinklingfor the light pressureof the handpiece on the skin
Quartz windowfor permitting toexert a lightpressure during the treatment
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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.
SPECIFIC PROTOCOLSSPECIFIC PROTOCOLS
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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.
SPECIFIC PROTOCOLSSPECIFIC PROTOCOLS
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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.
SPECIFIC PROTOCOLSSPECIFIC PROTOCOLS
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