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
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 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

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.

ve c

lo c

er

a lL

v ic

BP

ly s i

pel

o sis

om

to p

s te n

ne r

pos

ttr a

am

pos

in f l

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

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

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

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