DBC Active Rehabilitation For Back, Neck, Shoulder and ... · PDF fileDBC Active...
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DBC Active RehabilitationFor Back, Neck, Shoulder and
KneeDisorders
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.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 ACTIVEREHABILITATION.
• 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 Riskof Re injury Bleeding
Inflammation
Reduced Riskof Re injury
Inadequate
Rehabilitation
Atrophy Adequate
Why inactivity is Bad?
• Bones, muscles and ligaments weaken sooner.
• The spine stiffens and loses control and coordination.
• Overall physical fitness deteriorates.• 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 • Improves coordination and control of movement.
• Builds fit muscles and stronger bones and ligaments.
• Makes one generally fit.
Rehabilitation
Rehabilitation:
1. Therapeutic Modalities1. Therapeutic Modalities
2. Therapeutic Exercises
Rehabilitation GOAL :
1. Therapeutic Modalities:• Decrease Pain• Decrease Inflammatory• Decrease Effusion
2. Therapeutic Exercises: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
Healing Rate forVarious Tissue Type:
TISSUE:
Time to Return to normal
Strength:
BONE 12 weeks
Ligaments
40 - 50 weeks
Muscle 6 weeks - 6 months
Tendon 40 – 50 weeks
What is DBC ?
Documentation Based Care treatments for Knee, Back, Neck,Shoulder and Knee
Disorderand Dysfunction, that focus on healing chronic
pain.
MISSION… to become the leading active Spine,
Shoulder & KneeRehab Center.
VISIONVISION..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, 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 countriesserving 70,000 registered patients.
DBC Treatment Concept
Pain Cycle Pain Cycle Activation CycleActivation 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.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
Back devices Neck devices
DBC State-of-the-art technology
Shoulder
Knee devices
Shoulderdevices
Knee, Back, Neck, & Shoulder Problems
Knee Back Neck Shoulder
-POST-OP ACL
-POST TRAUMA
TIC FUNCTIO
NAL
•INFLAMMATORY
• POST -TRAUMATIC
• POST -OPERATION
• NERVE ROOT
•
INFLAMMATOR
Y
• POST
TRAUMATIC
•SHOULDER DISLOCATION
• SHOULDER ARTHRITIS
• POST-OPERATIONNAL
IMPROVEMENT
-Osteoarth
ritis
Post-Op meniscus
-Conservative PCL
- Post.-Op. PCL
-Isolated MCL
-ACL+MCL combined
• NERVE ROOT COMPRESSIO
N
• NARROWING OF SPINAL
CANAL
• PELVIC AND LOW BACK
PAIN
•SPONDYLOLISTHE SIS/-LYSIS
• SCOLIOSIS/ POS TURAL
DYSFUNTION
• MUSCULAR DISTROPHY
• STENOSIS
TRAUMATIC
• WHIPLASH-
ASSOCIATED-
DISORDER
• POST-
OPERATIVE
• NARROWING
OF SPINAL
CANAL
• NERVE ROOT
OR
CERVICOBRA
CHIAL
• FROZENSHOULDER
• AC SEPARATION
•DISLOCATION
• INSTABILITY
• SLAP LESION
• ROTATOR CUFF TEAR
• PROXIMAL FRACTURE
•IMPINGEMENT
( SUB ACROMIAL
DBC includes:
1. Pre Assessment Test
2. Medical Consultation
3. Personalized treatment
5. Post-Assessment Test6. Out-come Documents.7. MAINTENANCE8. Home Exercise Protocols
treatment module
4. 6-week Therapy (12 x)
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 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 stabilizing muscles of
the spine
Lumbar Thoracic Rotation (LTR)
• Specific exercises for Abdominal Oblique and Transversal muscles, and
Spinal Rotatores, Multifidus and
Semispinalis muscles 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 musclesIliocostal 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 3-
D movement arch
Cervical 3D Rotation (C3D)
• Simultaneous cervical flexion, lateral flexion and rotation replicating
the delicate 3-D movements of cervical
biomechanicsbiomechanics
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 post-operative 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 upper thoracic area and
arms
KNEE DEVICE : LEG PRESS
KNEE Device
MLU Modification:
• Knee flexion
• Knee extension• Knee extension
• Hip exercises
What Results To Expect?
80 - 85% of patients respond tothe DBC treatment with:
• Pain relief,• Pain relief,• Restored function,• Back at work,• Return to Training for
Competition for the athlete,
• Improved Performance .
DBC QA resultspain vs pattern
70
80
PAIN
; 6 w
eeks average (VAS, 0-100)
baseline
+95%CI
outcome
0
10
20
30
40
50
60
in flamm
pos ttra u
pos top er
ne rve com
s ten osis pe l
vic ly sis
localLBP
PAIN
; 6 w
eeks average (VAS, 0-100)
outcome
+95%CI
DBC compared to conventional pain relieving physiotherapy
DBC QA resultspain vs pattern
□ Baseline +95%CI
□Outcome+95%CI
DBC Adds VALUE Compare
With Traditional Physiotherapy
DBC Traditional
Rehabilitation ACTIVE PASIF
Lock
System
Lock System
& Cervical
3D Rotation
Un-Lock System
Target
Inner & Outer Layer
Muscle
Outer Layer
Muscle
Patient Flowchart
REFERRAL
BASELINE
EVALUATIONEVALUATION
TREATMENT
OUTCOME
EVALUATION
FOLLOW UP
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
• may be multiple
clinical examination
• inspection
• posture
• muscle tightness
• functional examination
• SI-joint
• Hip joint
• SLR
• Art. circulation
• motor • motor conduction
• sensory conduction
• reflexes
• palpation
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)
• one measurement / direction
• EMG-Endurance
Quality Assurance2008
DBC Clinics Indonesia (2)
VS
DBC Clinics Worldwide (131)DBC Clinics Worldwide (131)
Pain100
50
75
VAS
54.2
53.9
WorldRSIBRSGP
0
25
12
sessions
30.7
25.1
22.3
45.3
Rotation Mobility180
90
99,9
112.1
75.
104,9
81,9
WorldRSIB
RSGP
0
45
6 WEEK
74,1
75.3
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) 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.
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
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