Introduction
Traumatic brain injury (TBI) is a serious condition that can have long-lasting effects on patients' physical and cognitive abilities, resulting in a wide variety of neurological, psychiatric, cognitive, and emotional consequences. TBIs are a significant health concern, affecting many individuals every year.
Traditional treatment options for TBI often focus on managing symptoms rather than promoting actual tissue repair. However, there has been a growing interest in exploring alternative therapies for treating traumatic brain injuries (TBIs). One such therapy gaining attention is photobiomodulation therapy, also known as light or laser therapy, which has shown promising results in treating TBIs. This non-invasive treatment approach involves the use of red and near-infrared light to stimulate healing and improve brain function.
In this article, we will discuss research findings as well as our clinical experience in treating TBIs with laser therapy. Specifically, we will focus on mild to moderate TBIs, for these are the most common forms and have diverse consequences.
Diagnosing TBI
TBIs result from trauma to the brain, which can be caused by direct contact or non-contact forces. Common causes include sports-related injuries, motor-vehicle collisions, falls, and blast forces. The severity and duration of the injury, as well as individual factors, such as genetics, can influence the effects of a TBI. TBI symptoms vary widely but can include headaches, visual disturbances, dizziness, cognitive impairment, memory impairment, fatigue, and emotional disturbances. Recognizing these symptoms and evaluating for TBIs is vital because, unfortunately, undiagnosed and untreated TBIs are prevalent—particularly in children and the elderly. Diagnosing and treating TBIs in a timely manner can help to mitigate the TBI’s potentially significant impact on both the patient’s quality of life and long-term health. Although stroke is not classified as a TBI, it shares similarities in terms of damage to the central nervous system, so keep that in mind when diagnosing patients with TBI and stroke symptoms.
TBI is characterized by a collection of symptoms rather than a single, easily identifiable condition. This complexity often leads to a delay in diagnosis as the symptoms can be nebulous and can develop gradually over time. Moreover, the severity of these symptoms can vary greatly from one person to another, making TBIs notoriously difficult to diagnose and treat effectively. The diversity of symptoms also contributes to the challenge of managing these injuries.
One of the most challenging aspects of dealing with TBI is its symptoms’ unpredictability. For example, a person might seem perfectly fine immediately after an accident, only to start showing signs of cognitive impairment weeks or months later. This delay in the onset of symptoms can sometimes create a false sense of security, leading to a delay in seeking treatment. TBI symptoms can emerge weeks, months, or even years after the event, further complicating the diagnosis. However, as medical science advances, our understanding of TBI also evolves, and promising new treatment options are being explored.
Traditional Treatment Options for TBIs
It is critical to start treatment as early as possible: preferably within the first two years following the injury. Research has shown that the sooner treatment begins, the better the potential outcomes. Early intervention can help to mitigate the long-term effects of the injury and improve the patient's quality of life.
Current treatment approaches for TBIs primarily focus on pharmacotherapy and cognitive rehabilitation therapy. While these interventions may provide some relief from symptoms, they often have limited effectiveness in addressing the underlying brain damage. Residual cognitive and psychological impairments can persist, requiring alternative therapeutic options to promote healing and recovery.
Medications can help manage symptoms such as depression, attention disorders, cognition, and insomnia. Again, though, these medications primarily address the symptoms of, rather than the underlying damage to, the brain. Also, in some cases, prescribed drugs can even hinder the neurological regeneration process, slowing down the patient's recovery. This is why it's important for doctors and patients to explore other treatment options apart from medication.
Cognitive rehabilitation and behavioral therapies can be beneficial in promoting neurogenesis and facilitating functional recovery. Nutritional supplements have shown potential in aiding recovery by supporting brain health. Also, although further research is needed, preliminary results suggest that certain nutraceuticals may contribute to neurogenesis and functional recovery.
Other treatment modalities, like transcranial magnetic stimulation and hyperbaric oxygen treatment, have been explored for their potential in TBI treatment. The efficacy of these therapies remains controversial, though, so more research is needed before clinical application can be recommended. For example, hyperbaric oxygen treatment involves administering high concentrations of oxygen under pressure with the hope of delivering more oxygen into the blood. However, concerns of oxygen toxicity and the potential for placebo effects limit its effectiveness and acceptance.
Exercise has also shown promise as a treatment option, with consistent physical activity potentially improving cognitive function and brain perfusion in TBI patients. Before pursuing these treatment options, though, it is crucial to consider individual circumstances and comorbidities that may limit a patient's ability to engage in exercise. Not everyone with such injuries can exercise, especially if they have concurrent physical injuries. Additionally, exercise as a TBI treatment requires consistency over at least six months to see benefits for brain recovery; this may not be a feasible timeline for some patients.
Laser Therapy for TBIs
Laser therapy shows promise as a potential treatment for TBIs. It utilizes near-infrared light to modulate intracellular mechanisms associated with healing. One key chromophore in laser therapy, cytochrome c oxidase, stimulates changes in damaged tissues, aiding in the recovery process. Laser therapy may also enhance the transmission of mitochondrial-based water across membranes, leading to the regulation of cell metabolism and normalization of cellular components in damaged nerve areas. Laser therapy has been shown to improve cognitive function, increase cerebral blood flow, and stimulate neurogenesis—even years after the initial injury. This means that patients who have been living with the symptoms of TBI for years could see improvements with laser therapy. However, to achieve these types of results, it is crucial to administer the proper dosage of laser therapy, as the dose delivered to deeper tissues may differ from the surface dose.
The effectiveness of laser therapy can vary from person to person. Individual evaluation is crucial to determine not only the appropriateness of this treatment for each patient, but also the dosage that should be delivered to each patient. Laser should be used as part of a comprehensive treatment plan that takes into account the unique needs and circumstances of the patient. When practitioners do this, treating traumatic brain injuries with laser therapy can bring about a profound impact on individuals' lives.
By using high-intensity lasers, healthcare providers can reliably and effectively deliver therapeutic doses to the brain, promoting tissue repair and alleviating symptoms. This therapy uses light to stimulate healing in the brain. The mechanism of action involves the release of nitric oxide, which triggers vasodilation, angiogenesis, and the production of anti-inflammatory molecules and neuro-protective factors. This non-invasive treatment has shown promise in promoting the repair and regeneration of damaged brain tissue, facilitating improved outcomes for TBI patients—helping them regain their independence, mental well-being, and functionality.
Penetration of Light to the Brain
One of the challenges in delivering laser therapy to the brain is the penetration of light through the various layers of skin and tissues. LED devices have limited penetration of human skin, making it difficult to reach the brain effectively. Higher power lasers, however, have shown greater effectiveness in delivering therapeutic doses through the superficial tissues. For example, a 15-watt, near-infrared laser can push 17% of its energy through 2mm of human skin. This highlights the importance of using high-power lasers for optimal treatment outcomes. High-power lasers (this, for most studies, means within the 10- to 15-watt range) have been found to deliver up to 3% of the light’s energy to the brain through the skin and skull. This penetration is crucial for accessing the damaged tissues and for promoting repair of those tissues.
A study involving 10 subjects with mild to moderate, chronic TBI showed positive results with laser therapy. The patients experienced improvements in mood, cognitive function, and sleep—which is a critical component to brain health, as emerging research shows sleep promotes brain health through the glymphatic system, removing plaque built up in the brain from tau, beta-amyloid, etc. In the study, laser therapy also helped alleviate symptoms such as anxiety, depression, and insomnia. Laser therapy also facilitated the return to work for several patients who were previously unemployed due to their TBI symptoms. The total dosage of laser therapy ranged from 14 to 81 joules per centimeter squared, exceeding the recommended dosage for skin treatment. These findings underscore the potential of laser therapy as a viable treatment option for TBI.
Study on Light Therapy for Veterans with TBIs
Among veterans, TBIs have become known as the signature wounds of the Iraq and Afghanistan wars. The incidence of TBIs has increased significantly over the past decade or so, affecting soldiers who have been exposed to blasts and concussions. These injuries not only cause physical damage, but also lead to psychological symptoms such as depression and anxiety. Finding effective treatments for TBIs is crucial to improve the quality of life for veterans.
A study was conducted on 12 veterans with TBIs to evaluate the effectiveness of light therapy. The participants had a varied history of brain injuries, including concussions from sports, motor-vehicle accidents, and blasts from improvised explosive devices. The study aimed to rule out the brain's natural healing process by selecting veterans who had a minimum time since the last reported brain injury of 18 months.
The participants underwent 20-minute light-therapy sessions at 3 times per week for 6 weeks, totaling 18 sessions. The light used in the therapy was a combination of red and infrared wavelengths. The results of the study showed improvements in 14 out of 15 neuropsychological parameters and increased regional cerebral blood flow in 8 out of 12 participants. While the improvements were significant, they were not as large as initially expected, indicating the need for further research to optimize treatment protocols and expectations.
Current Considerations and Future Research
While light therapy shows promise in treating TBIs, there are still several factors to consider and areas for further research. We know laser therapy provides the opportunity to modulate intracellular mechanisms and promote healing in damaged nerve areas. However, it is probably best to integrate this modality with other treatment options to address the diverse consequences TBIs pose. Utilizing a personalized approach that considers each patient's unique needs is essential.
Further research is crucial to fully understand the effectiveness of different therapies and their long-term impact on TBI recovery. If you suspect a TBI in your patients, it is crucial to evaluate and refer them to appropriate specialists for further assessment and treatment. As a laser provider, you can offer a unique treatment that has shown positive effects and carries no known side effects. To deliver these positive effects to your patients, though, you will need to apply the correct wavelengths, pulsing frequencies, power, and dosage—delivered at intervals consistent with the treatment frequency optimal for your patient.
If you would like to confidently treat TBIs with clinically proven treatment protocols, contact us here to learn whether an LTI Membership is right for you. If so, you will receive the necessary tools, techniques, and protocols to achieve successful outcomes in treating your patients suffering from TBI.
Conclusion
Laser therapy has emerged as a promising treatment modality for TBIs. Its ability to penetrate deep into the brain and stimulate tissue repair offers new hope for individuals suffering from this condition. As a non-invasive and safe approach that has the potential to improve cognitive and psychological impairments, as well as promote neuro-protection and stimulate the healing process in the brain (even years after the initial injury), high-intensity lasers can—when delivered with proper treatment techniques and protocols—help TBI patients achieve better outcomes and improve their quality of life.