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

DBC Active RehabilitationFor 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 ACTIVEREHABILITATION.

• The DBC Measurement & Treatment concept • 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.

• 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:• Return to Full ACTIVE & PAIN FREE at • 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.

VISION..to be the Rehab provider in Hospitals & Sport ..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 IMPROVEME

NT

-Osteoarthritis

Post-Op meniscus

-Conservative

•INFLAMMATORY

• POST -TRAUMATIC

• POST -OPERATION

• NERVE ROOT COMPRESSION

• NARROWING OF SPINAL CANAL

• PELVIC AND LOW BACK PAIN

• INFLAMMATORY

• POST TRAUMATIC

• WHIPLASH-

ASSOCIATED-

DISORDER

• POST-OPERATIVE

• NARROWING OF

SPINAL CANAL

•SHOULDER DISLOCATION

• SHOULDER ARTHRITIS

• POST-OPERATION

• FROZENSHOULDER

• AC SEPARATION

• DISLOCATION

• INSTABILITY-Conservative PCL

- Post.-Op. PCL

-Isolated MCL

- ACL+MCL combined

- Osteo-chondraldefects

-Total knee

Conservative ACL

- Anterior Knee Pain

•SPONDYLOLISTHE

SIS/-LYSIS

• SCOLIOSIS/ POS TURAL

DYSFUNTION

• MUSCULAR DISTROPHY

• STENOSIS

• DISLOCASION

• RHEUMATOID DISEASE

• DISC HERNIATION

• LOCAL LBP

• NON-SPECIFIC PAIN

• NERVE ROOT OR

CERVICOBRACHIAL

• PLEXUS

COMPRESSION

• LOCAL , NON-

SPECIFIC NECK

PAIN

• INSTABILITY

• SLAP LESION

• ROTATOR CUFF TEAR

• PROXIMAL FRACTURE

• IMPINGEMENT

( SUB ACROMIAL

IMPINGEMENT SYNDROME)

DBC includes:

1. Pre Assessment Test

2. Medical Consultation

3. Personalized treatment module

4. 6-week Therapy (12 x)

5. Post-Assessment Test6. Out-come Documents.7. MAINTENANCE8. 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 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

60

70

80

PAIN

; 6 w

eeks average (VAS, 0-100)

baseline

+95%CI

outcome

+95%CI

0

10

20

30

40

50

in flamm

pos ttra u

pos top er

ne rve com

s ten osis pe l

vic ly sis

lo calLBP

PAIN

; 6 w

eeks average (VAS, 0-100)

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

SystemLock System &

Cervical 3D Un-Lock SystemSystem Cervical 3D Rotation

Un-Lock System

Target Inner & Outer Layer Muscle Outer Layer Muscle

Documentation & Assessment

Complete

(Finland)Simple

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 Assurance

2008

DBC Clinics Indonesia (2)

VS

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

World

RSIB

RSGP

0

45

6 WEEK

74,1

75.3

CLINIC