WO1993021993A1

WO1993021993A1 - Low level laser for soft tissue treatment

Info

Publication number: WO1993021993A1
Application number: PCT/US1993/004123
Authority: WO
Inventors: Kim Robin Segal
Original assignee: Kim Robin Segal
Priority date: 1992-04-24
Filing date: 1993-04-26
Publication date: 1993-11-11
Also published as: AU4228593A

Abstract

An apparatus for treating living tissue by stimulation with low level light energy includes a laser (61), an optical fiber (62), a scanner (63) and a controller (64). The laser (11) generates an output of light energy. The optical fiber (62) is optically coupled to the laser. The scanner (63) includes a housing (65), an x-axis servo mechanism (66), a y-axis servo mechanism (67) and a z-axis servo mechanism (68). The x-axis servo mechanism (66), the y-axis servo mechanism (67) and the z-axis servo mechanism (68) are coupled to the housing (65) and are controlled by the controller (64). The scanner (63) is optically to the optical fiber (62) so that the output of light energy from the laser (61) to an area of skin is externally located adjacent to a tissue to be treated. The controller (64) is electrically coupled to the scanner (63) and the laser (61).

Description

LOW LEVEL LASER FOR SOFT TISSUE TREATMENT

Background of the Invention

The field of the is the use of low level laser energy for treating soft living tissue by stimulation.

U. S. Patent No. 5,050,597 teaches a laser thermotherapy apparatus which includes a laser splitter which branches laser energy from a laser source to either laser diodes or optical fibers.

U. S. Patent No. 5,024,236 teaches an electric probe for locating acupuncture points and a light emitting diode which are disposed in a relatively compact, easily portable assembly.

U. S. Patent No. 5,176,130 teaches a heated massage therapy device which has a hand-held housing, a mechanical vibration generator disposed within the housing. At least one source of infrared radiation is disposed within the housing.

U. S. Patent No. 3,648,706 teaches an irradiation device for thermotherapy which includes at least one series of light sources which are arranged one next to the other and intended to be placed over a portion of the human body.

The neodymium doped yttrium-aluminum-garnet (Nd:YAG) laser is also in widespread use. The Nd:YAG laser has a predominant mode of operation at a wavelength of 1.064 microns in the near infrared region

SUBSTITUTE SHEET of the electromagnetic spectrum. The Nd:YAG optical emission is absorbed to a greater extent by blood than by water making it useful for coagulating large, bleeding vessels. The Nd:YAG laser at 1.064 microns has been transmitted through endoscopes for treatment of a variety of gastrointestinal bleeding lesions, such as esophageal varices, peptic ulcers and arteriovenous anomalies.

Such application soft laser energy are thus well adapted where high energy thermal effects are desired, such as tissue vaporization, tissue cauterization, coagulation and as a surgical scalpel.

U. S. Patent No. 5,021,452 teaches a method of using a low power laser emitting light energy of a wavelength in the range of 600 to 1100 nanometers to irradiate a wound site. The inventors, Labbe and Rettmer, published their results in Lasers in Surgery and Medicine_f Volume 10, pages 201-207, 1990. The inventors stated that clinical investigations of laser photobioactivation, or biostiumulation, might be differently designed and more fruitful if knowledge of basic biochemical mechanisms were better understood. In their investigation, biochemical events identified as responses to irradiation by light energy having a wavelength of 904 nanometers included increased ascorbic acid uptake by fibroblasts.

U. S. Patent No. 4,671,285 teaches a method of applying essentially monochromatic light having a non-traumatic power density to to the skin area adjacent to a specific peripheral nerve region of the body and for sufficient time so as to achieve a

SUBSTITUTE SHEET decrease in pain or a reduction in muscle spasms. The inventor, Walker, described her research in an article, published in The Clinical Journal of Pain. Volume 3, pages 183-187, 1988. Human subjects received irradiation of the skin overlying peripheral nerves with a helium-neon laser at a power of 1 milliwatt, at a wavelength of 632.5 nanometers and at a pulse rate of 20 Hz) for 20 second to each treatment site. This treatment was accompanied by irradiation of the skin overlying painful facial areas for 30 to 90 second according to a predetermined protocol. Control subjects received placebo treatment by an apparatus that looked identical to the laser apparatus but emitted no radiation. Laser or placebo therapy was repeated three times a week for ten weeks. Subjects in the experimental group exhibited a statistically significant reduction in the intensity of pain as measured by the visual analog scale and the number of painful episodes. These results, combined with previous research, indicate that laser therapy may provide relief from some kinds of chronic pain.

England described his clinical study of low power laser thereapy for shoulder tendonitis in an article published in Scandinavian Journal of

Rheumatology. Volume 18, pages 427-431, 1989. In this clinical study 30 patients with supraspinatus or bicipital tendonitis were randomly allocated to active infrared laser therapy at 904 nanometers three times weekly for two weeks, dummy laser or drug treatment for two weeks. Objectively maximum active extension, flexion and abduction of the shoulder, and subjectively pain stiffness movement and function were measured at zero and two weeks. Significant improvement of active

SUBSTITUTE SHEET over dummy laser was noted for all seven assessments. Active laser therapy produced significant improvement over drug therapy for all three objective measures and pain. Naproxen sodium significantly improved only movement and function compared to dummy laser. These results demonstrate the effectiveness of laser therapy in tendinitis of the shoulder.

U. S. Patent No. 4,945,489 teaches a laser multiplexing system which is capable of time-sharing high-power laser output among a number of work stations. The laser beam is directable in guick succession into the ends of various optical fibers leading to remote work stations. The precise position of focus of the beam into each optical fiber is originally determined and continually monitored during the beam travel cycle for each work station.

U. S. Patent No. 4,917,084 and U. S. Patent No. 4,950,266 teach an infrared laser catheter system for use with laser energy produced by a laser operating in the mid-infrared region (approximately 2 microns) is delivered by an optical fiber in a catheter to a surgical site for biological tissue removal and repair. Laser sources which have an output wavelength in this region include: holmium-doped yttrium aluminum garnet (Ho:YAG), holmium-doped yttrium lithium fluoride (Ho:YLF), holmium-doped yttrium-scandium-gadolinium- garnet (Ho:YSGG), erbium-doped YAG, erbium-doped YLF and thulium-doped YAG. Laser output energy is applied to a silica-based optical fiber which has been specially purified to reduce the hydroxyl-ion concentration to a low level. The catheter may include a single optical fiber or a plurality of optical fibers arranged to give overlapping output patterns for large

SUBSTITUTE SHEET area coverage. For tissue removal, the lasers are operated with relatively long pulses at energy levels of approximately one joule per pulse. For tissue repair, the lasers are operated in a continuous wave mode at low power. For the removal of atheroscleotic plague, the Holmium-doped laser operating in the wavelength range of from about 1.9 to about 2.1 microns is preferred. For removal of such plague by a Holmium-doped laser, it has been found that the threshold energy density should be greater than about 0.6 joule/cubic millimeter per pulse, and that the pulse width should be substantially less than about 83 milliseconds, and that the repetition rate should be in the range of from about 1 to about 10 Hertz.

TJ. S. Patent No. 4,925,265 teaches an apparatus which mechanically shifts a collimated beam of light energy from a laser into one optical fiber at a time in a bundle or an array of a plurality of optical fibers. The apparatus includes a connector member having a plurality of passages extending longitudinally therethrough, the passages being disposed in a nominal common plane. The input end of each optical fiber extends through a respective passage, with the axes of the input ends spaced closely together and oriented parallel to the axis of a laser beam directed toward the input ends. The collimated beam of light energy passes through a positive lens having a focal plane coincident with the input ends of an optical fiber. An axially translatable shaft extends generally perpendicular to the nominal plane and to the beam axis and is coupled to a drive mechanism to shift the axial position of the shaft selectively, rapidly, and reiteratively.

SUBSTITUTESHEET U. S. Patent No. 4,927,226 teaches an apparatus for multiplexing a coherent high power continuous-wave laser beam which has a mirror mounted on a galvanometer to interrupt the laser beam and another mirror mounted on another galvanometer to deflect the laser beam to a selected pair of optical fibers. The other mirror is moved only when the laser beam is interrupted to avoid fiber damage. Yet another mirror mounted on a galvanometer can be used to provide a greater number of addressable fibers. A method of multiplexing comprises interrupting a laser beam, deflecting it, changing its direction only when interrupted, focussing it, and transmitting it through the optical fibers.

The application of conventional lasers for the purpose of stimulating soft tissue to cause a reduction in pain and inflammation, in stimulation of microcirculation to reduce healing time has been attempted at very low power levels, typically well under 100 milliwatts. Although some therapeutic benefits have been achieved, the treatment time has been unacceptably long.

U. S. Patent No. 4,836,203 teaches a device for therapeutical irradiation of organic tissue by laser radiation which includes a first laser, a second laser, a mirror system and an optical system. The first laser is a helium-neon laser and emits on a wavelength of 633 nanometers. The second laser has a continuous-wave operation and emits light energy which has a wavelength in the range of 800 to 870 nanometers, preferably 840 nanometers. The optical system serves -to widen the beams of the first and second lasers which

SUBSTITUTESHEET follow the same beam path. The optical system allows continuous adjustment of the size of the field irradiated up to a maximum diameter of the order of 30 millimeters. The mirror system includes an outer mirror rotatable around two axes for positioning the irradiation field for beam switching between the first and second lasers and the beam outlet opening of the device.

ϋ. S. Patent No. 4,686,986 teaches an apparatus for the stimulation of biological processes related to cellular activity, particularly for promoting the healing of wounds, ulcers and epithelial injuries. The lesion is irradiated with linearly polarized light of predetermined intensity, comprising incoherent components of wavelength, exceeding 300 nanometers. The apparatus includes a light source, constituted by a lamp emitting incoherent visible and/or infrared light, a deflecting system projecting the light beams into the given direction of treatment, a polarizer placed in the path of the light beam, projected into the direction of treatment, and preferably ultraviolet and infrared filters.

Summary of the Invention

The present invention is generally directed to an apparatus for treating living tissue by stimulation with low level light energy includes a laser, an optical fiber optically coupled to the laser and a controller. The controller is electricaly coupled to the laser.

In a first aspect of the present invention, a

SUBSTITUTE SHEET scanner is optically to the optical fiber so that the output of light energy from the laser to an area of skin is externally located adjacent to a tissue to be treated. The controller is electricaly coupled to the scanner.

In a second aspect of the present invention, the scanner includes a housing, an x-axis servo mechanism, an y-axis servo mechanism and an z-axis servo mechanism. The x-axis servo mechanis , the y- axis servo mechanism, the z-axis servo mechanism are coupled to the housing.

Other aspects and many of the attendant advantages will be more readily appreciated as the same becomes better understood by reference to the following detailed description and considered in connection with the accompanying drawing in which like reference symbols designate like parts throughout the figures.

The features of the present invention which are believed to be novel are set forth with particularity in the appended claims.

Brief Description of the Drawing

Fig. 1 is a schematic drawing of an apparatus for treating soft living tissue by stimulation with low level laser energy which includes a laser, an output coupler, four stationary probes, an ohmmeter and two conductive members.

Fig. 2 is a perspective view of one of the four stationary probes with one of the two conductive

SUBSTITUTESHEET members of Fig. 1.

Fig. 3 is an elevational view in cross- section of the stationary probe and the conductive member of Fig. 3.

Fig. 4 is a schematic view of the laser and the output coupler of Fig. 1.

Fig. 5 is a perspective view of a holder for use with each of the four probes of Fig. 1.

Fig. 6 is an elevational view of a combination of the stationary probe with the conductive member of Fig. 3 and the holder of Fig. 5 in cross- section.

Fig. 7 is a schematic drawing of a belt holding two combinations of the stationary probe with the conductive member and the holder of Fig. 6 to a patient's back.

Fig. 8 is an elevational view of four connectors holding together the four combinations of the stationary probe with the conductive member and the holder of Fig. 6 in order to treat either a patient's wrist or any other similar joint, including his knee and his elbow joint.

Fig. 9 is a partial elevational view of the four connectors holding together the four combinations of the stationary probe with the conductive member of Fig. 3 and the holder of Fig. 5.

Fig. 10 is a schematic drawing of a belt

SUBSTITUTESHEET holding three combinations of the stationary probe with the conductive member and the holder of Fig. 6 to a patient's shoulder.

Fig. 11 is a perspective view of an apparatus for treating soft living tissue by stimulation with low level laser energy which includes a laser system, a scanner and a servo system and which is treating a patient's shoulder in accordance with the principles of the present invention.

Fig. 12 is a perspective view of the apparatus of Fig. 11 which is treating a patient's wrist.

Fig. 13 is a schematic drawing of the apparatus of Fig. 11.

Fig. 14 is a perspective view of the servo system of the apparatus of Fig. 11.

Fig. 15 is a front elevational view in cross- section of the scanner of the apparatus of Fig. 11.

Fig. 16 is a side elevational view of the scanner of the apparatus of Fig. 11.

Detailed Description of the Preferred Method

Referring to Fig. 1 in conjunction with Fig.

2 and Fig. 3 an apparatus 10 includes a laser 11, a first stationary probe 12 which has a first housing 13 and a first lens system 14 for treating living tissue by stimulation with low level light energy. The laser 11 generates an output of light energy at a wavelength in the range of the near infrared region of the electromagnetic spectrum. The laser 11 may be either a Nd:YAG laser or a laser diode. The laser 11 produces 100 to 800 milliwatts in either a pulsed mode or a continuous mode. The first lens system 14 is disposed in the first housing 13 and optically couples the laser 11 to a first area of skin which is externally located adjacent to the tissue to be treated. The apparatus 10 also includes an ohmmeter ϊ5, a first conductive member 16, a second conductive member 17. The first conductive member 15 is mechanically coupled to the first housing 13 and. is disposed contiguous and adjacent to the first area of skin. The second conductive member 11- is disposed contiguous and adjacent to a second area of skin, which is oppositely disposed from the first area of skin. The first and second conductive members 16 and 17 are electrically coupled to the first area of skin, respectively. The ohmmeter 15 has a first terminal 18 and a second terminal 19. The first and second terminals 18 and 19 are electrically coupled to the first and second conductive members 16 and 17 so that the ohmmeter 15 is monitored during treatment in order that the effective- ness of the treatment may be monitored by observing the change in conductivity of the treated tissue. The apparatus 10 further includes a second housing 20, a second lens system 21, a third housing 22, a third lens system 23, a fourth housing 24 and a fourth lens system 25. The second lens system 21 is disposed in the second housing 20 and optically couples the output of light energy from the laser 11 to a second area of skin which is oppositely disposed from the first area of skin. The second conductive member 17 is mechanically

SUBSTITUTESHEET coupled to the second housing 20 and is disposed contiguous and adjacent to a second area of skin. The third lens system 23 is disposed in the third housing 22 and optically couples the output of light energy from the laser 11 to a third area of skin which is externally located adjacent to the tissue to be treated. The fourth lens system 25 is disposed in the fourth housing 24 and optically couples the output of light energy from the laser 11 to a fourth area of skin which is oppositely disposed from the third area of skin.

Referring to Fig. 1 in conjunction with Fig. 4 the apparatus still further includes a power supply 26, a timer 27, an output coupler 28 which has a single optical input 29 and four optical output 30, four optical shutters 31 and a controller 32. The power suppy 26 is electrically coupled to the laser 11. The timer 27 is electrically coupled to the power suppy 26 and controls the power supply 26. The single optical input 29 of the output coupler 28 is mechanically and optically coupled to the laser 11 by an optical fiber 33. Each of the four optical output 30 of the output coupler 28 is mechanically and optically coupled to one of the four optical shutters 31 by one of four optical fibers 34. ϋ. S. Patent No. 4,950,266 teaches an output coupler for an infrared laser system. Each of the first, second, third and fourth lens systems 14, 21, 23 and 25 is mechanically and optically coupled to one of the four optical shutters 31 by one of four optical fibers 35. The controller 32 is electrically coupled to each of the four optical shutters 31.

Referring to Fig. 5 in conjunction with Fig.

SUBSTITUTE SHEET 4, Fig. 6 and Fig. 7 each stationary probe 40 is formed by a housing 41 and a lens system 42. The lens system includes a defocusing lens 43 and a cover lens 44. The housing 41 is hollow and has a cylindrical portion 45 and a truncated-conical portion 46. The defocusing lens 43 is disposed in the cylindrical portion 45. The cover lens 44 is disposed in the truncated- conical portion 46. A cylindrical member 47 secures the defocusing lens 43 against a ledge 48 within the cylindrical portion of the housing 41. A face-ring 49 secures the cover lens 44 in place. The apparatus 10 may also include a holder 50 for use in holding the probe in place. The holder 50 has a first sheet 51 and a second sheet 52. The first sheet 51 has a hole 53 which may be aligned with the cover lens 44. The second sheet 52 has a U-shaped hole 53 so that when the first and second sheets 51 and 52 are joined together they form the holder 50 for the probe 40. The holder 50 has a pair of slots 55 in which either a belt 56 or a strap may be inserted for forming a hinge. The belt 56 holds two probes 40 to a patient's back.

Referring to Fig. 8 in conjunction with Fig. 7, Fig. 9 and Fig. 10 four fastening straps 61 connects together four probes 40 in order to treat either a patient's wrist or any other similar joint, including his knee, his elbow joint. The belt 56 connects together three probes 40 in order to treat a patient's shoulder.

The inventor has used a Nd:YAG laser operating at a fundamental wavelength of 1.064 microns and at an output power level in the range of 100 to 800 milliwatts to generate light energy. This light energy

T is applied to regions of the body which reguire a decrease in muscle spasm, increased circulation, decrease in pain or enhanced tissue healing. The area of skin is demarcated and the tissue to be is irradiated with a beam of this light energy in a grid fashion for the amount of time and intensity necessary to produce the desired therapeutic effect, with the energy density of the irradiated tissue being limited to the range of from about 1 to about 15 joules per cubic centimeter. The intensity and duration of treatment is determined by the character of the tissue to be treated, the depth of penetration desired, the acuteness of the injury and the condition of the patient.

The inventor has demonstrated therapeutic treatment by a low level reactive laser system for the purposes of reducing pain, reducing inflammation, and enhancing healing of damaged tissue by stimulation of microcirculation, all being successfully accomplished without producing damaging thermal effects in the tissue. The Nd:YAG laser had an adjustable output beam of light energy at a power of 100 to 800 milliwatts. The Nd:YAG laser was capable of operation in a pulsed or continuous mode. The output was controlled by an exposure timer in the range of 0.1 to 9.9 minutes. The pulse on-time was adjustable from 0.1 to 9.9 seconds in 0.1 second intervals. The pulse off-time was also adjustable from 0.1 to 9.9 seconds in 0.1 second intervals. The therapeutic beam output of light energy was directed by a helium-neon laser beam, having an output of less than 1 milliwatt because the beam of light energy from the Nd:YAG is invisible. The visible light energy from the helium-neon laser beam is in the

SUBSTITUTESHEET red portion of the electromagnetic spectrum at 633 nanometers. Both beams of light energy are precisely aligned and are coincident upon impact at the tissue site. The method for delivering the beams of light energy to the target sight is a flexible quartz fiber and either a focusing handpiece or a stationary probe 40.

The beam of light energy exits the Nd:YAG laser through the output coupler of the laser head and is steered by a pair of alignment wedges before passing through a circularly variable, neutral density attenuator. Light passing through the attenuator is focused through a pair of 90 millimeter focal length lenses onto the proximal end of an optical fiber cable. The main beam attenuator is a shutter placed outside the laser head between the output coupler of the laser and the beam steering mirror. It includes four components: a 90 degree reflecting prism, a shutter arm, a shutter mounting bracket and an actuating solenoid. The prism is mounted to the shutter arm so that, in the normally closed position the prism intercepts the laser beam and reflects it downwardly into a beam dump in the laser deck. The solenoid is energized when an output channel has been selected and the foot pedal is depressed, which causes the shutter arm to raise and allows the beam to pass. When the solenoid arm is de-energized, the shutter drops into the closed position. The laser system is obtained from Melles Griot and includes a helium-neon aiming laser, Model 05LHR007, and a Nd:YAG laser, Model 607C, which

1 V is provided with an optical fiber guide and a coupler for directing the beam of optical energy to the tissue to be treated. The beam of light energy from the Nd:YAG laser is controlled and applied to produce a

SUBSTITUTE SHEET minimum absorption rate in the irradiated tissue which will elevate the average temperature of the irradiated tissue to a level above the basal body temperature, but which does not exceed the maximum absorption rate which is great enough to convert the irradiated tissue into a collagenous substance.

The inventor has determined through extensive testing that the foregoing condition is satisfied by the Nd:YAG laser operated at a power output level of from 100 to 800 milliwatts, with the laser beam being focused to produce an energy density of the projected laser beam in the range of from about 1.0 to about 15 joules per square centimeter. Since the beam of light energy is coherent, a variable power density of the light was obtained by converging the laser beam into small treatment areas, for example, from about 0.5 to about 2 square millimeters at each grid treatment point.

The inventor observed certain physiological mechanisms in the tissue and at the cellular level when she used the above process. In the evaluation of the microcirculatory system, for example, she has demonstrated that the blood vessel walls possess photosensitivity. When the blood vessel walls are exposed to laser irradiation as set forth above, the tonus is inhibited in smooth myoctyes, thus increasing the blood flow in the capillaries. She has observed other effects which are peripheral capillarid neovascularization, reduction of blood platelet aggregation, reduction of 0₂ from the triplet to the singlet form which- allows for greater oxygenation of the tissue, reduction of better substance concentration in the blood, stabilization of the indices of erythrocyte deformation, reduction of products of perioxidized lipid oxygenation of the blood, other effects which have been observed are increased index of antithrombin activity, stimulation of the enzymes of the antioxidant system such as superoxide dismutase and catalase. An increase in the venous and lymph and outflow from the irradiated region has been observed. The tissue permeability in the area is substantially enhanced. This assists in the immediate reduction of edema and hematoma concentrations in the tissue. At the cellular level, the mitochondria have also been noted to produce increased amounts of ADP with subsequent increase in ATP. There also appears to be an increased stimulation of the calcium and sodium pumps at the tissue membrane at the cellular level.

At the neuronal level, the following effects have been observed as a result of the foregoing therapeutic treatment. First, there is an increased action potential of crushed and intact nerves. The blood supply and the number of axons is increased in the irradiated area. Inhibition of scar tissue is noticed when tissue is lased. There is an immediate increase in the membrane permeability of the nerve. Long term changes in the permeability of calcium and potassium ions through the nerve for at least 120 days have been observed. The RNA and subseguent DNA production is enhanced. Singlet 0₂ is produced which is an important factor in cell regeneration. Pathological degeneration with nerve injury is changed to regeneration. Both astrocytes and oligodedrocytes and stimulated which causes an increased production of peripheral nerve axons and myelin. Phygocytosis of the blood cells is increased, thereby substantially reducing infection. There also appears to be significant anti-inflammatory phenomena which provides a decrease in the inflammation of tendons, nerves, bursae in the joints, while at the same time yielding a strengthening of collagen. There is also an effect on the significant increase of granulation tissue in the closure of open wounds under limited circulation conditions.

Analgesia of the tissue has been observed in connection with a complex series of actions at the tissue level. At the local level, there is a reduction of inflammation, causing a reabsorption of exudates. Enkephalins and endorphins are recruited to modulate the pain production both at the spinal cord level and in the brain. The serotnogenic pathway is also recruited. While it is not completely understood, it is believed that the irradiation of the tissue causes the return of an energy balance at the cellular level which is the reason for the reduction of pain.

Referring to Fig. 11 and Fig. 12 an apparatus

60 for treating living tissue by stimulation with low level light energy includes a laser 61, an optical fiber 62, a scanner 63 and a controller 64. The laser

61 is a Nd:YAG laser which generates an output of light energy at a power in the range of 100 to 800 milliwatts in either a continuous mode or a pulsed mode. The optical fiber 62 is optically coupled to the laser 61.

Referring to Fig. 13 in conjunction with Fig. 14, Fig. 15 and Fig. 16 the scanner 63 includes a housing 65, an x-axis servo mechanism 66, a y-axis servo mechanism 67 and a z-axis servo mechanism 68, The x-axis servo mechanism 66, the y-axis servo mechanism 67 and the z-axis servo mechanism 68 are coupled to the housing 65 and are controlled by the controller 64. The scanner 63 is optically to the optical fiber 62 so that the output of light energy from the laser 61 to an area of skin is externally located adjacent to a tissue to be treated. The controller 64 is electricaly coupled to the scanner 63 and the laser 61.

From the foregoing it can be seen that an apparatus for treating soft living tissue by stimulation with low level laser energy has been described. It should be noted that the sketches are not drawn to scale and that distance of and between the figures are not to be considered significant.

Accordingly it is intended that the foregoing disclosure and showing made in the drawing shall be considered only as an illustration of the principles of the present invention.

SUBS ITUTESHEET

Claims

1. An apparatus for treating living tissue by stimulation with low level light energy, said apparatus comprising: a. a laser which generates an output of light energy; b. an optical fiber optically coupled to said laser; c. a scanner optically to said optical fiber so that the output of light energy from said laser to an area of skin is externally located adjacent to a tissue to be treated; and d. a controller electricaly coupled to said scanner and said laser.

2. An apparatus for treating soft living tissue by stimulation with low level laser energy according to claim 1 wherein said laser is a Nd:YAG laser which produces 100 to 800 milliwatts in a pulsed mode.

3. An apparatus for treating soft living tissue by stimulation with low level laser energy according to claim 1 wherein said laser is a Nd:YAG laser which produces 100 to 800 milliwatts in a continuous mode.

4. An apparatus for treating soft living tissue by stimulation with low level laser energy according to claim 1 wherein said laser is a diode laser which produces 100 to 800 milliwatts in a pulsed mode.

IT TESHEET

5. An apparatus for treating soft living tissue by stimulation with low level laser energy according to claim 1 wherein said laser is a diode laser which produces 100 to 800 milliwatts in a continuous mode.

6. An apparatus for treating soft living tissue by stimulation with low level laser energy according to claim 1 wherein said scanner includes: a. a housing; b. an x-axis servo mechanism coupled to said housing and controlled by said controller; c. an y-axis servo mechanism coupled to said housing and controlled by said controller; and d. an z-axis servo mechanism coupled to said housing and controlled by said controller.

7. An apparatus for treating living tissue by stimulation with low level light energy, said apparatus comprising: a. a laser which generates an output of light energy; b. an optical fiber optically coupled to said laser; c. a controller electricaly coupled to said laser; and d. a scanner optically to said optical fiber, said scanner including a housing, an x-axis servo mechanism coupled to said housing and controlled by said controller, an y-axis servo mechanism coupled to said housing and controlled by said controller and an z-axis servo mechanism coupled to said housing and controlled by said controller whereby the output of light energy from said laser to an area of skin is externally located adjacent

SUBSTITUTE SHEET to a tissue to be treated.

8. An apparatus for treating living tissue by stimulation with low level light energy for use with a laser which generates an output of light energy, said apparatus comprising: a. a first housing; b. a first lens system which is disposed in said first housing and which optically couples the output of light energy from the laser to a irst area of skin which is externally located adjacent to a tissue to be treated; c. a first conductive member which is mechanically coupled to said irst housing and which is disposed contiguous and adjacent to the first area of skin, said first conductive member being electrically coupled to the first area of skin; d. a second conductive member which is disposed contiguous and adjacent to a second area of skin, which is oppositely disposed from the first area of skin, said second conductive member being electrically coupled to the second area of skin; and e. an ohmmeter which has a first terminal and a second terminal with said first terminal being electrically coupled to said first conductive member and said second terminal being electrically coupled to said second conductive member whereby said ohmmeter is monitored during treatment in order that the effectiveness of the treatment may be monitored by observing the change in conductivity of the treated tissue.

9. An apparatus for treating soft living tissue by stimulation with low level light energy according to claim l wherein said apparatus further comprises: a. a second housing; and b. second lens system which is disposed in said second housing and which optically couples the output of light wherein said second conductive member is mechanically coupled to said second housing and is disposed contiguous and adjacent to the second area of skin.

10. An apparatus for treating soft living tissue by stimulation with low level light energy according to claim 2 wherein said laser produces 100 to 800 milliwatts in a pulsed mode.

11. An apparatus for treating soft living tissue by stimulation with low level light energy according to claim 2 wherein said laser produces 100 to 800 milliwatts in a continuous mode.

12. An appratus for treating living tissue by stimulation with low level laser energy from a laser which generates light energy, said apparatus comprising: a. a first housing; b. a first lens system which is disposed in said first housing and which optically couples the laser to a first area of skin which is externally located adjacent to a tissue to be treated; c. a second housing; and d. a second lens system which is disposed in said second housing and which optically couples said laser to a second area of skin which is oppositely

SUBSTITUTE SHEET disposed from the first area of skin.

13. An apparatus for treating soft living tissue by stimulation with low level laser energy according to claim 5 wherein said laser is a Nd:YAG laser which produces 100 to 800 milliwatts in a pulsed mode.

14. An apparatus for treating soft living tissue by stimulation with low level laser energy according to claim 5 wherein said laser is a Nd:YAG laser which produces 100 to 800 milliwatts in a continuous mode.

SUBSTITUTE SHEET