Phototherapy indications and contraindications. "Physical foundations of phototherapy" cycle of improvement "Physiotherapy

Light therapy in physiotherapy is a procedure for dosed effects on the body. various kinds light radiation. Moreover, each of the types used in the body causes only its inherent changes and processes, which determines the indications and contraindications for the procedures. The longer the wavelength, the deeper the light will penetrate the tissue.

infrared irradiation

When exposed to this type of radiation on the body, three positive effects- anti-inflammatory, lymphatic drainage and vasodilator. The peculiarity of the procedure is that under the influence of these rays a short-term vasospasm occurs, which lasts no more than 30 seconds, after which there is an increase in the blood flow of the irradiated part of the body. The released heat accelerates the metabolism in the tissues. Increased vascular permeability helps to cope with soft tissue edema. It causes fast healing wounds and trophic ulcers. positive impact appears on all internal organs.

The main indications for the use of this method of treatment are considered to be:

1. Almost all chronic diseases, inflammatory processes internal organs without the formation of pus.
2. Burns.
3. Frostbite.
4. Badly healing wounds.
5. Pathology of the peripheral nervous system with pain.

As with any method of phototherapy, infrared irradiation has its own contraindications, therefore, before starting therapy, it is necessary to consult a doctor. Contraindications that do not allow this type of therapy include:

1. Any tumors.
2. Acute inflammatory pathologies.
3. Chronic diseases in the acute stage.
4. Bleeding.
5. active tuberculosis.

To obtain this type of light rays, I use special lamps. Any thermal effect on the body leads to the fact that the molecules begin to move faster, which leads to an acceleration of cell reproduction, enzymatic processes and regeneration. Most often, this type of radiation is used in combination with massage and gymnastics.

ultraviolet irradiation

Ultraviolet irradiation penetrates the skin to a depth of only 1 mm, while carrying the most high energy. The skin on the trunk is most sensitive to these rays, the skin on the extremities is the least sensitive.

The use of this method with the right dosage and good control gives a high therapeutic effect. In this case, there is a rapid healing of wounds, and regeneration of the nervous and bone tissue.

The main indications for the use of this method of light therapy can be considered:

1. Acute pathologies of the joints.
2. Chronic diseases of the joints.
3. Respiratory diseases.
4. Problems with the female genital organs.
5. Diseases of the peripheral nervous system.
6. hardening.

This method of light treatment has not only indications, but also contraindications. These include:

1. Tumors.
2. Exacerbation of any pathologies.
3. Bleeding.
4. Increased blood pressure.
5. active tuberculosis.

It should be remembered that such treatment should be strictly dosed and carried out only under the supervision of a physician. An overdose can lead not only to premature aging skin and reduce its elasticity, but also the development of skin and various oncological pathologies.

quantum therapy

This type of phototherapy involves the use of devices for laser therapy. These devices emit monochromatic coherent non-scattering beams of radiation. In surgery, such rays are used in the form of a light scalpel, and in ophthalmology - for the treatment of retinal detachment.

Such radiation can be used in the treatment of degenerative-dystrophic diseases of the spine, rheumatoid arthritis, long-term non-healing wounds, ulcers, polyneuritis, arthritis, stomatitis and bronchial asthma.

Chromotherapy

This treatment involves the application of a different spectrum of visible study. For example, White light used to treat seasonal depression, which occurs in the autumn-winter period, when there is a shortening of daylight hours.

In the treatment of neonatal jaundice, it is best to use blue and blue radiation, which leads to the destruction of hematoporphyrin, which is bilirubin. And red color is successfully used in the treatment of acne.

Any type of phototherapy should be strictly dosed and used only as directed by a doctor. If you use such treatment without control, you can cause significant harm to the body. Therefore, you should definitely visit a doctor and find out all the available contraindications for each type of light therapy.

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Light therapy, or phototherapy (Greek phos, photos - light + therapeia - treatment), is the use of infrared, visible and UV rays from artificial sources for therapeutic or prophylactic purposes.
Like many others physical methods treatment, phototherapy was born in deep ancient Spectrum electromagnetic oscillations used in phototherapy sti from human communication with factors environment, in particular the sun's rays. It originated as a treatment with the sun, or heliotherapy. Written instructions for therapeutic action sunlight can be found in the "father of history" Herodotus (484-425 BC). However, the inscriptions read on the walls of the ancient temples of Egypt and Rome suggest that healing action sunlight was known much earlier. For example, the inscription on the temple of Diana in Ephesus reads: "The sun gives life with its radiant light." The first physician to recommend the use sunbathing with a therapeutic purpose, was Hippocrates (460-377 BC). IN Ancient Greece And Ancient Rome on the roofs of houses arranged special areas - solariums, on which with health and medicinal purposes sunbathing was taken.
In the Middle Ages, doctors stopped using light as healing factor. A pleasant exception was the famous Avicenna, who during this period was an ardent supporter and propagandist of sun therapy.
And only at the end of the XVIII century. a revival of light therapy began. In 1774, the French physician Faure suggested using Sun rays for treatment open sores legs, after which a number of works devoted to phototherapy appeared. First scientific work(dissertation), concerning the study of the influence of light on the human body, was published by Bertrand more than 200 years ago. In 1801, I. Ritter and W. Wollaston discovered UV rays. A year earlier, Herschel discovered infrared rays. In 1815, Lebel designed a special apparatus that allowed him to concentrate the sun's rays for the treatment of patients. Since then, the idea of ​​using concentrated light has been one of the most important trends in phototherapy.
In 1816, Professor of Chemistry I. Debereiner in Vienna published a work in which phototherapy was first considered from scientific positions and indicated the value of the wavelength of light. This is how chromotherapy (treatment with visible light) was born, which today, in the form of biotron color therapy, is being revived on new basis. In 1855, the Swiss A. Rikli founded the first sanatorium for sun therapy in Oberkrain, and Walde (Australia) founded the first institute for heliotherapy. After the discovery by Herschel chemical action UV rays, and Doyun and Blount - their bactericidal action UV rays began to spread rapidly in medical practice. In the widespread introduction of phototherapy in medical practice Swiss doctors A. Roll and F. Bernhard played an important role. The use of incandescent light bulbs in therapy also belongs to this period (Stein, 1890; Gachkovsky, 1892).
The golden page in the development of phototherapy was written by the Danish physiotherapist Niels Finsen, who is rightfully considered the founder of modern phototherapy. In 1896, he founded the Institute of Light Therapy in Copenhagen, where he developed scientific foundations phototherapy, primarily treatment with natural and artificially produced UV rays. He was the first to develop an apparatus for producing artificial UV rays, and proposed a number of techniques to enhance them. therapeutic action. In 1903 Finzen was awarded Nobel Prize in medicine and physiology for their work on the effects of UV rays on the human body. Along with the desire to serve natural forces man has always tried to become independent of nature and help himself (especially in the fight against ailments) with technical devices that replace natural light. Among these ascetics, in addition to the already mentioned Lebel and Finsen, one should name a galaxy of doctors and engineers who contribute to the achievement of modern level phototherapy. Here are just a few of these names: the American physician Kellogg, the inventor of the first electric light bath; Russian doctor A.I. Minin is the author of a reflector with a blue bulb, familiar to every family today; Kromeyer (1906), Nagelschmidt (1908), Bach (1911) and Jezionek (1916) are the developers of quartz lamps, who opened the way for artificial UV rays in medical practice.
By the end of the 1920s, along with heliotherapy, all ranges of light - infrared, visible and UV rays - began to be used in medicine. Since that time, light therapy began to develop extremely rapidly. Research was carried out both in the field of studying the mechanisms therapeutic action various parts optical spectrum, and in the field of methodology for the treatment of various diseases. During this period, the development of phototherapy greatest influence provided by domestic researchers (A.N. Maklakov, S.B. Vermel, P.G. Mezernitsky, S.A. Brushtein, I.F. Gorbachev, etc.).
Phototherapy is based on the interaction of light with biological structures(primarily molecules) of tissues, accompanied by photobiological reactions. The nature and severity of the latter depend on the physical parameters of the acting light, its penetrating power, as well as the optical and other properties of the tissues themselves. Crucial in this case, it has a wavelength of optical radiation, on which the energy of quanta also depends.
In the infrared region, photon energy (1.6-2.4 10-19 J) is sufficient only to increase the energy of oscillatory processes of biological molecules. Visible radiation, which has photons with higher energy (3.2-6.4 10-19 J), can cause their electronic excitation and photodissociation. Quanta of UV radiation with an energy of 6.4-9.6 10-19 J are capable of causing various photochemical reactions due to the ionization of molecules and the destruction of covalent bonds. Typical photochemical reactions are: photoionization knocking out an electron by a radiation quantum outside the molecules; photoionization produces ions or free radicals; photoreduction and photooxidation - the transfer of an electron from one molecule to another; one molecule is oxidized while the other is reduced; photoisomerization - a change in the spatial configuration of a molecule under the action of light, a change in the structure of the molecule; photodimerization - the formation of a chemical bond between monomers under the action of light.
Subsequently, the energy of optical radiation is transformed into heat or primary photoproducts are formed, acting as activators and initiators of physicochemical, metabolic and physiological reactions that form the final therapeutic effect.
The first type of energy transformations is inherent to a greater extent in infrared, and the second - in UV radiation. The physical and chemical processes inherent in each type of optical radiation determine the specificity of their therapeutic effects and methods of application in phototherapy (table).
Indications. The main therapeutic effects of infrared rays are anti-inflammatory, metabolic, local anesthetic and vasoactive, which allows them to be used in chronic and subacute inflammatory diseases, consequences of injuries of the musculoskeletal system, pain neurological syndromes etc. (see. Infrared irradiation).
Visible rays, which have a psycho-emotional, metabolic and anti-inflammatory effect, are used in the treatment of wounds and trophic ulcers, neuroses, sleep disorders, some inflammatory processes.
UV rays, depending on the wavelength, have different and very diverse effects, and therefore they have enough broad indications to application.
Contraindications for phototherapy, in addition to general ones, are active tuberculosis, thyrotoxicosis, generalized dermatitis, malaria, Addison's disease, systemic lupus erythematosus, photosensitivity.

Light therapy is a method of physiotherapy, which consists in a dosed effect of infrared (IR) or ultraviolet (UV) radiation on the patient's body.

Light is a stream of electromagnetic oscillations in the optical range, i.e., having a wavelength from 400 microns to 2 nm. Such vibrations are emitted in separate portions - quanta or photons with different energies.

The biological action of light is based on the absorption physical energy its quanta by tissues and its transformation into other types of energy, primarily thermal and chemical, which in turn have a local and overall impact on the body. It is known that the quantum energy is inversely proportional to the wavelength, i.e. the shorter the wave, the higher the energy potential. The luminous flux only seems to be uniform. A beam of light passed through the prism of a spectroscope breaks up into a series of spectral bands of red, orange, yellow, green, blue, indigo and purple. The phenomenon of decomposition of white sunlight is widely known, which underlies the multicolored rainbow after rain. A rainbow occurs as a result of the refraction of the rays of the sun in the smallest droplets of water, as in the prism of a spectroscope.

Radiant energy is emitted by any body at a temperature above absolute zero(-273 °С). A further increase in temperature causes the emission of visible light - everyone knows red and white heat. At temperatures above 1000 °C, UV radiation begins.

Biological action light radiation depends on the depth of its penetration into the tissue. The longer the wavelength, the stronger action radiation. IR rays penetrate tissues to a depth of 2-3 cm, visible light - up to 1 cm, UV rays - 0.5-1 mm.

INFRARED RADIATION

Infrared radiation (thermal radiation, infrared rays) is a section of the general electromagnetic spectrum. IR rays penetrate deeper into the tissues of the body than other types of light energy - up to 2-3 cm, which causes heating of the entire thickness of the skin and partly the subcutaneous tissues. Deeper structures are not subjected to direct heating.

direct action IR rays are limited to the site of exposure, but it indirectly spreads to the entire body. Irradiation of large areas of the body (light baths) causes general overheating, accompanied by increased sweating. Therefore, local hyperthermia causes and general reaction organism.

Local heating in the irradiation zone primarily affects the thermoreceptors of the skin and almost immediately causes a reaction in its vessels. Initially, a spasm occurs, which occurs reflexively in response to irritation of thermoreceptors. It is quickly replaced by vasodilation of the skin and increased blood flow in them. Biological entity of this phenomenon lies in the thermoregulation of tissues due to increased peripheral circulation caused by the difference in blood temperature in heated and unheated tissues. The phase of active hyperemia of the skin is characterized by redness of the irradiated area, erythema appears even during the procedure, gradually disappearing after the cessation of irradiation. In this it differs from persistent ultraviolet erythema that occurs after a certain latent period. In addition, after erythema with infrared irradiation, usually there is no age spots

Active hyperemia in the area of ​​skin irradiation is accompanied by an increase in the permeability of the capillary walls. There is an increased effusion of the liquid part of the blood in the tissue and a simultaneous increased absorption tissue fluid. In this regard, tissue metabolism increases, redox processes are activated.

Intensive heating of the skin leads to the breakdown of its protein molecules and the release of biologically active substances, including histamine-like substances, which contributes to the expansion of blood vessels and an increase in the permeability of their walls.

Violation of the rules for conducting infrared irradiation procedures can lead to dangerous overheating of tissues and the occurrence of thermal burns I and even II degree, as well as circulatory overload, dangerous in cardiovascular diseases.

Therapeutic effect infrared irradiation is determined by the mechanism of its physiological action. Light therapy procedures with infrared irradiation are used mainly for local action even on large areas of the body. Strengthening of local microcirculation has a pronounced anti-inflammatory effect, accelerates the reverse development of inflammatory processes, increases tissue regeneration, local resistance and anti-infective protection. The generalized effect of infrared irradiation is manifested by an antispastic effect, in particular on smooth muscle organs. abdominal cavity often accompanied by suppression pain especially in chronic inflammatory processes.

Region therapeutic use IR radiation is quite wide. It is indicated for non-purulent chronic and subacute inflammatory local processes, including internal organs, burns and frostbite, poorly healing wounds and ulcers, various adhesions and adhesions, myositis, neuralgia, consequences of injuries of the musculoskeletal system.

Infrared irradiation is contraindicated in malignant neoplasms, tendencies to bleeding, acute purulent-inflammatory diseases.

Equipment

In most physiotherapy devices, incandescent lamps serve as a source of infrared and visible radiation. The temperature of the filament in them reaches 2800-3600 °C. The UV rays emitted by them in a small amount are almost completely absorbed by the glass of the lamp.

The Minin lamp consists of a parabolic reflector with a wooden handle, in which a 25 and 40 W emitter is placed. The lamp is often used of blue color. The simplicity and portability of the device allow it to be used at home. The irradiation distance is 15-30 cm, it is adjustable according to the feeling of pleasant warmth. The duration of the procedures is 15-20 minutes, daily. The course of treatment is 10-15 procedures.

The "Solux" lamp is a much more powerful source of radiation with a power of 200-500 watts. The lamp is enclosed in a parabolic reflector with a removable tube mounted on a stationary or portable stand. The irradiator is installed at a distance of 40-80 cm from the surface of the patient's body. The duration of the procedure is 15-30 minutes, daily or every other day. The course of treatment is 10-15 procedures.

The light-thermal bath is a frame with plywood walls, on inner surface which in several rows there are incandescent lamps with a power of 25-40 W each (Fig. 56). Depending on the purpose of the bath, 12 (body bath) or 8 (limb bath) lamps can be used. During the procedure, the patient, partially or completely naked, is in the supine position on the couch, the bath frame is installed over the corresponding part of the body, covered with a sheet and a woolen blanket. During the procedure, the patient is exposed to visible and infrared radiation and heated to 60-70 ° C air. The procedure lasts 20-30 minutes, is carried out 1-2 times a day. The course of treatment is 12-15 procedures.

Lamp Minin Lamp "Solux" stationary.

The bath is light-thermal.

Methodology

During the procedure nurse must exactly follow the doctor's prescription, which should indicate the type of apparatus, the area of ​​​​irradiation, its duration, the number of procedures per course, and the intervals between them. The intensity of irradiation according to the sensations of the patient can be specified. The irradiation area is marked graphically on the destination diagram.

Assignment examples. 1. Irradiation of the epigastric region with the Solux lamp. Intensity - to a feeling of pleasant warmth. Duration 20-30 minutes, daily. Course 15 procedures.

2. Light-thermal bath for the kidney area. Intensity - until a sensation of pronounced heat (cause intense sweating). Duration from 30 minutes to 1 hour, daily. Course 15 procedures.

Preparation of the patient for the procedure consists in examining the area of ​​irradiation, its exposure, occupation by the patient desired posture, warning him of the intensity of heat he should feel during the procedure. When radiation spreads to the area of ​​the face, the patient's eyes must be protected with special glasses. During the procedure, it is necessary to ensure that the irradiator is not directly above the irradiated surface, in order to avoid, in case of damage to the apparatus, its hot parts getting on the patient's body. After the end of the procedure, it is necessary to turn off the device, wipe the irradiated area of ​​the body dry, inquire about the patient's condition and invite him to rest for 20-30 minutes in the rest room. Rest should be longer if the patient has to go outside in cold weather. The stages of the procedure are shown in Scheme 10.

Treatment with infrared and visible radiation

Infrared (IR) rays are thermal rays that, being absorbed by body tissues, are transformed into thermal energy, excite skin thermoreceptors, impulses from them enter thermoregulatory centers and cause thermoregulatory reactions.

Mechanism of action:

• 1. local hyperthermia - thermal erythema, appears during radiation and disappears after 30-60 minutes;
• 2. spasm of blood vessels, followed by their expansion, increased blood flow;
• 3. increase in the permeability of capillary walls;
• 4. increased tissue metabolism, activation of redox processes;
• 5. release of biologically active substances, including histamine-like ones, which also leads to an increase in capillary permeability;
• 6. anti-inflammatory effect - increased local leukocytosis and phagocytosis, stimulation of immunobiological processes;
• 7. acceleration reverse development inflammatory processes;
• 8. acceleration of tissue regeneration;
• 9. increase in local tissue resistance to infection;
• 10. reflex decrease in the tone of striated and smooth muscles
• - reduction of pain associated with their spasm.
• 11. Itching effect, because. the sensitivity of the skin changes - the tactile feeling increases.

Contraindications:

• 1. malignant neoplasms;
• 2. tendency to bleed;
• 3. acute purulent-inflammatory diseases.

Visible radiation penetrates the skin to a shallower depth, but has a slightly higher energy, in addition to providing a thermal effect, they are capable of causing weak photoelectric and photochemical effects.

In the treatment of skin diseases, visible radiation is used together with infrared radiation.

Sources of infrared radiation and visible rays - irradiators with incandescent lamps or heating elements (Minin reflector, sollux lamp, light-thermal baths, etc.).

Procedures are carried out daily or 2 times a day for 15-30 minutes, for a course of treatment up to 25 procedures.

UV treatment

Kinds ultraviolet radiation:

• - UV-A (long-wave) - wavelength from 400 to 315 nm;
• - UV-B (medium wave) - from 315 to 280 nm;
• - UV-C (shortwave) - from 280 to 100 nm.

Mechanism of action:

• 1. neuro-reflex: radiant energy as an irritant acts through the skin with its powerful receptor apparatus on the central nervous system, and through it to all organs and tissues of the human body;
• 2. part of the absorbed radiant energy is converted into heat, under its influence in the tissues there is an acceleration of physico-chemical processes, which affects the increase in tissue and general metabolism;
• 3. photoelectric effect - the electrons split off in this case and the positively charged ions that appear cause changes in the "ionic conjuncture" in cells and tissues, and consequently a change in the electrical properties of colloids; This results in an increase in permeability. cell membranes and the exchange between the cell and the environment increases;
• 4. the occurrence of secondary electromagnetic radiation in tissues;
• 5. bactericidal action light, depending on the spectral composition, radiation intensity; the bactericidal action consists of the direct action of radiant energy on bacteria and an increase in the reactivity of the body (the formation of biologically active substances, an increase in the immunological properties of blood); coolant ozokeritetreatment sand radiation
• 6. photolysis - the breakdown of complex protein structures into simpler ones, up to amino acids, which leads to the release of highly active biological substances;
• 7. when exposed to ultraviolet radiation, pigmentation of the skin appears, which increases the resistance of the skin to repeated exposure;
• 8. change physical and chemical properties skin (decrease in pH due to a decrease in the level of cations and an increase in the level of anions);
• 9. stimulation of the formation of vitamin D.

Under the influence of intense UV radiation, erythema occurs on the skin, which is an aseptic inflammation. The erythematous effect of UV-B is almost 1000 times stronger than that of UV-A. UV-C has a pronounced bactericidal effect.

Selective phototherapy (SPT)

The use of UV-B and UV-A rays in dermatology is called selective phototherapy (SPT).

The appointment of photosensitizers for this type of phototherapy is not required.

The photosensitizing effect on the long-wave region A is exerted by medium-wave UV radiation.

Two main UVI methods are used: general and local. Sources of selective UV radiation include:

• 1) Fluorescent erythema lamps and fluorescent erythema lamps with a reflector of different power. Designed for treatment and prevention.
• 2) Uveola germicidal lamps with a power of 60 W and arc germicidal lamps emitting predominantly UV-C.

For the treatment of psoriasis, it should be considered promising and appropriate to use the range from 295 nm to 313 nm UV-B radiation, which accounts for the peak of antipsoriatic activity, and the development of erythema and itching is practically excluded.

The dose of SFT is determined individually. In the dominant majority of cases, treatment begins with a dose of 0.05-0.1 J/cm2 using the method of 4-6 single exposures per week, with a gradual increase in the UV-B dose by 0.1 J/cm2 for each subsequent procedure. The course of treatment is usually 25-30 procedures.

Mechanism of action of UV-B rays:

decrease in DNA synthesis, decrease in epidermocyte proliferation o influence on vitamin D metabolism in the skin, correction of immune processes in the skin;

"photodegradation of inflammatory mediators;

keratinocyte growth factor.

SFT can be used as a monotherapy option. The only necessary addition in this case is external preparations - softening, moisturizing; agents with mild keratolytic action.

Local side effects SFT:

• - early - itching, erythema, dry skin;
• - remote - skin cancer, skin aging (dermatoheliosis), cataracts?

Contraindications:

• 1. benign and malignant neoplasms;
• 2. cataract;
• 3. pathology of the thyroid gland;
• 4. insulin-dependent diabetes mellitus;
• 5. acute infarction myocardium;
• 6. hypertonic disease, stroke;
• 7. sub- and decompensated diseases of the liver and kidneys;
• 8. active tuberculosis of internal organs, malaria;
• 9. increased psycho-emotional excitability;
• 10. acute dermatitis;
• 11. lupus erythematosus, pemphigus vulgaris;
• 12. increased photosensitivity;
• 13. photodermatosis (solar eczema, pruritus, etc.)
• 14. psoriatic erythroderma.