Purpose: The purpose of this evidence-based literature analysis is to determine the effectiveness of transcranial near-infrared laser therapy on executive function after an insult to the brain has occurred versus treatment using standard physical therapy alone. Background: With the incidence and prevalence of both stroke and traumatic brain injuries (TBI) nearing an all-time high, a lack of sufficient medical and therapeutic treatment has come to light as a major public health concern. Long-lasting effects of both ischemic stroke and TBI decrease quality of life, impair physical and mental capabilities of an individual, and often result in decreased independence and safety for the individual. The serious and widespread nature of both ischemic stroke and TBI call for an effective treatment plan to address all aspects of the individual with a focused on improved quality of life and return to prior level of function. The current medical standard of treatment for ischemic stroke is a drug called tissue plasminogen activator (tPA) which must be given within 4 hours of onset of symptoms. There is not a good physical therapy approach to improve neuronal function for any patient having suffered an insult to the brain, with a large portion of physical therapy intervention focusing on compensatory strategies and "learning a new normal." However, there are several studies that indicate that near infrared laser therapy could augment current treatment of ischemic stroke and TBI patients, focusing on improving neuronal function on a cellular level with improved ATP production and mitochondrial function. Case Description: This case study is based on a 69-year-old male who suffered an infarct in the frontal lobe, resulting in impaired word finding, memory, abstract problem solving, and increased impulsivity. This patient had no significant medical history other than benign essential hypertension and Gilbert's syndrome. He had a Cholecystectomy and TKA in 2004 as well as a THA in 2016. The patient's impaired memory, abstract problem solving, and increased impulsivity prompted this evidence-based analysis to answer the following PICO question: "What are the outcomes of transcranial near-infrared laser therapy on executive function after an insult to the brain has occurred versus standard physical therapy treatment?" Outcomes: A review of the literature identified several studies that investigated the use of near-infrared laser therapy in the treatment of brain injury. The overall quality of evidence may be sufficient to answer the PICO question, still the current research is sparse in human subjects and few studies compare near-infrared laser therapy to standard physical therapy. Much more research needs to be done on this topic; however, near-infrared laser therapy is known to be a safe treatment and has great potential to be highly effective in improving neurological function. Discussion: Near-infrared laser therapy (NIR) has produced promising results in animal trials, but in regards to its effectiveness in humans, research remains insufficient. The research does indicate that NIR is a promising treatment tool to be used in conjunction with physical therapy in acute care as well as on an outpatient basis. It is possible that NIR could be similar to a TENS unit in the future, in the sense that patients could acquire a unit for home use. Third-party payers have not yet approved NIR for the treatment of stroke of TBI patients at this time. If future studies do prove beneficial this may be modified in the future. No adverse reactions were reported in any study, indicating that it is a safe treatment option. NIR can be completed in any setting, hospital, clinic, or home. While NIR units are expensive and not paid for by insurance at this time, if future research proves beneficial this may change.
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Brain Injuries; Executive Function; Laser Therapy
Stoltzfus, Megan. "Near Infrared Laser Therapy versus standard Physical Therapy for Treatment of Impaired Executive Function." (2016). https://digitalrepository.unm.edu/dpt/3
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