1. “ Success is what you do with what you ‘ve got”
ART brace Training
“ Success is what you do with what you ‘ve got”
Polycarbonate
Construction
Management
Module N° 5-7

2. Design Polycarbonate Construction Management
Unbreakable (25x stronger)
Lightweight (4 mm)
Tensegrity respect (high Rigidity)
Soft Contact
No bisphenol A
Glass transition 147° - 155°
Easy bending brake
Best insulation Rvalue: 1.43
Transparency
Polycarbonate
Construction
Management
We shall describe the new concepts, their involvement in the realization of the brace and the results obtained using these new concepts.

3. Training 1
ART brace
Design
Unbreakable
Polycarbonate
Unbreakable

4. Polycarbonate is unbreakable
Polycarbonate is by far one of the strongest (highest impact resistant) plastic materials. It is commonly confused with Acrylic or Plexiglass which has similar properties but Polycarbonate is 25 times stronger.

5. 2 Polycarbonate Lightweight Training ART brace Design Lightweight
Unbreakable
Polycarbonate
Lightweight

6. Stronger = 4 mm sheets - 30 % Weight
The characteristics of polycarbonate compare to those of polymethyl methacrylate (PMMA, acrylic), but polycarbonate is stronger 

7. High Rigidity and Global Detorsion
Dans le plan frontal, la seule mobilité s’effectue dans les expansions. Dans le plan sagittal, il n’y a pas de mobilité. Par contre un cisaillement et une dérotation sont possibles en fonction de la déformation de l’ensemble barre postérieure et charnières.
The only mobility is in detorsion

8. 3 Polycarbonate Tensegrity Training ART brace Design Tensegrity
Lightweight
Unbreakable
Polycarbonate
Tensegrity

9. Thoracic cage and Tensegrity
Ligaments under
Continuous tension
Bone under
Discontinuous
Compression

10. Nonlinear Viscoelasticity
Nonlinear viscoelasticity is phenomenologically observed in all soft connective tissues.

11. 4 Polycarbonate Soft Contact Training ART brace Design Soft Contact
Tensegrity
Lightweight
Unbreakable
Polycarbonate
Soft Contact

12. Polycarbonates are ironically soft
despite the fact they can withstand high magnitude of impact force.
Hautes pressions
Pression moyenne
SOFT CONTACT
Système 3 points
Zones de contact limitées
Système 3 points
Pelotes internes
Contact sur l’ensemble de la surface

13. 5 Polycarbonate No bisphenol A Training ART brace Design
Soft Contact
Tensegrity
Lightweight
Unbreakable
Polycarbonate
No bisphenol A

14. Polycarbonate but No Bisphenol A
After 600 braces
No cutaneous problem

15. New and unwashed T-Shirts

16. 6 Polycarbonate Glass transition temperature Training ART brace Design
147° - 155°
ART brace
No bisphenol A
Design
Soft Contact
Tensegrity
Lightweight
Unbreakable
Polycarbonate
Glass transition
temperature

17. Thermal properties for manufacturing
Polycarbonate has a glass transition temperature of about 147 °C (297 °F), so it softens gradually above this point and flows above about 155 °C (311 °F).Tools must be held at high temperatures, generally above 80 °C (176 °F) to make strain-free and stress-free products.

18. Thermoforming 147° - 155°
Bending brake till 120°

19. 7 Polycarbonate Easy Bending Brake Training ART brace Design
147° - 155°
ART brace
No bisphenol A
Design
Soft Contact
Tensegrity
Lightweight
Unbreakable
Polycarbonate
Easy Bending
Brake

20. Sheet bending brake
Polycarbonate can undergo large plastic deformations without cracking or breaking. As a result, it can be processed and formed at room temperature using sheet metal techniques, such as bending on a brake.
PMMA/Acrylic, which is similar in appearance to polycarbonate, is brittle and cannot be bent at room temperature.

21. 2 lateral hemishells

22. Trim lines on the patient

23. Abdominal Expansion

24. 1975 – Centre des Massues (40 years ago)
Georges MOLLON
Pierre LECANTE

25. 8 Polycarbonate Insulation 4 mm Rvalue = 1.43 Training ART brace
Insulation R=1.43
Bending Brake 120°
147° - 155°
ART brace
No bisphenol A
Design
Soft Contact
Tensegrity
Lightweight
Unbreakable
Polycarbonate
Insulation
4 mm Rvalue = 1.43

26. Polycarbonate is most thermal isolating than glass. (1200 J·kg-1·K-1)

27. Polycarbonate insulation properties
Polycarbonate 4 mm R = 1,43
The R-value is used to determine the effectiveness of the insulation property of various types of products which are used to minimize heat loss.

28. 9 Polycarbonate Transparency Training ART brace Design Transparency
Insulation R=1.43
Bending Brake 120°
147° - 155°
ART brace
No bisphenol A
Design
Soft Contact
Tensegrity
Lightweight
Unbreakable
Polycarbonate
Transparency

29. Transparency Visible region UV
IR transmittance of polycarbonate. Also, polycarbonate is almost completely transparent throughout the entire visible region until 400 nm, blocking UV light

30. Design Polycarbonate Construction Management
Two lateral hemishells with anterior opening
Posterior adjustable hinges on rear metal mast
Anterior closure with two ratcheting buckle
Polycarbonate
Construction
Management
We shall describe the new concepts, their involvement in the realization of the brace and the results obtained using these new concepts.

31. Two lateral polycarbonate hemishells with anterior opening

32. Brace assembly – Metallic hinges

33. Final Assembly

34. Final look with ratcheting buckle

35. Thoracic and Lumbar curves ThoracoLumbar curves
With the three oriented mouldings, each level is modified in the respect of inter-vertebral possibilities of movements, and thus of the natural mechanisms.
There is no more push creation.
At each level, shifting and re-orienting the volumes are based on global untwisting, by modification of the circumferences. The brace will tight and contain this untwisting on all the levels. Indeed, this holding changes progressively of direction while rising along the rachis, until invert its sense at the thoracic level, in case of combined curves.

36. Trim lines
Anterior
2 cm

37. Trim lines
breast
large

38. Antero superior iliac spine
Trim lines
Anterior
Inferior
Antero superior iliac spine

39. Trim lines
Antero
Superior
Iliac
Spine

40. Trim lines
Posterior
3 cm
with
apical
Concave
Expansion

41. Trim lines
Posterior
Inferior
coccyx
acetabulum

42. Trim lines
Anterior
Inferior
Posterior
Inferior

43. Trim lines
Posterior
Superior
Very high

44. Trim lines

45. Trim line Profile

46. Design Polycarbonate Construction Management When – Indications
How – Three essentials
Compliance
Timewear protocol
Flowchart
Example: 35° Cobb
Example: 25° Cobb
Choice of the brace
The best or nothing
Polycarbonate
Construction
Management
We shall describe the new concepts, their involvement in the realization of the brace and the results obtained using these new concepts.

47. Indications for treatment
(1)
Fast puberty
Les indications ont bien été codifiées au niveau international.
(1)
Low puberty
EU casting
& bracing

48. 3 essentials of good bracing
A mobile, mild idiopathic curve that radiologically corrects well in the brace
Curve
Reducibility
a competent fully trained orthotist using a well designed brace
a compliant patient
Orthotist
Brace Design
Compliance

49. Brace wear time depending on the initial angulation
> 40°
35-40°
30-34°
25-29°
< 25°

50. Rate of Treatment Success according to average hours of Daily Brace Wear
100 %
50 %
00 %
8h/24
12h/24
16h/24
20h/24
24h/24
Daily Wear
BrAIST RCT: Weinstein - Dolan

51. Report of the patient and the parents
Compliance (SRS)
Report of the patient and the parents
Timer
To put a timer in every brace would add to the expense of the orthosis and is probably not necessary 12 6 3 9 .
as to how many hours per day the brace is worn
16 hours a day
Longterm
Studies with part-time bracing between 12 and 16 hours per day interestingly do not show inferior results compared with the 20 hour regime
Many of the longterm reviews do not consider compliance
may be the optimum value as a balance between effectiveness of brace correction and tolerance of bracewear

52. ARTbrace is an Overcorrecting brace
Plan B in case of non compliance
PLAN B
NON COMPLIANT
If for climatic or psychological reasons the brace is only being worn for part of the time probably at night then it would be a realistic option to use a night overcorrecting brace
ARTbrace is an Overcorrecting brace

53. Decrease by Blocks of 4 hours 1 month full time every year
Management of ARTbrace
Full time
23 h / 24
Curve stable
Curve Unstable
Elasticity
Worsening > 5°
Decrease by Blocks of 4 hours
No change +
1 month full time every year
No change

54. Brace wear time depending on the curve elasticity (in-brace & out of brace)
> 40°
23h / 24
20h / 24
16h / 24
12h / 24
8h / 24
6 mths
6 mths
6 mths
6 mths
end

55. Thoracic & Double Major
Example: 25° Scoliosis
Idiopathic Scoliosis
Thoracic & Double Major
Thoraco-lumbar
Lumbar
New Born
Asymmetrical plaster shell
Early Onset Scoliosis
Milwaukee
8 h /24
Milwaukee or
ARTbrace 8h/24
(if non compliant)
Milwaukee brace
or GTB 8h/24
Adolescent
Risser 0 – 3
ART brace
16 h / 24
ARTbrace
GTB
Adolescent
Risser 4 - 5
ARTbrace
12 h / 24
GTB
Adult

56. Thoracic & Double Major
Example: 35° Scoliosis
Idiopathic Scoliosis
Thoracic & Double Major
Thoraco-lumbar
Lumbar
New Born
Asymmetrical plaster shell
Early Onset Scoliosis
Milwaukee
20 h /24
Milwaukee or
ARTbrace 20h/24
(if non compliant)
Milwaukee brace
or GTB 20h/24
Adolescent
Risser 0 – 3
ART brace
20 h / 24
ARTbrace
GTB
Adolescent
Risser 4 - 5
ARTbrace
16 h / 24
GTB
Adult

57. Thoracic & Double Major
Example: 45° Scoliosis
Idiopathic Scoliosis
Thoracic & Double Major
Thoraco-lumbar
Lumbar
New Born
Asymmetrical plaster shell
Early Onset Scoliosis
Milwaukee
23 h /24
Milwaukee or
ARTbrace 23h/24
(if non compliant)
Milwaukee brace
or GTB 23h/24
Adolescent
Risser 0 – 3
ART brace
23 h / 24
ARTbrace
GTB
Adolescent
Risser 4 - 5
ARTbrace
23 h / 24
GTB
Adult

58. Step by step Rigidity Strategy1 2 3 4
Polycarbonate
Polymethacrylate
Polyethylene
Soft = Total Failure
More rigid don’t mean more invasive

59. The two concepts
Risk of Failure culture

60. Check-in after 3 days
Moulding
Fitting
Delivery
Chek-in

61. Constant In-Brace Deformation then the stress will gradually decrease
Stress relaxation
Under constant strain
Constant In-Brace Deformation
Stress Relaxation
1st night
Time
The first night is always difficult. For a constant in-brace deformation,
then the stress will gradually decrease

62. The 10 Commandments:
1 – You shall not compress the rib cage before puberty, (need of large expansions)
2 – You shall stretch the ligaments of concavity by a full time period
3 – You shall carry out an adjustable brace during growth,
4 – Three regional mouldings are better than one
5 – Axial elongation always with fixed sagittal plane

63. The 10 Commandments: 6 – You shall adjust the brace every 6 months
7 – You shall model the chondro-costal anterior gibbosity
8 – You shall not forget the Teamwork
9 – You shall adjust time of wearing according to the evolutivity
10 – You shall advise the practice of physio-therapy and sport

64. Conclusion
The best brace don’t exist, and there is nothing to burn, but we can support you to create the best ARTbrace for your patient.