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A brain injury cannot be seen from the outside Its experienced from within. It is
scientifically proven that you cannot be at 100% Health without 100% function You cannot be
at 100% function without your brain and nervous system functioning properly.

-World Health Organization

Peripheral Nervous System injuries are severely debilitating and affect more than 90,000
people yearly, only shadowed by nearly 1.7 million people who sustain Traumatic Brain Injuries
annually (Faul et al., 2006). Unlike PNS (Peripheral Nervous System) injuries though, 80% of
brain injured patients are treated and released from emergency rooms, almost fully recovered
(Sanders, 2006). Peripheral nerve injury, usually severe, occurs with the retrograde degeneration
of axons and their corresponding neurons in the spinal cord. Recovery does take place, but is
usually slow and frequently incomplete. This is typically because when peripheral neurons are
injured, their axons undergo Wallerian degeneration on the distal end, losing their myelin sheath,
and undergo either apoptosis or Chromatolytic regeneration, which is an attempt to repair the
axon, at the proximal end (Anders et al., 2003; Schwartz et al., 2000). Clinically, demyelination
and axon degeneration result in the interruption of sensory functioning or motor functioning, or
both. If a peripheral nerve injury is vastly proximal, such as a Brachial Plexus injury or a Sciatic
nerve injury, nerve regeneration will not take place quickly enough to allow for muscle
reinnervation, since the proximal stump is too far from the distal end, the axon connected to a
receptor or motor end plate (Novak, 2011). Even if surgical restoration is performed within 3-6
months of the injury, the muscles of the hands and feet, arms, lower legs or even shoulders,
cannot be used if the injury is at the trunk level, or higher. A cross-sectional study was created to
evaluate the biomedical factors that came with disability after an upper extremity PNS injury.
The follow up period lasted 6 months to 15 years. The DASH (Disabilities of the Arm, Shoulder
and Hand) questionnaire was used to assess the disability, and scores predicted cold sensitivity,
elapsed time since injury, pain intensity, employment status, older age and the presence or
absence of Brachial Plexus injury, which is the injury of a nerve running from the spine towards
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the anterior of the Pectoralis Major and clavicle bone, and into the armpit (Bassil, 2014;
Mackinnon et al., 2011; Novak, 2011). A score up to 11 indicates no functioning disabilities, and
a score of anywhere between 45-55 is classified as Unable to move and Disabled (Saeed,
Awais, 2014). In middle aged to older patients, a decline in neurotransmitter release, impassable
scar tissue and weak synaptic excitation is observed. This leads to many severe peripheral
communication errors, which then leads to the incidence of several conditions, such as motor
impairment, muscle atrophy and Phantom limb pain. Conditions like these are observed in older
people mostly due to decreased and neuron flexibility, and a decline in new synaptic
connections (Doidge, 2015; Rotshenker, 1994). Neuroplasticity, however, states that the brain
changes throughout ones lifetime, and can be rewired using light, a natural source for therapy
and healing. Light can be passed through, absorbed, or scattered by cells, and can promote
regeneration and functioning within the injured peripheral nerves (Reviewed in Doidge, 2015).
Light therapy is usually used in-vivo, and treatments to lower high bilirubin levels in babies who
suffer from jaundice have been promising (Reviewed in Doidge, 2015). Hence, using Low Light
Laser Irradiation, which is a type of phototherapy, on injured peripheral nerves can promote
regeneration of the axon and synaptic connections, and recover peripheral nerve function. The
axon can also regrow through impassable scar tissue regions (Yin Q et al., 1998). Using LLLI
(Low Light Laser Irradiation) during the critical stage of injured nerve regeneration, the
chromatolytic stage, promotes the healing process when the axon regrows from the distal end to
the proximal stump, and can cover large distances.

Phototherapy promotes Regeneration and Functional recovery of injured Peripheral Nerve

Various tool that have been aimed at post-traumatic peripheral nerve regeneration include
drugs, exercise and hormones (Lundborg, 2002). One new method that has been studied is
Phototherapy to enhance nerve function recovery. Phototherapy reportedly has a wide range of
effects on nerve cell function, growth and regeneration. Firstly, an unknown number of all-
female Sprague-Dawley rats were anesthetized and placed in a dark room on an isothermal pad.
The isothermal pad acted as an external regulator of body temperature. The rats then had their
facial nerve crush injured unilaterally. The facial nerve lies lateral to the mouth. Next, the rats
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were injected with Horseradish Peroxidase, an enzyme that increased detectability and created
fluorescence in cells when it broke down. The researchers labelled the neurons as an assay to
measure regeneration after the crush injury. The optimum laser wavelength was determined;
632.8nm, an orange HeNe laser that created 110mV of energy and raised body temperature (in
the absence of an isothermal pad) by 2.45OC. Three control groups were created, indicating a
Randomized Control Trial; an experimental group, where the rats had their nerves crushed, HRP
(Horseradish Peroxidase) enzyme injected, and received laser irradiation for 9 days, a control
group, and a 2nd control where the nerve was crush injured but no transcutaneous laser treatment
was given, hence being a sham treatment group. The researchers hypothesized that the low-
level laser therapy would promote regeneration of axons, and increase motor nerve function
recovery. The null hypothesis was that the Phototherapy would show no change in nerve
regeneration time. The results obtained were as follows; seven days post-crush showed 22 HRP
labelled neurons, and 116 nine days post-crush, for the control group that received the sham
treatment. The results for the experimental group that received nine days of HeNe low level laser
treatment were; 34 seven days post crush and 1725 nine days after crush injury. These results
validated the alternative hypothesis and proved that transcutaneous LLLI promotes nerve
regeneration and motor nerve function recovery, by almost 3-fold. Despite the positive results
gathered from the experiment, a limitation of the method was that only female rats were used
during the procedure, for both intervention and control groups. Female hormonal release could
interfere with the data, depending on the rats reproductive cycle stage during the procedure.
According to Gerald B. Colvin, the physiological and anatomical changes in the reproductive
organs during the Estrous cycle, also trigger the release of luteinizing and follicle stimulating
hormones. Also released during the estrous cycle are the estrogen and progesterone hormones,
which signal the increase in size of the uterus. Colvin stated that the hormones released interfere
with the effects of the anaesthetic drug used during his Changes in Circadian Rhythms in
Female Rats study, indicating high levels of brain activity, and hindering results (Colvin et al.,
1967). The hormones might have produced an antagonistic effect on the anaesthetic drug,
increasing brain activity during the phototherapy post crush. Overall, this experiment was
considered ethical on the following grounds; the experiment produced more than satisfactory
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results, and validated the alternative hypothesis. The side effects the damage induced in the rats
post-treatment were minimal to none, despite having no informed consent (Rockhind, Nissan,
2003). Finally, the field of phototherapy is promising in terms of activating the bodys potential
to increase autonomic healing, and promoting regeneration of injured nerves in both the CNS
and PNS, and overall, no ethical regulations were violated. The situation that needs to be clearly
understood is that Phototherapy is a promising upcoming field of study, and that patients,
especially middle-to-old-aged, almost never fully recover from PNS injuries, but with LLLI, the
regeneration and recovery of nerves and nerve function, respectively, will increase significantly.

Significance to Society

Peripheral Nervous System injuries are severely debilitating, and result in motor, speech
and sensory impairments, especially in the middle aged to older population. This is mostly due to
decreased neuron flexibility and synaptic connections. Nervous System injuries result in $150
billion spent in healthcare dollars in the United States annually (Grinsell, Keating, 2014). Most
of the peripheral nerve injuries are in the upper extremities, i.e. the arms and shoulders, and are
mostly caused by trauma. In 2014 alone, 20 million Americans suffered from traumatic nervous
system injury (Fitzroy, 2014). Moreover, a meta-analysis conducted in the UK of median and
ulnar nerve repairs that only 51.6% of the nerve injured population achieved satisfactory motor
recovery (Mario, 2005). Before the discovery of Phototherapy, experiments and results to
promote nerve regeneration were disappointing. In 1850, Waller discovered the major biological
roadblock towards regenerating several injured nerves through studying with frogs; Wallerian
degeneration. (Millesi, 1959). In 1945, Sunderland introduced microsurgical nerve repair, using
injured WWII soldiers, but this procedure brought setbacks, including unwanted side effects
(Kurz, 1964). Hence, over the past fifty years, only minor refinements have been created, and the
major technique used for injured nerve repair and regeneration is epineural repair, an invasive
method using interposition analogous nerve grafts (Flores, 2000) The major research question
now is; how effective and consistent will Phototherapy using LLLI be? Thus far, it has been
validated in almost every research study conducted, and the results are promising. The impact
that phototherapy using LLLI would have in the medical world would be astounding, where
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more and more injured patients would restore satisfactory function in the Peripheral Nervous
System.

For my own research in the future, I would like to examine the outcome of grafting PNS
axons from the body to an injured central nerve proximal stump, and test, using LLLI, whether
the axon from the body can regrow from the axon hillock of the proximal stump. CNS nerves
and axons fail to regenerate, so brain diseases such as Alzheimers and Parkinsons are
permanently degenerative. Using regenerative nerve cells from the Peripheral Nerve System, and
using transcutaneous Low Level Laser Irradiation, axons might be able to regrow and form
synaptic connections with adjacent degenerating axons, thereby reducing the affects of the
degenerative diseases. This future experiment can hinder the effects and onset of degenerative
diseases and its symptoms, and promote regeneration of injured nerves, indications of a wide
field of new research and methods to improve injured nerve regeneration using Phototherapy.

The nervous system holds the key to the to the bodys amazing potential to heal itself
- Anonymous

References
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Anders, J.J, Rockhind, S., Guena, S. (2003). Phototherapy promotes regeneration and functional
recovery of injured peripheral nerve. Physiology and Genetics, 26: 233-234.

Bassil, K., Zabkiewicz, D. (2007). Health Research Methods: A Canadian Perspective, Canada:
Oxford.

Colvin, B., Barbara, L.P, Wallace, B.M, Wallace, C.D, David, A.S, (1967). Longitudinal sleep
EEG, temperature, and activity measurements across the menstrual cycle. Psychiatry, 30: 285-
303.

Doidge, N. (2015). The Brain's Way of Healing: Remarkable Discoveries and Recoveries from
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Faul, M., Xu, L., Coronado, V.G. (2006). Traumatic brain injuries during emergency department
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Fitzroy, M. (2014). Peripheral nerve reconstruction after injury: a review of clinical and
experimental therapies. Biomedical Review Article 5: 137-143.

Flores, D. (2000). The mechanical and humoral control of specificity in nerve repair, in
operative nerve repair. Physiology Review Article 3: 56-67.

Grinsell, G.K., Keating, M. (2014). Peripheral nerve reconstruction after injury: a review of
clinical and experimental therapies. Biomedical Review Article 5: 145-146.

Kurz, T. (1964). Microtechniques in neurological surgery, USA: Puffin.

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Mackinnon, S.J., Rory, N.L., Macdonald, F., Peters, M. (2011). Degeneration, trophic
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Mario, N. (2005). Biomedical Engineering Strategies, USA: Thompson.

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Millesi, J. (1959). Peripheral nerve repair and reconstruction, journal of bone and joint surgery.
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