dbc clinic - amcor · a spinal treatment system for back, neck, shoulder and knee disorder mission...

DBC CLINIC

a NEW CONCEPT onPain Management

ofpost-Surgical

Back, Neck, Shoulder, and Kneecases

a NEW CONCEPT onPain Management

ofpost-Surgical

Back, Neck, Shoulder, and Kneecases

OVERVIEW• Today’s SPINE specialists are widely aware of the harmful effects

caused by bed rest and immobility

• DBC responds directly to the NEW APPROACH ofActive REHABILITATION.

• DBC active treatment is a total body workout• focusing on QUALITY of movement rather than Quantity.

• DBC treatment exercises• strengthening & stabilising the core musculatures.

• It is a Neuromuscular & Musculoskeletal conditioning programto achieve balanced muscular development

and improve posture.

• Today’s SPINE specialists are widely aware of the harmful effectscaused by bed rest and immobility

• DBC responds directly to the NEW APPROACH ofActive REHABILITATION.

• DBC active treatment is a total body workout• focusing on QUALITY of movement rather than Quantity.

• DBC treatment exercises• strengthening & stabilising the core musculatures.

• It is a Neuromuscular & Musculoskeletal conditioning programto achieve balanced muscular development

and improve posture.

Cycle of InjuryInjury

Greater Riskof Re Injury Bleeding

Inflammation

Reduced Riskof Re injury

Inadequate

Rehabilitation

Atrophy

BleedingInflammation

Adequate

DBC Treatment Concept

Pain Cycle Activation CyclePain Cycle Activation Cycle

Reflex inhibition= Delay in response to loading

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 andsensitive to pain.

• Resuming normal activity and daily routines becomesmore difficult.

• Bones, muscles and ligaments weaken sooner.

• The spine stiffens and loses control and coordination.

• Overall physical fitness deteriorates.

• Sufferers become more prone to depression andsensitive to pain.

• Resuming normal activity and daily routines becomesmore difficult.

Why active Exercise is Good?• Promotes a feeling of well-being while reducing

depression an anxiety.

• Releases natural chemicals known to reducepain.

• Improves coordination and controls movement.

• Builds & strenghtening muscles and strongerbones and ligaments.

• Promotes a feeling of well-being while reducingdepression an anxiety.

• Releases natural chemicals known to reducepain.

• Improves coordination and controls movement.

• Builds & strenghtening muscles and strongerbones and ligaments.

Rehabilitation GOAL :Return to

active & PAIN-FREEat all Range of Motion (ROM)

Return tofull Muscular Strength,

Power & Endurance

Return to• full asymptomatic functional activities

at the pre-Injury level

Return toactive & PAIN-FREE

at all Range of Motion (ROM)

Return tofull Muscular Strength,

Power & Endurance

Return to• full asymptomatic functional activities

at the pre-Injury level

What is DBC ?Documentation Based Care

a spinal treatment system forBack, Neck, Shoulder and Knee Disorder

MISSIONfocus to achieve healing chronic pain

with a holistic approach

VISIONBecome the leading active Spine Rehab Centre

and Education & Research Center.

What is DBC ?Documentation Based Care

a spinal treatment system forBack, Neck, Shoulder and Knee Disorder

MISSIONfocus to achieve healing chronic pain

with a holistic approach

VISIONBecome the leading active Spine Rehab Centre

and Education & Research Center.

Brief history

• DBC is founded in FINLAND in 1991.

• R&D programs are in cooperation withThe National Technology Agency & University TAMPERE inFINLAND.

• Headquarter in Helsinki, with branches in London (UK),Holland,South Africa, Dubai,Iran, Singapore,Malaysia,Thailand,HongKong,Korea & Indonesia (3-clinics).

• DBC CLINICs in Indonesia is three out of the 131 Clinics in 23countries serving 100,000 registered patients.

• DBC is founded in FINLAND in 1991.

• R&D programs are in cooperation withThe National Technology Agency & University TAMPERE inFINLAND.

• Headquarter in Helsinki, with branches in London (UK),Holland,South Africa, Dubai,Iran, Singapore,Malaysia,Thailand,HongKong,Korea & Indonesia (3-clinics).

• DBC CLINICs in Indonesia is three out of the 131 Clinics in 23countries serving 100,000 registered patients.

DBC Adds VALUE CompareWith Traditional Physiotherapy

DBC Physio GYMRehabilitation ACTIVE Active

SystemSAVETY

LockSave during

exercise

Free-movementNot save

SystemSAVETY

LockSave during

exercise

Free-movementNot save

Target Innermusculature

Outer LayerMuscles

DocumentationAssessment

reports

Baselinevs

Outcome

Basic

DBC Excellence• DBC Patented ”Lock System” precisely

targets the desired muscle groupssimultaneously guiding the corrects

Movement Pattern.

• DBC Medical Exercise Equipments:small loading weights (200-500grm) with

ecliptic kinetic movements

• DBC Patented the Cervical 3-D Rotationreconstructs Cervical Spine Movement.

• DBC Patented ”Lock System” preciselytargets the desired muscle groups

simultaneously guiding the correctsMovement Pattern.

• DBC Medical Exercise Equipments:small loading weights (200-500grm) with

ecliptic kinetic movements

• DBC Patented the Cervical 3-D Rotationreconstructs Cervical Spine Movement.

Lumbar ThoracicExtension (LTE)

• Specific exercises for smallintervertebral stabilizing muscles,

Spinal Multifidus and Erectormuscles

• Effectively restoresdeteriorated extension endurancecapacity related to low back pain





Cervical 3D Rotation(C3D)

• Simultaneous cervical flexion,lateral flexion and rotationreplicating the delicate 3-D

movements of cervicalbiomechanics




Back devices Neck devices

DBC State-of-the-art technology

Shoulderdevices

Knee devices

Shoulderdevices

DBC active rehab cares problems:Knee Back Neck Shoulder

-POST-OP ACL-POST TRAUMA

TIC FUNCTIO NALIMPROVEMENT- Osteoarthritis

-Post-Op meniscus-Conservative PCL

-- Post.-Op. PCL-Isolated MCL

- ACL+MCLcombined

- Osteo-chondraldefects

-Total kneeConservative ACL- Anterior Knee

Pain

•INFLAMMATORY• POST - TRAUMATIC• POST - OPERATION

• NERVE ROOTCOMPRESSION

• NARROWING OFSPINAL CANAL

• PELVIC & LOW BACKPAIN

• SPONDYLOLISTHESIS/-LYSIS

• SCOLIOSIS/ POSTURAL DYSFUNTION

• MUSCULARDISTROPHY• STENOSIS

• DISLOCASION• RHEUMATOID

DISEASE• DISC HERNIATION

• LOCAL LBP• NON-SPECIFIC PAIN

• INFLAMMATORY

• POST TRAUMATIC

• WHIPLASH-ASSOCIATED-

DISORDER

• POST-OPERATIVE


• NERVE ROOT ORCERVICOBRACHIAL

• PLEXUSCOMPRESSION

• LOCAL , NON-SPECIFIC NECK PAIN

•SHOULDERDISLOCATION• SHOULDERARTHRITIS

• POST- OPERATION• FROZEN

SHOULDER• AC SEPARATION

• DISLOCATION• INSTABILITY

• SLAP LESION• ROTATOR CUFF

TEAR• PROXIMALFRACTURE

• IMPINGEMENT( SUB ACROMIALIMPINGEMENTSYNDROME)

-POST-OP ACL-POST TRAUMA

TIC FUNCTIO NALIMPROVEMENT- Osteoarthritis

-Post-Op meniscus-Conservative PCL

-- Post.-Op. PCL-Isolated MCL

- ACL+MCLcombined

- Osteo-chondraldefects

-Total kneeConservative ACL- Anterior Knee

Pain

•INFLAMMATORY• POST - TRAUMATIC• POST - OPERATION

• NERVE ROOTCOMPRESSION


• PELVIC & LOW BACKPAIN

• SPONDYLOLISTHESIS/-LYSIS

• SCOLIOSIS/ POSTURAL DYSFUNTION

• MUSCULARDISTROPHY• STENOSIS

• DISLOCASION• RHEUMATOID

DISEASE• DISC HERNIATION

• LOCAL LBP• NON-SPECIFIC PAIN

• INFLAMMATORY

• POST TRAUMATIC

• WHIPLASH-ASSOCIATED-

DISORDER

• POST-OPERATIVE


• NERVE ROOT ORCERVICOBRACHIAL

• PLEXUSCOMPRESSION

• LOCAL , NON-SPECIFIC NECK PAIN

•SHOULDERDISLOCATION• SHOULDERARTHRITIS

• POST- OPERATION• FROZEN

SHOULDER• AC SEPARATION

• DISLOCATION• INSTABILITY

• SLAP LESION• ROTATOR CUFF

TEAR• PROXIMALFRACTURE

• IMPINGEMENT( SUB ACROMIALIMPINGEMENTSYNDROME)

DBC Excellence

treatment adopts a holistic approachin reaching total

physical & mentalrecovery

treatment adopts a holistic approachin reaching total

physical & mentalrecovery

i) Verbal and Written messagesii) Establishing realistic expectations

iii) Established functional goalsiv) Education: gradual reactivation will

enhance recoveryv) ~Change ways of thinking

(cognitive)vi) ~change ways of acting

(behaviour)

i) Verbal and Written messagesii) Establishing realistic expectations

iii) Established functional goalsiv) Education: gradual reactivation will

enhance recoveryv) ~Change ways of thinking

(cognitive)vi) ~change ways of acting

(behaviour)

DBC protocols:1. Clinical Assessment2. Baseline Assessment

Test.3. Treatment Plan4. Personalized

treatment module

5. 6-week Therapy (12 x)6. Post-Assessment Test.7. Out-come Documents.8. MAINTENANCE

1. Clinical Assessment2. Baseline Assessment

Test.3. Treatment Plan4. Personalized

treatment module

5. 6-week Therapy (12 x)6. Post-Assessment Test.7. Out-come Documents.8. MAINTENANCE

ALUR s.o.p ( Non Operative Case)

ALUR s.o.p ( Operative Case)

Progressive DBC Treatments

(6-week )Therapy of 12-session treatments:

• wk1~ Rebuild core muscles:(pembentukan serabut otot).

• wk2~ Strenghtening: (menguatkan otot)

• wk3~ Endurance: (meningkatkan daya tahan otot).

• wk4~ Re-Conditioning: (mengembalikan fungsi otot)

• wk5/6~ Co-ordination: (mengontrol keseimbangan otot).







DBC flexion relaxation testusing surface EMG

LBP patient

Healthy individual

Progressive DBC Treatments













Dorsal Muscles

Longissimuscapitis

Longissimuscervicis

Spinaliscervicis

Multifidus

Intertransversarii

Iliocostaliscervicis

The Importance of Trunk Muscles

SpinalisthoracisLongissimus

Iliocostalislumborum

Iliocostalisthoracis

Multifidus

Lumbar ThoracicFlexion (LTF)

• Specific exercises forAbdominal rectus muscles

• Effectively exercises thestabilizing muscles of the spine

Lumbar ThoracicFlexion (LTF)

• Specific exercises forAbdominal rectus muscles

• Effectively exercises thestabilizing muscles of the spine

Lumbar ThoracicRotation (LTR)

• Specific exercises forAbdominal Oblique and

Transversal muscles, and SpinalRotatores, Multifidus and

Semispinalis muscles

• Effectively improves therotational impairment by

increasing the range of motionand awareness of posture

Lumbar ThoracicRotation (LTR)

• Specific exercises forAbdominal Oblique and

Transversal muscles, and SpinalRotatores, Multifidus and

Semispinalis muscles

• Effectively improves therotational impairment by

increasing the range of motionand awareness of posture

Lumbar ThoracicLateral Flexion (LTL)

• Specific exercises forLumbar Quadratus,

Intertransversal, and Iliocostalmuscles

• Broadens the range of motionin sidebending and rotation in

addition to improving muscularcapacity

Lumbar ThoracicLateral Flexion (LTL)

• Specific exercises forLumbar Quadratus,

Intertransversal, and Iliocostalmuscles

• Broadens the range of motionin sidebending and rotation in

addition to improving muscularcapacity

Cervicothoracic EllipticExtension (CEE)

• Extension exercise simulatingthe natural 3-D movement arch

Shoulder BladeAdduction (SBA)

• Specific exercises for thestabilizing muscles of the upper

thoracic area

Shoulder BladeAdduction (SBA)

• Specific exercises for thestabilizing muscles of the upper

thoracic area

Glenohumeral RotationDevice (GHR)

The DBC Shoulder Program isintended for non-operative and post-operative rehabilitation of shoulderdisorders including

•Shoulder dislocation•Instability•Impingement and rotator cuff tear•AC separation•Shoulder arthritis•Frozen shoulder

Glenohumeral RotationDevice (GHR)

The DBC Shoulder Program isintended for non-operative and post-operative rehabilitation of shoulderdisorders including

•Shoulder dislocation•Instability•Impingement and rotator cuff tear•AC separation•Shoulder arthritis•Frozen shoulder

Multipurpose Low-Friction Unit (MLU)

• Enables a wide array ofexercises improving the key

functions of the upper thoracicarea and arms

Multipurpose Low-Friction Unit (MLU)

• Enables a wide array ofexercises improving the key

functions of the upper thoracicarea and arms

KNEE DEVICE : LEG PRESS

KNEE Device

MLU Modification:

• Knee flexion

• Knee extension

• Hip exercises

KNEE Device

MLU Modification:

• Knee flexion

• Knee extension

• Hip exercises

KNEE Device: Multipurpose Bench

Results ?

80 - 85% of patients respond tothe DBC treatment with:

• Pain relief; Pain-Free• Restored function,• Back at work,• Return to Training for

Competition for the athlete,• Improved Performance.

80 - 85% of patients respond tothe DBC treatment with:

• Pain relief; Pain-Free• Restored function,• Back at work,• Return to Training for

Competition for the athlete,• Improved Performance.

DBC QA resultspain vs pattern

0

10

20

30

40

50

60

70

80

inflamm

posttrau

postoper

nervecom

stenosis

pelvic

lysis

localLBP

PA

IN; 6

wee

ks a

vera

ge (

VA

S, 0

-100

)

baseline+95%CI

outcome+95%CI

Inflam-nt post-oper

stenosisspondolysis

PAIN

0

10

20

30

40

50

60

70

80

inflamm

posttrau

postoper

nervecom

stenosis

pelvic

lysis

localLBP

PA

IN; 6

wee

ks a

vera

ge (

VA

S, 0

-100

)

baseline+95%CI

outcome+95%CI

Post-trauma Nerve-com

pelvic LBP-HNP

DBC compared to conventional painrelieving physiotherapyDBC QA resultspain vs pattern

□ Baseline+95%CI

□Outcome+95%CI

PAINVAS

□Outcome+95%CI

BACK Result

Trouble Pain

POST-OPERATIVE POST-OPERATIVE

NECK Result

Pain Trouble

Post- Operative Post- Operative

Quality Assurance2010

DBC Clinics Indonesia (2)VS

DBC Clinics Worldwide (131)


DBC Clinics Indonesia (2)VS

DBC Clinics Worldwide (131)

Pain100

50

75

VAS

54.2

53.9

WorldRSIBRSGP

0

25

12 WEEK

30.7

25.122.3

45.3

Trouble100

50

75

VAS

52.6

52.8

WorldRSIBRSGP

0

25

12 WEEK

30.026.4

25.6

39.9

Rotation Mobility180

90

99,9

112.1

75.3

104,9

81,9

WorldRSIBRSGP

ROM

0

45

12

Weeks

74,1

75.3

Sagital Mobility90

45

55,3

66,365,3

54,6

67,466,6

0 12

Weeks

WorldRSIBRSGP

Lateral Flexion Mobility180

90 87,0

103,0

82,1

88,0

76,6

0 12

Weeks

72,5

76,6

WorldRSIBRSGP


RS Premier Bintaro


RS Premier Bintaro

SHOULDER TREATMENTPain (Change decreased – VAS)

NECK TREATMENTPain (Change decreased – VAS)

BACK TREATMENTPain (Change decreased – VAS)

DBC objectives:• 1) PAIN FREE Return to work

• 2) PAIN FREE Return to normal function & activity

• 3) REDUCE treatment cost

• 4) Cost benefit for HEALTH & PAYMENT Providers

• 5) Treatment served to Upper + Middle + Working Class

• 6) Become an Insurance Health Product

• 7) Research & Development Study Centre

• 8) To develop evidence based therapies and technologies that

offer an improvement of clinical productivity in the treatment

and rehabilitation of musculoskeletal disorders. ………..

• 1) PAIN FREE Return to work

• 2) PAIN FREE Return to normal function & activity

• 3) REDUCE treatment cost

• 4) Cost benefit for HEALTH & PAYMENT Providers

• 5) Treatment served to Upper + Middle + Working Class

• 6) Become an Insurance Health Product

• 7) Research & Development Study Centre

• 8) To develop evidence based therapies and technologies that

offer an improvement of clinical productivity in the treatment

and rehabilitation of musculoskeletal disorders. ………..

DBC CLINIC