a NEW CONCEPT on Pain Management of post-surgical Back, Neck, Shoulder, and Knee cases

Transcription

1 DBC CLINIC

2 a NEW CONCEPT on Pain Management of post-surgical Back, Neck, Shoulder, and Knee cases

3 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 of Active 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 program to achieve balanced muscular development and improve posture.

4 Cycle of Injury Injury Greater Risk of Re Injury Inadequate Bleeding Inflammation Atrophy Rehabilitation Reduced Risk of Re injury Adequate

5 DBC Treatment Concept Pain Cycle Reflex inhibition = Delay in response to loading Activation Cycle

6 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.

7 Why active Exercise is Good? Promotes a feeling of well-being while reducing depression an anxiety. Releases natural chemicals known to reduce pain. Improves coordination and controls movement. Builds & strenghtening muscles and stronger bones and ligaments.

8 Rehabilitation GOAL : Return to 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

9 What is DBC? Documentation Based Care a spinal treatment system for Back, Neck, Shoulder and Knee Disorder MISSION focus to achieve healing chronic pain with a holistic approach VISION Become the leading active Spine Rehab Centre and Education & Research Center.

10 Brief history DBC is founded in FINLAND in 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,Korea & Indonesia (3-clinics). DBC CLINICs in Indonesia is three out of the 131 Clinics in 23 countries serving 100,000 registered patients.

11 DBC Adds VALUE Compare With Traditional Physiotherapy Rehabilitation System SAVETY Target Documentation Assessment reports DBC ACTIVE Physio GYM Active Lock Free-movement Not save Save during exercise Inner musculature Baseline vs Outcome Outer Layer Muscles Basic

12 DBC Excellence DBC Patented Lock System precisely targets the desired muscle groups simultaneously guiding the corrects Movement Pattern. DBC Medical Exercise Equipments: small loading weights ( grm) with ecliptic kinetic movements DBC Patented the Cervical 3-D Rotation reconstructs Cervical Spine Movement.

13 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

14 Cervical 3D Rotation (C3D) Simultaneous cervical flexion, lateral flexion and rotation replicating the delicate 3-D movements of cervical biomechanics

15 DBC State-of-the-art technology Back devices Neck devices Shoulder devices Knee devices

16 DBC active rehab cares problems: Knee -POST-OP ACL -POST TRAUMA TIC FUNCTIO NAL IMPROVEMENT - Osteoarthritis Post-Op meniscus -Conservative PCL - Post.-Op. PCL -Isolated MCL - ACL+MCL combined - Osteo-chondral defects -Total knee Conservative ACL - Anterior Knee Pain Back INFLAMMATORY POST - TRAUMATIC POST - OPERATION NERVE ROOT COMPRESSION NARROWING OF SPINAL CANAL PELVIC & LOW BACK PAIN SPONDYLOLISTHE SIS/-LYSIS SCOLIOSIS/ POS TURAL DYSFUNTION MUSCULAR DISTROPHY STENOSIS DISLOCASION RHEUMATOID DISEASE DISC HERNIATION LOCAL LBP NON-SPECIFIC PAIN Neck INFLAMMATORY POST TRAUMATIC WHIPLASHASSOCIATEDDISORDER POST-OPERATIVE NARROWING OF SPINAL CANAL NERVE ROOT OR CERVICOBRACHIAL PLEXUS COMPRESSION LOCAL, NONSPECIFIC NECK PAIN Shoulder SHOULDER DISLOCATION SHOULDER ARTHRITIS POST- OPERATION FROZEN SHOULDER AC SEPARATION DISLOCATION INSTABILITY SLAP LESION ROTATOR CUFF TEAR PROXIMAL FRACTURE IMPINGEMENT ( SUB ACROMIAL IMPINGEMENT SYNDROME)

17 DBC Excellence treatment adopts a holistic approach in reaching total physical & mental recovery

18 i) Verbal and Written messages ii) Establishing realistic expectations iii) Established functional goals iv) Education: gradual reactivation will enhance recovery v) ~Change ways of thinking (cognitive) vi) ~change ways of acting (behaviour)

19 DBC protocols: 1. Clinical Assessment 2. Baseline Assessment Test. 3. Treatment Plan 4. Personalized treatment module 5. 6-week Therapy (12 x) 6. Post-Assessment Test. 7. Out-come Documents. 8. MAINTENANCE

20 ALUR s.o.p ( Non Operative Case)

21 ALUR s.o.p ( Operative Case)

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24 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).

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34 DBC flexion relaxation test using surface EMG LBP patient Healthy individual

35 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).

36 Dorsal Muscles

37 The Importance of Trunk Muscles Longissimus capitis Iliocostalis cervicis Intertransversarii Longissimus cervicis Spinalis cervicis Multifidus Iliocostalis thoracis Iliocostalis lumborum Spinalis thoracis Longissimus

38 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

39 Lumbar Thoracic Flexion (LTF) Specific exercises for Abdominal rectus muscles Effectively exercises the stabilizing muscles of the spine

40 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

41 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

42 Cervicothoracic Elliptic Extension (CEE) Extension exercise simulating the natural 3-D movement arch

43 Cervical 3D Rotation (C3D) Simultaneous cervical flexion, lateral flexion and rotation replicating the delicate 3-D movements of cervical biomechanics

44 Shoulder Blade Adduction (SBA) Specific exercises for the stabilizing muscles of the upper thoracic area

45 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

46 Multipurpose LowFriction Unit (MLU) Enables a wide array of exercises improving the key functions of the upper thoracic area and arms

47 KNEE DEVICE : LEG PRESS

48 KNEE Device MLU Modification: Knee flexion Knee extension Hip exercises

49 KNEE Device: Multipurpose Bench

50 Results? 80-85% of patients respond to the DBC treatment with: Pain relief; Pain-Free Restored function, Back at work, Return to Training for Competition for the athlete, Improved Performance.

51 DBC QA results pain vs pattern PAIN baseline +95%CI stenosis 70 Inflam-nt spondolysis postoper Post-trauma Nervecom pelvic loc all BP lys is pe lvi c ste no sis po sto pe r ne rv ec om u po stt ra mm 0 inf la PAIN; 6 weeks average (VAS, 0-100) 80 LBP-HNP outcome +95%CI

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53 DBC compared to conventional DBC QA results pain relieving physiotherapy pain vs pattern PAIN VAS Baseline +95%CI Outcome +95%CI

54 BACK Result Trouble POST-OPERATIVE Pain POST-OPERATIVE

55 NECK Result Trouble Pain Post- Operative Post- Operative

56 Quality Assurance 2010 DBC Clinics Indonesia (2) VS DBC Clinics Worldwide (131)

57 VAS Pain 10 0 World RSIB RSGP WEE K

58 VAS Trouble 10 0 World RSIB RSGP WEE K

59 Rotation Mobility ROM 18 0 World RSIB RSGP ,9 99, , , Weeks

60 Sagital Mobility 90 67,4 66,3 65,3 66,6 55,3 54,6 45 World RSIB RSGP 0 12 Weeks

61 Lateral Flexion Mobility ,0 88, ,0 82,1 76, 6 72,5 World RSIB RSGP 0 12 Weeks

62 Quality Assurance 2011 RS Premier Bintaro

63 SHOULDER TREATMENT Pain (Change decreased VAS)

64 NECK TREATMENT Pain (Change decreased VAS)

65 BACK TREATMENT Pain (Change decreased VAS)

66 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...

67 DBC CLINIC