DBC Active Rehabilitation For Back, Neck, Shoulder and Knee Disorders

(1)

DBC Active Rehabilitation

For Back, Neck, Shoulder and

Knee

(2)

OVERVIEW

• Up to

80%

of all Adult will have at least

one episode of Back, Neck , and

Shoulder pain in their lifetime.

• Most of these episode will not cause the

Patient to see

a Doctor.

• About

70%

of all Patients claim to be well

& back at work within 14 days, and about

90%

within two months.

• The remaining

10%

will tend to become

chronic & have Pain & disability beyond

three months.

(3)

OVERVIEW

• Today’s Back, Neck, Shoulder & knee

specialist are widely aware of the harmful

effects caused by bed rest and inactivity.

• DBC

responds directly to that growing

demand with the NEW APPROACH ACTIVE

REHABILITATION

.

• The DBC Measurement & Treatment concept

is Based on the principles of modern

Evidence – Base & Quality management.

• Traditional Physiotherapy is continuously

challenged for being ineffective,

unsystematic, open ended and less than

evidence-based..

• Inadequate Rehabilitation

Greater Risk of

(4)

Cycle of Injury

Injury

Greater Risk

of Re injury

Bleeding

Inflammation

Reduced Risk

of Re injury

Inadequate

Rehabilitation

Atrophy

_Adequate

(5)

Why inactivity is Bad?

• Bones, muscles and ligaments weaken

sooner.

• The spine stiffens and loses control and

coordination.

• Overall physical fitness deteriorates.

• Sufferers become more prone to

depression and sensitive to pain.

• Resuming normal activity and daily

routines becomes more difficult.

(6)

Why Regular Exercise

is Good?

• Promotes a feeling of well-being while

reducing depression an anxiety.

• Releases natural chemicals known to

reduce pain.

• Improves coordination and control of

movement.

• Builds fit muscles and stronger bones

and ligaments.

(7)

Rehabilitation

Rehabilitation:

1. Therapeutic Modalities

(8)

Rehabilitation GOAL :

1. Therapeutic Modalities:

• Decrease Pain

• Decrease Inflammatory

• Decrease Effusion

2. Therapeutic Exercises:

• Return to Full ACTIVE & PAIN FREE at

all Range of Motion (ROM)

• Return to full Muscular Strength, Power

& Endurance

• Return to full asymptomatic functional

activities at the PRE INJURY LEVEL

(9)

Healing Rate for

Various Tissue Type:

TISSU

E:

Time to

Return to

normal

Strength:

BONE

12 weeks

Ligame

nts

40 - 50

weeks

Muscle

6 weeks - 6

months

Tendon

40 – 50

weeks

(10)

What is

DBC

?

Documentation Based Care

treatments

for Knee, Back, Neck,Shoulder and Knee

Disorder

and Dysfunction, that focus on healing

chronic

pain.

MISSION

… to become the leading active

Spine,

Shoulder & Knee

Rehab Center.

VISION

..to be the Rehab provider in Hospitals & Sport

Centers

(11)

Brief history

• DBC is founded in

FINLAND

in 1991.

• R&D programs are in cooperation with

The National Technology Agency &

University TAMPERE

in FINLAND.

• Headquarter in

Helsinki

, with branches

in London (UK), Holland,South Africa,

Dubai,Iran,

Singapore,Malaysia,Thailand,

HongKong, and Korea.

• DBC CLINICs in Indonesia is

three

out

of the

131 Clinics

in

23 countries

(12)

DBC Treatment Concept

Pain Cycle

Activation Cycle

Reflex inhibition = Delay in response to loading

(13)

DBC Excellence

• DBC

Patented

”Lock System”

precisely

targets

the desired

muscle groups of the Lower

Back,Neck,Shoulder,or Knee

simultaneously guiding the

corrects Movement Pattern.

• DBC

Patented the

Cervical 3-D

Rotation reconstructs

Cervical

(14)

DBC Excellence

Lock System

(15)

DBC Excellence

Cervical 3-D Rotation Recontructs

c

(16)

Back devices

Neck devices

DBC State-of-the-art

technology

Shoulder

Knee devices

Shoulder

devices

(17)

Knee, Back, Neck, & Shoulder

Problems

Knee

Back

Neck Shoul

der

-

POST-OP

ACL

-POST

TRAUMA

TIC

FUNCTIO

NAL

• INFLAMMATO

RY

• POST

-TRAUMATIC

• POST

-OPERATION

• NERVE ROOT

• INFLAMMATOR

Y

• POST

TRAUMATIC

• SHOULDER

DISLOCATION

• SHOULDER

ARTHRITIS

• POST-OPERATION

NAL

IMPROVE

MENT

-Osteoarth

ritis

Post-Op

meniscus

-

Conserva

tive PCL

-

Post.-Op. PCL

-

Isolated

MCL

-ACL+MCL

combined

• NERVE ROOT

COMPRESSIO

N

• NARROWING

OF SPINAL

CANAL

• PELVIC AND

LOW BACK

PAIN

• SPONDYLOLIS

THE SIS/-LYSIS

• SCOLIOSIS/

POS TURAL

DYSFUNTION

• MUSCULAR

DISTROPHY

• STENOSIS

TRAUMATIC

• WHIPLASH-

ASSOCIATED-DISORDER

• POST-OPERATIVE

• NARROWING

OF SPINAL

CANAL

• NERVE ROOT

OR

CERVICOBRA

CHIAL

• FROZEN

SHOULDER

• AC

SEPARATION

• DISLOCATION

• INSTABILITY

• SLAP LESION

• ROTATOR

CUFF TEAR

• PROXIMAL

FRACTURE

• IMPINGEMENT

( SUB

ACROMIAL

(18)

DBC includes:

1. Pre

Assessment

Test

2. Medical

Consultation

3. Personalized

treatment

5. Post-Assessment

Test

6. Out-come

Documents.

7. MAINTENANCE

8. Home Exercise

Protocols

treatment

module

4. 6-week Therapy

(12 x)

(19)

Progressive DBC

Treatments

6-week Therapy of 12-session

treatments:

• Rebuild core muscles

.

• Strenghtening muscles

• Endurance muscles

• Re-Conditioning muscles function

(20)

Neck & Shoulder

Muscles

(21)

Lumbar Thoracic

Extension (LTE)

• Specific exercises for

small intervertebral

stabilizing muscles,

Spinal Multifidus and

Erector muscles

• Effectively restores

deteriorated extension

endurance capacity

related to low back pain

(22)

Lumbar Thoracic

Flexion (LTF)

• Specific exercises for

Abdominal rectus

muscles

• Effectively exercises

the stabilizing muscles of

(23)

Lumbar Thoracic

Rotation (LTR)

• Specific exercises for

Abdominal Oblique and

Transversal muscles, and

Spinal Rotatores,

Multifidus and

Semispinalis muscles

• Effectively improves

the rotational impairment

by increasing the range

of motion and awareness

(24)

Lumbar Thoracic

Lateral Flexion

(LTL)

• Specific exercises for

Lumbar Quadratus,

Intertransversal, and

Iliocostal muscles

• Broadens the range of

motion in sidebending

and rotation in addition

to improving muscular

capacity

(25)

Cervicothoracic

Elliptic Extension

(CEE)

• Extension exercise

simulating the natural

(26)

Cervical 3D

Rotation (C3D)

• Simultaneous cervical

flexion, lateral flexion

and rotation replicating

the delicate 3-D

movements of cervical

biomechanics

(27)

Shoulder Blade

Adduction (SBA)

• Specific exercises for

the stabilizing muscles of

(28)

Glenohumeral

Rotation Device

(GHR)

The DBC Shoulder

Program is intended for

non-operative and

post-operative rehabilitation of

shoulder disorders

including

•Shoulder dislocation

•Instability

•Impingement and rotator

cuff tear

•AC separation

•Shoulder arthritis

•Frozen shoulder

(29)

Multipurpose

Low-Friction Unit

(MLU)

• Enables a wide array

of exercises improving

the key functions of the

upper thoracic area and

(30)

(31)

KNEE Device

MLU Modification:

• Knee flexion

• Knee extension

• Hip exercises

(32)

What Results To Expect?

80 - 85% of patients

respond to

the DBC treatment with:

• Pain relief,

• Restored function,

• Back at work,

• Return to Training for

Competition for the

athlete,

(33)

DBC QA results

pain vs pattern

70

80 P

A

IN

;

6 w

e

k

s

a

ve

ra

g

e

(

V

A

S

,

0 -1

0

0 )

baseline

+95%CI

outcome

0

10

20

30

40

50

60 inf

lam

m

po

sttr

au

po

sto

per

ner

vec

om

ste

no

sis

_pel

vic

lys

is

loc

alL

BP

P

A

IN

;

6 w

e

k

s

a

ve

ra

g

e

(

V

A

S

,

0 -1

0

0 )

outcome

+95%CI

(34)

DBC compared to conventional

pain relieving physiotherapy

DBC QA results

pain vs pattern

□

Baseline

+95%CI

□

Outcome

+95%CI

(35)

DBC Adds VALUE

Compare

With Traditional

Physiotherapy

DBC

Traditio

nal

Rehabilit

ation

ACTIVE

PASIF

Lock

System

Lock

System

&

Cervical

3D

Rotation

Un-Lock

System

Target

Inner &

Outer

Layer

Muscle

Outer

Layer

Muscle

(36)

Patient Flowchart

REFERRAL

BASELINE

EVALUATION

TREATMENT

OUTCOME

EVALUATION

FOLLOW UP

(37)

Assessment flowchart

BASELINE

EVALUATION

PROGRESS

CHECK

• only one baseline in

one period

• may be multiple

order of the assessments in one period has to be always:

baseline, progress check (may be multiple), outcome, follow-up (may be multiple)

CHECK

OUTCOME

EVALUATION

FOLLOW

UP

• only one outcome in one period

• can be changed into progress check

(38)

clinical examination

• inspection

• posture

• muscle

tightness

• functional

examination

• SI-joint

• Hip joint

• SLR

• Art.

circulation

• motor

conduction

• sensory

conduction

• reflexes

• palpation

(39)

range of motion

• no warm up

• order of the tests

–

flexion (LTE)

–

extension (LTE)

–

rotation, left-right (LTR)

–

rotation, left-right (LTR)

–

lateral flexion (LTL)

(40)

•

(41)

(42)

(43)

(44)

(45)

(46)

(47)

(48)

(49)

(50)

Quality Assurance

2008

DBC Clinics Indonesia (2)

VS

DBC Clinics Worldwide (131)

(51)

Pain

10

0

5

0

7

5

VA S

54.

2

53.

9 Worl

d

RSI

B

RSG

P

0

2

5

1

2

sessio ns

30.

7

25.

1

22.

3

45.

3

(52)

Rotation Mobility

18

0

9

0 99,9

112.

1

75. 104,

9 81,

9 Worl

d

RSIB

RSG

P

0

4

5

6 WE

EK

74,

1

75.

3

(53)

(54)

1. Apakah singkatan DBC?

Documented Based Care

Suatu PROGRAM REHABILITASI actif yang dirancang & dikembangkan di

FINLANDIA untuk mengatasi masalah cedera khususnya pada TULANG BELAKANG, LEHER dan PUNGGUNG.

2. Apakah DBC Active Spine Care ? .

DBC Active Spine Care adalah suatu PROGRAM THERAPY ACTIF untuk mengatasi rasa nyeri/sakit yg disebabkan oleh cedera pada Tulang Belakang,

Leher dan Bahu.

3. Apakah CLINIC DBC?

Klinik DBC merupakan cabang dari 130 klinik DBC yang tersebar di 23 negara

dengan 57,000 pasien yg tercatat, dibawah pengawasan DBC Internasional berpusat di negara Finlandia.

4. Apakah PROGRAM THERAPY DBC?

Adalah Program PELATIHAN aktif sebanyak 12x Treatment, menggunakan

alat-alat Medis yang dirancang & dikembangkan di negara Finlandia bekerja sama dengan pusat pengembangan di Universitas TAMTERE di kota Helsinki.

5. Bagaimana Cara Therapy DBC bekerja?

Therapy DBC bekerja dengan cara melatih secara aktif dan bertahab:

Pada otot-otot halus yang melekat pada Tulang Belakang; berperan dalam

menstabilkan serta meng-kokoh-an susunan Tulang Belakang yang cedera.

6. Bagaimana CARA pelaksanaan Therapy DBC?

Langkah Terapi DBC akan dimulai dengan:

(i) ASSESMENT TEST AWAL: oleh seorang Dokter Rehabilitasi Medis

apakah Anda layak dapat mengikuti program Rehab DBC atau tidak. (ii) MENGISI SCREENING QUESTIONAIR: untuk memasukan data2

lengkap kedalam soft-ware DBC yg menyangkut NYERI yg dialami selama ini; Untuk mendapatkan rancangan program therapy yg tepat untuk Anda.

(iii) MELAKUKAN PELATIHAN AKTIF (12x sesi): dengan menggunakan

Alat2 mesin DBC secara disciplin yg diawasi oleh Fisioterapis yang mempunyai sertifikat DBC Internasional.

(55)

7. Bagaimana Therapy DBC bekerja

Therapy DBC bekarja secara BERTAHAB (dalam 12x sesi selama 6 minggu):

(i) Memulihkan fungsi kerja Otot2 Tulang Belakang yang terganggu,

(ii) Mengontrol posture Tulang Belakang,

(iii) Memperbaiki Koordinasi serta

(iv) Mengembalikan Mobilitas serabut Otot Tulang Belakang.

(v) Meningkatkan Kekuatan dan Ketahanan susunan Tulang Belakang. ...alhasil rasa NYERI akan hilang!

9. Penyakit apa saja yang menerlukan program DBC

DBC sangat tepat untuk masalah nyeri krosnis (berulang) disebabkan oleh gangguan

fungsi Tulang Belakang, Leher dan Bahu yang disebabkan oleh :

1. Trauma (benturan keras)

2. Penyempitan , herniasi diskus tulang belakang,

3. Decompresi susunan Tulang Belakang

4. Dislokasi, Instabilitas , Distrofi Otot, Rematik, Peradangan

5. Scoliosis ( kelainan postur)

6. Pemulihan setelah Operasi pada Tulang Belakang, dll

7. Bermanfaat pada pemulihan pasca operasi tulang belakang

4. Kontra indikasi DBC

Program terapi DBC tidak dianjurkan pada penyakit sbb :

1. Adanya jepitan atau kompresi pada Saraf Medulla Spinalis

2. Osteoporosis

3. Fraktur baru

4. Penyakit sistemik :

5. Keganasan

6. Infeksi akut dan Peradangan

10. Paket Program Terapi DBC Active Spine Care terdiri dari:

- 12 sesi Therapi @ 1 - 1,5 jam

- Dilakukan 2x/mg, selama 6 minggu

- Stretching Exercises setelah pelatihan pada masing2 Alat/Mesin DBC - Anjuran & Larangan khusus dalam melaksanakan aktivitas sehari2. - Latihan2 yang harus dilakukan dirumah setiap hari.

Sebelum dan sesudah program terapi dilakukan penilaian Pra dan Pasca Therapi oleh seorang dokter Rehab.

(56)

11. Apa yg diharapkan dari hasil Program Terapi DBC?

Berdasarkan uji klinis acak ( randomized control trial )pada 57,000 pasien DBC, diseluruh dunia didapatkan penurunan rasa nyeri dan perbaikan fungsi gerak sampai

<30% ( Bilamana program therapi dilaksanakan secara rutin dan disiplin.) Dengan

gaya hidup aktif dan melakukan home exercise secara rutin, serta patuh menghindari aktifitas/gerak larangan, maka pemulihan dari rasa nyeri akan bertahan lama.

12. Assessment Test:

1.Test Assesment Awal sebelum mengikuti program terapi DBC, harus Anda

jalani untuk menilai kondisi seta pola NYERI, Lokasi nyeri, Gangguan fungsi

kerja dll. Hasil Penilaian Awal ini dipakai untuk menyusun modul latihan khusus untuk setiap pasien yg mana akan diserahkan kepada Dokter rujukan dan si Pasien.

2. Test Evaluasi sesudah selesai mengikuti program Therapi DBC:

Anda akan mendapatkan grafik hasil akhir penilaian kondisi nyeri serta mengisi

Questionair Kepuasan Hasil Akhir.

13. Apa bedanya program Therapy DBC dengan Gym biasa?

a) DBC Active Spine Care menggunakan alat pelatihan Medis

dirancang khusus dengan system Lock/ Penguncian

pada Pinggul, Lutut dan Bahu agar dapat menTARGETkan serta meng-ARAHkan pelatihan pada OTOT2 utama yang berperan pada susunan Tulang Belakang yg cedera.

.

c) Pelatihan alat2 Gym biasanya : hanya bekerja pada Otot2 besar bagian luar

14. Mengapa harus membayar 1 paket sekaligus?

Pemulihan Otot dan Tulang yang cedera memakan waktu minimal 6 minggu, sehingga Terapi Rehabilitasi berkesinambungan

dilaksanakan secara disiplin untuk mencapai hasil akhir yg memuaskan.

15. Paket Terapi DBC terdiri dari pemulihan bertahab:

Minggu I : Memulihkan fungsi kerja Otot2 Tulang Belakang yang cedera

Minggu II : Mengontrol posture Tulang Belakang,

Minggu III : Memperbaiki Koordinasi serta

Minggu IV : Mengembalikan Mobilitas Otot Tulang Belakang.

Minggu V : Meningkatkan Kekuatan & Ketahanan Tulang Belakang

Minggu VI : Meng-kokohkan susunan Tulang Belakang...alhasil rasa nyeri

(57)

16. Apakah Program DBC menggunakan obat2an atau suntikan:

Tidak.

17. Apa tindakan lanjut setelah menyelesaikan 1paket Therapy DBC?

Untuk mendapatkan hasil akhir yang memuaskan,

(sesuai dengan Test Assesment Akhir & Anjuran dr. Rehab):

i) Terapy dapat dilanjutkan atau

ii) Terapi Maintenance atau

iii) Mengikuti Floor Exercise

18. Berapa biaya Program Therapy DBC?

Untuk suatu program DBC biaya yang dibutuhkan terdiri dari : - Assessment awal Rp. 350,000,-

- Paket 12x pelatihan Rp. 6 ,000,000,- - Assessment akhir Rp. 150.000,-

TOTAL Rp. 6

,500,000,-DBC

REHAB Convensional

PRICE Mahal Murah

Measureable/ Objective Yes No

3 –D Physiologic movement

Yes No

Beban yang dapat disesuaikan dengan kebutuhan dan merata sepanjang gerakan

Yes No

( Patented Lock System ) Yes No

Pre and Post Operative

Treatment Yes No

Recommended by the Back Pain association Yes ? Continuous International Standardized Training Yes ? Continuous Research n Development and evidence based program Yes No International QC Monitoring Yes No