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Biophysics

Two in one

Device uses ultrasound and laser simultaneously to rehabilitate arthritis patients

Handheld probe with ultrasound emitter in the center and four laser emitters on the outer border

EDUARDO CESARHandheld probe with ultrasound emitter in the center and four laser emitters on the outer border EDUARDO CESAR

Arthritis, a rheumatoid disease of the joints that inflicts pain and limits mobility, afflicts about 20% of the world’s population. The disease, known in the medical world as osteoarthritis, worsens with age and affects an estimated 85% of all people by age 64, becoming universal after age 85. It is incurable, and treatment consists of alleviating pain and improving the functional capability of patients by recovering or maintaining bodily mobility. The good news is that a group of scientists at the University of São Paulo (USP) and the Federal University of São Carlos (UFSCar) have developed a new therapeutic option to treat the disease, combining simultaneous use of ultrasound and laser light. Experimental clinical studies have shown promising results. The new equipment was tested on approximately 80 women with arthritis in their hands and knees . A patent was filed at the Brazilian Industrial Property Institute (INPI) in March 2014, although the device is still in the prototype stage and must be approved by Brazil’s sanitation authorities before commercial use.

The positive effects of ultrasound and laser in the rehabilitation of patients suffering from arthritis and other joint troubles are well-known by doctors, physical therapists, and occupational therapists. The innovation lies in the simultaneous application of both techniques using a single machine. “The methodology we developed is groundbreaking, combining the mechanical effects of ultrasound with the phototherapeutic effects of laser. This produces a considerable synergistic effect, relieving pain and accelerating recovery from the inflammatory state. The new technology shortens treatment time, accelerates patients’ physical rehabilitation, and expedites the return to their daily activities,” says physicist Vanderlei Salvador Bagnato, professor at the São Carlos Institute of Physics of the University of São Paulo (IFSC-USP) and coordinator of the Optics and Photonics Research Center (CePOF), a Research, Innovation and Dissemination Center (RIDC) funded by FAPESP.

Bagnato explains that ultrasound is a type of mechanical wave, through which vibration energy is transformed into molecular energy. This triggers a range of therapeutic effects including increased vascularization and collagen synthesis, in addition to shortening the inflammatory process and thus leading to tissue repair. A laser beam is composed of electromagnetic waves, which produce modulating and stimulating effects such as pain relief and tissue regeneration. “Ultrasound is essentially a mechanical stimulus, so the body needs to respond to it. If the area is very debilitated, this response will be limited. So laser stimulation completes the therapeutic effect,” says Bagnato, who also heads up the USP Innovation Agency.

The manner of application and the equipment's casing

EDUARDO CESARThe manner of application and the equipment’s casingEDUARDO CESAR

“The equipment that our group created, associating laser and ultrasound in a single machine, enhances the therapeutic effect in a non-invasive and non-pharmacological manner, making it a better option for people with chronic diseases, the elderly, adults at a productive age, and athletes. Because of these characteristics, it can be associated with other existing treatments,” says occupational therapist Alessandra Rossi Paolillo, professor at the Occupational Therapy Department of UFSCar and member of the team that developed the new technology. “Good ergonomics and portability are additional advantages of the system, permitting its use in home-care or outpatient settings, including applications for physical rehabilitation or for cosmetic purposes.”

During the therapeutic sessions conducted experimentally on a group of 43 women ages 60 to 80 with arthritis of the hand, the prototype was applied to five areas for a total of 15 minutes on each hand, using slow, gentle circular motions. The sessions were held once a week for three months. According to Paolillo, quantitative and qualitative assessments were made before and after treatment. “First, we took X-ray images to diagnose osteoarthritis. Then we measured prehensile strength, using a hand-held dynamometer, and we used an electrogoniometer to measure the range of motion of the finger joints, simultaneously placing an accelerometer on the wrist in order to measure the acceleration, speed, and amount of movement,” says the occupational therapist.

Less time
At the end of the treatment, the researchers evaluated the pain thresholds and the functionality of the patients’ hands. They saw by performing a specific test that the activity “pick up small objects” was performed in less time – 8 seconds, down from about 11. “This indicates that the patients increased their fine motor coordination and functionality as they simulated movements to grasp everyday objects.  There was also a significant increase in the pain threshold of the group treated with the equipment, while there was no significant difference in the placebo group,” says Paolillo.

The positive results obtained with the device developed by the research group in São Carlos – whose members also include physical therapists Jéssica Patrícia João and Fernanda Rossi Paolillo, physicist Herbert João, and undergraduate student Daniela Frascá from IFSC-USP – has attracted attention from companies. According to Vanderlei Bagnato, MM Optics, a company based in the high-tech hub of São Carlos, has already shown an interest in manufacturing the machine and making it available to health care professionals in Brazil. “The equipment will cost an estimated R$10,000,” says Bagnato. The researchers believe that the studies will be completed and the equipment may be ready for placement on the market within a year.

Project
CePOF – Optics and Photonics Research Center (No. 2013/07276-1); Grant mechanism Research, Innovation and Dissemination Center (RIDC); Principal investigator Vanderlei Bagnato (USP); Investment R$8,287,218.51 and $5,825,805.65 over 5 years (FAPESP).

Scientific article
PAOLILLO, A. R. et al. Synergic effects of ultrasound and laser on the pain relief in women with hand osteoarthritis. Lasers in Medical Science. v. 30, p. 279-86. 2015.

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