DBC Active Rehabilitation For Back, Neck, Shoulder and Knee Disorders
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.
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 Re injury & chronic Pain
Cycle of Injury Injury
Greater Risk of Re injury
Inadequate
Bleeding Inflammation
Atrophy
Rehabilitation
Reduced Risk of Re injury
Adequate
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.
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. • Makes one generally fit.
Rehabilitation
Rehabilitation:
1. Therapeutic
Modalities
2. Therapeutic Exercises
Rehabilitation GOAL : 1. • • •
Therapeutic Modalities:
2. •
Therapeutic Exercises:
• •
Decrease Pain Decrease Inflammatory Decrease Effusion
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
Healing Rate for Various Tissue Type: TISSU E:
Time to Return to normal Strength:
BONE
12 weeks
Ligame nts
40 - 50 weeks 6 weeks - 6 Muscle months 40 – 50 Tendon weeks
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
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 serving 70,000 registered patients.
DBC Treatment Concept Pain Cycle Activation Cycle
Reflex inhibition = Delay in response to loading
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 Spine Movement.
DBC Excellence Lock System
DBC Excellence Cervical 3-D Rotation Recontructs c
DBC State-of-the-art technology Back devices
Neck devices
Shoulder devices
Knee devices
Knee, Back, Neck, & Shoulder Problems
Knee
Back
-POST-OP ACL
•INFLAMMATO RY
-POST TRAUMA TIC FUNCTIO NAL IMPROVE MENT
• POST TRAUMATIC
Osteoarth ritis Post-Op meniscus -Conserva tive PCL - Post.Op. PCL -Isolated MCL ACL+MCL combined
• POST OPERATION • NERVE ROOT COMPRESSIO N • NARROWING OF SPINAL CANAL • PELVIC AND LOW BACK PAIN • SPONDYLOLIS THE SIS/-LYSIS
Neck Shoul der • INFLAMMATOR
•SHOULDER DISLOCATION
Y
• SHOULDER ARTHRITIS
• POST
• POSTOPERATION
TRAUMATIC • WHIPLASHASSOCIATEDDISORDER • POSTOPERATIVE
• FROZEN SHOULDER • AC SEPARATION • DISLOCATION • INSTABILITY
• NARROWING • SLAP LESION OF SPINAL • ROTATOR CANAL
CUFF TEAR
• SCOLIOSIS/ POS TURAL DYSFUNTION
• NERVE ROOT
• PROXIMAL FRACTURE
• MUSCULAR DISTROPHY
CERVICOBRA
• STENOSIS
OR CHIAL
• IMPINGEMENT ( SUB ACROMIAL
DBC includes: 1. Pre Assessment Test 2. Medical Consultation 3. Personalized treatment module 4. 6-week Therapy (12 x)
5. Post-Assessment Test 6. Out-come Documents. 7. MAINTENANCE 8. Home Exercise Protocols
Progressive DBC Treatments 6-week Therapy of 12-session treatments: •
Rebuild core muscles.
•
Strenghtening muscles
•
Endurance muscles
•
Re-Conditioning muscles function
•
Co-ordination muscle
Neck & Shoulder Muscles
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
Lumbar Thoracic Flexion (LTF) • Specific exercises for Abdominal rectus muscles • Effectively exercises the stabilizing muscles of the spine
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 of posture
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
Cervicothoracic Elliptic Extension (CEE) • Extension exercise simulating the natural 3D movement arch
Cervical 3D Rotation (C3D) • Simultaneous cervical flexion, lateral flexion and rotation replicating the delicate 3-D movements of cervical biomechanics
Shoulder Blade Adduction (SBA) • Specific exercises for the stabilizing muscles of the upper thoracic area
Glenohumeral Rotation Device (GHR) The DBC Shoulder Program is intended for non-operative and postoperative rehabilitation of shoulder disorders including •Shoulder dislocation •Instability •Impingement and rotator cuff tear •AC separation •Shoulder arthritis •Frozen shoulder
Multipurpose Low-Friction Unit (MLU) • Enables a wide array of exercises improving the key functions of the upper thoracic area and arms
KNEE DEVICE : LEG PRESS
KNEE Device MLU Modification: • Knee flexion • Knee extension • Hip exercises
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, • Improved Performance.
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P A I N ; 6 w e e k s a ve ra g e (V A S , 0 -1 0 0 )
DBC QA results pain vs pattern
80
baseline +95%CI
70
60
outcome +95%CI
50
40
30
20
10
0
DBC compared conventional DBC QAto results pain pain relieving physiotherapy vs pattern □ Baseline +95%CI
□Outcome +95%CI
DBC Adds VALUE Compare With Traditional Physiotherapy Traditio DBC
nal
Rehabilit ACTIVE PASIF ation Lock System & Un-Lock System Cervical System 3D Rotation Inner & Outer Outer Layer Target Layer Muscle Muscle
Patient Flowchart
REFERRAL
BASELINE EVALUATION
TREATMENT
OUTCOME EVALUATION
FOLLOW UP
Assessment flowchart
BASELINE EVALUATION
• only one baseline in one period
• may be multiple PROGRESS CHECK
OUTCOME EVALUATION
• only one outcome in one period • can be changed into progress check
FOLLOW UP
• 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)
clinical examination • inspection • posture • muscle tightness
• functional examination • SI-joint • Hip joint • SLR • Art. circulation • motor conduction • sensory conduction • reflexes • palpation
range of motion • no warm up • order of the tests – flexion (LTE) – extension (LTE) – rotation, left-right (LTR) – lateral flexion (LTL) • one measurement / direction
• EMGEndurance
Quality Assurance 2008 DBC Clinics Indonesia (2) VS DBC Clinics Worldwide (131)
VA S
Pain
10 0
Worl d RSI B RSG P
7 5 54. 2 53. 9
5 0
45. 3
30. 7
2 5
25. 1 22. 3
0
1 2
sessio ns
Rotation Mobility
18 0
Worl d RSIB RSG P
112. 1 104, 9 99,9
9 81, 0 9 75. 3 74, 1 4 5
0
6 WE EK
CLINIC
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.
7. Bagaimana Therapy DBC bekerja Therapy DBC bekarja secara BERTAHAB (dalam 12x sesi selama 6 minggu): (i) (ii) (iii) (iv) (v)
Memulihkan fungsi kerja Otot2 Tulang Belakang yang terganggu, Mengontrol posture Tulang Belakang, Memperbaiki Koordinasi serta Mengembalikan Mobilitas serabut Otot Tulang Belakang. 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.
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 menghilang!
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
Mahal
Murah
Measureable/ Objective
Yes
No
3 –D Physiologic movement Beban yang dapat disesuaikan dengan kebutuhan dan merata sepanjang gerakan ( Patented Lock System )
Yes
No
Yes
No
Yes
No
Yes Yes
No ?
Yes
?
Yes
No
Yes
No
PRICE
Pre and Post Operative Treatment Recommended by the Back Pain association Continuous International Standardized Training Continuous Research n Development and evidence based program International QC Monitoring
