Transcranial Low-level Laser Therapy may Improve Alertness and Awareness in Traumatic Brain Injured Subjects with Severe Disorders of Consciousness: A Case Series

Abstract

Background: Transcranial low-level laser therapy (T-LLT) proved promising in acute stroke studies and in single traumatic brain injured subjects (TBI). It was assumed to increase cortical mitochondrial energy production and/or vasodilatation.Objective: Within this case series the potential of transcranial low-level laser therapy in improving the alertness and awareness in TBI subjects with severe disorders of consciousness will be investigated. Methods:Following a 21-day baseline, the forehead of five patients, four chronic in a state of unresponsive wakefulness or minimal consciousness, one subacute in the state of akinetic mutism, was stimulated with the T-LLT (785 nm, 10 mW/cm 2 , CW mode, 21 emitting diodes) for 10 min every workday for six weeks. Follow-up was four weeks after end of intervention. Primary variable was the revised version of the Coma Recovery Scale (r-CRS, 0-23), blindly assessed by an external reviewer with the help of videos. Results:The r-CRS, almost stable during baseline, improved in all patients during the intervention, from 3 to 12, 9 to 12, 8 to 12 and 5-12 in the chronic, and from 6 to 21 in the subacute patient. Follow-up revealed a sustained effect. The patient in the state of akinetic mutism improved her competence in the activities of daily living and mobility status. Single epileptic fits occurred in two patients during the intervention.Conclusion: T-LLT improved the patients' alertness and awareness; epileptic fits were potential side effects. Sham-controlled studies including the quantitative assessment of awareness should follow the case series.

Brain Photobiomodulation Therapy: a Narrative Review

“…The higher fluence of NIR laser resulted in greater clinical efficacy such as diminished signs of headache and improved sleep quality as well as improved cognitive and mood states in TBI patients [61]. In addition, improving the alertness and awareness in TBI patients with severe disorders of consciousness was achieved following irradiation at 785 nm, a somewhat uncommon wavelength for transcranial PBM therapy [198].…”

Devices used for photobiomodulation of the brain—a comprehensive and systematic review

“…To uniformize the information, instead of the head areas in which the device was placed, the target brain area was determined for each situation (e.g., if the right side of the forehead was being stimulated, it was identified as the right prefrontal cortex (PFC). When the description provided in the article did not indicate the target brain area, the article description was considered [ 14 , 23 , 24 , 30 , 61 , 62 , 64 , 78 , 96 ].…”

“…More than half the subjects (56%) were related to cognitive function or stroke studies. The sex of the subjects was not reported in 13 articles (30%) [ 2 , 3 , 5 , 31 , 35 , 38 , 48 , 58 , 61 , 64 , 66 , 88 , 91 ], while, in studies reporting this information, 51% of all subjects were female. The subjects were aged between 18 and 90 years, except in four studies in which subjects under 18 years (i.e., 5 to 17 years) were used [ 63 , 78 , 98 , 99 ].…”

“…Clear influence on brain activity, but only in regions that were functionally active. Effective and safe Traumatic brain injury [ 15 – 18 , 60 , 61 , 64 , 95 , 98 , 103 ] 10 142 111 patients. 31 healthy volunteers 14–71 years 11 females.…”

Reabilitação Sensório-Motora Associada À Fotobiomodulação Transcraniana Em Pacientes Com Lesão Do Sistema Nervoso Central

“…O treinamento de marcha realizado em esteira permite maior intensidade de exercício quando comparado a reabilitação convencional, chegando a um número 10 vezes maior de passos (HESSE; WERNER; BYHAHN, 2015). Munari e colaboradores (2018), relatam que treinamento em esteira contribui para um equilíbrio na geração de torque dos músculos quadríceps e isquiotibiais paréticos vs lado não parético, promovendo uma maior eficiência biomecânica da marcha.…”