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

Todays 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 InjuryInjury

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 Disorder

and 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 Systemprecisely 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

INFLAMMATORY

POST TRAUMATIC

SHOULDER DISLOCATION SHOULDER ARTHRITIS

POST-OPERATIONNAL

IMPROVEMENT

-

Osteoarthritis

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

CERVICOBRACHIAL

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 dislocationInstabilityImpingement and rotator cuff tearAC separationShoulder arthritisFrozen 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 DeviceMLU 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

TargetInner & 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

54.253.9

WorldRSIBRSGP

0

25

12

sessions

30.7

25.122.

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

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