1. ART brace Training Initial Full time Bracing Module N° 13
“What, Why?...”
Module N° 13

2. Training 1
ART brace
Full Time bracing
Experience
Experience

3. Ponseti’s clubfoot experience

4. 1 – maximal reduction 2 – ligament flow 3 - Compliance 4 - Modelling
Le plâtre est actuellement réalisé couché en cadre Elongation Dérotation Flexion de Cotrel.
Le traitement orthopédique conservateur actuel est ambulatoire, mais conserve les grands principes de traitement :
réduction avec modification de la longueur des ligaments par corset plâtré de 1 à 4 mois selon l’angulation. Le plâtre modèle le thorax avant la réalisation de l’orthèse et prépare la peau pour une meilleure tolérance physique et psychologique de l’orthèse

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

6. 5 weeks = structural scoliosis
Posture
5 weeks = structural scoliosis

7. BrAIST – correlation with inbrace reduction & wear time
Average wear of at least 15 hours/day in the first 6 months of treatment was strongly associated with high probability of success. Increasing hours of wear beyond this did not significantly increase the probability of success.

8. 2 Training ART brace Definitions Full Time bracing Definitions
Experience
Definitions

9. Spine Ligaments

10. Strain – Stress definitions
Stress is "force per unit area"
tensile stress - stress that tends to stretch or lengthen the material - acts normal to the stressed area
Strain
Strain is defined as "deformation of a solid due to stress“
Young's Modulus - Modulus of Elasticity (or Tensile Modulus) - Hooke's Law 
Most deforms proportional to imposed load over a range of loads. Stress is proportional to load and strain is proportional to deformation as expressed with Hooke's law
E = stress / strain

11. Ligaments Ultrastructure

12. Tensile stress Definition
This stress is called the tensile stress because every part of the object is subjected to tension. The SI unit of stress is the newton per square meter, which is called the pascal. 1 pascal = 1 Pa = 1 N/m2

13. The Relationship between Stress & Strain
is known as material's stress–strain curve. It is unique for each material and is found by recording the amount of deformation (strain) at distinct intervals of tensile or compressive loading (stress). These curves reveal many of the properties of a material (including data to establish the Modulus of Elasticity, E)

14. Response to Tensile Forces

15. DEFORMATION MECHANISM
Science of Spinal Rods
Philippe MAXY
1515
DEFORMATION MECHANISM
A ligament under tension is characterized by:
a Elastic behavior (elastic deformation) at the start of elongation,
A plastic behavior (plastic deformation) after exceeding the elastic limit

16. ELASTICITY
The structure takes its initial size and its original shape upon removal of an applied load.
= Reversible deformation
Spring effect

17. ELASTICITY LIMIT This is exactly the crossing point between:
Science of Spinal Rods
Philippe MAXY
1717
ELASTICITY LIMIT
This is exactly the crossing point between:
ELASTIC region and PLASTIC region
Maximum stress for the return to the initial state.
The elasticity limit is often correlated to the maintenance of the correction: The elasticity limit exceeded, a fraction of the deformation becomes permanent and not reversible, and the correction remains partially.

18. Plasticity
The structure does not return to its initial size and its original shape after removal of applied loads.
= Permanent deformation.
Lead pipe effect
Final Deformation =
Initial Magnitude of Deformation - loss of deformation by elastic return

19. Types of load

20. Visco Elastic model
When an elastic material containing fluid is deformed the return of the material to its original shape is delayed in time and it is slower to restore to its original position.

21. Tissue response to load
Dependent on:
Magnitude of load
Duration of load
Prior loading
Types of response
Stress Relaxation
Creep
Hysteresis

22. Creep response of a visco-elastic material

23. Ligamentous strain approach to scoliosis
Stress relaxation
Under constant strain
The first night is always difficult. For a constant in-brace deformation, then the stress will gradually decrease

24. Ligamentous creep approach to scoliosis
Under constant stress
Creep = Time dependent elongation of a tissue when subjected to a constant stress.
4 weeks are needed to achieve sustainable elongation

25. Creep strain increasing time

26. 3 Training ART brace In every day Practice Full Time bracing
In pratice
Definitions
Experience
In every day Practice

27. The first aim of the ARTbrace was to avoid the plaster cast

28. Final look for a Lenke 1C

29. Maintenance of the skin
Cost of material: 25 €
Time for MD: 15’
Time for nurse: 90’
Day Hospital: 4 hours

30. Trying to avoid the plaster cast is not a new concept, but ART is the 1st brace used with the same “full time” than plaster cast (with better correction)
and with shower

31. The wrist watch principle
When the pressure is constantly applied to the skin, the sensitivity decreases

32. Conclusion Initial “full time” bracing is A physiological approach
A compliance test
A key for final success

33. Source: National Training Laboratories Bethel Maine
1st Training Course: September 2015 – Lyon (Fr)
= 75 % (Learning Pyramid)
Lecture - Reading = 10 %
Level 3
Audiovisual = 20%
Demonstration = 30 %
Level 2
Discussion = 50 %
Practice doing = 75 %
Level 1
Teach others = 90 %
Source: National Training Laboratories Bethel Maine